Why Are Pilots Hiding Their Mental Health Issues? – In this episode of Uplink, we confront a pressing and often hidden issue in aviation: the mental health of pilots. The recent arrest of off-duty Alaska Airlines pilot Joseph Emerson, who attempted to shut down an aircraft's engines midflight, serves as a startling wake-up call to the aviation industry. This incident, coupled with the National Transportation Safety Board's (NTSB) summit on mental health in aviation, highlights a concerning trend among pilots to conceal their mental health struggles. We are joined by Dr. William "Billy" Hoffman, a renowned neurologist and aeromedical researcher who sheds light on why pilots often delay seeking medical care and the implications of this behavior for public safety. Dr. Hoffman, an assistant professor of aerospace at the University of North Dakota, brings a wealth of experience from studying over 5,000 pilots and his prominent media appearances discussing pilot health. In this episode, we delve into the reasons behind pilots' reluctance to disclose mental health issues, the potential risks this poses to aviation safety, and the steps that can be taken to address this silent crisis. We also discuss the broader impact on the public's perception of flight safety and the future of aviation health protocols. Welcome to Uplink – the aviation dialogue starts here.
Please note that the views and opinions expressed by the speaker are solely their own and do not necessarily reflect the views, positions, or policies of any other organization or entity with which they may be affiliated. The content provided is for informational purposes only and is not intended to represent the official stance of any other group or institution.
In this insightful episode of Uplink, we tackle the sensitive and crucial topic of mental health in the aviation industry, focusing on the hidden struggles of pilots. Our conversation with Dr. William "Billy" Hoffman, a neurologist and aeromedical researcher, sheds light on the complexities of healthcare avoidance among pilots and the broader implications for aviation safety.
We delve into the multifaceted reasons behind pilots' reluctance to disclose mental health issues, exploring how this fear affects their well-being and professional lives. Dr. Hoffman illuminates the unique challenges pilots face in managing their mental health, distinct from other professions. He discusses the delicate balance between ensuring aviation safety and supporting pilots' mental health needs, especially given their concerns about losing certification.
The discussion further uncovers the demographic factors influencing pilots' healthcare avoidance and the implications of these behaviors on a personal level, rippling through the aviation industry. We examine pilots' unique position regarding health disclosures and how this influences their decisions, especially in light of Dr. Hoffman's research revealing the vast scope of this issue, with over half of U.S. pilots reporting a history of healthcare avoidance.
Addressing the pressing need for change, we explore alternative approaches and solutions to effectively and compassionately address pilots' mental health concerns. The conversation also highlights the significant issue of pilots avoiding healthcare for fear of losing their flying status and the widespread nature of this problem in the aviation industry.
We consider the dynamic nature of mental health and whether the current system adequately supports pilots dealing with temporary or situational mental health issues. The episode also delves into the negative repercussions pilots face when grounded due to mental health issues, including the evolving narrative about pilots' health behavior and its implications following the Alaska Airlines incident.
Our discussion with Dr. Hoffman is not just an analysis of current events; it's a deep dive into the challenges of public trust, industry confidence, and the future of aviation safety. We explore the critical steps needed to shift the aviation culture towards a more open and supportive approach to mental health, ensuring pilots' well-being and passengers' safety. Join us on Uplink as we navigate these crucial issues, charting a course toward a more understanding and supportive future in the aviation industry.
Key Moments:
0:00 - 4:47 - Introduction and Overview: Starting with the focus on mental health in aviation, the introduction of Dr. Billy Hoffman, and his advocacy for innovative mental health solutions for pilots.
4:47 - 9:29 - Impact of Mental Health Disclosure and Unique Needs: Discussion about the effects of mental health issue disclosure on pilots' well-being, their unique mental health needs, and the balance between aviation safety and mental health support.
9:29 - 14:29 - Addressing Mental Health in Aviation: Emphasizing the importance of addressing mild mental health symptoms in pilots, the barriers they face in seeking mental health care, and alternative approaches for pilot mental health.
14:29 - 20:27 - Comprehensive Mental Health Challenges: Exploring the necessity of honest health disclosure, transitioning to a performance-based approach, and addressing mental health among new mothers in aviation.
20:27 - 26:02 - Demographics, Misinformation, and Global Perspectives: Focusing on demographic differences in healthcare avoidance, the impacts of informal healthcare seeking, and international perspectives on aviation mental health.
26:02 - 31:35 - Systemic Changes and Cultural Shifts: Discussing training programs and healthcare avoidance, the need for systemic change in the aviation industry, and the role of unions and organizations in advocating for pilots' mental health.
31:35 - 39:44 - In-depth Analysis and Closing Thoughts: Delving into the historical context of pilot health standards, the dual role of military flight surgeons, and Dr. Hoffman's final thoughts on mental health in aviation.
47:12 - 49:05 - The conversation continues. Join the Uplink—LinkUp and Uplink—LinkUp: DC Metro
00;00;00;00 - 00;00;14;19
Shaesta Waiz
Welcome to Uplink. The aviation dialog starts here. I'm Shaesta Waiz.
00;00;14;19 - 00;00;16;01
Michael Wildes
And I'm Michael Wildes.
00;00;16;03 - 00;00;28;08
Shaesta Waiz
Thank you for joining us.
00;00;28;10 - 00;00;56;11
Shaesta Waiz
In recent times, the aviation industry has been facing a pivotal challenge that has often been overlooked. The state of mental health among aviation professionals. This issue has gained heightened attention due to recent incidents, notably the case involving off-duty Alaska Airlines pilot Joseph Emmerson. As detailed in a CBS News report by Alex Sundby on October 23rd, 2023.
00;00;56;13 - 00;01;29;02
Shaesta Waiz
Emerson's attempt to shut down an aircraft engine mid-flight, leading to his arrest and subsequent arraignment on multiple charges, including endangering an aircraft, has brought to the forefront the critical mental health challenges in aviation. Following these developments, the National Transportation Safety Board, the NTSB, organized a crucial summit on December six, 2023, to address the mental health issues prevalent in aviation.
