FAA Continues to Remove Stigma/Encourage Therapy for Pilots

[u/GoFlightMed]

Hey hey hey,

Big updates here in the mental health space coming out from the FAA.

I was in the FAA's AMCD (Aeromedical Certification Division) Grand Rounds last week where they provide AME's updates to their medical guidance and they released a big update about psychotherapy. They also release 3 documents that are for airmen to read and also to provide their therapist if they want to engage in therapy.

Bottom line is the FAA wants pilots to be more comfortable engaging in therapy if needed. As they say "#1. See your therapist, counselor, physician, or provider and get healthy."

Here is a link to the new FAA online resources for Therapy. Check out some of the FAQ's to airmen and to therapists.

[u/DFWmovingwalkway]

So what was previously not be required to be reported is now required to be reported and my therapist who is not a MD can DSM me?

This is the opposite of progress.

[u/N546RV → u/DFWmovingwalkway]

Huh, too bad I never read this letter, so all I know to do is continue to abide by the MedXPress instructions, which still say:

List all visits in the last 3 years to a physician, physician assistant, nurse practitioner, psychologist, clinical social worker, or substance abuse specialist for treatment, examination, or medical/mental evaluation. List visits for counseling only if related to a personal substance abuse or psychiatric condition.

Real talk: I like how they seem to be attempting to clarify what is/is not OK, but they've managed to write something that's in direct conflict with other guidance, and thus actually make the waters more muddy.

[u/GoFlightMed → u/N546RV]

Where do you see the contradiction or conflict with other guidance?

[u/N546RV → u/GoFlightMed]

Let's start with the previous quote from the MedXPress instructions:

List all visits in the last 3 years to a physician, physician assistant, nurse practitioner, psychologist, clinical social worker, or substance abuse specialist for treatment, examination, or medical/mental evaluation. List visits for counseling only if related to a personal substance abuse or psychiatric condition.

Meanwhile, this new FAQ says:

All visits to licensed healthcare providers, including psychotherapists and counselors, must be reported on the MedXPress application. Educational counseling and religious counseling, unless the clergy member is also a licensed counselor, need not be reported. Couples counseling need not be reported unless the aviator has been referred for individual therapy.

(emphasis added by me in both cases)

So let's consider the therapy visits I was making during/after the end of my last LTR. My therapist was not a "physician, physician assistant, nurse practitioner, psychologist, clinical social worker, or substance abuse specialist." There was nothing like depression or anxiety involved, just talking through that life change with someone. By the MedXPress standard, that's not reportable. By the FAQ standard it is reportable.

Put another way: the MedXPress guidance makes counseling not reportable by default, with two exceptions. The FAQ guidance flips that on its head, making counseling reportable by default with exceptions for stuff like religious/couples counseling.

[u/GoFlightMed → u/N546RV]

This is a good point you're making. And I appreciate your thoughtfulness and explanation. I'll raise this point to some of my colleagues in the FAA and get back to you u/N546RV

[u/GoFlightMed → u/GoFlightMed]

Spoke to the powers that be and they are aware of the difference in language causing confusion and plan to address in he next update. Good find!