Mental health concerns amongst air traffic controllers (ATCOs) are increasingly being recognised as a critical issue in aviation safety.

2024 study by Southern Illinois University entitled Exploring Mental Health Disorders Among Air Traffic Controllers reported that nearly 20% of ATCs in the US and 13% of those in the rest of the world present moderate to severe anxiety levels, while over 10% show signs of depression.

Chronic stress is also an issue, with 10%-15% showing high symptoms of psychological stress according to the International Federation of Air Traffic Controllers’ Associations (IFATCA).

These kinds of issues can be linked to impaired concentration, memory lapses, and a higher risk of making mistakes, all of which pose a threat to air travel safety.

Contributing pressures

There appear to be several role-specific contributing factors to these significant health and safety concerns. According to IFATCA, there’s the issue of chronic understaffing, with US air traffic control (ATC) facilities operating at just 81% capacity.

“This is leading to mandatory overtime for staff with 60-hour workweeks in 41% of facilities and inadequate recovery time. Similar shortages in the Turks and Caicos Islands led to resignations and operational crises,” notes Zeljko Oreski, a member of the IFATCA Mental Well-being Task Force.

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The schedules are gruelling according to Oreski, with 10-hour mandatory rest periods often including commuting time, and rotating shifts disrupting circadian rhythms and amplifying fatigue.

“There’s also psychological pressure, as each decision must be carefully considered. Each decision carries potential consequences, compounded by legal liability and public scrutiny,” Oreski explains.

“There could be conflicting priorities, with ATCOs having to maintain traffic flows, increase performance and reduce delays, while safety shall always remain the top priority. Pressure builds up and goes down, and, at times, a tension described as ‘airmiss complex’ can be felt.”

These factors are also leading to an increase in the rate of ATCO burnout, which is only creating a feedback loop that’s worsening staffing gaps. Adding to the issue is the fact that some ATCOs who may be struggling with their mental health will avoid asking for help. This is often due to potential career repercussions, such as losing their medical clearance to work. So, what’s the solution?

Breaking stigma and building support

Over recent years, the aviation industry has begun to acknowledge the pressures faced by ATCOs and shifted the approach to mental health, marked by policy reforms, regulatory updates, and collaborative industry initiatives.

For example, in 2023, the US Federal Aviation Administration (FAA) established a Mental Health Rule-Making Committee to reduce stigma and modernise policies, while organisations like IFATCA and the Air Line Pilots Association (ALPA) have been prioritising initiatives like peer support networks, fatigue management, confidential counselling, and systemic reforms.

This has included IFATCA’s Wellbeing Task Force, which was established in 2023 with four members who discuss the mental health and wellbeing needs of ATCOs and its importance as an imperative for ATCOs globally in the future.

“In 2024, the group expanded to 11 members and a survey was hosted during the annual conference in Singapore to better understand the state of peer support across member associations,” Oreski says.

The task force’s work has also included creating guidelines for effective collaborative peer support together with the Civil Air Navigation Services Organisation (CANSO) and air navigation service providers (ANSPs), and developing regional support hubs for smaller ANSPs lacking resources.

Aviation-specific mental health training

There are also new legislative and institutional efforts to bridge the gap between mental health professionals and aviation needs, such as the US Air Traffic Control Workforce Development Act introduced in February of this year. This requires the FAA to help develop training for mental health professionals to understand the aviation environment, introduce more advanced mental health modules for air medical examiners, and team up with experienced organisations to provide critical incident stress management (CISM) training.

ANSPs are also playing a role in improving the mental health of, and support for, ATCOs by introducing positive organisational change. For example, NAV CANADA won the 2023 CANSO global safety achievement award for its fatigue risk management system, which helps govern ATCO shift scheduling and ensures limits are in place for shift lengths, consecutive evening shifts and mandatory rest periods.

“Furthermore, our mental health and wellness initiatives are regularly assessed. This allows us to measure employee satisfaction, identify areas for improvement and make adjustments to programmes as needed,” says a NAV CANADA spokesperson.

In the UK, NATS has a well-established peer support programme that’s been running for 20 years, in addition to an employee assistance programme that provides expert advice and compassionate guidance 24/7. Usage of these has risen in recent years due to regular communications about wellbeing and mental health.

Alongside this, the NATS Human Performance team has been developing its fatigue management capabilities, with the first Fatigue Management Manual published last year, consolidating fatigue management practices across the organisation.

“We’re reviewing fatigue reports and introducing a bio-mathematical modelling tool across the business to further develop our understanding of potential fatigue factors,” says a NATS spokesperson. “The team continues to develop and deliver proactive education and training activities, and we’ve also tested new technologies, including heart rate monitoring and eye tracking hardware in operations.

“Trials show a connection between task load and heart rate and pupil size, which could provide real-time workload insights. This has led to trials of desk-mounted eye tracking, potentially providing for them to support real-time human performance decision-making.”

What still needs to happen?

While the industry has started taking steps to address stress among ATCOs, recent incidents like the 2024 Caribbean flight diversion and the 2025 midair collision near Washington DC make it clear there’s still a long way to go.

Work must continue on reducing the stigma around speaking up about mental health issues, and solutions found that will stop ATCOs from avoiding mental healthcare due to concerns for their career. This could include prioritising early intervention and confidentiality, according to Oreski.

Support and momentum continue to grow, however, with the International Peer Assist Aviation Coalition (IPAAC) hosting its next summit this November to advance multinational mental health frameworks, and the FAA’s Mental Health Rule Making Committee planning to finalise recommendations this spring, focusing on reducing reporting burdens and expanding therapy access.

These are promising signs, but real change will require a sustained, industry-wide commitment. Mental health must be treated as integral to aviation safety, not separate from it. Only then can we build a culture where ATCOs feel supported, not scrutinised, when they ask for help.