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Some employees face a dilemma: Seeking mental health treatment endangers their jobs, but avoiding treatment endangers others.
On October 31, 1999, when EgyptAir flight 990 plummeted into the Atlantic Ocean off Rhode Island, killing all 217 on board, officials pointed to pilot suicide as an apparent cause. The crash—which is still under investigation—has raised concerns about what might happen when employees whose jobs affect public safety have emotional or psychological problems.
These employees, including pilots, air traffic controllers, truckers, law enforcement officers and emergency medical personnel, are in a bind. If they seek help, they could be taken off the job, depending on the severity of their condition and its treatment. So the employees, fearing for their careers, might not seek the treatment and medication they need, possibly endangering themselves, other employees and the public—and ending the careers they sought to save.
This catch poses special challenges for HR, which must help employees while protecting employers. “The roles of the HR manager are to find ways of helping employees with a minimum of career disruption and provide as many early-identification avenues as possible,” says Thomas M. Anderson, chair of the Society for Human Resource Management’s Workplace Health and Safety Committee and HR and risk management director for Fort Bend County in Richmond, Texas. “We try to identify problem areas and correct them before a catastrophic event happens.”
Get Help and Get Grounded
In a climate where every accident makes headlines, nowhere is the issue of employee mental health and public safety more in play than in air transportation. Since 1927, the Federal Aviation Administration (FAA) has regulated the medical readiness of U.S. airline pilots, who are usually employed by private companies, and air traffic controllers, who are FAA employees. The FAA sets and enforces not only physical fitness thresholds but also mental health standards. Conditions that automatically ground a pilot include psychosis, bipolar or severe personality disorder, and substance dependence.
“The catch-22 is with depression,” says John Mazor, spokesman for the Air Line Pilots Association (ALPA), which represents 55,000 airline pilots at 51 airlines in the United States and Canada. “If a pilot uses a [antidepressant] drug such as Prozac or Zoloft to fight depression, he is grounded, even if the drug is taken under strict supervision.” A pilot also can be grounded for a mental health problem—depending on the diagnosis and severity of the problem—regardless of whether he seeks treatment on his own. “The problem ALPA has is that we know so much more about depression than when the regulations were written and have much better treatments available today,” says Mazor.
The FAA, which is responsible to the public as well as to employees covered by its regulations, takes the conservative approach that pilots and air traffic controllers may not work under the influence of psychotropic medications, period, even though those medications are beneficial. “It is a two-pronged issue,” says FAA Flight Surgeon John Jordan, M.D., at the administration’s headquarters in Washington, D.C. “We continue to be concerned about potential side effects as well as for what conditions the drug is being prescribed.”
But some psychiatrists say that pilots should not be grounded based on diagnosis or treatment unless the pilots’ conditions result in performance and safety problems such as near misses or bizarre behavior in the cockpit. In a letter published in USA Today, Dr. Robert J. Hedaya, clinical professor of psychiatry at Georgetown University Hospital in Washington, D.C., responded to the speculation surrounding the EgyptAir crash: “I, for one, would rather that my pilot be emotionally stable on a medication proven to normalize brain function and reaction time than his hiding a melancholic, suicidal or even psychotic depression. Is it not time to expose this outdated and ill-informed folly?”
Agreeing with Hedaya’s characterization, Mazor says that ALPA is quietly working with government regulators to update policies based on medical advances. Mazor believes that drug use coupled with strict supervision by a therapist is preferable to a flat prohibition on all drug use.
Stress and Trauma
Employees who work safety-sensitive jobs often undergo psychological screening. Pilots, for example, must undergo a battery of medical and psychological exams, simulations of air emergencies, observation by FAA inspectors and by veteran pilots in the cockpit. Why, after all that testing, might pilots or other safety-sensitive workers still exhibit mental health problems?
The capacity for handling stress can be associated with the ability to shrug off both cumulative stress and psychological traumas, according to Andrew S. Baum, Ph.D., of the University of Pittsburgh’s Department of Psychiatry. Occupations where safety is involved have plenty of both these problems.
