The Atlantic’s Jocelyn Frank reports on the detailed system that may be unintentionally leading pilots to avoid the mental-health care that they need, and increasing risks to passenger safety. Get more from your favorite Atlantic voices when you subscribe. You’ll enjoy unlimited access to Pulitzer-winning journalism, from clear-eyed analysis and insight on breaking news to fascinating explorations of our world. Atlantic subscribers also get access to exclusive subscriber audio in Apple Podcasts. Subscribe today at theAtlantic.com/listener. Learn more about your ad choices. Visit megaphone.fm/adchoices
Chapter 1: What invisible safety risks do pilots face?
Pilots themselves have been raising the alarm about a different kind of risk to passenger safety and a risk to their own well-being. It involves a rule that's designed to protect passengers, but it might instead be making flying more dangerous. I'm Hannah Rosen. This is Radio Atlantic. Today, our producer Jocelyn Frank is with us with a story. Hey, Jocelyn.
Hi, Hannah. Thanks for having me.
Sure. So you've been talking to pilots, and what have they been telling you?
Yeah. I recently interviewed quite a number of pilots, and one of them has really got me thinking differently about flight safety. His name is Chris Finlayson. He's been a pilot for 13 years. He's married, he has two young daughters, and he's a first officer with one of the major airlines in the U.S., It's a job that comes with a lot of responsibility. You know, a few flights every day.
He's probably responsible for a few hundred people every time he shows up for work. So when he got COVID, he had no hesitation about being grounded. He immediately stopped flying.
I got a really bad bout of long COVID. Memory loss, brain fog, fatigue. That really tanked my serotonin that all of a sudden triggered every anxiety I possibly had. December 19th, 2021 was my last flight.
Even after most of his COVID symptoms subsided, his anxiety just kept going. And then he got anxiety about his anxiety.
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Chapter 2: Why do pilots avoid seeking mental health care?
I remember sitting in my bed after a panic attack and just thinking, I can't do this. And I remember going into the doctor's office in February of 2022, thinking that, frankly, I was throwing my career away.
For most people in a similar situation, having stress, anxiety, even panic attacks, it would lead them to some behavioral therapy or medication. And then ideally, you just get back to a stable, typical, healthy life. But Chris Finlayson is a pilot. And for pilots, there's a different calculation.
When pilots do seek out mental health care, they risk derailing their careers, disrupting their livelihoods, and ultimately, sometimes their permission to fly. And if they don't seek help, they could be putting their lives and the lives of hundreds of passengers at risk.
These haunting images are the first we've seen up close of the twisted metal and shattered debris, all that is left of Germanwings Flight 9525.
In 2015, there was a terrible crash, an airline called Germanwings. And it turned out that the co-pilot intentionally crashed the plane.
The plane mysteriously crashed into the rugged French Alps on Tuesday, killing all 150 souls on board.
Even though it wasn't a U.S. airline, basically since then, the FAA has been trying to tighten their approach to mental health. They want to reduce any risk to passenger safety that's linked to any kind of serious mental health challenge.
I think you have to understand that the FAA is, from their perspective, is interested in helping people fly as long as they're safe for themselves and the public. And they intend to get as many people flying as they can safely.
Thomas Jetser works as a medical consultant for the FAA. He's a certified AME, which stands for Aviation Medical Examiner. He's one of hundreds of special doctors across the United States who meet with pilots on a yearly or on a six-month basis to review their medical records and decide if they're fit to fly. And he thinks it's a pretty good system.
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Chapter 3: How does the FAA's scrutiny affect pilots' mental health?
Well, you're right. There's not as close an observation review of the doctors every six months or a year. There is for nuclear operators. You don't have it for police or firefighters.
Okay, so Jocelyn, surgeons, police officers, firefighters, all these are also people responsible for the safety and well-being of hundreds of people. But they could each theoretically just visit a therapist and keep it to themselves.
They could each theoretically visit a psychiatrist. They could be prescribed anti-anxiety medication and just keep on with their jobs without having to report anything to a special doctor or to their boss or to take time off. And this added layer of scrutiny for pilots, I mean, they're responsible for hundreds of people at a time.
So the FAA wants to be as sure as they can that anyone who's in the cockpit is in a really healthy state of mind.
Which totally makes sense that they want that. Like, you should be in a healthy state of mind if you're flying a plane. I guess my question is, is this invasive amount of scrutiny from your employer or your boss encouraging a healthy state of mind, or is it encouraging you to pretend that you have a healthy state of mind?
Yeah, it's a really good question, a really serious question. And I looked into FAA safety systems in some more detail, and it turns out that the processes that they have in place have led to some really terrible unintended consequences. Like what? In the fall of 2021, an aviation student who was attending the University of North Dakota, he took his life in a university aircraft accident.
19-year-old John Houser, a commercial aviation student from Chicago, died near Buxton. The National Transportation Safety Board says there were no mechanical problems with the aircraft.
It was later discovered that he actually wrote a note revealing he'd been struggling emotionally, but he felt like he couldn't do anything about it because he feared losing his medical certificate. His mom actually read some of that letter out loud during a National Transportation Safety Board summit.
In a letter describing the turmoil that John was silently facing, he wrote, I want to seek help more than anything. I really do. I want to get better. I just know if I try, I will have to give up on aviation. And frankly, I'd rather not be here than to do that.
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Chapter 4: What happened to pilots who faced mental health struggles?
Well, at first, Finlayson thought he might not have to go through the full process. The way the FAA system works is basically if you go on medication and then you get off of it for 60 days and your treating psychiatrist says, you're good, the FAA can consider this as all just like a little health blip. You're grounded. You're not flying for that period of time. No regular paycheck.
