The mental health of pilots may become more closely monitored in the aftermath of the Germanwings crash that killed 150 people last year. French aviation officials have recently called for stricter international monitoring of pilots’ mental health and for guidelines that would require mental health professionals to report pilots whose psychological condition could pose a threat to public safety.
French aviation officials made the recommendations on Sunday, as part of a report conducted by French accident investigators into the crash that occurred last year. The investigation concluded that the crash had been deliberate and caused by the Germanwings jetliner’s co-pilot Andreas Lubitz, which had been prescribed antidepressants in the month leading up to the accident. The case was not reported to German aviation authorities because of the country’s strict privacy laws.
According to representatives of France’s Bureau of Investigations and Analyses, the incident could have been avoided had such warnings been voiced, as the co-pilot would not have been allowed to fly the passenger plane. In the wake of the investigation, the Bureau recommended that international air safety regulators and health agencies collaborate to modify the conditions that would require doctors to issue warnings concerning an airline pilot’s mental health status to the proper authorities should the existing issues pose a potential risk to public safety, even if the patient does not consent to this disclosure.
Assessing the Mental Health of Pilots
Investigators found that Mr. Lubitz had been prescribed powerful antidepressants and sleeping pills before the disaster. Several physicians had examined and treated the co-pilot and, at least, one doctor had strongly recommended that Mr. Lubitz be hospitalized for a possible psychotic disorder prior to the crash.
Despite the obvious concerns that these doctors had regarding Mr. Lubitz’ condition, none of them alerted the German aviation authorities about the co-pilot’s mental health issues or about his ongoing treatment. This was due to the doctors’ fears of breaking Germany’s strict privacy laws, which guard patients’ privacy and guarantee that patient-doctor confidentiality rules will not be breached. However, the French Bureau of Investigations and Analyses representatives suggested that these laws be changed in the case of airline pilots suffering from mental health issues that may pose a risk to public safety.
The French report advised the German authorities to consider modifying the current privacy laws and to limit the legal penalties for doctors who breach patient confidentiality in order to prevent potentially dangerous situations such as this one. Investigators also advised German authorities to consider redefining the types of health issues that can be considered “imminent dangers” to the flying public in the case of airline pilots.
French investigators also urged European flight safety regulators to monitor pilots who have a history of mental health issues of any kind more closely. They also recommended that regulators consider allowing some pilots to fly while taking antidepressant medication as long as these pilots are under strict medical supervision. Other countries, including the United States of America, have already made such provisions for pilots.
New Measures to Better Monitor the Mental Health of Pilots
The French bureau that conducted the investigation does not have the legal authority to impose the changes on the current German laws and safety regulations. However, the airline industry and airline safety regulators have typically acted on investigators’ proposals after air crashes in the past. This report is the first in which a team of air accident investigators have issued recommendations to the global medical community.
The report also contained recommendations concerning the promotion of confidential peer-support programs by airlines. Investigators explained that support programs for pilots with mental health issues could help reduce the risk of such incidents reoccurring. They also called on the airline industry to find new ways of mitigating the economic consequences for pilots who fear losing their jobs if they disclose their mental health issues.
Fighting the Mental Health Stigma for Airline Pilots
Many airline pilots currently fear revealing their mental health issues to airline regulators for fear of the stigma that is still associated with mental health disorders. Patient confidentiality laws often prevent doctors from reporting potentially dangerous cases to airline safety officials. However, providing pilots with counseling and support sessions and encouraging them to disclose mental health issues without fear of job loss could help reduce the risks of such incidents reoccurring.
According to the French report and to German prosecutors, Mr. Lubitz’ psychological issues had begun in 2008 and that the co-pilot had originally informed the airline of the illness at the time, but that airline safety regulators had been unaware of the severity of the condition. The co-pilot had withdrawn from an elite flight-training school operated by Germanwings’ parent company Lufthansa when he had first started experiencing these symptoms. He was eventually reinstated with the approval of Lufthansa flight doctors.
The French investigators found that the co-pilot’s psychological issues had resurfaced in late 2014. Mr. Lubitz began complaining of sleep disorders and vision problems that had no physiological explanation. The investigation revealed that only two weeks before the crash a private physician had referred the co-pilot for inpatient treatment at a psychiatric hospital for a possible psychotic disorder.
No counselor or health care provider involved in the co-pilot’s treatment reported any medical concerns to the air safety regulators for fear of breaching medical confidentiality laws. French investigators theorized that these doctors perceived this medical confidentiality breach as riskier, in particular for themselves, than not reporting the co-pilot’s condition to the proper authorities.
Director of the French Bureau of Investigations Rémi Jouty expressed his hope that the report’s findings would generate a broader discussion among aviation regulators and health care providers worldwide concerning the need to properly balance patient privacy laws and public safety concerns.
Mr. Jouty admitted that the attitudes towards patient privacy vary from one country to another and that a universally amiable solution will be difficult to find. He did, however, express his optimism regarding the effects of the report, stating that it would lead to concrete changes in current airline safety regulations to better manage the mental health of pilots and to combat the stigma that still surrounds this issue.