AIR TRANSPORT Mental health and wellbeing
Covid-19 – a hidden mental health crisis?
MARC ATHERTON MRAeS, Chair: RAeS Human Factors Wellbeing Group, looks towards a risk management approach for mental wellbeing in civil aviation – which the pandemic has given new importance.
The Germanwings tragedy in 2015 raised the risk posed to civil aviation resulting from the mental health status of safety-critical personnel from an under-discussed, under-assessed and under-managed element in safety management to a high-profile issue both within the profession and in the media. It is in this area that this paper focuses as an element of a broad concept of wellbeing.
In the period since Germanwings, there has been a shift towards addressing the issue of mental health and wellbeing as a safety risk factor that extends beyond pilots. There is also a growing consideration of poor mental health and wellbeing in any safety-critical group posing a risk to the safe operational capability of the entire sector.
Viewed as an identified risk factor, an argument can be made that the mental health and wellbeing of safety-critical staff should be incorporated into the safety management systems approach that has given the aviation sector the enviable safety record that it has.
Covid-19 and mental health
The Covid-19 pandemic has had a major impact on civil aviation, adversely affecting the mental health and wellbeing of individuals and groups, whether having been continuously in work, on furlough or returning to work in a ‘new reality’.
This situation mirrors that of the population as a whole, where levels of stress, anxiety and depression have risen dramatically because of the Covid pandemic and the societal responses to it. The actual levels of adverse impact are almost a moot point – the widespread rise in levels of common mental health issues is a major challenge faced by civil aviation and the society of which it is a part.
THE COVID-19 PANDEMIC HAS HAD A MAJOR IMPACT ON CIVIL AVIATION, ADVERSELY AFFECTING THE MENTAL HEALTH AND WELLBEING OF INDIVIDUALS AND GROUPS, WHETHER HAVING BEEN CONTINUOUSLY IN WORK, ON FURLOUGH OR RETURNING TO WORK IN A ‘NEW REALITY’
The challenges faced during the Covid pandemic, and the positive response of regulators, aircraft operating companies (AOC), staff bodies, professional bodies and third sector organisations to them, has demonstrated the ability of the civil aviation community to respond in a positive and broad-based way. What is lacking in this is a co-ordinating set of principles for supporting the mental health and wellbeing (MH&WB) of our people for the entire industry going forward.
The fostering, support, and development of mental health and wellbeing is seen to be an aspirational goal for people the world over. High levels of individual mental health and wellbeing are associated with reduced illness, higher performance, and higher levels of engagement. There is a close link between workforce wellbeing and organisational resilience and productivity.
The European Union Aviation Safety Authority (EASA), via the Together4Safety Initiative, has recognised that the positive mental health and wellbeing of all safety-critical professional aviation staff is a crucial element in the safe and efficient operation of the civil aviation sector. EASA has determined that the provision of a curated Wellbeing Resource Hub, hosted on an EASA website, that would allow individuals and organisations to offer and/or locate resources to support and enhance wellbeing would be a valuable service to the sector during the Covid crisis and going forward into the post-crisis recovery.
The importance of addressing this challenge is also highlighted by the UK Civil Aviation Authority (CAA) in its preamble to the implementation of Peer Support Programmes in response to EASA Ruling 2018/1042
‘The psychological wellbeing and positive mental health of commercial pilots is of fundamental importance to safe Commercial Air Transport (CAT) operations.’
United Kingdom Civil Aviation Authority Guidance Material, September 2018 Page 1 of 4, paragraph 1.1
Pilot Support Programme – Guidance for Commercial Air Transport (CAT) Operators
The aviation insurance industry, typified by Aon Aviation Insurance, in response to the Germanwings tragedy, took the view that:
‘The primary risk factor is now seen to be the human factor’.
Aon Insurance (London), Aviation Practice,
2016 Annual Report
One key point here is that we must look beyond only pilots and consider the MH&WB of all safety-critical stakeholder groups as risk factors. We also cannot get away from the simple statistic that, across the UK and the EU general population, one in six people will be managing mild to moderate levels of stress, depression, or anxiety at any one time.
Researching mental health
Research in the civil aviation sector conducted during 2020 by the Centre for Innovative Human Systems (CIHS), Trinity College Dublin (TCD) shows that the prevalence and levels of stress, depression and anxiety being experienced across individuals from multiple safety-critical stakeholder groups during the Covid pandemic are concerning. The research collated data from over 2,000 respondents to an online survey. The graph below shows a snapshot from the TCD research relating to respondents’ self-reported mental health status. The research data points towards addressing the MH&WB of the people who make the sector function as a key capability both during and post-Covid as the industry reopens into a new reality. One approach to this challenge could be by the creation of an industry approach to wellbeing risk management around mental health.
The overarching aim of a wellbeing risk management (WRM) approach would be to support the safe and efficient operation of the civil aviation sector while meeting the two primary definitions (used with permission) below adopted to underpin the development of the EASA Wellbeing Resource Hub. Mental Health and Wellbeing has been characterised as:
At the individual level
‘… a state in which the individual is able, through the self-awareness and self-management of the physical, psychological, social, and practical aspects of their life, to work positively and productively coping with the stresses they face while achieving their personal goals and contributing in a meaningful way.’
World Health Organization, 2020, UK NICE,
2020
At the organisational level
‘… a state in which the organisation, through its culture, policies, procedures and resources mitigate the physical and psychosocial risks (e.g. high levels of stressors) to an individual, and the individual is able to work and develop in an atmosphere of respect, fairness, honesty and open communication without fear of sanction or discrimination.’
