Pilot suicides

Following last Tuesday’s crash of flight 9525 in the French Alps, the disturbing realisation was that one of the co-pilots of the Germanwings jetliner orchestrated its deadly descent into the French mountainside. This has made the general public ask: how do we know if airlines are taking necessary precautions to see whether their crew is mentally fit to fly? The problem, aviation experts say, is that there is no uniform consistency across the industry to know for sure. The Civil Aviation Authority (CAA), for instance, says its commercial pilots must have their mental health assessed during each medical exam, which is typically done every year.
In the US, the Federal Aviation Administration (FAA) requires captains to have a first-class medical certificate renewed every year if the pilot is younger than 40 and every six months if the pilot is 40 or older. But psychological checks are not required although concerned doctors could order pilots to undergo testing for “emotional stability and mental state”. The emphasis, however, is on the physical and less on the mental, mainly because mental health is harder to quantify.
The system relies on pilots self-declaring. Therefore, unless a pilot is honest about an alcohol problem or a psychiatric disorder, there is no guarantee a problem will be spotted. Even though commercial airline pilots undergo psychological testing, aviation experts acknowledge those who are depressed or suicidal may be difficult to detect. The problem is that pilots who report symptoms run the risk of having their commercial pilot license suspended or revoked, so they stay quiet. Pilots are not likely to disclose any potential mental health problems, including signs of depression or anxiety, because that would take them out of the sky. Pilots are not going to tell anything any more than a medical doctor would about their mental health. Pilots, like doctors and policemen and others with high-stress jobs, tend to be good at compartmentalising, walling off difficult or emotional experiences so they do not interfere with their ability to function day-to-day. Medical examiners, who evaluate pilots for their recertification, are also not always trained in mental health, so they may not recognise subtle signs of conditions such as depression or alcoholism. Screening methods need to be put into place and pilots must disclose all existing physical and psychological conditions and medications or face significant fines if they are found to have falsified information. In the case of mental health evaluations, pilots are taken off the flight schedule while they are treated or begin antidepressant medications. Until 2010, even these drugs were banned and pilots who required them could no longer fly.
It is high time that we have some kind of deeper thinking about this issue because it is one of the most difficult in aviation medicine. Currently, it is a system that largely relies on self-reporting, hence sound, clinical, evidence based procedures are required where examiners will be instructed to look for general impressions of pilots’ emotional stability and mental health through the latest psychological testing and mental health interview techniques.
The subject of pilots acting bizarrely or even sabotaging their planes is rare but not unheard of. In 2012, a JetBlue flight was diverted after leaving New York City when the captain began pounding on the cockpit door and yelling threats. In February 2014, the co-pilot of an Ethiopian Airlines flight took control of the plane, locking his co-worker out of the flight deck in order to demand political asylum. The deliberate crash of Germanwings flight 9525 has turned attention to the unsettling and rare phenomenon of aircraft-assisted pilot suicide. If the investigation reveals that mental health played a role, it would not be without precedent.
In a 2014 study in the Journal of Aviation, Space and Environmental Medicine, researchers looked at 20 years of data. From 1993 to 2012, 24 of 7,244 plane crashes were thought to be deliberately caused by a pilot. That is less than one percent of the total but it is still enough to raise questions about the mental health stressors of pilots. When the US air force began requiring annual suicide prevention and awareness training in 1995, including screening for mental illness, the suicide rate plummeted from about 16 suicides per 100,000 members to about nine.
Pilot suicides have been extremely rare over the past two decades but they have been suspected in up to four major crashes in the past few decades, including a Mozambique Airlines flight that went down in Namibia two years ago, an Egypt Air flight that crashed into the Atlantic Ocean about 60 miles southeast of Nantucket in 1999 and a Silk Air flight that crashed in Indonesia in 1997. The Malaysia Airlines flight that disappeared last March may have been deliberately flown off course, though it is not known.
Andreas Lubitz, the 27-year-old co-pilot of flight 9525, who is believed to have locked himself in the cockpit before intentionally crashing the plane into the French Alps, passed all psychological screenings and there was no indication he had any links to terrorism. It is difficult to speculate what Lubitz’s mindset might have been because so little has been written on people who commit suicide and take others with them. This is an extremely rare event that will lead regulators to question whether it is possible to implement more oversight of the mental health of pilots and cabin crew.
Even for experts, however, judging whether a pilot is suicidal is one of the hardest parts of the job. That is no surprise since the struggles of spotting and talking about suicide plagues our entire society where we are so quick to try to make it okay, to say it will pass and to tell people to pull their socks up. We really do not listen to ourselves and we do not listen to psychiatrists very effectively. However, pilots and those in other high pressure occupations face several unique stressors, like having a physically demanding job and being responsible for other lives. In a lot of positions of authority and leadership, people are supposed to be capable and on top of things. They do not have a lot of people to share with and talk to, to be less than perfect and less than okay. That adds to the stress.

The writer is a professor of Psychiatry and consultant Forensic Psychiatrist in the UK. He can be contacted at fawad_shifa@yahoo.com