Captain Sully: Pilots Need To Feel Safe Admitting Mental Illness

Last week’s plane crash in the French Alps was one of the most horrific and disturbing in the history of aviation — certainly one of the worst I have seen during my nearly five decades as a pilot, much of that as an aviation and safety expert.

I can only imagine the grief family members and friends must be experiencing since Germanwings Flight 9525 slammed into a mountainside on March 24, resulting in the death of all 150 aboard.

But I think I speak for many Americans when I say there was also something uniquely unsettling about this tragedy because it appears to have resulted from a deliberate action by the copilot of that flight.

The questions this raises are big ones: How could something like this occur? And what must we do to prevent anything like it from happening again?

Some things are clear: Pilots who are not fit to fly should not fly. Passengers trust that pilots will keep them safe, and thousands of aviation professionals prove themselves competent, reliable, and worthy of that trust many times every day.

The airline industry also has screening processes and an exemplary safety record. The U.S. requires extensive training for commercial pilots, and regular checkups and medical disclosures. Airline pilots are the most scrutinized professionals (much more so than medical practitioners) and for good reason.

But there are areas in which we must do better.

One needed long-term measure is including lavatories inside the cockpit area so pilots do not need to step outside.

Another more immediate measure is to greatly increase the rate of self-reporting of mental health issues, such as depression. Current screening and checkups are not enough, especially given that little screening is done after a pilot is hired.

More than 40 years of experience with safety reporting systems has revealed there is some critical safety information that cannot be gleaned in any other way than self-reporting. And as The Wall Street Journal recently reported, there are limits to what screening can reveal.

Even with required disclosure of disqualifying conditions and doctor visits, and stiff penalties for failure to disclose, self-reporting rates are thought to be low. To correct this, we must remember the vital role of trust in this industry. The public must be able to trust pilots, and pilots must be able to trust that they will be treated justly and not punitively should they develop a mental health problem. Rigid new rules would only keep mental health issues underground, where they can never be solved.

Airline companies, pilots’ unions, and aviation regulators must form an effective partnership so aviation professionals can have the confidence to self-report, get the help they need, and when their condition is resolved, return to work.

In the U.S., we have long enjoyed two airline safety advantages. One is that, until recently, about 75% of newly hired airline pilots were previously military aviators. They proved themselves in the most rigorous, disciplined, and demanding flight operations in the world even before being screened by airlines.

A second is that airline hiring and training standards have been high enough that most non-military pilots have had extensive experience and been screened by multiple employers before being hired by an airline. (The copilot on the Germanwings flight could not have been an airline pilot in the U.S. because he lacked the 1,500 hours of flight experience required to have an Airline Transport Pilot certificate.)

Today, far fewer newly hired pilots now have prior military experience, which means that we need an ever more robust system that combines screening, self-reporting — and a healthy dose of realism.

Depression is a common mood disorder, and we cannot think that because a pilot has not experienced it in the past, he or she never will do so in the future.

I spoke with Stuart Eisendrath, MD, Director of the UCSF Depression Center, who said, “Self-reporting of symptoms is the most important way to diagnose depression.” With appropriate treatment, he added, depression does not have to be career-ending. “But having an open environment to raise the diagnosis of depression is an important step in this process.”

Until 2010, the Federal Aviation Administration took a hard line on mood disorders: One depressive episode could be career-ending. It now takes a more enlightened approach, offering a few more options for pilots to seek treatment. But we must do everything possible to ensure that all the elements that go into ensuring passenger safety fit together within a culture that makes them effective.

Let us move forward in honoring the victims of this tragedy by having a global conversation about how to ensure that all such standards and best practices are complied with in every profession where people’s safety is on the line.