00;01;29;05 - 00;02;01;23
Shaesta Waiz
This summit, emphasized by NTSB chair Jennifer Homendy, was focused on modernizing approaches to mental health in the industry, particularly in light of the current system for evaluating the mental fitness of aviation professionals amid these circumstances. Uplink Podcast sought to explore the issues further by inviting Dr. William Billy Hoffmann, a distinguished neurologist and aeromedical researcher, for an in-depth discussion.
00;02;01;26 - 00;02;34;21
Shaesta Waiz
Dr. Hoffman serves as an Assistant Professor of Aerospace at the University of North Dakota. John de Odegaard School of Aerospace Science has dedicated his career to understanding pilot health care-seeking behaviors in aeromedical screening. His research, which has involved studying the healthcare behaviors of over 5000 pilots across North America, offers critical insights into the patterns and implications of healthcare avoidance in this field.
00;02;34;24 - 00;03;06;22
Shaesta Waiz
He advocates for innovative solutions such as a national aviator and a health care advisory phone line, allowing pilots to seek medical advice anonymously, thereby enhancing aviation safety and ensuring better treatments for pilots. Furthermore, Dr. Hoffman's unique perspective is enriched by his personal journey. A graduate of Georgetown University of Medicine and a recreational pilot. He blends his passion for neuroscience and aerospace seamlessly.
00;03;06;28 - 00;03;42;14
Shaesta Waiz
Inspired by his research, his novel Wings of Deceit explores the consequences of healthcare avoidance among pilots. Showcasing his ability to translate complex issues into accessible narratives, Dr. Hoffman's expertise is not confined to academia alone. He has been an international speaker on pilot's health with appearances on NBC and Fox News, and his work has been featured in renowned publications such as Scientific American Flying Magazine and AOPA magazine.
00;03;42;21 - 00;04;17;23
Shaesta Waiz
This extensive engagement with both the media and the science community underscores his prominent role in addressing aviation mental health issues. This conversation on the upcoming podcast was particularly timely given the recent alarming incidents and the subsequent NTSB summit. Dr. Hoffman provided a comprehensive overview of the current state of mental health in aviation, delving into the implications for pilots and the public and discussing the necessary steps forward to tackling these challenges effectively.
00;04;18;01 - 00;04;47;10
Shaesta Waiz
His analysis was informed by his deep understanding of the intersection between neuroscience and aerospace, as well as his commitment to enhancing the safety and well-being of those in the aviation industry. In summary, Dr. Hoffman's contributions, both as a researcher and as a public intellectual, positioned him as a leading voice in the ongoing conversation about mental health and safety in the aviation industry.
00;04;47;11 - 00;05;02;25
Shaesta Waiz
His insights on the upcoming podcasts offered invaluable perspectives for understanding and addressing these critical issues. Dr. William Billy Hoffman, Welcome to the Airplane podcast. How are you doing today?
00;05;02;28 - 00;05;15;26
Dr. Billy Hoffman
Very well, thank you so much. Shaesta and Michael. This is just a really exciting opportunity to be with you both today. Thank you so much for taking an interest in our pilot patients in this really exciting time that we have found ourselves in.
00;05;15;27 - 00;05;32;09
Shaesta Waiz
Thank you for joining us, and we'll dive into it. I'd love for you to explain to our audience so that we can better understand how the fear of disclosing mental health issues might impact the well-being of pilots in their professions.
00;05;32;12 - 00;06;02;19
Dr. Billy Hoffman
So, pilots are required to meet certain medical standards in order to maintain an active flying status. And, of course, the intention of that is to ensure that pilots are safe to perform their flying duties. But if a pilot develops new symptoms and discloses it during their periodic health assessment with an aeromedical medical examiner, who is an appointed physician by the FAA, they run the risk of usually temporary loss of their ability to work or fly.
00;06;02;22 - 00;06;32;06
Dr. Billy Hoffman
This can have negative occupational, social, and financial repercussions for the pilot. And so this paradigm can inadvertently, at times, leave pilots weighing the risks of seeking care against what it might mean for their career hobby. And, you know, the data speaks to this. Our study of over 5000 pilots across North America showed that over 50% reported a history of healthcare avoidance due to fearful loss of flying status.
00;06;32;09 - 00;06;36;22
Shaesta Waiz
And Billy, can you just define how you define mental health?
00;06;36;24 - 00;07;07;12
Dr. Billy Hoffman
Well, that's a squishy, evolving, and complicated term, and it raises bigger questions about the words that we're using in society, about mental health and mental wellness, and how that applies to aviation. For example, terms like excited or depression in 1980 and 1990 can mean different things in 2023 and 2024 in some ways. And so we are grappling with that.
00;07;07;15 - 00;07;32;09
Dr. Billy Hoffman
But, you know, organizations like the World Health Organization would define mental health as a state of health mindset. So that people can participate in their world, seek meaning, engage with people in relationships, and find meaning in their work. But again, lots of people have different, you know, descriptions. And I think in aviation, we're grappling with what mental wellness means exactly.
00;07;32;13 - 00;07;48;24
Michael Wildes
So, Billy, can you explain what a pilot's situation, apart from other careers, in terms of mental health needs? Because this discussion, you know, seems to be happening across other industries as well, But how is mental health for pilots different compared to other careers?
00;07;48;26 - 00;08;13;23
Dr. Billy Hoffman
Pilots find themselves in a unique circumstance that changes in their sleeping patterns, a life on the road, and, you know, removing from social networks regularly are just unique risk factors in and of themselves, and there could be factors that contribute to mental health symptoms. Those are just human beings. Those things can do that.
