The following Q & A covers many of the common questions that have been raised regarding the HIMS Program and HIMS Australia Advisory Group.
Contact the Advisory Group if further clarification is required on any additional subject.
HIMS Australia (the HIMS Australia Advisory Group – HAAG) is made up of a diverse group of Aviation and Medical Health Professionals, including pilots, DAME’s, addiction medicine specialists (FAChAM) and psychologists.
It is essentially a “Steering Group”, resource rich with a broad cross-section of passionate industry stakeholders with a dual purpose: collaborate with industry stakeholders to better understand (and manage) a very human condition and through experienced peers, offer supportive monitoring for colleagues who have been negatively impacted by the misuse of alcohol or other drugs.
The HAAG advocates a multidisciplinary approach to assisting peers who have been negatively impacted by the misuse of alcohol and other drugs. This involves drawing appropriately from multiple disciplines to redefine problems outside of the normal boundaries and reach solutions based on a better understanding of this very complex condition.
Just like any other occupational group, pilots are not immune to the ravages of substance abuse or substance dependence. Symptoms include compulsive use (overwhelming desire), preoccupation (neglecting responsibilities), tolerance and denial of consequences.
In the workplace, pilots who return a positive alcohol breath or drug test often display the symptoms listed above. This is not wilful behaviour; it's an insidious, cruel and deceptive illness with testing often “catching” people only when the disease has progressed. The HAAG advocates for clinical and psychological assessment after returning a positive test with an offer of a return to flying duties under clinical and peer supervision (HIMS) if dependency exists while respecting CASA regulations and company policies.
Traditionally, pilots who have been negatively impacted by the misuse of alcohol or other drugs have had to “fend for the themselves” with what outwardly appears as a very daunting path satisfying regulatory requirements and return to work plans; all the while dealing with the societal stigma associated with substance use disorder. With a collaborative, multidisciplinary approach (taking care to respect professional boundaries) utilising peer support and accountability, individuals are able to return to work in a more efficient way.
While substance use disorder is definitely a medical condition, it is “all about” many things. It is a complex condition, a complex interaction between human beings and their environment; it has biological, chemical, neurological, psychological, medical, emotional, social, political, and economic underpinnings – to name but a few. Recognising and understanding these aspects help to de-stigmatise the illness and provide a safe environment for those seeking help.
HIMS is a proven process that can assist pilots afflicted with substance use disorder, a proven way back to flying through the requirements of the regulations
It stands to reason that any process designed to assist pilots grappling with a diagnosed, debilitating illness (whether it be drugs or alcohol) and having to meet regulatory requirements of “evidence of stability” (CASR Part 67.150) should be embraced by the Australian pilot community.
Numerous Australian pilots are very thankful for the opportunity that supportive monitoring through peers has provided and allowed them to continue what they love doing most: flying aircraft.
There are numerous examples of pilots in the advanced stages of the disease who have had their flying career ended prematurely. There are pilots who have died from this disease while in their middle age of life. Sadly, as in any aspect of our society, this will always be the case.
Knowing a supportive system is in place can and has proven to help return pilots back into the sky earlier than previously has been the case.
HIMS originated in the US in the 1970s. It stands for Human Intervention Motivation Study, a name given to the early work looking at assisting pilots with a substance misuse problem. In the US, like many other countries, the aviation regulator lists the condition of substance misuse with dependency as a chronic medical condition with significant safety implications.
This condition meant that pilots did not meet the medical requirements for an aviation license and hence were no longer able to fly. With the introduction of HIMS US pilots had a pathway to appeal for licence reissue. The HIMS program is a structured agreement that pilots with this diagnosis enter into. It is based on best medical practice for treating substance misuse with dependency. Treatment includes initial intensive treatment and education, abstinence, counselling as required and peer support meetings. There is also surveillance requirements such as alcohol breath tests which tend to have a positive effect on recovered pilots.