EU-OSHA Wellbeing at Work (2020), UK
HSE SMS (2010), CCOHS Psychological Health Safety Management Systems (2020),
WHO Healthy Workplace (2010), Just Culture Initiative (2017)
The TCD research cited above has also shown that, across key stakeholder group respondents in the research, there is a strongly expressed view that organisations are not seen as being supportive of their wellbeing by a large percentage of individuals.
The following chart from the CIHS, TCD research highlights the situation regarding respondents’ views towards organisational wellbeing support across the different stakeholder groups included in the study.
© Graph provided by: Lived Experience Project, CIHS, Trinity College Dublin, 2020. Used with permission.
The TCD research currently provides the most comprehensive data known to the author to allow insight into the scale of incidence and severity of the mental health challenges being experienced ‘across the board’ by safety-critical stakeholder groups.
The precise relationship between levels of incidence and severity of mental ill health and operational safety is, as yet, unquantified. The actual level of risk posed by the identified levels of mental ill health on safety related incidents, and accidents, is currently terra incognito due to a lack of evidence-based research. This lack of data into an acknowledged risk factor is one area that the industry should look to address. The adage ‘absence of evidence is not evidence of absence’ applies and, in a post-Germanwings Covid world, is an area for consideration.
What is known is that even low levels of stress, anxiety, depression, and burnout can have significant adverse performance impacts on even highly trained people. Germanwings has shown that, without insight into the potential risk prevalence, tragic outcomes are possible and, in the operational world of the Covid-19 pandemic, they are potentially more likely.
This leads to the concept of wellbeing risk management being focused primarily on monitoring and supporting the mental health and wellbeing of staff from professional groups across the industry, and avoiding the Germanwings tragedy causing a focus only on pilots. From this perspective, the current EASA 2018/1042 Regulation represents a direct response to Germanwings, and the argument made in this article points the way towards an approach to create a proactive wellbeing risk management initiative, grounded within a safety management system (SMS) framework, to mental health and wellbeing in civil aviation.
Wellbeing as a risk management initiative: justifying principles. Civil aviation operates with an evidence-based paradigm at its core. It is also a business that operates within strict regulatory and financial boundaries. The different stakeholder groups have differing professional, organisational, regulatory and legal status and it is unlikely that any one solution would be relevant to all stakeholder groups. A flexible approach following a strategic framework may be a way forward.
© Graph provided by: Lived Experience Project, CIHS, Trinity College Dublin, 2020, used with permission. (Full details of the research and copies of available published papers can be obtained from Dr Joan Cahill, CIHS, Trinity College Dublin, cahilljo@tcd.ie)
There are several factors that support the concept irrespective of which stakeholder group is being looked at:
The moral argument: The moral argument for creating a work environment that supports the mental health and wellbeing of staff is founded on the simple principle of it being the right thing to do. Work plays a significant role in the lives of staff, and employers should look to create a work environment that respects the dignity of individuals and treats them with a degree of care and compassion to ensure that their lived experience of work contributes to their overall quality of life. (WHO Healthy Workplace report, 2010)
The legal argument: Employers in most of the world’s economies have a legal duty of care to provide a safe working environment for their staff. Typically, this has referred to the physical environment but recent changes in legislation and best practice have expanded this to include providing a psychologically safe workplace. Failure to achieve this can lead to legal liability issues.
The safety/performance argument: A workforce that is operating in a psychologically safe work environment is more engaged and performs at a higher level. This contributes to enhanced safety performance at the individual and organisational level.
The financial argument: Civil aviation is a business, and any changes to operations or capability have financial implications. There is, however, a body of evidence that shows that investing in mental health and wellbeing programmes – in effect moving towards a wellbeing risk management concept- can show a positive return on investment (ROI) with data from non-aviation sectors globally. Published figures from other sectors show return on investment (ROI) figures for investment in mental health and wellbeing programmes to be in the range 2.5-5.0 to 1.0(1).
The benefits identified as contributing to these ROI figures are primarily reduced absenteeism, increased productivity and performance, reduced compensation claims and reduced presenteeism.
Summary
If we accept these four lines of arguments as being a high-level justification for the creation of a ‘wellbeing risk management’ concept in civil aviation, it raises the question of what are the key elements that would need to be implemented to bring it to life in a way that is both operational and sustainable. Evidence from other industries can inform civil aviation, but the global nature of the industry and the unique challenges it faces, both operationally and financially, will inevitably require a solution approach grounded in the realities of the post-Covid world.
Evidence from other sectors and industries has shown the benefits: operationally, financially, and reputationally, of positively and proactively creating a psychologically safe workplace with high levels of staff mental health and wellbeing. Civil aviation, as it reopens to the world, could well benefit in kind from taking a similar strategy, building on the current regulatory requirements of EASA Regulation 2018/1042 as a signpost towards creating a ‘wellbeing risk management’ solution. This is both the challenge and the opportunity facing the sector.
The RAeS HF Wellbeing Group is co-ordinating a conference on 27-28 April 2021 to address the topics raised in this paper, as well as examining the implementation status of EASA Rule 2018/1042 in the industry. Details for the conference can be found on the RAeS website.
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(1) Aldana (USA, 2001), in an analysis of multiple mental health corporate initiatives, found a positive return on investment (ROI) of approximately 2.5 to 1 for every dollar spent Deloitte (Canada, 2018) showed an ROI of between 1.6 and 2.2 to 1. The Mental Health Alliance/PwC (Aus., 2019) found a positive ROI of 2.3 to 1. The Farmer Review (UK Govt, 2017) found a positive ROI with a median value of 2.3 to 1. An October 2019 update to the Farmer Review (MIND/Deloitte, UK Govt 2019) showed a median ROI for Mental Health initiatives of 5.2 to 1.