PILOTS HELPING PILOTS

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1 2PROJECT LIFT PILOTS HELPING PILOTS... it is possible that pilots are not fully aware of the effect that stress has on them; and even when they are aware of these effects, a variety of internal and external pressures make it less likely that a pilot will report or seek help for symptoms (e.g., due to fear of losing face in the eyes of other pilots, of being perceived as less reliable or of being removed from flight status). They are often counselled by colleagues to avoid mental health care at all costs. James Young, NASA Aviators are notorious for avoiding flight surgeons and would disavow the very existence of mental health professionals if given the opportunity. Both occupations (flight surgeons and mental health professionals) represent a threat to a pilot s flying status. (Hamilton, Fear and loathing in the air: Combat fear and stress in the air force, 2005).

2 Stigma tells pilots that mental illness is a weakness, which conflicts with typical pilot traits. Pilots mental health and stigma is an essential topic we need to discuss. The rules will continue to sharpen in light of the recent attention to pilots mental health. As a career pilot and avid mental health advocate, I encourage the conversation. Capt. Christina Halli Delta Airlines Pilot Assistance Network In September of 2015, the Aerospace Medical Association (AsMA) recommended that... greater attention be given to mental health issues by aeromedical examiners and by the aviation community in general, especially to the more common mental health conditions and life stressors that can affect pilots and flight performance. (Dr. Kris Belland, President of AsMA, 2015). AsMA also noted that approaches (to helping pilots with mental health issues) that provide a safe zone for reporting and discussing mental health issues would enhance aviation safety and optimize pilot mental health while minimizing career jeopardy and the stigma of mental health assistance. Examples noted by AsMA include: o o o Project Wingman - (Allied Pilots Assoc. at American Airlines) HIMS Program - (Air Line Pilots Association - ALPA) Pilot Assistance Network (PAN) - (Delta Airlines) Aviation safety is enhanced if pilots can talk about mental health issues in a way that minimizes any jeopardy to their career and avoids the stigma of mental health assistance. SWAPA has decided to broaden our pilots helping pilots model to include helping pilots who are experiencing any type of non-physical issue that might be affecting fitness for flying. We are calling our program Project LIFT. A group of your fellow pilots have volunteered and been trained to man a 24/7 phone line to provide information, assistance, and referrals. You do not have to give your name if you call and no records will be kept beyond the date your particular issue is resolved. We also encourage pilots who know of another pilot who might need our help to let us know and we will reach out. Since this is completely a no

3 fault, no foul system, you can do so anonymously. Pilots helping pilots is now recognized as one of the most effective ways to address the lack of mental health reporting among pilots. Even the military is instituting a system of buddy care for such things as suicide prevention, backed up by medical and chaplain resources. However, it still remains that The major problem is persuading someone to ask for assistance in the mental health area. (Aviation Medicine Advisory Services). We hope Project LIFT can make asking for assistance an easier process for Southwest Airlines pilots. Our volunteers are trained to help you sort through whatever you might be experiencing in the way of anxiety, depression, or substance misuse issue - without jeopardy to your career. Our volunteers are not counselors, but they can refer you to a counselor and advise you on how it might impact your career. PILOTS AND STRESS Several studies rank airline pilot as one of the most stressful jobs. The executive chairman of the Air Line Pilots Association s human performance structure said, no other industry in the United States has been under more direct stress and pressure since 9/11 and we know that our members are carrying that stress. (Burke, When your mental state cries mayday your union stands with you, Air Line Pilot, August, 2007). We all know that pilots face very unique stressors. Few professionals are as watched as are professional pilots. Having the responsibility for another person s life is grave enough. Being responsible for the safety of many is even more stressful. Added to those stressors particular to the profession are the stressors of everyday life: relationship difficulties, financial worries, health concerns, bereavement issues, work related problems, and separation from family. Pilots are no more immune to these things than anyone else. SWAPA started Project LIFT as a way to help with the effects of that stress. I believe aviators will be much more likely to acknowledge the effects of life stress (if) their organizations destigmatize emotional and psychological issues and improve the medical community s handling of these cases (e.g., improve mental health providers understanding of the impact of their evaluations and... recommendations, improve flow of communication