But after, you can potentially get fairly smoothly back into your job. So Finlayson was hoping for that when he went to see a nurse practitioner and he started taking a low dose SSRI for his anxiety.
10 milligrams. Did that for about six months, tried to go off it. And unfortunately that didn't work.
He knew he couldn't stay off the medication and feel well enough to fly. If he stayed on medication, he'd have to pursue the longer path for his medical certificate. It's called requesting a special issuance. Even with that request, there's no guarantee the FAA would decide he could ever fly again. And he felt totally stuck.
And that's when my psychiatrist was like, look, like, I get all this stuff, but we should really escalate you up to 20 just to see what happens because there's nothing to lose at this point. And that's when I really gave up like, okay, I guess I'm just going to be on this rug no matter what. So I am going to, no matter what, need these special issuance.
And once Finlayson sort of let go of the possibility of that faster path back to his job, the fast path to that medical certificate, his health improved.
When I started that higher dosage of my SSRI, After about six weeks on that, I was like, oh, this is clarity. This is awesome. This is a good state to be in. I've maintained that ever since.
So Finlayson achieved this mental recovery, this clarity, but the path back to piloting was still extremely murky.
I didn't know how long it was potentially going to take. I wasn't sure what exactly that cost was going to be, how I was going to pay for that if I wasn't going to be working. the lack of transparency involved with the FAA's processes, all of those things.
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Chapter 5: How many pilots are avoiding care due to fear?
Definitely not. In 2024, out of 150,000 commercial pilots, only about 9,000 applied. And in the end, only about 3,000 were approved. So Finlayson was hoping to be one of those 3,000. He and his doctors decided he needed to take this anti-anxiety medication long-term, which meant he was going to have to enter this longer process.
And it became clear it was going to be a really detailed and at times tedious process. According to the FAA, a lot of people get denied for failing to provide some specific requested information. It actually accounts for more than 75% of all denials. And from the start, Chris Finlayson was feeling that potential. He would think he'd checked a box, only to learn it was the wrong box.
The other requirement is to be evaluated by a board certified psychiatrist. The psychiatrist that I was seeing, she was a nurse practitioner. That wasn't at the level for which the FAA would require. So I then had to search out a MD.
And that took an additional month. He had to be on a stable dose for six months before beginning his application. And that switch in care meant he had to start the six-month count again. And he learned there were additional requirements.
I had to go through a cognitive screening, a personality screening, as well as an interview by a neuropsychologist.
Each of these tests has a cost and each has to be submitted to this special FAA doctor to review.
I also had to go through neurological testing.
What is that like?
It is boring. It is paying about four grand out of pocket to play. Oh, what's the app on the phone? Basically like paying four grand to play luminosity while a doctor stares over your shoulder. That's all elective testing. None of that is covered by insurance. So it's all out of pocket.
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Chapter 6: What challenges do pilots face when seeking treatment?
And I have to say, with recent cuts to federal staffing at the FAA, it's unlikely that this process is going to get any more efficient.
You know, Jocelyn, listening to you, I'm a little torn. I fly often enough. I'm not a particularly nervous flyer. I'm not sure if I should be worried about my safety. Like, is there any research that gets at the actual bottom line, the actual outcome of the system they set up? Does this system, flawed though it may be, result in me, the passenger, being any safer?
It's pretty clear from those terrible suicide-type flights that we do not want a pilot in the pilot seat who is suffering from that kind of intense, untreated mental health problem. It definitely adds risk to passenger safety.
I asked William Hoffman, that researcher, what we know about having mental health problems that you're treating, that you're addressing, or something that was on your record from the past. What do we know about how that impacts risk? And here's what he told me.
Right now, there is this simple model that using services, mental health services, or having a diagnosis is a marker for risk. But remarkably, that has never been systematically studied in research. That's a complete assumption.
So that is a big assumption.
Yeah. And it's an assumption that's costing Chris Finlayson and thousands of other pilots multiple years away from their careers. But it's nearly impossible to get pilots to raise their hands and say, hey, I'll participate in your research. I should probably be seeing a therapist.
Or, hey, I'm secretly taking mental health medication, so study me, check my flight records, and see how well I'm doing, or calculate all the small mistakes I'm making compared to this other pilot so we can figure out if my mental health issues are actually a problem when it comes to flight safety.
No one's volunteering for that kind of scrutiny, partially because doing so would mean admitting they had not been fully honest about their health prior to that kind of study.
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Chapter 7: Is the FAA system actually keeping passengers safe?
Okay, so if they can't get the data and they don't actually know the answer, what can be done about any of this?
So even if we don't know exactly how risky it is to fly with the current system, we do know that the current system is keeping pilots from seeking care. And that's a part of the system where risk could be reduced. One of the reasons I wanted to look into this story is because the FAA did recently request recommendations from a panel of experts about how to address that problem.
Hoffman was one of them. The group delivered 24 suggestions to lower the barriers to mental health access. And they presented these suggestions to the FAA last year, in April of 2024. And a few were acted on really quickly.
For example, expanding the number of medications that can be used. So that was almost immediately implemented.
The total is now eight different drugs, but they're conditionally allowed, which means that you would still need to request a special medical certificate. And it might be granted, but it's not guaranteed.
They also narrowed some of the requirements for neuropsychological testing that a pilot might need to undergo if they are on a medication for mood.
So if a pilot like Chris Finlayson were to begin this medical screening again, he might have fewer tests to go through in order to request the special medical certificate. And the committee recommended a bunch of other aspects of the process be changed, too.
They asked the FAA to modernize the system to reduce paperwork, to improve training for doctors who are reviewing all of these medical records for more consistency, wider disability coverage so pilots maybe could be covered more often. And Hoffman was excited about another recommendation, too.
One of the key recommendations was requiring that pilots have access to peer support services.
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