Air traffic control is a high-pressure job, one that requires full attention and immediate decision-making. It is a role that requires resilience, but that doesn’t mean that air traffic control officers are immune to the impact of their high-stress work environment.
“Stress and fatigue may negatively impact the cognitive functions essential for safety-relevant tasks. Extreme acute stress or long-term exposure to high stress may lead to memory lapses causing ATCOs to forget crucial steps in operating procedures or miss important communications,” says Dr Cristian Panait, medical expert in EASA’s aircrew and medical department. “It can also reduce their ability to concentrate and multitask, increasing the likelihood of missed signals or instructions.”
But while the impact of stress and fatigue on ATCOs is understood, the assessment of and support for those dealing with mental health challenges is not yet homogenous across the ATC sector.
The industry has begun to take steps in the right direction. For example, the International Civil Aviation Organisation (ICAO) now requires the implementation of fatigue risk management programmes and recommends that proper mental health support should be put in place. However, many experts agree that much more still needs to be done.
Keeping the skies safe
In some cases when an ATCO discloses mental health symptoms, they risk the temporary removal of their licence and therefore suspension from work. While this may appear to be the safest thing to do, many believe it might be making the skies more dangerous, as some struggling employees will choose to avoid asking for help, due to the fear of being suspended.
“Time out of work can result in lost pay, and the evaluations required to return can be prolonged, unpredictable and expensive. For this reason, I and others have argued that safety-critical staff face a barrier to seeking mental health care due to what a change in health status might mean for their career,” says William Hoffman, an affiliated assistant professor of aviation at the University of North Dakota and the vice chair of the Aerospace Medical Association’s (AsMA’s) mental health working group.
Many working groups and organisations are looking into different solutions to address the challenge of assessing staff with mental health concerns and supporting them. Here we take a look at some of the latest initiatives from across the globe.
Peer support
Captain Dave Fielding is a British Air Line Pilots Association (BALPA) representative, secretary of the European Pilot Peer Support Initiative (EPPSI) and chair of the International Peer Assist Aviation Coalition (IPAAC). Having been a union representative for 30 years, he has seen his fair share of colleagues lose their jobs due to stress, burnout or substance abuse.
During the 2000s, Fielding decided to create a programme where pilots could get the help, a safe space to talk before things spiral out of control. The initiative got off to a slow start, but its roll-out was boosted in 2015, after pilot Andreas Lubitz deliberately crashed Germanwings flight 95245 into the Alps.
“Views around the impact of mental health issues changed after that crash. Support went from being nice to have to a must-have, as they recognised that mental illness could kill,” Fielding says.
The pilot peer support programmes “offer a warm arm around the shoulder and a friendly ear from a colleague that gets the lifestyle and the stresses,” Fielding says. “They’re also supported with advice from mental health professionals, so colleagues know when to pass on cases.”
These support programmes have since been expanded to cover all safety-sensitive personnel in aviation, including ATCOs and aircraft engineers. Fielding says, “Even though there are different licencing requirements we still suffer the same issues. As far as I’m concerned, anyone who touches an aircraft needs to have access to support for their mental health.”
The mental wellbeing task force
The International Federation of Air Traffic Controllers’ Associations (IFACTA) has created a Mental Wellbeing Task Force to look at what it can do to support the mental health and well-being of operational staff. During his research, Dr Jaco van der Westhuizen, IFACTA’s mental wellness chair, found that many informal buddy-checking systems had developed of their own accord – something he puts down to “ATCOs immense professionalism and pride in their work”.
He adds, “Everyone is focused on getting the job done well, but when you’re going through something yourself, you don’t always realise how it’s impacting your behaviour. I think it is intrinsically hardwired into this workforce to look out for each other, and so buddy systems have emerged.”
A recent survey showed the IFATCA task force that peer support programmes have been established by ANSPs and IFACTA member associations in several countries. These are usually overseen by a mental health professional who trains a group of peer volunteers. Van der Westhuizen says, “The benefit of peer support is that your peers can relate to you quickly. They understand the pressures and implications of your work.”
He goes on to highlight the importance of ensuring the mental health professionals involved have experience or an understanding of the aviation world. “There was an individual who went to see a private psychologist – one that didn’t understand the rules and regulations of the profession. In the psychologist’s report, they used certain disqualifying words and prescribed disqualifying medication that someone more knowledgeable about the system would have avoided,” says van der Westhuizen.
“We need that knowledge to ensure people can overcome whatever they’re dealing with, but while continuing to work – as long as there is no threat to safety.”
The IFATCA task force is looking at ways it can provide resources to support the creation of more peer support schemes around the world.
