Airlines Task Pilots With Identifying & Reporting Mental Health Issues, but Should They Do More?
Jeff Edwards March 27, 2015
Although it is a rare occurrence, when commercial airline pilots suffer mental breakdowns in-flight, the results can be catastrophic, but airlines primarily rely on crews to self-report potential psychological issues.
Following the stunning allegation by officials that the co-pilot intentionally crashed Germanwings Flight 9525 into the French Alps, killing all 150 onboard, scrutiny has focused on the safeguards in place to identify pilots at risk of suffering a mental break on the flight deck. It is becoming clear that airlines, by and large, rely on the pilots themselves to report any mental health issues that may make them unfit for duty.
While incidents of pilots suffering a mental health emergency in the cockpit are exceedingly rare, such incidents are not unheard of.
In October of 1999, EgyptAir Flight 990 was en route from John F. Kennedy International Airport (JFK) to Cairo International Airport (CAI) when it crashed into the Atlantic after the captain left the flight deck, leaving the co-pilot in control. It is widely believed that the EgyptAir flight was intentionally flown into the ocean.
As recently as 2012, a JetBlue captain had to be locked out of the flight deck by the first officer and restrained by passengers after suffering a psychotic breakdown on a flight from JFK to McCarran International Airport (LAS). In this case, the co-pilot was able to safely land the aircraft after the pilot began to incoherently rant about religion and terrorism.
BBC News reports that the parent airline of Germanwings, Lufthansa, like many European carriers, relies primarily on flight crews to self-report mental health issues that could possibly lead to an in-flight tragedy. Regular physical evaluations that are required to certify flight crew fitness for duty require physicians to “make a general enquiry about mental health which may include mood, sleep and alcohol use,” but even this evaluation relies on pilots to voluntarily disclose symptoms of mental illness.
“There is an element of trust in it. We have to trust,” Mike Vivian, former Flight Operations Director at the CAA, told the BBC.
Following what is being described as the intentional downing of 4U 9525, many are asking if the procedures in place to identify mental health issues in pilots are sufficient.
“We have at Lufthansa a reporting system where crew can report without being punished their own problems or they can report about problems of others without any kind of punishment,” Lufthansa CEO Carsten Spohr told CNN. “That hasn’t been used either in this case, so all these safety nets we are so proud of here have not worked in this case.”
In the U.S., a similar system is in place. According to a USA Today report, the FAA expects pilots to disclose any mental disorders or health issues on an FAA medical form that accompanies the required physical exams. Pilots face potential sanctions for providing dishonest information on this form. The certified aviation medical examiner could also require additional psychological testing based on the initial evaluation.
Relying on pilots to volunteer mental health concerns is not a perfect system, but Embry-Riddle Aeronautical University Chairman of Behavioral and Safety Sciences, Erin Bowen, says it may offer the best chance of identifying potential issues. “It’s not like a blood test that tells you you’re sick,” Bowen told USA Today. “That level of ambiguity, between the legal liability and the moral liability of telling someone they can’t do their job because you think that a test said they might be a risk — the field is not there yet.”
In only the most extreme cases will mental health problems cause a professional aviator to take the lives of hundreds of passengers along with their own. There are legitimate concerns that attempts to aggressively diagnose or investigate possible mental disorders in flight crews has the potential to backfire, leading pilots to avoid treatment for mental health issues and instead allowing those very issues to go untreated out of fear of losing their livelihood.
“It’s hopeful that the tragedy will continue to open up the discussion about how we deal with and treat and respond to mental illness in our professional group,” said Bowen. “how we deal with it when it affects workplace safety and security.”
[Photo: iStock]
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1) The rules must be international. There is no alternative. 2) The airlines, manufacturers and software providers must all join forces to upscale their support and logic. 3) Penalties for not following must move from being entirely civil to have coverage in the criminal arena. Poor judgment must have a cost. It kills people. And this is where it must begin. From a multi airline million miler and seen the failures over the years of the above to do their jobs.
You assume your doctor knows you are a commercial pilot. Mine doesn't.
In the end, absent clearly unusual behavior or statements, all mental health issues depend on self-reporting whether to a doctor or to an employer. As Mr. Edwards points out, it isn't like there is a blood test. Do we want to discourage people from seeking the help they need by turning the doctor into a snitch for employers? We also don't know whether the symptoms which Mr. Lubitz discussed with his doctor rose to the level of suggesting that it was unsafe for him to fly an aircraft.
Allow me, as a physician, to give some perspective: a) In the US, most states require any physician (whether a psychiatrist or not) to report any person known to them who expresses or presents an "apparent" danger to self or to others to authorities - this may or may not be the case in Germany, and it is subject to interpretation what "apparent" means and how that is interpreted by prevailing law b) a physician has the ethical responsibility of reporting any suspicions about patients that are overtly acting in a dangerous manner--but again this is subject to jurisdiction an regulation c) among the other concerns, we have to practice against a backdrop of patient confidentiality versus public threat, and that is governed entirely by whatever jurisdiction the physician and patient are in With saying all of that, if the copilot was not receiving therapy, or had refused follow-up or there were other circumstances in play (copilot did not self-report as may be required or the authorities did nothing [more common and dangerous than most think!]), there is nothing a physician can do except report where necessary and required. If the proper authorities do not act, unless a mental health law permits a physician to order involuntary confinement for mental evaluation (and I don't know about the EU or German law specifically), there is little to nothing a physician can legally do except report to the appropriate authorities and it is up to them to act (or not).
This should not be an action that should be self-reported. If a doctor has diagnosed a condition like this in a profession where one's job is to ensure the safety of hundreds of people, it should be mandatory for the doctor to report the condition immediately. I don't think this is wihtout precendent. At least in Canada and the US, if a doctor diagnoses a condition whereby someone no longer has the ability to safely operate a motor vehicle, they are required to call this in to the State authority to have their driver's license cancelled. It seems that it is a no brainer that the same should apply to commercial pilots - that a doctor diagnosing a condition making it unsafe for them to fly an aircraft should have to be reported to the pilot licensing authorities, who can revoke thier license, and in turn should immediately notify their employer. Or the other way around - that they immediately notify the employer so they know to not allow the pilot in question to work until further notice, and they should be required to call the authorities to cancel their pilot license. There is just too many lives at stake to have a pilot in danger to themselves and others, flying a commerical aircraft.