Flying High, Feeling Low: Why Pilots Need to Take Their Own Mental Health Seriously

As a psychologist who flies, I am constantly reminded that to safely operate an aircraft, pilots need to be “fit to fly”. That’s a phrase loaded with meaning as pilots are – quite rightly - held to high standards. In terms of mental health, the regulations require that a pilot must be free of significant symptoms of concern which might impair their ability to function. Very few conditions are permanently excluding but the requirement to maintain a current medical certificate can mean that a pilot should not be flying when those in other professions would be safe and able to continue working.

While the airline industry has taken significant steps to promote psychological well-being, pilots remain human and subject to the same stressors, social and psychological challenges we all experience. Aviation has a culture which can sometimes lag a few decades behind others in attitudes to factors such as mental health. In my experience, there is an above-average level of stigma associated with being unfit for mental health reasons and the pressure to “carry on” or maintain a “stiff upper lip” remains high. My experience is that pilots in general are high functioning and tend to cope well with the psychological challenges this sometimes peculiar profession can pose.

Surrounded by expectations of resilience and professionalism, the human inside the pilot’s uniform can be thought of as managing a constant balancing act. On one hand, the job provides meaning and valued experience, especially in terms of the skill and mastery flying involves, and the view out of my “office” window is among the best in the world. Pilots also work with teams of people with shared interests and understanding of procedure and culture. Those factors support psychological well-being. On the other hand, rostering and jet lag can challenge the basics we all need for good health of food, sleep and exercise. It can also interfere with social relationships at home and reduce the number of meaningful relationships we experience at work. To be fit to fly therefore demands investing time, energy and attention to a pilot’s physical and mental health.

Fear of being grounded

Perhaps the most common reason pilots avoid seeking mental health care is fear. The fear of being declared unfit. The fear of losing certification. The fear of being grounded—not by weather or technical fault—but by vulnerability.

That fear is not unfounded. For many years, regulatory approaches to mental health were rigid, risk-averse, and at times punitive. Disclosure of anxiety or low mood, even if well-managed, could trigger protracted investigations or restrictions. For a profession built on stability and forward momentum, this risk felt too high.

Though reforms have been made in some jurisdictions—recognising treated mental health conditions as compatible with safe flight—the legacy of silence persists. Too many pilots still assume that speaking up will lead to career derailment. And so they stay quiet, coping, or not coping, alone. That stiff upper lip and composure under pressure? Ironically, it can become a well-used mask for psychological distress.

But untreated mental health symptoms can carry far greater risk than disclosure ever could. Delayed reactions, impaired judgment, irritability, sleep disruption—these are not abstract clinical ideas. They are operational realities when psychological distress is ignored.

The relational cost of silence

The effects of untreated distress aren’t limited to the individual pilot. They ripple outward—into relationships, families, and team dynamics. Pilots often live in a state of flux: present, then gone; home, then airborne; alert, then depleted. The classic research on “intermittent spouse syndrome” is a sobering reminder that aviation careers bring challenges to social relationships, and thus mental health, seen in only a small proportion of industries.

Partners may describe feeling like emotional ground crew—responsible for managing re-entries and absences. Children learn to adapt to unpredictability. Friends grow distant. And for some pilots, coming home becomes harder than taking off—because it means confronting what’s been held at bay during duty.

Mental health care is not just about symptom reduction—it’s about protecting one’s capacity for connection, presence, and joy. It's about safeguarding the parts of life that exist outside the uniform.

A profession that absorbs more than it shows

There’s something unique about aviation: the culture, the camaraderie, the expectations. There’s pride in being trusted, in delivering people safely from point A to point B. There’s meaning in the quiet competence required.

But there’s also risk in the invisibility of distress. So many pilots have learned to function through grief, anxiety, insomnia, or trauma—because the job demands continuity. Because silence has been safer than disclosure. And when you’re flyinh with a different team tomorrow, the ability of colleagues to identify and support distress is very limited. That pilot with the reputation for being snappy recently? Is it a personality trait, temporary tiredness, a bad day or a significant cause for concern?

But functioning is not thriving. And coping is not healing.

The transition from “I can still do my job” to “I want to feel better” is subtle but essential. Because the cost of constant coping can be profound—and pilots deserve better than silent endurance.

What support might look like

Mental health care in aviation must be practical, confidential, and culturally attuned. It must acknowledge the nuances of licensing, the unique lifestyle pressures, and the performance expectations.

For some, support may look like brief psychological input to manage sleep disruption, stress, or transition. For others, it may involve a more sustained therapeutic relationship—one that offers reflection, recalibration, and emotional clarity.

What matters is that the pathway exists. That it’s visible, safe, and free from judgment.

And beyond individual care, peer networks, organisational cultures, and aviation medicine must all align in reducing stigma. Psychological wellbeing isn’t a luxury—it’s a safety imperative.

To those who fly: your mind matters

You are trained to lead, to reassure, to react. But you are also human. And the systems you navigate—internally and externally—deserve tending.

Taking your mental health seriously is not about stepping back from aviation. It’s about ensuring you remain strong within it. It’s about flying not just safely, but sustainably. Not just performing, but living.

Reflection

There is dignity in silence, but also danger. And in a profession where lives are entrusted to your care, it is not weakness to seek support—it is wisdom.

Let’s shift the narrative. Let’s make space for mental health to sit alongside technical excellence and physical fitness. Let’s remind ourselves—and each other—that resilience isn’t the absence of struggle, but the willingness to engage with it.

Because you are not just a pilot. You are a person. And your wellbeing is not optional—it’s foundationa