The South African aviation industry has been in a state of distress for many months, even before the COVID-19 pandemic came along and halted flying worldwide. During the time of the hard lockdown levels 5 and 4, when all flying ceased, there were many worried aviators wondering “what comes next”? This is over-and-above any talks of airline liquidations, business rescue and restructuring.
Naturally, many people have struggled to cope with the uncertainty, the financial impact and the loss of a profession that is more a passion than a job. It may even be that some people found themselves suffering from anxiety and depression, and sought medical help.
Whilst your mental health may be daunting to address due to fear of being stigmatised, incurring additional medical expenses and ultimately being grounded, the SACAA’s Mood Disorder Protocol seeks to ensure the longevity of your career in a healthy and manageable way. As aviators our first responsibility is to ensure we are SAFE. As such, the decision to address your mental health is an easy one, but requires great courage. The process that follows however may be challenging to manage at times.
Some see the SACAA Mood Disorder Protocol is a progressive protocol in terms of world standards. It has been a godsend for pilots suffering from anxiety, depression and PTSD, as in the past a diagnosis of depression/anxiety was grounding. What it boils down to is that aircrew are now able to resume their flying careers after diagnosis.
Let’s outline the basics of it:
1. The CAR Part 67.00.9, Duties of the holder of a Medical Certificate, states that if you are aware of any medical condition which could affect the validity of your certificate, you are obligated to ground yourself and report the condition to your DAME. If you feel you are suffering from depression and/or anxiety, ask your DAME for a referral to a psychiatrist who has a knowledge of aviation, if possible, otherwise get a referral from your GP.
2. Print out and take along the SACAA Mood Disorder Protocol to your first appointment with the doctor. The psychiatrist or GP will need to know what medications can be used to treat you and still allow you to continue with your career. To find the protocol, go to www.caa.co.za Legislation — Technical Standards (Personnel Licensing) — SA-CATS 67 Medical Requirements — Schedule 30: Protocol on Mood Disorder (depression).
3. In addition, print out and take along the list of approved medications which is found in Part 67.00.9(1). www.caa.co.za – Legislation — Technical Standards (Personnel Licensing) — SA-CATS 67 Medical Requirements — 67.00.9 1. Medication and Flying.
4. Manage your expectations and note that your depression will not be “cured” after taking the first pill. Everyone is different; however, it can take weeks and sometimes months for anti-depressants to take effect. Also note active flying duty limitations when taking certain medications, for example one is not permitted to fly on anti-anxiety medication.
5. The protocol stipulates an initial grounding period of at least 3 months. This is to ensure that the medication has had adequate time to take effect, and that you are symptom and side-effect free.
6. You will also need to consult with a psychologist, and please note that the protocol specifically states a CLINICAL psychologist, not a counselling psychologist. It is quite handy finding a practice where the psychiatrist and the psychologist work together, as they can co-ordinate their efforts in bringing you back to health. Both of them will be required to submit regular reports in compliance with the protocol to the SACAA, and it is essential that they both have the same diagnosis. Differing diagnoses on the reports will be a stumbling block in getting your medical back.
7. Once you have completed the initial 3-month grounding and have been symptom and side-effect free for a period of at least 4 weeks, you can begin the process of applying for recertification. Your case will have to be presented at the Aeromedical Panel.
8. Ask your psychiatrist for a report detailing: the diagnosis, length and course of treatment, type and dosage of anti-depressant, any side effects that were experienced, and confirmation that you are now side-effect free. Additionally, you will need to complete the HAMD 17 (Hamilton Depression Scale) which is a requirement of the protocol. The report will need to include a HAMD score on diagnosis, and a current HAMD score of consistently less than 7. Your clinical psychologist will also need to supply a report responding to similar criteria as required from the psychiatrist.
9. Take all of the paperwork mentioned above to your DAME, who will submit them to the SACAA for consideration at the next monthly Aeromedical Panel. The Aeromedical Panel usually sits on the second-last Tuesday of every month. The documentation needs to be submitted 7 working days before the scheduled sitting of the Aeromedical Panel. Being granted permission to fly on the protocol has some particular restrictions with which you need to be familiar, and which include the following:
• You will be restricted to multi-crew flying only.
• For the first six months you will be required to submit a monthly psychiatrist report. Then a follow up at 9 months, then another at 12 months, and thereafter at 6 monthly intervals for as long as you hold a medical.
• If at any time your psychiatrist changes your medication or dosage, you will have to be booked off flying again until such time as you are symptom and side-effect free on the new medication or dosage.
• If you come off the medication, and have a subsequent episode of depression, you will be disqualified from flying due to the safety implications of being mentally unstable. As such, it is recommended to remain on anti-depressants as per your psychiatrist’s recommendation for the remainder of your flying career.
The protocol process can seem quite daunting when first tackled, but if you take it step-by-step, and are armed with all the information as presented in the two documents mentioned above, the process should be smooth and easier to navigate.
If during this process you require support please make use of the support of friends, family and MAYDAY-SA.