Ahead of a landmark RAeS Conference on pilot mental health - MARC ATHERTON MRAeS* looks at this challenging topic in the wake of recent aviation tragedies such as Germanwings and MH370.
The Germanwings disaster was a wake-up call for pilot mental health issues. (French Ministry of Interior)
The 2015 Germanwings tragedy brought into stark relief the role that aircrew mental health and wellbeing can play in the safe operation of the civil aerospace sector. The challenges that mental health issues pose are multi-dimensional and complex and are currently exercising regulators and other stakeholders.
Include unresolved questions around the mental state of the captain of MH370 in 2014, The LAM Mozambique incident in 2013 and the JetBlue incident in 2012 with the Germanwings tragedy in 2015 and the issue of mental health in civil aviation is an area that the industry needs to respond to with a clear policy direction.
Over the next 25 years as the civil aerospace sector grows and the demands for, and on, aircrew increases the global industry faces some key issues and dependencies in managing this complex area from the risk, organisational performance and aircrew duty-of-care perspectives.
This article looks primarily at flight crew but the arguments put forward apply, with differing degrees of risk, to the full range of people who make the sector function.
IATA's Tony Tyler has flagged up the challenges of mental health and well being for airline pilots. (IATA)
Civil aviation has an enviable record for safety, transparency and critical self-examination. Where an aircraft is lost the various accident investigation boards around the world leave no stone unturned until the key causal factors are uncovered and a remedy identified and implemented.
The initial investigation into the Germanwings tragedy suggests that ‘pilot mental health problems’ were a major contributing factor to the incident. From the perspective of how to mitigate this risk in the future current best practice is seen to be less than satisfactory.
At the 2015 IATA AGM in Miami, CEO Tony Tyler identified that mental health problems posed a challenge to the industry and Lufthansa A.G. CEO Carsten Spohr pointed out that psychological testing and pilot mental states are difficult topics to deal with. This ‘difficulty’ has complex technical, legal and practical components.
Is there a problem for pilots?
Flying is a high-pressure job - but how many pilots could be affected? (Lufthansa)
A rigorous study in Brazil (Feijo, Luiz and Camara, 2012) detailed an incidence rate of 23,7% for Common Mental Disorders in a sample of 807 pilots with a heavy workload and recommended that mental health be considered a key topic and priority of civil aviation in Brazil. This work sets out one clear area that needs addressing: research to provide the evidence base on which to continue to develop policy and regulation.
Looking at population base rates for Common Mental Disorders using the UK as a reference, the figure of 23.7% found in the Brazil study aligns closely with the 1 in 4 figure for lifetime mental health risk in the general population. Recent MIND figures show that in the UK population at any one time 2.6/100 will be suffering from depression, 4.7/100 will have anxiety disorders and 9.7/100 will exhibit mixed anxiety and depression. With approximately 15,000 commercial pilots in the UK unless it can be shown that the pilot population differs significantly from the general population then there could be 1500 individuals flying with some form of mental health issue!
Additionally with global suicide rates for males at approximately ~30/100k (this figure has been on the rise over the last 30 years from the ~20/100k typical of the UK currently) while that for females has been steady at ~5/100k (Dr. A. Evans, ICAO, 2007) there is a valid question as to the level of risk posed by these base rates.
The current inclusion of mental health and wellbeing assessments in the regular aircrew medical screening is generally seen to be inadequate and a strong response will likely be mandated by regulators for the industry.
There are however some significant problems with mental health screening of aircrew. The first is that of the availability of qualified personnel and diagnostic tools to manage the number of individuals to be assessed (globally ~ 130,000 pilots which becomes much more challenging if cabin crew are included). The second is the legal and political challenge of agreeing and implementing a separate and specific ‘mental health assessment’.
Claude Thibeault, IATA’s Medical Advisor, has suggested that the approach to reducing mental health risk needs to be multi-layered, and Dr Bimal Dias, (Senior Civil Aviation Inspector-Aviation Medicine, P/CAPSCA-A) wrote on Oct 21, 2015 that ‘It is high time for us to think more about the ways and means of solving this issue using lessons learnt from the Germanwings Airbus crash’.
Key stakeholder groups with a view on aircrew mental health
To address the issue of aircrew mental health it is necessary to identify the key stakeholder groups who, in the view of this author, have a part to play in managing aircrew mental health issues going forward. It is beyond the scope of this article to detail all the issues but the number of stakeholder groups alone suggests that any solution is likely to be complex.