4 between the mental health professional and the treating/referring physician). (Young, 2008) This issue is exactly what we hope to address with Project LIFT. We hope to circumvent the stigma associated with pilots acknowledging emotional or psychological issues by giving them a confidential place where they can discuss mental health issues, anonymously if they choose. We also hope to be able to help counselors/mental health professionals understand how their assessments affect pilots careers. Our end goal is that pilots feel less constrained about admitting to mental health problems and thereby get the help they need. Obviously, for many pilots, stresses from family problems are major sources of stress. Therefore, Project LIFT is also available for those family members to call if they would like to discuss help for themselves or their pilot family member. There are no negative consequences to calling Project LIFT. All information is kept strictly confidential and will only be shared with written permission from the pilot unless there is an immediate threat to life. WHAT WE CAN HELP YOU DO First, and foremost, we are all active Southwest Airlines pilots. Secondly, we have trained to be good service providers to our fellow pilots. Often just knowing there is someone else with whom you can talk, who can understand the stressors you face as a pilot, is helpful. We can help you find professional assistance if you need it. Many pilots are opposed to going to a counselor of any kind for any variety of reasons, but more and more pilots are seeing it as a wise choice in getting proper guidance. Thinking you should intuitively know how to handle every life issue is like saying you should intuitively know how to play golf. If you want to learn to play golf you can buy clubs and start whacking away at a golf ball, or you can ask for advice on how best to play the game. Counseling is the same. Asking for help is not a sign of mental weakness. At Project LIFT we can help you find a provider. Choosing a Counselor There are several types of professionals that provide counseling:

5 Clinical Social Workers: Most states have a license that must be obtained to use the title of Clinical Social Worker. All practitioners must have a Masters degree from an accredited School of Social Work. Licensed Professional Counselors: These professionals must possess at least a Master s degree from an accredited university in a field related to counseling, and a State license. Licensed Marriage and Family Therapist (LMFT): The requirements are roughly the same as for the LPC. Psychiatrists: Psychiatrists are physicians who have chosen to specialize in treating mental health. Generally they do not do talk therapy, but are more concerned with using traditional medical treatments such as pharmaceuticals. It is rare for a pilot to need treatment from a psychiatrist. Psychiatrists must be licensed as physicians. Psychologists: Psychology is divided into several different branches, but the psychologists with whom you might interact are generally going to be those who specialize in counseling psychology or testing psychology. They will usually have a doctorate, but there are many who practice with a Masters degree. Clinical psychologists must be licensed. Helpful questions to ask when trying to find a counselor include: From what school did you get your counseling degree? What, exactly, is the title of your degree? How long have you been in practice? (Generally it is a good idea to find an experienced counselor). With what problems are you most experienced? Are there any issues with which you will not work? Are you familiar with pilots and the rules of the FAA with respect to pilot mental health? (not many counselors are familiar with FAA rules, so don t count one out just because of unfamiliarity with the

6 FARs. We at Project LIFT can advise you on how to educate the counselor on these issues). The most common problems for which you might want to seek counseling are depression, anxiety, relationship difficulties, and bereavement issues. Most common of all is depression. DEPRESSION Depression is characterized by loss of interest in normally pleasurable activities, irritability, insomnia or hypersomnia, excessive fatigue or loss of energy most days, significant weight loss or gain without trying to lose or gain weight, and feelings of worthlessness. Depression is so common that it is sometimes referred to as the common cold of mental illness. Most people have felt sad or depressed at times. Feeling depressed can be a normal reaction to loss, life's struggles, or an injured self-esteem. But when feelings of intense sadness -- including feeling helpless, hopeless, and worthless -- last for many days to weeks and keep you from functioning normally, your depression may be something more than sadness. It may very well be clinical depression, a treatable condition. How Do I Know If I Have Depression? According to the DSM-5, a manual used to diagnose mental disorders, depression occurs when you have at least five of the following symptoms at the same time: A depressed mood during most of the day, particularly in the morning Fatigue or loss of energy almost every day Feelings of worthlessness or guilt almost every day Impaired concentration, indecisiveness Insomnia (an inability to sleep) or hypersomnia (excessive sleeping) almost every day Markedly diminished interest or pleasure in almost all activities nearly every day