00;08;13;26 - 00;08;46;11
Dr. Billy Hoffman
Then, this need to maintain a certification adds additional stress, all with the gravy of being responsible for the lives of hundreds of people every day in functioning in one of the most complicated systems that humans have created, and that the aerospace system creates this mix of of of stress and for many times really relies on pilots coping skills to to to be Well, and listen, I'm a pilot of a recreational pilot, I'm sure.
00;08;46;15 - 00;09;10;21
Dr. Billy Hoffman
Are you guys both pilots? I understand, right? Yeah. Okay. And we're all very unique. You know, we're all very special. But also, in many ways, pilots are just regular human beings who need health care just like everyone else. And that's okay. And so I think we're finding ourselves in a period where we are rethinking about how we help meet the unique mental health care needs of pilots while maintaining safety in the system.
00;09;10;21 - 00;09;29;24
Shaesta Waiz
So you just touched on a balance there that I think we're all trying to find within the industry. You've written about pilots avoiding health care due to concerns about losing their certifications. Can you discuss how we can strike a balance between ensuring aviation safety and supporting the mental health needs of pilots?
00;09;29;29 - 00;09;55;13
Dr. Billy Hoffman
It's important to first recognize that mental health and mental wellness fall on this tremendous spectrum, and that can be on one end. Pilots face symptoms related to regular life circumstances. This could be the stress of a job; this could be a financial strain. And then this can also be things like divorce or the loss of a loved one on the opposite end of that spectrum are the extremes.
00;09;55;16 - 00;10;19;23
Dr. Billy Hoffman
These would be symptoms like decompensated schizophrenia or other significant mental health disorders that result in significant disability. So what's important to recognize is the conversation that we are that our group personally is very interested in, and I'm in, I know many others, is how we help pilots with mild symptoms. There are many pilots who likely fall into this category.
00;10;19;26 - 00;10;42;29
Dr. Billy Hoffman
And how do we think about addressing their needs in a new way? And, you know, I think that's where the that's where our question relies on is how do we lower the barriers to care, to ensure that symptoms can hopefully resolve as quickly as possible and more effectively and dynamically identify when a pilot is okay to be flying?
00;10;42;29 - 00;10;47;20
Dr. Billy Hoffman
And maybe there's a period of time when they need to step away from flying for a short period of time. And that's just okay.
00;10;47;21 - 00;11;12;00
Michael Wildes
So, you know, you've researched extensively about avoiding health care pilots, avoiding health care. If this were to continue to happen, what would be the implications for pilots and the industry and a career apart from them? I mean, unfit to fly, you know, and not being treated for symptoms? If they were to continue to avoid health care, how would this be significant for, I guess, the industry?
00;11;12;02 - 00;11;36;21
Dr. Billy Hoffman
All stakeholders stand to gain by thinking about and working to address healthcare avoidance for regulators. This is about safety for airlines. This is about, you know, profitability and dependability, minimizing, call out for operations. This is about maintaining a safe and healthy workforce. And for pilots and the physicians that help take care of them.
00;11;36;21 - 00;11;58;23
Dr. Billy Hoffman
This is about ensuring that this unique patient population is one that we all need to trust, and, of course, for pilots, it is for their own health. You know, how do we address and ensure that they achieve their health in a new way? So, you know, there's not there's not an easy solution to this. And I think it's going to take all stakeholders coming together to think about this in a creative way in the foundation.
00;11;58;23 - 00;12;18;08
Dr. Billy Hoffman
This is going to be trusted. You know, how do we empower pilots to help make easy and informed decisions at the point of operation about when they are and are not fit to fly and in trust, going the opposite direction of how do we ensure that the regulator has the information they need to to ensure that the system is safe?
00;12;18;08 - 00;12;28;17
Dr. Billy Hoffman
Ultimately, the regulator reports to the public, and their role is to say, you know, for the general public, this system is safe and dependable, and you can fly it with trust.
00;12;28;22 - 00;12;54;08
Shaesta Waiz
So, Billy, I'm a graduate of Embry-Riddle. One of the things that we've learned from a few professors in our program was to protect your medical, you know, So when you go in to see your doctor, be very brief, don't elaborate. Everything's okay. And I felt like that just put a sense of fear in myself and my peers.
00;12;54;10 - 00;13;04;02
Shaesta Waiz
I'd love to hear from your point of view. Can you elaborate on how this fear might be affecting pilots on a personal level and how it can ripple through the aviation industry?
00;13;04;06 - 00;13;32;23
Dr. Billy Hoffman
If we think about the barriers that pilots face in seeking medical care and mental health care, it can feel very unique to aviation. But in many ways, this barrier is just like any other one in health care. You know, health barriers are ubiquitous in medicine. And what we're hopeful to do is frame the barriers that pilots face in seeking mental health care, using the same framework and tools that we do in the rest of medicine.
00;13;32;26 - 00;14;02;02
Dr. Billy Hoffman
And that's important because that highlights that there are factors that contribute to healthcare avoidance. And part of that is the certification decision, the loss of the certificate. But it's also important to recognize that there are many factors in that system that we can modify. For example, the certification decision. Does the pilot meet those minimums? Yes. No, that's probably always going to exist in some form, but there are other factors that we can address.
00;14;02;04 - 00;14;29;19
Dr. Billy Hoffman
And those factors include examples like health literacy, having the knowledge to navigate the system, the understanding of the policies to get to a special issuance and in clarifying and making it, you know, navigable, so to speak; three is the financial burden off of getting a special issuance. That's the medical testing. If you're a professional pilot who's stepping away from flying in the loss of pay, how do we address that?
00;14;29;19 - 00;14;48;27
Dr. Billy Hoffman
Things like disability insurance are in many others. And there are some factors that we can address and some factors that we can't. One factor that has come up repeatedly in the data is our concerns about misinformation, and that is the conversations that are happening in the classroom. These are the conversations that are happening on the flight deck.
00;14;49;03 - 00;15;11;21
Dr. Billy Hoffman
These are the conversations happening in the chief pilot's office. And that is is, you know, at times, it is becoming clear in the data that there's information that is just not correct. And we all stand to gain. We all have a responsibility to spread information that's accurate. There are many pilots that don't know you can be unnecessary and be a pilot.
