Captain Robert Graves sees strangers every day as a pilot for Southwest Airlines.
There鈥檚 not always a deep relationship with the people he works with or the people he meets. It鈥檚 a few constant people he may see, but even then, it may be months until he recognizes the co-pilot or flight attendants on his flight. It鈥檚 a job that can feel alienating just by the nature of the work, he said. It sometimes feels isolating.
鈥淧ilots are supposed to be solid citizens,鈥 said Graves, 64, who lives in Nashville and is based in Baltimore. He鈥檒l retire next year. 鈥淲e鈥檙e supposed to be grounded. We鈥檙e supposed to be emotionally stable.鈥
Pilots need to maintain mental and physical well-being to fly and obtain a medical certificate from the Federal Aviation Administration, undergoing a medical exam with an aviation medical examiner every six months to five years, depending on the type of flying they do and their age.
For that reason, many pilots may not speak up about how they鈥檙e feeling, Graves said. He isn鈥檛 experiencing mental illness but is well aware of what the job can do to a person.
鈥淚t is very difficult to get pilots (as patients), particularly in public to admit to these concerns because if you do, I mean, this is the double bind,鈥 said Penny Levin, a clinical psychologist and certified flight instructor. 鈥淚f you go to me for treatment, you will not be flying anymore.鈥
Mental health issues still are a challenge and ongoing conversation at U.S. airlines, including local carriers Southwest Airlines and American Airlines and their competitors. Last year an off-duty pilot was accused of attempting to bring down an Alaska Airlines flight and later told federal investigators he took psychedelic mushrooms and had been depressed, experiencing a mental breakdown.
Airline workers operate in stressful environments amid a pilot shortage and historic levels of travel demand. Even at Southwest and American, both airlines have recognized that there is a problem and the companies and their unions can help pilots from within.
What the Federal Aviation Administration is doing
The mayor of a Northwestern city in Germany called it the 鈥渄arkest day鈥 on March 24, 2015. That was the day a German jetliner plunged into the French Alps and killed 150 people. The root cause of the crash of the Airbus A320 was later determined to be the pilot onboard who had suffered from severe mental illness and didn鈥檛 tell his employer.
The jarring event is commonly referred to when the topic of pilot mental health arises. It inspired the Federal Aviation Administration to create the Pilot Fitness Aviation Rulemaking Committee in 2016 to make recommendations on the mental fitness of pilots.
A 2022 study showed that 56.1 % of pilots reported that they had avoided seeking medical or mental health treatment or reporting issues because it could threaten their certification to fly, according to a report from University of North Dakota neurologist and affiliated professor of aviation William Hoffman. The survey of 3,765 pilots found that 45.7% of pilots sought informal medical care instead and 26.8% said they had once misrepresented or withheld information when asked on a health questionnaire.
In recent years, the Federal Aviation Administration has taken a stronger look at the mental health of pilots.
If pilots seek help for mental health issues, most conditions, if treated, won鈥檛 disqualify them from flying. The agency said only about 0.1% of medical certificate applicants who disclose their health issues are denied.
鈥淭he consequences and the ability to get back are so tangled in the bureaucracy, that it can lead folks to make some poor choices and not getting help,鈥 said Dennis Tajer, spokesman for the Allied Pilots Association.
In December, FAA Administrator Michael Whitaker announced another group, the 鈥淢ental Health and Aviation Medical Clearances Rulemaking Committee,鈥 to remove barriers that discourage pilots from disclosing and seeking help. It is working on the same issue for air traffic controllers.
鈥淭hings are trying to move, but it鈥檚 a very slow pace,鈥 said David West, a pilot involved in the Southwest Airlines Pilots Association鈥檚 critical incident response team.
The FAA continues to stress mental health resources for pilots, including training for medical examiners, research and clinical studies, hiring additional mental health professionals to expand in-house resources and more. They have also been completing clinical research and amending policies to decrease the frequency of cognitive testing in pilots using antidepressant medications.
鈥淟ike anything, it鈥檚 getting better, but it鈥檚 just taking a long time to get there,鈥 West said.
Recently, the FAA published the task forces鈥 results to encourage pilots to get help with mental health issues. The committee recommended a pathway for disclosing mental health conditions, revising requirements for reporting mental health disorders, a closer look at screening protocols and more resources for pilots.
Reporting mental illness
While obtaining a medical certificate is a part of the pilot鈥檚 normal routine to be able to fly, before the exam, pilots must report any health professional visit during the previous three years, all medications and a complete medical history. There are also questions about mental health.
If the pilot discloses anything on the form or during an examination, the examiner may further question mental health conditions or symptoms.
Levin said sometimes pilots may feel the need to lie about getting care or even just not seek it.
The FAA can request additional psychological testing or the application may be sent to the FAA鈥檚 Office of Aerospace Medicine. Commercial airlines can also have mental health screenings or requirements.
If an outside source discloses to the FAA that a pilot has a mental health condition, the Office of Aerospace Medicine can require the pilot to provide documentation or a professional mental health evaluation.
Certain medical conditions such as psychosis, bipolar disorder and some types of personality disorders automatically disqualify a pilot.
What options do pilots at American, Southwest have?
Fort Worth-based American, which has about 15,000 pilots, has a program called Project Wingman which was created in 2011 along with the pilot union to provide peer support and crisis intervention to pilots and family members with no pressure to reveal sensitive information.
Pilots can connect with other pilots to share challenges. The program has pilots who are members of the Allied Pilot Association to serve as 鈥淲ingman committee volunteers鈥 to assist with mental health problems. Volunteers help pilots reduce stress and share resources.
鈥淲e鈥檙e proud of pioneering the industry-leading Project Wingman peer support program and of the pilot volunteers who have made, and continue to make, meaningful differences in the lives of American鈥檚 pilots for 13 years,鈥 said Lindsey Martin, spokeswoman at American. 鈥淜ey to Project Wingman鈥檚 success is the collaboration between the Allied Pilots Association, pilot volunteers, company program sponsors and American鈥檚 best-in-class aviators raising their hand for support in whatever they may be facing.鈥
Tajer called American and the Allied Pilots Association 鈥減ioneers in providing a safe place for pilots.鈥
Volunteers have worked with pilots on depression and grief, stress and anxiety, marital or relationship issues, family issues, aging or elder care issues, chemical dependency, suicidal thoughts, domestic violence and other challenges.
鈥淚t鈥檚 an extraordinarily supportive program that other airlines and unions come to us and get briefed on emulating what we have,鈥 Tajer said.
There are similar programs and support at Southwest Airlines.
West said the union offers peer support while helping pilots who are dealing with mental health.
Project Lift is another support program administered through the union. The company supports the program financially and connects pilots to insurance resources.
At Southwest, the airline has a crew assistance program team as a part of its flight operations department. The team will connect pilots to leave programs, coordinate benefits, co-fund the union peer-support programs and provide advice to pilots seeking help or information. The program works with the Southwest Airlines Pilots Association and both coordinate to determine if the airline or union is the correct party to assist the pilot.
The perception of mental health has changed over the years, and grown to have a larger acceptance. And in a profession like being a commercial pilot, it鈥檚 an important part of the job. According to the National Alliance on Mental Illness, one in five adults in the U.S. experience mental illness.
鈥淪afety is a symphony,鈥 Tajer said. 鈥淚f there are a couple of instruments out of tune, you don鈥檛 have to be an expert to hear it.鈥