Welcome to the Air Line Pilot Podcast. I'm Jason Ambrosi. As we wrap up Mental Health Awareness Month, we wanted to shed more light on how mental health is handled for pilots. And in the aviation industry at large. It is important that we all understand how we can take care of our mental health as pilots and understand how as a union and an industry we're working to make mental health support more accessible for our members. Today I'm honored to be joined
by Dr. Susan Northrup, the FAA is federal air surgeon. Thanks for joining us Dr. Northup.
It's absolutely my pleasure to be here.
So just start off, I guess basic for our listeners, can you explain the role of the federal air surgeon?
Well, I gotta tell you, it's one of the best jobs in the world, I think. But as the federal air surgeon, I'm responsible for several major programs within the FAA, the one that touches your constituents the most closely, of course, is airman medical certification. So I have not only the policy development piece of it, I have the implementation piece of it. And peripherally Well, not really peripherally. But the AME is as designees of the FAA work for me through given to me by
the FAA administrator. So functionally, we develop the policy, we publish the guide for aviation medical examiner's, which is sort of the go to book for AME's. And I'm trying to encourage pilots to go there, because there's just an absolute
wealth of information there. And then if someone has a condition that needs to be reviewed, and hopefully receive a special issuance, that comes through my staff as well, that's coordinated effort between the airman medical certification division at Oklahoma City and the regional flight surgeons in the nine regions. The other area that your constituents or your members may find interesting is we also have research, which includes human factors, looking at how the human interacts with
machine, and air medical research. So as we're developing new policies, we look at the current information and the current science to inform how we change things over time, because we want to make sure that we keep up with what's happening in the field of medicine, when we apply it to the pilots. Couple of the other areas, air traffic control health programs AME designation, so we manage the amas. And this is a plea for
your members. If you know a doctor that's interested, I have spots for a AME that we can designate if they go through training, just as a really nice benefit for the AME right now if the IRS doesn't change it, and AME, who's a pilot can in fact take tax credit for up to 50 hours a year. So maybe you even have a pilot who happens to be a doctor, we're still looking for
good AME our external aid app program. So we oversee the drug programs that are in the airlines in the maintenance facilities to be sure that all of the programs adhere to the minimums required. And then we have an airman education division. That is we've, I think we've even sent the prote to some of your conferences, which is a mixed gas, so people can experience hypoxia symptoms, without having to go to altitude, which is an awful lot of fun. And in the not too
distant future. We have a research facility called y-waves that will replace our old research pool and our education pool and be able to produce 10 foot waves and 26 knot winds so people can experience what it would be like to ditch or have to get out of an airplane or helicopter in the high seas.
Wow. That's that's very interesting, very interesting. On the on the topic of mental health, why is addressing mental health of aviation workers such a priority for the for the FAA.
Mental health conditions are very important. And it is huge priority right now because of a couple of very high profile incidents that has shined a light on it and given us an opportunity through the arc, which we certainly thank your organization for providing some of our subject matter experts that we could do better. So why do we worry about mental health conditions? Anything that can cause a sudden or subtle
incapacitation in the air deserves our attention. And it's absolutely critical that we begin to address mental wellness. So hopefully we give people the tools early in their career so that they can handle life stresses and know when to reach out for help. I have a safe path to do that I have the goal or the FAA has a goal even bigger, that we return pilots and air traffic controllers to flying and controlling duties as soon as it is safe to do so in a manner that is transparent,
consistent, and timely. So we're working hard, using the recommendations from the ARC to make sure that we get the message out to as wide a population as we can, that you need to get the help you deserve early before it becomes an issue.
Yeah, I know our members certainly appreciate that because they, they want to get back to the cockpit as soon
as they as soon as they can. As you mentioned, ALPA recently co chaired the mental health and aviation medical clearances, aviation rulemaking committee, but reviewing that phase mental health policies and discussing ways we can break down those those barriers to reporting what is important about the work that the committee did, and what are the next steps for for the excellent recommendations they made.