“All of us are exposed to cumulative stress, although it varies a lot by amount and opportunity,” Baum says. “Healthy people find ways to purge their stress periodically,” he says, such as through physical activity, vacations or therapy.
People in some safety-sensitive occupations are especially susceptible to trauma—a psychological blow or an acute isolated event that is “so out of whack with people’s reality that it causes them to question their assumptions about life,” Baum explains. Police officers, firefighters, emergency room workers and disaster relief workers are particularly susceptible to psychological traumas, in part because they deal with uncalculated risks.
In addition to the psychological explanation, there is also a social one in some high-stress occupations. “Some air traffic controllers have a work-hard, play-hard mentality,” says Brenda R. Blair, a consultant who frequently works with employers who have safety-sensitive jobs. “They come off the job and they’ve got adrenaline pumping. Some told me that they self-medicate with alcohol or drugs to calm down. Over time, they may become caught in a cycle. It can be hard for the employee to recognize when a problem becomes a problem,” says Blair, a principal at Blair & Burke in College Station, Texas. Such work-related behaviors either can cause or be aggravated by a deteriorating home life. “Before you know it, you’ve got three or four coexisting problems, and the person is in a continually negative state of mind,” says Blair.
Employees may be reluctant to seek help because of two hurdles, according to Thomas L. Moriarty, director of health and emergency services for Shippensburg University in Shippensburg, Pennsylvania. The first obstacle is a macho culture of self-reliance that pervades many dangerous occupations. The second is a more general bias against mental health counseling.
“Many police believe that if a fellow officer has an emotional problem, that person can’t be trusted, so there’s a strong bias by individual officers against exhibiting any weakness and against getting help,” Moriarty says. “Ironically, this can increase the person’s job stress and vulnerability to illness.
“Even when a person is ready to seek help, other factors come into play before he steps over the line,” Moriarty continues. “I believe one subtle inhibitor is the negative experience that many people previously had with guidance counselors in educational settings, because the counselors often played the role of disciplinarian. The roles of ‘counselor’ in the educational and psychotherapy settings are very different, but may be associated together.”
Other safety-sensitive occupations do not have the strict psychological fitness-for-duty standards of aviation. Most transportation companies outside of aviation primarily are concerned with meeting federal drug and alcohol testing requirements. “We don’t deal with psychological problems formally like the airline industry,” says Garry Ritzky, risk and human resource manager for Turner Brothers Trucking and Turner Brothers Crane and Rigging in Oklahoma City.
The company’s pre-employment screening helps determine whether job candidates are cut out for trucking life. The tests assess personal control needs, people orientation, safety orientation and attention to detail. For example, when assessing safety orientation, “We prefer crane operators who do yard work or work on their computers on the weekend instead of motorcycle racing,” Ritzky says. “We know that they are more likely to be willing to use a safety manual and less likely to be suddenly sidelined by injury through no fault of the company.”
In the case of law enforcement, peer scrutiny can be tougher than any regulations. “There is no particular medical treatment or psychotropic medication that would automatically disqualify an officer from duty,” says Lawrence Berger, general counsel to the Federal Law Enforcement Officers Association (FLEOA). “There’s immense discretion on the part of managers” to determine whether an officer is stable enough for active duty.
For example, Berger says, if an officer exhibits unacceptable conduct on the job, his manager may require that he be given medical and psychological examinations. If a psychiatrist for one of the 51 federal law enforcement agencies determines that an officer is not fit for duty due to major depression or another psychiatric illness, a manager can remove him from duty.
Typically, the federal officer will be given the opportunity for rehabilitation, while being suspended with pay. Then, if he’s cleared by the treating psychologist and agency psychiatrist, he can be reinstated for duty. Usually clearance must happen within four to six months after treatment starts, or the officer will be fired. “There’s no requirement that he be reinstated even after treatment is successful,” says Berger. “There’s a profound bias against officers having psychological problems. Even if they are cured according to a medical model, it’s more of a social issue by which the agent is judged by his peers.”
