Much as in the aftermath of many modern-day disasters and tragedies, the weeks and months following the Germanwings disaster in Europe have brought increased attention on mental health and mental health in aviation, in particular. In this case, there is heightened awareness and call for greater scrutiny of the psychological well-being of aircrew. Indeed this has been an area of intense study for quite some time, but the public and even mental health professionals are often unaware of the attention that is already paid to pilot mental health.
Aviation psychology and neuropsychology are specialized disciplines that are uniquely focused on the aeromedical impact and significance of mental and cognitive disorders. The Federal Aviation Administration maintains stringent physical and mental health criteria and there are clearly defined excluding conditions defined in the Federal Air Regulations with which pilots may not fly.
In the United States, a pilot must possess both a license to pilot aircraft and a medical certificate certifying their physical and mental suitability to perform the duties of a pilot. Three different classes of medical certificates are issued Class 3 for general aviation such as recreational and private pilots, Class 2 for commercial/ non-airline duties such as parachute jump plane pilots, and Class I for commercial aviation. All are subject to periodic examination by a designated aeromedical examiner (AME) and the intervals for re-examination vary depending on class and age (24 to 60 months for Class 3, 12 months for Class 2, and 6 to 12 months for Class 1). At each visit, the pilot is required to complete a form detailing his or her medical history and any medications taken at the time of examination or in the past. Questions pertaining to mental health are included. Furthermore, in addition to the standard physical examination, the aeromedical examiner screens the pilot’s mental status.
Admittedly, this is a far from perfect system as one can plainly see that it relies heavily on the honesty of the pilot as well as on the AME’s comfort and expertise in identifying potential mental disorders. However, particularly at the level of the commercial airline industry, pilots may be subject to psychological screenings at the time of hire, are mandated to undergo periodic proficiency checks, and are closely followed by their chief pilots. In addition, open communication between crew members is an integral part of training and communications regarding concerns of fellow crew is encouraged. Add to this monitoring, random Department of Transportation drug and alcohol screenings to identify pilots who may have substance abuse issues.
Therefore, there are multiple mechanisms by which a pilot who is experiencing difficulty may be identified for further examination. Referrals for more formal examination can come from the airline, the AME, and the FAA, at the time of the initial application or at any point during the flight career in which a significant medical, psychological, or developmental history may come to light.
Once identified, it is the charge of the aviation psychologist to examine the pilot for psychologically excluding conditions and aeromedically-significant neurocognitive deficits. All with an eye on the aviation standards as defined in the Federal Air Regulations as well as on the public safety.
Much has developed in the understanding of cognitive demands on resources while performing routine and non-routine pilot duties. For example critical cognitive abilities such as working memory, processing speed, and cognitive flexibility and prospective memory are examined in detail with both traditional and aeromedically-specific tests. In addition, the aviation psychologist must be skilled in both the psychiatric interview and in the use of psychometrically-sound diagnostic procedures for the identification of excluding mental conditions.
It is important to add that the FAA and the Civil Aeromedical Institute are not solely focused on excluding pilots from flight but have also made and continue to make great strides in encouraging pilot mental health. For example the adoption of the SSRI protocol in 2010 allows pilots who have demonstrated stability on their medication to return to duty with routine monitoring. Pilots with histories of substance abuse and dependence and even certain developmental conditions, can be considered eligible for what is referred to as a Special Issuance Medical certificate.
The question remains, how and why did the Germanwings tragedy occur and the ever-present could it happen here? We may never know fully the circumstances that led to that first officer’s actions, nor can we never fully guarantee that a pilot will never do the same thing in our airspace. But it is certain that we have one of the safest air transport systems in the world and safety records continue to improve with better training, more advanced technologies and scrutiny of the systems including the human elements at the level of the pilots and air traffic controllers. Despite the level of safety and professionalism in the United States, there is always room for improvement in the assessment and management of pilots with psychological conditions.
Rather than ostracize those experiencing stress or symptoms of depression or anxiety, we should help to remove the stigma of mental illness, encourage our pilots to seek the mental health services they need, and encourage open and honest discourse among professionals in the aviation industry. That will ensure a course of continuing improvements in safety and wellbeing.
More is to come. The breathless coverage of the immediate aftermath of the Germanwings tragedy squelched a measured and carefully deliberate discourse on a path forward. Now, the FAA has announced a task force to more closely examine the psychological screening of aircrew and the time is now upon us when the aviation psychology and aviation medicine communities to come together to offer even more suggestions for the fair and feasible assessment of aircrew to ensure the safety of all.