ACS Neuropsychiatry helps aviators keep head in the game, stay in the fight

Lt. Col. Kevin Heacock, Neuropsychiatry Branch chief of the Aeromedical Consultation Service, leads discussion on a medical waiver recommendation request case during a branch case review conference October 17. The Neuropsychiatry Branch reviewed 463 cases in 2016 with 80 percent of cases receiving recommendations for medical waivers. (Parts of documents are blurred to protect privacy) (U.S. Air Force photo/John Harrington)

Lt. Col. Kevin Heacock, Neuropsychiatry Branch chief of the Aeromedical Consultation Service, leads discussion on a medical waiver recommendation request case during a branch case review conference October 17. The Neuropsychiatry Branch reviewed 463 cases in 2016 with 80 percent of cases receiving recommendations for medical waivers. (Parts of documents are blurred to protect privacy) (U.S. Air Force photo/John Harrington)

John Heaton (left), Neuropsychiatry Branch manager of the Aeromedical Consultation Service, and Lt. Col. Kevin Heacock, ACS Neuropsychiatry Branch chief, oversee a demonstration of a psychological test on Master Sgt.Walter Croft, the branches NCO in charge and mental health technician. The test is one of several that are administered to waiver candidates to evaluate cognitive functioning. (The test is not revealed here in order to not compromise its effectiveness in the future). (U.S. Air Force photo/John Harrington)

John Heaton (left), Neuropsychiatry Branch manager of the Aeromedical Consultation Service, and Lt. Col. Kevin Heacock, ACS Neuropsychiatry Branch chief, oversee a demonstration of a psychological test on Master Sgt.Walter Croft, the branches NCO in charge and mental health technician. The test is one of several that are administered to waiver candidates to evaluate cognitive functioning. (The test is not revealed here in order to not compromise its effectiveness in the future). (U.S. Air Force photo/John Harrington)

Lt. Col. Kevin Heacock, Neuropsychiatry Branch chief of the Aeromedical Consultation Service, leads discussion on a medical waiver recommendation request case during a branch case review conference October 17. The Neuropsychiatry Branch reviewed 463 cases in 2016 with 80 percent of cases receiving recommendations for medical waivers. (U.S. Air Force photo/John Harrington)

Lt. Col. Kevin Heacock, Neuropsychiatry Branch chief of the Aeromedical Consultation Service, leads discussion on a medical waiver recommendation request case during a branch case review conference October 17. The Neuropsychiatry Branch reviewed 463 cases in 2016 with 80 percent of cases receiving recommendations for medical waivers. (U.S. Air Force photo/John Harrington)

John Heaton, Neuropsychiatry Branch manager of the Aeromedical Consultation Service, briefs flight surgeon students on his branch as part of the Aerospace Medicine Primary Course. The Neuropsychiatry Branch reviews the cases of medically disqualified aviators and flight status Airmen to determine the risk involved with them returning to flight duty and whether or not to recommend a medical waiver to the waiver authority, usually a major command. (U.S. Air Force photo/John Harrington)

John Heaton, Neuropsychiatry Branch manager of the Aeromedical Consultation Service, briefs flight surgeon students on his branch as part of the Aerospace Medicine Primary Course. The Neuropsychiatry Branch reviews the cases of medically disqualified aviators and flight status Airmen to determine the risk involved with them returning to flight duty and whether or not to recommend a medical waiver to the waiver authority, usually a major command. (U.S. Air Force photo/John Harrington)

EDITORS NOTE:  This is the third part of a four-part series on the Aeromedical Consultation Service at Wright-Patterson. Part one is the ACS Overview and part two delves into how the ACS' Internal Medicine branch keeps Air Force aviators safely in the skies. A link to those stories, and the Air Force Waiver Guide, appears below. 

WRIGHT-PATTERSON AIR FORCE BASE, Ohio –
 Whether it’s flying a multimillion-dollar fighter jet at 600 knots in a storm, trying to land a helicopter in the sands of a deployed location or transporting 170,000 pounds to troops downrange, Air Force aviators face unique workplace stressors that require intense focus.

Sometimes the stress of the job, or even everyday life, can get to be too much and aviators find themselves benched from flying duties.

“It’s normal day-to-day stuff, family issues,” said John Heaton, Aeromedical Consulting Service Neuropsychiatry Branch manager. “The majority of folks we see [coming to us seeking waiver recommendations] have relational problems. It’s not disqualifying to have a relationship problem, but it can, if not treated or managed well, lead to anxiety, depression, adjustment disorders or something like that. Then, they can become grounded or disqualified.”

