An off-duty Alaska Airlines pilot’s alleged midair sabotage attempt of a Horizon Air flight from Seattle to San Francisco on Sunday — and the pilot’s later admission that he had been depressed — highlights the major concerns that pilot mental health poses to the airline industry.

It was an issue that came to international attention when a Germanwings copilot in 2015 locked the captain out of the cockpit midflight and deliberately dove their Airbus into the French Alps, killing all 150 aboard. At that time, the FAA reviewed and revised its mental health policies for flight crews. But experts say that seeking treatment can cost pilots their wings.

“If you’re crazy enough to admit you have a mental problem, that’s basically the end of your career at an airline,” said Ross “Rusty” Aimer, a retired airline pilot and CEO of Aero Consulting Experts. “We as pilots hide anything that has to do with mental illness. It’s sad. We need to at the airlines do a better job of addressing mental health and not make it a taboo subject.”

The pilot involved in Sunday’s incident, Joseph David Emerson, 44, of Pleasant Hill, remained in custody Wednesday in Portland, Oregon, where the flight he was taking was diverted after he allegedly attempted to shut down the jet’s engines. He had been riding as a guest in a cockpit jump-seat when he suddenly threw off his headset, announced “he was not OK,” and grabbed shut-off handles before being wrestled away by the pilots. Authorities said Emerson reported having suicidal thoughts while in custody and was being closely monitored.

State authorities have charged Emerson with 83 counts each of attempted murder and reckless endangerment of others — one for each of the other people on the plane, including 11 children under age 14 — as well as endangering an aircraft. His next court hearing on those charges is Nov. 1. Federal authorities have charged Emerson with interference with a flight crew, for which he is scheduled for arraignment Thursday.

Affidavits filed in support of the state and federal charges said Emerson told police that he’d struggled with depression for as long as six years and had just lost his best friend. He told investigators that he’d taken “magic mushrooms” 48 hours earlier, was dehydrated, hadn’t slept in more than 40 hours and was in mental crisis. He told police that he seized the controls “because I thought I was dreaming, and I just wanna wake up.”

Mental health crises linked to deadly air crashes are rare. But given the nature of the airline industry, the potential for disaster is high if anything’s mentally amiss with the folks in the cockpit — their hands on the yoke sticks at 30,000 feet in the sky.

The Federal Aviation Administration did not respond to questions about pilot mental health screening Wednesday. But its website says FAA regulations require airline pilots to undergo a medical exam every six months to five years, depending on the type of flying they do and their age. Aviation Medical Examiners are trained to determine the pilot’s mental health and fitness to fly.

The regulations require pilots to report any medical visits during the previous three years, all medications they are taking and other medical history, and pilots must disclose all existing physical and psychological conditions and medications. The examiner may ask further questions and can request additional psychological testing.

But the FAA also says it is “reducing the stigma of mental health to help pilots receive care.” The FAA said it “encourages pilots to seek help if they have a mental health condition since most, if treated, do not disqualify a pilot from flying.”

The regulations specify that certain medical conditions such as a psychosis, bipolar disorder and some types of personality disorder automatically disqualify a pilot from obtaining an FAA medical certificate. The FAA’s posted mental health policy doesn’t say how it handles depression in pilots, and the linked regulations don’t mention it.

But William R. Hoffman, a physician and FAA aeromedical examiner, wrote in a November 2022 Scientific American article that, in practice, the regulations bar pilots from the cockpit for months and sometimes years for mild anxiety or depression. He argued in the article that “We must rethink the system that drives pilots from attending to their mental health and change what seeking mental health care services means in aviation.”

The Air Line Pilots Association International, which represents pilots at many large carriers including Alaska Airlines, said in a statement that “it is important to remember that the airline pilot profession in North America is one of the most highly vetted and scrutinized careers, and for good reason.”

“U.S. pilots are continuously evaluated throughout their careers through training, medical exams, crew resource management, and programs such as the Line Operations Safety Audit, as well as by the airline and during random flight checks by the Federal Aviation Administration.”

Susan J. Lewis, a licensed psychologist and lawyer in Denver who has worked with several pilots, said the FAA rules allow for a more nuanced approach to treating depression and that it’s not necessarily a career-ender for them.

“It’s on a case-by-case basis. It would depend on if the clinician believed the pilot could fly safely,” Lewis said. “The FAA is trying to be sensitive to mental health and the stress pilots go through. But with any governmental organization, the wheels turn slowly. I always think more things can be done in terms of mental health.”

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Lewis said she wasn’t a fan of one change implemented since the Germanwings crash: The FAA’s encouragement of pilot peer support programs organized by airlines and unions.

“Pilots are pilots, not mental health practitioners,” Lewis said. “There’s a difference between needing support and needing mental health care.”

But Lewis said the FAA has eased its policy toward antidepressants, allowing their use in some cases. And Aimer noted that the FAA recently changed the way it views transgender pilots, so it’s no longer treated as a disorder requiring additional medical scrutiny.

Aimer said the FAA has done better at dealing with substance abuse among pilots, but that mental health remains a challenge. There have been several pilot suicides following stressful airline mergers, but “it’s a taboo subject, and everybody wants it to go away.”

“I wish I knew all the answers — I don’t, I’m not a psychiatrist,” Aimer said. “We need some really serious minds and professionals to address this properly.”

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