The crash of Germanwings Flight 9525 into the French Alps earlier this week appears to have been a deliberate act carried out by a co-pilot.
It is too soon to put the label "suicide" on the co-pilot's actions. Not enough is known yet about his state of mind or what his motivation might have been. But as investigations continue, the incident raises questions about whether better mental health screening can prevent a person with suicidal tendencies from taking charge in the cockpit in the first place.
Unfortunately not, says Gregory Simon, a psychiatrist at the Group Health Research Institute in Seattle. There are basic questionnaires that can help identify people at risk of suicide. But these surveys routinely miss a major percentage of people who later kill themselves.
What's more, if a routine screening test were offered to a pilot, who knew he might lose his job if he admitted that he was thinking frequently about death, the chances of identifying someone at risk drops even more.
"For more than half of suicide attempts or deaths, we don't have any clue or signal ahead of time," Simon says. "Another important thing is that these [questionnaires] work in situations where people are seeking help and have some assurance of confidentiality. This would be different in a situation where someone's livelihood is at stake."
In the United States, there are some 500,000 known suicide attempts each year and 40,000 people die at their own hands, making suicide the 10th most common cause of death in this country. And it's not just an American problem. Three-fourths of the world's 800,000 yearly suicide deaths occur in low- and middle-income countries.
But preventing suicide is extremely difficult, in part because the people who succumb often die before anyone knows something was wrong.
Studies that have analyzed millions of suicides show that only about 55 percent of people who kill themselves had any previous contact with a mental health professional. For those who seek help, basic questionnaires can be useful: People who say they spend more time thinking about death and harming themselves, Simon says, are more likely to kill themselves during the next year or two.
But even among people who take these surveys, results flag only about 30 percent who later kill themselves. Instead, studies show that suicidal actions are often impulsive.
"There's a very interesting phenomenon of people who actually saw health care providers and filled out questionnaires and said no to questions about thoughts of death or harming themselves and then made suicide attempts," Simon says. "It's not an infrequent occurrence."
The lack of knowledge about suicides that involve violent events is a further obstacle to predicting an act like a pilot suicide. Of those who survive a suicide attempt — and can possibly be interviewed by researchers — 80 percent tried to overdose on pills. It's possible that people who choose to act violently have different behavior patterns.
For now, there are no brain scans, hormonal screenings or other technologies that can distinguish a suicidal person from anyone else. Instead, within certain populations, self-policing is the primary method for catching mental health issues. And for pilots, that strategy can work pretty well, says Dave Funk, a retired Northwest Airlines captain who now works as an aviation security consultant at Laird & Associates in Reno, Nev.
It's a small industry, he says. Pilots tend to work with each other repeatedly. And they keep an eye on how their colleagues are doing. In his 40 years as a pilot, Funk adds, mental health incidents in the cockpit have been exceedingly rare. Out of tens of millions of flights over the past four decades, there have previously been only five cases worldwide of a commercial pilot who was believed to have intentionally caused an airplane accident.
Instead of more mental health screening, he argues, airlines around the world need to be more vigilant about regulating what happens in the cockpit. Since Sept. 11, the FAA has required that a flight attendant sit upfront whenever one of the pilots has to use the bathroom. If the Germanwings crew had followed the same protocol, maybe the flight attendant could've opened the door from the inside and called out for help.
"The real issue here isn't this guy's mental health," Funk says. "Why was he in the flight deck by himself?"
Attempting to screen pilots more aggressively could also have the unintended consequence of driving people with mental health problems deeper underground, adds Simon. Before 2010, the FAA prohibited flying for any pilot who took antidepressants or related drugs.
As a result, plenty of pilots either lied about their medications or avoided getting treatments they needed.
"Back in the day, I had a situation where a commercial airline pilot was referred to me for treatment," Simon says. "He said he would never take medication because he would lose his license."