Andre M.’s question answered:
Major U.S. airlines have great programs in place for this possibility, including my own airline, called the EAP (Employee Assistance Program).
Additionally, the ALPA Pilots Union has their own department within each councel to help any pilot with this, if ever needed.
This assurance of help for any pilot in need encourages the individual pilot to self-report to a strictly confidential phone number 24/7.
When a pilot needs help
IF a pilot does not self-report, then any fellow pilot observing i.e. a stress, mental, or alcohol problem is obligated to approach his pilot brother or sister in need in confidentiality, to try to help and convince the affected pilot to go self-report. This is an immediate intervention-mandatory procedure.
Here’s an example from real life: Pilot A notices that Pilot B has a stress, mental, or alcohol problem, showing up unfit for flight duties (perhaps drunk?) at the hotel the morning of departure.
Pilot A pulls pilot B aside, and says, «hey B, why don’t you call in sick for your trip today? You are not doing well. And please call the Union for help too.»
In 9 out of 10 cases pilot B will «call in sick» to crew scheduling, followed by an immediate EAP call.
Following treatment the pilot may return to flying once found fit by the doctor and the FAA. But, he will receive mandatory continuous F/U to ensure he has recovered fully.
When a pilot does not seek help voluntarily
IF a pilot does not self-report, then each pilot observing the problem is obligated to call the EAP on behalf of the pilot needing help. The reporting pilot’s name remains anonymous in the system outside of the EAP folks and the Union officers, who are sworn to confidentiality.
So, it’s still true that you never «backstab» or tell on another pilot. However, in today’s airline world every airline pilot out there appears to like this new set-up for safety. It’s proven effective, and it has truly helped a few affected pilots recover fully.
Now there are even procedures in place for handling a dangerous pilot with degrading flying skills. Similar to a stress, mental, alcohol, or a drug problem, those procedures are set up to correct the situation nicely too.
Hope this answered your question.