Fit to Fly? Why so Many Pilots Hide their Physical and Mental Health Struggles

Here’s a question: what do you really ask yourself when assessing whether you’re fit to fly or not? More importantly, how comfortable do you feel talking about not being fit to fly with your AME, colleagues, and employer? If you do have a health issue, how bad does it need to get before you decide to come forward about it and attack the problem head-on?

If this is easy for you, that’s great. For many pilots though, it’s not just the question of “What is my current mental and physical health?”. It’s actually about weighing off being honest against the consequences that could follow.

Today, we’ll explore the journey pilots face when they have to confront the challenge of admitting they might not be fit to fly. From the weight of professional consequences, to the discipline it takes to acknowledge you’re simply not up for the task. All of this has lead to large group of pilots hiding their physical and mental health struggles. We dive into this often overlooked aspect of aviation safety!

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Why so Many Pilots are not Transparent about Their Health

Recent studies are revealing some troubling figures about pilots trying to hide their mental and physical health issues. We’ve talked about the impact of mental health on flight safety, but the issue is bigger than that.

One study showed that 72% of 4320 military pilots reported a history of healthcare avoidance behaviour, and 42% of pilots reported witholding information during an aeromedical exam.

Another study showed that 78% of pilots reported feeling worried about having to seek medical care.

So how did we get here? Why is an industry that prides itself on being just and safe, so notorious for employees concealing important safety-impacting information?

The truth is, there isn’t just 1 thing that makes pilots hide their mental and physical health battles. Out of all the data we’ve gone through, we have distilled it down into 3 main root causes:

1) The Long Term Professional Consequences of Health Issues

2) The Effect of Ego, Personal Pride, and Shame

3) The Personal Challenge of Converting Grey (how healthy do you feel?) into Black or White (are you fit to fly or not?)

Let’s have a look at these individual reasons, so we can discuss the solutions later on.

The Long Term Professional Consequences of Health Issues

It isn’t a secret that pilots are, in general, required to stay in optimal mental and physical shape. This is obviously in the interest of flight safety. Physical health issues could present barriers to doing our jobs effectively. Mental health issues can affect the way we process information, as well as result in emotional states that are not helpful inside a cockpit.

However, it’s a little bit more complicated than it sounds.

Why?

Well, imagine going to your AME and saying you feel depressed, or think you have an issue with your blood sugar levels. I think we can all roughly come up with what the eventual consequence of this will be:

You’re now grounded until – well – who knows?

For a group of individuals that are not only very passionate about their careers, but are also under a lot of financial pressure: doing something that actively goes against your self interest is going to be hard.

The question is:

Is it fair to assume from a regulatory perspective that pilots are going to be honest about their health issues, without exception?

The research data suggests that this is an ignorant and naive way of going about this issue. You can’t just assume pilots are going to come forward and immediately surrender to the system, no matter what their circumstances might be.

Of course we all have a professional responsibility to make decisions in the interest of flight safety. However, is a system that stacks safety against someone’s wellbeing and self-interest, a good design?

After all, a systemic issue requires a systemic solution! But more on this later.

The Effect of Ego, Personal Pride, and Shame

So, here’s the cold hard truth: we’re all flawed, imperfect, and fail at random things here and there. Denying this is a very effective way to get yourself in a dark place in your career, and personal life.

We all like to get the job done, be competent, dependable, efficient, and reliable. This is why it can be tricky to admit to yourself that you should hang up your uniform for a few days (or much longer) and ‘be the opposite’.

For some pilots it can even feel like a blow to their pride or self-esteem. Just because this isn’t rational doesn’t mean it’s not how many often feel. The reality is: We’re all human! Humans can get ill, humans can feel shit, and human struggle with all sorts of things.

Admitting you’re ‘not good enough’ (whether short or long term) can for some people feel against the very fabric of our profession, where being able to deal with variables and threats are so baked into our brains. Of course this way of thinking doesn’t apply to everyone, as we all often think about similar things in completely different ways.

For others, it’s the fear of the unknown – the uncertainty of what others, including employers and colleagues, will think of us if we admit we’re not safe to fly an aircraft today or this year.

