The reverberations of the 2015 Germanwings tragedy continue to echo through the civil aerospace sector as Regulators, AOC holders and other stakeholder groups address the implications of that event. MARC ATHERTON MRAeS looks at the regulatory and implementation challenges facing our industry in advance of the 2017 Aircrew Mental Health Conference.

Mental Health

Regulators and AOC holders have responded to the challenges posed by the fall-out by acknowledging the need to have a Peer Support System in place as part of the safety management systems required for all operators.

A Peer Support System provides a mechanism whereby a pilot can access a confidential helpline and obtain support form a trained (pilot) peer in addressing any mental health related issues that the individual has.

AOC holders and pilot organisations will already have internal systems that meet this need for issues around alcohol and substance problem, some of which have been expanded to include mental health issues (c.f. BA PAN programme, Dutch …., German Stiftung Mayday/AntiSkid). The PSS initiative provides a requirement and a framework which is specifically targeted on providing a secure and effective means of support for aircrew facing mental health challenges such as anxiety, depression or stress related symptoms.

There are of course several challenges in implementing a PSS in an operational airline. These challenges include issues around process and content (how is the system accessed? Is the system voluntary or can individuals be referred? what levels of confidentiality are incorporated? what level of training is appropriate for individual Peer Support individuals? What are the boundary limits for the PSS intervention? What procedures exist for further referral beyond the PSS if appropriate?)

The current PSS regulations and implementation guidelines are an evolving project. As AOC holders gather experience and data over the coming years the knowledge base of ‘what works’ will grow. This growing knowledge base will inform and ‘tune’ the content and process of dealing positively with aircrew mental health issues going forward.

In effect the sector will do what it does so well – it will learn from a form of ‘on condition’ monitoring and that learning will be disseminated through civil aviation to benefit both the sector and the individual.

As we move forward with this process there are several issues that any good risk assessment and mitigation approach (which is what the PSS is a part of) still needs to have a view on.

One key part of the challenge, if we view mental health as an operational risk, is the incidence base rate and severity in the population. We monitor engine performance and have scheduled airframe maintenance based on an understanding of the risk profiles that result from operational use. We resource our systems and procedures based on this understanding of the risk profile faced to mitigate it appropriately.

National statistics 

In the UK the generally accepted base rate for mental health issues in the population is a 1 in 4 lifetime risk. In other words 1 in 4 adults will have some form of mental health issue in any given year. Assuming that we believe that our aircrew are members of the population and not a distinct sub-species then we should take this as a given.

There is however a further question that warrants attention, and that is are there any role specific factors that might impact on that assumed base rate?

A recent study of teachers in Scotland, cited in the Times Higher Education supplement, identified a rate of almost 50% population incidence of mental health issues including anxiety, depression and stress related symptoms. The study concluded that this was a result of work related factors including high workloads, continuous performance assessment, long hours and complex reporting demands amongst others.

Mental Health

An argument could easily be made that the role of the modern civil aircrew has many of these features. As such.  the questions as to whether the incidence base rate we are dealing with in our aircrew is higher than the national baseline rate, and whether the incidence severity profile is skewed as well, are reasonable ones to ask. Currently, in terms of data and evidence around these issues we are, as an industry, ‘flying blind’

The PSS programmes will provide some insight into this issue as they evolve and to support this activity a review could be considered that builds on existing knowledge of aircrew mental health problem incidence rates. This approach could provide a ‘validated’ data set for the scale of the risk against which PSS resourcing requirements can be mapped.

It is more that just pilots

Looking more broadly across the civil aviation sector from the perspective of the underlying risk factors several other groups may well benefit from an integrated approach to dealing with mental health issues. Cabin staff, Air Traffic Controllers and aircraft maintenance engineers all work under similar pressures to aircrew and as such may well benefit from considering whether lessons learned and knowledge gained from the current PSS initiatives could benefit their operations and staff in terms of risk mitigation and staff well-being.

The Society is hosting a second aircrew mental health and wellbeing conference on 23 May 2017 at Hamilton Place which will bring together regulators, operators and other key stakeholders. The purpose is to bring a focus to these and closely related areas as part of the ongoing process of responding to the Germanwings tragedy and its’ fallout. A significant aim of the conference will be to share current knowledge and best practice as AOC holders and other stakeholders begin to work with PSS programmes as part of the response to aircrew, and other civil aviation populations, mental health challenges in the 21st Century. 

Marc Atherton
21 March 2017