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Business Insider: "Crisis in the skies"

Even in the throes of a mental health crisis, pilot Joseph David Emerson never sought help — until it was too late. 

Business Insider: Crisis in the Skies

Moments before an off-duty pilot tried to pull two red fire handles and cut off fuel to the engines during an Alaska Airlines flight in October, he made an admission. 

"I'm not OK," he told the two stunned pilots in the cockpit. 

Joseph David Emerson, who was arrested upon landing in Portland, Oregon and is now charged with 83 counts of attempted murder, told authorities he was depressed, hadn't slept in 40 hours, and was having a nervous breakdown, according to court records. Emerson denied taking any medication, but said he'd recently used psychedelic mushrooms for the first time.

But despite Emerson's emotional collapse, he reportedly never sought help or told his employer or the FAA he was in the throes of a mental health crisis — until it was too late. That, pilots and aviation experts told Insider, is due in part to a major flaw in the FAA's mental fitness regulations: The agency relies on pilots to self-report when they seek therapy or treatment for mental illness, but punishes them for doing so. 

Though the FAA says the majority of mental health conditions do not disqualify pilots from flying, aviation industry insiders told Insider the reality is more complicated. When a pilot discloses mental health treatment — whether it's therapy or medication — they immediately lose the ability to fly, and will remain grounded for months or even years while undergoing FAA-mandated medical evaluations. Pilots lose their income while they're out of the skies, and may pay thousands of dollars out of pocket to complete the necessary medical evaluations to regain their wings.

Emerson's wife recently told Oregon Public Radio that Emerson's depression began after the sudden death of his closest friend. He refused to talk to a professional or obtain medication because he feared any disclosure would ground him, she said, and the couple couldn't afford to lose his income.

man stands during arraignment
Joseph David Emerson, left, 44, was arraigned in Multnomah County Circuit Court on Oct. 24, 2023, in Portland, Oregon.
Dave Killen/The Oregonian/AP

The FAA did not address a list of specific questions sent by Insider. In a statement, a spokesman said the agency was "committed to prioritizing the mental health of pilots," and pointed to an inspector general's report touting the procedures for evaluating pilots' psychological health.

"The FAA encourages pilots to seek early help if they have a mental-health condition since most, if treated, do not disqualify a pilot from flying," the spokesman said. "Mild depression and anxiety are examples of conditions that if properly treated are not necessarily disqualifying."

Joe LoRusso, an aviation attorney who represents pilots who have had their medical certifications denied, told Insider that the process is so daunting, expensive, and risky that many pilots prefer to suffer in silence. If a pilot lies on a medical form, for example, the consequences can be significant: a five-year prison sentence, a $250,00 fine, and three years of supervised release. 

"It is more than a job, it is more than a hobby — it is an absolute identity. These people identify as pilots, and without that identity they're lost," LoRusso, who also works as a pilot, told Insider. "And because of that, they are not willing to lie on a government form, and they are more willing to sacrifice their health." 

But the consequences can be deadly.

'It was essentially him saying goodbye to us'

To his friends and family, John Hauser was an ambitious young aviation student, a joyful and social 19-year-old who had dreamed since middle school of becoming a pilot. Hauser earned his private pilot's license at 18, saving up money from years' worth of odd jobs so he could pay nearly $10,000 for lessons and exams and flight time.

Like most teenagers who lived through the COVID-19 pandemic, Hauser's adolescence lacked certain hallmarks. He lost much of the latter half of his senior year of high school, and his graduation ceremony was canceled. Though he was co-captain of his rowing team, the shutdown meant his team lost the chance to compete nationally. 

Despite the setbacks, his parents didn't feel that Hauser acted out or struggled any more than his peers. He even organized a virtual poker club for his friends to play late into the night.

Nobody, it seems, had any suspicions about his mental health until October 18, 2021, when he crashed a plane into a field outside Buxton, North Dakota. 

Sitting at their dinner table that evening, Anne Suh and Alan Hauser received a text from their son saying he had a solo flight planned. They recalled responding as they always did, with a "be safe" or "we love you." But less than an hour later, they got a second text. 

"It was essentially him saying goodbye to us," Suh told Insider in an interview. "As a parent reading it, you knew that something was very, very wrong." 

Suh and Hauser texted him back immediately, then called. Then texted again, and called again. Nothing. A National Transportation Safety Board investigation would later show that the Piper PA-28 Hauser was flying did a 180-degree turn some 30 miles after takeoff, and began a "rapid descent" from 3,700 feet before crashing into a plowed dirt field. 

Photos of John Hauser
Photos of John Hauser
Anne Suh and Alan Hauser

Piecing together their own timeline afterwards, his parents said Hauser fired off a barrage of goodbye texts to his family, friends, and girlfriend as he steered his plane straight downward.

