Time for FAA Psychiatric Illness Reform

[ProjectInfinity1]

Good evening gents, it’s been almost two years since I last posted on here. It’s been a bit of a adventure, one suicide attempt, two weeks in inpatient, another two weeks at a diagnostic program, and 3 months at a adolescent OCD treatment program.

However unfortunately the FAA hasn’t really made any progress on policies affecting mental illness suffers. It seems counterproductive in the middle of a pilot shortage to bar the next generation of aviation enthusiasts as improved screening practices allows for better recognition over pervious generations. For what was once “strange”, “undisciplined”, or “damaged” now has names. All while many pilots suffer in silence out of fear of losing their medical, not to mention.at this current rate we will be losing out a quite noticeable number of Millennials and generation Z.

But as a result this better recognition is used to discriminate by the FAA. I get it, there are some illnesses such as Psychosis, BPD, BIpolar type I, Schizophrenia, ect. That shouldn’t be able to fly.
But Mild ADHD? It depends on a person by person basis, but there is no reason that someone who has a passion for aviation yet is primarily inattentive about history or politics (just an example) can’t fly safely.

As for my personal case, I was introduced to aviation at young age by my uncle who worked with a local air museum and pulled a TBM avenger back in the 90s out of Maine. What started as an interest in WW2 Air Combat blossomed into a affection for flight as a whole.

With the FAA polices being as it is, I bought into my second passion, firearms. I’ve worked for an FFL, and am getter my own license in the coming year. I own a 40MM grenade launcher (DD), an buying a premay 1986 machine gun. My question is, for all the prohibitions, (which can be acknowledged as acceptable for First class medicals.)
I do still have suicidal ideation, but if I really had no self control why would I have not just shot myself by now? What harm comes of having a SI for primarily inattentive ADHD? It’s very much a catch 22 to find a “drive” in life, when a potential one you have is blocked by your lack of said “drive”.

Just my 0.02 but perhaps food for thought. Hope everyone had a wonderful mother’s day with their families.-Mat

 

[PeterNSteinmetz]

I will ask this question again as I have in other threads because I am curious.

Are there any studies which document that FAA aeromedical regulation improves the safety of flight at reasonable cost?

It is clearly a question of the rate of true and false positives versus the costs. I’ve not seen this (but haven’t searched real hard).

But if there is no such evidence, what we really have is regulation by knee-jerk reaction.

As I recall, the initial setup of regulation of the medical condition of pilots was adopted by the CAA in the 1930s without much thought being given to it. It was just stated and assumed that of course pilots had to be of excellent health and the CAA should check that.

 

[PeterNSteinmetz]

I understand given German Wings, Egypt Air, ect. the reason why the policies are implemented. It’s just I need to be able to demonstrate and show the FAA, “That isn’t me”. And it would be a hell of a lot easier for pilots who currently have cert but are suffering in the shadows, paying out of pocket to have off the record time with a Doc.)

This is one reason to believe that the FAA’s current aeromedical regime may actually _decrease_ the safety of flight. The regulations may create a much larger population of pilots flying with questionable health in order to avoid the problems with medical certification than the number of possible Lubitz’s they prevent. The ability to predict that kind of behavior is likely to be very poor.

It is a question of risk benefit trade off and I am not aware of studies to suggest that the current probing of mental health conditions by the FAA had improved the safety of flight. I’ve asked many times for references on that - so far nothing.

 

[PeterNSteinmetz]

First, there is no way to determine the % of the less than 7000 sports pilots who are active. Assuming private pilot retention, >1/2 of the sports pilots certified are active pilots today. Nor can anyone determine how many private pilots or higher certificates are flying light sport without a medical.

The data here are definitely soft. Nonetheless, I think suggestive that the 3rd class medical rules do not improve the safety of flight. Certainly the data available do _not_ support the contention that the 3rd class rules do improve the safety of flight.

 

[PeterNSteinmetz]

Actually, the data does not even meet the standard for a correlation.
I can argue all day about the 3rd class medical being unneeded. However, using the sport pilot or the basicmed numbers does not help make the case.

I suspect if one obtained the actual datasets one might be able to make a case.

If there are several thousand sport pilots accumulating hours at roughly the same rate per capita as 3rd class holders and the accident rates are the same per hour, is there some reason to think that does not argue having the 3rd class has no effect on the accident rate? Even with significant power to detect a small difference?

I guess one could run the power calculation explicitly, but my sense of it is that power would not be bad.

