Like anyone, pilots and air traffic controllers can develop anxiety. Experiencing anxiety doesn’t mean you can’t fly or carry out aviation activities.
CASA recognises that mental health conditions like anxiety vary in severity and impact. For aviation medical certification, CASA takes a case-by-case approach. We consider the type of anxiety, how well it’s managed, and whether the symptoms or treatment affect aviation safety.
The statistics
The Australian Institute of Health and Welfare says that anxiety is the most common mental health condition in Australia. Feeling stressed and worried is a normal part of life. Most people can manage these feelings when they understand why they happen. Simple strategies like relaxation or counselling often help.
Sometimes stress and worry become severe and cause ongoing problems. In these cases, doctors may diagnose you with an anxiety disorder.
Effects of anxiety on operators
Anxiety disorders can include extreme fear and worry. These feelings can occur without a clear reason and are hard to settle.
Physical symptoms can include:
- heart palpitations
- heart pounding
- shaking hands
- nausea, vomiting and diarrhoea
- poor sleep
- headaches
- trouble concentrating or thinking clearly.
It’s important you see your GP if you have any of these symptoms.
Do not fly or control aircraft during this time. These symptoms can affect your ability to do safety-critical tasks.
Some medical conditions have similar symptoms to anxiety. These include problems with the thyroid, heart or stomach. Your GP can make the right diagnosis and get you the right treatment.
Other mental health conditions are similar to anxiety disorders. These include phobias and panic disorder. These affect people in very different ways.
Effects of treatment on operators
Treatment for anxiety usually includes:
- lifestyle changes, like avoiding alcohol and caffeine
- getting good quality sleep
- making healthy food choices
- therapy with a clinical psychologist
- medication in some cases.
Medications used for anxiety that can affect aviation duties as they can affect how people think and behave. It’s important that you discuss any medication with your DAME, and not return to flying duties until you are cleared by CASA or an authorised DAME.
With treatment, symptoms often ease over time. You can usually return to normal activities.
Symptoms may return, but using psychological and wellbeing strategies reduces how often and how severe they are.
Approach to medical certification
Every case of anxiety is different. This is general guidance only.
Each person responds differently to treatment. This makes it hard to predict when you can return to aviation duties. Most people return once the symptoms settle, and the treatment or medication remains stable.
Mild to moderate anxiety
You can continue to fly or control aircraft if you have well-managed mild to moderate anxiety and have been cleared by CASA or an authorised DAME.
You are considered to have mild to moderate anxiety, for aeromedical purposes, when you are managing your anxiety with either:
- strategies from a counsellor or psychologist
- an approved medication such as:
- fluoxetine
- sertraline
- citalopram
- escitalopram
- venlafaxine (low-dose only)
- desvenlafaxine.
- fluoxetine
Your medical certificate will generally be suspended while you start treatment and work towards recovery. Once you are stabilised and symptoms have resolved, CASA or an authorised DAME can clear you to return to flying or controlling.
In some cases the medical certificate may have conditions relating to your aviation duties and operations, or may require extra reporting from your health care providers.
Severe anxiety
Some individuals experience more complex and severe forms of anxiety. Severe or high-risk anxiety is where you:
- have symptoms that stop you from doing normal daily activities at home, at work or socially
- have symptoms that continue or occur often (several times a year)
- are using multiple medications to manage your symptoms
- are using any medication that causes sedation
- require treatment in hospital
- have thoughts or behaviours that could harm yourself or others
- are using substances such as alcohol and other drugs
- have another mental health diagnosis at the same time as anxiety.
These situations require careful management to ensure both personal wellbeing and aviation safety. You may need a longer period to recover before returning to aviation duties, often around one to 2 years.
CASA works closely with treating specialists to assess readiness. We may apply additional conditions to a medical certificate to support safe return to duty.
You may also need extra conditions on your medical certificate to manage your risk profile. Ongoing specialist review and regular mental health reporting are usually part of the process for any medical certificates issued.
Seeking help
Your DAME or treating doctor can give advice and treatment options.
Peer support programs are also available across the aviation industry. These connect you with trained peers who understand the pressures of flying and aviation work.
Many employers, including airlines, also provide employee assistance programs. These offer free, confidential counselling for a wide range of personal and work issues.
If left untreated, mental health problems can affect aviation safety. Like physical illness, treatment may require time away from aviation duties. Most pilots and air traffic controllers with treated anxiety disorders can return to their roles.
Seeking help protects safety. It also helps you feel and perform at your best.