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One man’s fight to help jets fly—despite mental illness

A debate rages: Should people with depression be allowed in jobs with life-or-death responsibilities?


 
Jade Bethune outside of the Kelowna Airport. (Photograph by Brian Howell)

Jade Bethune outside of the Kelowna Airport. (Photograph by Brian Howell)

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?

In this May 21, 2015 file photo, an air traffic controller works in the tower at Newark Liberty International Airport in Newark, N.J. ( AP Photo/Julio Cortez, File)

In this May 21, 2015 file photo, an air traffic controller works in the tower at Newark Liberty International Airport in Newark, N.J. ( AP Photo/Julio Cortez, File)

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.”

MORE: The problem with sealed cockpits

French gendarmes and investigators work amongst the debris of the Airbus A320 at the site of the crash, near Seyne-les-Alpes, French Alps March 26, 2015. A young German co-pilot locked himself alone in the cockpit of Germanwings flight 9525 and set it on course to crash into an Alpine mountain, killing all 150 people on board including himself, prosecutors said on Thursday. French prosecutors offered no motive for why 28-year-old Andreas Lubitz apparently took the controls of the Airbus A320, locked the captain out of the cockpit and deliberately set it veering down from cruising altitude at 3,000 feet per minute. (Emmanuel Foudrot/Reuters)

French gendarmes and investigators work amongst the debris of the Airbus A320 at the site of the crash, near Seyne-les-Alpes, French Alps March 26, 2015. A young German co-pilot locked himself alone in the cockpit of Germanwings flight 9525 and set it on course to crash into an Alpine mountain, killing all 150 people on board including himself, prosecutors said on Thursday. French prosecutors offered no motive for why 28-year-old Andreas Lubitz apparently took the controls of the Airbus A320, locked the captain out of the cockpit and deliberately set it veering down from cruising altitude at 3,000 feet per minute. (Emmanuel Foudrot/Reuters)

To Thibault, the Germanwings tragedy speaks in favour of systems that encourage people suffering from mental illness to come forward. In previous decades, he notes, fear of losing one’s professional licence (or not get it in the first place) led pilots and controllers to keep their problems to themselves—in some cases pressuring sympathetic doctors to understate their conditions in medical reports. “It’s better to have someone who’s properly medicated and under close surveillance flying,” he concludes, “than someone whose condition is not known, who is flying depressed or is on medication that is not acceptable.”

Aviation isn’t the only sector coming to grips with Thibault’s way of thinking. In a widely cited case from 2010, the Human Rights Tribunal of Ontario ordered Toronto’s city police board to reinstate a probationary officer who’d been fired after an apparently pointless scuffle with a drunk man in a McDonald’s. The officer had been suffering post-traumatic stress stemming from a previous gun incident, the tribunal heard; he was suspended and received successful psychiatric treatment while off duty, but was fired before he could return to work. In refusing to consider medical evidence that the officer was fit for duty, the tribunal ruled, the police board had discriminated on the basis of disability.

This legal nudge resonated throughout Canadian law enforcement, and when a similar case arose two years later in Halton, Ont., the regional police force bent over backwards to help the officer. In that instance, a constable suffering from severe obsessive compulsive disorder was deemed unable to do patrol work: he was consumed by fear of contracting disease from exposure to bodily fluids of suspects. The force scrambled to find positions he could manage (though even handling documents triggered his compulsion to wear gloves or wash his hands) and eventually gave him a civilian position as a clerk. The human rights tribunal ruled that was a fair attempt at accommodation.

That cops deserve extra consideration makes intuitive sense—few occupations test one’s mental health so severely. Less understood has been the plight of doctors suffering from mental disorders, in part because stability seems a prerequisite for the job. These are the people, after all, on whom we unload our own problems.

By the 1970s, however, concern arose over the number of troubled physicians medicating themselves with alcohol, or the drugs in their office cabinets. The result was a patchwork of addiction resources offered by medical associations, which in some provinces has evolved into a kind of separate intake system for doctors with psychiatric or medical problems. In Ontario, for instance, a physician in crisis can dial up the Ontario Medical Association’s “Physician Health Program” (PHP), where he or she will receive confidential advice, referrals for treatment and if needed, ongoing monitoring.

The response depends on the severity of the problem, says Derek Puddester, the program’s associate medical director. Some are directed to the PHP by the College of Physicians and Surgeons of Ontario, after informing the provincial regulator they have a problem. Others have not, but are advised to stop treating patients while they seek help, and to inform the college of their diagnosis, as required by law. A few are already facing complaints or discipline. “If we can prevent issues,” says Puddester, “or we can help people access care so they don’t become identified by the regulator, then great.” The OMA receives about 50 calls per week from doctors, he adds, but doesn’t track the number with mental health problems.

Still, for all the talk of attitudinal shift, concern about public perception looms large, as authorities worry about the fallout should someone known to have psychological troubles break down in a way that costs lives. That’s especially true in aviation, where the travelling public keenly feels its dependence on those in the tower and cockpit. Pilots, Transport Canada notes in its policy on SSRIs, are “in a position where the safety of the fare-paying public is front and centre and expectations about [their] medical competency and stability are high.”

That leaves little room for case-by-case exceptions, if Bethune’s experience is any guide. His psychiatrist, Paul Latimer, could hardly have given a stronger endorsement, telling Transport Canada that his patient was in full remission, adding, “in my opinion, his prognosis is excellent.” But in an emailed response to Maclean’s, a Transport Canada spokeswoman said use of a second medication still raises flags, because it points to “a more complicated medical file.” For now, wrote Natasha Gauthier, “there is insufficient information on the combination and interaction of more than one medication for the department to determine how these can be used safely in the aviation environment.” (As for Nav Canada, the private company that provides air navigation service across the country, it was aware of Bethune’s condition and medications, and was ready to take him on as a trainee if he got the all-clear from Ottawa.)

Bethune hasn’t given up hope. The feds have advised him they won’t appeal the federal court ruling, and has requested the five years of medical records Justice Michael Phelan ordered it to examine. There’s no guarantee that will tip the balance in Bethune’s favour—the decision requires little more of Transport Canada than a closer look at facts and documentation. Still, Bethune quickly had his doctor send them off, telling Maclean’s he remains in excellent spirits despite the setback, and would gladly apply all over again. “In the best case scenario,” he told his hearing, “I would pass the training and I would become the poster child: a stellar air-traffic controller, someone who has a mental illness but has not let it prevent him from succeeding in life.”


 

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