For decades, when it comes treating mild or moderate mental health issues, many commercial pilots say they have faced an impossible choice.
"It's either their career or their mental health," said Chris Arnold, pilot assistant vice chair with the Air Line Pilots Association.
But a bill, called the Mental Health in Aviation Act of 2025, now working its way through Congress could make it easier for pilots to seek mental health help.
To make sure they’re fit to fly, professional pilots must have a current medical certificate from an FAA examiner. For those 40 and under, it is an annual requirement, and professional pilots age over 40 need to get a new first-class medical certification every six months.
Dr. Jon Grazer has been flying since he was a teenager and is now a senior aviation medical examiner.
"There's a checklist –– that if you don't meet that criteria, I cannot issue an exam that goes to the FAA," Grazer said. "Then they have to review it."
Pilots are required to self-disclose any mental disorders, including depression and anxiety, leading many pilots to avoid seeking care for fear of being grounded indefinitely.
"Instead of choosing 18 months out of the cockpit pilots, you say, 'Oh, it's not that bad yet. It's not that bad. I could just deal with it. I can deal with it. i'm just going to go and keep on dealing with it,' until they can't and all of a sudden, we have a pilot that is having, frankly, a crisis," said Chris Finlayson, executive director of the Pilot Mental Health Campaign, one of the groups behind the proposed legislation.
He said that the current system perpetuates a culture of silence and that pilots who do come forward are often faced with delays, confusion and a sea of regulation keeping them out of the cockpit.
"For the majority of pilots, it's career ending because they can't get paid. They can't progress in their career because they don't have a medical certificate to get hired. They don't have the ability to find new work," Finlayson said.
Part of what prompted this bill was the death of John Hauser, 19, a student pilot at the University of North Dakota, who took his own life in a plane crash in 2021. In letters left behind, he said he was struggling with depression and feared a trip to the doctor or a counselor would prevent him from becoming a commercial pilot. His final request was to change the FAA rules.
"Just the back and forth of being able to send medical documentation to and from the FAA can be a lengthy process," Arnold said.
In December of 2023, the FAA established a committee made up of stakeholders from throughout the aviation industry to identify barriers to mental health care for pilots. It came up with a list of 24 recommendations to improve the current system.
"What the 'Mental Health in Aviation Act' does is it says to the FAA, these aren’t recommendations. These are necessities. These are things that need to be enacted within two years from the signing of this bill," Finlayson said.
If passed, the bill would force the agency to more quickly address a backlog of pilot medical certifications and hire additional FAA physicians with mental health backgrounds. More medications to treat mental health conditions would also be reclassified and added to the list of drugs that may be safely prescribed to pilots.
In a statement, the FAA said, "Since 2023, we have approved more medications for pilot use, significantly expanded the diagnoses for which aviation medical examiners can issue medical certificates... and are addressing the committee’s recommendations. The FAA issues medical certificates to approximately 98 percent of applicants with mental health conditions that are not automatically disqualifying when they provide all the required documentation.”
"They’re constantly evolving, trying to make things streamlined. You know, the FAA is not, I don't think, trying to take your license away," Grazer said. "They're just trying to make it safe."
The Air Line Pilots Association, the world’s largest union for airline pilots, also backs the bill and stresses the importance of peer support groups available at many of the major airlines. It's something United CEO Scott Kirby mentioned during an interview with Spectrum News in September.
"We have a series of formal processes that work where they get protection, you know, if they need to take time off from their career to deal with mental health," Kirby said. "We have a whole system, but it’s really run by the pilots for the pilots."
Supporters hope they can push the bill through Congress –– to encourage commercial pilots to get the help they need before getting back in the air.
"We just assume that pilots are this stoic, robotic profession, right? Day in, day out," Arnold said. "When in reality, we're just all human, just like everyone else."