(a)Mental health assessment as part of the initial class 1 aero-medical examination
(1)A comprehensive mental health assessment should be conducted and recorded taking into account social, environmental and cultural contexts.
(2)The applicant's history and symptoms of disorders that might pose a threat to flight safety should be identified and recorded.
(3)The mental health assessment should include assessment and documentation of:
(i)general attitudes to mental health, including understanding possible indications of reduced mental health in themselves and others;
(ii)coping strategies under periods of psychological stress or pressure in the past, including seeking advice from others;
(iii)childhood behavioural problems;
(iv)interpersonal and relationship issues;
(v)current work and life stressors; and
(vi)overt personality disorders.
(4)Where there are signs or is established evidence that an applicant may have a psychiatric or psychological disorder, the applicant should be referred for specialist opinion and advice.
(b)Mental health assessment as part of revalidation or renewal class 1 medical examination
(1)The assessment should include review and documentation of:
(i)current work and life stressors;
(ii)coping strategies under periods of psychological stress or pressure in the past, including seeking advice from others;
(iii)any difficulties with operational crew resource management (CRM);
(iv)any difficulties with employer and/or other colleagues and managers; and
(v)interpersonal and relationship issues, including difficulties with relatives, friends, and work colleagues.
(2)Where there are signs or is established evidence that an applicant may have a psychiatric or psychological disorder, the applicant should be referred for specialist opinion and advice.
(3)Established evidence should be verifiable information from an identifiable source related to the mental fitness or personality of a particular individual. Sources for this information can be accidents or incidents, problems in training or proficiency checks, behaviour or knowledge relevant to the safe exercise of the privileges of the applicable licence(s).
(c)Assessment of holders of a class 1 medical certificate referenced in MED.B.055(d) Assessment of holders of a class 1 medical certificate referenced in MED.B.055(d) may require psychiatric and psychological evaluation as determined by the medical assessor of the licensing authority. A SIC limitation should be imposed in case of a fit assessment. Follow-up and removal of SIC limitation, as necessary, should be determined by the medical assessor of the licensing authority.
(d)Psychoactive substance testing
(1)Drug tests should screen for opioids, cannabinoids, amphetamines, cocaine, hallucinogens and sedative hypnotics. Following a risk assessment performed by the competent authority on the target population, screening tests may include additional drugs.
(2)For renewal/revalidation, random psychoactive substance screening test may be performed based on the risk assessment by the competent authority on the target population. If random psychoactive substance screening test is considered, it should be performed and reported in accordance with the procedures developed by the competent authority.
(3)In the case of a positive psychoactive substance screening result, confirmation should be required in accordance with national standards and procedures for psychoactive substance testing.
(4)In case of a positive confirmation test, a psychiatric evaluation should be undertaken before a fit assessment may be considered by the medical assessor of the licensing authority.
(e)Assessment and referral decisions
(1)Psychotic disorder Applicants with a history, or the occurrence, of a functional psychotic disorder should be assessed as unfit. A fit assessment may be considered if a cause can be unequivocally identified as one which is transient, has ceased and the risk of recurrence is minimal.
(2)Organic mental disorder Applicants with an organic mental disorder should be assessed as unfit. Once the cause has been treated, an applicant may be assessed as fit following satisfactory psychiatric evaluation.
(3)Psychoactive medication Applicants who use psychoactive medication likely to affect flight safety should be assessed as unfit. If stability on maintenance psychoactive medication is confirmed, a fit assessment with an OML may be considered. If the dosage or type of medication is changed, a further period of unfit assessment should be required until stability is confirmed.
(4)Schizophrenia, schizotypal or delusional disorder Applicants with an established history or clinical diagnosis of schizophrenia, schizotypal or delusional disorder may only be considered for a fit assessment if the medical assessor of the licensing authority concludes that the original diagnosis was inappropriate or inaccurate as confirmed by psychiatric evaluation, or, in the case of a single episode of delirium of which the cause was clear, provided that the applicant has suffered no permanent mental impairment.
(5)Mood disorder Applicants with an established mood disorder should be assessed as unfit. After full recovery and after full consideration of the individual case, a fit assessment may be considered, depending on the characteristics and severity of the mood disorder.
(6)Neurotic, stress-related or somatoform disorder Where there are signs or is established evidence that an applicant may have a neurotic, stress-related or somatoform disorder, the applicant should be referred for psychiatric or psychological opinion and advice.
(7)Personality or behavioural disorders Where there are signs or is established evidence that an applicant may have a personality or behavioural disorder, the applicant should be referred for psychiatric or psychological opinion and advice.
(8)Disorders due to alcohol or other psychoactive substance(s) use or misuse
(i)Applicants with mental or behavioural disorders due to alcohol or other psychoactive substance(s) use or misuse, with or without dependency, should be assessed as unfit.
(ii)A fit assessment may be considered after a period of two years of documented sobriety or freedom from psychoactive substance use or misuse. At revalidation or renewal, a fit assessment may be considered earlier with an OML. Depending on the individual case, treatment and evaluation may include in-patient treatment of some weeks and inclusion into a support programme followed by ongoing checks, including drug and alcohol testing and reports resulting from the support programme, which may be required indefinitely.
(9)Deliberate self-harm and suicide attempt Applicants who have carried out a single self-destructive action or repeated acts of deliberate self-harm or suicide attempt should be assessed as unfit. A fit assessment may be considered after full consideration of an individual case and may require psychiatric or psychological evaluation. Neuropsychological evaluation may also be required.
(10)Cognitive disorders
(i)Applicants who exhibit signs of cognitive disorders should undergo a satisfactory neuropsychiatric evaluation to assess the severity of the cognitive impairment before a fit assessment may be considered. Applicants with mild cognitive impairment may be assessed as fit with an OML limitation and regular monitoring of the cognitive decline.
(ii)For applicants above the age of 60 performing single-pilot HEMS operations, AMEs should pay particular attention to early signs of cognitive decline. A comprehensive specialist evaluation should be considered where the medical assessors received information from the personnel performing regular training and checking of these applicants in accordance with ORO.FC.230 or AMEs performing the recurrent aero-medical examination documenting a potential cognitive decline of such pilots.
(11)Assessment The assessment should take into consideration whether the indication for the treatment, side effects and addiction risks of such treatment and the characteristics of the psychiatric disorder are compatible with flight safety.
(f)Specialist opinion and advice
(1)In case a specialist evaluation is needed, following the evaluation, the specialist should submit a written report to the AME, AeMC or medical assessor of the licensing authority as appropriate, detailing their opinion and recommendation.
(2)Psychiatric evaluations should be conducted by a qualified psychiatrist having adequate knowledge and experience in aviation medicine.
(3)The psychological opinion and advice should be based on a clinical psychological assessment conducted by a suitably qualified and accredited clinical psychologist with expertise and experience in aviation psychology.
(4)The psychological evaluation may include a collection of biographical data, the administration of aptitude as well as personality tests and clinical interview.