The unspeakable tragedy of the death of 150 people in what is thought to be a deliberate act of pilot suicide over the French Alps has brought into sharp focus the question of mental health of airline pilots. French investigators say that the Germanwings plane was brought down by the co-pilot who locked the pilot out of the cockpit and refused to let him back in despite his desperate attempts to force entry.
Airline safety has been an exemplar for other safety-critical industries. Healthcare has learnt a lot about patient safety by looking at and emulating many of the safety features adopted by airlines, including a highly professional attitude, a step-by-step approach to tasks, standardised operating procedures, and checking and cross-checking by independent members of staff. Such an approach has made flying a very safe undertaking.
However, has the airline industry’s approach to safety been skewed towards the mechanical, technical, and engineering aspects of the aircraft rather than the human factors important to flying? It appears that pilots have to undergo physical and mental health evaluations at the time of their appointment. Under US Federal Aviation Administration (FAA) regulations, a number of physical health problems are covered extensively. But depressive disorder, the commonest psychiatric cause of self-harm and suicidal behaviours, does not find a prominent mention in the list of mental disorders. The standards specify that pilots can have no diagnosis of psychosis, or bipolar disorder, or severe personality disorders.
Pilots also need to undergo regular physical assessments if they are to keep their flying licence. But there are no mandated regular mental health assessments, apart from screening for alcohol and drug problems. It appears to be left to the professionalism of the pilots to declare themselves not fit to fly if they are experiencing mental health problems or for colleagues to raise an alert. This does not appear to be enough of a safeguard against tragedies such as the one that befell Germanwings flight 9252. There is a high degree of variability in such regulations for various countries and airlines.
This has recognisable parallels with healthcare and human factors in patient safety. Prior to the introduction of revalidation of UK doctors based on their annual appraisals, there was no systematic assessment and ongoing review of doctors’ performance against the core attributes of Good Medical Practice and hence, of their fitness to practise. Although revalidation is unlikely to prevent the occasional big medical scandal or malpractice, it serves to reassure the patients and the public that there are established mechanisms to detect problems early and deal with them in a timely manner. May be such a system is needed for the airline industry as well.
The introduction of any such large scale multi-layered assurance system comes at a cost. It will be inconvenient, expensive and sceptics will doubt whether it will ever be effective. But at least it will have the benefit of restoring public confidence in flying. Just as flight technology has evolved by learning from each aviation accident where the machine was at fault, the airline industry needs to demonstrate that it is equally serious about addressing the human factors in aviation safety.
Kallur Suresh is a consultant psychiatrist in the specialist dementia/frailty service at the North Essex Partnership University NHS Foundation Trust. He is a GenerationQ fellow at the Health Foundation.
Competing interests: I have read and understood BMJ policy on declaration of interests and declare the following interests: None.