Mental Health in Aviation Act of 2025 Requires FAA Mental Health Regulatory Reform

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Summary

• Pilots and air traffic controllers face intense operational stress, and FAA mental health regulations historically discourage seeking care, creating a culture of fear and underreporting.
• Reforming mental health policies is essential to protect aviation personnel, improve safety, and prevent tragedies linked to untreated and undisclosed mental health conditions.
• H.R. 2591, the Mental Health in Aviation Act of 2025, requires the FAA to update regulations, hire aviation medical examiners with mental health backgrounds, and fund mental health supportive programs.

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Aviation is a complex, high-stakes industry relying not only on pilots and air traffic controllers but also on the critical coordinated efforts of airport operators, flight attendants, maintenance technicians, Transportation Security Administration (TSA) officers, and countless other professionals. It is no secret that choosing a career in aviation, especially as a pilot or air traffic controller, comes with extreme levels of stress, focus, and dedication.

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Aviation is one of the most heavily regulated industries in the world, and so are the professionals who work within it. After all, they carry thousands of lives in their hands every day. They are held to the highest standards of safety and performance. But what about their own well-being and safety? The stigma surrounding mental health remains widespread, especially in aviation, where many fear that acknowledging mental health concerns could put their careers and livelihoods in jeopardy. So, how are the industry standards beginning to shift?

Operational Stressors and Challenges in Aviation

Becoming a pilot or air traffic controller requires years of rigorous training and dedication, not only to achieve certification but also to enter the profession, followed by ongoing proficiency training and evaluations to maintain both certification and skills. All applicants, both controllers and pilots, must pass rigorous testing, psychological and medical screening, and security clearance processes. Entering these aviation career fields requires overcoming substantial barriers to entry, and the obstacles within the career are equally significant.

The U.S. air traffic control system has been pushed “nearly to its breaking point” due to the staffing shortage that has resulted in the Federal Aviation Administration (FAA) restricting flights and 41% of controllers working 10-hour days, six days a week, just to meet the operational minimum needs. As a result, controllers report unsafe workloads, chronic fatigue, and declining mental health—issues that have led to panic attacks, heart problems, individuals “outright quitting,” and even the loss of medical clearance due to depression. These same factors contribute to many controllers leaving the profession well before the early mandatory retirement age of 56. Only about 10% of applicants meet all the basic requirements to apply, and virtually half of new hires wash out of the process before they complete their qualification. With no clear means to relieve the understaffing, the system will continue to operate under serious strain, raising growing concerns for the safety of both the skies and of the controllers themselves.

Pilots must balance constant situational awareness and simultaneous tasks competing for their attention, a demand that is draining on their mental and physical capabilities. Extensive research has focused on the safety impact of fatigue in pilots, recognizing the dangers, but with less emphasis on the mental health impact of fatigue in commercial airline pilots. After all, their lifestyle is not conducive to maintaining regular sleep patterns. A 2018 review of depression and suicide in pilots identified a similar, if not potentially increased, risk of depression in airline pilots when compared to the general population due to the professional stressors they face. Commercial airline pilots are subject to “disrupted circadian rhythms and fatigue, . . . high workload, experiencing verbal and sexual harassment, and corporate instability of airline companies,” all of which are potentially associated with depression; notably, it is not the only health-related condition that can arise.

Pilots and air traffic controllers share the primary responsibility to ensure the safety of the aircraft, the skies, and the passengers. Pilots have irregular schedules with trips lasting days, and they spend considerable time traveling in cockpits and in hotels, subsequently leading to extended time away from home, long hours, and fatigue. Air traffic controllers, on the other hand, work fixed shifts in a tower or radar room and return home each day, but their duties require constant concentration, rapid decision-making, and management of intense traffic loads, conditions that create a consistently high-stress environment. While the positions are quite different, the obvious stressors are difficult to ignore.

