June 11, 2024 • 25 mins
ALPA President, Capt. Jason Ambrosi interviews Dr. Susan Northrup the FAA’s Federal Air Surgeon, who oversees the FAA’s aviation medical programs— about how pilots can stay healthy and navigate mental health concerns with their aviation medical examiner. It is vital that pilots have the resources, support, and access to help mental wellness. Listen to this interview to hear about the pathways available to pilots.
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Episode Transcript
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Jason Ambrosi (00:04):
Welcome to the Air Line Pilot Podcast. I'm
Jason Ambrosi. As we wrap upMental Health Awareness Month,
we wanted to shed more light onhow mental health is handled for
pilots. And in the aviationindustry at large. It is
important that we all understandhow we can take care of our
mental health as pilots andunderstand how as a union and an
(00:25):
industry we're working to makemental health support more
accessible for our members.Today I'm honored to be joined
by Dr. Susan Northrup, the FAAis federal air surgeon. Thanks
for joining us Dr. Northup.
Susan Northrup (00:39):
It's absolutely my pleasure to be here.
Jason Ambrosi (00:41):
So just start off, I guess basic for our
listeners, can you explain therole of the federal air surgeon?
Susan Northrup (00:48):
Well, I gotta tell you, it's one of the best
jobs in the world, I think. Butas the federal air surgeon, I'm
responsible for several majorprograms within the FAA, the one
that touches your constituentsthe most closely, of course, is
airman medical certification. SoI have not only the policy
development piece of it, I havethe implementation piece of it.
(01:10):
And peripherally Well, notreally peripherally. But the AME
is as designees of the FAA workfor me through given to me by
the FAA administrator. Sofunctionally, we develop the
policy, we publish the guide foraviation medical examiner's,
(01:30):
which is sort of the go to bookfor AME's. And I'm trying to
encourage pilots to go there,because there's just an absolute
wealth of information there. Andthen if someone has a condition
that needs to be reviewed, andhopefully receive a special
issuance, that comes through mystaff as well, that's
coordinated effort between theairman medical certification
division at Oklahoma City andthe regional flight surgeons in
(01:53):
the nine regions. The other areathat your constituents or your
members may find interesting iswe also have research, which
includes human factors, lookingat how the human interacts with
machine, and air medicalresearch. So as we're developing
new policies, we look at thecurrent information and the
(02:15):
current science to inform how wechange things over time, because
we want to make sure that wekeep up with what's happening in
the field of medicine, when weapply it to the pilots. Couple
of the other areas, air trafficcontrol health programs AME
designation, so we manage theamas. And this is a plea for
(02:38):
your members. If you know adoctor that's interested, I have
spots for a AME that we candesignate if they go through
training, just as a really nicebenefit for the AME right now if
the IRS doesn't change it, andAME, who's a pilot can in fact
take tax credit for up to 50hours a year. So maybe you even
(03:00):
have a pilot who happens to be adoctor, we're still looking for
good AME our external aid appprogram. So we oversee the drug
programs that are in theairlines in the maintenance
facilities to be sure that allof the programs adhere to the
minimums required. And then wehave an airman education
division. That is we've, I thinkwe've even sent the prote to
(03:21):
some of your conferences, whichis a mixed gas, so people can
experience hypoxia symptoms,without having to go to
altitude, which is an awful lotof fun. And in the not too
distant future. We have aresearch facility called y-waves
that will replace our oldresearch pool and our education
pool and be able to produce 10foot waves and 26 knot winds so
(03:45):
people can experience what itwould be like to ditch or have
to get out of an airplane orhelicopter in the high seas.
Jason Ambrosi (03:53):
Wow. That's that's very interesting, very
interesting. On the on the topicof mental health, why is
addressing mental health ofaviation workers such a priority
for the for the FAA.
Susan Northrup (04:09):
Mental health conditions are very important.
And it is huge priority rightnow because of a couple of very
high profile incidents that hasshined a light on it and given
us an opportunity through thearc, which we certainly thank
your organization for providingsome of our subject matter
experts that we could do better.So why do we worry about mental
(04:34):
health conditions? Anything thatcan cause a sudden or subtle
incapacitation in the airdeserves our attention. And it's
absolutely critical that webegin to address mental
wellness. So hopefully we givepeople the tools early in their
career so that they can handlelife stresses and know when to
(04:58):
reach out for help. I have asafe path to do that I have the
goal or the FAA has a goal evenbigger, that we return pilots
and air traffic controllers toflying and controlling duties as
soon as it is safe to do so in amanner that is transparent,
consistent, and timely. So we'reworking hard, using the
(05:21):
recommendations from the ARC tomake sure that we get the
message out to as wide apopulation as we can, that you
need to get the help you deserveearly before it becomes an
issue.
Jason Ambrosi (05:34):
Yeah, I know our members certainly appreciate
that because they, they want toget back to the cockpit as soon
as they as soon as they can. Asyou mentioned, ALPA recently co
chaired the mental health andaviation medical clearances,
aviation rulemaking committee,but reviewing that phase mental
health policies and discussingways we can break down those
(05:56):
those barriers to reporting whatis important about the work that
the committee did, and what arethe next steps for for the
excellent recommendations theymade.