Though he didn't spell out depression as the source of his anguish, his parents believe it was the likely diagnosis. They said he left them a letter in which he described feeling trapped. He believed that if he sought treatment, it would risk his future career as a pilot. That realization was crushing.

"I want to get help, I really do. I just know that if I get help, I won't be able to fly, and that's what I really love," John wrote, according to his father.

Though intentional aviation crashes stemming from mental health conditions are rare, they are not unheard of. In 2015, Andreas Lubitz crashed the Germanwings flight he was piloting into the French Alps, killing 144 passengers and six crew members. Lubitz had been treated for suicidal ideation, but hid his condition from his employer.

In the aftermath of their son's death, Suh and Hauser said they heard two very different narratives from those within the aviation industry on what, precisely, would have happened to his career had he sought treatment for depression.

"We've been told that he was, in essence, wrong, and that he could have gotten help and it would not necessarily have jeopardized his ability to fly," Suh said. "On the other hand, we've talked to a lot of pilots who have said, 'No, he was right.'" 

Though the FAA outwardly encourages pilots to seek help for mental health conditions — the agency notes on its website that "most, if treated, do not disqualify a pilot from flying" — Suh and Hauser believe their son likely heard from working pilots, and from peers in his aviation program whose parents were pilots, that seeking treatment would ruin his career. For Hauser, his parents say, the system designed to keep struggling pilots on the ground actually helped drive him into a mental health crisis — while keeping him in the air.

Hauser said his son included a request in his letter: "If there's anything you could do for me. Get the FAA to change their rules on pilots seeking help with mental health. I know it would change a lot of things for the better and it would help a lot of people out."

A daunting process

Pilots must report all physical and psychological conditions, medications, and visits to any health professionals to the FAA on regular medical certification forms — typically, every six months or every year, depending on the age of the pilot.

There are certain conditions that the FAA says completely disqualify a pilot from flying, including bipolar disorder, psychosis, severe personality disorders, and substance abuse or dependence. But for conditions like mild to moderate depression, the FAA has approved the use of five common antidepressants, and will grant pilots what they call "special issuance medical certificates" on a case-by-case basis. 

The problem comes when you read the fine print, according to LoRusso. After beginning an approved antidepressant, pilots must be deemed "clinically stable" — meaning their dosage must be consistent — for a minimum of six continuous months before they can be granted medical clearance to fly. But users often need to experiment with their dosages, raising or lowering them — and that resets the six-month clock each time.

Pilots conduct a pre-flight check in the cockpit of a jet before taking off from Dallas Fort Worth airport in Grapevine, Texas, on Dec. 2, 2020.
Pilots conduct a pre-flight check in the cockpit of a jet before taking off.
AP Photo/LM Otero, File

At a minimum, a pilot would spend six months out of the air and out of a paycheck. In reality, LoRusso said, wait times are often far longer. Even just waiting for the appropriate FAA authority to review a pilot's initial medical certificate application can take over a year, he said, adding that many pilots feel they can't take the time off work. 

Between flight school, plane rentals to bank flight time, and necessary licenses and certificates, it can cost anywhere from $100,000 to $250,000 to become a pilot.

Though they can apply for short-term disability through their employers, LoRusso said long wait times can outlast those payments. 

The decision to come forward about mental illness, LoRusso said, "has so many different ripples."

The FAA spokesman said the agency has worked in recent years on decreasing wait times for return-to-fly decisions, and has hired additional mental health professionals. The spokesman added that it has also amended its policies to lessen the frequency of cognitive testing for pilots who take one of the five approved antidepressant medications.

Though the FAA's regulations are intended to protect the public and ensure safe air travel, LoRusso believes the agency's approach to pilots' mental health is doing the opposite. 

"We say we want our pilots to be healthy and we want the FAA to be critical of them — without realizing that the FAA has created a situation that's more dangerous."

'You always need to have that switch turned on'

One pilot who spoke to Insider said he assumed a career in aviation would be full of glamor, exotic travel, crisp uniforms, and first-rate planes. He felt bewildered when a flight instructor once asked him if he got homesick — surely a pilot's travels would be too exciting to think about home, he remembered thinking.

So it was a shock when he began working and realized there was another side to his dream job: Immense and unyielding pressure, exhausting shifts of up to 10 hours of flight time, grueling travel, uncomfortable or unsafe hotels, terrible food, and going days or even weeks without seeing a familiar face. Even being on standby is stressful, he said — he spends those days trapped in a hotel room, waiting for a phone call. 

He said the pressure to perform perfectly, as well as the nonstop need for vigilance, has shaken his confidence in his chosen career. It's a standard that feels impossible to meet, he said.

"It's a job that you always need to have that switch turned on. It's not a job where you can just sit back for a minute and take a coffee break," he said. 

LoRusso said the stress of pilots' work environments is comparable to those of surgeons — precision is crucial, and mistakes can be deadly.