So the FAA is reviewing those recommendations and beginning to strategize how we're going to address them. But the the absolute most critical thing that the ARC highlighted is it's going to take the entire aviation community to address this, some of the barriers that are out there, as a regulator, I don't have much control over them. So the the whole stigma and the culture and the lack of knowledge, the ARC report really
lays those out very, very nicely. And if you haven't, their members haven't read it, it's public facing, go take a look at it, provide us feedback there. But if we're truly going to affect this, at the national level, all the way down to the grassroots, when the young person is looking up in the sky going, you know, I want to do that someday. And we talk about it very early in their careers, so that we can de stigmatize what's going on. And they understand there are things that
they can reach out and get help. Because I really want to put those tools in the hands of everybody in the aviation industry, so that they get the help they need before they get to the point where they have a diagnosis. If we do this, right, we're going to have a much fitter population that's aspiring to mental health wellness, as opposed to struggling with the illness. But if they're struggling with the illness, we have to provide the education and hopefully the
encouragement for early intervention. As far down in the system as we can and for that, I need your help. I need the industry's help, I need the school's help. I need the university's help. I need academia, it's the whole gamut that we're going to have to use to address this problem.
Agree with that, all hands on deck. Today, if a pilot has concerns about their mental health, what is the current process look like for seeking help discussing it with their AME and ideally, how they retain their ability to continue working.
So within ALPA, you have an absolutely wonderful peer support program. And you have been integral in developing basic training requirements and supporting that throughout the industry. That is a great first step for a pilot that's dealing with some concerns or thoughts to go to the peer support program. Because those individuals will help normalize
some of the reactions and be able to provide some advice. And as it turns out, rarely, and I'll get into that in just a minute, recommendations to the individual that they seek professional help. The peer support interaction does not have to be reported to us.
That was one of my questions to clarify for our listeners. To hear it right from you is the the pilot talks to one of our peer support program volunteers that to reiterate that it is not reportable. You're you're talking to a colleague.
It's confidential. And one of the tenets of the peer support program is that it is confidential. Unless somebody says something that really raises concern, safety has to trump no matter what, but the peer support systems that have been set up in the industry are outstanding. And that model is morphing into other areas of the
aviation environment, which is a beautiful thing. There are some studies out there that show at 85% of the individuals that utilize a peer support program never have to advanced more care because they get the tools so that they stopped the downward spiral. That's really, really important. Now, of course, some of the models in several of the members of your organization have been supporting this, in the university level, have to be
modified slightly, right? Because an airline has a cadre of people, and you tend, not all but you tend to work for a long time, once you're in one of the majors or one of the regional carriers. So you've got a stable set of peer support folks. And you add some in some retire, but at the university level, hopefully for their parents who are footing the bill, they graduate in four years. So you, so you have a turnover. And
that's going to require constant support. But we should support that, because it's giving people the tools and we get better able candidates for aviation jobs at higher levels.
That's, that is very interesting. So I'm surprised by the numbers of success and the peer support program that just reiterates how important it is that the pilots reach out and use that resource. If, if that's not enough, and pilot needs to, to seek help, what does that process look like? And how do they go about it.
So the FAA absolutely encourages people to get the support they need, and the treatment if it's required. Sometimes you've got to be more worried about making sure
everything's good than other items. So what it looks like and we encourage people to seek the help they want, they can get reference or recommendations from their aviation medical examiner or the peer support program, to get somebody that's familiar with our standards, if possible, but if that's not possible, somebody to provide the help that they need before it becomes a major issue. If a diagnosis is made, then they have to report that at their next application, 14 CFR 61 dot
53 will apply. And that's what's printed on the back your medical that you don't fly. If you have if you know or have reason to know you have a condition that free vents safe execution of those duties. I'm paraphrasing the laws, of course, something anybody can look up. If they have a condition that requires us to defer, or the need to defer to us, the guy for aviation medical examiners has a set of checklists, which is
really, really helpful. So one of the things I encourage pilots as they begin to seek the care they need, go to the guide for aviation medical examiners, pull down those checklists, take those to your treating providers. So that they know in advance the sort of things we're going to be looking for on the back end. Now, the other thing that's really cool that we've done in the last year is there are two worksheets in the guide
for aviation medical examiners. And to shorten that the rest of this discussion, I'll just call it the AME guide for PTSD, and situational anxiety or depression, if it hasn't risen to a certain level of requiring treatment, the AME can issue.
