Aircrew Mental Health and Wellbeing

The acknowledgement and acceptance of issues of mental health in the generalpopulation has, thankfully, recently become far less of a taboo subject. Whilst the extrememanifestation, in the form of suicide, only affects a small proportion, it nonetheless showsthe 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 issuesfrom the perspective of academic research, treatment and practical programmes fromairlines were addressed. Where the particular demands of this profession are distinct frommost others is that there is potentially a direct link between the behaviours of theindividuals and an impact on public safety.

The tragic event with the loss of the Germanwings aircraft starkly highlighted the worstcase scenario which, fortunately, is very, very rare. However, the issue of theconsequences of less than perfect mental health in operating crews in the aviation industrymerits closer examination. It is perhaps worth emphasising that, as is the case in thebroader population, the increasing pressures of the 21st century mean that the baseline ofstress appears to be ever-increasing. Whilst some level of stress is both inevitable and, ata 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 theirlifetimes, and some even suggest that at any given time the population at large is sufferingin that same ratio.

The pilot role has always had a higher level of stress that many other jobs, so there isnothing new in that, but with the increasing demands of that role the critical level of stresscan be reached more quickly than before. The task of operating the aircraft has becomeincreasingly complex with the challenge of monitoring the situational awareness in both thereal world and the virtual world of intricate onboard systems; departure and arrivalprocedures are more complicated, the air traffic more dense and so on. Pilots areexpected to have a much more detailed understanding of the commercial pressures of theairline and thus the direct commercial consequences of their actions. As many airlinesbecome more customer focussed the active role of the flight deck in that arena is now anadditional 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 themix it is unsurprising that some people have difficulty. Closely tied to the question ofstress is fatigue. The very nature of the job, when Maximum Flight Time rules become atarget and not a limiting figure from a human factors point of view, points to the potentialfor a problem. The high-density of a multiple sector day puts short-haul operators underpressure. So far as long haul is concerned, the managing of sleep patterns when coupledwith jet lag is known to pose a problem. For both disciplines, the irregular duty day andshifts themselves present a challenge. The combination of increased stress and fatiguecan rapidly lead to depression, which itself has many shades of grey. That leads tochanges 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 thepilot teams. Robust selection processes seek to identify stable characters who areintrinsically resilient and who can work under pressure. Training systems nurture theprinciple of always having a backup and being able to adapt to a dynamic situation both asan individual and within the team. We encourage crews to be “able to cope”, so that whenan individual becomes subject to greater than normal stress it is most likely that they willtry to “cope” on their own, and there is evidence to show that this has historically been thecase. The problem here is that, under stress, the higher cognitive functions like self-criticismand judgement can be rapidly eroded. Not only does that potentially impact on theprofessional capabilities, but the ability to recognise one’s own problems can besignificantly reduced.

In the highly regulated world of aviation, pilots are properly subject to close scrutiny, bothon their professional standards through simulator and flight assessments, but also from amedical point of view. Any negative observation/assessment can have an immediateimpact of their authorisation to operate, with the potential that ultimately they may nolonger have a job, with all that that implies. How many people would willingly volunteer toput their livelihood at risk by confessing to a problem which they believe they canmanage? It is a matter of record that the male half of the population are generally not welladapted to communicating emotion and feelings effectively, and so that barrier has also tobe overcome. The highly specialised world in which pilots live and work can mean thatthose 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?

Regulatory Position

Largely as a result of the Germanwings event, the regulators are under pressure torespond in order to drastically limit the potential for a similar incident. However, because ofthe broader issues mentioned above, a considered solution is essential. Proscriptiveregulation 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 withpsychiatrists, whilst comparatively easy to legislate for (if nigh on impossible toimplement), is perhaps not the best way to address the subject. The problem ischallenging the legislators, who, on the one hand, must be seen to react, and who, on theother hand, have to fashion a more human-orientated, pragmatic and effective approach.

Airlines

Airlines, too, have an increased awareness and responsibility for managing the generalwellbeing and mental health of the pilot teams. Some solutions are already beingimplemented by major airlines in the United Kingdom.

The basis for this approach is founded on research and experience which show that, forthe very particular case of a subject which still has a measure of taboo around it, the pilotpopulation tends to be most at ease and open when discussing mental health issues withfellow pilots. The present Best Practice appears to be to put in place a robust PeerSupport process. One airline launched this in January 2016, with another due to launchthis effort this summer. A volunteer team of suitably trained and experienced pilots act asan initial point of contact for a pilot feeling under excessive stress or for a colleague whohas noticed atypical behaviour in a fellow crew member. Sometimes acting just as aconfidential and active listener can help, but, if the circumstances merit further action, thenthe listener can suggest contacting the appropriate agency to help address the source ofthe stress. This may range (in no order of importance or priority) management to relievethe burden of poor rostering, or to offer some downtime to address an extra problem athome (death, divorce etc). If the union can offer advice then that may be a suitableresponse, and, of course, a greater or lesser involvement from a medical professional maywell serve to defuse a complicated situation. If such a process can be seen to be bothconfidential and sympathetic then the buy-in from the pilot group can help to identifypotential problems early. Prompt action can then remedy the situation before there is anysignificant impact on the pilot performance. The benefits to an airline are clear - better toallocate resources to such a system early than to compensate for poor work performancewhich 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 systemdesign for many years. When applied to the issue of mental health and well being it is stillhelpful to apply those same principles.

The knowledge of the kind of stresses to which a pilot can be subject is essential for boththe pilot group and management teams. The primary indicator of excessive stress isbehaviour which has either changed or is simply abnormal, and those who observe suchchange, either in themselves or in others, must be educated as to how to address thatissue.

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 keypeer support.

The biggest issue at the present time is that attitudes towards mental health have tochange so that they embrace the informed and proactive approaches to the issue whichare now embedded in many other walks of life.

Aircrew Wellbeing and Mental Health are issues which have received intense mediaattention recently. Irrespective of the immediate reaction of extreme events, there must bea reasoned and realistic approach to managing the issue to best effect for the pilotsthemselves, the airlines and, of course, the general public. Education and training for thatcan and must be put in place.

By Chris Long