00;15;11;23 - 00;15;27;03
Dr. Billy Hoffman
There are many pilots that don't know. You can be talking to a therapist and still fly in many other conditions. So there are many other circumstances. So, you know, we need to work on the misinformation part, and ultimately, the regulator doesn't own that. We own that.
00;15;27;04 - 00;15;49;28
Michael Wildes
Yeah, that's interesting. So you suggest, and you've written this; I believe in one of your studies, you said you suggested a doubling down on an imperfect system is not the right answer. Can you propose alternative approaches or solutions that could help address the mental health concerns of pilots in a more effective and compassionate way? What are some practical things that could be put into place?
00;15;50;02 - 00;16;15;03
Dr. Billy Hoffman
It should be noted that the consistency in the safety of the system is dependent on people being honest. So it's important that you should, you know, as the rules stand, disclose your health information. And pilots who intentionally break that rule, as evidenced by this Washington Post article with the V.A. disability claim. You know, that makes an example of the challenges that lie ahead.
00;16;15;06 - 00;16;43;23
Dr. Billy Hoffman
And ultimately, you know, to some degree, there are questions about pilots are probably held accountable for that. But more broadly, from a policy perspective, doubling down and punishing pilots is not going to bring about the change we want to see. And this goes back into the hospital, for example, if there is a near-miss or a mistake in a hospital, blaming that health care provider will, you know, maybe address that specific instance to some degree.
00;16;43;25 - 00;17;06;10
Dr. Billy Hoffman
But just like pilots, most of the farm jury of healthcare providers don't want to make a mistake. It's not intentional. And so targeting and blaming individual factors, you know, members of the system, may not bring about the change you want to see. So, it compels us to think hard about how we can do better and how we might do this in a new way.
00;17;06;12 - 00;17;34;17
Dr. Billy Hoffman
And one possible way that, to my knowledge, is not operationally ready yet. It's a research question: how might we transition from our clinical approach in mental health in aviation that uses diagnoses and the use of health care services as a marker for risk and transition to more of a performance-based approach? That is, regardless of what's in the medical record, can the pilot perform their duties at the point of operation?
00;17;34;19 - 00;17;58;25
Dr. Billy Hoffman
How might that be achieved? That would be using biometric data and point of operation neuropsychological testing that the pilot can use in the airplane, which can help basically objectively quantify their I'm Safe checklist. And so in what that might look like if I have a magic wand, see, I'm an academic, so I can have pie in the sky and think about what could be someday in the future, even though it doesn't exist yet.
00;17;58;28 - 00;18;16;19
Dr. Billy Hoffman
But that would be a pilot who gets in the airplane, pulls out their device, and says, This is my sleep pattern. These are my other, you know, fitness data. And they do a quick sample of neuroscience testing. It says, you know, this is how I usually test. I'm good to go. Or maybe it says, you know what, This is a little less than I usually am.
00;18;16;21 - 00;18;30;27
Dr. Billy Hoffman
Should I be flying today? Do I need to talk to a therapist? When you talk to somebody, do I need to sleep? Or maybe I simply need to tell my copilot, You know what? I'm not batting 100 today. Keep an eye on me. And that's how we address this risk in a new way.
00;18;30;28 - 00;19;02;12
Michael Wildes
I think that's fascinating. And just to sidestep, because you said it might be farfetched, but I think this is what we see in sports. In sports players, basketball has become known for being an analytical sport where they're measuring your steps, you measure how hard your footprint is, they measure your vertical, and before you are good to go to hold the apartment, is speaking with the coaches to let them know sort of your status.
00;19;02;14 - 00;19;17;07
Michael Wildes
And so I believe there is a parallel there between athletes who are performing at a high level and pilots. And so maybe it is a step that needs to happen, as you're saying, going from analytical or clinical to more performance-based.
00;19;17;08 - 00;19;38;23
Dr. Billy Hoffman
And you're absolutely right; there's nothing novel here. There's nothing you know, there's nothing truly, you know, that we're not seeing in other industries. And that goes back to, you know, aviation is unique, but we should be looking to other disciplines who have addressed these similar patterns in different ways. In medicine. There are studies out there using emergency medicine.
00;19;38;23 - 00;20;02;25
Dr. Billy Hoffman
Residents use these types of tools to help determine or quantify fatigue on a night shift. And so these things exist and, you know, we can be leaning into them to help answer these questions. But an important point is that, to my knowledge, I'm not I don't think people are advocating for pilots with severe mental health symptoms to be flying.
00;20;02;28 - 00;20;19;17
Dr. Billy Hoffman
I think all of us would agree that we need to have a system that allows for the identification, the quick, you know, allow of treatment for this group. And then when they if they choose to and if they're fit to go back to flying. But what we're really interested in here is people who have mild symptoms suddenly facing a divorce.
00;20;19;23 - 00;20;27;20
Dr. Billy Hoffman
Stress changes with the child or just life stress. How do we help that population get the care they need easily earlier?
00;20;27;21 - 00;20;44;18
Shaesta Waiz
I'd love to hear about your research. Have you at all looked into moms, new moms who take a break from flying to go have their kid, and I'm coming back in? I don't know if you've done any research in terms of where their mental health is and if there are any resources for them.
00;20;44;25 - 00;21;09;00
Dr. Billy Hoffman
You bring up a tremendously important point. Pilots are not a monolith. It's highly heterogeneous and is becoming increasingly so. And that's exactly what should be happening. We're going to be having more voices and more perspective in the pilot population, and that is so exciting. For that reason, we know that subpopulations are going to face unique barriers that other populations will not.