IATA Director General and CEO Tony Tyler (op cit) also spoke of pilot screening and mental health measures aimed at preventing a recurrence of the Germanwings tragedy being non-stigmatising. This would be necessary to avoid the risk of problems being hidden for fear of any licensing implications. A critical legal element in this area is that of national Data Protection laws. Within Europe alone there are differing legal frameworks defining medical secrecy in all 28 EU nations. Any solution would need to find a route through this legal labyrinth including non EU jurisdictions.
Patrick Ky, executive director of the European Aviation Safety Agency, told Reuters in an interview in 2015 that the idea (of the industry’s response to Germanwings) would be to "minimize the risk of a similar tragedy in the future,"
For the airline operators’ mental health is not purely compliance issue and has impacts on their financial performance. A poor mental health environment costs businesses money. Mental health issues cost the UK economy £120bn a year according to Sir Cary Cooper, a leading global expert on workplace mental health and wellbeing. Airlines are not immune to these costs and apart from the compliance and duty-of-care issues they have financial responsibilities to address. Any global solution proposed must however be workable and affordable for carriers of all sizes.
Quo Vadis mental health?
Could technology (such as DCAPS) designed to indentify signs of PTSD help in screening aircrew for mental health issues? (University of Southern California)
Beyond any procedural response such as requiring at least two crewmembers in the cockpit at all times and some changes to medical examinations a satisfactory approach to the ‘wicked’ problem must address the needs of all the key stakeholder groups. One possible approach might be to consider the UK Health and Safety Executive Stress Management Standards as a possible model.
The Standards take a three layered approach to dealing with stress and its adverse consequences in the workplace. It looks to the organisation to take all ‘reasonable’ steps to create a positive working environment and regularly assess for adverse impact; the individual is provided appropriate training in stress management and mitigation techniques, and there is a restorative ‘no-fault’ individual treatment option available for the individual who does suffer from stress induced illness.
In terms of the current civil aerospace mental health situation the layered model may be a good starting point to address the issues of risk, liability, mitigation and management of creating and supporting mental wellbeing rather than the approach of reacting to mental illness – a proactive prevention rather than a reactive cure policy position.
Additionally there have been recent developments in Data Analytics, Artificial Intelligence and Mobile Technology that offer the sector a possible future-proof solution to the changes likely over the 2015 to 2040 timescale.
This is best summed up by the ex-Director of the US National Institute for Mental Health (now at Google Life Sciences - renamed ‘Verily’).
..the data analytics from tech companies ....... promise of technology to change health care, shifting it from episodic to continuous, from reactive to proactive, from physician-centred to patient-centred. Dr Tom Insel, (as Director US NIMH) 31/08/2015
Apple, IBM and Intel are all working in this field and some examples of potential approaches which could be appropriate in the aerospace sector are already available. IBM research in 2015 (with Columbia University) demonstrated that computer analysis of speech patterns can more accurately predict the onset of psychosis after 2.5 years than conventional tests. A US Government Veteran Administration programme called DCAPS (Detection and Computational Analysis of Psychological Signals) is showing promise in monitoring the mental health and suicide risk of ex-military personnel using a non-intrusive Data Analytics approach. In the UK, the National Health Service has a successful mental health monitoring and support programme called Whitewall which is accessed through mobile or web technology.
A multdisclipinary approach?
Tim Robinson in a recent RAeS blog argues:
The future challenges for aerospace and aviation are not a quest for speed or height but a set of complex (wicked) interconnected problems that engage social, political, economic and regulatory spheres.. it has never been more important for a body like the Royal Aeronautical Society to advance the ‘art, science and engineering’ of aeronautics through its global, professional membership and learned output.
In essence an approach which takes a ‘systems’ view of mental health risk management through ensuring that the industry has a reviewed and coordinated ‘best practice’ strategy that reflects relevant key stakeholder concerns in a workable way may offer a solution balancing effective and practical requirements. We can never manage risk away entirely, but a combined policy, best practice and technology-enabled approach may give us a viable route into managing the level of risk faced as a consequence of aircrew mental health issues, and a balanced approach to mitigating that risk which meets the need of all the key stakeholder groups.
In terms of the authors personal view, the role for the Society Tim Robinson proposes is a sound description of where we should be, leading the way in addressing the ‘wicked’ problem of mental health and wellbeing as an integral part of the industry landscape as we move further into the 21st century.
On 9 May the RAeS will be holding a conference on Aircrew Mental Health and Well-Being 2015-2045 to consider the issues raised in this article. For more information click here.
(*Behavioural Scientist, Business Psychologist at Allaxa.)