US aviation regulators rely on airline pilots to disclose mental-health treatment when they undergo medical screening as often as once every six months.
Still, it's relatively easy for pilots -- including Clayton Osbon, the JetBlue captain who was locked out of the cockpit by his co-pilot and tackled by passengers March 27 after becoming erratic -- to conceal psychological issues, Richard Jennings, a doctor on the faculty at the University of Texas Medical Branch in Galveston, said in a phone interview.
"To a large degree, the aviation medical examiner has to depend on the honesty of the aviator," said Jennings, who is authorized to perform pilot exams by the Federal Aviation Administration. "It's just a snapshot."
Pilots must disclose "mental disorders of any sort; depression, anxiety, etc.," according to an exam form supplied by the Federal Aviation Administration yesterday. They must say whether they're using medications or have neurological disorders.
While the system may be flawed, overhauling it to more closely examine mental health isn't warranted, Farhad Sahiar, director of aerospace medicine at the Wright State University Boonshoft School of Medicine in Dayton, Ohio, said in a phone interview.
The additional workload on physicians wouldn't be worth the small number of unstable pilots it would identify, said Sahiar, a doctor who performs pilot exams for the FAA.
The stakes are already high for pilots who volunteer any mental health issues, Chesley "Sully" Sullenberger III said today in an interview on Bloomberg Television.
"If we make it more punitive, we'll drive people underground," said Sullenberger, the retired US Airways Group Inc. pilot who safely crash-landed a crippled jet into New York's Hudson River in January 2009.
There's never been a US airline passenger death attributed to a pilot health issue, physical or mental, Jennings said.
"This is probably not because we are so smart as doctors," he said. "Certainly pilots have heart attacks in flight. But what are the chances of two people having a medical episode that threatens passengers? It's that second pilot that's critical and it always has been."
The FAA is conducting a "full investigation" of the JetBlue incident, the agency said in an e-mailed statement.
Osbon remains in a medical facility in Amarillo, Texas, where the co-pilot diverted the plane and landed safely, said Jenny Dervin, a spokeswoman for New York-based JetBlue. Osbon was charged by US prosecutors yesterday with interfering with the plane's flight crew, which carries a maximum penalty of 20 years in prison and a $250,000 fine.
The FAA requires airline pilots to get a medical checkup once a year until they reach 40 and twice a year after that. Osbon passed his most recent exam in December, according to his pilot license information on the FAA website.
Agency-approved medical examiners ask pilots about their psychological condition, according to the FAA. Doctors may also request a psychological exam if a pilot reports issues that raise concern or displays unusual behavior, according to the agency.
Lying on the FAA's medical questionnaire is punishable by as much as $250,000 in fines and five years in jail.
The Air Line Pilots Association, the largest pilots' union in North America, defended the FAA system in an e-mailed statement yesterday. "We are confident the FAA medical standards are appropriate," the Washington-based union said.
Family members, co-workers, random drug testing and airline health programs form an important safety net to identify pilots who are mentally unstable, Jennings said.
Those methods would be more reliable at detecting potentially dangerous lapses in mental health even if more extensive psychological exams were required, he said.
Regulators and doctors have wrestled with how to react to research showing commercial pilots underreport depression, Patrick Veillette, a corporate pilot who has written on the role of pilot health and safety, said in an interview. The stigma of having to admit they are suffering, combined with the threat of being taken off the job, leads many pilots to deny they are depressed, Veillette said.
The FAA two years ago began allowing airline pilots to take psychiatric medicines such as Prozac provided they can show after one year they are stable and healthy, Jennings said.
Veillette, citing his own examinations of thousands of anonymous safety-related reports by corporate pilots to NASA, said he's found only a handful of incidents that describe mental health issues.
"The aeromedical exams and questions have been very effective at preventing these from happening in flight," he said.
The systems of vetting pilots around the world for mental illness isn't perfect, however. In at least three cases since 1982, accident investigators suspect that deranged pilots intentionally downed airliners, killing a total of 345 people. None of those cases involved US pilots.
On October 31, 1999, an Egyptair flight crashed in the Atlantic Ocean off Massachusetts after the co-pilot shut off the engines and dove, according to the US National Transportation Safety Board. All 217 people aboard died.
The co-pilot had been reprimanded days prior to the flight, according to NTSB records.
A SilkAir flight in Indonesia crashed on December 19, 1997, after both of the jet's flight recorders were disabled, killing the 104 people aboard.
The NTSB, which was assisting Indonesian officials, issued a report that said the steep dive was intentional and probably caused by the captain.
A pilot on a Japan Airlines flight, who had suffered from a psychological disorder, crashed his plane into Tokyo Bay on February 9, 1982, killing 24 people, according to the AviationSafetyNetwork website.
For help or information visit beyondblue.org.au, Lifeline on 131 114 or SANE Australia - 1800 18 SANE (7263)