Mental Fitness to Fly: Psychiatry Updates & the HIMS Program

Transcription

1 Mental Fitness to Fly: Psychiatry Updates & the HIMS Program Daniel Danczyk, MD, MPH Senior Associate Consultant, Psychiatry & Psychology Civil Aviation Medical Association Annual Meeting, Mayo Clinic September 9, MFMER slide-1

2 DISCLOSURE INFORMATION Financial: Prior consulting for JetBlue (2013) No off-label med use and/or investigational 2016 MFMER slide-2

3 OBJECTIVES Discuss the challenges associated with gathering data regarding mental health evaluations of pilots Review and differentiate how mental health evaluations required by the FAA are processed Discuss some preliminary findings of my survey analysis 2016 MFMER slide-3

4 AGENDA Background HIMS ARC Report Updates on HIMS Renewals only Research Findings Sneak Peek 2016 MFMER slide-4

5 Aviationweek.com 2016 MFMER slide-5

6 2016 MFMER slide-6

7 HUMAN INTERVENTION MOTIVATION STUDY (HIMS) Himsprogram.com 2016 MFMER slide-7

8 Occupational Alcohol Addiction Treatment Program (1970s) Aircrewacademy.com Drugs of Abuse 4 SSRIs (2010) HIMS today (2016) Alcohol / Drug Monitoring SSRI Protocol 2016 MFMER slide-8

9 ARC REPORT Background Commercial Aviation Safety Team (CAST) 370 / 9525 tragedies Asma.org Relevancy to HIMS Enhanced AME training Pilot assistance programs Professional reporting 2016 MFMER slide-9

10 MAJOR HIMS CHANGES Covers SI renewals ONLY HIMS AME may issue 6 mo interim Seeks to minimize differences b/t SSRI & Drug / Alcohol Provides new Certification Aids 2016 MFMER slide-10

11 STREAMLINING Standardizes reports All classes In person exam q6 mo HIMS AME Report Evaluate Summarize Send to OKC not DC If concern (even no shaded areas marked) must defer & outline concern 2016 MFMER slide-11

12 SUMMARY FAA CERTIFICATION AID DRUG / ETOH RE-CERT HIMS AME Lab testing Psychiatry History Report Aftercare Chief Pilot Peer Pilot Additional providers 2016 MFMER slide-12

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15 SUMMARY FAA CERTIFICATION AID SSRI RE-CERT HIMS AME Psychiatrist Interim Report Psychologist / Neuropsychologist Chief Pilot Additional providers 2016 MFMER slide-15

16 HIMS CHANGES THEMES EACH PARTY Clearly delineated req ts Explicit req t to immediately report changes (status of airman) AIRMAN FAA strongly recommends Certification Aid be provided to parties 2016 MFMER slide-16

17 HIMS AME CHECKLIST TAKE-AWAYS Must indicate reviewed airman s Auth Letter Allows issuance of 6-mo med cert Analogies complicated CACI certain doc m submitted Quality improvement of formatting (MEB for Air Force) Consolidates between MH and SA 2016 MFMER slide-17

18 PROJECT BACKGROUND Survey request (ESAM) Task force approval (EASA) 2016 MFMER slide-18

19 CROSS-SECTIONAL SURVEY Aviation Professionals in MH / SA Gov t, industry, private, military Focus on medical certification process Initially keep to U.S. & Europe Information gathered Demographics on those seeing airmen Practice and process characteristics Services provided How communicated mental health data Perceptions 2016 MFMER slide-19

20 CHALLENGES Getting survey out ESAM (aviation medical authorities, psychologists, AMEs) Other groups CAMA, AsMA, HIMS, Flight Safety, Flying Physician Association No response rate (no surprise) 2016 MFMER slide-20

21 GEOGRAPHIC BREAKDOWN % of Respondees, N= % 26.0% 57.5% U.S., n=177 Europe, n=80 Other, n= MFMER slide-21

22 European Breakdown # countries=18 Counts/country distribution: MIN 1 MEDIAN 3 MEAN 4.4 MAX 14 Belgium UK Netherlands Germany Austria Greece France Italy Spain Sweden Bulgaria Norway Portugal Switzerland Estonia Hungary Moldova Poland 2016 MFMER slide-22

23 What is your specialty and/or area of expertise? (Mark all that apply.) 50% 45% 40% 35% 30% 25% 20% 15% 10% 5% 0% * * U.S. Europe * p < MFMER slide-23

24 PERSONAL AVIATION EXPERIENCE? 70% 60% 58% 50% 40% 30% 30% 25% 20% 14% U.S. Europe 17% 15% 10% 9% 8% 0% None* Lsns Solo Cert(s)* * p < MFMER slide-24

25 Have you undergone any special training / courses / programs aimed at supporting pilots with mental health or substance abuse concerns? (No/Yes) 70% 60% 63% 51% 49% 50% 37% U.S. Europe 40% 30% 20% 10% 0% No Yes N=237, p= MFMER slide-25

26 [If Yes ]: What was the name of the training/course/program? (Mark all that apply.) 45% 40% 39% * 35% 30% 28% 25% 20% 17% U.S. Europe 15% 10% 6% 5% 0% HIMS* Other * p < MFMER slide-26

27 Mental Health Data Produced 70% 64% 60% 53% 50% 40% 37% U.S. Europe 33% 30% 22% 20% 10% 11% 6% 1% 0% Psych Eval* Counseling* Med Cert* Sent to Gov't* * p < MFMER slide-27

28 Do you think providers in your country should be required to report any pilot diagnosed with mental health/substance abuse, or undergoing treatment, to the aviation medical authority, and be protected under the law if they do so?(no/yes) 90% 83% 80% 83% 70% 60% 50% U.S. Europe 40% 30% 20% 17% 17% 10% 0% NO YES N=198 (no significant difference) 2016 MFMER slide-28

29 Should pilots with a history of bipolar disorder or psychosis, with maintenance treatment and favorable prognosis, be considered for waiver or special consideration to return to flying? (No/Yes) 90% 80% 80% 70% 66% 60% 50% 40% U.S. Europe 34% 30% 20% 20% 10% 0% NO YES N=198, no significant difference 2016 MFMER slide-29

30 CONCLUSION HIMS & Beyond Combating stigma and naysayers Robustness of SSRI Protocol? HIMS for other countries?? Huffingtonpost.com 2016 MFMER slide-30

31 Questions & Discussion CONTACT INFO: 2016 MFMER slide-31