Is there some other reason to deny there is even a correlation there? Or are my assumptions about the size and rates likely to be off above?

 

[PeterNSteinmetz]

As I said before; the supposition is that the group of pilots are equal. They are not. Many have posted on here about switching to BasicMed to drop the AirMed SI process, or going LSA. These pilots are self selecting; and are generally pilots trying to be legal; and are aware of their health complications.

While that is true, wouldn't this type of selection argue that the accident rate due to medical complications should be higher amongst the LSA pilots? I can't see how it would suggest the accident rate would be lower.

Thus the existence of such self selection would seem to argue that the conclusion that the 3rd class medical requirements do not affect accident rates is even _stronger_, not weaker.

Overall, no apparent evidence that the 3rd class medical requirements improve the safety of flight. And I would say some suggestive evidence that they have no effect. Though a real study based on the available data would be an improvement. Some reasonable general arguments and anecdotal evidence that the 3rd class requirements might actually hurt the safety of flight.

 

[PeterNSteinmetz]

There are so many reasons why these comparisons make no sense. The number of pilots, the number of planes (there are less than 3,000 LSAs in the US). The LSA accident rate is twice that of the rest of GA (unless you don't believe Aviation Safety). Then you look at the number of unexplained in-flight LOC accidents in LSAs - there are a lot. Average pilot age? 63.

Would agree that the rates of accidents have to be compared, not the absolute number. A couple of thousand planes and pilots is a fairly decent sample in most cases, though the accident rates are low. With the actual data, the ability to detect differences, the statistical power, can actually be computed.

Interesting about the number of unexplained in-flight LOC accidents in LSAs. If the rate of such is significantly different from the rate in certified planes amongst people with 3rd class or higher medicals, I would agree that that is concerning and would suggest that 3rd class requirements may improve the safety of flight. Do you have a source for those numbers handy?

 

[PeterNSteinmetz]

I contend that the only way to truly compare would be to eliminate medicals for ten years and compare the rates. LSAs, both pilots and planes, are way too far between.

Thanks for the link. Agreed that would be the cleanest sort of study. And probably should be done, perhaps with continuous monitoring of results, given the lack of clear data that the 3rd class medical rules improve the safety of flight.

I suppose BasicMed pilots over the years will provide another comparison group that is much larger.

I think it would be great to do that sort of thing with the vast majority of these regulations. Some may actually be needed, but I suspect most are based on knee jerk reaction to an event with little or no actual data.

 

[PeterNSteinmetz]

because in the 5 years from 1945-1950, there were no medical requirements. the accident rate was astonishing.

Is there some data we are not seeing here? Because looking at the graphs @Warmi posted (apparently from the FAA itself), I have to agree with him. There is not a hint of a change in the fatal accident rate in 1950 or 1951 that deviates from the general downward trend.

In fact, I think you have to interpret the data in those graphs as arguing the 3rd class medical requirement makes no difference in the fatal accident rate.

Maybe there is a study somewhere justifying this rationally, or maybe not...

 

[PeterNSteinmetz]

Interesting gap in the numbers during the war years, and then an apparent increase right after the war (though one has to wonder whether the methods changed during that gap). Then a downward trend starts in 1946 that just rolls along. Not deflection evident in 1950 or 1951.

One wonders if the 3rd class was adopted due to the apparent jump during the war years?

Another note on the graphs. The scale appears logarithmic, so a straight line is an exponential decay, but it contains 0 as the bottom label, which cannot be correct on a log scale. The line are labeled fatal accidents per mile, etc, but that also appears in error because the numbers would be way to high. The axis is labeled as some type of safety index. None of this is explained clearly in the text.

I have looked for the history of the enactment of this and possible reasoning at the time, but have not been able to quickly find it.

 

[PeterNSteinmetz]

I don’t see it ...

What is the source of those graphs? I tried tc.faa.gov but that doesn’t seem to resolve.

 

[PeterNSteinmetz]

From that report and regarding the graphs posted here “All of these indices showed progress over the 1940s and 1950s, although the air carriers results were erratic enough so that the “up ticks” could raise justifiable concern. With the exception of a postwar increase, nonairline flying showed the steadiest progress in safety, although in the longer run, this has also proven to be the slowest. In assessing this record, it must be recognized that safety oversight was not the only, or perhaps not even the most important, factor. Advances in air navigation and air traffic control, aircraft improvements, changes in traffic patterns, and improvements initiated by the air carriers themselves, all contributed to the gains in safety.”