00;21;09;02 - 00;21;40;23
Dr. Billy Hoffman
And we published a paper showing that female pilots have higher, you know, higher rates of health care avoidance than non-female pilots. The hypothesis is that people from traditionally underrepresented groups in the pilot population may face similar challenges. So, at various levels, ranging from the one-on-one relationship in the cockpit to the chief pilot's office to flight schools to a policy level, how do we build that into the system to meet those unique needs?
00;21;40;29 - 00;22;05;10
Dr. Billy Hoffman
There are many unanswered questions. Postpartum depression is a question. The unique factors like for parenting that, you know, both female and male pilots face. How do we address this in a new way and, most broadly, in a very dynamic way that minimizes loss of flight time if it's necessary and when ready to hopefully get pilots back in the flight deck if they want to, and as quickly and safely as possible?
00;22;05;13 - 00;22;23;15
Michael Wildes
How do you think informal health care seeking impacts the overall health management of pilots? If pilots started to open sort of this new pathway, how would that impact overall health management? I know you talked about the biometrics, but are there any other impacts that you think would come into play?
00;22;23;18 - 00;23;12;03
Dr. Billy Hoffman
Finding oneself in a pilot lounge or in another social setting? Sometimes pilots might hear about people seeking informal medical advice, seeking informal treatment, and, you know, relying on resources like the Internet or simply just forgoing care altogether. The chair of the NTSB, Jennifer Hamadi, spoke about this at the NTSB roundtable on Wednesday. And that is a system where pilots feel, and I'm paraphrasing here, so I'm doing my best to paraphrase it as accurately as possible but that is that pilots in a system that feel that they are compelled to seek care informally or withhold information, is it resulting a decrement in safety?
00;23;12;05 - 00;23;32;28
Dr. Billy Hoffman
And so while we, you know, maybe is the time is now to rethink about a system where we lower the barriers to care, that, you know, is it possible and how can we build a data back to say that seeking care is not a marker and may not be a marker for risk? Most of the time, it's instead a marker for safety because it addresses latent risk in the system.
00;23;33;00 - 00;24;02;21
Dr. Billy Hoffman
The data suggest there is a potentially large population of pilots who are suffering in silence and using standard SMS terminology that would be called a latent risk. You know, the sit, the safe pilot is not one that is in the system getting special issues, getting care. The unsafe pilot is the one who is suffering quietly in silence, and another speaker at the NTSB roundtable spoke about this.
00;24;02;21 - 00;24;43;26
Dr. Billy Hoffman
That is the silent suffering; an untreated pilot is probably the least safe; the pilot who is seeking informal care but not disclosing it might be a little safer than the pilot who is getting the formal care that they needs and is going through the process may be the safest. These are hypotheses. I don't really have the data to back it up, but, you know, this is just using logic and pragmatism and but, you know, using the chair's words, not mine, is that pulling the pilot seeking formal care for multiple months in that perceived punishment is maybe may not be the system we want to have for the future as younger generations come.
00;24;43;26 - 00;25;06;21
Dr. Billy Hoffman
in. This is my own opinion is that as the language around mental health changes, there is going to be less and less tolerance for these barriers to seeking talk therapy. And anecdotally, I talked to young people who are just like, well, if I can't see a therapist, I'm just not going to fly. Which culturally is very different than maybe the eighties, nineties, and generations before.
00;25;06;21 - 00;25;16;07
Dr. Billy Hoffman
So aviation, the face of aviation, the culture of aviation is changing rapidly. And so it'll be interesting to see how we grapple with that in new ways.
00;25;16;10 - 00;25;41;07
Michael Wildes
It seems like we are going through a phase shift, as you said, and a big part of it is that dirty, systemic structures that exist in the industry today that don't fit the demographic. And so it's really interesting because changing the fabric of the industry requires really removing some of these systems that have been in place for a long time.
00;25;41;07 - 00;26;02;17
Michael Wildes
And because, as you're saying, there are more people who are silently suffering than we assume. And so there has to be sort of like this grappling with while, well, actually, a big part of the population isn't well. And so we need to sort of create some a safe space for them to express themselves.
00;26;02;19 - 00;26;44;05
Dr. Billy Hoffman
Certainly, and it raises bigger questions. Who owns mental wellness in aviation? The airlines are a business and will often use financial metrics to measure success. And, of course, there's a range, and there are many good Samaritans, but ultimately there are businesses. The FAA and regulators are safety organizations. Oftentimes, they use safety metrics to measure success. Well, aviation is exceptionally safe, but the voice that's lost, in my opinion, is often the voice of the pilot patient.
00;26;44;08 - 00;27;08;23
Dr. Billy Hoffman
And so how do we how do we amplify that voice? How do we bring that voice in? And I'm just so inspired by this rising generation of pilots coming in because they're so full of energy and creative ideas and ready just to engage this in a new, novel way. And the hierarchical culture that often finds itself in aviation just doesn't exist in the same way for many of these young people, which is so great.
00;27;08;25 - 00;27;36;28
Dr. Billy Hoffman
And that's how innovation is generated. So it's important that people get in the conversation and and and help help make that contribution to to progress forward. And I'll also mention that in the rest of medicine, this is a simple boil-down model. But how do we bring drugs to the market? There are three powerful voices in there as we bring drugs to the market outside of aviation.
00;27;37;00 - 00;28;03;01
Dr. Billy Hoffman
One, there's the voice of the drug company that makes them, you know, that makes the medication. There are two voices of the regulator. That's the FDA that ensures safety. And three, there's the voice of the pilot patient or the patients advocating for the medication. And so those three voices come together to bring about safe, effective, and financially solvent drugs.
00;28;03;04 - 00;28;25;16
Dr. Billy Hoffman
Well, if you use that corollary in aviation, you can use a similar model. One, there's the airlines. That's the company. Two, there's the regulator. That's the FAA. And three. The point that's missing here seems to be the voice of the pilot patient. That loud voice of the patients demanding care is lost in some ways, and it's not always true.
