The dark side of flying: fear of grounding deters pilots from seeking help for mental health concerns

The Hindu

25-07-2025

A day after the world saw live visuals of Air India's Boeing 787-8 aircraft turn into a massive fire ball 32 seconds after taking off from Ahmedabad for London on June 12, a pilot commanding the Air India Delhi- Frankfurt flight suffered a panic attack as he lined up the aircraft on the runway.
The pilot, who was operating the same type of aircraft involved in the crash, a Boeing 787, promptly returned it to the boarding gate after informing the air traffic control that a crew onboard had fallen ill.
A few days later, a young First Officer, also on Air India's Boeing 787 aircraft, reported sick for his flight as he couldn't sleep before his duty as his mind kept replaying the different scenarios that may have occurred inside the cockpit moments before the worst air accident in the country in three decades in which 260 people were charred to death.
'I was on a downward spiral,' the young pilot told The Hindu on condition of anonymity.
The last message he had exchanged with the First Officer on the AI flight, Clive Kundar, the social media feed and the relentless television coverage 'weighed a little heavy on me,' he said. He and a few friends 'cried it out' as an exercise in collective purging to cope with the tragedy that had struck their close colleagues.
In the days following the crash, many First Officers and cabin crew would report sick as they battled post-traumatic stress disorder (PTSD). Heightened safety concerns prompted many passengers too to cancel their Air India bookings.. This along with a combination of other factors that included additional checks ordered by the DGCA forced Air India to take a 'safety pause' and reduce international flights by 15% for a few weeks. The airline also reached out to pilots and cabin crew offering them peer support, as well as an in-house psychologist in case of mental health concerns.
The trauma among the crew post the crash and suggestions of deliberate pilot action resulting in a crash have once again brought under focus the mental health of Indian pilots who are known to be under tremendous stress because of a multitude of factors which include occupational challenges as well as systemic failures that excessively penalise the cockpit crew. But one of the dark secrets of the industry remains the reluctance among pilots to access medical help for mental health concerns because of a perception that they may either be grounded leading to loss of pay, or their licence will be cancelled.
'Some airlines provide pilots with relatively stable rosters, but in many others, unpredictable schedules and inadequate notice of changes disrupt personal routines, making it difficult to plan family or social time,' says Captain Subhashish Majumdar, a former airline executive and senior commander with long-haul international flying experience. 'In many organisations even casual leave requires prior sanction or has to be justified with documentary evidence , and calling in sick at the last moment can lead to administrative scrutiny. Additionally, time-zone changes, graveyard shifts and night flying can leave a pilot's body clock out of sync for days.'
Majumdar acknowledges that he personally benefited from a stable schedule during much of his career. But many others -- especially those flying high-frequency domestic sectors across the industry -- face relentless rosters and consecutive layovers that leave little room for rest or meaningful family engagement. 'Pilots across airlines speak of strained relationships, missed birthdays and school events, and the emotional fatigue of being physically present but emotionally distant.'
Over time, the cumulative toll of such schedules can strain personal bonds and foster a sense of isolation. Within aviation circles, this phenomenon is informally referred to as Aviation-Induced Divorce Syndrome.
Another challenge is the growing reliance on digital crew management systems. While efficient for record-keeping and cost control, these often lack the human touch. 'Raising tickets on apps or sending emails that go unanswered only increases frustration,' Majumdar explains. 'There's a big difference between being able to lift the phone and speak to someone empathetic, versus dealing with a faceless interface that offers no timely resolution. The absence of human engagement adds to the anxiety.'
He acknowledges, however, the pressure airline managements face. 'This is a cost-sensitive industry, with wafer-thin margins, volatile input costs, and fierce competition. Managements walk a tightrope between viability and crew welfare.
But passengers must also realise that improving pilot working conditions, safety buffers, and quality of life may ultimately require a willingness to absorb higher airfares.'
Despite growing awareness of mental health issues post-pandemic, many pilots remain reluctant to seek help for anxiety, depression, or burnout—not just due to social stigma, but out of fear that disclosure could affect their medical clearance and earning capacity. 'The concern is real,' says Majumdar. 'Even if stigma is easing, the consequences of seeking help are uncertain. In a profession where medical fitness determines livelihood, that becomes a serious deterrent.'
Indeed, a study in 2022 by William Hoffman, a US-based neurologist with interest in pilot health care behaviour found that 56.1% of the 3,765 U.S. pilots who participated in a survey reported a 'history of healthcare avoidance behaviour' due to a 'fear of losing their aeromedical certificate'. Indian pilots too speak of complicated, lengthy and inefficient regulatory processes that in some cases have led to year-long groundings for misdiagnoses deterring pilots from reporting medical concerns. The situation is likely to worsen for mental health concerns, exacerbated by stigma and a lack of clear guidance from regulators.
In February 2023, the DGCA issued a circular on 'mental health promotion' for flight crew and air traffic controllers, mandating airlines, charter operators, and flying schools to establish non-punitive peer-support programmes to encourage self-reporting. DGCA-empanelled doctors, who conduct pilots' annual medical exams, were directed to use a 29-question questionnaire to assess cognitive functions and alertness. Pilots with a poor score have to be referred to the DGCA's Medical Directorate.
On July 22, 2025, the DGCA reminded empanelled doctors to use the questionnaire. 'Some of us have since enquired the DGCA on how we are to grade pilots and whether it is to be done on a scale of 1 to 10 or alphabetically. We also need to know what is the protocol to be followed if and when we find a concern,' says Sangeeta Kujur, a DGCA-empanelled examiner and former Chief Medical Officer at Air India Express where she set up the peer support programme for the airline. But the medical circular provides no details to pilots about what this scrutiny may entail, and for which conditions.
Since the Germanwings crash of March 2015, deliberately caused by the first officer Andreas Lubitz who had been previously treated for suicidal tendencies and declared unfit to work by his doctor ,which he kept from his employer, regulators around the world have overhauled their policies. Europe introduced a pilot medical database, random health checks, and peer support programmes. The FAA clarified that mental health issues rarely disqualify pilots (0.1% rejection rate), listing conditions like psychosis and bipolar disorder that do.
The FAA's 2016 Pilot Fitness Aviation Rulemaking Committee recommended peer support, enhanced training for medical examiners, approved new medications that can be taken during active flying, and public campaigns to reduce mental health stigma, alongside maintaining a safe medication list for pilots.
MESAFE, an EASA-funded project under the EU's Horizon Europe, recognises pilots' reluctance to self-report mental health issues due to systemic shortcomings. It advocates Peer Support Programs that extend beyond medical interventions, and foster a mental well-being culture within a just-culture work environment. The project emphasises reporting and mitigating organisational stressors impacting the mental health of safety-critical aviation personnel.
( Mental health helplines across the country can be accessed here)