"It is very, very stressful to fly an airplane and to have 120 people behind you and to navigate weather in real time and to shoot these approaches," LoRusso said. "Pilots are not immune to that stress." 

airport maui
Passengers try to rest and sleep thousands were left stranded at the Kahului Airport (OGG) in the aftermath of wildfires in western Maui in Kahului, Hawaii on August 9, 2023.
Patrick T. Fallon/AFP via Getty Images

The pilot, who works for a private aviation company and spoke to Insider on condition of anonymity to avoid jeopardizing his job, said he experiences depression and anxiety as a result of his work. Though he wants to seek help, he knows that even just a visit to a therapist would require a disclosure on his upcoming medical certification, and that would trigger months of uncertainty and possibly cost him his job.

"We're hesitant as pilots to go seek the treatment because of these repercussions that may come from it," he said. 

Besides the stress that comes from the pressure of the job, pilots may also deal with the kinds of life-related stressors familiar to most people — the birth of a child, the death of a loved one, the loss of a partner's job, or a traumatic event. LoRusso and the pilot said that even a single visit to a grief counselor would necessitate disclosure.

The pilot said these factors are often compounded by the stigma against mental illness that pilots themselves perpetuate. 

The FAA spokesman said the agency has increased outreach to pilot groups to educate them on available resources, but the pilot said his peers remain reluctant.

"Pilots are not seeking the treatment they need, and are not really talking about how they're feeling. At the end of the day, it's like this macho mentality," he said. (According to the Bureau of Labor Statistics, 90.8% of pilots are male). "A lot of pilots feel like, 'Well, why do I have to open up?'"

The FAA's public encouragement for pilots to seek mental health treatment has not been convincing, he said. He recalled a common refrain among students at his aviation school: "The FAA says, 'Don't be sad.'" 

"They're like, 'Well, yeah, go seek out treatment, but don't be sad. What do you have to be so sad about? You're flying an airplane,'" he said.

Though it's unclear precisely how many of the roughly 750,000 Americans who hold active pilot's certificates have been concealing mental illnesses, research suggests the number could be high. One study published last year in the Journal of Occupational and Environmental Medicine surveyed nearly 4,000 pilots and found that 56% had avoided seeking healthcare because they feared losing their medical clearance to fly. Twenty-six percent had either misrepresented or withheld information during their FAA health check-ups. (Though the study focused broadly on medical care, the authors wrote that they suspected the same was true of mental healthcare.)

The pilot said he's had conversations with people who have balked at the idea of pilots seeking therapy — a stigma that is just as discouraging as the FAA's protocols.

"Who wants a depressed pilot?"

Balancing passenger and pilot safety

A pilot who accepts help for a treatable mental health condition will improve both his personal and professional life, and see far more benefits than consequences, according to Dr. Matthew Goldenberg, an aviation psychiatrist who frequently evaluates pilots undergoing the FAA medical certification process. Though he conceded that the medical evaluation process is onerous and expensive for pilots, he believes it works.

"When you have a diagnosable and treatable mental health or addiction condition, you always have the opportunity to voluntarily seek the help that you need and you deserve. If you don't, you run the risk that the condition will worsen and the disease will make the decision," Goldenberg said. "Your disease doesn't always make the right decisions."

He said the goal is to protect the public, not punish the pilot.

"Being a pilot is not a right. It's a privilege we hold," Goldenberg said. "There is no other way to both give somebody the treatment that they need to be safe, and protect the public in a way that builds public trust."

A police officer stands guard outside the FAA air traffic control center in Aurora, Illinois.
REUTERS/Karl Plume

LoRusso disagrees. He believes the FAA should remove its requirement that pilots disclose visits to mental health professionals, while keeping the requirement to disclose any medications.

"Let a pilot see a counselor or a therapist without the scrutiny of the FAA," LoRusso said. "I promise you, there would be a significant amount of pilots who would take advantage of that, and their symptoms would not compound, and it would not be self-medicated, and it would solve a lot of the issues."

The incident with Emerson, the Alaska Airlines pilot, could hamper public support for more lenient mental health regulations. Anne Suh, John Hauser's mother, said she hopes Emerson's incident prompts the public to ask, "Why did he have to do what he did?" Though the FAA's regulations are intended to safeguard the public, they may be causing harm instead, they believe. 

"I wonder when I get on planes now: Is this pilot a healthy pilot?" Suh said.

If you or someone you know is experiencing depression or has had thoughts of harming themself or taking their own life, get help. In the US, call or text 988 to reach the Suicide & Crisis Lifeline, which provides 24/7, free, confidential support for people in distress, as well as best practices for professionals and resources to aid in prevention and crisis situations. Help is also available through the Crisis Text Line — just text "HOME" to 741741. The International Association for Suicide Prevention offers resources for those outside the US.

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