00;28;25;16 - 00;28;46;26
Dr. Billy Hoffman
But how do we build that? In my personal recommendation? I don't speak on behalf of anybody else today but myself. Is that leaning into organizations like the Aerospace Medical Association and other grassroots organizations to help organize that voice in a productive way, to help meet, you know, to help bring that to the conversation with how we grapple with these challenging questions?
00;28;46;27 - 00;28;57;24
Michael Wildes
In terms of the voice of the pilot, in this case, the airline industry is heavily unionized. In this case, would it be the pilot unions that need to speak up on behalf of the pilots?
00;28;57;27 - 00;29;25;14
Dr. Billy Hoffman
Pilot unions have done so many incredible things and continue to do so many incredible things for pilots. And their voice is so important to ensure that pilots get the care that they need. But, you know, there might be opportunities for this voice to be organized in either different ways or additive ways. And that might be, you know, through organizations like medical associations or other grassroots efforts because of the of the dynamics in the system.
00;29;25;16 - 00;29;42;19
Dr. Billy Hoffman
You know, the system exists currently with certain players, but we see that there's a problem. So, you know, this gap that brings us together is a problem to some degree. So, we may need to think about how we address that in a new way. And bringing in additional voices will be a big part of that stability.
00;29;42;19 - 00;30;09;07
Shaesta Waiz
A lot of our discussions have been focused around the U.S., and I've had the privilege of living in the Middle East for about four years, and I had the opportunity to just make so many pilot friends over there. And I quickly learned that the mental space, the mental health space, and the culture are just so different outside of the U.S., So I'd love to hear about your observations or research.
00;30;09;09 - 00;30;17;07
Shaesta Waiz
Is the International Aviation community shifting its culture around mental health now that there are more discussions happening in the U.S.?
00;30;17;09 - 00;31;03;28
Dr. Billy Hoffman
It's an incredibly important question. What I will say is, from a data perspective, there is a huge opportunity to help answer that question in a data-backed way. The long answer is, I don't know. And I am going back to encouraging our young, rising researchers and aviators to help us answer that question with data. I've had the privilege of learning from some incredible people at RKO, which I'm not speaking on behalf of in any way, but thinking about these questions from a global level is very challenging because of, you know, local cultural differences, jurisdiction and rules differences, resourcing differences.
00;31;04;00 - 00;31;14;28
Dr. Billy Hoffman
When we zoom out and look beyond the U.S., I think you're right that the challenge seems to exist, and there is even a bigger data gap that we need to try to fill.
00;31;15;05 - 00;31;35;00
Michael Wildes
So, you've talked about mental health avoidance among airline pilots, but you also researched mental health avoidance among military pilots. You have a study that says 72% of military pilots report healthcare avoidance behavior. Could you explain what prompted you to investigate this issue in the first place?
00;31;35;03 - 00;32;07;17
Dr. Billy Hoffman
Certainly so. Importantly, I speak on behalf of nobody today, and these views are my own and not necessarily those of any other organization. And everything I will share with you has been published already, and that is that of all comers. We found that just about 50% of U.S. pilots reported a history of healthcare avoidance. Well, the number one cited factor that people will say discourages people from seeking care in the U.S. seems to be financial.
00;32;07;17 - 00;32;35;08
Dr. Billy Hoffman
That is, if they step away from flying, they're going to need to pay money to get their certificate back, and they might lose income. Interestingly, if financial loss was the only factor that resulted in health care avoidance, theoretically, there should be no health care avoidance in the military because pilots are salaried. Healthcare avoidance is not only similar to the general population in the military, but it's actually higher in the military than it is in the rest of the population.
00;32;35;10 - 00;33;01;22
Dr. Billy Hoffman
So this raises a couple of points: one, the aeromedical system of the civilian sector is very different from that of the military. What that tells us is that we need to study these populations in different ways because they are the unique factors that influence care. And two is that there's an opportunity for knowledge sharing. There are things that the airlines are doing very well that might be served in other jurisdictions and vice versa.
00;33;01;24 - 00;33;06;07
Dr. Billy Hoffman
And so it's a highly heterogeneous population, and this data speaks to that.
00;33;06;09 - 00;33;24;26
Shaesta Waiz
So kind of taking it back to, you know, I think change in culture, you kind of have to go back to the foundation. So, I'd love to hear your opinion based on your findings; how might pilot training or educational programs be adaptive to addressing these healthcare avoidance tendencies?
00;33;25;04 - 00;33;43;29
Dr. Billy Hoffman
How do we get here? How did we get to this? How did we get to this problem where healthcare points are so significant? And to answer that question, it can be helpful to look at it from a historical perspective. In World War One, if you were not healthy enough to lead soldiers on the ground, you were put in an airplane.
00;33;44;01 - 00;34;05;13
Dr. Billy Hoffman
Well, after losing a bunch of airplanes because of fitness problems, they quickly realized that they needed some medical standards. And so they generated those standards. And in order to determine whether or not pilots met those standards, they made a special discipline in medicine called aerospace medicine. So this came out of that period of time. And, of course, there are people long before them researching the Mongo Fear brothers and studying hypoxemia.
00;34;05;13 - 00;34;32;19
Dr. Billy Hoffman
However, these physicians in the military during this time of conflict had two jobs. One, does the pilot meet the minimum standards? Yes or no? Their second job was if the answer was no, they had they had a responsibility to get them to yes. So they had a regulatory relationship, and they had a therapeutic relationship. And then that seems to exist in many military organizations today.
00;34;32;21 - 00;34;57;17
Dr. Billy Hoffman
Flight surgeons have a regulatory relationship and a therapeutic relationship. Well, Zoom passed the war, and now we have a bunch of civilians that go into the general population. And now, we need to maintain medical standards. How do we do that in today's current Army model? We borrowed from that system, except an army only has one job.
00;34;57;19 - 00;35;21;12
Dr. Billy Hoffman
Does the pilot meet the minimums? Yes. No. But if the answer is no, it is. It does not fall on the army to get them to say yes. The army only has one job regulatory. So, military flight surgeons have two jobs. Regulatory and therapeutic enemies have one job. For better or worse, it's regulatory. I'm not saying it is good or bad, and that's just the system we find ourselves in.
