A HIMS psychiatric evaluation is an in-depth assessment addressing both psychiatric and substance use concerns, conducted by an evaluator knowledgeable in pilot medical standards and the HIMS program.
This evaluation results in a detailed report, which, while guided by FAA specifications, does not follow a standardized template. Reports vary in length but must thoroughly address each required topic on the FAA specification sheet. Although grounded in clinical information, this report serves as evidence in a regulatory process rather than as a clinical document.
What does a HIMS program look like?
1. Residential Rehab
The FAA and Part 121 carriers consider residential rehabilitation to be the starting point for a traditional HIMS program. These programs typically last between thirty and ninety days, depending on the specific program and the pilot’s condition upon entry. The most recognized HIMS programs use the Minnesota model, which integrates 12-Step therapy with evidence-based treatments like Cognitive Behavioral Therapy (CBT), Dialectical Behavioral Therapy (DBT), Acceptance and Commitment Therapy (ACT), and other scientifically supported techniques. Top programs also incorporate aspects of spirituality, family dynamics, recreation, creativity, and nutrition for a holistic approach.
What qualifies as intensive treatment? The best way to ensure your program meets standards is to ask your employer. A Part 121 carrier will have established relationships with top centers nationwide, so if your airline refers you to a program, it’s likely approved by both the airline and the FAA.
If you’re not supported by a Part 121 carrier, ask potential programs where they fall on the ASAM (American Society of Addiction Medicine) Levels of Care Continuum. A comprehensive program suited to a pilot’s needs should be rated at ASAM level 3.5, 3.7, or 4. If the program can’t confirm this, it may not meet the necessary HIMS standards. While you don’t need to be an expert in ASAM levels, know that programs rated below 3.5 may lack the comprehensive care required by HIMS.
2. Outpatient Programs
While the FAA and Part 121 carriers generally prefer residential treatment, other options are available. An Intensive Outpatient Program (IOP), as defined on the ASAM Levels of Care spectrum, involves three-hour sessions held three times a week for a minimum of four weeks, with some programs extending up to twelve weeks.
For professional pilots, an IOP is considered a secondary option. Although IOPs have strong clinical support, they are not yet regarded as the gold standard for pilot treatment, with residential programs remaining the benchmark for aviation professionals. An acceptable IOP should be rated at ASAM Level 2.1, and some programs may begin with a higher-intensity Partial Hospitalization Program (PHP) at Level 2.5 for the initial phase.
A First Class pilot should have a compelling reason, such as a hardship, to opt for an IOP over residential treatment. For instance, a single parent with young children or someone facing financial constraints may choose an IOP for the flexibility it offers. However, pursuing an IOP may result in a longer process to demonstrate stability to the FAA compared to a residential treatment program.
What’s next?
Aftercare
Aftercare programs consist of group therapy sessions facilitated by a licensed counselor, typically lasting sixty to ninety minutes each week. The FAA and Part 121 carriers require pilots to attend regularly, with a minimum of two sessions per month.
Your program must provide documentation to your EAP, HIMS AME, or aviation psychiatrist. Before enrolling, confirm the organization’s documentation practices. If they don’t provide written reports for your HIMS AME or employer, the program may not be suitable for your needs.
Self-Help Groups
The most widely supported self-help group model is the 12-Step program, such as Alcoholics Anonymous (AA). These programs are accessible almost everywhere, typically free of charge, and highly encouraged. The ideal standard for pilots is to attend one meeting per day during the first three months post-treatment, following the “ninety meetings in ninety days” approach. Pilots are also expected to engage fully by working through the steps with a sponsor.
While not every pilot connects with the 12-Step model, alternatives are available. If a pilot chooses a different self-help group, it’s important to select one with peer-reviewed scientific support for its effectiveness in recovery. Regardless of the model, pilots should attend meetings as frequently as those in AA.
Sobriety Monitoring
The third element of HIMS monitoring after intensive treatment is for the pilot to participate in a sobriety monitoring program. The type and frequency of monitoring should be tailored to the specific needs of the pilot’s recovery, though the FAA requires a minimum of at least one, and sometimes two, sobriety tests per month.
In some cases, pilots may use a portable alcohol monitor, which has its own advantages and drawbacks. Whether sobriety is tracked through a portable device or via a no-notice testing program, the monitoring plan should align with the standards set by the carrier or HIMS AME, depending on who oversees the testing results.
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