Mental Fitness to Fly: Psychiatry Updates & the HIMS Programcivilavmed.org/wp-content/uploads/2016/12/Dr_Danczyk_Presentation_A..pdf · ©2016 MFMER | slide-20 CHALLENGES • Getting

©2016 MFMER | slide-1

Mental Fitness to Fly: PsychiatryUpdates & the HIMS ProgramDaniel Danczyk, MD, MPHSenior Associate Consultant, Psychiatry & PsychologyCivil Aviation Medical Association Annual Meeting, Mayo ClinicSeptember 9, 2016


DISCLOSURE INFORMATION• Financial: Prior consulting for JetBlue (2013)• No off-label med use and/or investigational


OBJECTIVES• Discuss the challenges associated with

gathering data regarding mental healthevaluations of pilots

• Review and differentiate how mental healthevaluations required by the FAA are processed

• Discuss some preliminary findings of my surveyanalysis


AGENDA• Background

• HIMS• ARC Report

• Updates on HIMS• Renewals only

• Research Findings –Sneak Peek


Aviationweek.com



HUMAN INTERVENTION MOTIVATIONSTUDY (HIMS)

Himsprogram.com


Aircrewacademy.com

OccupationalAlcohol AddictionTreatmentProgram (1970s)

Drugs of Abuse

Alcohol / Drug Monitoring

4 SSRIs (2010)

HIMS today (2016)

SSRI Protocol


ARC REPORT

• Background• Commercial Aviation

Safety Team (CAST)• 370 / 9525 tragedies

• Relevancy to HIMS• Enhanced AME training• Pilot assistance programs• Professional reporting

Asma.org


MAJOR HIMS CHANGES

• Covers SI renewals ONLY• HIMS AME may issue 6 mo interim• Seeks to minimize differences b/t SSRI

& Drug / Alcohol• Provides new “Certification Aids”


STREAMLINING…

• Standardizes reports• All classes• In person exam q6 mo

• HIMS AME Report Evaluate ≠Summarize

• Send to OKC not DC• If concern (even no shaded areas marked) must defer & outline concern


SUMMARY –FAACERTIFICATIONAIDDRUG / ETOHRE-CERT

• HIMS AME• Lab testing• Psychiatry History Report• Aftercare• Chief Pilot• Peer Pilot• Additional providers




SUMMARY –FAACERTIFICATIONAIDSSRI RE-CERT

• HIMS AME• Psychiatrist Interim

Report• Psychologist /

Neuropsychologist• Chief Pilot• Additional providers


HIMS CHANGES – THEMES

• EACH PARTY• Clearly delineated req’ts• Explicit req’t to immediately report

changes (status of airman)• AIRMAN

• FAA “strongly” recommendsCertification Aid be provided toparties


HIMS AME CHECKLIST TAKE-AWAYS• Must indicate reviewed airman’s Auth Letter• Allows issuance of 6-mo med cert• Analogies

• “complicated” CACI – certain doc’m ≠submitted

• Quality improvement of formatting (MEB forAir Force)

• Consolidates between MH and SA


PROJECT BACKGROUND

• Survey request (ESAM)• Task force approval (EASA)


CROSS-SECTIONAL SURVEY• Aviation Professionals in MH / SA

• Gov’t, industry, private, military• Focus on medical certification process

• Initially keep to U.S. & Europe• Information gathered

• Demographics on those seeing airmen• Practice and process characteristics

• Services provided• How communicated mental health data

• Perceptions


CHALLENGES• Getting survey out

• ESAM (aviation medical authorities,psychologists, AMEs)

• Other groups• CAMA, AsMA, HIMS, Flight Safety, Flying

Physician Association• No response rate (no surprise)


GEOGRAPHIC BREAKDOWN

% of Respondees, N=308

U.S., n=177Europe, n=80Other, n=51

16.5%

26.0% 57.5% 257


European BreakdownBelgiumUKNetherlandsGermanyAustriaGreeceFranceItalySpainSwedenBulgariaNorwayPortugalSwitzerlandEstoniaHungaryMoldovaPoland

# countries=18Counts/countrydistribution:MIN 1MEDIAN 3MEAN 4.4MAX 14


What is your specialty and/or area ofexpertise? (Mark all that apply.)

0%5%

10%15%20%25%30%35%40%45%50%

U.S.Europe

* p < 0.05

*

*


PERSONAL AVIATION EXPERIENCE?

0%

10%

20%

30%

40%

50%

60%

70%

None* Lsns Solo Cert(s)*

U.S.Europe

14%

25%

15%17%

8%9%

30%

58%

* p < 0.05


Have you undergone any special training /courses / programs aimed at supportingpilots with mental health or substanceabuse concerns? (No/Yes)

0%

10%

20%

30%

40%

50%

60%

70%

No Yes

U.S.Europe

N=237, p=0.0843

51%

63%

49%

37%


[If “Yes”]: What was the name of thetraining/course/program? (Mark all thatapply.)

0%

5%

10%

15%

20%

25%

30%

35%

40%

45%

HIMS* Other

U.S.Europe

* p <0.05

*39%

6%

17%

28%


Mental Health Data Produced

0%

10%

20%

30%

40%

50%

60%

70%

Psych Eval* Counseling* Med Cert* Sent to Gov't*

U.S.Europe

* p < 0.05

11%

22%

1%

6%

33%

53%

37%

64%


Do you think providers in your country should berequired to report any pilot diagnosed with mentalhealth/substance abuse, or undergoingtreatment, to the aviation medical authority, andbe protected under the law if they do so?(No/Yes)

0%10%20%30%40%50%60%70%80%90%

NO YES

U.S.Europe

83%

17%

83%

17%

N=198 (no significant difference)


Should pilots with a history of bipolar disorder orpsychosis, with maintenance treatment and favorableprognosis, be considered for waiver orspecial consideration to return to flying? (No/Yes)

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

NO YES

U.S.Europe

66%

80%

34%

20%

N=198, no significant difference


CONCLUSION• HIMS & Beyond…

• Combating stigma and naysayers• ↑ Robustness of SSRI Protocol?• “HIMS” for other countries??

Huffingtonpost.com


Questions & Discussion

CONTACT INFO:[email protected]

Mental Fitness to Fly: Psychiatry Updates & the HIMS Programcivilavmed.org/wp-content/uploads/2016/12/Dr_Danczyk_Presentation_A..pdf · ©2016 MFMER | slide-20 CHALLENGES • Getting

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