Mental Health in Aviation: Conditions & Regulations

Understanding the regulatory landscape and clinical background for aviation professionals.

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Mental Health: A Common Consideration

Mental health conditions are common across the general population, and aviation professionals are no exception. Having a mental health condition is not necessarily an exclusion from aviation duties; however, non-declaration can pose significant issues.

Prevalence of Mental Health Conditions

To illustrate how common mental health conditions are, a comprehensive study by the Mental Health Foundation demonstrated that one in six (17%) people over the age of 16 had a common mental health problem in the week before being interviewed.

Nearly half (43.4%) of adults think that they have had a diagnosable mental health condition at some point in their life (35.2% of men and 51.2% of women). A fifth of men (19.5%) and a third of women (33.7%) have had diagnoses confirmed by professionals.

A third of people (36.2%) who self-identified as having a mental health problem in surveys have never been diagnosed by a professional.

In 2014, 19.7% of people in the UK aged 16 and older showed symptoms of anxiety or depression. (Ref: Mental Health Foundation 2016)

Aircrew prevalences often appear reduced. This raises questions: is this a true reflection of effective screening during training and selection, or is it partially a consequence of non-declaration?

UK CAA Guiding Principles

Declaration is Key: Openness about mental health is crucial for accurate assessment and ensuring safety.

Trust is Crucial: A trusting environment between aviation professionals, AMEs, and regulatory bodies is vital for a safe flying environment.

The Regulatory Framework

Disqualifying Conditions & Risks

Certain conditions are generally disqualifying, including: Schizophrenia / schizotypal / delusional disorder, and Mania.

The use of certain psychoactive medications and substances (including recreational drugs and alcohol) poses the greatest risk to flight safety in terms of accidents in both general and commercial aviation.

Relevant CAA Regulation Extracts:

MED.B.055 Psychiatry

"(a) Applicants shall have no established medical history or clinical diagnosis of any psychiatric disease or disability, condition or disorder, acute or chronic, congenital or acquired, which is likely to interfere with the safe exercise of the privileges of the applicable licence(s)."

"(f) Applicants with an established history or clinical diagnosis of schizophrenia, schizotypal or delusional disorder shall be assessed as unfit."

MED.B.060 Psychology

"(a) Applicants shall have no established psychological deficiencies, which are likely to interfere with the safe exercise of the privileges of the applicable licence(s)."

The bottom line is that in aviation, non-disclosure of potentially relevant issues is often more problematic than the issue itself. It is always better to mention concerns—even if past or seemingly irrelevant—rather than to withhold information.

Why Mental Health Assessments are Crucial

Mental health assessments are vital for pilots, air traffic control staff, and cabin crew for several key reasons:

1. Safety and Performance

Mental well-being directly impacts the ability to perform critical tasks and make sound decisions. Unaddressed issues can impair cognitive functions essential for safety.

2. Stress and Fatigue Management

Aviation roles involve high stress and irregular schedules. Assessments help manage stressors, develop coping strategies, and mitigate burnout risk.

3. Identification of Conditions

Early detection of conditions like anxiety, depression, or substance abuse allows for treatment, minimising impact on job performance.

4. Duty Fitness Determination

Assessments evaluate overall fitness, ensuring individuals are mentally suitable to perform their duties safely and effectively.

5. Regulatory Compliance

Authorities like ICAO require periodic medical exams including mental health assessments, maintaining industry safety standards.

6. Support and Treatment

Assessments facilitate early intervention and access to support, improving outcomes and enabling safe return to roles.

Mental Health Assessment Process

Understanding when a specialist psychiatric review may be necessary for any aviation professional.

AME Screening & Referral

A psychiatric assessment is not a standard part of every medical. However, if your AME requires additional clarification on any aspect of your current or past mental health for submission to the regulatory authority, they may request one.

It is then your responsibility to arrange this specialist assessment, which is where we can help.

Scope of Assessment

Sometimes the assessment is relatively straightforward – for example, evaluating the impact of past treatment or counselling and any current effects on licensing.

Other times, it may focus more on demonstrating resilience and effective coping strategies against external stresses.

More complex situations, like significant past mental illness, trauma, or suspected conditions, will require a more detailed assessment and formal report for your AME and potentially the licensing authority.

Assessment Frequency

Often, this is a one-off assessment for initial licensing or return to work after sickness. Occasionally, the regulatory authority may require ongoing periodic mental health assessment and monitoring, which we can also provide.

Learning from Past Incidents

Several aviation incidents have underscored the critical need for robust mental health screening, support, and ongoing monitoring for all crew members.

Germanwings Flight 9525 (2015)

The co-pilot, with a history of concealed depression, deliberately crashed the aircraft. This highlighted issues of non-disclosure and mental health history.

Japan Airlines Flight 350 (1982)

The first officer, suffering from mental health issues, intentionally caused the crash, emphasising the need for psychological screening.

SilkAir Flight 185 (1997)

Investigation suggested intentional crash by the captain, who reportedly had financial/personal problems, pointing to stress factors.

JetBlue Airways Flight 191 (2012)

A captain's mental health episode mid-flight showcased the need for protocols to identify and address acute mental health crises.

Emirates Flight 521 (2016)

A crash landing linked to compromised decision-making under psychological stress, emphasising stress management and mental well-being.

These incidents underline the critical need for robust mental health screening, support systems, and ongoing monitoring of crew members' well-being within the aviation industry to ensure the safety of passengers and crew alike.

Expert Assessment & Support

As a trained aviation psychiatrist and ex-pilot, I provide informed mental health assessments for Aviation Medical Examiners, compliant with CAA/EASA/FAA procedures. Understanding and addressing mental health is key to a safe and resilient aviation industry.

Remember, seeking assessment is a proactive step towards ensuring your fitness for duty and contributing to overall aviation safety.

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