Mental well-being and absence of mental illness are essential to the safe performance of pilot and aviation safety-sensitive duties. There are many mental health conditions, such as grief, psychosocial stress, depression, anxiety, panic disorders, personality disorders, and substance misuse/abuse, that are common, and that show patterns that facilitate early detection, and that have proven effective treatment strategies.
Mental health refers to our cognitive, behavioural, and emotional wellbeing. It is all about how we think, feel and behave. The term mental health is sometimes used to mean an absence of a mental disorder. Mental health can affect daily life, relationships, and even physical health.
The magnitude of mental health problems/disorders in aviation is unknown. Mental health is influenced by various personal and occupational factors. Most mental disorders are probably related to depression, anxiety, and alcohol and drug dependence. Being labelled with a "mental health problem" in aviation might have consequences, including stigma and discrimination (perceived and real); grounding; additional costs, including costs associated with examinations and treatment to obtain/maintain medical certification; loss of income; and fear of loss of employment. Possible outcomes of being diagnosed with a mental health problem include self-esteem and self-confidence issues; reluctance to seek help due to medical confidentiality matters; seeking help, but declining treatment; obtaining treatment but failing to disclose the condition or treatment; having peers be hesitant to report concerns to an employer/regulatory authorities; increasing stress and isolation; experiencing adverse effects on the progress of a mental disorder and/or the exacerbation of symptoms. All of these situations can lead to an increased risk to aviation safety, and, in extreme cases, to, Pilot Suicide .
Since the European Aviation Safety Agency Germanwings Flight 9525 Task Force Report recognition of the importance of mental health in aviation has gained a great deal more attention. Mental health problems are present in aviation as in any other industry, and more must be done to identify mental health problems, both during a pilot's career and during the hiring process. It is important to have a wide variety of tests and screening processes to determine the true wellness of pilots. Even though pilots need to have their medical licenses renewed periodically by a certified medical examiner, there is little focus on mental health. There is no follow-up by a psychologist or psychiatrist unless the pilot requests such a follow-up, which is rarely the case. Additionally, in the main, psychiatrists are unfamiliar with the regulations governing pilots suffering from mental health issues. Airlines are familiar with the consequences of mental health, which is why they now administer personality tests during the selection process to identify mental health issues. One example is the Minnesota Multiphasic Personality Inventory (MMPI). This long questionnaire can identify at-risk candidates, by asking a series of questions, worded differently, about a similar subject. Pilots are aware of the importance of having perfect mental health. As a result, they tend to be defensive about their results, perhaps even more so than indviduals in the non-pilot population, and try not to show signs of any mental health issues.
Five significant warning signs of mental health risk. A pilot may exhibit one or more of the following;
- A change in personality, acting like a different person, not acting or feeling like himself of herself;
- Uncharacteristic behaviour, heightened open displays of anxiety, anger or moodiness;
- Social withdraal, always doing things on their own, becoming isolated;
- Lack of self-care or a tendency to display risky behaviours in public; and
- A sense of hopelessness or feeling overwhelmed.
The following are key factors that contribute to a pilot's mental health. In isolation, these factors may appear relatively insignificant. However, an individual who displays more than one could lead the observer to suspect that the pilot may be at risk of deteriorating mental health:
- Emotional – Pilots who are struggling with their mental health may seem irritable and sensitive to criticism, demonstrate an uncharacteristic loss of confidence or seem to lose their sense of humour.
- Cognitive – A pilot may make more mistakes than usual, have problems making decisions, or not be able to concentrate. He or she may display a sudden and unexplained degradation in performance, both on and off the flight deck.
- Behavioural – This could include things like arriving late, not taking rest breaks, taking unofficial time off, not joining in flight deck banter, becoming more introverted or extroverted; and generally acting out of character.
- Physical – Pilots who are stressed sometimes exhibit physical symptoms such as a constant cold, being tired at work, looking like they haven’t made an effort with their appearance, or rapid weight loss or gain.
The concept of mental health advocacy has been developed to promote the human rights of persons with mental disorders and to reduce the stigma often associated with mental health problems and the resulting discrimination. It consists of actions aimed at changing the major structural and attitudinal barriers to achieving positive mental health outcomes. More recently, the concept of advocacy has been broadened to include the needs and rights of persons with less severe mental disorders and the mental health needs of the general population. Mental health advocacy actions include the following:
- Raising Awareness – Provide information, education and training; develop support networks for information exchange; provide emotional and instrumental support (e.g., providing facilities for meetings and contacts with other groups); provide mental health services (counselling and professional support), promote the formation of alliances of stakeholders for mental health advocacy; and establish implement review boards.
- Prevention - Safeguard the mental health of your workforce by creating an open and caring culture that makes staff feel supported and looked after.
- Culture – Create a culture of openness and awareness by encouraging people to talk about mental health. Develop a mental health policy because having a concrete policy reassures employees that their company cares about their well-being.
Accidents and Incidents
- A320,_en-route_Alpes-de-Haute-Provence_France,_2015: On 24 March 2015, after waiting for the Captain to leave the flight deck and preventing his return, a Germanwings A320 First Officer put his aircraft into a continuous descent from FL380 into terrain killing all 150 occupants. Investigation concluded the motive was suicide, noted a history of mental illness dating from before qualification as a pilot and found that prior to the crash he had been "experiencing mental disorder with psychotic symptoms" which had not been detected through the applicable "process for medical certification of pilots". Conflict between the principles of medical confidentiality and wider public interest was identified.
- E190,_en_route,_Bwabwata_National_Park_Namibia,_2013: On 29 November 2013, an Embraer 190 Captain intentionally initiated a high speed descent from the previously-established FL380 cruise altitude after the First Officer left the flight deck and thereafter prevented him from re-entering. The descent was maintained to ground impact with the AP engaged using a final selected altitude below ground level. The Investigation noted that the Captain had been through some “life experiences" capable of having an effect on his state of mind, but in the absence of any other evidence, the investigation was unable establish any motive for suicide.
- "Understanding Pilot Wellbeing, and Its Impact on Flight Safety," 2017 Safety Forum Poster, Capt. Paul Cullen, Dr Joan Cahill (TCD) & Dr Keith Gaynor (SJOG).
- Pilot Fitness Aviation Rulemaking Committee Report, Federal Aviation Administration, 18 Nov. 2015.
- "Pilot Mental Health," British Airline Pilots' Association (BALPA), 2018.
- Pilot Mental Health - Updated Expert Working Group Recommendations, Aerospace Medical Association, President Kris M. Belland, Executive Director Jeffrey C. Sventek 21 Sept. 2015.
- "Aircrew Mental Health and Well-Being: 2015 to 2040," Royal Aeronautical Society, Marc Atherton, MRAeS, 4 March 2016.
- "Strengthening Mental Health in Civil Aviation" Dr Ansa Jordaan Chief Aviation Medicine Section, ICAO. Atlantic City April 2016.
- Pilot Mental Health Assessment and Support - Practitioners Guide, Robert Bor, Carina Eriksen, Margaret Oakes, & Peter Scragg, 2017.
- "An Aviation Professional's Guide to Wellbeing", Flight Safety Foundation, April 2020.