Susan Northrup (06:06):
So the FAA is reviewing those recommendations
and beginning to strategize howwe're going to address them. But
the the absolute most criticalthing that the ARC highlighted
is it's going to take the entireaviation community to address
this, some of the barriers thatare out there, as a regulator, I
don't have much control overthem. So the the whole stigma
(06:29):
and the culture and the lack ofknowledge, the ARC report really
lays those out very, verynicely. And if you haven't,
their members haven't read it,it's public facing, go take a
look at it, provide us feedbackthere. But if we're truly going
to affect this, at the nationallevel, all the way down to the
grassroots, when the youngperson is looking up in the sky
(06:50):
going, you know, I want to dothat someday. And we talk about
it very early in their careers,so that we can de stigmatize
what's going on. And theyunderstand there are things that
they can reach out and get help.Because I really want to put
those tools in the hands ofeverybody in the aviation
(07:11):
industry, so that they get thehelp they need before they get
to the point where they have adiagnosis. If we do this, right,
we're going to have a muchfitter population that's
aspiring to mental healthwellness, as opposed to
struggling with the illness. Butif they're struggling with the
(07:31):
illness, we have to provide theeducation and hopefully the
encouragement for earlyintervention. As far down in the
system as we can and for that, Ineed your help. I need the
industry's help, I need theschool's help. I need the
university's help. I needacademia, it's the whole gamut
that we're going to have to useto address this problem.
Jason Ambrosi (07:53):
Agree with that, all hands on deck. Today, if a
pilot has concerns about theirmental health, what is the
current process look like forseeking help discussing it with
their AME and ideally, how theyretain their ability to continue
working.
Susan Northrup (08:12):
So within ALPA, you have an absolutely wonderful
peer support program. And youhave been integral in developing
basic training requirements andsupporting that throughout the
industry. That is a great firststep for a pilot that's dealing
with some concerns or thoughtsto go to the peer support
(08:36):
program. Because thoseindividuals will help normalize
some of the reactions and beable to provide some advice. And
as it turns out, rarely, andI'll get into that in just a
minute, recommendations to theindividual that they seek
professional help. The peersupport interaction does not
(09:02):
have to be reported to us.
Jason Ambrosi (09:05):
That was one of my questions to clarify for our
listeners. To hear it right fromyou is the the pilot talks to
one of our peer support programvolunteers that to reiterate
that it is not reportable.You're you're talking to a
colleague.
Susan Northrup (09:21):
It's confidential. And one of the
tenets of the peer supportprogram is that it is
confidential. Unless somebodysays something that really
raises concern, safety has totrump no matter what, but the
peer support systems that havebeen set up in the industry are
outstanding. And that model ismorphing into other areas of the
(09:45):
aviation environment, which is abeautiful thing. There are some
studies out there that show at85% of the individuals that
utilize a peer support programnever have to advanced more care
because they get the tools sothat they stopped the downward
spiral. That's really, reallyimportant. Now, of course, some
(10:06):
of the models in several of themembers of your organization
have been supporting this, inthe university level, have to be
modified slightly, right?Because an airline has a cadre
of people, and you tend, not allbut you tend to work for a long
time, once you're in one of themajors or one of the regional
carriers. So you've got a stableset of peer support folks. And
(10:31):
you add some in some retire, butat the university level,
hopefully for their parents whoare footing the bill, they
graduate in four years. So you,so you have a turnover. And
that's going to require constantsupport. But we should support
that, because it's giving peoplethe tools and we get better able
(10:51):
candidates for aviation jobs athigher levels.
Jason Ambrosi (10:56):
That's, that is very interesting. So I'm
surprised by the numbers ofsuccess and the peer support
program that just reiterates howimportant it is that the pilots
reach out and use that resource.If, if that's not enough, and
pilot needs to, to seek help,what does that process look
like? And how do they go aboutit.
Susan Northrup (11:19):
So the FAA absolutely encourages people to
get the support they need, andthe treatment if it's required.
Sometimes you've got to be moreworried about making sure
everything's good than otheritems. So what it looks like and
we encourage people to seek thehelp they want, they can get
(11:39):
reference or recommendationsfrom their aviation medical
examiner or the peer supportprogram, to get somebody that's
familiar with our standards, ifpossible, but if that's not
possible, somebody to providethe help that they need before
it becomes a major issue. If adiagnosis is made, then they
(11:59):
have to report that at theirnext application, 14 CFR 61 dot
53 will apply. And that's what'sprinted on the back your medical
that you don't fly. If you haveif you know or have reason to
know you have a condition thatfree vents safe execution of
those duties. I'm paraphrasingthe laws, of course, something
(12:19):
anybody can look up. If theyhave a condition that requires
us to defer, or the need todefer to us, the guy for
aviation medical examiners has aset of checklists, which is
really, really helpful. So oneof the things I encourage pilots
(12:40):
as they begin to seek the carethey need, go to the guide for
aviation medical examiners, pulldown those checklists, take
those to your treatingproviders. So that they know in
advance the sort of things we'regoing to be looking for on the
back end. Now, the other thingthat's really cool that we've
done in the last year is thereare two worksheets in the guide
(13:02):
for aviation medical examiners.And to shorten that the rest of
this discussion, I'll just callit the AME guide for PTSD, and
situational anxiety ordepression, if it hasn't risen
to a certain level of requiringtreatment, the AME can issue.
