Abstract
Mental health challenges among commercial air transport (CAT) pilots represent a significant concern for both individual well-being and aviation safety. Understanding the factors that facilitate or hinder access to appropriate psychological support within this occupational group is essential for the development of targeted and effective interventions. This narrative review was therefore undertaken to appraise and synthesize existing evidence on the barriers and facilitators influencing mental health care utilization among CAT pilots. A literature search was conducted across major academic databases, regulatory archives, and aviation-specific sources for English-language studies published between 2010 and 2025 that addressed barriers and facilitators to mental health help-seeking within the CAT pilot population. Eligible studies were thematically analyzed to identify key determinants of mental health support, with particular attention to help-seeking behaviors, organizational structures, and regulatory frameworks. The synthesis identified several primary barriers, including: (1) a prevailing culture of silence and stigma; (2) fears related to job security and medical certification; (3) limited trust in confidentiality; (4) regulatory and procedural constraints; and (5) organizational and logistical barriers. Conversely, key facilitators of mental health support comprised: (1) structured peer-support programs; (2) non-punitive disclosure and reporting policies; (3) comprehensive mental health education and initiatives to shift organizational culture; (4) accessible, independent, and confidential mental health care services; and (5) socioeconomic protections to mitigate perceived risks of disclosure. In summary, addressing mental health challenges among CAT pilots necessitates coordinated action across cultural, organizational, and regulatory domains. The implementation of confidential, non-punitive support mechanisms, in which occupational medicine plays a central role in prevention, early detection, and care coordination, combined with meaningful regulatory reform and sustained cultural change, holds the potential to significantly improve pilot well-being while strengthening overall aviation safety.