New details are still emerging about the Germanwings plane crash in the Alps in March of this year. Many are focused on the fact that co-pilot, Andreas Lubitz, had been diagnosed with a mental illness as being his major risk factor for suicide and mass murder. Mental illness alone is NOT a risk factor for violence or mass murder. It is also important to focus on the fact that the combination of untreated mental illness and substance abuse raises the risk of violent behavior 7 fold (Steadman et. al., 1998).   

 SEBASTIEN MORTIER

What were the signs that Lubitz may have been headed for a larger explosion?  There are reports that Lubitz may have been emotionally explosive at times. He may have had what might be interpreted as unusual or cryptic communications. He woke up with nightmares of his plane crashing.  These should have been evaluated to determine their nature, source, and treatment. However, in a system that relies on self-report with dire consequences for reporting problems, officials will not get to the truth. It is not in the person’s best interest to tell the truth in these circumstances for fear of penalty. Reuve (2008) stated that many psychosocial and neurological factors come together to create a situation where a person commits mass murder. Therefore, increasing the monitoring of the mental health of pilots and others in sensitive positions alone will not solve the problem seen retrospectively in the crash of flight 9525. Additionally, we now know that Lubitz rehearsed his deadly flight, but the equipment that recorded those flight deviations is not routinely checked. Many airlines are now considering implementing a policy that is already in effect for some major airlines, such as Aer Lingus, where two members of crew need to be inside the cockpit at all times. That is a good prevention strategy and others are coming to light.

Several pilots in recent years have committed suicide by crashing their planes. There must be a way to monitor red flags such as changes in mood or behavior, substance abuse, domestic or community violence, law breaking, personality disorders, immature or egocentric personality development, and the lack of ability to cope with extremely stressful life events such as the potential to lose one’s career. The combination of these factors is more likely to lead to violence than mental illness alone, especially if the mental illness is being appropriately treated. 

It appears in this case, Lubitz was being treated and, at one time, notified the company of his psychological problems. It appears that this was not an issue of an employee hiding his illness, at least initially. However, he may have hid the severity and ongoing nature of his illness from the airline. Casual medical screening is not sufficient to assess for suicidality or homicidal tendencies, we must create and test the validity of new tools that use known risk factors, which measure risk for suicidality and homocidality in a very organized and valid way. As a society, we must re-examine the rights of individuals to do as they wish and keep their illnesses private, versus the rights of the public to be safe. A new line may need to be drawn. If we redraw this line, we must do it very carefully and with much debate and scientific input. 

Is this case, keeping our collective heads in the sand about the suicidality and homocidality of some pilots is not in the flying public’s best interests. Monitoring and the release of medical records of those at risk must be part of the solution. How does management determine who is at risk of suicide or mass murder? Self-report is obviously not sufficient. The risk factors for suicide and mass murder are known. Monitoring mental health in traditional ways is simply not sufficient. If a medical screener asks someone if they are suicidal or homicidal, they may or may not get to the truth. Businesses must monitor the risk factors for suicide or violence with a valid and reliable tool that does not rely on self-report.

Lubitz had risk factors, which are clearly seen in retrospect. Airlines need to see the risk factors before a flight and take definitive action. Scales that use these risk factors need to be validated and tested on a variety of populations and used to put treatment into place rather than keeping people from staying in their jobs.  Compliance with treatment and being emotionally stable could mean that you keep your job whereas non-compliance with treatment and emotional instability means you cannot go back to work until you are compliant and stable.

Businesses upon which the public relies for their safety, such as airlines and police, should be screened for risk of unwarranted harm to the people in their care on a routine basis. Those at risk to harm others should be required to be “sound of mind” and not dangerous to themselves or others while engaged in care and safety of the public.  We need to do more, we can do more, and we must do more.

 

Written by: Dr. Kathryn Seifert

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