FAA Fast Track Pathway for Anxiety, Depression, and Related Conditions
There is no shortage of recent press about aviators avoiding seeking treatment for mental health concerns. Most airmen are afraid to seek help for fear of losing or delaying their FAA medical certification. Issues ranging from anxiety, depression, substance use, grief after death of a loved one, marital issues or divorce, and PTSD, are amongst common conditions. Lest we forget, pilots are people too.
The FAA is responding. In May of 2024, the FAA announced new approved medications for mental health for starters.
But what about therapy? Psychiatrist visits? Visits to a marriage counselor or grief counselor?
What about online therapy sites?
At the end of June, 2024, the FAA updated the Aviation Medical Examiner Guide (AME) to better address these questions.
This article addresses common questions about pilots seeking mental health, including whether a pilot can see a therapist and what implications this may have on their FAA medical certification.
The new FAA AME DECISION TOOL is called Fast Track Pathway.
The Fast Track Pathway has SIX key components that an airman has to qualify for that would allow an AME to issue a medical certificate at the medical appointment. If the airman does not meet these criteria, the AME must ‘defer’ the medical application to the FAA’s Aviation Medical Certification Division for consideration of issuance of a medical.
The first two components of Fast Track Pathway are: Medication and Psychotherapy.
The big questions:
1. Psychotherapy: Does the airman have ONLY 2 defined conditions (see below)
AND
2. Medication: NOT been on medication in the last two (2) years.
1. Psychotherapy Diagnoses
Criteria: Up to TWO listed conditions treated with psychotherapy (see list below)
Uncomplicated:
i. Anxiety:
- Generalized Anxiety Disorder
- Situational anxiety (aka adjustment disorder with anxiety)
- Social Anxiety Disorder
- Unspecified anxiety
ii. Depression:
- Postpartum depression
- Situational depression* (aka adjustment disorder with depressed mood)
- Situational
- Anxiety and Depression (adjustment disorder with mixed anxiety and depressed mood)
- Unspecified depression
iii. Other:
- Obsessive Compulsive disorder (OCD)
- Post-Traumatic Stress Disorder (PTSD)
- V code^ (DSM)/Z code (ICD-10) table items
- Uncomplicated Bereavement;
- Relationship distress with spouse or intimate partner;
- Parent-Child relational problem; and/or
- Phase of Life Problem (problems adjusting to major life transitions such as newly retired, getting married, empty nest, new career, becoming a parent, etc.
2. Medication
Criteria: Medication: A single mental health medication last taken, prescribed, or recommended two (2) or more years ago.
- This includes when the treating physician changed medications for better treatment response, provided only ONE medication was taken at a time and last use was two or more years ago.
FAST TRACK DISQUALIFYING MENTAL HEALTH HISTORY – The AME has to defer.
Any of the following history requires the AME to defer the Airman’s application:
- Does the individual have any additional mental health diagnosis or symptoms such as bipolar disorder, psychosis, neuro-developmental disorder (e.g., autism, ADHD that does not meet ADHD FAST TRACK requirements, etc.), personality disorder, somatoform disorder, impulse control disorders, substance misuse or disorder, eating disorder, or any diagnosis NOT listed as acceptable?
- Any history of suicidal (or homicidal) ideation, attempt(s), or self-harm behavior (such as cutting) ever in their life
- Any history of an involuntary mental health or substance use evaluation (including involuntary transport) and/or court-ordered treatment
- Any history of any forms of the following treatment modalities: Electroconvulsive (ECT), Transcranial Magnetic Stimulation (TMS), Ketamine, or Psychedelic therapy
- Any history of a mental health hospitalization (psychiatric or substance use
- Has the individual experienced more than one episode? (This includes recurrent episodes spaced out over an extended period of time
- This condition has unresolved sequelae or continued symptoms severe enough to interfere with safety related duties
- Mental health medications: Multiple medications have been used at the same time OR use of any medication has continued during the last two years
- Does the licensed mental health specialist, treating clinician, or the AME have ANY concerns
10. Has the individual ever been treated with:
- Antipsychotics (neuroleptics)
- Benzodiazepines
- Mood stabilizers (lithium, anti-epileptics)
- Stimulants
11. Does the individual have any history of:
- SI/SC for SSRI use (current or previous);
- Recurrent episodes or symptoms. If the individual had multiple failed attempts to discontinue or stay off medication(s) over any period;
- If the individual has any history of requiring more than ONE mental health medication at a time (e.g., dual or triple therapy); and/or
- Diagnosed with Major Depressive Disorder (MDD) or Persistent Depressive Disorder (dysthymia) or Seasonal Affective Disorder.
The Role of Aviation Medical Examiners (AME)
The Office of Aerospace Medicine has established comprehensive guidelines to evaluate pilot mental fitness. These guidelines allow aviation medical examiners (AME) to assess the psychological and psychiatric health of pilots, ensuring that those who have been treated for mental health issues are not automatically disqualified from flying. For instance, individuals treated with medications like Cymbalta, Effexor, or other antidepressant medications may continue to pursue their careers as long as they meet the required criteria.
Learn more about mental health issues and mental health conditions guidelines for pilots here. The FAA encourages pilots to seek help and resources regarding their right to maintain their FAA medical certification while addressing their mental health needs.
Final Thoughts on Pilots Seeking Mental Health Treatment
Prioritizing pilot mental health is vital for ensuring the safety and well-being of those in aviation. The FAA recognizes that a mental health condition can significantly affect a pilot’s performance and decision-making capabilities. As pilots and air traffic controllers face unique pressures, it is crucial that they feel supported in addressing their mental health needs without fear of repercussions.
The recent emphasis on peer support programs and mental health resources signifies a positive shift in the aviation industry. By encouraging pilots to seek help and providing access to mental health professionals, the FAA aims to foster an environment where addressing mental health issues is viewed as a strength rather than a liability.
As the industry moves forward, it is essential for all stakeholders, including pilots, aviation organizations, and regulatory bodies, to work collaboratively in creating a culture that supports mental well-being. This commitment not only enhances aviation safety but also ensures that pilots can perform at their best, contributing positively to the aviation community as a whole.
Contact Barnett Law Offices for a Consultation
Understanding FAA guidelines on mental health is essential for pilots navigating the medical certification process. Contact us today for a confidential consultation to discuss your specific situation and learn how we can assist you in achieving your aviation goals.