00;35;21;14 - 00;35;44;17
Dr. Billy Hoffman
Well, how do we get to? Yes, in the United States? It really ends up falling on the pilot, and for that reason, falling, you know, navigating the system to get a special issuance requires a tremendous amount of health literacy there. There are many physicians who don't know the difference between a neurologist, a psychiatrist, a neuropsychologist, and a neuropsychiatrist.
00;35;44;19 - 00;36;07;25
Dr. Billy Hoffman
And many of these specialties are the ones that pilots will need to get reports from in order to get a special issuance. So requires a great, great T.V., a great degree of health literacy. So flight training programs are in a unique position to help trainees build health literacy and have the tools to seek special assurance someday in the future.
00;36;07;25 - 00;36;24;03
Dr. Billy Hoffman
Most people are going to have a medical thing that's just being a human being, and so having the tools to navigate a system will really serve them well. So that's point one, too, which is normalizing care-seeking and spreading accurate information.
00;36;24;10 - 00;36;31;20
Michael Wildes
Are there other negative repercussions other than loss of pay that pilots face when they're grounded due to mental health issues?
00;36;31;25 - 00;36;52;24
Dr. Billy Hoffman
Well, I'm speaking to the choir here and probably many of your listeners, and that is that anecdotally, for many, many pilots, being a pilot is a part of their identity. Dr. Susan Northrup is someone I have tremendous respect for, and I find her to be a great leader in this charge. She's been, you know, I think we have a lot to thank her for.
00;36;53;01 - 00;37;17;09
Dr. Billy Hoffman
And she talks about it. She talked about this at a conference in Cologne last year, earlier this month. And she says if she is asked what's the one word that summarizes her or her identity? She used the word mom when she asked pilots, and I'm paraphrasing here, doing my best to accurately portray what she said. And she said many pilots will use the word pilot.
00;37;17;12 - 00;37;37;27
Dr. Billy Hoffman
And I think that's true. My experience has been that to be the case. I mean, you guys are laughing. I see. And I may find some of that to be accurate, too. And so beyond the financial loss, beyond the headache of navigating, especially issuances, that rocking this population in many ways to what they may perceive as forgoing their identity.
00;37;37;29 - 00;38;04;26
Dr. Billy Hoffman
There are some deep cultural factors with this here, too. Also, the type of person that's willing to sit in front of 250 passengers at 38,000 feet over the North Atlantic and be ready for an engine failure. An electronic failure, a medical emergency in a bad weather storm, and say, you know what I got? This may not be the same type of skill set as somebody who's easily ready to raise their hand and say, you know what? I need to step back and get help.
00;38;04;29 - 00;38;19;07
Dr. Billy Hoffman
And so I think that is definitely uniquely aviation, and that is how we need to rely on our young people as our experts in how to build a system that addresses these health care needs that are very human in a very aviation way.
00;38;19;14 - 00;38;52;19
Shaesta Waiz
So, Billy, we talk so much today about statistics and studies. If someone's listening to this episode today who is struggling with mental health and they're in aviation, have you found a resource or a pathway that they can pursue where they won't find information that the information might be a little bit clearer to understand? Have you found an avenue, a resource where people can go to just have a sense of relief or just to learn more about what their options are?
00;38;52;24 - 00;39;22;08
Dr. Billy Hoffman
If a pilot is so, I feel a responsibility to say a pilot who is finding themselves needing help should absolutely get help soon. And that's for a couple of reasons. One, by getting help early, hopefully, the symptoms will resolve quicker, and that's also just good for your general health and will be helpful in your overall trajectory of seeking help and disclosing that information early.
00;39;22;09 - 00;39;45;16
Dr. Billy Hoffman
It builds trust in your certification examination. And a pilot with mild symptoms who seeks, you know, certain mild symptoms like talk therapy or even just a simple SSRI, oftentimes finds themselves in a situation that's easier to certify that a pilot that's had a hospitalization or alcohol misuse or something like that. So if you're a pilot needing help, get help you need it.
00;39;45;18 - 00;40;10;22
Dr. Billy Hoffman
And that's okay. You're a human being, and disclose that information. Be truthful on your certification exam. And that will be good for both your health and it will lower the risk of it. It will ease your certificate and certification and empower you with knowledge. The FAA is an Aeromedical Examiners guide AME guide if you just Google it.
00;40;10;27 - 00;40;35;01
Dr. Billy Hoffman
It's a PDF on the FAA website, and if you go control F in search of your condition, you will actually find it's a very user-friendly document, and it's very checklist-oriented for pilots. And so go and read about what you need to get your certificate back or, you know, in assuming that you're ready in, that's what you choose to do.
00;40;35;06 - 00;41;08;18
Dr. Billy Hoffman
But then the documents were very helpful. If you have questions, print that document off. And when you see your health care provider have that resource with you, and they can help you navigate that information that's needed, of course, or of course, with your Amy. One thing that we see often is that, you know, with a pilot with a mental health diagnosis, for example, it's really best just to get the care that you need and get better and wait to submit your cert application until you're better.
00;41;08;21 - 00;41;35;27
Dr. Billy Hoffman
Because for better or worse, there can be back and forth between the pilot and the FAA if you're not quite ready yet, and they need observation periods. So I would encourage pilots to work with their AME to decide strategically when it's time to submit a special issuance application because these are ways to kind of forgo the administrative hiccups, you know, and that can be either submitting too early or not, including a checklist.
00;41;36;00 - 00;41;51;21
Michael Wildes
How is this recent Alaska Airlines incident moving the discussion along? Obviously, there has been a lot of public commentary and this case is ongoing. But how is it moving the discussion along?
