This story was originally published in the Flight Safety Australia March-April 2015, iPad and Android editions. It was scheduled to be published on the Flight Safety Australia website today. This was scheduled before the latest developments regarding Germanwings flight 4U9525 were announced. It does not represent a CASA response to the issues raised by the Germanwings crash.
When 131 unassuming passengers boarded their JetBlue flight from New York to Las Vegas in March 2012, their captain suffering a mid-flight ‘meltdown’ is probably the last thing they imagined would happen.
A flight attendant and passenger managed to placate Clayton Osborne—the very person who essentially had the safety of his crew and passengers in his hands—after he went on a rampage in the cabin, ranting about September 11, making references to terrorists and yelling, ‘Guys, push it to full throttle’.
His co-captain had the good sense to lock Osborne out of the cockpit and safely landed the plane (after diverting to Amarillo, Texas) and Osborne’s ‘brief psychotic disorder’ was eventually blamed on ‘sleep deprivation’.
While a major incident such as this has not been reported in Australian skies that’s not to say that the ‘black dog’ doesn’t often sniff around the ankles of our commercial and general aviation pilots.
What is depression?
Anxiety and low mood are a part of the human condition—emotional and mental difficulties are very common and while there shouldn’t be a stigma about them, it’s obvious they will affect some pilots during their aviation career.
‘It is becoming something which more people are prepared to own up about and want to talk about a bit more—culturally, however, I don’t think Australia is at the forefront for men to talk about this sort of thing, says Michael Drane, CASA’s principal medical officer.
‘The trouble with depression particularly, is that it is frequently insidious. You don’t realise until something bad happens that things actually are bad … it’s not something that many people are prepared to admit to.’
According to the Black Dog Institute—an organisation dedicated to improving the lives of people affected by mood disorders through high quality translational research, clinical expertise and national education programs—signs of depression include the following:
- lowered self-esteem (or self-worth)
- change in sleep patterns, that is, insomnia or broken sleep
- changes in appetite or weight
- less ability to control emotions such as pessimism, anger, guilt, irritability and anxiety
- varying emotions throughout the day, for example, feeling worse in the morning and better as the day progresses
- reduced capacity to experience pleasure: you can’t enjoy what’s happening now, nor look forward to anything with pleasure. Hobbies and interests drop off
- reduced pain tolerance—you are less able to tolerate aches and pains and may have a host of new ailments
- changed sex drive—absent or reduced
- poor concentration and memory—some people are so impaired that they think that they are becoming demented
- reduced motivation—it doesn’t seem worth the effort to do anything, things seem meaningless
- lowered energy levels.
The important thing to realise is that if you are suffering depression you are not alone. In fact, according to beyondblue—also a national organisation devoted to increasing awareness and understanding of depression in the community—more than three million Australians are currently living with anxiety or depression.
Diagnosing depression in pilots
In diagnosing depression, pilots are asked two very simple questions in CASA’s medical questionnaire about whether they’ve been feeling flat and down and if they’ve been actually enjoying life or not.
- During the last month have you felt down, depressed or hopeless?
- In the last month have you often been bothered or had little interest in doing things?
‘Depression is a more global concept where it means what is says—many of your body’s systems are simply depressed, they’re not working at their normal sort of level,’ says Dr. Drane.
‘All sorts of functions become impaired. This is why people don’t necessarily recognise it. They may not feel unhappy when they’re depressed but at the same time they’re not eating very well, not sleeping very well and finding it hard to concentrate, it’s really hard to get up in the morning…yet it’s not like you’re in floods of tears all the time.’
‘That’s a really important thing to understand … that’s why I think depression has medical significance; it’s the whole system that has wound down for some reason.’
‘Doctors and pilots have a lot in common in terms of personality types—they tend to be driven, coping, high-achieving … men. None of these promote objective awareness, or an honest assessment of one’s emotional state.’
