Mental Health/NAMI/Med Boards…. for a friend.

[FinkUFreaky]

Of course, and this is by no means limited to mental health. Ultimately there are standards in place for safety reasons, and we have to rely on individuals to self report… even if they risk permanently DQing as a result.

I’ve dealt with crippling gout. It sucked. But didn’t want to be med down. Imagine if I had schizophrenia. I probably wouldn’t have reported it. They do need to come up with a better system for mental health; I’ve dealt with it with an ex that was able to get help, but not many NA’s would ask for that help. I’m proud of the OP’s “friend” for doing so, but I wouldn’t have likely in his shoes, hence the problem. FAA has a big problem with it too.

 

[FinkUFreaky]

I might have also taken ibuprofen before flying, without asking my flight doc. Just saying. There’s the rules, and you should follow them, but if you know reporting a mental illness would end your career, whether in the navy or the show, the smart person would try to cope. Maybe I’m mentally ill in that scope, but I think that’s what’s most who are relying on/enjoy their professions would do. So policies that encourage hiding problems (like everything in Naval agitation) don’t help actual health. I get safety of the crew, and the pilot needs to be able to fly. I just agree there might be some benefit to having some sort of mental health coverage. Or relaxing the absurd OTC meds rules. Makes it easier to be in compliance while being responsible.

 

[Swanee]

But should it be treated as a medically disqualifying condition? Are you really being objective on this subject, or just lamenting that people with conditions that place their reliability in the air in question no longer get to do fun stuff?

Yeah that's tricky, right? I don't think all mental health disorders should be disqualifying and I think our medical standards are stuck in the mid 80s at best wrt to mental health. There are some big ones that military service and flying just aren't compatible with. Schizophrenia, Bipolar Disorder, Borderline Personality Disorder... you're not flying in the military with those, and never will. Depression? That's a curious one.

Think of the big injuries guys have gone through, one's where they almost died- car accidents, ejections- and spent multiple months if not years rehabbing, only to finally get back into the airplane once they could prove they had a handle on their health and could do it again. Perhaps they have some limit (no single pilot aircraft for instance) but they're back. I know a guy who is still flying and considered deployable with Type 2 Diabetes. It took a lot of effort, but it happened. Guys have had cancer and came back after a time.

We don't give the same consideration to someone in a depressive episode. Anything that requires any type of meds for any amount of time is pretty much a career and service ender. They'll give out opioids like candy for back spasms, but if you're going through a divorce and are looking at losing your kids and need a couple of months of Lexipro to stay level, you're out.


MFLACs and MilitaryOneSource are great resources, and provide decent short term talk therapy. But that's not a get well plan, that's pretty much one step above crisis intervention. Our get well plans with mental health don't involve getting back to one's job.

 

[Brett327]

I guess my larger point is that those standards haven’t changed for decades even with significant advances in how metal health is treated.

I'm all for NAMI reevaluating the impact of modern treatment methods, but I don't think either of us are qualified to presume that those necessarily change anything WRT conditions being DQ. In most cases, they want you to be off meds and symptom-free for a period of time, which I don't think is likely to change. I would imagine that thoroughly studying how various psychiatric drugs affect people in an aeronautical environment would be enormously expensive, so not likely to be a good use of resources, considering the relatively small number of Aviators it would impact.

I know that's not what some people want to hear, but most policy decisions are based on risk/reward, and I don't think this meets the mark.

 

[Brett327]

I’ve dealt with crippling gout. It sucked. But didn’t want to be med down. Imagine if I had schizophrenia. I probably wouldn’t have reported it. They do need to come up with a better system for mental health; I’ve dealt with it with an ex that was able to get help, but not many NA’s would ask for that help. I’m proud of the OP’s “friend” for doing so, but I wouldn’t have likely in his shoes, hence the problem. FAA has a big problem with it too.

I hear you. I don't think there are any easy answers to this.

 

[Brett327]

I don't think all mental health disorders should be disqualifying and I think our medical standards are stuck in the mid 80s at best wrt to mental health.

And you make this judgement based on your years of clinical work as a psychiatrist? I hear your frustration, but I don't think you're being objective.