It requires us to set aside our ego and prioritise safety over self-image. This conflict has proven for some to lead to feelings of guilt, inadequacy, and even shame.

Some pilots pride themselves and openly broadcast how little they get ill, fatigued, or have sick days. If you ask us, this isn’t really something we should be celebrating as an industry. It can introduce new barriers for pilots to be honest.

Overcoming this challenge requires not only courage, but also a shift in the way we think about this whole thing. Where safety takes priority over your own personal feelings and emotions.

Yep, we agree: easier said than done!

The Personal Challenge of Converting Grey into Black or White

Deciding whether you’re fit to fly isn’t always that simple, despite how employers may make it sound. Yes, it’s a ‘simple’ question: are you fit to fly? But getting to the actual answer isn’t.

Think about it this way: sometimes, we might feel ‘a bit off’. A little stressed, tired, or just not 100%. You might feel a little under the weather, but still be okay to fly. Someone else might make a completely different decision based on the exact same feeling: it’s all very subjective!

It’s like having a scale from feeling awesome, to pretty miserable. When it comes to deciding if you can safely fly, it’s either a yes or a no – there’s no in-between.

So where’s the line? Where is YOUR line? Don’t let us (or anyone else) tell you!

The rules for flying are strict. Aviation authorities across the globe have set clear guidelines about what pilots need to be able to do to fly safely. However, these rules don’t always account for the fact that human health is usually NOT black and white. People’s minds and bodies often interact with similar variables in very different ways.

How can the Industry Help Pilots be Honest about their Health?

Just slapping an IMSAFE checklist on the table and blaming a pilot for making the wrong decision is simply not good enough anymore.

The industry and factors that have nothing to do with the pilots themselves need to be included, if we want to have a proper conversation on how to fix the issue of pilots not opening up.

To make things easier, we need to change how we think about pilot health.

Instead of just focusing on fit to fly or not, we should look at the bigger picture. That means supporting pilots to take care of themselves and talking openly about how they’re feeling, and what health issues they’re facing.

We did the same when encouraging pilots to file safety reports, talk about mistakes, and supporting those who raise their hands when they screw up. The results speak for themselves!

So why is the same approach not taken when it comes to mental and physical health? Sure, we might still be grounded if the facts show it presents a lot of risk, but the way these cases are treated should flip around.

We learnt very quickly that if you want pilots to talk openly about mistakes, you need to foster a Just Culture. That doesn’t make the mistakes themselves any safer, but this approach has made the industry as a whole much safer in general!

This is the mission for the upcoming decade: make pilots feel more comfortable on speaking up about not feeling well, or having mental / physical health issues that a simple medical test won’t reveal.

If we succeed in this, we can actually catch and fix potential problems before they become serious, both on a personal and flight safety level – when it might be too late in the form of another accident report.

A Fit to Fly Guide to Assess Yourself Fairly Beyond IMSAFE

As we mentioned earlier, an IMSAFE checklist might be a start, but it’s a check that for many only really considers the immediate and ‘now’.

We need to zoom out if we want to make an accurate assessment of our physical and mental health, and accept that what might feel ‘not good enough’ to us, might be different for others.

Look at the big picture, be brutally honest with yourself. Not just about the right here right now, but the last 3 months and project it into the future as well. How are you really doing, and is it impacting flight safety if you enter the cockpit right now?

Only you can make an informed decision about whether it’s safe for you to fly or not based on these items. One category might be more important to you than others, based on how well you’re able to deal with it. Don’t let anyone tell you how you should or shouldn’t feel about issues you’re facing!

Conclusion

Many pilots struggle with deciding whether they’re fit to fly, and often feel uncomfortable discussing their health issues. This reluctance comes from fear of professional consequences, pride, and the challenge of converting feelings into a simple “yes” or “no.”

To address this, our industry needs to shift towards fostering a culture where pilots feel supported in prioritising their physical and mental wellbeing. By encouraging open conversation and providing resources for self-assessment without judgment, we can enhance safety and prevent potential problems before they escalate. A systemic issue requires a systemic solution!