President’s Corner, 1Q16, “A Wingman for Every Pilot”
A Wingman for Every Pilot
Pilot Mental Health – Critical for Safety…If Done Right
Pilot Fitness For Duty (FFD) issues are growing in international awareness and calls for action. The recent release of unofficial details of the medical files Andreas Lubitz, the first officer of the Germanwings murder-suicide flight, has increased calls for action regarding pilot mental health monitoring. Dangers exist in well intentioned, but poorly thought out, actions to give the appearance of improving safety.
I have written about the full spectrum of Pilot FFD, to include physical/medical, psychological, psychiatric and cognitive fitness for flight duties in several earlier pieces. Clearly, the majority of pilot FFD concerns can be addressed, identified and treated to allow a safe return to flight duties. FFD is not only for pilots, but also for cabin crew, aircraft maintenance personnel, dispatchers, air traffic control specialists and many others involved with aviation safety. The public has focused its attention narrowly on pilots and their mental health. Thus I will do so here.
The FAA Administrator was originally scheduled to release the findings of the FAA Pilot Fitness ARC in December, but has delayed that announcement. Hopefully it will send a strong message that the US airspace is safe with the systems currently in place, although with some opportunities for improvement. In the interim, we have seen calls mainly from overseas, to have pilots submit to routine psychological testing and to require their treating medical providers notify employers and regulators when any psychological issue arises. Currently the European medical privacy rules preclude these notifications. Swinging the notification and testing pendulum fully in the opposite direction would be a mistake and would weaken the safety system we have in place.
First, the issue of regular or periodic psychological testing is one fraught with problems. Some airlines administer computerized cognitive testing prior to bring pilots online. These tests look more at aptitude for flying cognitive functions and don’t address psychological pathology. Some test for personality traits consistent with a good crew member. Testing for psychological pathology is specialized, detailed and lengthy and requires expert interpretation. Analysis requires several days to weeks and the costs are substantial. Information to prevent a Germanwings type event would not be available on a timely basis for action. Testing for identification for future psychiatric pathology is neither sensitive nor specific.
Briefer screening tests may be quickly administered, but are not definitive and subject to false positives. More problematic is that once the favorable answers to these brief screening tests are known to the tested populations (pilot networks are amazingly fast), the responses lose validity as pilots will “know the right answers” and put them down at each screening opportunity, thus negating the value of testing.
Secondly, requiring physicians and counselors to routinely notify employers or civil aviation authorities of pilots or other aircrew who seek counseling or possibly treatment with medication would have an immediate stifling effect on pilots seeking appropriate counseling for life’s routine events as well as more serious psychological conditions. Not only would this violate the medical privacy of individuals seeking help, but it is also discriminatory as many other workers in safety sensitive positions (nuclear power plant workers, subway and rail operators, etc.) do not have similar requirements. Medical providers in the United States already have reporting requirements to authorities if they feel an individual presents an imminent threat of harm to themselves or others, although laws vary from state to state.
Such action (mandatory reporting of all mental health visits) is contrary to a former FAA Administrator’s wise encouragement for pilots to seek help for family and personal matters without needing to report those visits on their next medical application when the issues are not associated with drug or alcohol problems, result in a personal psychiatric diagnosis or require any treatment for a diagnosed disorder or any psychoactive medication. Many common and minor psychological conditions exist that respond well to brief interventions. Pilots seeking help for these conditions should have a “Safe Haven” to do so.
The most practical and least expensive solution to the dilemma of pilots having a resource to use when faced with everyday life stressors (economics, family problems, schedule requirements, deaths of loved ones, eldercare, etc.) already exists at some airlines and is being adapted by many. A Peer-to-Peer (P2P), also termed Peer Support Program (PSP), network of non-medical pilot volunteers created by pilot labor groups and supported by airline management provides a trusted and confidential source of support to those pilots reaching out for help.