For those wanting to return to the skies, and most do according to Heaton, it can lead to aviators’ cases being reviewed by the ACS, a part of the United States Air Force School of Aerospace Medicine and the 711th Human Performance Wing of the Air Force Research Laboratory. The ACS provides a medical waiver recommendation to the aviator’s waiver authority, generally the major command.

“If an aviator has any kind of history of mental health diagnosis that would otherwise be concerning for somebody in that position, the major command asks us to weigh in on ‘Is this somebody we can get back to flying?’” said Lt. Col. Kevin Heacock, ACS Neuropsychiatry chief and psychiatrist. “So, our goal is to support those missions by giving them the people they need, but also making sure the ones they have can do the job adequately from a mental health perspective.”

Mental health doesn’t just have the ability to impact aviators, it can also curtail several other aviation-related jobs as well. And, just because someone is diagnosed with a mental health issue doesn’t mean it’s the end of their career.

“If they have some kind of life situation or maybe even a combat-related situation that makes it difficult for them to perform adequately, they get treatment,” Heacock said. “Then, after the treatment, if they’re doing well, the major commands want to make sure this person is ready to go back in the air or the tower or whatever their aviation-related duty is.”

ACS Neuropsychiatry is charged with assessing that risk. With a staff of three psychiatrists, two psychologists, one neuropsychologist, one neurologist and four support staff, they work to answer the questions that major commands can’t, using: psychology – basic mental health, mostly emotional, the most common; psychiatry – the medical physiological aspect of mental health; and neurology – how brain and spine medical conditions can affect cognitive functioning.

“The ACS plays a very critical role in the waiver process,” said Col. Talib Ali, Aerospace Medicine Division chief at Headquarters Pacific Air Forces, who represents some 1,600 aviators and battlefield Airmen throughout the Pacific Air Forces Command. “They are the subject matter experts who we refer complex cases for an aeromedical risk assessment. Every case has its distinct subtleties and nuances. Consequently, the ACS ‘leaves no stone unturned’ during the evaluation.”

The Neuropsychiatry Branch reviewed 463 cases in 2016. In about two-thirds of cases, the branch can make a waiver request recommendation based solely on the materials submitted with the case from the major command. The rest required week-long, in-person evaluations.

“Turning those stones” in-person routinely involves 20 hours of clinical interviewing, by both a psychologist and psychiatrist, four to eight hours of psychological testing and several more hours of research before making a waiver request recommendation, what Heaton calls their “Gold Standard” of review.

“What we are capturing in basically four or five days is the onset of the mental health issue, what got them to be disqualified in the first place, through [the time of their] treatment, through a stability period and then leading up to them being ready for a waiver,” Heaton said.

And granting recommendations for waivers is what the branch loves to do.

“We’re in the waiver business,” Heaton said. “We want aviators back in the air. The Air Force has spent millions of dollars on these pilots, every single one of them. We’re there to help them get safely back in the air as soon as possible.”

And the ACS Neuropsychiatry Branch has been largely successful in that mission, granting waiver recommendations to 80 percent of cases reviewed.

“We try to say ‘yes’ as often as we safely can,” Heacock said. “They wouldn’t be here if their major command really didn’t want them to be waived. Really, our goal is to get them back in the fight, to keep that tip of the spear as sharp as possible”

That “spear” covers the whole of the Air Force, with the ACS’ impact being felt around the globe.

“The ACS Neuropsychiatry Branch plays a key role in supporting our mission in the Pacific,” Ali said. “Often, referrals are complex cases that require extensive diagnostics and thorough evaluations to come to an honest risk assessment. It is costly and time intensive to train aviators and special operational duty Airmen. Careers can be ended with medically disqualified aeromedical recommendations.

“I have worked extensively with Dr. Roger Hesselbrock, an aerospace neurologist, in the past on complex neurological cases,” Ali said. “In every case, he provides an honest, well-thought-out recommendation considering the role of the flyer, flight safety, and mission completion to provide an overall aeromedical risk assessment. It takes a 20-year career to gain the clinical skill set and judgment that he provides. We are lucky to have him.”

Regardless of mission or career impact, Heaton and Heacock encourage aviators and flight status Airmen to not suffer alone with a mental health issue.

“The most important thing is for them to get the treatment they need,” Heacock said. “Because, yes, some people can recover on their own and find their own coping skills, but a lot of people need help to figure out how they can improve.”

And with treatment, most do improve to return to the fight, according to Heaton.

“I could not ask for better service from the ACS,” Ali said. “From the world-class customer service that the case managers provide to the demanding aeromedical evaluation that the clinicians bring, the ACS ensures superior performance and safety in the aerospace environment. No one else comes close.”