While the physical wellbeing of commercial pilots is systematically verified—they must pass a medical based on ICAO standards and recommended practices and have yearly check-ups—mental health is not so easily established.

ICAO’s Manual of Civil Aviation Medicine, published in 2012, suggests that medical reviews should include questions about “psychiatric disorders or inappropriate use of psychoactive substances”. The manual lays out questions for medical examiners to ask on a variety of subjects, including depression, anxiety and use of alcohol and drugs.

But that same manual asserts that psychological tests of aircrew are “rarely of value” and not “reliable” in predicting mental disorders.

It’s a view backed by health experts. A working group of the Aerospace Medical Association (AsMA) came to a similar conclusion following a 2012 JetBlue incident, for example. “AsMA does not recommend an extensive psychiatric evaluation as part of the routine pilot aeromedical assessment,” it concluded in its report, which found such tests to be neither productive nor cost-effective.

Claude Thibeault, IATA’s Medical Advisor, believes that “the approach to reducing mental health risk needs to be multi-layered.”

That multi-layered approach includes pre-screening in the hiring stage and a number of ongoing monitoring opportunities, some structured, some ad-hoc. Various support mechanisms, from medical assistance to peer networks, underpin the strategy.

Thibeault affirms that self-reporting or colleague intervention will be paramount to any successful initiative to combat mental health issues. The crux of the matter, he says, is creating a non-punitive environment that encourages self-reporting without unnecessary recrimination.

“Excluding pilots with a history of mental health issues from flying has a potentially detrimental effect on overall safety, as there is evidence this will further stigmatise mental health and drive the issue underground with pilots flying untreated or unmonitored,” he concludes.

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