Jason Ambrosi (13:22):
That's huge. That's encouraging for sure.
Susan Northrup (13:26):
Yeah. And the the other thing we released last
August, is a fast track forADHD, which we're seeing
diagnosed with great frequencyin certain age groups in our
population. But if it's beenmore than four years, since they
required medical treatment, andthey're doing well, in either in
their occupation or theirschooling, there is a fast track
(13:48):
to get there. That doesn'trequire coming to the FAA, they
can do that all with their AME.The end of this month, we'll be
publishing some more things. Anda lot of these recommendations
came out of the arc. We didn'twait for the arc to actually
publish before the office ofaerospace medicine began to work
(14:08):
on some of these suggestions.Because these are really good
ideas. And we've moved forwardand in many cases, we
accelerated policy changes wealready had been working on. For
instance, last month, we addedthree additional medications
that are in the SNRI category tothe allowed medications for
antidepressants or individualswith uncomplicated anxiety.
(14:32):
That's a pretty big step. Wewould have been working on that
for a year, year and a half andwe published it, it's a glorious
thing than once or if somebodygets to the point where a
medical has to be deferred tothe FAA. If a pilot wants to
expedite that process, they needto go to the AME guide, download
(14:55):
that checklist and if we say wewant it on that checklist, make
sure it is in the pack gets thatsubmitted to us.
Jason Ambrosi (15:02):
That makes sense. That makes sense.
Susan Northrup (15:05):
And the other thing I really strongly advise
people applying for the medicalto do is actually read the
package that goes in, because wewill. And if there is a piece of
information in there, that'sincorrect. It is a lot easier to
fix that with your treatingproviders before you send it to
(15:27):
us. So that we don't askquestions, and send letters to
ask for additional information.Some of the biggest delays in
our system where because we'reasking for information, and
we're just going back and forthand getting stuff. So use the
checklist, read what you send uscorrect anything that is
(15:47):
incorrect or unclear. And thenyou can submit it to us. Now,
many people may not be awarethat about a year ago, we
modified the system such thatthe am ease can direct upload
documents into the pilotsmedical records on our site.
(16:08):
That is huge. Sure is not anemail, mail, not just snail
mail, not just FedEx, not ups,the amas can upload direct to
our system, up to 25 documents,three megabytes per document.
We're working hard to increasethe number and the size of
those. But if you submit acomplete package, so
everything's in there,everything's addressed upfront,
(16:31):
you reduce the back and forthtime so that it'll sail through
the system well sales probablytoo strong word but it'll get
through the system in a muchmore efficient manner.
Jason Ambrosi (16:39):
So how long would that be Dr. Northrup, if a pilot
follows AME checklist has makesure that their documents are
correct. follows your your youradvice here, how long? How long
would that process take? I'm notgonna hold you to it, but is the
best estimate you can get.
Susan Northrup (16:56):
Okay, if I may, let me start at the very
beginning. Sure. So a pilot, asan issue can't be handled at a
lower level requires medicationfor a period of time and does
much better on gosh, we used tocall it the SSRI program, I've
got to change the antidepressantprogram. So they go on a
(17:16):
medication right now there's asix month wait time before you
can apply. One of the ARCrecommendations is to look at
that wait time and we are. Sostandby for changes in that
field. But right now, sixmonths, the next day, you can
(17:38):
get the studies required on thechecklist. Which is where you
can really front load this withyour treating physicians for
providers so that they know onday 181 We need to schedule this
stuff. Because of the shortageof providers in the US in
(18:00):
certain career fields. You don'twant to be caught, hey, I need
the appointment on day 181. Andthey're scheduling out three
months, right? Right, get thatscheduled early. Right. Anyway,
put that all together, submit itthrough your, your AME. And you
know the for this particularprogram, you need to hims AME.
And that's all in the checklistand how that works. That that
(18:21):
list gets updated on a routinebasis and is available online.
It comes to the FAA. We reviewit for completeness. And then
it'll go to our our psychiatrybranch. We have cut the time for
initial review of a completepackage in half in the last six
months. So we're down aroundfour months once we get a
(18:45):
complete package for the initialSSRI. Our goal is 30 days. Okay.
And we're getting theirrenewals. We're working in real
time, providing we have acomplete package. And again,
it's really, really importantthat they go out and look at
what we're going to require.Read the letter, keep a copy of
that, make sure the treatingproviders have it.
