Flying, medicals, mental health - my take on things.
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Flying, medicals, mental health - my take on things.
I've been lurking around these parts long enough to gain some knowledge of the "medical" system. I've also been through the process of gaining a medical (class2), and, until recently, have worked at the front edge in primary care, where, I estimate, 30-40% of my consultations had a "mental health" component attached to them. I hope it's okay to make a few observations.
Firstly, the whole process of gaining and maintaining the medical ticket, does rely on trust, and self reporting. As far as I know, there is no formal link between the pilot's GP and the CAA. To some extent, it has to be. Medical records are often chaotic, and open to differing interpretation. Formalising the links between the CAA and GP's is a possibility. Cross disciplinary working has come on leaps and bounds in some areas (eg Safeguarding), and my medical colleagues are far more aware of the "public interest" element when they gain knowledge in a consultation, but there is some question of where we draw the line. Risk / benefit equations are constantly performed by clinicians, but I suspect that the whole nature of "depression" clouds the picture somewhat.
Secondly, the attitude of the aviation industry towards depression appears to have changed (for the better), in recent times. When I started to lurk on here, mental health problems were rarely discussed. Certainly, from my own observations, there appeared to be a bit of a "stiff upper lip" attitude towards mental health problems. I remember watching an interview with a medical examiner (some years ago), who admitted that often he would sign a patient off with a "chest infection," when he knew that the underlying issue was concerned with mental health. Pilot's are no less prone to mental health problems than the rest of society. In fact I'd hazard a guess that the additional burden of responsibility, fear (who hasn't ever looked down and thought "oh ****"), sleep issues, isolation, increasing scheduling pressures and the rest, would make pilots more at risk than Joe Average. The recognition of mental health problems being as "real" as having angina or a bad knee, has, to some extent, reduced the stigmata attached to them. It is interesting, that even on this anonymous forum, pilots with mental health problems are encouraged to discuss their issues, tucked away in a secret little corner. (This is not me having a go at the forum, I do understand the reasons for this, but it is perhaps a reflection of society's attitude as a whole. Already, I hear cries of ground everyone with depression. A backwards step in my opinion. The main aim here involves identification and seeking help. Sweeping problems under the carpet is in no-ones interest.
Thirdly, the nature of the beast itself. There but the grace of god and all that. There are of course, risk factors which make one person more susceptible to problems than others, but translating this to a usable tool to identify which people go on to develop problems is problematic, if not impossible. Depression is highly treatable, and outcomes are improving all the time. Monitoring treatment, and developing strategies to identify those at risk of suicide has become more refined throughout the years. The National Institute of Clinical Evidence encourage us to ask "the suicide question" at every available opportunity, and generally, patients are usually quite honest, although we all have our skeletons in the cupboard that haunt us. Managing risk is a lot more refined than it used to be, but it's a sad fact that the biggest killer of young men is suicide.
Sorry I haven't got the answers, but I hope my observations stimulate some debate.
Firstly, the whole process of gaining and maintaining the medical ticket, does rely on trust, and self reporting. As far as I know, there is no formal link between the pilot's GP and the CAA. To some extent, it has to be. Medical records are often chaotic, and open to differing interpretation. Formalising the links between the CAA and GP's is a possibility. Cross disciplinary working has come on leaps and bounds in some areas (eg Safeguarding), and my medical colleagues are far more aware of the "public interest" element when they gain knowledge in a consultation, but there is some question of where we draw the line. Risk / benefit equations are constantly performed by clinicians, but I suspect that the whole nature of "depression" clouds the picture somewhat.
Secondly, the attitude of the aviation industry towards depression appears to have changed (for the better), in recent times. When I started to lurk on here, mental health problems were rarely discussed. Certainly, from my own observations, there appeared to be a bit of a "stiff upper lip" attitude towards mental health problems. I remember watching an interview with a medical examiner (some years ago), who admitted that often he would sign a patient off with a "chest infection," when he knew that the underlying issue was concerned with mental health. Pilot's are no less prone to mental health problems than the rest of society. In fact I'd hazard a guess that the additional burden of responsibility, fear (who hasn't ever looked down and thought "oh ****"), sleep issues, isolation, increasing scheduling pressures and the rest, would make pilots more at risk than Joe Average. The recognition of mental health problems being as "real" as having angina or a bad knee, has, to some extent, reduced the stigmata attached to them. It is interesting, that even on this anonymous forum, pilots with mental health problems are encouraged to discuss their issues, tucked away in a secret little corner. (This is not me having a go at the forum, I do understand the reasons for this, but it is perhaps a reflection of society's attitude as a whole. Already, I hear cries of ground everyone with depression. A backwards step in my opinion. The main aim here involves identification and seeking help. Sweeping problems under the carpet is in no-ones interest.
Thirdly, the nature of the beast itself. There but the grace of god and all that. There are of course, risk factors which make one person more susceptible to problems than others, but translating this to a usable tool to identify which people go on to develop problems is problematic, if not impossible. Depression is highly treatable, and outcomes are improving all the time. Monitoring treatment, and developing strategies to identify those at risk of suicide has become more refined throughout the years. The National Institute of Clinical Evidence encourage us to ask "the suicide question" at every available opportunity, and generally, patients are usually quite honest, although we all have our skeletons in the cupboard that haunt us. Managing risk is a lot more refined than it used to be, but it's a sad fact that the biggest killer of young men is suicide.
Sorry I haven't got the answers, but I hope my observations stimulate some debate.
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I think the real difficulty is that mental health issues are not quantifyable, and cannot be predicted.
If you have, say, a surgical matter, there is a diagnostic stage, a time when you are out of action, and a reasonably good prediction of when you will be back in gear (or that you won't get back, should the matter be serious or a known disqualifier).
But anxiety/depression is another matter. Diagnosis is mostly done by questioning -- there is no standard "test". Predicting the severity, duration, recovery, and possible side effects is somewhat of a black art. Knowing when the patient no longer has the condition is likewise difficult.
Aviation has taken the easy way out, especially the FAA: If you are in treatment, you lose your medical. Period. Can't work.
Now the aviation regulators are faced with the very difficult task to trying to find some way to separate the really disturbed from the large number of those simply stressed or anxious.
I don't know how that can be done. This week's event has aggravated the problem.
If you have, say, a surgical matter, there is a diagnostic stage, a time when you are out of action, and a reasonably good prediction of when you will be back in gear (or that you won't get back, should the matter be serious or a known disqualifier).
But anxiety/depression is another matter. Diagnosis is mostly done by questioning -- there is no standard "test". Predicting the severity, duration, recovery, and possible side effects is somewhat of a black art. Knowing when the patient no longer has the condition is likewise difficult.
Aviation has taken the easy way out, especially the FAA: If you are in treatment, you lose your medical. Period. Can't work.
Now the aviation regulators are faced with the very difficult task to trying to find some way to separate the really disturbed from the large number of those simply stressed or anxious.
I don't know how that can be done. This week's event has aggravated the problem.