Aviation in the Present Moment

Issues of mental health for both pilots and air traffic controllers often gain attention, unfortunately, only in the wake of unignorable matters, such as significant tragedies or systemic disruptions. Events include the Germanwings disaster, the fatal midair collision near Reagan National Airport, and, most recently, the effects of the government shutdown.

On March 24, 2015, Germanwings Flight 9525 crashed into the French Alps, resulting in the death of 150 people. The final accident report revealed that the crash was deliberate by the copilot, who had been suffering from severe depression since 2008, and whose medical certificate had been renewed each year. Shortly before the incident, the copilot’s private physician “recommended the copilot receive psychiatric hospital treatment due to a possible psychosis, but no aviation authority was informed.” This intentional crashing, paired with the failure to warn proper aviation authorities, was a key motivator for the strict mental health policies created by the FAA.

Even before the government shutdown, the FAA was restricting the number of flights in busy markets due to the air traffic controller staffing deficit. This issue was further amplified by the fatal collision of an American Airlines flight from Wichita, Kansas, on final approach to Reagan National Airport with a U.S. Army helicopter; no party survived the crash. Crash investigators did not blame the Reagan National tower for the incident, but shortly after the crash, it was confirmed that one controller was manning two positions at the time: local traffic and helicopter traffic. The industry was jolted into the spotlight, and even though the controllers were deemed not responsible, it brought the staffing crisis back into focus, similar to the attention following the recent LaGuardia crash between an Air Canada Express aircraft and a Port Authority fire truck.

Increased stress and the need to take on second jobs while unpaid due to the government shutdown led to more absences, leaving additional control towers understaffed. Already a highly stressful position, the added financial strain further increased the workload on an overburdened system. In response, the FAA’s safety team recommended flight reductions to alleviate some strain on the aviation system. Sean Duffy, the U.S. Secretary of Transportation, shared reports of “planes getting too close in the air, more runway incursions, and pilot concerns about controllers’ responses.” The shutdown and resulting disruptions highlight the importance of air traffic controllers, demonstrate the current burden on the system, and draw attention to pilots’ concerns for their colleagues’ well-being and the overall safety of the skies.

Current Landscape of FAA Regulations

The FAA is responsible for issuing medical certificates, which are classified as first-class, second-class, or third-class. While certain pilots and air traffic controllers are held to different medical and licensing standards, all three certificates have the same core standards for mental health requirements and disqualifiers.

Automatic disqualifying conditions include psychosis, bipolar disorder, and some personality/mental disorders. The FAA emphasizes that its goal is to encourage pilots to seek treatment, noting that only about 0.1% of individuals who divulge mental health issues are denied certification and that most treated mental health conditions do not disqualify a pilot from flying. Medical evaluations may involve disclosure of case history and clinical evaluation by psychologists or psychiatrists. Some pilots have reported that these disclosure requirements are “invasive” and raise significant privacy concerns. If the FAA receives external information regarding possible issues with a pilot’s mental health or if there is a medically related incident, they can demand evaluations and additional medical documentation. Otherwise, it is the responsibility of the party to self-disclose any pertinent information.

The FAA maintains an authoritative list of approved medications, along with extensive—but not all-inclusive—lists of drugs designated as “do not fly” and “do not issue” for aviation medical examiners (AMEs). It is also worth noting that AMEs are trained to evaluate mental health, but they are not always mental health professionals. Air traffic controllers cannot take any SSRIs (selective serotonin reuptake inhibitors), such as Lexapro, Prozac, or Zoloft, unless they obtain a waiver, and this waiver process may take a year or more. Recent updates have allowed pilots and air traffic controllers to take certain antidepressants, such as Cymbalta, Effexor, and Pristiq.