Jason Ambrosi (19:07):
That's that's excellent advice. I did i I'll
admit I'm not I'm that pilotthat didn't know there was a
checklist in the in the AMEguide. So I'm sure many of our
members don't or aren't aware aswell. So excellent, excellent
advice. As always, if you're ifyou're prepared, just like an
interview, if you're preparedwhen you when you get there,
it'll be much more successful,successful outcome. Yeah, we
(19:29):
hear from pilots, some pilotsraise concerns that they feel
pressure to hide mental healthconcerns or avoid treatment to
keep their jobs they're there.They're worried about the
potential stigma what what canwe do together to change the
mentality or or the rules thatthat will prompt pilots and or
other aviation workers to getthe help? They need to feel that
(19:51):
this is not something that theyneed to
Susan Northrup (19:54):
keep in the dark? A part of it is we have to
talk about it and that's whythese podcasts And events like
this, I'll be, I'll tell you, Iwill talk about mental health,
you put a microphone on my faceasked me to talk I will, because
it's so important to get themessage to every single pilot,
every single air trafficcontroller, every single
(20:15):
aviation worker, get help gethelp early. Because if you get
help early, before it becomes amajor diagnosis, or having
friends is one of the ultimateacts, we can work with that it
is so much easier to get awaiver. And frequently you don't
(20:35):
even have to get it through us,you can work with your AME. And
that's much, much, much faster.So we have to stop the cycle as
soon as we can in the process.And the way we need to do that
is with education. And then makeit real clear on the processes
that are required. And then wehave to continue on the FAA side
(20:58):
to improve those processes andreduce the wait times. But it
begins at the very lowest levelof aviation in my mind, where we
talk about it, if we talk aboutit, we can recognize it if we
recognize it. It reduces thefear and allows us to act.
Jason Ambrosi (21:17):
So what can we do I mean, other than our podcast
here and getting the message outindustry, the airlines the
government asked us his laborwhat what can we do more, you
know, education is obviouslyessential, but is there anything
else that you can you can thinkof that we could do to help move
(21:38):
the thing, move this along, keep
Susan Northrup (21:41):
up the peer support work. I think that is
really critical. Support theindividuals that are coming
forward, and you all over theyears have done a really good
job with that. We're going tomake the process faster, we're
going to put the decisions aslow in the hierarchy as we can.
(22:04):
Because if we do this right, ifpeople get the the help they
need early, they become moreresilient. And wouldn't it be
nice if they didn't need mebecause everything was handled
at a level where they had thetools to react to life stress.
Jason Ambrosi (22:22):
Or I'd be remiss if I didn't give a shout out to
Travis in our pilot peer supportteam here because they do they
do such a great job not only onthe with the peer support but on
the rulemaking committee andmaking sure that that we do
everything we can to bring thehelp to this this situation
Susan Northrup (22:44):
and you have a great team I've really enjoyed
getting to know them
Jason Ambrosi (22:47):
yeah, we certainly do. I could say on
behalf of my members thank youfor your your leadership on this
because I think we all agreethat that you know pilots want
to fly and and the quickest waywe can get people healthy and
get them get them flying but weweren't taught first and
foremost we want to make surethe healthy right get healthy
(23:10):
whether it's a physicallymentally everybody is healthy
and then when we can get themback to the cockpit as soon as
possible. Right so I appreciateyour leadership and trying to
get get him there. Well beforewe before we call today, Dr.
Northrup Is there anything you'dlike to add? No, I
Susan Northrup (23:31):
would just reiterate our goal. The FAA is
goal to return pilots and airtraffic controllers to fly in
and controlling duties as soonas it is safe to do so in a
manner that's transparent,consistent and timely. That's
where we need to go. And that'swhat we're trying to do. And
(23:52):
thank you for your help and yourpartnership. It has been an
absolutely wonderful experiencegetting to know your team.
Jason Ambrosi (24:01):
Thank you so much for for joining us today Dr.
Northrup I know that Ipersonally learned a lot about
the process about the the AMEguide and mental health in
general and I'm sure ourlisteners did as did as well. As
part of mental health awarenessmonth out was pilot assistance
group launched the Are You inthe Green campaign to encourage
(24:21):
members to pay attention tomental health of our peers or
families and importantlyourselves. The campaign is named
after a question every pilotshould ask before stepping foot
on the flight deck. Are you inthe green? Asked if you're
mentally healthy and ready tofly. stress and mental health
concerns can come in many formsand from many sources, but we
(24:45):
need to make sure that when whenwe fly, we are tuned into
ourselves. If you aren't in thegreen that is a sign that you
need to take action to take careof yourself and reach out to
ALPA as pilot peer support yousystem. To learn more, visit
www.alpa.org/green Thank you fortuning into this episode of The
(25:10):
airline pilot podcast and thanksagain for joining us, Dr.
Northrup. If you haven'talready, make sure you subscribe
so that you don't miss anyepisodes. And if you enjoy this
episode, let your fellow crewmembers know about the show. If
you have any questions or topicsyou'd like us to cover, reach
out to podcast@alpa.org tolisten and subscribe to the
(25:32):
airline pilot podcast or learnmore about ALPA. Check us out
online@alpa.org Or find us onall major podcast platforms.