7 Recurring thoughts of death or suicide (not just fearing death) A sense of restlessness or being slowed down Significant weight loss or weight gain A key sign of depression is either depressed mood or loss of interest in activities you once enjoyed. For a diagnosis of depression, these signs should be present most of the day either daily or nearly daily for at least two weeks. In addition, the depressive symptoms need to cause significant distress or impairment. They cannot be due to the direct effects of a substance, for example, a drug or medication. Nor can they be the result of a medical condition such as hypothyroidism. People with depressive illnesses don't all experience the same symptoms. How severe the symptoms are, how frequent, and how long they last will vary depending on the individual and his or her particular illness. ANTIDEPRESSANT MEDICATION AND THE FAA While most cases of depression respond quickly and effectively to cognitive therapies, sometimes pilots might find they are helped considerably by antidepressants. There are four antidepressants approved by the FAA that pilots can take while flying. Lexapro (escialopram) Zoloft (sertraline) Prozac (fluoxetine) Celexa (citalopram) These antidepressants are from a class of drugs called SSRIs (selective serotonin reuptake inhibitors). You may take one of these drugs and be considered for an FAA authorization of a Special Issuance (SI) of an Airman Medical Certificate if you meet all of the following three criteria: 1. You have one of the following diagnoses: Major depressive disorder (mild to moderate) either single episode or recurrent episode

8 Dysthymic disorder Adjustment disorder with depressed mood Any non-depression related condition for which the SSRI is used 2. For at least six continuous months prior you have been clinically stable while on a stable dose of medication without any aeromedically significant side effects or an increase in symptoms. If you have been on the medication fewer than six months you will have to wait until you have a full six months of continuous use before you can be considered for an SI. If you are on an SSRI that is not one of the four listed above, you will not be considered for a Special Issuance Medical Certificate while taking it. 3. You DO NOT have symptoms or history of: Psychosis Suicidal ideation Electro convulsive therapy Treatment with multiple SSRIs concurrently Multi-agent drug protocol use (prior use of other psychiatric drugs in conjunction with SSRIs.) If you meet all of the above criteria and wish to continue use of the SSRI, you must be further evaluated by a Human Intervention Motivation Study (HIMS) AME. (Go to select the tab Get Help Now and HIMS AMEs for a list of qualified AMEs, or call Project LIFT.) If you take an SSRI and then stop using it, your AME must note that you have done so in Block 60, Comments on History and Findings, on FAA Form (the application for an Airman Medical Certificate) and then defer issuance of your medical certificate to the FAA. To reapply for regular issuance, you must be off the SSRI for a minimum of 60 days with a favorable report from the treating physician indicating your mood has been stable and that you have had no aeromedically significant side effects.

9 If you receive a Special Issuance Medical Certificate from the FAA that allows you to continue use of an SSRI then you must have a status report from a psychiatrist every six months thereafter, a letter from your Chief Pilot every three months attesting to your occupational functionality, and you must take a Cog-Screen AE (aeromedical neuropsychological test) every year. SUICIDE The reason Project Wingman was started at the Allied Pilots Association (which represents pilots at American Airlines), was because of 6 pilot suicides in one 18 month period. One of these men, a highly respected senior check airman, reported to his wife that he was distressed that taking an antidepressant meant his career was finished (this was before the FAA began allowing pilots to fly while on antidepressants). Here are some pertinent things to know about suicide. (The following information is taken from Understanding and Preventing Suicide The World Health Organization estimates that approximately one million people die each year from suicide. What drives so many individuals to take their own lives? To those not in the grips of suicidal depression and despair it is difficult to understand what drives so many individuals to take their own lives, but a suicidal person is in so much pain that he or she can see no other option. Common misconceptions about suicide FALSE: People who talk about suicide won't really do it. Almost everyone who commits or attempts suicide has given some clue or warning. Do not ignore suicide threats. Statements like "you'll be sorry when I'm dead," "I can't see any way out," no matter how casually or jokingly said, may indicate serious suicidal feelings. FALSE: Anyone who tries to kill him/herself must be crazy. Most suicidal people are not psychotic or insane. They must be upset, griefstricken, depressed or despairing, but extreme distress and emotional pain

