Aviation Mental Health: Magnitude unknown

According to the World Health Organisation (WHO) 25% of the world’s population develop one or more mental or behavioural disorders in their lifetime while mental disorders are expected to increase from 12% to15% by 2020 . Additionally, 800,000 people commit suicide each year and for each suicide, there are an average of 20 previous failed attempts, suggesting that there are often missed opportunities to identify and manage those in crisis. Those experiencing mental illness are also at increased risk of developing other diseases such as HIV, cardiovascular problems and diabetes.

While the incidence of mental health in the general population is on the rise, the magnitude of mental health problems in aviation is not so well understood largely due to perceived stigma and discrimination issues, fear of loss of employment and sensitivity around loss of licence for pilots.

Aviation mental health has become more of a concern among airlines, regulators, and passengers since the 2015 German wings crash and the lesser known LAM Flight 470 accident in Namibia in 2013. These accidents have highlighted that mental health problems are present in aviation, just like in any other industry, but more must be done to more effectively manage these issues. While the mental health of pilots has been the focus following the German wings crash, other flight operations safety sensitive personnel like cabin crew, maintenance, air traffic services and airport/ground handling staff should not be forgotten.

Just how big is the problem?

To understand the magnitude of aviation mental health issues, we can examine two sources of evidence

  1. Accident investigation findings
  2. Research, incident reports and confidential surveys etc

Accident investigations

There have been a total of seven accidents since 1982 resulting in 572 fatalities of which mental health issues has been cited as a contributing factor – and some of these are disputed findings:

  • 1982,Japan Airlines DC-8 24 fatalities – pilot crashed aircraft into Tokyo Bay moments before it was to land. The pilot was prosecuted, but was found not guilty by reason of insanity, although he had a history of ‘psychosomatic disorders.
  • 1994, Royal Air Maroc ATR-42 Commuter aircraft, 54 fatalities – deemed pilot suicide from the pilot intentionally disconnecting the automatic navigation system and crashing the plane into the Atlas Mountains shortly after takeoff
  • 1997, B737-300 SilkAir Flight 185 from Jakarta to Singapore – NTSB alleged crash was a result of deliberate flight control inputs by the Captain.
  • 1998, Air Botswana ATR-42 pilot intentionally flew aircraft into other company aircraft at Gaborone airport – pilot had been grounded after AIDS diagnosis.
  • 1999, B767 Egypt Air Flight 990 LAX to Cairo – Alleged First Officer act of revenge.
  • 22013, Embraer 190, Lam Mozambique Airlines Flight 470. All 27 passengers and 6 crew were killed – Mozambican Civil Aviation Institute (IACM) found that the pilot intentionally crashed the aircraft
  • 2015, A320 German Wings 9525, First Officer locked Captain out of the cockpit. Aircraft deliberately crashed into French Alps. All 150 people on board were killed. First Officer was found to have a history of mental illness and had received 18 months treatment from a psychiatrist

Despite the above list, historical accidents provide little illumination as to the magnitude of aviation health issues as they are not a good representation of the wider industry.

Industry Data
Mental health issues are the second most common issue considered by Australia’s CASA after cardiovascular disease. Of these mental health issues, depression, anxiety (including General Anxiety Disorder, panic disorder and PTSD) and Substance Misuse are the most commonly reported issues.
What research does tell us is that there are a number of occupational risk factors that exacerbate these issues, such as shift-work, away from home, fatigue / high demands, lack of supervision, lack of control on change or career progression, access to alcohol and other drugs and high levels of stigma. However on the positive side there are many protective factors at work such as a highly  screened and selected population, relatively stable employment, high levels of self-esteem and a strong sense of being part of the well regarded aviation community.

In the last 5 years, the US, Canada and the U.K have adopted a similar approach to Australia (since the early 1990s) and allowed pilots to fly on antidepressants. Research has not indicated any safety risk if stable and suitable treatment is continued. There is a clear recognition that a disqualifying policy drives issues underground. Early access to treatment is best for the pilot’s health and therefore is also the best outcome from a medical certification perspective. The vast majority of aircrew can return to flying and as early as 4 weeks from commencing treatment (based on CASA data).

How can mental health be managed?

There are a number of strategies that can be considered including:

  • Create a dialogue about mental health to remove stigma
  • Implement policies and procedures for medical issues – similar to maternity leave to allow recovery
  • Allow safety sensitive personnel to discuss or disclose mental health issues without fear of losing license or aviation medical certificate
  • Follow up by airlines and regulators to ensure full recovery
  • Having two pilots present on the flight deck as an international standard
  • Provide all flight crew and examiners with awareness and symptoms of mental health to better recognise potential issues

One effective strategy to proactively manage mental health issues, addiction and life stress issues in aviation has been the introduction of Peer Support Programs. The European Aviation Safety Agency (EASA) has indicated that it will mandate pilot peer support programs for airlines by 2020 and the U.S Federal Aviation Administration (FAA) and other State jurisdictions are expected to follow.  Other successful strategies to manage alcohol and other drug addiction include the Human Intervention Motivation Study (HIMS), that has been established within a number of airlines in the U.S since the 1970’s. The cornerstone of HIMS is the understanding that substance dependence is a treatable medical condition and through careful management it is possible to assist pilots to return to work. While the HIMS program has been successful in the U.S. for pilots it is now being increasingly adopted in other parts of the world including the Asia Pacific region.

Want to know more?

Attend our highly practical 5-Day program on Aviation Mental Health and Wellbeing which is designed for any sector of the aviation industry and will equip aviation personnel with the knowledge and skills to more effectively manage mental health and wellbeing issues. Regardless of whether your organisation has well established mental health and well being programs or are still exploring ways to manage these sensitive issues, this workshop will provide greater clarity on the essential elements required for success and the critical role that a Peer Support Program (PSP) plays in breaking down a reluctance of impacted persons to seek help.

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