Until next time, this is theairline pilot podcast production
copyright ALPA 2024. All rightsreserved. Thanks and have a safe
flight
Welcome to the Air Line Pilot Podcast. I'm
Jason Ambrosi. As we wrap upMental Health Awareness Month,
we wanted to shed more light onhow mental health is handled for
pilots. And in the aviationindustry at large. It is
important that we all understandhow we can take care of our
mental health as pilots andunderstand how as a union and an
(00:25):
industry we're working to makemental health support more
accessible for our members.Today I'm honored to be joined
by Dr. Susan Northrup, the FAAis federal air surgeon. Thanks
for joining us Dr. Northup.
Susan Northrup (00:39):
It's absolutely my pleasure to be here.
Jason Ambrosi (00:41):
So just start off, I guess basic for our
listeners, can you explain therole of the federal air surgeon?
Susan Northrup (00:48):
Well, I gotta tell you, it's one of the best
jobs in the world, I think. Butas the federal air surgeon, I'm
responsible for several majorprograms within the FAA, the one
that touches your constituentsthe most closely, of course, is
airman medical certification. SoI have not only the policy
development piece of it, I havethe implementation piece of it.
(01:10):
And peripherally Well, notreally peripherally. But the AME
is as designees of the FAA workfor me through given to me by
the FAA administrator. Sofunctionally, we develop the
policy, we publish the guide foraviation medical examiner's,
(01:30):
which is sort of the go to bookfor AME's. And I'm trying to
encourage pilots to go there,because there's just an absolute
wealth of information there. Andthen if someone has a condition
that needs to be reviewed, andhopefully receive a special
issuance, that comes through mystaff as well, that's
coordinated effort between theairman medical certification
division at Oklahoma City andthe regional flight surgeons in
(01:53):
the nine regions. The other areathat your constituents or your
members may find interesting iswe also have research, which
includes human factors, lookingat how the human interacts with
machine, and air medicalresearch. So as we're developing
new policies, we look at thecurrent information and the
(02:15):
current science to inform how wechange things over time, because
we want to make sure that wekeep up with what's happening in
the field of medicine, when weapply it to the pilots. Couple
of the other areas, air trafficcontrol health programs AME
designation, so we manage theamas. And this is a plea for
(02:38):
your members. If you know adoctor that's interested, I have
spots for a AME that we candesignate if they go through
training, just as a really nicebenefit for the AME right now if
the IRS doesn't change it, andAME, who's a pilot can in fact
take tax credit for up to 50hours a year. So maybe you even
(03:00):
have a pilot who happens to be adoctor, we're still looking for
good AME our external aid appprogram. So we oversee the drug
programs that are in theairlines in the maintenance
facilities to be sure that allof the programs adhere to the
minimums required. And then wehave an airman education
division. That is we've, I thinkwe've even sent the prote to
(03:21):
some of your conferences, whichis a mixed gas, so people can
experience hypoxia symptoms,without having to go to
altitude, which is an awful lotof fun. And in the not too
distant future. We have aresearch facility called y-waves
that will replace our oldresearch pool and our education
pool and be able to produce 10foot waves and 26 knot winds so
(03:45):
people can experience what itwould be like to ditch or have
to get out of an airplane orhelicopter in the high seas.
Jason Ambrosi (03:53):
Wow. That's that's very interesting, very
interesting. On the on the topicof mental health, why is
addressing mental health ofaviation workers such a priority
for the for the FAA.
Susan Northrup (04:09):
Mental health conditions are very important.
And it is huge priority rightnow because of a couple of very
high profile incidents that hasshined a light on it and given
us an opportunity through thearc, which we certainly thank
your organization for providingsome of our subject matter
experts that we could do better.So why do we worry about mental
(04:34):
health conditions? Anything thatcan cause a sudden or subtle
incapacitation in the airdeserves our attention. And it's
absolutely critical that webegin to address mental
wellness. So hopefully we givepeople the tools early in their
career so that they can handlelife stresses and know when to
(04:58):
reach out for help. I have asafe path to do that I have the
goal or the FAA has a goal evenbigger, that we return pilots
and air traffic controllers toflying and controlling duties as
soon as it is safe to do so in amanner that is transparent,
consistent, and timely. So we'reworking hard, using the
(05:21):
recommendations from the ARC tomake sure that we get the
message out to as wide apopulation as we can, that you
need to get the help you deserveearly before it becomes an
issue.
Jason Ambrosi (05:34):
Yeah, I know our members certainly appreciate
that because they, they want toget back to the cockpit as soon
as they as soon as they can. Asyou mentioned, ALPA recently co
chaired the mental health andaviation medical clearances,
aviation rulemaking committee,but reviewing that phase mental
health policies and discussingways we can break down those
(05:56):
those barriers to reporting whatis important about the work that
the committee did, and what arethe next steps for for the
excellent recommendations theymade.