That's huge. That's encouraging for sure.
Yeah. And the the other thing we released last August, is a fast track for ADHD, which we're seeing diagnosed with great frequency in certain age groups in our population. But if it's been more than four years, since they required medical treatment, and they're doing well, in either in their occupation or their schooling, there is a fast track to get there. That doesn't require coming to the FAA, they can do that all with their AME. The end of this month, we'll be
publishing some more things. And a lot of these recommendations came out of the arc. We didn't wait for the arc to actually publish before the office of aerospace medicine began to work on some of these suggestions. Because these are really good ideas. And we've moved forward and in many cases, we
accelerated policy changes we already had been working on. For instance, last month, we added three additional medications that are in the SNRI category to the allowed medications for antidepressants or individuals with uncomplicated anxiety. That's a pretty big step. We would have been working on that for a year, year and a half and we published it, it's a glorious thing than once or if somebody gets to the point where a
medical has to be deferred to the FAA. If a pilot wants to expedite that process, they need to go to the AME guide, download that checklist and if we say we want it on that checklist, make sure it is in the pack gets that submitted to us.
That makes sense. That makes sense.
And the other thing I really strongly advise people applying for the medical to do is actually read the package that goes in, because we will. And if there is a piece of information in there, that's incorrect. It is a lot easier to fix that with your treating providers before you send it to us. So that we don't ask questions, and send letters to ask for additional information. Some of the biggest delays in our system where because we're asking for information, and
we're just going back and forth and getting stuff. So use the checklist, read what you send us correct anything that is incorrect or unclear. And then you can submit it to us. Now, many people may not be aware that about a year ago, we modified the system such that the am ease can direct upload documents into the pilots medical records on our site.
That is huge. Sure is not an email, mail, not just snail mail, not just FedEx, not ups, the amas can upload direct to our system, up to 25 documents, three megabytes per document. We're working hard to increase the number and the size of
those. But if you submit a complete package, so everything's in there, everything's addressed upfront, you reduce the back and forth time so that it'll sail through the system well sales probably too strong word but it'll get through the system in a much more efficient manner.
So how long would that be Dr. Northrup, if a pilot follows AME checklist has make sure that their documents are correct. follows your your your advice here, how long? How long would that process take? I'm not gonna hold you to it, but is the best estimate you can get.
Okay, if I may, let me start at the very beginning. Sure. So a pilot, as an issue can't be handled at a lower level requires medication for a period of time and does much better on gosh, we used to call it the SSRI program, I've got to change the antidepressant program. So they go on a medication right now there's a six month wait time before you can apply. One of the ARC recommendations is to look at that wait time and we are. So standby for changes in that
field. But right now, six months, the next day, you can get the studies required on the checklist. Which is where you can really front load this with your treating physicians for providers so that they know on day 181 We need to schedule this stuff. Because of the shortage of providers in the US in certain career fields. You don't want to be caught, hey, I need the appointment on day 181. And they're scheduling out three months, right? Right, get that scheduled early. Right. Anyway,
put that all together, submit it through your, your AME. And you know the for this particular program, you need to hims AME. And that's all in the checklist and how that works. That that list gets updated on a routine basis and is available online. It comes to the FAA. We review it for completeness. And then it'll go to our our psychiatry branch. We have cut the time for initial review of a complete package in half in the last six months. So we're down around four months once we get a
complete package for the initial SSRI. Our goal is 30 days. Okay. And we're getting their renewals. We're working in real time, providing we have a complete package. And again, it's really, really important that they go out and look at what we're going to require. Read the letter, keep a copy of that, make sure the treating providers have it.
