New guidance for pilots and ATCS who would like to seek counseling or psychotherapy was released in the May 2026 update to the Guide for Aviation Medical Examiners. This guidance is the latest in a series of updates that have been released since 2024 with a goal of aligning the AME guide to reflect current mental health science and practices. Instead of making determinations of mental fitness based solely on the existence of a diagnosis, the AME guide now takes a safety-based approach, evaluating each applicant’s specific symptoms and treatment for aeromedical relevance.
The full list of decision considerations for psychiatry (Item 47) can be found here: https://www.faa.gov/ame_guide/app_process/exam_tech/item47/amd
The newest guidance, Therapy, Psychotherapy, and Counseling Information: Pilots/ATCS encourages professionals to focus on their mental health first. The FAA has provided two key documents; one is written for the aviation professional, and the other is to be given to your chosen mental health professional. In the Therapy, Psychotherapy, and Counseling FAQs for Pilots and ATCs, the FAA answers many common questions for those seeking mental health support. These questions include when to report, when to ground, and what records would potentially need to be shared. This guidance also suggests consulting with a Pilot Peer Support Program, your AME or primary care physician if you need guidance in finding a mental health professional.
The USHST launched the Peer Pilot Program in 2025, which is administered by the Centre for Aviation Psychology. This program is free and confidential, and you can learn more at https://www.ushstpeer.org/ It is an excellent first step in self-care, as you will be connected with a fellow aviation professional who has been trained in psychological first aid and related topics. The program is overseen and supported by a licensed mental health professional who specializes in aviation mental health. If your needs extend beyond the scope of peer support, they can help you navigate finding a licensed professional.
Aviation professionals can send their chosen mental health professional the new Information for Psychotherapists Treating Pilots and ATCS. This document clarifies the information that may be needed by the AME to determine aeromedical safety and fitness for duty. This guidance advises therapists to only send necessary documentation (not detailed process notes!), provides sample wording for clarification, and emphasizes the importance of accurate clinical documentation. There are now 11 diagnoses and Z/V codes that can cleared by your AME by using the Anxiety, Depression and Related Conditions Disposition Table, which has significantly reduced the rate of application deferral.
While most mental health concerns can be effectively managed through peer support or treated in talk therapy, the FAA recognizes that antidepression medication may be needed for some. The Antidepressant Protocol was updated Dec 2025, reducing the observation period on medication from six (6) months to three (3). Application review times have also been drastically reduced from months to weeks.