Susan Northrup (06:06):
So the FAA is reviewing those recommendations
and beginning to strategize howwe're going to address them. But
the the absolute most criticalthing that the ARC highlighted
is it's going to take the entireaviation community to address
this, some of the barriers thatare out there, as a regulator, I
don't have much control overthem. So the the whole stigma
(06:29):
and the culture and the lack ofknowledge, the ARC report really
lays those out very, verynicely. And if you haven't,
their members haven't read it,it's public facing, go take a
look at it, provide us feedbackthere. But if we're truly going
to affect this, at the nationallevel, all the way down to the
grassroots, when the youngperson is looking up in the sky
(06:50):
going, you know, I want to dothat someday. And we talk about
it very early in their careers,so that we can de stigmatize
what's going on. And theyunderstand there are things that
they can reach out and get help.Because I really want to put
those tools in the hands ofeverybody in the aviation
(07:11):
industry, so that they get thehelp they need before they get
to the point where they have adiagnosis. If we do this, right,
we're going to have a muchfitter population that's
aspiring to mental healthwellness, as opposed to
struggling with the illness. Butif they're struggling with the
(07:31):
illness, we have to provide theeducation and hopefully the
encouragement for earlyintervention. As far down in the
system as we can and for that, Ineed your help. I need the
industry's help, I need theschool's help. I need the
university's help. I needacademia, it's the whole gamut
that we're going to have to useto address this problem.
Jason Ambrosi (07:53):
Agree with that, all hands on deck. Today, if a
pilot has concerns about theirmental health, what is the
current process look like forseeking help discussing it with
their AME and ideally, how theyretain their ability to continue
working.
Susan Northrup (08:12):
So within ALPA, you have an absolutely wonderful
peer support program. And youhave been integral in developing
basic training requirements andsupporting that throughout the
industry. That is a great firststep for a pilot that's dealing
with some concerns or thoughtsto go to the peer support
(08:36):
program. Because thoseindividuals will help normalize
some of the reactions and beable to provide some advice. And
as it turns out, rarely, andI'll get into that in just a
minute, recommendations to theindividual that they seek
professional help. The peersupport interaction does not
(09:02):
have to be reported to us.
Jason Ambrosi (09:05):
That was one of my questions to clarify for our
listeners. To hear it right fromyou is the the pilot talks to
one of our peer support programvolunteers that to reiterate
that it is not reportable.You're you're talking to a
colleague.
Susan Northrup (09:21):
It's confidential. And one of the
tenets of the peer supportprogram is that it is
confidential. Unless somebodysays something that really
raises concern, safety has totrump no matter what, but the
peer support systems that havebeen set up in the industry are
outstanding. And that model ismorphing into other areas of the
(09:45):
aviation environment, which is abeautiful thing. There are some
studies out there that show at85% of the individuals that
utilize a peer support programnever have to advanced more care
because they get the tools sothat they stopped the downward
spiral. That's really, reallyimportant. Now, of course, some
(10:06):
of the models in several of themembers of your organization
have been supporting this, inthe university level, have to be
modified slightly, right?Because an airline has a cadre
of people, and you tend, not allbut you tend to work for a long
time, once you're in one of themajors or one of the regional
carriers. So you've got a stableset of peer support folks. And
(10:31):
you add some in some retire, butat the university level,
hopefully for their parents whoare footing the bill, they
graduate in four years. So you,so you have a turnover. And
that's going to require constantsupport. But we should support
that, because it's giving peoplethe tools and we get better able
(10:51):
candidates for aviation jobs athigher levels.
Jason Ambrosi (10:56):
That's, that is very interesting. So I'm
surprised by the numbers ofsuccess and the peer support
program that just reiterates howimportant it is that the pilots
reach out and use that resource.If, if that's not enough, and
pilot needs to, to seek help,what does that process look
like? And how do they go aboutit.
Susan Northrup (11:19):
So the FAA absolutely encourages people to
get the support they need, andthe treatment if it's required.
Sometimes you've got to be moreworried about making sure
everything's good than otheritems. So what it looks like and
we encourage people to seek thehelp they want, they can get
(11:39):
reference or recommendationsfrom their aviation medical
examiner or the peer supportprogram, to get somebody that's
familiar with our standards, ifpossible, but if that's not
possible, somebody to providethe help that they need before
it becomes a major issue. If adiagnosis is made, then they
(11:59):
have to report that at theirnext application, 14 CFR 61 dot
53 will apply. And that's what'sprinted on the back your medical
that you don't fly. If you haveif you know or have reason to
know you have a condition thatfree vents safe execution of
those duties. I'm paraphrasingthe laws, of course, something
(12:19):
anybody can look up. If theyhave a condition that requires
us to defer, or the need todefer to us, the guy for
aviation medical examiners has aset of checklists, which is
really, really helpful. So oneof the things I encourage pilots
(12:40):
as they begin to seek the carethey need, go to the guide for
aviation medical examiners, pulldown those checklists, take
those to your treatingproviders. So that they know in
advance the sort of things we'regoing to be looking for on the
back end. Now, the other thingthat's really cool that we've
done in the last year is thereare two worksheets in the guide
(13:02):
for aviation medical examiners.And to shorten that the rest of
this discussion, I'll just callit the AME guide for PTSD, and
situational anxiety ordepression, if it hasn't risen
to a certain level of requiringtreatment, the AME can issue.
