Pilots are too afraid to seek mental health treatment – and the consequences can be devastating

Telegraph

7 days ago

The name Joseph Emerson might not mean much on this side of the Atlantic. But over the past year, the California-based pilot has become somewhat of a controversial media personality in his native US, giving various television interviews about the 'most consequential' three seconds of his life.
In this instance, 'most consequential' might be an understatement. In October 2023, Emerson was travelling on an Alaska Airlines flight to San Francisco.
As a licensed pilot travelling off-duty, he was given a spare seat in the cockpit, in order to make room for more paying passengers. At some point during the flight, Emerson suffered what he says was a dissociative episode, which led him to attempt to cut off the plane's engines.
Involuntary or not, Emerson's sabotage was unsuccessful, with the working pilots able to resume control and make an unscheduled landing. Almost two years on, Emerson is awaiting trial on a slew of federal and state charges (including 83 counts of attempted murder – one for every person on board), which could see him serving 20 years in prison.
Free to speak about his case in the media, Emerson and his wife have founded their own campaign group, Clear Skies Ahead, which addresses what they say is a tendency of pilots to downplay any mental health issues in order to keep flying.
In interviews, Emerson has said he was acting in a dream-like state, having taken magic mushrooms days earlier after a severe bout of depression brought on by the death of his friend.
The case has been back in the spotlight, following the news that investigators are pursuing the possibility that the tragic Air India crash – in which 260 people lost their lives on a flight from Ahmedabad to London – could have been a case of pilot murder-suicide.
If true, it could be the third or fourth such case in just over ten years. (The 2015 Germanwings tragedy is confirmed as being caused deliberately; pilot murder-suicide is a leading theory in the disappearance of 2014 Malaysia Airlines Flight 370; the crash of China Eastern Airlines Flight 5735 in 2022 may have also been deliberate.)
For all the media attention on his case, Emerson gets short shrift from some aviation professionals. 'To be honest, I think that intentionally crashing a plane with hundreds of passengers on board has less to do with mental health and more to do with a psychopathic mind,' says one industry insider.
At the same time, there is a growing consensus that mental health has become a critical issue for aviation safety – even if the kind of disasters seen in previous cases (such as the infamous Germanwings tragedy, in which 150 passengers died when a suicidal pilot crashed his plane into the French Alps) represent the most extreme end of the wedge.
'Pilots face a perfect storm of psychological risk factors'
According to a paper published last year by the Royal Aeronautical Society, there are 'high levels of self-reported mental health issues' across the civil aviation sector.
The paper cites an ongoing wellbeing survey from Trinity College Dublin, which has found that around 10 per cent of pilots report having poor mental health, with a third of that group (so 3 per cent total) describing their mental health as 'very bad'.
'Pilots face what I often call a 'perfect storm' of psychological risk factors,' says Dr Kultar Singh Garcha, an NHS GP and the medical director for mental health app Flow Neuroscience. 'You've got long hours, disrupted sleep cycles from constant time-zone shifts, chronic fatigue, and often a strange kind of emotional isolation – even though they're surrounded by people all day.
'It is also true that there's an incredible sense of responsibility. Most people don't go to work knowing that hundreds of lives literally depend on their performance. That level of pressure isn't inherently bad – some pilots thrive on it – but over time, it can wear down your nervous system. Especially if you're not sleeping well, or if there are things going on at home that you feel cut off from.'
It's true that those factors might not be unique to pilots. But one factor that has become particularly pertinent in discussions around mental health and aviation is the increased reluctance of pilots to come forward about their issues, particularly given the risk (perceived or otherwise) that they could lose their licence or be suspended from duty.
In 2022, a study published in the Journal of Occupational and Environmental Medicine suggested that 56 per cent of pilots avoided seeking medical help in case it resulted in them being removed from duty.
That raises the risk that manageable mental health problems will worsen over time, or that pilots will turn to riskier strategies to 'self-medicate' and keep working.
The issue was brought into sharp focus following the Germanwings crash, when it was revealed that the pilot in question, Andreas Lubitz, had previously sought treatment for suicidal tendencies, but had hidden this from his employer for fear of losing his job.
Searching for solutions
Following the tragedy, various regulatory changes were made, including stricter rules around having two pilots in the cockpit at all times. But while having an additional pair of eyes may prevent these specific cases, the more significant change – say pilots – has been the push to make it easier for pilots to come forward with any potential mental health issues.
'The biggest change has been the peer support programmes that you now see across all of the major airlines,' says a member of the British Airline Pilots' Association (BALPA), speaking on condition of anonymity. 'In the past few years, you've had hundreds of pilots contacting these programmes who would have otherwise been suffering in silence.'
'I know that BA has a confidential helpline manned by other staffers – sort of like an internal Samaritans,' says one industry insider. 'They are well aware that the stresses of the job can lead to personal crises – and not just for pilots.'
They point to a case earlier this year when a crew member reportedly danced naked through the business-class cabin, following a suspected mental health episode.
At the same time, though, the impetus still remains on pilots to come forward in the first place. 'We can see from recent studies in America that the same issues of fear of losing your licence are still very prevalent,' says Marc Atherton, an aviation psychologist and chair of the Royal Aeronautical Society's mental health specialist group. 'That tells me we still have a long way to go.'
Solving that particular conundrum remains the trickiest question. In the immediate wake of the Germanwings tragedy, the airline's parent group, Lufthansa Group, suggested random psychological testing of pilots – though that suggestion was quickly dismissed as less than helpful. 'I think it was a case of the industry wanting to be seen to be doing something,' says the (anonymous) BALPA member and current pilot.
Pilots who want to seek treatment shouldn't be so worried, they suggest, given that the number of cases in which licences are suspended for mental health reasons are vanishingly small. What they might have to contemplate, though, is the possibility of taking time away from work – which can bring complications in its own right.
Sick leave policies will differ across airlines, but we have seen examples of airlines being very forward-thinking in terms of giving pilots a chance to still be involved with the company during that time while they're not flying,' they say.
'If someone is taking time away from flying for addiction issues, for example, having some positive experience of work during that time will be very helpful.'
Over in the States, Clear Skies Ahead insists there are 'no easy answers' and that 'every pilot should get the care they need, because they are worth it and will be better for it'.
With more than 300,000 airline pilots currently working across the world, the real changes will happen behind the scenes – rather than those horrific cases that make the headlines.