Andreas Lubitz, the 27 year old co-pilot who deliberately flew Germanwings Flight 9525 into the Swiss Alps, had always wanted to be a pilot. Yet from the beginning problems were apparent. For an extended period of time in 2009 Lubitz was treated for deep depression, even having to drop out of the pilot training program for several months. In addition, German prosecutors noted that he had been treated for suicidal tendencies, though they didn't say when. Lufthansa, the parent company of Germanwings, said an evaluation after Lubitz wished to return to flight training found him to be “100 percent flightworthy without any limitations.”
 
The tragedy of this Germanwings crash is shining the light on both the importance and shortcomings of screening pilots for mental health problems. Piloting an aircraft and being responsible for the lives of hundreds of passengers clearly must have a higher standard than almost any other occupation. Pilots do receive medical exams regularly and are expected to voluntarily disclose any physical or mental health problems and any medications they are taking. However, no psychiatrist or psychologist is generally involved in a pilot's evaluation. Lubitz’s apparent suicide/murder illustrates the crucial role mental health plays in commercial pilots' lives. Where do we draw the line between individual privacy and protecting the public from an individual with a potentially dangerous mental illness?

As in Germany, US pilots are required to have yearly physical exams for those under 40 and every six months for all others, but that does not include a psychological evaluation. There was a time when pilots were banned from flying if they either disclosed a mental illness or had one diagnosed. That changed with advances in psychopharmacology, especially with respect to depression. Since antidepressants could treat mild to moderate depression extremely well, standards were relaxed and, in turn, pilots were more likely to both seek treatment and disclose their issues.
 
In today's world a pilot’s annual or biannual physical is performed by an aviation medical examiner (AME), a physician designated by the aviation authority to perform physical exams and issue aviation medical certificates. However, a psychological exam is only ordered if the AME is concerned about a pilot's emotional and/or mental state. The FAA stipulates that pilots are required to tell their airline employer about any and all physical and/or psychological conditions. If they do not, they face stiff penalties—fines, suspensions, reprimand letters and in extreme cases, termination.
 
Herein lies the problem. If a pilot self-reports a mental illness, he may be grounded if the condition is serious enough; yet in mild cases this wouldn't pose a problem. In the US and other developed countries, mild to moderate depression can be treated with antidepressants (or therapy), and pilots are eligible to continue flying under a special medical certificate. But when severe depression or psychosis is the issue, perhaps as in Lubitz's case, a pilot could fear losing his job, so self-reporting becomes a dilemma. We can speculate that Lubitz probably knew he had a condition severe enough to ground him, so he hid his illness from his employer. In addition to his mental health issue, Lubitz was also experiencing vision problems which may have played a role here as well.

Clearly the system is flawed, as some pilots will not inform their employer that they suffer from a psychological or physical condition in order to keep working.  A severe mental health disorder might cost them their job. What would be their incentive to disclose such information with such a potentially huge downside?   
 
A recent NY Times editorial suggests a solution similar to the medical profession where a doctor can confidentially approach (or a colleague can report to) an impaired physician organization for an evaluation and help. But again, this relies too much on self-reporting. A simpler solution is needed and is available. Random drug screens which are already performed on pilots could be expanded. We now have the technology to test for virtually any medication, including standard psychiatric meds. Yes, this would be more expensive, but it wouldn’t have to be performed for every screen. Merely the possibility of being tested for psych meds would increase the self-reporting currently required and if the penalties for failure to report were severe enough—especially for those who lied—this would go a long way toward identifying those that were taking medication which could identify a potentially severe mental health condition.
 
This story is sad on so many levels beyond the obvious tragic loss of 150 lives. Antidepressants were found in Lubitz's apartment and a law enforcement source told CNN that Lubitz relapsed with severe depression in 2014. Lubitz saw five to six doctors over the days before he took the controls of flight 9525, frantically doctor shopping in an attempt to get help. No doubt he wanted relief, but he probably also feared being grounded.
 
By all accounts it now appears that this was a very sick individual in crisis. Authorities searching through his apartment after the crash found a tablet with a search history that included “suicide”, and the security associated with cockpit doors. Had a comprehensive drug screen have been performed randomly in the months before the fateful flight, there is a good chance that this crisis could have been avoided either via Lubitz self-reporting because he knew that a random screen would catch him or by a positive screen. Not only that, but then he could have been treated in the open with the support of his peers and employer rather than covertly and desperately trying to find help on his own.

One tragedy such as this is enough. New rules on drug testing for pilots need to be implemented immediately.

About the Author

Dr. Dale Archer

Dale Archer, M.D., is a clinical psychiatrist and the author of Better Than Normal: How What Makes You Different Can Make You Exceptional.

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