10 are not necessarily signs of mental illness. FALSE: If a person is determined to kill him/herself, nothing is going to stop them. Even the most severely depressed person has mixed feelings about death, wavering until the very last moment between wanting to live and wanting to die. Most suicidal people do not want death; they want the pain to stop. The impulse to end it all, however overpowering, does not last forever. FALSE: People who commit suicide are people who were unwilling to seek help. Studies of suicide victims have shown that more than half had sought medical help in the six months prior to their deaths. FALSE: Talking about suicide may give someone the idea. You don't give a suicidal person morbid ideas by talking about suicide. The opposite is true bringing up the subject of suicide and discussing it openly is one of the most helpful things you can do. [Source: SAVE Suicide Awareness Voices of Education] Warning signs of suicide Take any suicidal talk or behavior seriously. It's not just a warning sign that the person is thinking about suicide it's a cry for help. If you believe that a friend or family member is suicidal, you can play a role in suicide prevention by pointing out the alternatives, showing that you care, and getting a doctor or psychologist involved. Major warning signs for suicide include talking about killing or harming oneself, talking or writing a lot about death or dying, and seeking out things that could be used in a suicide attempt, such as weapons and drugs. These signals are even more dangerous if the person has a mood disorder such as depression or bipolar disorder, suffers from alcohol dependence, has previously attempted suicide, or has a family history of suicide.

11 A more subtle but equally dangerous warning sign of suicide is hopelessness. Studies have found that hopelessness is a strong predictor of suicide. People who feel hopeless may talk about "unbearable" feelings, predict a bleak future, and state that they have nothing to look forward to. Other warning signs that point to a suicidal mind frame include dramatic mood swings or sudden personality changes, such as going from outgoing to withdrawn or well-behaved to rebellious. A suicidal person may also lose interest in day-to-day activities, neglect his or her appearance, and show big changes in eating or sleeping habits. Suicide Warning Signs Talking about suicide Seeking out lethal means Preoccupation with death No hope for the future Self-loathing, selfhatred Getting affairs in order Saying goodbye Any talk about suicide, dying, or self-harm, such as "I wish I hadn't been born," "If I see you again..." and "I'd be better off dead." Seeking access to guns, pills, knives, or other objects that could be used in a suicide attempt. Unusual focus on death, dying, or violence. Writing poems or stories about death. Feelings of helplessness, hopelessness, and being trapped ("There's no way out"). Belief that things will never get better or change. Feelings of worthlessness, guilt, shame, and self-hatred. Feeling like a burden ("Everyone would be better off without me"). Making out a will. Giving away prized possessions. Making arrangements for family members. Unusual or unexpected visits or calls to family and friends. Saying goodbye to people as if

12 Suicide Warning Signs they won't be seen again. Withdrawing from others Self-destructive behavior Sudden sense of calm Withdrawing from friends and family. Increasing social isolation. Desire to be left alone. Increased alcohol or drug use, reckless driving, unsafe sex. Taking unnecessary risks as if they have a "death wish." A sudden sense of calm and happiness after being extremely depressed can mean that the person has made a decision to commit suicide. Suicide prevention tip #1: Speak up if you re worried If you spot the warning signs of suicide in someone you care about, you may wonder if it s a good idea to say anything. What if you re wrong? What if the person gets angry? In such situations, it's natural to feel uncomfortable or afraid. But anyone who talks about suicide or shows other warning signs needs immediate help the sooner the better. Talking to a person about suicide Talking to a friend or family member about their suicidal thoughts and feelings can be extremely difficult for anyone. But if you're unsure whether someone is suicidal, the best way to find out is to ask. You can't make a person suicidal by showing that you care. In fact, giving a suicidal person the opportunity to express his or her feelings can provide relief from loneliness and pent-up negative feelings, and may prevent a suicide attempt. Please call Project LIFT if you need direction: Ways to start a conversation about suicide: I have been feeling concerned about you lately.

13 Recently, I have noticed some differences in you and wondered how you are doing. I wanted to check in with you because you haven t seemed yourself lately. Questions you can ask: When did you begin feeling like this? Did something happen that made you start feeling this way? How can I best support you right now? Have you thought about getting help? What you can say that helps: You are not alone in this. I m here for you. You may not believe it now, but the way you re feeling will change. I may not be able to understand exactly how you feel, but I care about you and want to help. When you want to give up, tell yourself you will hold off for just one more day, hour, minute whatever you can manage. When talking to a suicidal person Do: Be yourself. Let the person know you care, that he/she is not alone. The right words are often unimportant. If you are concerned, your voice and manner will show it. Listen. Let the suicidal person unload despair, ventilate anger. No matter how negative the conversation seems, the fact that it exists is a positive sign. Be sympathetic, non-judgmental, patient, calm, accepting. Your friend or family member is doing the right thing by talking about his/her feelings.

