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About Mental Health

An off-duty Alaska Airlines pilot’s attempt to shut down the engines on a San Francisco-bound commercial flight Sunday is drawing renewed attention to airline pilot mental health — a topic long considered taboo in the industry but one that has generated more scrutiny in recent years since the co-pilot of a German jetliner deliberately crashed in the French Alps in 2015, killing himself and 149 others.

An off-duty Alaska Airlines pilot’s attempt to shut down the engines on a San Francisco-bound flight Sunday is drawing renewed attention to airline pilot mental health, a topic long considered taboo in the industry.
Scott Strazzante/The Chronicle

The off-duty Alaska pilot, Joseph David Emerson, told federal agents he became depressed about six months ago, denied taking medication and talked about having a nervous breakdown and trying psychedelic mushrooms, according to court documents filed Monday. Emerson was arrested Monday and faces dozens of attempted murder charges. He has pleaded not guilty.

Emerson’s attempt to shut down the plane’s engines was thwarted by the flight pilot and crew. But the incident raised disturbing memories of the 2015 Germanwings crash and other notable cases of possible murder-suicides by commercial airline pilots: the 1999 EgyptAir crash that killed 217 people, including more than a dozen from Northern California; the 1997 SilkAir crash that killed 104 people; and perhaps Malaysia Airline’s MH370, whose 2014 disappearance with 239 people aboard has never been explained.

The Federal Aviation Administration requires pilots to undergo medical exams every six months to five years, depending on their age and the type of flying they do, to keep their medical certificate. The exam is done by an aviation medical examiner who’s trained to assess the pilot’s mental health and can request additional psychological testing if they feel it’s necessary. Pilots must disclose psychological conditions and medications to the examiner. The FAA will revoke a pilot’s medical certificate if it becomes aware of significant mental health issues.

“The FAA encourages pilots to seek help if they have a mental health condition since most, if treated, do not disqualify a pilot from flying,” an FAA spokesman said in a statement. However, certain conditions including psychosis, bipolar disorder and some types of personality disorder automatically disqualify a pilot from obtaining their medical certificate.

Because the medical certification process relies heavily on self-reporting, many mental health conditions are likely underreported because pilots fear that disclosing certain conditions could prevent them from flying, according to research on pilot mental health.

Alaska Airlines said Emerson completed all FAA-mandated medical certifications throughout his career, and at no point were his certifications denied, suspended or revoked.

“Mental health is a taboo subject with pilots,” said Ross Aimer, a retired United Airlines pilot who is now CEO of Aero Consulting Experts, an aviation consulting firm. “After many, many years we’re finally taking care of drug addiction and alcoholism, but not mental health.”

With drug and alcohol abuse, there are benchmarks pilots can hit to be welcomed back into a cockpit, but Aimer said mental health is often the end of a career and thus there is a disincentive to talk about it.

“The moment you say something, you stop flying and your career could be over,” he said. “People do anything to hide it.”

The reluctance among pilots to self-report mental health issues is borne out by research.

“Underreporting of mental health symptoms and diagnoses is probable among airline pilots due to the public stigma of mental illness and fear among pilots of being ‘grounded’ or not fit for duty,” according to a 2016 study by researchers at the Harvard T.H. Chan School of Public Health. The study — the first to examine pilot mental health outside of the information derived from aircraft accident investigations or regulated health examinations — found that about 13% of airline pilots meet the criteria for depression and 4% reported having suicidal thoughts.

Commercial airline pilots are at similar or potentially higher risk of depression compared with the general population, according to a 2018 review of 20 previous studies on mental health disorders among commercial airline pilots. The prevalence of depression among pilots in those studies ranged from 2% to nearly 13%. Factors that affected pilots’ mental health included substance abuse, experiencing verbal or sexual abuse and occupational stressors such as disrupted circadian rhythms and fatigue.

The Germanwings co-pilot who intentionally crashed suffered from severe depression and may have been treated for suicidal tendencies before receiving his pilot’s license.

More recent research indicates many pilots avoid seeking health care because they are concerned it could lead to losing their medical certificate. One 2022 study, by a team at the University of North Dakota’s John D. Odegard School of Aerospace Sciences, found that 56% of U.S. pilots reported a history of avoiding health care, such as not seeking services for a new symptom. And 27% of pilots misrepresented or withheld information in a written health care questionnaire for fear of losing their certificate, according to the study, which surveyed nearly 3,800 pilots.

Since the Germanwings crash, the FAA has expanded mental health training for aviation medical examiners, supported research on pilot mental health and hired additional mental health professionals, the agency said.

Chronicle staff writer Matthias Gafni contributed to this report.  Reach Catherine Ho: