Among the first things off-duty pilot Joseph Emerson is said to have told police after he was accused of trying to bring down a Horizon Air flight last month was that he’d been struggling with depression for six months and hadn’t slept in 40 hours.
The Oct. 22 flight had left Everett’s Paine Field for San Francisco, Emerson’s home base with Alaska Airlines. Sitting in the cockpit jump seat, Emerson told the pilots, “I’m not OK.” Prosecutors contend Emerson then tried to activate a fire suppression system that would have cut the fuel supply to the engines.
Emerson had renewed his pilot’s license three months before, which means he passed the regular psychiatric evaluation required of all commercial airline pilots. The 44-year-old California man was not medicated, according to statements to police.
Emerson appears to have been among scores of U.S. pilots who keep quiet about their mental health struggles because of stigma, risks to their career and the understanding that commonplace mental health issues can ground them for months, if not longer.
U.S. pilots’ struggles with mental health have drawn congressional interest since at least 2015. In June, the Senate introduced a bill that would boost the FAA’s 2024 to 2028 budget to allow the agency to form a working group that can address pilot mental health protocols. The bill would also improve the FAA’s ability to issue special medical approvals to clear backlogs and get healthy pilots back to work.
In a country that relies heavily on air travel, passengers end up potentially impacted by pilots who don’t report mental health struggles due to systemic barriers.
At the same time, pilots risk months without work if they report mental health issues or seek care.
Forty percent of American adults have anxiety or depression symptoms, but pilots may also struggle with additional stress, anxiety or depression because of the nature of the work, said Dr. Ryan Shugarman, an Alexandria, Virginia-based psychiatrist who has worked for 10 years with pilots undergoing mental health evaluations.
“Pilots are not immune to mental health issues, and they have their own unique stressors,” Shugarman said. “Being away from family for extended periods of time, the inconsistency of (their) schedule can lead to marital disruption, sleep issues.”
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THE DISCLOSURE DILEMMA
One of the challenges of evaluating a person’s mental health is the reliance on self-reporting. Examiners count on patients to be honest when talking about their symptoms. There’s no universal test or scan for many of these seemingly invisible illnesses.
“There definitely are people that don’t report it and may slip through the cracks,” Shugarman said.
Mental health professionals routinely rely on self assessments, like Patient Health Questionnaire-9, to gauge a person’s mental health. The PHQ-9 evaluation asks patients questions like how often they’ve experienced “thoughts that you would be better off dead or of hurting yourself in some other way.” The FAA uses PHQ-9 as a tool as well.
Self-reporting can lead some pilots to minimize their symptoms. A 2022 study co-authored by William Hoffman, a neurologist and affiliated assistant professor of aviation at the University of North Dakota, showed 56.1% of pilots reported a history of health care avoidance due to the fear that they would lose their medical certificate, which attests to a pilot’s fitness. According to the study, 45.7% sought informal medical care and 26.8% misrepresented or withheld information on a health care questionnaire.
The FAA can fine pilots who lie on their medical examination up to $250,000, imprison them for up to five years, or both.
Pilots should be honest in their disclosures, but penalizing those who aren’t does not fix the problem, Hoffman said. Risk of prosecution is part of a system that forces pilots to choose between flying or taking care of their mental health.
The FAA said in an email pilots should seek early help for mental health conditions since most, if treated, don’t disqualify a pilot from flying.
For example, mild depression and anxiety, if properly treated, are not necessarily disqualifying, the agency said.
If a pilot seeks help early and receives care, they can get their medical certification more easily, Hoffman said. But mental health stigma remains a big issue for pilots.
“To be faced with that situation where they’re out of control, the loss of autonomy, in a lot of ways the loss of identity of pilots who are flying, is a very worrisome thing,” Hoffman said.
Reporting a mental health issue can also lead to months without flying.
Taking a prescribed antidepressant means at least six months without flying, according to FAA policies. After the six months are up, the pilot will be required to disclose whether they are still taking an antidepressant. Once they are no longer taking an antidepressant, the pilot will still be grounded for another two months before being cleared. During that time, pilots can apply for disability pay through their airline.