The last days of November last year were full of discoveries for me. One of them was that I had the pleasure of interviewing Paola Tomasello, an Italian from Naples, who presently is working with Deep Blue on the MESAFE project. MESAFE stands for “MEntal health for aviation SAFEty”. It is a research project, funded by EASA under the framework of the European Union's Horizon Europe research and innovation programme.
Paola is a psychologist accredited by the European Association of Aviation Psychologists (EAAP) and the Technical Lead of the project.
MESAFE, as it is said in the project description - under the supervision of EASA, is developing updated European guidelines to support Aeromedical Examiners and Assessors in certifying the mental fitness of pilots and air traffic controllers (ATCOs). MESAFE will propose new methods for aeromedical mental health assessment to address the risk of incapacitation due to psychological factors that can be sustainable for all parties involved, not only facilitating the assessment of mental health by aviation medical examiners but also simultaneously protecting the mental health of frontline aviation personnel and passenger safety.
Julija: Tell me about yourself - where do you come from, what's your background?
Paola: My name is Paola Tomasello, I am Italian, born in Naples. I live very close to the Fiumicino airport so I can see lots of aircraft during my day. My background is in Clinical Psychology, but I have some post-graduate specializations. These include specializing in work and organizational psychology, management of human resources and the postgraduate specialization in psychotherapy, for which I wrote a thesis about the Germanwings accident and possible measures to mitigate the safety hazards related to mental incapacitation and mental health issues in general.
I started my career in aviation in 2011 in Deep Blue. From the very beginning, I was involved in European research and development projects about human performance and safety in the framework of a new system's design for air traffic management. This included for example an arrival manager, the performance-based navigation and so on. In these projects, I had the opportunity to work very closely with the operational staff - ATCOs, and get their feedback and their experience when cooperating with automated systems, which supported them in analyzing information, predicting future conflicts and also sometimes making decisions or at least proposing options. Health has an impact on cognitive processes, so I had a chance to study how the air traffic controllers experience the mentioned support and how the cooperation between the human and the machine can be improved.
Later on, I started studying the report of the Germanwings accident and wrote my Psychotherapy thesis about it. And in 2020, I published, together with EUROCONTROL, the Stress Management guide for air traffic controllers, which is available on Skybrary.
Julija: Please, tell the readers more about MESAFE. What is it and what questions is it expected to answer?
Paola: MESAFE answers to two questions:
- Can the safety impact of mental disorders be assessed, both in qualitative as well as quantitative terms, given the proposed solutions and mitigations?
- What will the impact on regulations be?
To answer these questions, the project is developing evidence-based recommendations for new aeromedical developments for the early diagnosis as well as treatment of mental health conditions which could pose a safety risk for aviation and would consequently lead to pilots’ and ATCOs’ unfitness or the limitation of their license privileges for safety purposes. This is in line with what EASA required in the call for tenders.
After EASA launched that call, I reviewed my post-graduate thesis on the Germanwings accident and exploited it to send EASA a proposal for participation, together with a team of aeromedical experts. I'm really proud that EASA awarded Deep Blue for the project.
Our approach was to commence the research with stakeholder’s engagement thus we interviewed Aeromedical Examiners and Assessors, on the side of the professionals who have the responsibility to certify the mental fitness, and pilots and air traffic controllers, on the side of the applicants. We raised questions such as:
- How is the aeromedical mental health assessment carried out today?
- What challenges does one have when they carry out/undergo the aeromedical mental health assessment and what gaps do they encounter?
- What suggestions do you have to overcome current challenges?
The surveys were released last year and we had more than 140 replies from Aeromedical Examiners and Assessors, around 160 replies from pilots and a similar number of replies from ATCOs. We know it is not a lot, but the considerable overlap and comparability of the outcomes of the three surveys still helped us derive some high-level insights ultimately working as a starting point to detect main gaps to be further investigated and consolidated. For example, almost all the respondents on both sides agreed that mental issues can have an impact on the safety of operations. They all confirmed that insufficient resources are allocated to the aeromedical mental health assessment and assistance in terms of time, professionals and procedures. They confirmed that there is a high heterogeneity in psychodiagnostic methods and tools used by Aeromedical Examiners both for the initial and revalidation/renewal assessments. The shortage of mental health specialists and training modules about mental health have also been highlighted. They also agreed that loss of license concerns affect self-disclosure ultimately hindering the effectiveness of the whole assessment process. Almost all the respondents suggested:
- implementing proactive mitigations for loss of license;
- implementing standardized questionnaires and interviews;
- fostering a multidisciplinary collaboration among Aeromedical Examiners, Mental Health Specialists and peer support groups;
- managing work-related stress;
- promoting a no-blame culture around mental health issues.
