The acknowledgement and acceptance of issues of mental health in the general population has, thankfully, recently become far less of a taboo subject. Whilst the extreme manifestation, in the form of suicide, only affects a small proportion, it nonetheless shows the tip of the iceberg of mental problems. That is also reflected in the pilot demographic, and at a recent conference held by the Royal Aeronautical Society in London, the issues from the perspective of academic research, treatment and practical programmes from airlines were addressed. Where the particular demands of this profession are distinct from most others is that there is potentially a direct link between the behaviours of the individuals and an impact on public safety.
The tragic event with the loss of the Germanwings aircraft starkly highlighted the worst case scenario which, fortunately, is very, very rare. However, the issue of the consequences of less than perfect mental health in operating crews in the aviation industry merits closer examination. It is perhaps worth emphasising that, as is the case in the broader population, the increasing pressures of the 21st century mean that the baseline of stress appears to be ever-increasing. Whilst some level of stress is both inevitable and, at a low level, properly stimulating, at some point an individual can become overwhelmed. Academic research has identified that one in four people will suffer from depression in their lifetimes, and some even suggest that at any given time the population at large is suffering in that same ratio.
The pilot role has always had a higher level of stress that many other jobs, so there is nothing new in that, but with the increasing demands of that role the critical level of stress can be reached more quickly than before. The task of operating the aircraft has become increasingly complex with the challenge of monitoring the situational awareness in both the real world and the virtual world of intricate onboard systems; departure and arrival procedures are more complicated, the air traffic more dense and so on. Pilots are expected to have a much more detailed understanding of the commercial pressures of the airline and thus the direct commercial consequences of their actions. As many airlines become more customer focussed the active role of the flight deck in that arena is now an additional fundamental part of the day-to-day job.
None of that is unsurmountable but, as elsewhere, if the kind of lifetime stress factors, such as death of a partner or family, financial pressure or health issues are added to the mix it is unsurprising that some people have difficulty. Closely tied to the question of stress is fatigue. The very nature of the job, when Maximum Flight Time rules become a target and not a limiting figure from a human factors point of view, points to the potential for a problem. The high-density of a multiple sector day puts short-haul operators under pressure. So far as long haul is concerned, the managing of sleep patterns when coupled with jet lag is known to pose a problem. For both disciplines, the irregular duty day and shifts themselves present a challenge. The combination of increased stress and fatigue can rapidly lead to depression, which itself has many shades of grey. That leads to changes in behaviour which is a prime indicator of potential mental health issues. An important element which bears on the problem is the “standard” mental profile of the pilot teams. Robust selection processes seek to identify stable characters who are intrinsically resilient and who can work under pressure. Training systems nurture the principle of always having a backup and being able to adapt to a dynamic situation both as an individual and within the team. We encourage crews to be “able to cope”, so that when an individual becomes subject to greater than normal stress it is most likely that they will try to “cope” on their own, and there is evidence to show that this has historically been the case. The problem here is that, under stress, the higher cognitive functions like self-criticism and judgement can be rapidly eroded. Not only does that potentially impact on the professional capabilities, but the ability to recognise one’s own problems can be significantly reduced.
In the highly regulated world of aviation, pilots are properly subject to close scrutiny, both on their professional standards through simulator and flight assessments, but also from a medical point of view. Any negative observation/assessment can have an immediate impact of their authorisation to operate, with the potential that ultimately they may no longer have a job, with all that that implies. How many people would willingly volunteer to put their livelihood at risk by confessing to a problem which they believe they can manage? It is a matter of record that the male half of the population are generally not well adapted to communicating emotion and feelings effectively, and so that barrier has also to be overcome. The highly specialised world in which pilots live and work can mean that those in other fields may not understand all the factors which bear on the aircrew lifestyle. Who can an individual turn to if any official move may pose a threat?
Largely as a result of the Germanwings event, the regulators are under pressure to respond in order to drastically limit the potential for a similar incident. However, because of the broader issues mentioned above, a considered solution is essential. Proscriptive regulation has historically been seen as the way that the safety oversight is carried out. However, the subject of mental health is a field which requires some enlightened thinking. Merely marching reluctant pilots into a continuing succession of formal interviews with psychiatrists, whilst comparatively easy to legislate for (if nigh on impossible to implement), is perhaps not the best way to address the subject. The problem is challenging the legislators, who, on the one hand, must be seen to react, and who, on the other hand, have to fashion a more human-orientated, pragmatic and effective approach.
Airlines, too, have an increased awareness and responsibility for managing the general wellbeing and mental health of the pilot teams. Some solutions are already being implemented by major airlines in the United Kingdom.
The basis for this approach is founded on research and experience which show that, for the very particular case of a subject which still has a measure of taboo around it, the pilot population tends to be most at ease and open when discussing mental health issues with fellow pilots. The present Best Practice appears to be to put in place a robust Peer Support process. One airline launched this in January 2016, with another due to launch this effort this summer. A volunteer team of suitably trained and experienced pilots act as an initial point of contact for a pilot feeling under excessive stress or for a colleague who has noticed atypical behaviour in a fellow crew member. Sometimes acting just as a confidential and active listener can help, but, if the circumstances merit further action, then the listener can suggest contacting the appropriate agency to help address the source of the stress. This may range (in no order of importance or priority) management to relieve the burden of poor rostering, or to offer some downtime to address an extra problem at home (death, divorce etc). If the union can offer advice then that may be a suitable response, and, of course, a greater or lesser involvement from a medical professional may well serve to defuse a complicated situation. If such a process can be seen to be both confidential and sympathetic then the buy-in from the pilot group can help to identify potential problems early. Prompt action can then remedy the situation before there is any significant impact on the pilot performance. The benefits to an airline are clear - better to allocate resources to such a system early than to compensate for poor work performance which might impact on scheduling and, ultimately, safety.
So - What form of Education/Training Can Help?
The training mantra of Knowledge/Skills/Attitude has formed the basis of training system design for many years. When applied to the issue of mental health and well being it is still helpful to apply those same principles.
The knowledge of the kind of stresses to which a pilot can be subject is essential for both the pilot group and management teams. The primary indicator of excessive stress is behaviour which has either changed or is simply abnormal, and those who observe such change, either in themselves or in others, must be educated as to how to address that issue.
The skills to cope with effects of stress are more generally left to the medical specialists, but there are also skills which can be acquired to become competent to deliver the key peer support.
The biggest issue at the present time is that attitudes towards mental health have to change so that they embrace the informed and proactive approaches to the issue which are now embedded in many other walks of life.
Aircrew Wellbeing and Mental Health are issues which have received intense media attention recently. Irrespective of the immediate reaction of extreme events, there must be a reasoned and realistic approach to managing the issue to best effect for the pilots themselves, the airlines and, of course, the general public. Education and training for that can and must be put in place.
By Chris Long