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safely assessed as fit to fly.
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ICAO Preliminary Unedited Version — October 2008
Chapter 9. MENTAL FITNESS
Page
Introduction ....................................................................................................... III-9-1
Predisposition to psychiatric illness ............................................................. III-9-2
Psychological testing ......................................................................................... III-9-3
Psychiatric disorders in aviation personnel ....................................................... III-9-3
Mood disorders .................................................................................................. III-9-3
Schizophrenia and delusional disorders ............................................................ III-9-4
Neurotic, stress related, and somatoform disorders ........................................... III-9-5
Disorders of personality and behaviour ............................................................. III-9-5
Organic mental disorders ................................................................................... III-9-6
Sleep disorders .................................................................................................. III-9-6
Flying and psychoactive medicines ................................................................... III-9-8
Appendix 1.─ Mini mental status examination ......................................... III-9A1-1
References to Appendix 1
Appendix 2.─ Specific guidance concerning use of antidepressant
Medication ............................................................................................ III-9A2-2
References to Appendix 2
ICAO Preliminary Unedited Version — November 2009 III-9-1
INTRODUCTION
To pilot an aircraft requires the utilization of a complex set of physical and cognitive skills. Interference
with any aspect of these skills and their coordination may have serious personal and public safety
consequences. The assessment of mental fitness shall therefore be made with due regard to the privileges
of the licence and the ratings applied for or held, and to the conditions in which the applicants will have
to carry out their duties. The period of validity of the Medical Assessment (between six months and five
years) must also be taken into consideration.
The Standards and Recommended Practices of Annex 1, Chapter 6, while not sufficiently detailed to
cover all individual conditions, require specific levels of mental fitness. Many decisions relating to
individual cases will be left to the discretion of the medical examiner or will have to be decided by the
medical assessor of the Licensing Authority. The contents of this chapter will provide guidance for
making these decisions.
Annex 1 requirements on mental fitness, applicable to all categories of licences and ratings, are as
follows:
6.3.2.2 The applicant shall have no established medical history or clinical diagnosis of:
a) an organic mental disorder;
b) a mental or behavioural disorder due to use of psychoactive substances; this includes dependence
syndrome induced by alcohol or other psychoactive substances;
c) schizophrenia or a schizotypal or delusional disorder;
d) a mood (affective) disorder;
e) a neurotic, stress-related or somatoform disorder;
f) a behavioural syndrome associated with physiological disturbances or physical factors;
g) a disorder of adult personality or behaviour, particularly if manifested by repeated overt acts;
h) mental retardation;
i) a disorder of psychological development;
j) a behavioural or emotional disorder, with onset in childhood or adolescence; or
k) a mental disorder not otherwise specified;
such as might render the applicant unable to safely exercise the privileges of the licence applied for or held.
6.3.2.2.1 Recommendation.- An applicant with depression, being treated with antidepressant medication,
should be assessed as unfit unless the medical assessor, having access to the details of the case concerned,
considers the applicant’s condition as unlikely to interfere with the safe exercise of the applicant’s licence and
rating privileges.
Note 1.- Guidance on assessment of applicants treated with antidepressant medication is contained in the Manual
of Civil Aviation Medicine (Doc 8984).
Note 2.- Mental and behavioural disorders are defined in accordance with the clinical descriptions and diagnostic
guidelines of the World Health Organisation as given in the International Statistical Classification of Diseases and
Related Health Problems, 10th Edition — Classification of Mental and Behavioural Disorders, WHO 1992. This
　
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