'They need to get the care'

According to the NTSB, the pilot in command landed a damaged twin-engine Casa 212-200 at Raleigh-Durham International Airport after reporting over the radio that the only other crewmember aboard had jumped out of the airplane without a parachute. That co-pilot, identified in various media reports after the incident as Charles Hew Crooks, 23, was fatally injured in the fall. His brother, Crawford Crooks, urged the Charlotte News and Observer to "avoid speculation on his final moments, which are so much less important than the nearly 24 years of joy and wonder that he brought to everyone he met."

The North Carolina incident occurred during the week much of the aviation world was in Wisconsin attending EAA AirVenture Oshkosh. Three days before Crooks died, on July 26, AOPA hosted an interactive roundtable discussion on pilot mental health. Participating experts included the FAA's most senior medical certification official, Federal Air Surgeon Dr. Susan Northrup, who acknowledged the longstanding conundrum that has forced many pilots and aspiring pilots to choose silence over seeking support.

Northrup recalled another recent incident that has propelled a push for pilot mental health reform: John Hauser, a student training to become a professional pilot at the University of North Dakota who took his own life in a university airplane on October 18, 2021. Hauser's death prompted UND to take various actions including establishing confidential peer counseling and organizing a summit on mental health in aviation. Hauser's parents established a mental health initiative in his memory to create mechanisms to address concerns about coming forward at the perceived (and often very real) risk to one's aviation career.

"The scary part, to me, is he didn't get the help he needed because the myth was, if you ever admit to a mental health diagnosis you will never fly again. And that's relatively close to true if you get to the point where you've attempted suicide," Northrup said.

According to the NTSB preliminary report on the July 29 incident over North Carolina, the (so far unidentified) pilot in command told investigators the flight was en route to Raleigh-Durham after sustaining landing gear damage during an attempted go-around at Raeford West Airport in Raeford, North Carolina. Crooks had been the pilot flying when the aircraft approached that smaller airport to pick up another load of skydivers. Having flown a stable approach to low altitude, as reported by the PIC, the airplane suddenly "dropped" below the tree line on short final. Both pilots called for, and Crooks initiated, a go-around, the NTSB report states, but were unable to prevent a hard landing that sheared off the right main landing gear. Both pilots in the otherwise empty aircraft worked together to confirm the landing gear damage and set a course for the larger airport, where emergency services would be waiting.

About 20 minutes into that diversion, Crooks "became visibly upset about the hard landing," the NTSB report states. Investigators note that, according to air traffic control recordings, Crooks, who handled the radio calls during the diagnosis and diversion decisions, acknowledged a course heading in his final transmission. "The PIC described that about this time the SIC opened his side cockpit window, and 'may have gotten sick.' The PIC took over radio communications, and the SIC lowered the ramp in the back of the airplane, indicating that felt like he was going to be sick and needed air. The PIC stated that the SIC then got up from his seat, removed his headset, apologized, and departed the airplane via the aft ramp door."

The pilot left behind landed the airplane without being injured, though the damaged landing gear led to a runway excursion.

During the AOPA roundtable in Wisconsin that took place three days before the North Carolina incident, Penny Levin, a CFI with a doctorate who works as a clinical psychologist, said, "Pilot mental health is the elephant in the room," and that "mental health problems have skyrocketed since the pandemic."

Levin cited statistics including survey data that show about one in five people in the general population reported "symptoms consistent with depressive disorder," and nearly a third reported symptoms consistent with anxiety. Pilots, she said, have strong disincentives to seek help when they need it, noting that mental health has long been stigmatized. Many pilots see the act of seeking help as, "at best humiliating or embarrassing, at worst the end of our flying careers."

Anonymous surveys of pilots have borne that out, Levin added, noting that one study found 12 percent of active airline pilots reported symptoms consistent with depression, and 4 percent reported thinking about suicide. Similar studies have reached consistent conclusions, including one published in 2019 that found 56 percent of pilots avoided seeking needed healthcare "because of fear of not being able to fly," and another 27 percent admitted (anonymously) to lying on FAA forms.

"Mental health conditions remain high on my list of things we need to address within the FAA," Northrup said. She noted that the agency has added expertise to its staff evaluating various drugs prescribed to treat mental health disorders, including the four currently FAA-allowed selective serotonin reuptake inhibitors (SSRIs), a class of drugs used to treat depression. The Office of Aerospace Medicine has also added two more staff psychiatrists to address the increased number of psychiatric cases under review.

"There are in fact some conditions we don't ever waive, but we waive an incredible number of them," Northrup said. "But the trick is getting people to get the help they need early. Mild, minimal, moderate depression and anxiety are relatively easy to handle."

That may be true in the medical sense, but in the medical certification sense, reporting the use of SSRIs and other drugs triggers a deferral process that can delay medical certification for months or even years. Pilots taking part in that process may struggle to find trained mental health professionals amid a nationwide shortage that is particularly acute regarding aviation medicine. The FAA, Northrup said, is "trying to shove those decision points down further to the [aviation medical examiner]."

Northrop referred attendees to an agency podcast posted in May (during Mental Health Awareness Month) in which she discussed other measures that could help, including development of peer support networks "where some people are actually frightened of talking to us to a certain extent that maybe they wouldn't be so frightened initially, of going to a peer, a fellow pilot, or somebody in the university or the local FBO that can give them good advice … So once we talk about and once you recognize that then we can legitimately intervene by using some of these tactics and skills that are less concerning or threatening to an airman or a young person, in general."

In Oshkosh, Northrup emphasized the importance of early intervention, and the importance of changing an aviation culture that has long stigmatized some of the most common health afflictions.

"We need to change the mindset so that people come forward and get the help they need before they take some drastic action," Northrup said. "We're going to see what can be done to make this process easier… We want to get as many people in the air that it's safe for them to do."