Fit for flying?

The crash of an Air India Boeing 787 Dreamliner aircraft in Ahmedabad, India, on June 12 – which killed 241 occupants and 19 people on the ground – has once more brought the mental health of airline pilots into focus.

Pilots face numerous behavioural stressors, including fatigue and work-related stress, which can significantly impact their performance and safety.

These stressors can lead to decreased alertness, impaired decision-making and contribute to mental health issues like anxiety and depression.

Understanding these behavioural stressors and their potential impact on pilots is crucial for developing strategies to mitigate risks and promote mental well-being within the pilot communities.

Pilots manage complex flying tasks, often under pressure, to maintain schedules and adhere to strict regulations, which can lead to high levels of mental and emotional stress.

The demanding nature of their jobs often leads to extended periods away from home, contributing to feelings of loneliness and social isolation.

Flying an aircraft is a highly safety-sensitive occupation and requires not only physical fitness but also sound mental health.

Pilots’ psychiatric evaluations are a thorough assessment by a qualified psychiatrist to assess pilots’ mental health fitness for flying duties.

This evaluation is critical for ensuring aviation safety by identifying potential stressors that can impair a pilot's performance or judgment.

The evaluation process involves a detailed review of the pilot's medical and psychiatric history, a clinical interview, and often, psychological testing.

On October 31, 1999, a Boeing 767-300ER operating EgyptAir Flight 990 from Los Angeles International Airport to Cairo International Airport, with a stop at JFK International Airport, New York, crashed into the Atlantic Ocean about 60 miles south of Nantucket Island, Massachusetts, killing all 217 passengers and crew on board.

Since the crash occurred in international waters, it was investigated by the Ministry of Civil Aviation's Egyptian Civil Aviation Agency (ECCA) and the American National Transportation Safety Board (NTSB). Since the ECAA lacked the resources, the Egyptian government asked the American government for the NTSB to conduct the investigation.

The NTSB report concluded: "The National Transportation Safety Board determines that the probable cause of the EgyptAir flight 990 accident is the airplane's departure from normal cruise flight and subsequent impact with the Atlantic Ocean as a result of the relief first officer's flight control inputs. The reason for the relief of the first officer's actions was not determined."

CVR transcript evidence suggests the relief first officer may have committed murder-suicide.

On March 8, 2014, Malaysia Airlines Flight 370, operated by a Boeing 777-200ER aircraft, was on a flight from Kuala Lumpur International Airport in Malaysia to Beijing Capital International Airport in China. The aircraft with 227 passengers and 12 crew aboard made an unplanned deviation from its northerly course and began heading west over the Andaman Sea, and disappeared.

There were numerous conspiracy theories proffered, including murder-suicide by one of the people on board the aircraft. However, there was no cogent evidence to support any of these theories.

The world responded with surprise and disbelief that a modern aircraft could disappear in a digitally connected world.

Air navigation service providers responded swiftly to reduce the likelihood of a similar incident by the implementation of a space-based global tracking system for all aircraft outside the range of secondary surveillance radar.

TT, as the custodian of a flight information region with a very large oceanic sector, participates in the space-based tracking of aircraft.

To date, the aircraft and occupants have not been found and the cause of the disappearance remains one of the greatest mysteries in aviation history.

On March 24, 2015, an Airbus A320-211 operating Germanwings Flight 9525 from Barcelona’s El Prat Airport in Spain to Düsseldorf Airport in Germany crashed 100 km north-west of Nice in the French Alps, killing all 150 people on board.

The French and German investigators relied heavily on the cockpit voice recorder and the flight data recorder data and determined that the crash was deliberately caused by the co-pilot.

When the captain left the cockpit, possibly to use the toilet, the copilot locked the door and overrode the door code from the inside, preventing anyone from entering.

The analysis of the aircraft's flight data recorder indicated that the co-pilot set the autopilot to descend to 100 ft and accelerated the speed of the descending aircraft several times thereafter.

The captain requested re-entry using the intercom. He knocked and then banged on the door, but received no response.

The captain then tried to break down the door, but like most cockpit doors made after the September 11 attacks, it had been reinforced to prevent intrusion.

During the descent, the co-pilot did not respond to questions from French air traffic controllers, nor did he transmit a distress call.

Communication from the air traffic control tower, the captain's attempts to break in and the co-pilots' steady breathing were audible on the cockpit voice recording.

The screams of passengers in the last moments before impact were also heard on the recording.

The co-pilot was previously treated for suicidal tendencies and declared unfit to work by his doctor. However, he kept this information from his employer and instead reported for duty.

A 2022 paper by Embry-Riddle Aeronautical University – An Aviator Centred Approach to Mental Health, concluded: "More than seven years after the tragic events of Germanwings Flight 9525, a majority of aviators still report that they fail to seek care for physical and mental health issues due to fear of losing their medical certification and career.

"Regulating agencies and the airline industry have strived to destigmatise mental health treatment, yet the psychological barriers to seeking care appear to persist."

The conclusion continued, "These barriers present operational safety concerns to pilots, their crew members and the travelling public. Aviators show a willingness to seek help, but only in forms that they trust will not result in the loss of flying privileges. Research into a pilot-centred approach to mental health is needed to determine if aviators would benefit from receiving regulator-approved wellness counselling, self-evaluation training and self-help mental well-being training.

"These approaches may provide pilots with the psychological safety they need to overcome their fear and distrust of seeking the physical and mental health care they need and deserve."

Regulatory authorities should implement pilots' psychiatric evaluation programmes similar to that of the FAA.