President’s Corner, 3Q15, “Pilot Mental Health – A New Horizon Coming”

Pilot Mental Health – A New Horizon Coming

The issue of pilot mental health remains in the forefront of aerospace medical policy discussions, both among professionals and pundits.  In the last quarter’s AMAS Newsletter, I wrote about efforts to address this topic in a scientific and rationale manner, free from some of the public hysteria and well intentioned, but misguided cries for immediate action.  There appears to be a silver lining to this tragedy and a brighter horizon coming for pilots with mental health problems, both routine and significant.

The Aerospace Medicine Association’s Pilot Mental Health Working Group (PMHWG) forwarded its recommendations to AsMA’s leadership.  The PMHWG had robust discussions involving experts worldwide with backgrounds in aerospace medicine, flight operations, civil aviation certification, psychiatry and aviation psychology.  The recommendations were published on its public web site in September.  See pages 8-12 of the document for the September 2015 updates.  A list of the recommendations includes:

• “Mental well-being and absence of mental illness are essential to the safe performance of pilot    and aviation safety-sensitive duties”
• “Mental health should be evaluated as part of the aeromedical assessment of pilots”
• “Serious mental illness such as acute psychosis is relatively rare, and its onset is difficult to predict”
• “However, more attention should be given to less serious and more common mental health issues and conditions during the aeromedical  assessment of pilots”
• “Methods should be utilized to build rapport and trust with the pilot in a nonthreatening environment”
• “It is recognized that there may be barriers affecting a frank discussion of mental health issues between an aeromedical examiner and a  pilot”
• “Physicians performing aeromedical assessments should receive additional training in aviation mental health issues”
• “Clinicians not trained in aeromedical assessment should be provided guidance for when to seek aeromedical expertise”
• “Similarly, aircrew, their families and flight organizations (civil and military) should be made more aware of mental health issues in  aviation”
• “All aviation regulatory authorities and aviation employers should establish a policy and strategy on substance misuse and abuse”
• “There should be clear and universally accepted guidelines provided to health care providers on when their obligation to report  aeromedical concerns to authorities supersedes their responsibility to patient confidentiality”

What does this mean and why should pilots feel good about these recommendations?

First, the recommendations recognize that positive pilot mental health is essential for safe operations, but all pilots will face life’s routine stressors and some may face extraordinary stressors.  It is part of being human.  Very serious mental health conditions are rare and murder-suicides as in Germanwings are nearly impossible to predict with tools available for AME’s and mental health professionals.  In the context of a periodic aviation medical examination, a test or questionnaire based approach is unlikely to be successful in identifying significant problems as pilots will respond in a way to protect their medical certificate.  Thus, do not expect to see additional formalized mental health testing of pilots at periodic examinations.

Next, the recommendations point to the necessity of improved support of the pilot with potential mental health issues that commonly occur in the population.  Most of these can be treated and usually do not require time away from flying unless of significant severity.  Pilots’ natural reluctance to seek help may be addressed by encouraging Aviation Medical Examiners to develop a better rapport and knowledge of pilot’s lives outside of the cockpit.  A few simple questions showing honest concern at the time of the exam can help identify areas where pilots may benefit from mental health help.  What form that help takes varies widely.  To accomplish this, AME’s must receive training in this area and incorporate it in each pilot interaction.  Referral for mental health assistance should not be viewed as a career threatening event, but one to enhance health and protect a career, much like treating hypertension or hypercholesterolemia.

Thirdly, pilot unions and airline employers can provide a safe haven for pilots to come forward on their own to ask for help or to have pilot peers encourage reaching out for assistance before the magnitude of the problem adversely impacts safety or personal health and relationships.  Such programs already exist in different forms at some airlines (American, Delta) and others are ramping up programs to help pilots with the cooperation of the employers.  Dr. Keith Martin and I attended two meetings this month with United and FedEx pilot volunteers  and chief pilot support recognizing the benefits to all involved of having these programs.  Company management support is essential to make these programs work.  Publication of these programs, both to pilots and their families, is key to maximum involvement.  Financial protection through parity of mental health benefits with physical medical conditions is another key element for those pilots who may need to step away from flying temporarily.  Regulators should accept that treatment for a spectrum of mental health conditions is beneficial to pilots and to aviation safety programs.  Companies will reap financial benefits in addition to having safer, more productive aircrew.

The FAA/ALPA HIMS Program has effectively addressed substance abuse in the US airline industry as a peer based treatment, rehabilitation and monitoring with return to fly success story of over forty years.  The cooperation of airline management, mental health professionals, specially trained AME’s and the FAA make this possible.  Canada has a very similar successful program.  In November, I will travel to Australia with a team to conduct training in HIMS for Australia, New Zealand, Hong Kong and other Pacific rim countries.  Future training seminars may occur in India and Europe and are supported by the FAA.  Similarly, Critical Incident Response Programs focused on proactive peer support for pilots with traumatizing aviation and non-aviation events are blossoming worldwide.  These programs save lives and careers.  Their positive impact cannot be overstated.

Finally every mental health professional and aviation medicine specialist has an obligation to public safety just as pilots have a right to privacy of their medical information as well as a professional obligation to optimize their fitness for duty.  This is a delicate balance that should favor the pilot’s privacy in order to not inhibit seeking mental health treatment.  However, in those extremely rare cases where the pilot’s own life or public safety is in imminent danger, a reporting mechanism to intervene without significant legal liability must exist and we well known.  It is in everyone’s best interest to do so, but the threshold for initiating such a report should be very high.  Lower levels of significant concerns could potentially be raised through the safe haven programs noted above.

We await recommendations from the FAA’s Pilot Fitness Aviation Rulemaking Committee and EASA’s Pilot Mental Health Working Group which I have also had the privilege to participate in.  I believe the ultimate outcome of events triggered by this tragedy will be the breakdown of barriers to pilots needing mental health assistance, financial benefits to pilots and their employers, enhanced mental health in aviation professionals and improvement in aviation safety overall.

Be Well, Fly Safely!
Quay Snyder