“North America and parts of Europe are well-equipped, but there are a lot of places where they still need to get a programme up and running. It’s still early days for the task force, but we’re looking at how we can help facilitate that, keeping in mind different cultural perspectives,” van der Westhuizen notes.
“We see ours as a dual role, one that also involves improving awareness and education around mental health. We’ve already begun developing information about available mental health support. This will be sent to our member associations, who can then pass it on to their members.”
MEntal Health in Aviation SAFEty (MESAFE)
This April saw a raft of projects make headlines with the release of their findings. One such programme was MEntal Health in Aviation SAFEty (MESAFE), which culminated in a two-day conference at EASA’s headquarters in Cologne, Germany.
This two-year research project was launched by the EASA and overseen by Italian company SME Deep Blue. It examined the gaps and challenges reported by aeromedical examiners who carry out mental health checks.
“Our research found that there was a lot of variability in terms of the procedures and methods used in mental health assessments,” says aviation psychologist Paola Tomasello from Deep Blue, who is MESAFE’s lead consultant.
“Some situations didn’t have a structured interview but just a questionnaire, and very little time allocated to the assessment. In other cases, we saw mental health specialists cooperate with the medical examiner to do a proper assessment.”
Tomasello reported back on this variability, the lack of appropriate resources, mental health specialists and training on mental health for medical examiners.
The conclusions include 44 recommendations to update EASA policies related to aero-medical mental health assessments. These are based on a multi-layered approach, where all stakeholders are engaged in monitoring and protecting mental health. The team also produced guidelines for each of the stakeholders, education materials and a method called the mental incapacitation risk assessment process, which medical examiners can use to evaluate the risk that a mental issue could pose to flight safety. EASA is initiating regulatory action to evaluate how to implement several of the recommendations proposed by the study.
FAA to introduce changes
Also this April, the Federal Aviation Administration’s (FAA) Aviation Rulemaking Committee (ARC) on Mental Health published a landmark recommendations report regarding the mental health of pilots and ATCOs. In addition to identifying some of the barriers they face related to mental health, the ARC report proposed 24 solutions to the FAA “to make progress on these efforts in the years ahead,” says Hoffman.
These include making sweeping changes to its current health policies, such as dropping the requirement for ATCOs to inform administration if they see a counsellor, through to developing a pathway for them to continue working while on certain medications.
“Staff with a severe mental health condition certainly shouldn’t be working in these roles, but we are interested in how we might help those with mild symptoms – perhaps facing one of life’s common stressors – to get support when needed to prevent symptoms from worsening,” says Hoffman.
Now the FAA must decide which of the commendations to take on board. While new mental health education efforts are unlikely to face opposition, the most difficult will be decisions about what ATCOs can do while working and what they need to tell the FAA “amid a surprising paucity of safety data,” Hoffman notes.
“Data will be key to building tomorrow’s aviation system, where safety and wellness are at the centre. The AsMA recently concluded a working group to establish research priorities related to mental health in aviation and a report to follow. We hope this effort will encourage financial investment in research and drive work in this area.”
Proactive risk management
In the UK, the Royal Aeronautical Society (RAeS) published its own paper the same month entitled ‘Psychosocial Risk Management and Mental Health – The Mental Health Challenge to Civil Aviation Safety in the 21st Century’.
Developed by the society’s Human Factors Wellbeing Specialist Group, the paper highlights key areas of the civil aviation ecosystem that would be positively impacted by a coherent approach to recognising, managing and mitigating staff mental health and wellbeing.
“This paper is generally seen as the definitive work in this area and provides a more holistic approach to remedy this growing crisis rather than just attempting to put a plaster on an already concerning situation,” says Gerard Forlin, KC from Cornerstone Barristers, London and State Chambers, Sydney, one of the report’s authors and the only lawyer involved in its production.
The report highlights the growing recognition and acceptance of the concept of psychosocial risk management (PsRM) and that the ISO 450003 psychosocial risk management in the workplace approach offers a possible route towards creating a practical and pragmatic starting point for the sector. Looking at the issue through a variety of lenses including but not limited to regulatory, safety, insurance, human resources and legal, the paper concludes that a policy of proactive PsRM could lead to enhanced performance and safety, but Forlin notes that there’s still a way to go.
“The issue of psychosocial risk management and its consequential adverse impact on employee mental health as a risk factor in aviation greatly lags behind physical risk in the health and safety landscape,” Forlin says. “We need to create an integrated approach across the stakeholders to establish a strategic working group to focus on our paper’s 13 recommendations. This should ideally include the authors of the report.
“Much more needs to be done. We seem to have hit a turning point when it comes to pilots, but the rest of the aviation sector is generally seen to be lagging behind. This is a crucial issue. The prosecutors and regulators wait in the wings if we don’t act fast and far enough,” Forlin concludes.