So the MESAFE recommendations will combine these results with scientific evidence on psychodiagnostics and treatment of mental issues. Among our recommendations, we have included a focus on mental incapacitation events rather than on mental disorders’ diagnoses. When communicating among medical doctors or Mental health Specialists, the focus on mental disorders’ diagnoses, it is important to share the same language, to address mental health issues’ signs and symptoms so as to be sure that everybody understands the same meaning. Nevertheless, things change when medical doctors or Mental health
Specialists communicate with pilots and ATCOs, who do not have the same knowledge on mental health. In such situations, communicating in the form of diagnoses of mental health disorders may generate applicants’ concerns, worries and fears. The latter put an unnecessary burden on pilots and ATCOs and may also prove to be inconsistent with the real consequences of a mental health issue on their job. That’s why in MESAFE we propose to focus on Mental Incapacitation Events potentially occurring on-duty when speaking about mental health with the applicants. This helps applicants to practically understand the consequences of these events on operational safety and ultimately their mental (and physical) health, preventing blame, judgment and stigma.
In addition to that, there has to be a plan in place, in case of loss of license or limitations. These limitations to the license is a heavy stressor for the applicant, potentially leading to post-traumatic stress and this has to be proactively managed. In addition to these and several other recommendations that we are developing, we include the peer support groups as a helpful link to avoid building up stress. We think that it is very important to educate our Aeromedical Examiners to talk about work-related stress with their applicants, encouraging them to report work-related stressors to the employer. Of course this implies a commitment by the organizations such as ANSP’s and airlines in implementing work-related stress management monitoring and management programmes. Sounds like a dream, but our aim is to start changing the culture which we know takes a lot of time.
The MESAFE results will be published in March 2024 and we will present the following materials:
- Recommendations to update the current EU regulation on Class 1 and 3 aeromedical assessments.
- Training for Aeromedical Examiners. Not only about mental health, but also about interviewing skills.
- Safety promotion material including mental health self-monitoring tools, which targets pilots and air traffic controllers.
- A user-centered toolkit, including guidelines for stress management, targeting peer support groups and trained peers.
- A set of information cards about aeromedical psychology. This material is already available as we have been publishing one card per week since the beginning of the project on our LinkedIn profile.
Julija: Thank you, Paola, for this insightful interview and as a bonus Q/A I would like to add to the interview sort of a side question. As a clinical psychologist, what do you think are the biggest challenges for the operational staff and also for the managers to actually deal with the built up stress and fatigue of the essential personnel and also to manage the risk of them?
Paola: My opinion is that there still is a stigma towards psychological discomfort and fatigue in the sense that everybody knows that stress and fatigue are not an illness or not our fault. But still, people are afraid of declaring their stress levels. They are afraid of seeking help even if it can be a recoverable issue in the short-term. I think this is one of the factors. Also it is gender-based, because there is a cultural difference between men and women in the acceptability of seeking help and psychological support. I think the peer support programs are doing very, very well to change the culture of it.
Another problem is that sometimes we realize we are under stress only when it's too late. For example in the Deep Blue courses we try to train people to detect their breaking point. We all have a personal breaking point, when stress increases too much. When passing this breaking point, our performance decreases and sometimes even health deteriorates. It is very difficult to detect this breaking point, so what I do is I always ask people to think if it's easier to discover it themselves or is it easier to detect it in their colleagues. Implementing target procedures at operational, organizational and aeromedical levels can help build protective barriers against the safety hazards related to mental issues.
From a safety management perspective, I think there is a lot of economic pressure on them, if we think about the low cost companies for example. To my understanding, companies lack knowledge about economic savings of having stress management related programs. I would recommend putting stress and fatigue risk management in the business plan in the same ways as it is done with technical and operational risks. We published an article in the Hindsight magazine (issue 30) on wellbeing some years ago where we already proposed this approach for the companies.
I have to admit, as a second thing, a kind of criticism to my own community and to us as psychologists.
Sometimes we are too abstract and too theoretical in explaining things. Sometimes we miss the aviation context knowledge. I think that stress should be described, first of all, as a chain of biological reactions that cannot be stopped and when the reaction starts, it is very difficult to stop it. Secondly, stress should be described in terms of its relationship with mental health, namely in terms of effective or ineffective stress coping, as this has an impact on our health and performance in terms of safe acts and hazardous behaviors. Stress is really a matter of how we feel and stress coping is a matter of how we choose to respond and ultimately how we behave and perform at work. Monitoring and reporting procedures have to be developed. Peer Support and CISM (Critical Incident Stress Management) programs for the employees should be consolidated and extended to all EU pilots and ATCOs.