 

[Swanee]

And you make this judgement based on your years of clinical work as a psychiatrist? I hear your frustration, but I don't think you're being objective.

Yep, ad hominem away. That's the Brett we know.


One doesn't have to be an MD or clinical psychologist to compare the latest edition of the DSM with the practices of Navy (or Air Force) medicine, much less the NAMI waiver guide.

Given the attitude towards mental health, you're not going to find a long term study of pilots with any type of mental health disorder, no matter what treatments are available. Nor is anyone going to recommend a study.

So we continue down this same path.

 

[insanebikerboy]

Yep, ad hominem away. That's the Brett we know.


One doesn't have to be an MD or clinical psychologist to compare the latest edition of the DSM with the practices of Navy (or Air Force) medicine, much less the NAMI waiver guide.

Given the attitude towards mental health, you're not going to find a long term study of pilots with any type of mental health disorder, no matter what treatments are available. Nor is anyone going to recommend a study.

So we continue down this same path.

The problem, as I see it with mental health, is it’s not as black and white as other physical ailments.

Dudes tear an ACL, has a collapsed lung, steel rods in their legs from wrecking a motorcycle (all actual examples of people I personally know), the doctors can fix them and then have a pretty good prediction that the leg, lung, etc, will keep working.

Contrast with mental health, unfortunately I’ve had a few friends (flyers and non-flyers, civilian and military) who had mental health concerns, got medical treatment, appeared to be doing better, and then ended up committing suicide. I’ve yet to meet a guy who tore an ACL in an accident who then decides to tear it again, on purpose.

That outcome is what I think NAMI and the docs are trying to avoid. Does it suck a pilot can’t fly anymore? Of course it does. It’d suck a lot more if a pilot with severe depression relapses while flying and decides to invert and pull.

Sometimes medical issues and flying don’t mix, and that’s the hard truth we all have to accept. The unknown with mental health is the truly shitty part of it all.

 

[Brett327]

One doesn't have to be an MD or clinical psychologist to compare the latest edition of the DSM with the practices of Navy (or Air Force) medicine, much less the NAMI waiver guide.

Yeah, I think you do if you're determining standards for NAMI.

 

[sevenhelmet]

The problem, as I see it with mental health, is it’s not as black and white as other physical ailments.

Dudes tear an ACL, has a collapsed lung, steel rods in their legs from wrecking a motorcycle (all actual examples of people I personally know), the doctors can fix them and then have a pretty good prediction that the leg, lung, etc, will keep working.

Contrast with mental health, unfortunately I’ve had a few friends (flyers and non-flyers, civilian and military) who had mental health concerns, got medical treatment, appeared to be doing better, and then ended up committing suicide. I’ve yet to meet a guy who tore an ACL in an accident who then decides to tear it again, on purpose.

That outcome is what I think NAMI and the docs are trying to avoid. Does it suck a pilot can’t fly anymore? Of course it does. It’d suck a lot more if a pilot with severe depression relapses while flying and decides to invert and pull.

Sometimes medical issues and flying don’t mix, and that’s the hard truth we all have to accept. The unknown with mental health is the truly shitty part of it all.

To make all this even more complicated, the DSM-5 has gone from a 103 page manual that listed 106 disorders (in the 1950s), to a 947 page "NYC phone book", listing literally thousands of disorders, symptoms, and demographic data.

I was talking to a friend who is a longtime physician about this recently. His professional opinion (his words) is it's probable that anyone who walks into a psychologist's office today for a one hour appointment could be diagnosed with at least three mild mental disorders per the current DSM-5. He also said something like a third of people have something undiagnosed that could be classified as moderate to severe under current guidelines. And now you know the story of how I learned what the DSM-5 is and what it's used for.

Have NAMI and other military medical authorities appropriately taken those changes into account? My friend's opinion is no, and that's coming from a retired O-6 Navy flight surgeon.

 

[zippy]

Off the record, for a friend, of course. I’m trying to get some information regarding processes for being DQ’d while on flight status (Tactical Jets).

