How Airline Pilots Are Incentivized to Hide Their Mental Illness

The Supreme Court’s decision last year to overturn the 1984 Chevron doctrine may also have an effect on medical certifications. Until that ruling, the F.A.A. had essentially been the final authority on aviation-related issues; ambiguities related to medical certification were resolved by deferring to the agency. But the new ruling means that judges can, in theory, decide differently than the F.A.A. “I don’t know a single aviation attorney that isn’t excited,” Joseph LoRusso, a lawyer whom pilots have turned to when facing certification setbacks, told me.

But given the limits of aeromedical examinations and of psychiatry itself, the greatest impact on airline safety is not likely to be rulemaking so much as honesty. “Even with all the rules,” Noven says, “it really comes down to the person telling us the truth, and at the end of the day, we just cross our fingers and hope the people that aren’t telling us the truth don’t become a safety risk, because we can’t identify them.”

His remarks speak to why the Aviation Rulemaking Committee seeks to ease restrictions: to encourage more pilots to be honest — and to not rely on luck at all to ensure safety. The committee’s recommendations would “allow people who currently would be considered not ready to fly, to fly,” Steven Altchuler, the psychiatrist on the committee, says. While letting these pilots fly may result in what he calls some “unmeasurable increase in risk,” he compares that unknown risk with the known safety of our current system. Until the recent collision in Washington, the United States hadn’t had a major fatal commercial airline crash since 2009, the longest-ever such period. Even so, he says, that unknown risk would be “more than compensated” by getting more pilots the help they need — pilots who might otherwise hide their psychological symptoms. If these pilots are willing to get treatment, under F.A.A. oversight, “the folks on the 10,000 other flights may end up doing better,” Altchuler says, by being even less likely to be involved in a crash. “That’s a trade-off.” After all, zero risk does not exist — unless you want to never fly.

While the F.A.A. certifies pilots’ medical fitness, it is their co-workers who see them doing their jobs — most critically, in the moments before takeoff. After Emerson’s episode, a class-action lawsuit was filed claiming that if the captain had formally assessed Emerson, he might have detected something was wrong and prevented him from boarding the plane.

Airlines and their unions have set up confidential peer-support networks for pilots, which have shown promise in Europe. The Aviation Rulemaking Committee recommends expanding them. But they are no cure-all, Brian Bomhoff, the founder and chairman of the Pilot Mental Health Campaign, warns: “The F.A.A. and airlines, to some extent, might be overemphasizing the role that peer support alone can play.” The programs still depend on pilots themselves to initiate help, and their peers aren’t trained health professionals nor can they force people to get care.