Like law enforcement, trucking and aviation, different occupations develop their own means for dealing with impaired employees, depending on factors such as the amount of responsibility the employees have for other people’s lives and whether they carry firearms. Among the occupations explored here, only pilots and air traffic controllers are pulled from duty if they use any psychiatric medications. For other occupations, the employee’s performance and conduct on duty are the keys to whether psychological or emotional problems will affect their careers
How employers handle those problems depends on several considerations. Employers consider whether employees’ emotional and psychological impairment are as much a concern for them as alcohol and drug problems. They look at whether prescription drug treatments can sideline the employee.
Ritzky says the single most important thing an HR manager can do to protect his employer is to require employees to inform management about their use of medications that might affect mental or physical alertness. At Turner Brothers, an employee’s failure to provide such notification generally results in discipline that stops short of firing.
Since implementation of the Americans with Disabilities Act, HR managers have been the architects of job accommodations for people with disabilities. But accommodations that involve staying in the job may not be possible when the job is safety-sensitive and the disability is related to mental health.
“Among air traffic controllers, the only reasonable accommodation [was] to take them out of the control tower and give them a desk job,” says Blair. “[But] they became frustrated by jobs that didn’t fit their personalities.” Consequently, the HR manager often is left to negotiate an accommodation with no “win-win” solutions, she says.
The difficulty of accommodation, coupled with the risk of high-stakes mistakes if an impaired employee stays in the job, means HR must focus on preventive strategies. The ideal intervention is that initiated voluntarily by the employee when a problem is in its infancy. The prospect of a successful outcome is much better at this point than later—when co-workers can more easily become aware of management confrontations and compulsory referrals. In that case, the impaired employee is likely to feel that he is being taken to the woodshed for punishment.
The more doors that lead to help, the likelier it is that the employee will find one he’s willing to walk through. EAPs usually enable a self- or family-referred employee to have an initial problem assessment done without fear of career jeopardy. “An EAP can help the individual to sort through complex personal and social issues and figure out how to solve it in a safe environment,” explains Blair. “This helps to break down the walls of adversity that are created by governmental regulations.” Blair adds that other workplace services sometimes offered as adjuncts of EAPs, such as work/family services and critical incident debriefings, also are important problem awareness resources.
Another option for intervention is called an impaired professionals program. It relies heavily on peer interventions. The grandfather of all impaired professionals programs, called the Human Intervention Motivation Studies (HIMS) program, was started in the 1970s for airline pilots. Today, ALPA and the FAA use it. Impaired professionals programs like HIMS have worked because they are not employer-sponsored and because they rely mainly on the strength of peer, not managerial, referrals.
Conflict management services, though aimed at improving workplace relationships and not at treating psychological problems, also can identify impaired employees. “Getting stuck in a conflict is common” when the employee has emotional problems, says Norma Delp, a principal for Akron, Ohio-based conflict management firm Signal Tree Resolutions LLC. “One solution is a conflict prevention process in which employees can voluntarily participate and be trained at intervening or mediating,” Delp says. “They should be backed up by professional resources when the prevention process doesn’t work, and at this point we start to see employees with more serious personal problems.”
Is there a regulation-driven catch-22 in safety-sensitive occupations? One exists for pilots and air traffic controllers. Increasingly, experts on safety-sensitive occupations and psychiatric illnesses, such as the ALPA and Baum, advocate allowing these employees to take full advantage of advances in treatment and medication without jeopardizing their careers.
But another, informal, catch—the stigma, ostracism and career limitations faced by employees who acknowledge emotional or psychiatric problems—is just as real in other occupations. Fixing this problem depends not on regulatory changes but on changes in managers’ and co-workers’ attitudes. “You can’t force people to suddenly change attitudes that have been a lifetime in development,” notes Baum. “We have to do a better job of educating employees and the public at large about the treatability of mental health problems.”
Rudy M. Yandrick is a Mechanicsburg, Pa., freelance writer specializing in human resource and behavioral health issues.
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