‘Psychological hiccups and speed bumps are very common, but particularly in these professional groups, acknowledging or reporting and seeking help tends to be something that happens very much as a last resort rather than an early action. Women tend to be more in touch with what’s really going on, while guys tend to keep shoving it under the table and pretending it’s not there.’
According to Aviation Mental Health: Psychological Implications for Air Transportation (2006) there are five main sources of mental health problems among aviation employees. These include:
- Stresses associated with coping, safety and survival
- Stress that emanates from workload, how work is organised and the organisational climate (e.g. rostering, frequency of flights, jet lag, pensions and financial challenges)
- Personal problems that stem from disruption to personal relationships, which clinical research suggests should act as a buffer to work stress
- Ever-present concerns about loss of licence as a consequence of the onset of a disqualifying medical condition and
- Normal psychosocial problems that occur naturally in the everyday life of the population at large.
Hazards of depression
For pilots, the hazards of depression can mean the simple difference between life and death.
‘Concentration is impaired, your alertness is impaired, your reaction times are impaired, decision-making is impaired—they are the most common things—it’s all slow, it’s all reduced, so it’s a very important diagnosis,’ says Drane.
‘One of the other issues is you have less flexibility of thought and you have less capacity to deal with multiple issues—people will blow a fuse much quicker, they become more irritable and can’t cope and may suddenly reach a melt-down situation and in the air that would be a disaster.’
Diagnosis and treatment
Just like any workplace—and the aviation industry is no exception—mental health issues are also a matter of some sensitivity. This is due to social stigma, as well as the practical and legal consequences for both the affected individual and the organisation. This is certainly true in the aviation industry and psychological fitness to work is embedded within the practices. (Aviation Mental Health: Psychological Implications for Air Transportation )
If you answered yes to either of the two questions in CASA’s medical questionnaire, it doesn’t mean the end of your aviation career. The questionnaire tries to reflect the practical and health risks—and because psychiatric illnesses are incredibly common—it has been adjusted to reflect these sorts of risks.
For pilots, well-managed depression is compatible with medical certification, but you must report any relapse in depressive symptoms to your DAME.
Any change to medication (starting, stopping or changing drugs or doses) must be notified to your DAME and will require grounding for two to four weeks. Additional information may be required from family, treating doctors and flying colleagues.
In cases CASA assesses as ‘low-risk’, treating doctor reports (GP or DAME) or psychologist reports may be accepted in lieu of a psychiatrist report.
And there are certainly many cases where there is a happy ending. A 43-year-old commercial pilot was diagnosed with depression and grounded by a DAME for six months, but with the right medication and psychiatric treatment, he was returned to flying duties.
‘I can’t tell you the number of people after they’ve been treated who come and say, ‘I had no idea how bad things had got, till I started feeling better,’ says Drane.
CASA’s approach to certification
It was recognised that for a variety of reasons, pilots were either taking medication without declaring this, or not seeking treatment for depressive symptoms. The ground-breaking decision was made therefore to permit pilots who had recovered from depression to resume flying, even though they might still be taking medication. The type of medication is important, as some can continue to affect performance, and are therefore not permitted in the aviation environment.
The Clinical Practice Guidelines, on CASA’s website provide more information. It should be understood that this approach remains at variance with other regulators around the world. Pilots on antidepressant medication considering working in other jurisdictions may wish to discuss this further with the relevant authority.
Help and support at your fingertips
- beyondblue—seeking help and getting support is essential in treating depression and anxiety. Last year, beyondblue had more than 78,000 calls from Australians about mental health concerns or issues. They are available to talk and listen, 24 hours a day, seven days a week. Beyondblue’s website also contains useful resources (including people’s personal experiences of depression) and information on current initiatives—1300 22 4636.
- The Black Dog Institute—website contains information on when and where to get help, support groups, personal stories and videos. The Institute also provides an interactive self-help service, myCompass, which aims to promote resilience and wellbeing for all Australians.
- MensLine Australia—A telephone and online support, information and referral service, helping men to deal with relationship problems in a practical and effective way—1300 78 99 78.
- CASA Aviation Medicine contacts