It’s a serious career and a serious matter. Wondering if an individual would be seen in a positive light for taking control of a situation or struck off…
That's unfortunately the crux of the issue. If you take control of the situation and seek the help needed for any situation (like we would for any other situation in aviation), there is a very real potential that you lose your medical for good, especially if medication is required. So, people hide their issues hoping that it will all work out. Thankfully, I've not had any issues, but I've helped other pilots seek help for instances of sim anxiety up to depression. So this is the basis for the rest of my post.
I have a very good relationship with my CAME. We're part of the same running group, so it means we get to take our conversations out of her office. She knows full well that pilots are no different than the average population group, so it is likely that 5 out of every 100 pilots she sees is suffering from some form of mental illness, depression included. Yet, she only has 5 to 10 minutes to gauge the pilot, all during a time when the pilot is already anxious about just being there. It's simply not enough time to expect a trained individual to identify the signs. She just has to accept that she's not seen the signs. We've talked about our shared desire for the industry to adopt a format similar to how diabetes is handled here in Canada.
We adopt a system where the loss of the medical is not lifelong. The medical, just like for diabetes, will be revoked for no less than 3 to 6 months, during which time you go get the help that is needed. If, after that time you are in a better position, you are awarded the medical back with whatever conditions are deemed necessary (for example, two-crew ops only). If you're placed on medication, then there may be further restrictions - just like diabetes. If the medication has undesirable side effects, then you'll get your medical back once you are no longer taking the medication and after a prescribed waiting period and assessment. Except in the most extreme cases, no pilot would ever be told they will never get their medical back. In addition, we develop a list of conditions that will not result in the medical being revoked at any time. One pilot I had the pleasure of working with was the nicest guy at work but had the shortest fuse at home. He didn't seek help for his temper because he thought once it got back to his CAME that he had "seen a shrink" he'd be done for. It cost him his marriage. Unfortunately, his thoughts about going for anger management training were unfounded but came from the same place we're discussing. So it's not just those with serious mental issues we can help, but those at the periphery who harbor the impression that everything is included.
I believe knowing that there is a path will help. Unfortunately, it's the not knowing that is driving many to not seek help. I know it's too simple, but it's better we start down a road than none at all.