That's that's excellent advice. I did i I'll admit I'm not I'm that pilot that didn't know there was a checklist in the in the AME guide. So I'm sure many of our members don't or aren't aware as well. So excellent, excellent advice. As always, if you're if you're prepared, just like an interview, if you're prepared when you when you get there,
it'll be much more successful, successful outcome. Yeah, we hear from pilots, some pilots raise concerns that they feel pressure to hide mental health concerns or avoid treatment to keep their jobs they're there. They're worried about the potential stigma what what can we do together to change the mentality or or the rules that that will prompt pilots and or other aviation workers to get the help? They need to feel that this is not something that they need to
keep in the dark? A part of it is we have to talk about it and that's why these podcasts And events like this, I'll be, I'll tell you, I will talk about mental health, you put a microphone on my face asked me to talk I will, because it's so important to get the message to every single pilot, every single air traffic controller, every single
aviation worker, get help get help early. Because if you get help early, before it becomes a major diagnosis, or having friends is one of the ultimate acts, we can work with that it is so much easier to get a waiver. And frequently you don't even have to get it through us, you can work with your AME. And that's much, much, much faster. So we have to stop the cycle as soon as we can in the process. And the way we need to do that is with education. And then make it real clear on the processes
that are required. And then we have to continue on the FAA side to improve those processes and reduce the wait times. But it begins at the very lowest level of aviation in my mind, where we talk about it, if we talk about it, we can recognize it if we recognize it. It reduces the fear and allows us to act.
So what can we do I mean, other than our podcast here and getting the message out industry, the airlines the government asked us his labor what what can we do more, you know, education is obviously essential, but is there anything else that you can you can think of that we could do to help move the thing, move this along, keep
up the peer support work. I think that is really critical. Support the individuals that are coming forward, and you all over the years have done a really good job with that. We're going to make the process faster, we're going to put the decisions as low in the hierarchy as we can. Because if we do this right, if people get the the help they
need early, they become more resilient. And wouldn't it be nice if they didn't need me because everything was handled at a level where they had the tools to react to life stress.
Or I'd be remiss if I didn't give a shout out to Travis in our pilot peer support team here because they do they do such a great job not only on the with the peer support but on the rulemaking committee and making sure that that we do everything we can to bring the help to this this situation
and you have a great team I've really enjoyed getting to know them
yeah, we certainly do. I could say on behalf of my members thank you for your your leadership on this because I think we all agree that that you know pilots want to fly and and the quickest way we can get people healthy and get them get them flying but we weren't taught first and foremost we want to make sure the healthy right get healthy whether it's a physically mentally everybody is healthy and then when we can get them back to the cockpit as soon as
possible. Right so I appreciate your leadership and trying to get get him there. Well before we before we call today, Dr. Northrup Is there anything you'd like to add? No, I
would just reiterate our goal. The FAA is goal to return pilots and air traffic controllers to fly in and controlling duties as soon as it is safe to do so in a manner that's transparent, consistent and timely. That's where we need to go. And that's what we're trying to do. And thank you for your help and your partnership. It has been an absolutely wonderful experience getting to know your team.
Thank you so much for for joining us today Dr. Northrup I know that I personally learned a lot about the process about the the AME guide and mental health in general and I'm sure our listeners did as did as well. As part of mental health awareness month out was pilot assistance group launched the Are You in the Green campaign to encourage members to pay attention to mental health of our peers or
families and importantly ourselves. The campaign is named after a question every pilot should ask before stepping foot on the flight deck. Are you in the green? Asked if you're mentally healthy and ready to fly. stress and mental health concerns can come in many forms and from many sources, but we need to make sure that when when we fly, we are tuned into ourselves. If you aren't in the green that is a sign that you need to take action to take care of yourself and reach out to
ALPA as pilot peer support you system. To learn more, visit www.alpa.org/green Thank you for tuning into this episode of The airline pilot podcast and thanks again for joining us, Dr. Northrup. If you haven't already, make sure you subscribe so that you don't miss any episodes. And if you enjoy this episode, let your fellow crew members know about the show. If you have any questions or topics you'd like us to cover, reach out to podcast@alpa.org to listen and subscribe to the
airline pilot podcast or learn more about ALPA. Check us out online@alpa.org Or find us on all major podcast platforms. Until next time, this is the airline pilot podcast production copyright ALPA 2024. All rights reserved. Thanks and have a safe flight