 

[PeterNSteinmetz]

The fact is LSA rules and basic med have not been in place long enough to infer any safety claims.

I think it is a question of statistical power of the tests. That could be actually computed with the datasets. My feeling is there might be reasonable power for LSA and maybe BasicMed, given the larger numbers, but that is just a guess.

But as others have noted, it seems unlikely the FAA would bother to rationally examine the effects of its regulations in this manner. So far, no one has been able to point to a study which has examined the effects of the 3rd class medical requirements on safety of flight, which have been in place for how long?

 

[PeterNSteinmetz]

Some food for thought: https://www.psychologytoday.com/us/...-witch-hunt-depression-pilots-and-air-crashes

The article they are referring to is available at: https://www.researchgate.net/public...earned/link/5b443840aca2728a0d68b0d6/download

 

[PeterNSteinmetz]

But one area that has seen a large decline is alcohol related aviation accidents once the FAA started checking drivers records as part of the medical process.

Would you happen to have a reference on that?

 

[PeterNSteinmetz]

There is another difference to consider regarding the standard of evidence for regulations. People are convicted of criminal offenses after the crime is committed by a proof beyond a reasonable doubt standard. Regulations are attempts to prevent people from committing a bad action against others. Violation of them historically was a civil offense. Recently, that has been changed so that violation of regulations is a crime.

In my view, this makes having regulations much more serious. The old argument that well it is just a civil offense so we can forcibly require compliance with regulations based on a reasonable idea, rather than proof the regulatory violation leads to harm to others, is weaker now.

Some of the differences here are not really based on evidence or data, but rather political differences between when people think it is ok for the government to use violence or threat thereof to prevent other people from doing what they want. Some people think that is fine if it seems like a good idea to have the regulation and that it will possibly prevent harm. Others take the idea of using violence to enforce things more seriously and think that should only be done when there is a clear and present danger of harm.

 

[PeterNSteinmetz]

Appears to have been a more gradual accumulation of criminal regulations than I previously had been told.

https://www.heritage.org/crime-and-...rative-state-the-problem-criminal-regulations

Seems there have always been some criminal regulations, but that they have proliferated.

I guess what would be of interest particularly here would be the evolution of FAA regulations with civil penalties and those with criminal penalties.

 

[PeterNSteinmetz]

Do you think the requirements for getting one are unreasonable?

I would argue that requiring pilots to meet a standard, when there is not good evidence that the pilot failing to meet that standard constitutes a clear and present danger to others, is unreasonable.

When such evidence is lacking, it implies the regulatory agency is using violence or threats thereof, to force people to do something they don’t want to do, just because people in the agency think it is a good idea, but with very little evidence or proof. Not reasonable by any stretch in my view.

 

[PeterNSteinmetz]

I can't argue the point as I have no experience in this area.

That said, I'm not aware of any violence, or threats of such. Can you provide an example?

Well, the FAA says that if you don’t answer the questions on their medical application truthfully you will be guilty of a felony with a possible prison sentence of a number of years or they will forcibly take a large amount of your property. Sounds like a threat of violence if you don’t do what they say - doesn’t it?

Any time the government threatens a criminal penalty, there is a threat of violence if you don’t cooperate. Sure, it is couched more nicely than a guy robbing you at gunpoint in an alley, and it is administered by officials with judges etc, but at core, there is a threat of violence.

My point generally about reasonability is, we should be sure the threat of violence is appropriate to the circumstances. Sometimes violence or a threat is needed, like when defending oneself from imminent bodily harm or death, but many times it is not.

 

[PeterNSteinmetz]

The thing about such talk of violence is that it applies to laws that you approve of just as much as to laws that you don't approve of. It adds a significant layer of emotionalism to the discussion, and as such it seems disingenuous to ONLY mention it in relation to laws that you don't like.

Accusing the speaker of being disingenuous is a form of an ad hominem attack and as such, a logical fallacy. Also rude in a public forum. I’ll ignore it once here.

I agree that enforcement of all laws and regulations involves violence or threat thereof. That is why, in my view, it is important to make sure that such violence or threat thereof is really appropriate to the situation at hand.

As I noted, there are different levels of violence and threats, some more apparent and/or destructive than others. I suppose one could also say physical coercion instead of violence. But what terminology would you suggest generally to refer to all use of physical force to make people do things they don’t want to do?