Author Topic: We study airline pilot mental health Here is how we can do better  (Read 11676 times)

Offline KB4TEZ

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(Thank you William Hoffman)

I had posted a similar article topic back in March, heard back from quite a few folks.
With the recent events, came across this article on it from Monday.(same author)

By William Hoffman
Special to The Seattle Times
Off-duty pilot Joseph David Emerson’s reported attempt to hinder the engines on a San Francisco-bound flight amid what is thought to be a mental health-related episode filled the news. But while the story is compelling, we as clinicians taking care of pilots see rare events like these as a symptom of the broader issue pilots face related to mental health. It leaves many asking how we can do better — here’s how. 

Airline pilots are required to meet medical standards to fly. If they disclose new health information during their required periodic health assessments, they run the risk — usually temporary — of loss of their ability to work and fly. When it comes to a pilot struggling with mental health, this paradigm can inadvertently leave pilots weighing the benefits of seeking care against the risks to their career. While most pilots can return to duty, the system may inadvertently encourage some pilots to delay care until the symptoms become unmanageable alone.

For these reasons, some have argued that pilots face a barrier to seeking health care. The data speaks to this observation. In our recent study of 3,765 U.S. pilots, 56.1% reported a history of health care-avoidance behavior, including not disclosing health information during aeromedical screening or avoiding care when they felt it was needed. A follow-up study found similar rates in U.S. and Canadian pilots. 

While pilot medical standards will likely always exist in some form, there are multiple ways to address the barriers pilots face in seeking care. First, the resources and services U.S. airline pilots have access to are often highly variable when it comes to mental health. For example, a senior pilot at a major U.S. airline facing a life stressor may have access to different tools compared to a junior pilot flying for a small company. Availability of effective programs like peer support, employee assistance and other wellness programs differ based on the presence of a union, the employer and where pilots fly. Airline pilots in Europe are required by law to have access to peer support services, but such rules do not yet exist here. Further, disability programs for pilots who need to step away from flying for mental health reasons are variable. In fact, the largest pilot union in the U.S. places specific limits on disability payments for pilots who aren’t working because of their mental health.

Some pilots do not have such a disability safety net at all, leaving them without pay while working to regain their certificate. Further, the tests often required to regain certification related to mental health are often not covered by insurance.

Longer-term, we should study ways to transition from our clinical approach to mental health in aviation — one focused on diagnoses and use of services as a marker for risk — to one focused on performance. Regardless of what is listed in the medical record related to mental health, can the pilot perform their duties when it’s time to fly? Using a clinical information as a marker for aviation risk is fraught with limitations. Reasons range from variability between health care provider documentation and diagnostic practices, to health care access. Further complicating the picture is — outside of the extremes — the fact it is not entirely certain whether a pilot with a mental health diagnosis is unfit to fly most of the time and in most circumstances.

Certainly, pilots with a severe mental health condition should not be flying. Instead, we are interested in figuring out how we might help pilots with mild symptoms — perhaps facing one of life’s common stressors — get support when needed to prevent the symptoms from worsening. In a performance-based approach, objectives tools measuring biometric data like sleep patterns or cognitive testing measuring working memory aim to help a pilot inform their preflight health assessment. How such an approach might be implemented is an open research question that leaders should prioritize. While questions remain, there are many opportunities to address this problem to further support aviation’s exceptional safety record — all stakeholders stand to gain. 

William Hoffman is a neurologist and affiliated assistant professor of aviation at the University of North Dakota John D. Odegard School of Aerospace Science with an interest in air crew brain health and pilot health care behavior.