A critical question at the “Outbrief” – the final check that all is well prepared before the crew make their way to a Royal Air Force aircraft – is "Are you fit to fly?" Chris Long reports from the recent Royal Aeronautical Society Aerospace Mental Health & Wellbeing Conference.
Only if there is a convincing and positive answer does the mission get the authorisation to go. It may be a simple question, but behind it lies the recognition that there are times when, for any one of multiple reasons, the pilot or any crew members do not feel up to the task. That is particularly challenging in a goal-oriented organisation, the military, where admitting to be unable to undertake the task is in contrast to the primary “let’s do it” ethos. Particularly in a necessarily hierarchical organisation, it requires a major change of mindset to identify that issue and to manage it to meet all expectations, - looking after the mission as well as the individual. What is encouraging is that the UK Ministry of Defence has put in place a structure to address that.
The reality is that, on many occasions, that same focus on the task in hand also exists in the world of commercial aviation, and, as in the military, is not confined just to those on the flight deck. Arguably the equivalent question can be posed to cabin crew, air traffic controllers, technicians and all ground support - “Are you fit to do the job today?”
Mental Health and Wellbeing
At a recent conference at the RAeS headquarters in London, UK, the issue of mental health and wellbeing in aviation was addressed. The earlier question could generate a tension between the demands of the job and life outside work, and acknowledges the kind of pressures which can bring on stress, and therefore potential mental health issues. Many aspects of this were explored during the conference, but what became clear was that, in fact, the order of concerns should be reversed. If the goal is to reduce the effects of mental health on aviation professionals, then the start point should be to encourage and facilitate a holistic and healthy lifestyle and work/life balance. If that can be achieved, then the path to mental health issues could be diverted.
The problem of working conditions leading to stress in the aviation workforce has long been recognised. Across the disciplines, the common theme of increased workloads, complexity, challenges of technology and commercial pressure have ramped up the demands on the individual. Whilst those generally stay (just) within the personal comfort zone, there are times when, either in the short or long term, the pressure builds up to the point at which there is a significant impact on the aviation professional, and consequently on his/her performance, and that can have implications when safety-critical roles are involved.
The intensity of the aviation world has meant that, historically, there have been few opportunities, and even less encouragement, to admit to and discuss personal difficulties. The “Man Up” pills were given out by the handful, with no real thought of the consequences of working under unremitting pressure. Even those working in a small team, with ready access to friends with whom to talk, could not always bring themselves to open such a difficult conversation.
The issue is a sensitive one, and rarely discussed in open forum, but fortunately the need for a safety valve was identified some 20 years ago when, in Germany, the non-profit charity and foundation Stiftung – Mayday was started. The purpose of the organisation is to “support flight licence holders and next of kin in need” and to “support flight crews and next of kin after incidents and/or accidents”. The underlying principle is the provision of Peer to Peer Support. Recognising that many flight deck crews would not be at ease at opening up to those outside the pilot population because of the potential that the listener would not understand the context and specific issues, it became apparent that pilots were most likely to talk to other pilots. These did not necessarily have to be from the same airline/organisation, but should share a background of common professional knowledge. Stiftung Mayday, being independent of airlines, unions and other organisations, can recruit Peers from that demographic.
There were several presentations on the format of such Peer to Peer Support programmes, but all shared some fundamental principles. The common theme was that the primary component is: Trust
Without a solid trust in the system, no one is going to take the risk of exposing either weaknesses or possible incompetence/professional errors. Possibly even more difficult is to express very core emotional fears and issues, difficulties with family relationships or worrying personal concerns.
However, it is very complex to build a practical and credible application of this process which satisfies the soon-to-be mandatory regulations. Such a system must involve all the stakeholders:
- Subject Aviation professional
- Contact Peer (who must be carefully selected and trained)
- Trained Aviation Psychiatrist (to both train the Peers and oversee cases)
- Aviation Medical Examiner (AME) to facilitate treatment where necessary and make decisions on fitness to fly
- Regulator to understand and approve the process
Binding it together needs to be a transparent system of confidentiality which can protect the individual, but also has provision in exceptional cases to take action to pause the workload of the case subject. This will be framed around a Safe Zone, which should only be breached in the most challenging of circumstances, and in accordance with clearly-defined limits.
How Do You Measure Success?
If your system works, and problems have been solved before going critical, it becomes very difficult to measure success. However, basic data from Stiftung – Mayday indicates that some 80% of mental health issues are resolved at the early stages simply through the efforts of the volunteer Peers. A straightforward calculation of the reduction of days lost reveals significant savings, and retaining rather than losing a competent operator also has a massive cost-saving implication; importantly, another major impact is on the potential for avoidance of safety issues.
That commercial input should prove the business case to the airline/organisation and thus facilitate the release of the modest funds necessary to set it up. Much harder to calibrate is the hugely reduced impact on the individual. The personal angst and distress for the individual can be reduced and, hopefully, avoided; that is of no small importance.
Training and Education
There is a demanding training task in establishing an effective Peer to Peer Support Programme. Once selected, the skill set to become a competent Peer involves learning how to employ Active Listening as a tool, and to be flexible and empathetic in a surprising range of case problems. There is also the necessity of training the Peers on how to cope with the extra demands and emotional challenges that they themselves face in making their own downtime available in this way.
Perhaps the biggest challenge, though, is the continuing education of both top, and in particular, middle, management so that they can understand that the whole issue of mental health is no longer a taboo subject. The mainstream world is quickly coming to terms with the idea that mental health is simply one component of a holistic living pattern, where physical, mental and social health all play their part.
Some of the conference presentations are available for download at www.aerosociety.com/news/proceedings-aerospace-mental-health-and-wellbeing/
Published in CAT issue 4/2019