The FAA updated its Guide for Aviation Medical Examiners on May 27, 2026, adding new mental health counseling resources for pilots and air traffic control specialists. The revision adds therapy, psychotherapy, and counseling guidance under Item 47 (Psychiatric Conditions), along with three new documents: an information page for pilots and ATCS, an FAQ sheet, and a guidance document for psychotherapists who treat aviation professionals.
The agency’s message was direct: “Counseling or therapy is encouraged when medically appropriate.”
For an industry that has long struggled with the stigma of seeking mental health care, that sentence — from the FAA, in the AME Guide — carries significant weight.
What Did the FAA Actually Change?
The update adds counseling-specific resources to Item 47 of the AME Guide rather than changing the underlying medical certification framework. This is an important distinction.
Three new documents are now available through the FAA’s AME Guide:
A therapy, psychotherapy, and counseling information page for pilots and ATCS. This document explains that maintaining mental health is crucial for safety and operational performance, and explicitly encourages pilots and controllers to seek counseling when appropriate.
An FAQ document for pilots and ATCS. This addresses common questions about how therapy interacts with the medical certification process — the core concern that has historically kept pilots from seeking care.
A guidance document for psychotherapists treating pilots and ATCS. This gives therapists context on the unique regulatory environment their aviation clients operate in, including how the FAA’s medical certification process works and what therapists should know about their patients’ professional obligations.
The FAA directs pilots and controllers considering counseling to see a therapist, review the new FAQ document, and provide their therapist with the FAA’s guidance sheet. This is a practical workflow — not just a policy statement — designed to make the path from “I need help” to “I’m getting help” less opaque.
What Didn’t Change?
The update does not alter the FAA’s medical certification rules. Item 47 still affirms that use of psychotropic medications is disqualifying for aeromedical certification unless covered by listed exceptions. Aviation Medical Examiners are still directed to defer issuance and forward records to the Aerospace Medical Certification Division (AMCD) in cases involving psychiatric medications.
This means the fundamental tension in pilot mental health remains: the FAA now explicitly encourages therapy, but the regulatory framework still penalizes many forms of treatment that involve medication. A pilot who seeks counseling for anxiety and receives a prescription for an SSRI still faces a potentially career-disrupting certification process.
The new guidance addresses the counseling side of the equation — making it clear that talk therapy, in and of itself, should not be a barrier to flying. But it doesn’t resolve the medication side, which continues to drive the fear-based avoidance that the broader reform movement is trying to fix.
Why This Matters — The Stigma Problem
For decades, the aviation industry has operated under an unwritten rule: don’t seek help, don’t disclose, don’t risk your medical certificate. The consequences of this culture have been well-documented.
NTSB Chair Jennifer Homendy described the situation bluntly in 2025: the current rules impose “a culture of silence that is affecting safety.” Pilots who experience depression, anxiety, grief, or other common mental health challenges have routinely avoided seeking care because they feared losing their ability to fly.
The FAA’s own Aviation Rulemaking Committee (ARC) on Mental Health and Aviation Medical Clearances, which published its final report in March 2024, identified the core barriers: fear of career consequences, stigma within the aviation culture, a confusing certification process, and a lack of trust between pilots and the aeromedical system. The committee found that the FAA’s existing approach “does not account for varying levels of impairment associated with different mental health conditions” and treats mild concerns the same way it treats severe psychiatric disorders.
The new AME Guide update directly addresses two of those barriers — stigma and confusion — by making it clear that counseling is encouraged and by providing practical resources for both pilots and their therapists. It doesn’t fix the regulatory framework, but it changes the messaging.
The Legislative Push Running in Parallel
The AME Guide update arrives while the Mental Health in Aviation Act of 2025 is advancing through Congress. The bill passed the House unanimously on September 8, 2025, and the Senate companion (introduced by Senators John Hoeven and Tammy Duckworth) was unanimously approved by the Senate Commerce Committee on April 14, 2026.
If enacted, the legislation would go significantly further than the AME Guide update:
Regulatory revision. The FAA would be required to revise its medical certification regulations within two years to encourage voluntary disclosure of mental health conditions and reduce barriers to treatment.
Annual reviews. The FAA would conduct yearly reviews of the special issuance process, expand approved medications, and assess whether AMEs should be given more decision-making authority.
Funding. Approximately $15 million per year from 2026 through 2029 would go to the FAA’s Office of Aerospace Medicine to recruit and train additional medical examiners — including psychiatrists — to reduce the current backlog of special issuance applications.
Public awareness campaign. The bill allocates $1.5 million annually for a campaign to reduce stigma and encourage pilots and controllers to seek care.
The bill has broad bipartisan support and backing from AOPA, Airlines for America, the Regional Airline Association, ALPA, and the National Air Traffic Controllers Association.
AOPA President Darren Pleasance said it plainly: “For too long, pilots have lived with the fear of seeking treatment for a mental health concern. This bill takes meaningful steps to ensure pilots can prioritize their health and keep flying.”
What Pilots and CFIs Should Know
If you’re a pilot considering therapy or counseling, the FAA’s updated guidance gives you three concrete steps:
Read the new FAQ. The FAA’s FAQ for pilots and ATCS addresses the most common concerns about how counseling affects your medical certificate. It’s available through the AME Guide under Item 47.
Talk to a therapist. The FAA explicitly encourages counseling when appropriate. Share the FAA’s guidance document for psychotherapists with your provider so they understand the regulatory context.
Understand the medication boundary. Counseling and talk therapy are supported. Psychotropic medications remain subject to the existing certification framework. If medication is recommended, understand the special issuance process before making decisions.
For CFIs, this is a topic worth discussing with students — especially those pursuing professional pilot careers. Normalizing the idea that seeking help is compatible with a flying career may be one of the most important safety conversations an instructor can have.
Frequently Asked Questions
Does the FAA allow pilots to see a therapist? Yes. As of May 2026, the FAA’s updated AME Guide explicitly encourages pilots and air traffic controllers to seek counseling or therapy when medically appropriate. The update adds new informational resources under Item 47 (Psychiatric Conditions) for both pilots and their psychotherapists.
Will seeing a therapist affect my medical certificate? The FAA’s updated guidance indicates that counseling and talk therapy, in themselves, should not be a barrier to medical certification. However, use of psychotropic medications remains disqualifying unless covered by specific FAA exceptions. Pilots considering therapy should review the FAA’s new FAQ document under Item 47 of the AME Guide.
What is the Mental Health in Aviation Act of 2025? The Mental Health in Aviation Act (H.R. 2591) is bipartisan legislation that passed the House unanimously in September 2025 and advanced through the Senate Commerce Committee in April 2026. It would require the FAA to revise mental health certification rules, expand approved medications, hire additional psychiatric AMEs, and fund a $1.5 million annual anti-stigma campaign.
Why are pilots afraid to seek mental health care? The FAA’s medical certification process requires disclosure of mental health conditions and treatment. Historically, disclosure has led to lengthy special issuance reviews, grounding, and career uncertainty. This has created what NTSB Chair Jennifer Homendy described as “a culture of silence that is affecting safety.”
What documents did the FAA add to the AME Guide? The FAA added three new documents under Item 47: a therapy information page for pilots and ATCS, an FAQ for pilots and ATCS about counseling and certification, and a guidance document for psychotherapists treating aviation professionals. All three are available at faa.gov through the AME Guide.