Jason Ambrosi (13:22):
That's huge. That's encouraging for sure.
Susan Northrup (13:26):
Yeah. And the the other thing we released last
August, is a fast track forADHD, which we're seeing
diagnosed with great frequencyin certain age groups in our
population. But if it's beenmore than four years, since they
required medical treatment, andthey're doing well, in either in
their occupation or theirschooling, there is a fast track
(13:48):
to get there. That doesn'trequire coming to the FAA, they
can do that all with their AME.The end of this month, we'll be
publishing some more things. Anda lot of these recommendations
came out of the arc. We didn'twait for the arc to actually
publish before the office ofaerospace medicine began to work
(14:08):
on some of these suggestions.Because these are really good
ideas. And we've moved forwardand in many cases, we
accelerated policy changes wealready had been working on. For
instance, last month, we addedthree additional medications
that are in the SNRI category tothe allowed medications for
antidepressants or individualswith uncomplicated anxiety.
(14:32):
That's a pretty big step. Wewould have been working on that
for a year, year and a half andwe published it, it's a glorious
thing than once or if somebodygets to the point where a
medical has to be deferred tothe FAA. If a pilot wants to
expedite that process, they needto go to the AME guide, download
(14:55):
that checklist and if we say wewant it on that checklist, make
sure it is in the pack gets thatsubmitted to us.
Jason Ambrosi (15:02):
That makes sense. That makes sense.
Susan Northrup (15:05):
And the other thing I really strongly advise
people applying for the medicalto do is actually read the
package that goes in, because wewill. And if there is a piece of
information in there, that'sincorrect. It is a lot easier to
fix that with your treatingproviders before you send it to
(15:27):
us. So that we don't askquestions, and send letters to
ask for additional information.Some of the biggest delays in
our system where because we'reasking for information, and
we're just going back and forthand getting stuff. So use the
checklist, read what you send uscorrect anything that is
(15:47):
incorrect or unclear. And thenyou can submit it to us. Now,
many people may not be awarethat about a year ago, we
modified the system such thatthe am ease can direct upload
documents into the pilotsmedical records on our site.
(16:08):
That is huge. Sure is not anemail, mail, not just snail
mail, not just FedEx, not ups,the amas can upload direct to
our system, up to 25 documents,three megabytes per document.
We're working hard to increasethe number and the size of
those. But if you submit acomplete package, so
everything's in there,everything's addressed upfront,
(16:31):
you reduce the back and forthtime so that it'll sail through
the system well sales probablytoo strong word but it'll get
through the system in a muchmore efficient manner.
Jason Ambrosi (16:39):
So how long would that be Dr. Northrup, if a pilot
follows AME checklist has makesure that their documents are
correct. follows your your youradvice here, how long? How long
would that process take? I'm notgonna hold you to it, but is the
best estimate you can get.
Susan Northrup (16:56):
Okay, if I may, let me start at the very
beginning. Sure. So a pilot, asan issue can't be handled at a
lower level requires medicationfor a period of time and does
much better on gosh, we used tocall it the SSRI program, I've
got to change the antidepressantprogram. So they go on a
(17:16):
medication right now there's asix month wait time before you
can apply. One of the ARCrecommendations is to look at
that wait time and we are. Sostandby for changes in that
field. But right now, sixmonths, the next day, you can
(17:38):
get the studies required on thechecklist. Which is where you
can really front load this withyour treating physicians for
providers so that they know onday 181 We need to schedule this
stuff. Because of the shortageof providers in the US in
(18:00):
certain career fields. You don'twant to be caught, hey, I need
the appointment on day 181. Andthey're scheduling out three
months, right? Right, get thatscheduled early. Right. Anyway,
put that all together, submit itthrough your, your AME. And you
know the for this particularprogram, you need to hims AME.
And that's all in the checklistand how that works. That that
(18:21):
list gets updated on a routinebasis and is available online.
It comes to the FAA. We reviewit for completeness. And then
it'll go to our our psychiatrybranch. We have cut the time for
initial review of a completepackage in half in the last six
months. So we're down aroundfour months once we get a
(18:45):
complete package for the initialSSRI. Our goal is 30 days. Okay.
And we're getting theirrenewals. We're working in real
time, providing we have acomplete package. And again,
it's really, really importantthat they go out and look at
what we're going to require.Read the letter, keep a copy of
that, make sure the treatingproviders have it.
