Self-Reporting Mental Illness by Airline Pilots Abstract? XXXXXXXXXXword count. 1. Restate Research Topic and Issue 2. Restate Research Aim 3. Restate Research Questions (maybe) 4. Summarise the...

Self-Reporting Mental Illness by Airline Pilots
Abstract
There is a high prevalence of Mental Illness within the Australian population, most of which goes unreported, especially among males. The aviation industry employees are not free from this. This research paper studies the available means of assessing mental health among pilots in Australia. It aims at researching the effectiveness of mental health reporting system for pilots in Australia as well as analysing any further steps that can be taken to make the process better. The effectiveness of self-reporting system for mental illness by airline pilots has also been analysed. In order to draw necessary conclusions, the study has made use of extensive literature review within the scope of mental health of pilots. In addition, a survey pertaining to the efficacy of the cu
ent system was also made. The survey was responded to by 14 airline pilots and 10 DAME’s. Based on the studied literature and the two surveys, it is concluded that the cu
ent mental illness screening for pilots in Australia is inadequate. The DAME’s are required to make only a short interview on mental health during recertification process and most respondents think the system is lacking. Most respondents thought that better education regarding mental health would be helpful to pilot.
In order to improve mental health screening, steps like better education on mental health, job security, better cooperation from employers can help improve reporting mental illness among pilots. Due to the small size and limited time of the study, further research needs to be undertaken to verify the results of this research on a large scale.
Introduction
Mental illness is a widespread, highly stigmatised disorder that affects over half of the population of Australians during their lifetime (Health Direct, 2016). Up to one in ten people affected by mental illness dies by suicide (Health Direct, 2016). This has implications to the aviation industry; an industry based on safety and trust, that is also not immune to the effects of mental illness. In airline operations, the public have generally little understanding of the process of flight, and put their lives in the hands of professional pilots to see them safely to their destination. Though every pilot can
ing issues to the flightdeck such as unhappy work life or family issues which can affect their piloting performance, mental illness can make a pilot dangerous. The potential also exists for a pilot to hide an underlying mental health issue from their doctor, family and employer. This problem has been highlighted by events such as Germanwings Flight 9525 of March 2015, in which a pilot utilised a passenger aircraft as a means to commit suicide, in addition to killing many innocent people. This involved the co-pilot locking the captain out of the flightdeck and setting the aircraft into a descent into te
ain (BEA, 2016). A critical factor that led to the accident was the lack of medical information provided to the Germanwings about their pilot’s mental situation, as it was dependent upon self-declaration. The treating physician and psychiatrist who were aware of the pilot’s condition did not inform Germanwings in order to maintain medical confidentiality (BEA, 2016). Instead, they gave the pilot sick leave certificates and made the assumption he would use them (BEA, 2016). This accident will be further discussed in the literature review. Though rare, events such as this are devastating to the aviation industry and dissolves trust that people have in airlines.
The mental health of pilots in Australia is cu
ently assessed by the pilot’s Designated Aviation Medical Examiner (DAME) in an annual medical assessment to gain a Class One medical certificate; a check required to be fit for flight (CASA, 2018). The question arises; do pilots fear reporting changes to their mental health or suspicion of mental illness because they fear punitive measures imposed by the government aviation regulator or their employer? Combined with the dominance of pilots being male (McCarthy, Budd & Ison, 2015), and males being less likely than females to seek help for mental illness (White, 2013). This creates a potential for a massive problem as aviation is cu
ently a male dominated industry.
Mental health is an important factor in how a person acts and the decisions they make. It can affect day to day life, with illness such as anxiety and depression can modify behaviour.  this can have a drastic effect on the safety of air travel. Due to society’s negative perception of mental illness, many people already struggle to talk about their feelings for fear that something is wrong with them (Co
igan P, 2002). Pilots have the added stress of potential career setbacks if they are found to be medically unfit. As a result, there could be added pressure on pilots to appear as if they are coping in their lives to avoid a career difficulty. This may be incredibly hard for a pilot to come forward and talk to a professional without any punitive actions taking place. It raises the questions: what is the cu
ent Australian Civil Aviation Safety Authority (CASA) screening process for pilot mental health? how effective is the cu
ent process and, if needed, what can be done to improve it? What can be done to encourage pilots to seek assistance with mental health issues? The research aim for this study is to develop an understanding of the process and effectiveness of mental health screening in the aviation industry, and if improvements can be made for pilots to more willingly access professional help if need be.
Literature Review
Mental Illness and Stigma
Healthy, strong minded pilots are critical to the safety within the aviation industry, as they are responsible for countless lives that are flown around Australia, and the world, everyday (CASA, 2017). However, pilots are not immune to mental illness. A study by Wu et. al. (2016) estimated from a survey that as much as 12.6% of airline pilots are vulnerable to developing depression. Of those pilots, 13.5% had worked in the previous week. In comparison, CASA (2018) approximate that one in six (16.7%) will suffer from depression at least once in their life.
There are many types of illnesses that can affect mental health. Some of the major types include; depression, anxiety, schizophrenia, bipolar mood disorder and personality disorder (Department of Health, 2007). Mental illness is commonplace worldwide, with more than an estimated 300 million people affected (World Health Organisation (WHO), 2018). Depression, unlike other mental illnesses, is a serious health condition that can cause work ethic to suffer due to lack of motivation, as well as social exclusion from the stigma su
ounding mental health. The WHO assert that, if left untreated or undiagnosed, depression can lead to suicide, with suicide being the second leading cause of death in 15 - 29 year olds, with an approximated death toll of 800,000 people per year worldwide.