These peers understand the demands of the pilot and can lend a sympathetic ear to those feeling challenged or overwhelmed by their current situation. The P2P volunteers do not give medical advice nor make referrals for medical care; they just listen and reflect. An observation from a peer that a pilot should consider not flying or seek help is a powerful message for someone who may be in denial, fails to see the fallout from their current circumstances or wants to continue to fly out of a sense of responsibility to the employer. In most cases, a suggestion from a peer to seek counseling and inform the pilot of career protections in place is the trigger for a pilot to seek professional help.
In the rare circumstance that a P2P volunteer senses something more serious is occurring that may impact safety or the pilot’s career, a trusted relationship with a supportive management backed by adequate employment and health care coverage can not only enhance safety, but improve the health of a pilot and potentially save a life. A call, after obtaining the pilot’s consent, by a P2P leader to a chief pilot indicating that a particular pilot should probably come off the flight schedule with pay protection until the situation is improved or resolved, still protects the pilot’s privacy while triggering events that bring resources together to help the pilot. The peer cannot make a diagnosis and does not offer specific information on the pilot’s circumstances, simply a recommendation that the pilot be temporarily removed from flying responsibilities
A knowledgeable aeromedical resource who can build a relationship with the pilot and refer him/her for appropriate help is key at this point. Ultimately, the expectation is for the pilot to return to flying duties within the civil aviation authority’s knowledge and probable future monitoring. In these few cases where a long-term removal from flying or training status is appropriate, adequate disability and health insurance in place relieves the fear of economic hardship while recovering.
Robust volunteer P2P support programs already exist at several airlines and are tremendously successful as well as busy. American, Delta and FedEx Express have Project Wingman, the Pilot Assistance Network (PAN) and Pilot Assistance Team Hotline (PATH), respectively, with 24/7 telephone coverage to reach a P2P volunteer managed by trained volunteer pilots. The feedback from pilots participating, volunteers and management has been very supporting. Many times, pilots who called in for help become P2P volunteers after their personal situation is resolved. This is somewhat similar to the HIMS program for pilot’s drug and alcohol problems, but without the nature of the diagnosis given to the employer. It is also somewhat like Professional Standards programs which deal with unusual pilot behaviors. A peer based program excels in encouraging pilots to seek help early, get trusted information to speed resolution and returns a safe individual to the cockpit at the earliest time.
I had the recent privilege of moderating a panel of pilot and management experts from Europe, Canada and the US on Pilot Assistance Programs at the IFALPA Global Pilot Symposium. The desire for these programs on a wider scale and the success of similar programs internationally was dramatic. I have also attended presentations at the recent Airline Medical Directors Association, the Pilot Mental Health Working Group of the Aerospace Medical Association and a briefing by the lead investigator of the French BEA investigation into the German Wings event. These PSP programs are seen as a key element in improving safety by encouraging pilots to access help faced with many of life’s situational stressors and other mental health conditions.
Qantas Airlines has had a Pilot Assistance Network in place for 25 years supported by the airlines using peers, AME’s and aviation psychologists with the support of the employers and the civil aviation authority. Germany has a slightly different program administered through the Mayday Foundation. The key to all of these programs is that with company support for pilot privacy and regulator expectations that most pilots will continue or return to flying, the pilots have a safe harbor of peers to reach out to for help. No pilot is left without a Wingman if he or she wants to reach out.
The aviation world should heed AsMA’s recommendations (www.asma.org/publications/pilot-mental-health) and avoid knee jerk calls for mandatory reporting of all mental health visits by pilots and periodic psychological testing. Such actions would be costly, yield no measurable benefit and would exacerbate the problem they seek to cure. Pilots will not seek help for mental health issues in this environment and will hide any problems in an effort to protect their careers. P2P programs jointly supported by labor and management are the key to pilots improving their mental health, with companies reaping a significant return on investment and improving the safety of the aviation industry. Regulators maintaining an expectation of pilot’s recovery and maintaining a flying career coupled with adequate benefits to provide protection if a pilot is temporarily or permanently grounded removes other barriers to pilots seeking help from a Wingman and professionals. The aviation industry should support and encourage P2P volunteer programs for everyone’s benefit. We should never allow a pilot to go “lost Wingman.”