Psychiatry Guidance Material

Implementing Rules (IRs), Acceptable Means of Compliance (AMCs) and Guidance Material (GM) on psychiatric conditions

The following are the requirements for the medical certification of aircrew, including guidance material issued by the UK CAA Medical Department in relation to the psychiatric system.

Implementing Rules

Acceptable Means of Compliance

Guidance Material

MED.B.055 Psychiatry

(a) Applicants shall have no established medical history or clinical diagnosis of any
psychiatric disease or disability, condition or disorder, acute or chronic, congenital or
acquired, which is likely to interfere with the safe exercise of the privileges of the
applicable licence(s).

Fear of flying
Although fear of flying affects about 15% of the general population, it is unlikely those affected will opt for a career as a pilot and, if they do, habituation with consequent resolution of anxiety will have taken place during training.  The development of fear of flying in experienced fliers is normally due to the development of an underlying psychiatric disorder such as adjustment disorder, acute stress disorder, PTSD, agoraphobia, with or without panic disorder, or depression.  Management should be appropriate to the diagnosis.

Guidance on permissable medication when flying.

Medical reports - Fear of flying




Implementing Rules

Acceptable Means of Compliance

Guidance Material

(b) Applicants with a mental or behavioural disorder due to alcohol or other use or abuse of psychotropic substances shall be assessed as unfit pending recovery and freedom from substance use and subject to satisfactory psychiatric evaluation after successful treatment.

Applicants for a class 1 medical certificate shall be referred to the licensing authority.

Fitness of class 2 applicants shall be assessed in consultation with the licensing authority.

Class 1
(h) Disorders due to alcohol or other substance use 
   (1) Mental or behavioural disorders due to alcohol or other substance use, with or without dependency, are disqualifying.
   (2) A fit assessment may be considered after a period of two years documented sobriety or freedom from substance use. A fit assessment may be considered earlier with a multi-pilot limitation. Depending on the individual case, treatment and review may include:
   2.1 in-patient treatment of some weeks followed by;
   2.2 review by a psychiatric specialist; and
   2.3 ongoing review including blood testing and peer reports, which may be required indefinitely.

Class 2
(d) Disorders due to alcohol or other substance use
   (1) Mental or behavioural disorders due to alcohol or other substance use, with or without dependency, are disqualifying.
   (2) A fit assessment may be considered in consultation with the licensing authority after a period of two years documented sobriety or freedom from substance use.  A fit assessment may be considered earlier with an OSL or OPL limitation.  Depending on the individual case, treatment and review may include:
   2.1 in-patient treatment of some weeks followed by;
   2.2 review by a psychiatric specialist; and
   2.3 ongoing review, including blood testing and peer reports, which may be required indefinitely.

Disorders due to alcohol or other substance use

UK CAA Alcohol and Substance misuse flow chart.




Implementing Rules

Acceptable Means of Compliance

Guidance Material

(c) Applicants with a psychiatric condition such as:
   (1) mood disorder;
   (2) neurotic disorder;
   (3) personality disorder;
   (4) mental or behavioural disorder; shall undergo satisfactory psychiatric evaluation before a fit assessment can be made.

Class 1
(a)  Psychotic disorder
A history of, or the occurrence of, a functional psychotic disorder is disqualifying unless a cause can be unequivocally identified as one which is transient, has ceased and will not recur.


Class 2
(a) Psychotic disorder
A history of, or the occurrence of, a functional psychotic disorder is disqualifying unless in certain rare cases a cause can be unequivocally identified as one which is transient, has ceased and will not recur.

Class 1
(c) Psychotropic substances
Use or abuse of psychotropic substances likely to affect flight safety is disqualifying.

Class 2
(b) Psychotropic substances
Use or abuse of psychotropic substances likely to affect flight safety is disqualifying.  If a stable maintenance psychotropic medication is confirmed, a fit assessment with an OSL limitation may be considered.

Class 1
(b) Organic mental disorder
An organic mental disorder is disqualifying.  Once the cause has been treated, an applicant may be assessed as fit following satisfactory psychiatric review.

Psychotropic substances
UK CAA Centrally Acting Medication guidance

Medical reports - psychotropic substances

Class 1
(e) Mood disorder
An established mood disorder is disqualifying.  After full recovery and after full consideration of an individual case a fit assessment may be considered, depending on the characteristics and gravity of the mood disorder.  If a stable maintenance psychotropic medication is confirmed, a fit assessment should require an OML limitation.

Class 1
(f) Neurotic, stress-related or somatoform disorder
Where there is suspicion or established evidence that an applicant has a neurotic, stress-related or somatoform disorder, the applicant should be referred for psychiatric opinion and advice.


Class 1
(g) Personality or behavioural disorder
Where there is suspicion or established evidence that an applicant has a personality or behavioural disorder, the applicant should be referred for psychiatric opinion and advice.

Mood disorder
UK CAA Depression flow chart.

Medical reports - psychiatric




Implementing Rules

Acceptable Means of Compliance

Guidance Material


(d) Applicants with a history of a single or repeated acts of deliberate self-harm shall be assessed as unfit.  Applicants shall undergo satisfactory psychiatric evaluation before a fit assessment can be considered.


(e) Aero-medical assessment: 
   (1) applicants for a class 1 medical certificate with one of the conditions detailed in (b), (c) or (d) above shall be referred to the licensing authority; 
   (2) fitness of class 2 applicants with one of the conditions detailed in (b), (c) or (d) above shall be assessed in consultation with the licensing authority.

Class 1
(i) Deliberate self-harm
A single self-destructive action or repeated acts of deliberate self-harm are disqualifying.  A fit assessment may be considered after full consideration of an individual case and may require psychiatric or psychological review.  Neuropsychological assessment may also be required.


Medical reports - psychiatry




Implementing Rules

Acceptable Means of Compliance

Guidance Material

(f) Applicants with an established history or clinical diagnosis of schizophrenia, schizotypal or delusional disorder shall be assessed as unfit.

Class 1
(d) Schizophrenia, schizotypal or delusional disorder
Applicants with an established schizophrenia, schizotypal or delusional disorder should only be considered for a fit assessment if the licensing authority concludes that the original diagnosis was inappropriate or inaccurate or, in the case of a single episode of delirium, provided that the applicant has suffered no permanent impairment.

Class 2
(c) Schizophrenia, schizotypal or delusional disorder
An applicant with a history of schizophrenia, schizotypal or delusional disorder may only be considered fit if the original diagnosis was inappropriate or inaccurate as confirmed by psychiatric evaluation or, in the case of a single episode of delirium, provided that the applicant has suffered no permanent impairment.


Medical reports - psychiatry