Long story short, there’s a high probability that “my friend” has been diagnosed with “Major Depressive Disorder, Recurrent, Severe” as well as anxiety and PTSD and has been suggested to get placed on medication from this outside doc.

Unfortunately, this is obviously a hard downer, and as far as I can tell, and waivers aren’t recommended after treatment for multiple episodes.

My questions for “my friend” are:

1. What is the process once DQ’d after winging with about half your commitment left? Are you sent through a FNAEB? Do they take your wings or just ground you?

2. If grounded, what does the Navy do with you? Are you punished and sent to a ship for 4 years or do they send you to Diego Garcia to continue your depression but on an island? Or do they medically discharge?

3. If medical discharge, what’s the process there?

Thanks, for the “academic” help, “for my friend.” I’m sure this question has been asked, but I can’t seem to find much for current aviators in a situation where the NAMI waiver guide says it’s not allowable.

I don’t have many specifics but what you’re going through is not extremely rare.

Talk to an attorney that specializes in med boards… I know a guy who’s got one for another issue. PM me and I can see if I can get the contact info.

I have a friend who had a Bipolar disorder. He stopped flying his first tour in helos and is out doing video game design work. I think that he DOR’d and then selected a full designator to re-designate to in order to get let out of his AD commitment.

I know two guys who had PTSD and one with a second psych condition- both fly in the civilian world. One is medically retired from it and the other has 90%+ disability rating.

Contact wingman medical for the FAA side of the house if you wish to continue flying. In the cases of the guys I know, .mil life tended to exacerbate their psych conditions due to command climate and working conditions and access to adequate care. Things improved for all three once out.

Good discussion on psych and military care or lack there of. There seem to be a lot more options on the outside. .MIL is probably at least 20 years behind. I know several people 03-06 who have paid out of pocket to see outside civilian psychotherapists/psychiatrists for care due to the stigmas and career ending nature such treatments bring inside.

 

[exNavyOffRec]

To make all this even more complicated, the DSM-5 has gone from a 103 page manual that listed 106 disorders (in the 1950s), to a 947 page "NYC phone book", listing literally thousands of disorders, symptoms, and demographic data.

I was talking to a friend who is a longtime physician about this recently. His professional opinion (his words) is it's probable that anyone who walks into a psychologist's office today for a one hour appointment could be diagnosed with at least three mild mental disorders per the current DSM-5. He also said something like a third of people have something undiagnosed that could be classified as moderate to severe under current guidelines. And now you know the story of how I learned what the DSM-5 is and what it's used for.

Have NAMI and other military medical authorities appropriately taken those changes into account? My friend's opinion is no, and that's coming from a retired O-6 Navy flight surgeon.

I put a psychiatrist in the USN who essentially told me the same thing, he said if he wanted to he could find something wrong with anyone he talked to.

Interesting thing is after I put him in the USN about a year later he did a psych eval on an applicant I had.

 

[Swanee]

The problem, as I see it with mental health, is it’s not as black and white as other physical ailments.

Dudes tear an ACL, has a collapsed lung, steel rods in their legs from wrecking a motorcycle (all actual examples of people I personally know), the doctors can fix them and then have a pretty good prediction that the leg, lung, etc, will keep working.

Contrast with mental health, unfortunately I’ve had a few friends (flyers and non-flyers, civilian and military) who had mental health concerns, got medical treatment, appeared to be doing better, and then ended up committing suicide. I’ve yet to meet a guy who tore an ACL in an accident who then decides to tear it again, on purpose.

That outcome is what I think NAMI and the docs are trying to avoid. Does it suck a pilot can’t fly anymore? Of course it does. It’d suck a lot more if a pilot with severe depression relapses while flying and decides to invert and pull.

Sometimes medical issues and flying don’t mix, and that’s the hard truth we all have to accept. The unknown with mental health is the truly shitty part of it all.

Yeah. I've known people who have had multiple shoulder, knee, or ankle issues that keep getting "fixed" only for them to continue to fail. After a couple of surgeries it's apparent that their body can't do the job.

