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Air Force updates mental healthcare policies, lowers barriers

Total Force Mobility Air Force leaders pose for a group photo during the 2024 Spring Phoenix Rally at MacDill Air Force Base, Fla., April 29, 2024. Photo credit: Senior Airman Jessica Do

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SCOTT AIR FORCE BASE, Ill. (AFNS) -On Jan. 28, 2022, Gen. Mike Minihan, commander of Air Mobility Command, tweeted, "Warrior Heart. No Stigma." with a screen shot 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 where necessary, advocating for updates to mental health policy based on current standards.

In a major step forward in lowering barriers, the Air Force's mental health waiver policy in both the Air Force's Medical Standards Directory and Aerospace Medicine Waiver Guide has been updated to allow for airmen to receive 60 days of treatment for mental health concerns before a return to duty waiver to fly is required. This change benefits airmen across the Air Force seeking treatment for stress, post-traumatic stress and other mental health-related maladies.

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 MSD, special-duty airmen faced significant amount of time in a non-flying status while undergoing evaluation, treatment, and mandatory stabilization periods 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, there is no longer mandatory stabilization timelines. In addition, flight surgeons can submit a waiver for an airman seeking mental health treatment to return to flying status without a waiting period.

"If you want to look at a pilot with PTSD, you're looking at one right now," Minihan said to his command teams during the Spring 2024 Phoenix Rally. "This policy 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 more than 50 aircrew 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 Salzman, C-130J pilot and Lt. Col. Carrie Lucas, AMC behavioral health branch chief.

They were warned it could take 5-10 years to achieve the policy 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 the policy-making leadership as a subject matter expert." Salzman said, "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 mental health policy be amended, considering our evolving understanding of human responses to stress and development of resilience through early treatment."

"From a mental health perspective, this precedent-setting policy 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," Lucas said.

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