The issue of mental health in aviation reached a critical turning point in 2024, with government leaders and stakeholders across the industry coming together to address long-standing barriers that have discouraged pilots, air traffic controllers, and other aviation professionals from seeking necessary care. As such, the past year has seen a series of updates, initiatives, and other collaborative efforts focused on easing the path for pilots and air traffic controllers in need of help.

A much-anticipated Mental Health & Aviation Medical Clearances Aviation Rulemaking Committee (ARC) report was published in April heralding significant changes in the industry's approach to mental health.

Formed in December 2023, the FAA/industry ARC was tasked with identifying and addressing the barriers preventing aviation professionals from disclosing mental health concerns. The committee’s report laid out 24 specific recommendations to foster a safer National Airspace System (NAS) through better mental health support for pilots and controllers.

Key ARC member and NBAA director of safety and flight operations Mark Larsen highlighted the critical need for such changes, pointing out that concerns about culture, trust, stigma, and fear often keep aviation professionals from seeking timely care. “These concerns often stand in the way of pilots and controllers seeking mental health help,” he said in April.

The ARC's recommendations are divided into key focus areas, including creating non-punitive pathways for disclosing mental health conditions, revising reporting requirements for certain mental health conditions, and expanding peer support programs.

The FAA responded by updating its Guide for Aviation Medical Examiners (AME Guide). Pilots with a history or diagnosis of anxiety, depression, or related conditions now have clearer, less restrictive guidelines for obtaining medical clearance, provided they meet certain criteria. Changes to guidance allow AMEs to issue unrestricted medical certificates immediately for aviators who have an established medical history of up to two uncomplicated conditions, such as anxiety or depression, provided they meet certain criteria surrounding treatment and medications used.

The FAA has also made strides in reducing the time it takes to process medical certifications for pilots with mental health conditions. Historically, the certification process could take months, or even years, due to the complex paperwork and costly evaluations required. In 2024, the FAA introduced a new AME decision tool to streamline this process, helping to reduce wait times and making it easier for pilots to get back in the air.

However, the progress is not without limitations. The FAA still requires more extensive review for pilots with multiple conditions, recent use of certain medication, or any history of self-harm or suicidal ideation.

But the change in policy represents a significant step toward normalizing mental health care within the aviation industry, signaling that the FAA recognizes the importance of treating mental health with the same seriousness as physical health.

To further support mental health initiatives, the FAA has increased training for AMEs, who are critical in the certification process, since they are responsible for assessing whether a pilot is fit to fly. In 2024, the FAA expanded its training curriculum to include more robust mental health education, including effective interview techniques, mental health literacy, and how to engage in conversations with applicants about sensitive topics.

The goal of this expanded training is to ensure that AMEs are equipped with the tools to identify potential mental health concerns, offer appropriate guidance, and facilitate referrals for treatment if needed. This effort is particularly important in reducing the stigma surrounding mental health in aviation because AMEs play a key role in shaping the industry's culture of openness and acceptance.

While the U.S. has taken steps toward improving mental health support in aviation, global collaboration remains essential in creating a universal standard for addressing these issues. The ARC’s recommendations were heavily informed by the experiences of other international aviation authorities, and the FAA has continued to monitor global best practices.

As the regulatory landscape evolves, industry groups are stepping up with initiatives of their own. At the NBAA Regional Forum in June in White Plains, New York, Larsen moderated a panel discussion on mental health, focusing on a larger effort to expand peer support programs, which are increasingly seen as essential to mental healthcare in aviation.

Peer support has been shown to be highly effective—80% to 90%—in addressing or preventing many mental health concerns, according to ARC member and Aviation Medicine Advisory Service CEO Quay Snyder, participating in the NBAA panel. Snyder pointed to international studies to support this. Peer support is unreported to the FAA, offering a confidential means of support for pilots who might avoid seeking help due to the fear of medical certification issues or job loss.

Laila Stein, a CFI who has researched student mental health, highlighted the University of North Dakota’s pioneering peer support program, which has shown success in addressing mental health concerns among aviation students. “Ultimately, everyone deserves to be able to talk to someone,” Stein said.

Business aviation presents unique challenges when it comes to peer support programs. Unlike airlines, which can scale to offer robust peer support systems, small flight departments often lack the resources to implement such programs.

However, efforts are underway to adapt models that have been successful in other sectors. NBAA, in line with ARC recommendations, is exploring creating an aggregated approach to peer support to ensure that business aviation pilots have access to appropriate resources. Larsen noted that this will require creative solutions and cooperation within the industry to overcome the inherent limitations of smaller, dispersed operations.

One company at the forefront of mental health support for aviation professionals is MedAire, which launched a partnership with OdiliaClark in May 2024 to develop a peer-to-peer support network for flight crews. The peer support network allows flight crew members whose employers have contracted with MedAire to access real-time assistance from trained volunteers.

The services range from offering a sympathetic ear to someone who is simply going through a rough patch to providing more intensive support for those dealing with the aftermath of a traumatic in-flight event, such as an onboard medical emergency. According to OdiliaClark sales director Peter Whitten, peer support is particularly effective in aviation because it leverages the shared experience of being part of the same high-pressure—and often isolating—profession.

MedAire’s model is in direct response to the FAA’s encouragement to expand support networks for aviation professionals, with the goal of intervening before mental health issues escalate into crises. The company’s peer support program has been designed with strict training protocols to ensure volunteers can handle sensitive situations and know when to escalate concerns to professional healthcare providers.

Another new player in the field is MD Onboard, which launched in 2024 as a healthcare-led remote medical advisory service for aviation. Built on the telehealth technology of Northwell Health, MD Onboard’s proprietary app connects commercial airline and business aviation crews directly with paramedics for immediate triage, bypassing the traditional communication delays that often hinder timely medical advice during flights.

The platform improves decision-making during in-flight medical situations by offering crews faster access to medical expertise. It also provides mental health support, offering a direct line to professional help for pilots or crewmembers experiencing stress or other psychological issues on duty.

As we head into 2025, the progress made in 2024 offers a hopeful outlook for the future of mental health in aviation. The FAA’s rule changes, the expansion of peer support programs, and the growing number of services aimed at providing confidential mental health care are all steps toward ensuring that pilots and other aviation professionals have the tools and support they need to stay healthy—mentally as well as physically.

While the stigma surrounding mental health in aviation is gradually decreasing, it will take continued effort to fully integrate mental health care into the industry’s culture and operational processes. The progress made in 2024 is a testament to the industry’s commitment to addressing mental health challenges head-on, and supportive structures are being put in place to enhance well-being in the skies.