14 Offer hope. Reassure the person that help is available and that the suicidal feelings are temporary. Let the person know that his or her life is important to you. If the person says things like, I m so depressed, I can t go on, ask the question: Are you having thoughts of suicide? You are not putting ideas in their head, you are showing that you are concerned, that you take them seriously, and that it s OK for them to share their pain with you. Don t: Argue with the suicidal person. Avoid saying things like: "You have so much to live for," "Your suicide will hurt your family," or Look on the bright side. Act shocked, lecture on the value of life, or say that suicide is wrong. Promise confidentiality. Refuse to be sworn to secrecy. A life is at stake and you may need to speak to a mental health professional in order to keep the suicidal person safe. If you promise to keep your discussions secret, you may have to break your word. Offer ways to fix their problems, or give advice, or make them feel like they have to justify their suicidal feelings. It is not about how bad the problem is, but how badly it s hurting your friend or loved one. Blame yourself. You can t fix someone s depression. Your loved one s happiness, or lack thereof, is not your responsibility. Suicide prevention tip #2: Respond quickly in a crisis If a friend or family member tells you that he or she is thinking about death or suicide, it's important to evaluate the immediate danger the person is in. Those at the highest risk for committing suicide in the near future have a specific suicide PLAN, the MEANS to carry out the plan, a TIME SET for doing it, and an INTENTION to do it. Ask the following questions:

15 Do you have a suicide plan? (PLAN) Do you have what you need to carry out your plan (pills, gun, etc.)? (MEANS) Do you know when you would do it? (TIME SET) Do you intend to commit suicide? (INTENTION) If a suicide attempt seems imminent, call a local crisis center, dial 911, or take the person to an emergency room. Remove guns, drugs, knives, and other potentially lethal objects from the vicinity but do not, under any circumstances, leave a suicidal person alone. Suicide prevention tip #3: Offer help and support If a friend or family member is suicidal, the best way to help is by offering an empathetic, listening ear. Let your loved one know that he or she is not alone and that you care. Don't take responsibility, however, for making your loved one well. You can offer support, but you can't get better for a suicidal person. He or she has to make a personal commitment to recovery. It takes a lot of courage to help someone who is suicidal. Witnessing a loved one dealing with thoughts about ending his or her own life can stir up many difficult emotions. As you're helping a suicidal person, don't forget to take care of yourself. Find someone that you trust a friend, family member, clergyman, or counselor to talk to about your feelings and get support of your own. Antidepressants and suicide For some, depression medication causes an increase rather than a decrease in depression and suicidal thoughts and feelings. Because of this risk, the FDA advises that anyone on antidepressants should be watched for increases in suicidal thoughts and behaviors. Monitoring is especially important if this is the person's first time on depression medication or if the dose has recently been changed. The risk of suicide is the greatest during the first two months of antidepressant treatment. Common suicide risk factors include: Alcoholism or drug abuse

16 Previous suicide attempts Family history of suicide Terminal illness or chronic pain Recent loss or stressful life event Social isolation and loneliness History of trauma or abuse Suicide in Teens Teenage suicide is a serious and growing problem. The teenage years can be emotionally turbulent and stressful. Teenagers face pressures to succeed and fit in. They may struggle with self-esteem issues, self-doubt, and feelings of alienation. For some, this leads to suicide. Depression is also a major risk factor for teen suicide. Other risk factors for teenage suicide include: Childhood abuse Recent traumatic event Lack of a support network Availability of a gun Hostile social or school environment Exposure to other teen suicides Suicide warning signs in teens Additional warning signs that a teen may be considering suicide: Change in eating and sleeping habits Withdrawal from friends, family, and regular activities Violent or rebellious behavior, running away Drug and alcohol use Unusual neglect of personal appearance Persistent boredom, difficulty concentrating, or a decline in the quality of schoolwork Frequent complaints about physical symptoms, often related to emotions, such as stomachaches, headaches, fatigue, etc. Not tolerating praise or rewards Source: American Academy of Child & Adolescent Psychiatry