Controllers must requalify and undergo a yearly medical exam. But for pilots, it depends on the type of medical certificate they hold. Time frames can range from six months to several years, depending on the degree of certificate and the pilot’s age. When filing the examination forms, they are required to self-disclose “mental disorders of any sort; depression, anxiety, etc.” Once they have reported their condition, it triggers a thorough evaluation and a lengthy “monitoring” period. For pilots, this time period, which historically lasts around 12 months but at least six months, includes strict supervision before they are allowed to fly again. Even after reinstatement, the oversight continues with required check-ins every six months with medical examiners and psychiatrists, as well as additional status reports from chief pilots.

Both pilots and air traffic controllers fear losing their medical clearance and thus are discouraged from seeking help due to the current rules being “archaic” and in need of modernization. The present occupational stressors paired with the current culture have properly prompted the industry to launch updated approaches, programs, and calls for change.

Current Initiatives and Programs for Mental Health in Aviation

In 2025, National Transportation Safety Board (NTSB) Chair Jennifer Homendy called for a “complete overhaul” in the FAA’s outdated medical certification process handling of mental health issues. She emphasized that “[m]ental healthcare is healthcare,” and “we don’t want . . . a situation where a pilot feels like they have to lie to fly.” Homendy also highlighted how the United States is a leader in safety, and there is an opportunity to lead the way in aviation mental health.

The FAA has made strides toward a more modern approach, similar to what Homendy urged. In December 2023, the FAA established the Mental Health and Aviation Medical Clearances Aviation Rulemaking Committee (ARC) with the primary intention of providing recommendations on breaking down the current barriers. The ARC’s work builds on the previous efforts of the FAA to prioritize mental health. The committee’s April 2024 report outlines 24 recommendations that include creating a non-punitive pathway for disclosing mental health conditions and treatments; revising and evaluating the requirements for reporting psychotherapy, depression/anxiety, attention deficit hyperactivity disorder, and post-traumatic stress disorder; ensuring that screening protocols are based on proportionate, relevant, and risk-based principles; expanding the use and promotion of peer support programs; developing mental health literacy, education, and awareness campaigns; increasing mental health training and improving quality assurance for AMEs; and modernizing the FAA’s information management system.

The Pilot Mental Health Campaign (PMHC) is the only advocacy group dedicated to creating a more modern aeromedical system that supports pilots’ well-being and the safety of the skies. The group emphasizes that the “system is broken” and aviators face a “government-imposed culture of fear.” The board is composed of pilots, medical professionals, policy experts, and mental health psychologists, all with the goal of seeking reform and raising awareness. This organization helped introduce two bills into the 119th Congress, including H.R. 2591, the Mental Health in Aviation Act of 2025, discussed below, and H.R. 2592, the Aviation Medication Transparency Act of 2025.

More broadly, several resources already exist for pilots, though access varies. There are general assistance programs, such as those provided to members of the Air Line Pilots Association (ALPA). Some major airlines have peer support programs, but general aviation pilots often do not have access to such resources.

Importance of Reform

One study observed that “potentially hundreds of active pilots currently flying may be experiencing unreported mental health disorders, including suicidal ideation,” and “[a]ir deaths from pilot suicide may also be underreported.” Investigators are not always able to determine whether crashes are caused by human error, malfunctioning machinery, or a deliberate act of the pilot. Additionally, among pilots involved in aviation accidents with SSRIs detected in their systems, 88% had not disclosed a psychiatric condition, and 95% had never reported antidepressant use, supporting concerns that pilots underreport mental health symptoms.

The FAA’s ability to address safety risks regarding mental health issues is limited by the individual’s reluctance to disclose their conditions. Barriers to disclosure include “the stigma associated with mental health, potential impact on their careers, and fear of financial hardship.” Representative Sean Casten, who sponsored H.R. 2591, stated: “This often leaves the folks tasked with keeping our skies safe with an absolutely terrible choice: get help, and put your career and your paycheck on hold, or keep your career on track and just hope you’ll get better.” The FAA’s risk-mitigation and safety efforts are only effective with honest reporting and awareness, but the stigma runs deep, even before individuals enter their profession.

