The crash of Germanwings Flight 9525 has raised questions about whether airlines and regulators are doing enough to detect pilots who are too mentally ill to fly.
Aviation agencies in Europe and the United States once banned all pilots from flying if they disclosed a mental illness to their employers.
But in recent years, bowing to growing public awareness that common mental disorders such as depression are treatable, regulators loosened those restrictions, allowing the use of certain antidepressants for a small number of pilots and allowing some pilots whose illnesses were mild to stay on the job. In doing so, agency officials said, they hoped to encourage pilots who were experiencing problems to come forward and seek treatment.
The crash of Germanwings Flight 9525 on Tuesday has raised questions about how well those policies work and whether airlines and regulators are doing enough to detect pilots who are too mentally ill to fly.
The authorities have said that Andreas Lubitz, the co-pilot who is believed to have intentionally crashed the German aircraft, killing himself and the other 149 people aboard, suffered from a mental illness and hid the diagnosis from his employer. The exact nature of his disorder remains unknown, but Lubitz apparently sought treatment for vision problems that may have jeopardized his ability to work as a pilot.
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Still uncertain is whether there is a link between Lubitz’s vision problems and his psychological issues. The police found antidepressants during a search of his apartment in Dusseldorf on Thursday, an official said Saturday.
Since the crash, European airlines have scrambled to require that two people be present in the cockpit at all times, a rule already in place in the United States. But many experts said the focus should be on improving the process of hiring and screening pilots to better guard against someone like Lubitz climbing into the cockpit in the first place.
The programs used by airlines and regulators on both sides of the Atlantic, aviation experts and psychiatrists said, leave much to be desired. Screening exams are given annually and often merely nod to mental-health problems, including only a few questions about depression or other illnesses. The exams are often conducted by general practitioners, with no psychiatric expertise.
In addition, most programs are based on an honor system, relying on pilots to volunteer information about problems they might have. And to do that, several psychiatrists said, the pilots must overcome the stigma that still clings to mental illness, one that remains strong in commercial aviation, a profession with deep roots in the military that values a cool head and steady hand under pressure.
The screening process for pilots “really falls short for people who are involved in the public’s safety,” said J. Reid Meloy, a forensic psychologist who consults on threat assessments for corporations and universities.
The practice of screening only once a year is a particular problem, he said, because any number of life events — the breakup of a relationship, the death of a loved one or other setbacks — can affect mental functioning. Rather than coming out of nowhere, suicide often represents a convergence of troubled strands.
Investigators who delve into a suicide victim’s background — interviewing relatives, co-workers and friends in what is called a psychological autopsy — almost always find a troubled history and often uncover hints about suicidal intentions that were overlooked or ignored by others.
Screening systems in Europe closely mirror those imposed by regulators and airlines in the United States, aviation experts said, and in most cases, the tests that would-be pilots must pass to be licensed are focused far more on physical than mental health.
Dr. Warren Silberman, a former manager of aerospace medical-certification for the Federal Aviation Administration (FAA), said that in the United States, pilots applying for a license must fill out an online medical questionnaire. Only three questions on the form deal with mental health, he said.
“There is no specific psychological testing,” he said.
Before they are licensed, pilots must undergo a medical exam, conducted by a doctor trained and certified by the aviation agency. Some airlines impose additional screening procedures, but they vary from company to company. Active pilots are required to have a medical screening once a year until they turn 40 and then twice a year beyond that age. Only when pilots are found to have mental-health problems are they sent to a psychiatrist or psychologist for evaluation or treatment.
The system, Silberman and others said, leaves pilots on an honor system, albeit one reinforced by penalties to discourage them from concealing any health problems that could affect their fitness to fly, including mental illness. Pilots who falsify information or lie about their health face fines that can reach $250,000, according to the FAA.
Peter Goelz, a former managing director of the National Transportation Safety Board, said the system leaves a lot of wiggle room for pilots, who, for example, are allowed to choose doctors who might be less likely to report difficulties.
“They know which guys are more cordial to their concerns and which are not,” Goelz said. “My guess is that the industry and the FAA will look at this closely.”
Martin Riecken, a spokesman for Lufthansa, the parent company of Germanwings, said that airline’s screening procedures are similar to those in Europe and the United States.
Pilots are rigorously screened for physical problems before they are hired and fill out a questionnaire intended to vet their psychological fitness. Examination by a psychologist or psychiatrist is not a routine part of screening, he said.
As in the United States, pilots are required to report to the company any medical or psychiatric condition that might make them unfit to fly, Riecken said. But he added that in Germany, a private doctor who is consulted by a pilot is under no legal obligation to inform the airline about the pilot’s physical or mental state.
Seeking help from outside doctors is a common practice among pilots in Europe, said Dr. Alpo Vuorio, a researcher at the Mehilainen Airport Health Center in Finland who has studied depression in pilots and pilot suicides. Few pilots inform the airlines that they have done so.
Without a strict reporting system, accountability suffers, he said. “People start to find services all around the country and even from different countries, and then it’s lost,” he said.
In Lubitz’s case, the Duesseldorf University Hospital said he had been seen at their clinic in February and on March 10 for what it called a “diagnostic evaluation.” The hospital refused to give details, citing Germany’s privacy laws for medical records, including those of the dead, but denied reports that the co-pilot had been treated for depression. Prosecutors said that several doctors’ notes stating that Lubitz was too ill to work, including on the day of the crash, were found at his home; one of the notes had been torn up.
Because pilots and flight crews spend so much time working together in close quarters, airlines often rely on employees to monitor their colleagues’ behavior and raise concerns when a pilot appears unfit for flying.
“It’s very hard for mental illness to hide under those circumstances,” said Dr. William Hurt Sledge, a professor of psychiatry at Yale who has served as a consultant to the FAA, as well as to the Air Line Pilots Association and a number of carriers.
Yet Sledge conceded that the screening tools available were inadequate to the task of detecting a pilot determined to hide any signs of distress. Lubitz was heard on the flight recorder chatting amiably with the captain before locking him out of the cockpit.