Mentalhealth AssessmentofClass1pilots:

therole ofpsychiatrist andclinicalpsychologist expertinFrance

5thEuropean Congress ofAerospaceMedicineOslo- september 15-18,2016

ColMarie-Dominique Colas,MD,Prof.HeadofSMPCAA/AeMC Percy,Clamart,France

DISCLOSUREINFORMATIONMarie-Dominique Colas

5thEuropean Congress ofAerospaceMedicine

• Ihavenofinancial relationships todisclose.

• Iwill notdiscuss off-labeluseand/orinvestigationaluseinmy presentation

2DIFFERENTFRAMEWORKS« Psycho-vocational »Selection

- Human Resources field :psychometric testsandinterviewconducted under theresponsibilityoftheemployer(airlines,FrenchArmed Forces);- Conducted byoccupational psychologist ;- 2examples :AirFranceandFrenchArmedForces;-Process :testing abilities,psychomotor andcognitiveflightskills,adaptativecapacities (multi-crew cooperation,capacity tobe captain),motivation,personality,etc ;

- Goal:selecting themost suitable person tomeet theairtransportoperational needs andtheemployer’s expectations.

« Medico-psychological »Assessment

- Aeromedical field,complying with aregulatoryframework (Part-MEDtotheAircrew Regulation No1178/2011);- Conducted primarily byAeromedical Examiners ;

- 2examples :AirFranceandFrenchArmed Forces;

- Process :clinical evaluation ofcompatibilityofhealth with physiological andpsychologicalaeronautical constraints,related tothelicenceprivileges,andflightsafety ;

- Goal:individual health preservation andscreeningmedical andpsychological disorders that couldrepresent athreat forflightsafety.

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FLIGHT SAFETY

MEDICALANDPSYCHOLOGICALFITNESSASSESSMENT:AProcessBasedonClinicalPractice

«Medico-psychological »

fitness=apositiveaeromedicalprognosis ofadaptationtothejob,based onthedetermination ofanacceptablerisk forpilots’health and

flightsafety

Medical andpsychologicalassessment byaviation

psychiatristsandclinical

psychologists ifneeded

WarningsignsscreeningbytheAMEandbyallthestaffinthe

AeMC

MEDICALANDPSYCHOLOGICALASSESSMENTBYTHEAME:Detecting WarningSigns

- Circumstances of the medical examination ? : after a serious incident or accident ? After an interruption of flight ? - Appearance? Attitude? Behavioural change?

- Medical history of psychiatric conditions?- Application form :suicide attempts or self-harm? Psychotropic drugs uses ? - Medical record?

- Desire to fly? - Adjustment disorders? Stress and fatigue?+Examination

- Risk factors ? : for example,early age of contact with psychoactivesubstances (alcohol, cannabis, etc.)

- Life stressors? : divorce, difficulties withrelatives, friends and work colleagues ?

- Interpersonal and relationship issues ?

- Psychotropic drugs use ? Self-medication?- Psychotherapy?- Repeated sick leaves? Hospitalization ?

(hospitalization medical report analysis)

The pilot is referred to a psychiatrist or a clinical psychologist for review prior to her/his fit status being decided

MEDICALANDPSYCHOLOGICALFITNESSASSESSMENT:AProcess Based onClinical PracticeandonaComprehensive

Approach

«Medico-psychological »fitness=apositiveaeromedicalprognosis ofadaptationtothejob,based onthedetermination ofanacceptablerisk for

pilots’health andflightsafety

Medical andpsychologicalassessment by

aviationpsychiatristsandclinicalpsychologists

WarningsignsscreeningbytheAMEandbyallthestaffinthe

AeMC

NORMAL

ABNORMAL Psychiatrist ?

AEROMEDICALPROGNOSIS:thedetermination ofanacceptablerisk forpilots’

health andflightsafety

-Typeofmentalorbehaviouraldisorder ? Problematic useofpsychoactive substances?

- Severity ofthementalorbehavioural impairment?In-flightincapacitation?Risk-takingbehaviours?

- Risk related tothepsychotropicmedication?

- Risk related torelapseofpsychological deficiencies?

- Risk related topersonality?Motivation?

- Therisk ofundetected conditions?

- Environmentalconstraints?- CRM?

- Ensuring pilotmedical,psychological andpsychiatricaeromedical fitnessso that theirmedical conditionis less likely tointerfere with thesafe exerciceoftheprivileges oftheir licences

- Amedical staffanalysis withpsychiatrist andAMEtoproposeacceptablemeasures:fitnesslimitationcasebycase,enhancedthefollow-upforflightcrew withahistory ofpsychiatric condition.

ANETWORKOFEXPERTS

- A common training to aviation psychology and psychiatry for AME by aviation psychiatrists experts (initial and refresher trainings organized by Paris 5 University and by a military aeromedical training centre located in AeMC Percy) ;

- A proven experience based on 50 years of aeronautical clinical practice and on the doctor-pilot relationship ;- A special dedicated aviation psychological unit for all air crews ;

-Sharing of professionnal experience and practices used in decision-making(risk assessment related to incidence of mental disorders based on the continuousoversight and competency of AMEs),