However, with mental illnesses being highly stigmatised due to misinformation, prejudice, and discrimination (Beyondblue, 2015), those with mental illness are unlikely to seek treatment due to feelings of shame, guilt, disgrace and emba
assment of their condition. These conditions may instil feelings of worthlessness and low self-esteem. In addition, though mental health awareness may be promoted, mental health leaders are often deficient in public health skills and experience (Shah & Beinecke, 2009). So even if awareness of mental health is maximum, regulators such as CASA may not know how to properly handle people with these conditions.
The stigma exists because many do not fully understand mental illness, and the media can reinforce and sensationalise negative stereotypes, such as people with mental illness being crazy, violent, unpredictable and untreatable (HealthDirect, 2017). Stigmas can be both personal and perceived. According to Calear, Griffiths and Christensen (2011), personal stigma refers to an individual's personal thoughts and beliefs about depression. Perceived stigma is the individual's perception of other people’s thoughts and feelings about depression.
Mental Illness in Aviation Pilot Studies
Commercial airline pilots are usually seen as being healthier than the general public (Ykes et al., 2012). This is mainly attributed to pilots having the need to undergo annual or biannual medical examinations to obtain a Class 1 medical certificate. However, these medical examinations do not always detect mental illness. Whether it is in the initial stages of development or in a mature state of prolonged exposure for pilots. This can lead to serious issues where pilots begin to feel overwhelmed from stressors at home or from the workload of commercial operations. According to CASA (2018), many stressors of the job have the ability to worsen depressive symptoms, such as time zone changes, fatigue, and remote locations. Having a heavy workload and less than adequate physical exercise can increase the prevalence of common mental disorders by up to 31% (Aerospace Medical Association, 2012).
Of studies on depression and suicide in commercial airline pilots, twenty aircraft assisted suicide cases were analysed. From this analysis, it was found that pilots younger than the age of 40 were five times more likely to use aircraft as a means to commit suicide than those above the age of 40 (Pasha & Stokes, 2018). In a similar study in the US, it was found that though the total number of fatal general aviation accidents has declined, the number of aviation-assisted suicides increased between 1993-2002.  It is also stressed that the suicides were likely triggered by events occu
ing long after the medical certification process had been completed (Lewis et. al., 2007). This alludes to the possibility of the Class One medical being ineffective due to being completed only once a year.
In another study that analysed the use of SSRI antidepressants in pilot-fatality incidents, it was found that only 7 of 59 (12%) pilots in the study had reported their psychiatric condition. In a later medical examination, 6 of the 7 pilots indicated they were free from conditions and reissued medical certificates. (Sen et al., 2007)
In most cases, aircraft assisted suicide only has one fatality being the pilot themselves such as the one that follows. A 54-year-old male pilot was being treated by a psychotherapist for severe depression. At a later date. the pilot had departed an airport in a Cessna 172K and approximately thirty minutes after takeoff, flew into a mountain side. The pilot’s therapist told the investigating officers that the pilot had stated, ‘‘If he killed himself, he would do it in a plane” (Lewis et al., 2007). However, as seen in the Germanwings 9525 accident that follows, these suicides do not always end up in one casualty. Instead, these attempts at death can end up with hundreds dead.
Germanwings Flight 9525 and Other Related Incidents
In March of 2015, the co-pilot of Germanwings Flight 9525 may have intentionally locked the captain out of the cockpit and flew the Ai
us A320-200 into te
ain of the French Alps, killing all 150 people on board. After investigation, it was revealed that the co-pilot had a history of depression and was experiencing a psychotic depressive episode that began the previous year (Pasha & Stokes, 2018).
During August 2008, the co-pilot had started to suffer from severe depressive episodes. He had suicidal thoughts, but during multiple psychiatrist sessions had made numerous “no suicide pacts” (BEA, 2015). The co-pilot had undertaken antidepressant medication between January and July of 2009 and psychotherapeutic treatment from January 2009 until October 2009 (BEA, 2015). His treating psychiatrist stated that the co-pilot had fully recovered in July 2009. There were several sick leave certificates issued by physicians, however, none of them were forwarded to Germanwings (BEA, 2015).
The Germanwings incident, though being the most recent, was not isolated; in 1999, Egyptair Flight 990 crashed into the Atlantic Ocean sixty miles south of Nantucket, USA. The crash was investigated by the American National Transportation Safety Board (NTSB) and believed the cause was likely to have been deliberate actions by the first officer. There were 203 people on board (NTSB, 2002). Similarly, in 1997 Silkair Flight 185 was also suspected to have crashed into te
ain due to pilot suicide with 104 people on board. During investigation, it was found that the captain was found to have suffered difficulties at work over the previous six months and had amassed a significant debt (NTSC, 2000). In March 2016, a Qantas pilot was suspected to have hired a Cessna 172 and crashed into the sea off the coast of New South Wales. Despite being the only person on board, the suspected suicide came only a month after passing a Class One medical. The pilot was struggling to deal with the
eakdown of his ma
iage (Houghton, 2016).
Though rare, suicides made by commercial airline pilots utilising aircraft are devastating, involving high casualties and resulting in high costs to airlines. The Germanwings incident highlights a lack of action by aviation operators and regulators in assisting the control of mental health among airline pilots.
Changes Made by EASA
Following Germanwings Flight 9525, the European Aviation Safety Agency...