Mental Health in the Cockpit
The tragic crash of Germanwings Flight 9525 into the French Alps on March 24, 2015 ignited discussion not only about internal safety threats in aviation, but also the mental health of pilots. Dr. James Fraser, the FAA’s Federal Air Surgeon and top medical officer said safety depends on pilots “to be honest and forthright” about mental health and alert their employer and the FAA when a disturbance occurs. Unfortunately, this is a flawed system; particularly when nested in the well-known “suck-it up” culture of aviation. In addition, pilots risk job and financial security by reporting mental health concerns. As one veteran pilot reported, “If you had a mental health issue, you certainly wouldn’t tell your flight surgeon about that because it goes right to the FAA.”
One solution is for aviation leaders to build an intentional culture that supports mental and physical health. The FAA is increasingly concerned about physical health problems (e.g., rising rates of obesity and associated conditions like sleep apnea and heart disease), and conducts biannual health evaluations. Mental health, however, is only briefly examined with inadequate criteria such as a pilot’s personal hygiene or ability to carry on a conversation to judge mental health. Andreas Lubitz, the co-pilot who flew Flight 9525 to crash into the mountains, met basic job expectations and social norms the day of the crash even though he had a medical excuse letter for not flying that day.
An intentional culture to encourage mental health wellness requires policies that encourage pilots to take proactive behaviors to maintain mental wellness and seek early treatment for health concerns. A preventative, proactive, and non-punitive approach can most dramatically affect health outcomes, and as a result flight safety. Ideally, alternate work options, or sabbaticals, could be provided to pilots who seek treatment. Exercise and stress management programs, possibly incorporating counseling could address both mental and physical well-being before safety risks and costs escalate. These programs could be extended to other high stakes job groups like air traffic controllers, flight attendants, and/or Transportation Security Administration (TSA) agents.
Real-Time Mental Health Assessments
Once the plan for creating a culture that fosters health and well-being is enacted, consistent measurement can help aviation strengthen the culture to achieve greater mental and physical health outcomes. Dr. Fraser wisely said, “The solution lies in self-assessment, not in any kind of regular psychiatric assessment.” Real-time mental health surveys can be administered at numerous touch points throughout the year. If a non-punitive culture is in place, pilots are more likely to self-disclose on health assessments. Smart phone technology makes frequent assessments easy and feasible. Mental health surveys can provide individual feedback that delivers pilots with targeted, personalized suggestions for greater mental and physical health outcomes. Real-time surveys can help pilots understand how their mental and physical well-being fluctuates, and provide insight to aviation leaders about how the work environment and policy change affects stress and health.
Aviation leaders could also create programs to encourage the use of wearable technology to further foster a culture of health and wellness. Sleep, exercise, and physical and mental health are inter-related and pilots can benefit from real time tracking of these metrics. Exercise can significantly reduce mild-to-moderate depression and anxiety, and strengthen treatment effects for other mental illnesses, as well as help pilots manage the physical strain of shift work.
Culture Is the Key to Safety
Despite the array of technology driven options for proactive prevention and treatment of mental illness, if airlines and the FAA fail to create a culture that supports pilots when mental illness occurs, the effectiveness of these interventions will fail. Beliefs and values are the core of culture. Pilots must believe that their employer’s values support their health and well-being, and understand this will sustain safety as well as their own health in order to self-disclose mental health concerns, and engage in health promotion programs. While events such as the Germanwings tragedy are rare, they are preventable if those responsible for passenger and crew safety act.