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Air Force updates mental healthcare waiver timeline for aviators, lowers barriers

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  • Air Mobility Command Public Affairs

On Jan. 28, 2022, Gen. Mike Minihan, commander of Air Mobility Command, tweeted, “Warrior Heart. No Stigma.” with a screenshot of his calendar revealing an upcoming mental health appointment, thus beginning a movement within AMC to eliminate stigma, lower barriers and increase access and options to support Airmen mind, body and craft.

It also inspired the establishment of AMC’s Warrior Mental Health working group, which focused their effort on establishing pathways to care, strengthening command teams and reviewing, and where necessary, advocating for updates to regulations regarding mental health based on current standards.

In a step forward in lowering barriers, the Air Force updated the mental health waiver timeline in the Air Force’s Medical Standards Directory. The timing of grounding for an airman under treatment has shifted to allow for an adequate trial of treatment for certain mental health diagnoses before a return to flight duty waiver is required. This change benefits Airmen across the Air Force seeking treatment for stress, post-traumatic stress and other mental health-related concerns by allowing for and encouraging earlier action.

“The goal is and has always been to ensure members have prompt access to appropriate care and promote the safety of flight,” said Col. Richard Kipp, Air Force Medical Service Medical Standards Program Chief.

Per policy, aviators are restricted from flight status by their flight surgeon when dealing with health conditions that could impact safety of flight. This remains the case for many mental health concerns. With the new guidance, Airmen who seek care and are ready to return to full duty within 60 days of treatment initiation will be allowed to do so without a lengthy waiver process.

For Airmen who need to remain in non-flying status for more than 60 days from the start of treatment, the new guidance allows their flight surgeon to submit the return to duty waiver request as soon as the member has been deemed fit for a full to return to duty.

Previous guidance only allowed for 60 days in a non-flying status from the time of diagnosis, rather than after 60 days of treatment before a waiver was required. In some cases, this distinction meant the difference between an immediate return to duty or a lengthy waiver process due to appointment availability and wait times to see a mental health provider.

Maj. Jane Marlow, a C-130J Super Hercules pilot and the Warrior Mental Health working group lead, was motivated by personal experience.

“Like so many of my peers, I delayed seeking care until I was in a non-flying assignment because I knew that, as a pilot, the moment I picked up the phone to schedule that appointment, I would be grounded for an indefinite period,” Marlow said. “The trauma care I went through was life changing. I knew that I was, without a doubt, a safer pilot, a better leader, and a stronger wingman because of the care I received – yet I was still required to spend months in a non-flying status because of my diagnosis.”

Thanks to Marlow, her cohort, and medical experts, that has now changed.

Prior to the updated guidance, special duty Airmen like pilots, Career Enlisted Aviators, or Air Traffic Controllers faced significant amount of time in a non-fly/control status while undergoing evaluation, and treatment prior to being able to submit a waiver for return to duty. These long periods could have harmful impacts on careers, including delaying upgrades, formal training, and eligibility for developmental programs and opportunities.

Now, for mental health diagnoses, flight surgeons can submit the waiver earlier in the process for an Airman seeking mental health treatment.

“If you want to look at a pilot with PTSD, you’re looking at one right now,” said Minihan to his command teams during the Spring 2024 Phoenix Rally. “This [waiver timeline] affects me and if it affects me, it affects someone in your unit—they have it, haven’t sought help for it and suffering in silence. It is incredibly powerful work by this team to lower the barriers to mental health care for our Warrior Airmen.”

The Warrior Mental Health working group included over 50 members, 12 aviation psychologists, a pilot physician, flight surgeons across the Joint Force, and a specialized doctor from NASA. Two of the key contributors were Lt. Col. Sandra “Salty” Salzman, C-130J pilot and Lt. Col. Carrie Lucas, AMC Behavioral Health Branch Chief. They were warned it could take a long time to achieve the changes they sought, but through passionate leadership and by presenting sound evidence, they inspired change within a year.

“As a pilot-physician, I have the unique opportunity to advocate to for change with leadership as a subject matter expert.” said Salzman, “In this capacity, I presented new considerations based on mental health medical research and operational truths. Based on these new considerations, [the working group] suggested portions of the guidance be amended, considering our evolving understanding of human responses to stress and development of resilience through early treatment.”

“From a mental health perspective, this change is exactly what we need and is in line with General Minihan’s charge to reduce stigma and allow for Airmen to seek help when needed,” said Lucas.

Editor’s Note: This article was updated on May 10, 2024, to add additional clarity to the guidance changes.