A study at Western Michigan University (WMU) College of Aviation uncovered that both faculty/instructors (64%) and students (53.23%) believe the FAA’s restrictions around mental health are extremely restrictive and reduce their desire to seek professional mental health assistance. The study recommended that the school take steps to increase education and provide accurate, clear information about FAA mental health regulations in hopes of reducing the stigma and fear.

This is critical for those looking to enter the profession, as in the case of John Hauser. He was a 19-year-old aviation student from the University of North Dakota who loved to fly and knew he wanted to be a pilot since the 8th grade. Both his parents are physicians with training in psychiatry, and they had no indication that he was struggling. Hauser intentionally crashed his plane, leaving behind suicide letters, where he spelled out “very clearly . . . that he wanted to get help but that he would have to give up flying if he got help, and, in his words, he said life is not worth living if he could not fly,” shared his father. He also reportedly requested, “If you can do anything for me, try to change the FAA rules so that other young pilots don’t have to go through what I went through.” To John Hauser, giving up flying was not an option—a sentiment he may not be alone in. This tragedy, along with similar cases, highlights the urgent need to reconsider policies that force aspiring pilots to choose between their mental health and their dreams or career.

H.R. 2591: The Mental Health in Aviation Act of 2025

Originating in the U.S. House of Representatives and backed by Arizona Representative Greg Stanton and sponsored by Illinois Representative Sean Casten, the Mental Health in Aviation Act of 2025, or H.R. 2591, is a bipartisan legislation designed to update FAA regulations on mental health. This act has been supported by various parties, the FAA’s ARC, PMHC, and 43 other cosponsors.

Initially introduced on April 2, 2025, the bill passed the House on September 8, 2025, and was received by the Senate the following day. It is considered the most significant move yet in addressing the long-standing stigma and lack of mental health support by ending the FAA policies that, in effect, ban commercial pilots and other aviation professionals from seeking out any mental health aid, including simple therapy.

This bill requires the FAA to review and update its regulations and policies on mental health for pilots and air traffic controllers. Simply put, it urges the agency to implement the recommendations made by the NTSB and fund a public campaign focused on destigmatizing mental health care among aviators and increasing awareness of available mental health resources. The Mental Health in Aviation Act mandates that the FAA enact the 24 recommendations from the ARC within two years—or provide explanations to why they choose not to enforce such recommendations—which would include expanding the hiring of FAA physicians with mental health backgrounds and compelling the agency to address the backlog of medical certificates with special exceptions. The primary goal is to keep the process up to date and establish trust with pilots and air traffic controllers.

Looking Forward

Safety is the main priority of policymakers, workers, agencies, and all parties involved in the aviation world. As Representative Stanton stated:

The safety of our skies depends on the wellbeing of the people who keep them running. But for years, our aviation industry has suffered from staffing shortages that have left air traffic controllers and pilots overworked and undersupported. . . . Our Mental Health in Aviation Act is about breaking down stigma and ensuring pilots and aviation professionals can access the care they need.
This statement embodies the heart of the act. The stability of the aviation industry rests on the health and safety of those responsible for its core operations. Mental health stigma creates barriers both to entering the industry and to seeking care once inside. “Culture of silence” is a term used by both NTSB Chair Homendy and Representative Stanton, one that fairly describes the current state of mental health in aviation. The current stigma within the environment perpetuates the idea that keeping quiet is better than the alternative of unfair penalization, when that should not be the case. Change is coming, and initiatives such as the Mental Health in Aviation Act are beginning to address this.

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Endnotes

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Authors

Mikayla Erichsen Gibbons

Mikayla Erichsen Gibbons ([email protected]) is a 1L law student at Touro University Jacob D. Fuchsberg Law Center in Central Islip, New York. Although she has not yet developed specific legal practice experience, she...

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Authors

Mikayla Erichsen Gibbons

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