by Charlie Gillis
A debate rages: Should people with depression be allowed in jobs with life-or-death responsibilities?
Becoming an air traffic controller is one of the country’s most gruelling career paths: an ordeal of interviews, personality assessments, math exams and pattern-recognition tests that take place over months. So Jade Bethune was understandably proud when he reached the final stage of Nav Canada’s recruitment process, qualifying as a trainee at the company’s Pacific area control centre on B.C.’s Lower Mainland. If successful, the 34-year-old would be queuing up jumbo jets to land at Vancouver International Airport from his seat in a space-age setting of dimmed lights and ﬂickering consoles.It was, in his words, “about the coolest job you could imagine,” but there was a hitch. Bethune has suffered in the past from anxiety and depression, for which he takes medication. He disclosed the information as part of a medical fitness assessment, sending along a letter from his psychiatrist showing he’d been symptom-free for years. But Transport Canada had final say, and doctors advising the department were unmoved. “This man has been under treatment since 2005 . . . for what is said to be a single past episode,” observed an internal medical review board. “It seems highly unlikely that he’s had [only] a single past episode when in fact he has been in treatment for nine years.”
Final verdict: rejected.
Bethune was devastated. Both his parents were pilots, he says, and it was motion sickness, not depression, that prevented him from following them to a career in the skies. He’d spent his twenties obtaining a science degree, teaching abroad and working office jobs. But a chance visit to the control tower in Kelowna, B.C., where his mother had worked as a flight instructor, had revived his appetite for a career in aviation. “That planted the seed,” he says. “I thought, this is a job that I can do.”
What’s more, Transport Canada’s policies seemed to open the door to candidates who, like him, take a selective seratonin reuptake inhibitor (SSRI) commonly prescribed for depression. Bethune takes a second drug called lamotrigine, which he and his doctor found worked perfectly with his SSRI, citalopram. Guidelines published on the department’s website suggested candidates taking more than one psychotropic drug may be ineligible. But they also note that combination drug therapies are increasingly the norm, stressing that exceptions should be considered on a case-by-case basis.
So Bethune fought back. Last May, he won a decision from an internal appeal panel of Transport Canada that the government must consider the last five years of Bethune’s psychiatric records, and prove why lamotrigine usage prevents him from safely guiding air crews. Ottawa appealed to federal court, but Bethune won again, striking a blow for people with mental health problems trying to gain entry to aviation and other high-stakes professions, from medicine to law enforcement. While the public fixates on alarming cases like last year’s Germanwings crash caused by a suicidal pilot, people medicated for depression have been showing they can handle increasingly sensitive jobs when stabilized by innovative new therapies. Now, they’re challenging long-standing barriers that keep them out of the high-pressure, yet prestigious positions that carry life-and-death responsibility. If they’re qualified, and can prove they’re in good mental health, they ask, why not put the safety of the public in their hands?
To a degree, we already do. The same officials blocking Bethune’s career path boast that Canada has been ahead of the curve, opening the door in 1992 to pilots and controllers using SSRIs, and expanding accommodations since. Under current guidelines, updated in 2010, applicants are to be considered if they can show they’ve been on stable dosages for four months with no symptoms and side effects, while providing a detailed report of their psychiatric histories. Once on the job, they must undergo a psychiatric evaluation every six months, and if their mental condition takes a turn for the worse, their licence is temporarily suspended while they seek help. They can return to work once they’ve shown they’ve been stable for four months. “Canada is a leader, I would say the leader in the world, on this issue,” Dietmar Raudzus, Transport Canada’s aviation medical officer for the Pacific region, wrote in a letter filed at Bethune’s appeal hearing in 2015.
That’s the aspiration, at least. How often Transport Canada fulfills it is less clear. The department can’t say how many aviation applicants using psychotropic drugs have been approved or rejected, a spokeswoman says, because the medical reports containing that information are protected by doctor-patient confidentiality. Nor do they know how many pilots and air traffic controllers are currently using SSRIs—though it’s hard to imagine mental disorders are unheard of on the flight deck. According to statistics cited on Transport Canada’s website, one in 17 air crew suffer from depression, a rate close to that of the general population.
The fear this idea evokes among air travellers has a power all its own. The archetype of the crazed air traffic controller is a mainstay of popular culture, from the stricken father who causes a midair collision in Breaking Bad to John Candy’s stressed-out character in the ’80s comedy Summer Rental. In aviation circles, the assumption was that the high-pressure environment surrounding flight was bound to trigger mental or emotional problems, says Scott Shappell, a neuroscientist at the Embry-Riddle Aeronautical University in Daytona Beach, Fla. “Until about a decade ago, if you were taking any medications for any kind of mental disorder,” he says, “that was considered disqualifying.”
That changed with the advent of SSRIs, notes Shappell, which can stabilize sufferers of depression and anxiety without dangerous side effects like fatigue. Human rights law, meanwhile, evolved in many jurisdictions to define mental illness as a disability, preventing employers from using it as a basis to disqualify candidates.
Still, most countries have left a great deal of discretion in the hands of aviation authorities, who are as sensitive as anyone to horrors like the March 2015 downing of Germanwings Flight 9525. Co-pilot Andreas Lubitz deliberately crashed the airliner, killing all 150 on board; investigators found he’d been declared unfit to fly after being treated for suicidal tendencies, but withheld the information from Germanwings and showed up for work. Consensus among aviation experts was that blanket prohibitions on the mentally ill would not prevent such a disaster: you need to know they’re ill in the first place. But media coverage of the crash also led anyone who has buckled up to wonder about the mental state of their air crews, and authorities felt compelled to respond. “This is a very sad story,” says Claude Thibault, medical adviser of the Montreal-based International Air Transport Association (IATA). “But proportionally speaking, this kind of event is extremely rare.”