Jason Ambrosi (19:07):
That's that's excellent advice. I did i I'll
admit I'm not I'm that pilotthat didn't know there was a
checklist in the in the AMEguide. So I'm sure many of our
members don't or aren't aware aswell. So excellent, excellent
advice. As always, if you're ifyou're prepared, just like an
interview, if you're preparedwhen you when you get there,
it'll be much more successful,successful outcome. Yeah, we
(19:29):
hear from pilots, some pilotsraise concerns that they feel
pressure to hide mental healthconcerns or avoid treatment to
keep their jobs they're there.They're worried about the
potential stigma what what canwe do together to change the
mentality or or the rules thatthat will prompt pilots and or
other aviation workers to getthe help? They need to feel that
(19:51):
this is not something that theyneed to
Susan Northrup (19:54):
keep in the dark? A part of it is we have to
talk about it and that's whythese podcasts And events like
this, I'll be, I'll tell you, Iwill talk about mental health,
you put a microphone on my faceasked me to talk I will, because
it's so important to get themessage to every single pilot,
every single air trafficcontroller, every single
(20:15):
aviation worker, get help gethelp early. Because if you get
help early, before it becomes amajor diagnosis, or having
friends is one of the ultimateacts, we can work with that it
is so much easier to get awaiver. And frequently you don't
(20:35):
even have to get it through us,you can work with your AME. And
that's much, much, much faster.So we have to stop the cycle as
soon as we can in the process.And the way we need to do that
is with education. And then makeit real clear on the processes
that are required. And then wehave to continue on the FAA side
(20:58):
to improve those processes andreduce the wait times. But it
begins at the very lowest levelof aviation in my mind, where we
talk about it, if we talk aboutit, we can recognize it if we
recognize it. It reduces thefear and allows us to act.
Jason Ambrosi (21:17):
So what can we do I mean, other than our podcast
here and getting the message outindustry, the airlines the
government asked us his laborwhat what can we do more, you
know, education is obviouslyessential, but is there anything
else that you can you can thinkof that we could do to help move
(21:38):
the thing, move this along, keep
Susan Northrup (21:41):
up the peer support work. I think that is
really critical. Support theindividuals that are coming
forward, and you all over theyears have done a really good
job with that. We're going tomake the process faster, we're
going to put the decisions aslow in the hierarchy as we can.
(22:04):
Because if we do this right, ifpeople get the the help they
need early, they become moreresilient. And wouldn't it be
nice if they didn't need mebecause everything was handled
at a level where they had thetools to react to life stress.
Jason Ambrosi (22:22):
Or I'd be remiss if I didn't give a shout out to
Travis in our pilot peer supportteam here because they do they
do such a great job not only onthe with the peer support but on
the rulemaking committee andmaking sure that that we do
everything we can to bring thehelp to this this situation
Susan Northrup (22:44):
and you have a great team I've really enjoyed
getting to know them
Jason Ambrosi (22:47):
yeah, we certainly do. I could say on
behalf of my members thank youfor your your leadership on this
because I think we all agreethat that you know pilots want
to fly and and the quickest waywe can get people healthy and
get them get them flying but weweren't taught first and
foremost we want to make surethe healthy right get healthy
(23:10):
whether it's a physicallymentally everybody is healthy
and then when we can get themback to the cockpit as soon as
possible. Right so I appreciateyour leadership and trying to
get get him there. Well beforewe before we call today, Dr.
Northrup Is there anything you'dlike to add? No, I
Susan Northrup (23:31):
would just reiterate our goal. The FAA is
goal to return pilots and airtraffic controllers to fly in
and controlling duties as soonas it is safe to do so in a
manner that's transparent,consistent and timely. That's
where we need to go. And that'swhat we're trying to do. And
(23:52):
thank you for your help and yourpartnership. It has been an
absolutely wonderful experiencegetting to know your team.
Jason Ambrosi (24:01):
Thank you so much for for joining us today Dr.
Northrup I know that Ipersonally learned a lot about
the process about the the AMEguide and mental health in
general and I'm sure ourlisteners did as did as well. As
part of mental health awarenessmonth out was pilot assistance
group launched the Are You inthe Green campaign to encourage
(24:21):
members to pay attention tomental health of our peers or
families and importantlyourselves. The campaign is named
after a question every pilotshould ask before stepping foot
on the flight deck. Are you inthe green? Asked if you're
mentally healthy and ready tofly. stress and mental health
concerns can come in many formsand from many sources, but we
(24:45):
need to make sure that when whenwe fly, we are tuned into
ourselves. If you aren't in thegreen that is a sign that you
need to take action to take careof yourself and reach out to
ALPA as pilot peer support yousystem. To learn more, visit
www.alpa.org/green Thank you fortuning into this episode of The
(25:10):
airline pilot podcast and thanksagain for joining us, Dr.
Northrup. If you haven'talready, make sure you subscribe
so that you don't miss anyepisodes. And if you enjoy this
episode, let your fellow crewmembers know about the show. If
you have any questions or topicsyou'd like us to cover, reach
out to podcast@alpa.org tolisten and subscribe to the
(25:32):
airline pilot podcast or learnmore about ALPA. Check us out
online@alpa.org Or find us onall major podcast platforms.
Until next time, this is theairline pilot podcast production
copyright ALPA 2024. All rightsreserved. Thanks and have a safe
flight
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