17 Suicide in the Elderly The highest suicide rates of any age group occur among persons aged 65 years and older. One contributing factor is depression in the elderly that is undiagnosed and untreated. Other risk factors for suicide in the elderly include: Physical illness, disability, or pain Isolation and loneliness Major life changes, such as retirement Loss of independence Loss of sense of purpose Suicide warning signs in older adults Reading material about death and suicide Disruption of sleep patterns Increased alcohol or prescription drug use Failure to take care of self or follow medical orders Stockpiling medications Sudden interest in firearms Social withdrawal or elaborate good-byes Rush to complete or revise a will NATIONAL SUICIDE PREVENTION LIFELINE: and Project LIFT pilots are available to assist you with your needs and the needs of your family. Project LIFT hotline: There isn t a problem, situation, or concern that cannot be addressed. You are promised confidentiality, and service in a timely manner.

18 ANXIETY DISORDERS Anxiety is a normal emotion, but sometimes it is amplified to the point of discomfort and/or goes on for an unusual length of time, causing distress. In 1995 Anxiety Disorders surpassed alcoholism as the most common reason people sought counseling and has remained so. Anxiety disorders include panic disorder, post-traumatic stress disorder, obsessive-compulsive disorder, and phobias. One type of anxiety specific to pilots is anxiety during check rides. This is commonly referred to as check-ride-itis. Anxiety disorders are very treatable, and the sooner they are treated the easier they are to manage (including checkride-itis). Post-traumatic Stress Disorder (PTSD) PTSD and Acute Stress Disorder (ASD), are conditions resulting in anxiety, depression, panic attacks, sleep disturbance, and a host of other symptoms following a perceived life-threatening event. If symptoms occur within six months of the event it is ASD. If symptoms occur beyond six months after the event it is PTSD. Pilots are particularly at risk for this condition following an aircraft mishap or near mishap, or death of a fellow pilot in a mishap. Southwest Airlines Pilots Association has a program in place to deal with ASD and PTSD, called the Critical Incident Stress Management program, or CISM. Peer counselors of the SWAPA CISM Team are ready to respond immediately to any potential PTSD provoking situation. Our team is regarded around the world as one of the preeminent CISM teams in the airline industry along with Lufthansa and FedEx. The FAA policy on counseling for possible PTSD through pilot unions or corporate Employee Assistance Programs (EAP) is that the counseling is not reportable on FAA medical applications (8500-8) unless a diagnosis of PTSD or ASD is formally made by a licensed health care provider. FAA Policy on Mental Health Diagnoses Counseling may not have to be reported to the FAA. It depends on the condition for which you are seeking counseling (e.g. family counseling for a child s drug use, or marital counseling, do not have to be reported). Even if the counseling is for a personal psychiatric diagnosis and you have to report it, it may not be disqualifying for flying. If both the counselor and the

19 individual feel it is safe to continue aviation duties AND no medications are required, the pilot may generally continue to fly and attach a summary from the counselor at the next medical examination. In 1991 the FAA changed the reporting requirements on the application for an Airman Medical Certificate (FAA Form ), and mandated that all visits to health care providers, including counselors and psychologists, were required to be reported at each FAA physical. The Federal Air Surgeon wrote a letter to all Aviation Medical Examiner s (AMEs) in September of 1992 acknowledging that the effect of this interpretation of the s instructions discouraged pilots from seeking mental health assistance. The Federal Air Surgeon said that the FAA encourages pilots to seek assistance for all conditions, but does not want to restrict flying for those conditions that did not affect flying safety. His clarification, later incorporated into the explanation section of question 19 on the , stated that visits to mental health professionals were reportable ONLY if it was due to alcohol/substance abuse OR resulted in a personal psychiatric diagnosis. Pilots seeking counseling for marital or family problems, who are functioning well, but seeking to improve their life situation, have no obligation to report that counseling. Counseling by clergy, or even your personal physician, is not reportable if there is no personal psychiatric diagnosis, no alcohol or substance abuse, and no treatment with medications. Visits to corporate Employee Assistance Programs (EAP) for conditions described above are also not reportable. Project LIFT ( )

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