00;41;51;23 - 00;42;15;12
Dr. Billy Hoffman
I can't speak to what did or didn't happen during that unfortunate event. Other than that, my heart goes out to the many, many people impacted by this difficult situation. And we feel stories like this speak to the broader issues that we face related to healthcare avoidance in this pilot population. These events are related to the data that we see and also what we see in the clinic.
00;42;15;14 - 00;42;36;18
Dr. Billy Hoffman
And so we have an opportunity to bring the stakeholders together and think about how we do this in a new way. And I hope that we will lean into the general interest there is in this topic, too, to move a meaningful project forward. I'm really of the opinion that everyone wants the same thing: the regulator, the airlines, the pilots.
00;42;36;18 - 00;42;46;24
Dr. Billy Hoffman
We all want the same thing, and that is that pilots get the care that they need and that we maintain safety in the system. We have a chance to work together to make that happen, and we need all stakeholders at the table.
00;42;46;27 - 00;43;21;05
Shaesta Waiz
So, Billy, as we wrap up this discussion, you know you've been on so many panels, discussions, and publications. You've written a book about this topic. I'd love to hear from you. What is the low-hanging fruit that the industry can do to help move the needle in a positive way with mental health? And what would you say is a high profile one that the industry can invest in to get this to get people talking more about mental health and just feeling safer in this industry?
00;43;21;06 - 00;43;46;00
Dr. Billy Hoffman
I love that question. That's that's terrific. And that is a couple of things. We should be leaning into the data that exists to help answer these questions. And I would recommend that we address this using a health systems approach. And what I mean by that is that there are factors in the system. There are many factors that support utilization and factors that discourage utilization.
00;43;46;02 - 00;44;06;13
Dr. Billy Hoffman
One of those factors seems to be the loss of the certificate; that's part of the story. But there's a lot to the story. And so, what are the factors that are low-hanging fruit? This is an important question. What are the minimum resources that airline pilots in the United States should have access to as it relates to mental health?
00;44;06;15 - 00;44;38;12
Dr. Billy Hoffman
If you fly for a mainline U.S. air carrier, you may have access to different peer support services, disability insurance, and in-house aeromedical expertise to help navigate a special issuance process. Then, if you fly for a small carrier, you fly for a small business airline with two pilots or one airplane, or if you're in training, it's so because there is this variation, one can make the argument that this is inequitable, that we need to be thinking about what are the minimum resources, people.
00;44;38;14 - 00;45;05;13
Dr. Billy Hoffman
And that's important because we're going to need to bring different people to the table and be likely looking beyond aviation. For example, the CDC is responsible for public health. The OSHA and organizations like that are responsible for workplace safety. Insurers are responsible for insurance plans. So we may be needed. We need to look beyond aviation and bring those relevant people to the table.
00;45;05;13 - 00;45;35;15
Dr. Billy Hoffman
So low-hanging fruit are the financial factors disability EAP programs, peer support services, that stuff we can in misinformation, that stuff we can change today. In the longer term, I would encourage us to think about how we transition from a clinical approach to mental health in aviation to more of a performance-based screening approach. We are just about to publish a paper in the Journal of Occupational Environmental Medicine proposing how this might be achieved.
00;45;35;18 - 00;45;56;12
Dr. Billy Hoffman
But again, to my knowledge, there's no data that's ready that says that there's like an operationally ready tool to do that, but there's a chance for us to come together to research this. And the last plug, I'd say, is the Aerospace Medical Association, which is just about to publish a consensus document of research priorities related to mental health in aviation.
00;45;56;14 - 00;46;23;09
Dr. Billy Hoffman
This was an effort that I had the privilege of leading, where we brought 50 aerospace medicine experts from across seven ICAO countries. Over the course of three months, we generated this consensus statement. I hope all your young researchers and aviation lovers out there will need to do an undergraduate thesis or graduate thesis. Look at that document to pick the questions so that we can all be marching in the same direction.
00;46;23;10 - 00;46;48;16
Michael Wildes
Well, Billy, thank you so much. You've been a wealth of knowledge. We haven't even. I think we're still at the surface of the conversation. There are so many places that we could have taken. Taking it from the military to the civilian side, in addition to just the resources that are on the market as well as as you talked about, the low hanging on, high hanging fruits, but you've given us and our listeners a lot to think about.
00;46;48;16 - 00;46;59;19
Michael Wildes
And thank you for your advocacy and your research that has helped drive this process. And we look forward to continuing the discussions with you and the rest of the industry, you know.
00;46;59;19 - 00;47;12;07
Dr. Billy Hoffman
It's been my tremendous privilege, and I'm really grateful to you both for really, you know, sinking in and digging in to get into this complex, complex challenge. So, thanks again.
00;47;12;10 - 00;47;35;29
Shaesta Waiz
Thank you so much for joining us this week. Before we move on, we've got just a couple of important housekeeping notes for all of our listeners out there. The first is join up, linked, linked up community. Here's one benefit of joining. Suppose you're looking to dive deeper into the world of aviation and join the conversation. We'd love for you to be a part of our Uplink—LinkUp community.
00;47;36;02 - 00;48;02;00
Shaesta Waiz
It's a great space where enthusiasts like you can discuss, debate, and share insights about everything aviation. Joining is super easy. Just head over to our website or check out the show notes for the link in our Uplink—LinkUp WhatsApp Group. We have a general group for aviation discussions, and we have a special Uplink—LinkUp: D.C. Metro group for listeners in the D.C. area.
00;48;02;02 - 00;48;28;14
Shaesta Waiz
Being part of UpLink Linkup means you get to interact directly with us and other aviation enthusiasts. It's a fantastic way to get your questions answered, share your opinions, and even influence future podcast topics. So don't miss out on being part of the Uplink—LinkUp community. Join today and take your love for aviation to new heights. We can't wait to interact with you all.
00;48;28;19 - 00;48;29;16
Michael Wildes
Have a good weekend.
00;48;29;19 - 00;48;58;18
Shaesta Waiz
Thanks, Michael. Have a great week.