President’s Corner 1st Issue 2023
Rising from the Ashes to Shine – Hopefully
Terrible tragedies provide an opportunity for great good. Most of our aviation safety measures and regulations arose from our rigorous and non-judgmental method of investigating accidents to discover the root cause and institute mitigations to prevent recurrences. This strategy has made commercial aviation in the US the safest mode of travel in the history of mankind. Since 2010, there have only been two fatalities in Part 121 operations. In contrast, the CDC reports an average of 28 US fatalities annually from lightning strikes, 30,000+ automobile deaths annually and nearly 92,000 drug overdose deaths in 2020.
Two recent tragedies have led to significant improvements in aviation and the mental health of aviation professionals. The Germanwings 9525 murder-suicide in March 2015 highlighted the need for providing resources and removing barriers for pilots seeking mental health treatment. I have written about this previously and the efforts by the FAA, the European Union Aviation Safety Agency (EASA), and the International Civil Aviation Organization (ICAO) to provide guidance to airline operators and industry groups for these effort. We are emerging from a pandemic that caused nearly 7 million excess deaths worldwide and over a million deaths in the US alone.
The aviation industry, among several others, was devastated by the COVID pandemic with drastic reductions in flying for passenger carriers and business aviation, particularly outside the US, and extremely demanding flying schedules and health procedures for cargo carriers. The pandemic led to surveys and research on the mental health toll in aviation professionals. While acknowledging that survey data cannot be equated with population statistics, the data is nevertheless troubling. at Harvard surveyed airline pilots in 2016 and found that 12.6% of airline pilot respondents met criteria for depression in screening tests and 4.1% of pilots had suicidal thoughts in the previous two weeks. Cahill et al. did surveys of mental health in aviation workers at two points during COVID in 2020 and 2021.
Importantly, Cahill argued for an organizational (i.e., the airline or employer) responsibility for protecting and enhancing employee mental wellness. This is very important…but not enough. Responsibility for mental wellness in my opinion is one that is shared by the employer, the employee, and the regulator. Positive steps are being made in all these areas. Moreover, mental wellness is being considered in the context of a safety program, a personal wellness enhancement and for the efficiency of an organization.
One recent initiative in the regulatory realm includes EASA’s mandating pilot support programs to be offered by all airline operators in Europe. Others include the FAA’s increased training of AME’s in mental health, the endorsement of peer support programs in aviation, the mental health educational campaign for pilots, ATC’s and AME’s by the Federal Air Surgeon and FAA involvement of various airline and aviation university mental wellness and support programs. Australia’s Civil Aviation Safety Authority (CASA) has recently implemented a program based on the salutogenic approach to mental health rather than the traditional dichotomous pathogenic approach of mental illness vs normalcy. The salutogenic approach understands that mental wellness continuously moves along a spectrum in each of us and that receiving help, either from peers, trusted friends or mental health professionals, enhances our wellness and should be encouraged. Think of this as analogous to physical fitness varying in each of us with encouragement to improve our fitness regularly will produce healthier outcomes. This approach will help lower the barriers that pilots and ATC’s face when they consider getting mental health support.
Mental Health Working Groups are very active in ICAO, the International Federation of Airline Pilots Associations (IFALPA) and the international Aerospace Medical Association (AsMA). They meet regularly and have a sense of urgency to incorporate mental wellness as an essential part of aviation safety and possible integration into aviation Safety Management Systems. I recently hosted a workshop with representatives from all these organizations at the AsMA annual scientific meeting in May. Speakers included representatives from flight attendant organizations, aviation universities and regulators. The scientific meeting had many panels and working groups addressing mental wellness in a variety of contexts. The sense of urgency of this issue was clear. The military is also actively involved in mental health programs for not only aviators but all members. ICAO has published a book, Fit to Fly: A Medical Guide for Pilots that has three of its nine chapters dedicated directly or indirectly to mental wellness. I have previously encouraged this book be a part of every pilot’s library and one university is incorporating it as a textbook for all incoming aviation students.
The book above is an excellent reference for steps we can take as our personal responsibility to optimize our physical and mental health when we climb into an aircraft. It has nine chapters and an Introduction: Fitness to Fly. The chapters include: Understanding Cardiovascular Risk; How to Keep Well mentally; Impact of Alcohol and Drugs on Performance; What we know About Cancer; How to reduce Your health Risks from Musculoskeletal injury; Nutrition and Weight Management; Sleep and the Impact of Medical Conditions; Travel Health; and Hearing and Vision. It is written for pilots with major contributions from IFALPA as well as aerospace medicine physicians.
Airlines are also investing in mental wellness programs for their employees. Several North American airlines are participating jointly in peer support program training events with pilot groups. Australian and New Zealand have robust programs. New Zealand’s program includes support for all in the aviation industry including pilots, flight attendants, ground workers, ATC’s, flight schools and student pilots. I recently returned from an inspiring peer support training week in Singapore sponsored by their Civil Aviation Authority and attended by pilot groups and senior management from all three of the country’s airlines. Several European airlines have contracted with mental health professional groups to support their employees. Most of these programs include drug and alcohol programs, critical incident response and professional standards volunteers and mental health experts.
The tragedies of the past have highlighted the need to incorporate mental wellness programs as an essential component of aviation safety and aviation professional wellness. The tide is turning from one of avoidance of seeking mental wellness support because of stigma, fear, and perceived barriers to one of normalizing mental wellness as the responsibility of all involved in aviation. There is a new expectation that we all deserve support, that efficiency and safety is enhanced by mentally fit employees and that this effort is a shared responsibility we all have a vital stake in supporting. My hope is that the tide continues and that the need for mental wellness and support is soon accepted as a routine component of aviation that improves the lives of all involved just as our accident investigation system has led to the best positive safety culture in the world.