The HIMS program in the US has supported over 5,500 pilots. The success rates for this very complicated relapsing medical condition have been over 88% in the long term. It is believed that the success rate is helped because we are dealing with a professional group who are provided a pathway to return to their flying career with a robust structured support network in place. Approximately five years ago New Zealand have introduced a HIMS program across all of the countries aviation sectors including airline, general aviation, and military aviation. New Zealand is finding similar successes as the US. Cathay Pacific in Hong Kong introduced a formal HIMS program in 2012, along with airlines in France, Finland and Holland.
The regulatory authority may revoke a pilot’s medical certificate based on the evidence supplied by a suitably qualified medical health professional (addiction medicine specialist) after assessment. This is the responsibility of the regulator according to the requirements of CASR Part 67.150.
Globally, most regulators apply a minimum of 12 months and “evidence of stability” prior to the re-issuance of a medical certificate. Up until the advent is peer-led programs such as HIMS, the medical certificate was revoked completely with multiple DUI events.
Peer led programmes such as HIMS offer many benefits, including stability, and may offer the opportunity to shorten the time period before re-certification
Historically, the pilot had to bear the costs associated with specialist visits, inpatient/outpatient treatment, clinical testing and so on to provide the regulator with “evidence of stability”; also dealing with potential earnings loss while the medical certificate was revoked.
Some of the larger companies have paid for some of the specialist costs. General Aviation has traditionally seen the pilots bear the full costs. Some unions have assisted their members with “loss of licence” insurance while their medical certificate has been revoked while others do not recognise substance use disorder as an illness.
With more recognition, education, knowledge and understanding of the illness, the “big two” are providing more assistance in this regard. As with any other medical condition (e.g. diabetes), some costs are borne by the individual.
Qualified professionals are responsible for making any diagnoses through confidential assessments with the pilot.
That decision is made by the regulator as it always has been and will appear on the pilot’s medical certificate as a “Special Requirement”
A collaborative, multidisciplinary approach to an insidious illness built on trust, empathy and integrity, ostensibly driven by pilots helping other pilots grappling with a very complex condition is not a “witch hunt”.
The regulator and most organisations have established protocols for dealing with anonymous reports. This falls out of the scope of HIMS
Vexatious reports about pilots have occurred throughout history and will continue to occur in the future. The regulator and most organizations have established systems in place to deal with vexatious reports. By nature, vexatious reports tend to target individuals for personal reasons with an expected punitive outcome. Experience has shown that supportive structures such as HIMS that keep people employed has actually driven down vexatious reports relating to drugs and or alcohol.
HIMS is an aftercare process to assist pilots diagnosed with substance use disorder return to flying in a safe and efficient manner.
We do not think that a HIMS program would promote this type of behaviour. Such reports already occur and will continue to occur. They will continue to be managed as they always have been. The HIMS program in the US which has been running for over 40 years and the more recent program in New Zealand have not reported that this behaviour has increased with the introduction of the HIMS program.
A company manager, pilot, or any other person other than a suitably qualified medical health professional (i.e. an addiction medicine specialist in this case) has the qualification to diagnose any medical condition, let alone a complex illness such as substance use disorder.
The regulator and most organisations have established systems in place to deal with reports of this nature. HIMS is an aftercare process to assist pilots diagnosed with substance use disorder return to flying in a safe and efficient manner
From the medical perspective, the use of the word 'accusation' underlines one of the important principles of HIMS: possible substance dependence not as an accusation but a health concern. Just as we would not "accuse" someone of having heart disease, the same approach is taken.
But the actions taken to guard against unfounded concerns will not change with a HIMS program. Pilots would address these matters as they always have through all of the avenues available to them.
Perhaps a more difficult area is dealing with a diagnosis that the pilot does not agree with.
We would recommend that the pilot gets a second opinion from an addiction medicine specialist. The pilot would be able to seek advice about the diagnosis from their DAME or the company doctor. This is already available to pilots.
The introduction of a HIMS program would also mean that educated pilot peers would be able to provide advice from their perspective. Peers would not be qualified to comment on diagnosis, but would be able to provide advice about other cases and other experiences. /p>