Where I think the major failures are within our system is that people can't get a lower level of care. Let's take the overuse injuries we've seen for example. There no real equivalent for minor medical intervention in the mental health world to what we have with the physical health world. We can't go into a doctor and say," Yeah, I've been having these feelings lately, I think I need a break, or I don't know how to handle them or who to talk to about them." We can get help for that knee that we tweaked playing basketball, or our lower back that is aching and hurting after 10 years of abuse.

In my squadron we do have a mental health therapist. She's a part timer, and works on drill weekends. It's nice that she's read in to all of our programs so we can talk to her, and she's supposed to be on call. But what do we do if something in the mission goes sideways and someone isn't ready to go home and put on a happy face for the wife and kids? We pretty much only have the option to grab a couple of beers after the shift and talk about it. But we're not doctors- what do we really know about how to treat this?


If someone walked into a military sick call and said, "Man, that strike a couple weeks ago is sticking with me, and I'm not sleeping well, can't stop thinking about it and what I saw." They'd have a big fight trying to get back to flying. That's not okay.


I think this discussion exposes a lot of the thought around mental health- you're good until you're broken, and when you're broken, you break in such a way that there is no coming back. But we can get treatment for a tweaked knee that only requires a few days or weeks of light/limited duty/DNIF. We really don't have that option. We all know that if someone self reports for "stress" and ORMs out for 3 straight weeks the skipper and everyone else is going to up their ass about what's going on. But that same person get's crutches and opioids and 3 weeks of PT for their knees and they're back in the game.

 

[sevenhelmet]

If someone walked into a military sick call and said, "Man, that strike a couple weeks ago is sticking with me, and I'm not sleeping well, can't stop thinking about it and what I saw." They'd have a big fight trying to get back to flying. That's not okay.

Not sure I completely agree with this. On my last deployment, we had MH resources you could turn to (not sick call) and say exactly this, without immediate impact to flight or duty status. Our squadron leadership was awesome about it- after we were repeatedly extended, I had several sailors take advantage.

I think this discussion exposes a lot of the thought around mental health- you're good until you're broken, and when you're broken, you break in such a way that there is no coming back.

I get this- it’s exactly what I thought when I finally admitted I needed to talk to someone. Nobody understands the “exit criteria” for treatment, because they’re not the same for everyone. So, it causes patients to clam up, and (some) leaders to stop trusting folks who admit they needed help with the struggle.

That’s why I think early intervention is key. If it gets to a formal psych diagnosis, we have failed as leaders.

But we can get treatment for a tweaked knee that only requires a few days or weeks of light/limited duty/DNIF. We really don't have that option. We all know that if someone self reports for "stress" and ORMs out for 3 straight weeks the skipper and everyone else is going to up their ass about what's going on. But that same person get's crutches and opioids and 3 weeks of PT for their knees and they're back in the game.

The difference is physical symptoms. Mental stuff is often hard to see, and when everything is a potential mental health disorder, it’s a minefield of “is the real, or made up”?

The solution is complex, but I think there are a lot of potential mitigations between ignoring something and dropping off the flight schedule for 3 weeks.

 

[cfam]

Not sure I completely agree with this. On my last deployment, we had MH resources you could turn to (not sick call) and say exactly this, without immediate impact to flight or duty status. Our squadron leadership was awesome about it- after we were repeatedly extended, I had several sailors take advantage.

I get this- it’s exactly what I thought when I finally admitted I needed to talk to someone. Nobody understands the “exit criteria” for treatment, because they’re not the same for everyone. So, it causes patients to clam up, and (some) leaders to stop trusting folks who admit they needed help with the struggle.

That’s why I think early intervention is key. If it gets to a formal psych diagnosis, we have failed as leaders.


The difference is physical symptoms. Mental stuff is often hard to see, and when everything is a potential mental health disorder, it’s a minefield of “is the real, or made up”?

The solution is complex, but I think there are a lot of potential mitigations between ignoring something and dropping off the flight schedule for 3 weeks.

Completely agree. I’ve had the same experience in my current squadron. We haven’t had issues getting aircrew (and sailors) back in the fight if they haven’t been prescribed medication and aren’t a danger to themselves. A few weeks down has been a non-issue.