Summary

Mental health problems can affect the way one think, feel and behave and in a safety critical profession the reaction to, and understanding of what is happening to one is very important. Mental Health problems affect more people in the world than expected, and range from common mental health problems, such as depression and anxiety, to more rare problems such as schizophrenia and bipolar disorder. A mental health problem can feel just as bad, or worse, as any other physical illness – only one cannot see it.

Experiencing a mental health problem is often upsetting and frightening, particularly at first. If a person becomes unwell, one may feel that it’s a sign of weakness, or that one are ‘losing one’s mind’, and that it’s only going to get worse. A controller may be scared of losing their Air Traffic Control Licence or being seen as ‘mad’ by other people in their life. One may also be afraid of being locked up in an institution. These fears may stop one from talking about one’s problems, or seeking help. This, in turn, is likely to increase your distress and sense of isolation. However, in reality, mental health problems are a common human experience. Most people know someone who has experienced a mental health problem. It can happen to anyone, at any time. And it’s likely that, when you find a combination of self-care, treatment and support that works for one, one will get better.

Introduction

1.1 A scientific understanding of positive mental health, especially in Safety Critical Professions (SCP) and effective interventions, is important for building thriving individuals and safeguarding aviation.

1.2 Whilst Seligman (2002) explains that the general stance of Positive Psychology is prevention, he confirms there is very little focus on how to educate, promote and engage the wider community in proactive positive mental health activities.

1.3 According to the US Department of Health and Human Services, Mental Health includes our emotional, psychological, and social well-being. It affects how we think, feel and act. It also helps determine how we handle stress, relate to others, and make choices. Mental health is important at every stage of one’s life, from childhood and adolescence through adulthood. Over the course of one’s life, if one experiences mental health problems, thinking, mood, and behavior could be affected.

1.4 There is an enormous variation between individuals with respect to their mental function or balance. The word “normal” has no real relevance. The main issue is whether the individual’s mental state compromises his/her function, judgement, ability to deal flexibly with the environment and, ultimately, everyone’s safety.

1.5 Mental disorders/illnesses can hinder the individual’s ability to function in the workplace. This may occur acutely or chronically and may be unpredictable. Long-term illnesses such as dysthymia (chronic depression) can affect function over months or years. Other mental illnesses, including some personality disorders, panic disorder, phobic disorder or a brief psychotic episode, may diminish an individual’s ability to function within minutes or hours.

1.6 Mental disorders can be divided into several large groups – major disorders, minor disorders, developmental disorders and personality disorders.

1.7 Currently, the definitions of many mental disorders are only approximations. When assessing an individual with a mental disorder, it is crucial that their surroundings, responsibilities, history, attitudes and expectations are taken into consideration. This acknowledged, reporting of individuals with mental disorders must use DSM-5 (Diagnostic and Statistical Manual of Mental Disorders 2013 of the American Psychiatric Association) terminology to ensure consistency.

1.8 Mental disorders and abnormal mental function must be described in a consistent way. DSM-5 is the most widely recognised and accepted attempt at standardising the description of mental disorders. This manual is a work in progress and gets updated continuously.

1.9 This paper is a follow up on last year’s PLC paper on “Mental Fitness” and will have a brief look at mental disorders, give some examples and explain how it can affect a person. The paper will also give some guidelines on how one can take responsibility for one’s own mental health.

Discussion

2.1 Definitions

2.1.1 Mental health is defined as “a state of well-being in which every individual realises his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community”. (World Health Organisation, 2014)

2.1.2 The positive dimension of mental health is stressed in the World Health Organisation’s (WHO) definition of health as contained in its constitution: “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”

2.1.3 Mental illness is defined as “a condition that affects a person’s thinking, feeling or mood. Such conditions may affect someone’s ability to relate to others and function each day. Each person will have different experiences, even people with the same diagnosis”. (National Alliance of Mental Illness, 2016)

2.1.4 Recovery, including meaningful roles in social life, school and work, is possible, especially when starting treatment early and playing a strong role in one’s own recovery process.

2.1.5 A mental health condition isn’t the result of one event. Research suggests multiple, linking causes. Genetics, environment and lifestyle influence whether someone develops a mental health condition. A stressful job like air traffic control or home life makes some people more susceptible, as do traumatic life events like a serious incident or accident in an air traffic controllers work environment or being the victim of a crime. Biochemical processes, circuits and basic brain structure may play a role in the onset too.

2.1.6 Despite the increased use of the term mental fitness in the popular and psychological literature, there is little consensus in relation to theory, definition and measurement. The concept of mental fitness could be used to slowly engage, educate and promote proactive, positive mental health activities to the wider community, without stigma and within a language that is easily understood.

2.1.7 Mental fitness is defined as “the modifiable capacity to utilise resources and skills to flexibly adapt to challenges or advantages, enabling thriving”. (Conceptualising and measuring mental fitness, 2015)

2.1.8 There are four guiding principles to Mental Fitness;

2.1.8.1 Fitness is a positive term without connotations of illness implied by mental health or mental illness,

2.1.8.2 Mental fitness could be understood by the wider community in a similar way to physical fitness,

2.1.8.3 Mental fitness is measurable, and

2.1.8.4 Mental fitness can be improved, in a similar way to physical fitness.

2.2 Diagnostic Categories and ICD-10 codes

2.2.1 The Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association, contains a standard classification system of psychiatric disorders for health care professionals. It classified psychiatric disorders by diagnostic category. ICD-10 codes are the codes that are standardardly used by the medical profesion to indicate the type of treatment or disorder. These codes are used globaly and are needed in most cases to make a claim against one’s medical insurance. The standard codes could lead to a license suspension especially if the health care profesional is not aware of the aviation implication of the diagnoses he/she has made. For example a normal CISM debrief = mental problem = suspended license.

2.3 Description of Disorders

2.3.1 Major Disorders

2.3.1.1 Psychotic disorders represent a profound disruption of an individual’s ability to relate to his/her own internal and external environment. Sensation and perception are disorganised and disrupted. False sensations such as hallucinations (hearing voices, seeing images) and delusions (fixed beliefs not supported by reality) are common. There is disorganisation of both thought and emotion. The individual’s ability to integrate information about the outside world and bear judgement on it is severely compromised. Psychotic disorders may be very short term or very long term. They can occur as a manifestation of schizophrenia, manic-depressive disorder, acute stress reaction, personality disorder or illicit or prescription drug toxicity. It can also occur as a result of physical brain damage or of some overwhelming emotional crisis in an individual’s life.

2.3.2 Minor Disorders

2.3.2.1 The minor mental disorders include anxiety disorders, depressive disorders, disorders usually first diagnosed in infancy, childhood, or adolescence (developmental), and adjustment disorders.

2.3.2.2 In the anxiety disorders, anxiety-related symptoms predominate. In generalised anxiety disorder, the individual experiences a chronic high level of distress, characterised by agitation, distractibility, exaggerated startle response and overreaction. By contrast, in panic disorder or post-traumatic stress disorder, the individual experiences sudden onset of catastrophic anxiety which paralyses mental function, judgement and the ability to react appropriately. These attacks may come on without warning, or may be associated with a particular stimulus.

2.3.2.3 The depressive disorders are extremely important and must be looked for in any individual working in a SCP. The onset of depression is usually slow and insidious. Depression is accompanied by a slowing of personal tempo and diminution of mental agility and initiative, as well as distorted judgement and a pervasive sense of hopelessness. Individuals suffering from depression function at a lower level of efficiency for long periods. Sudden decompensation is rare. In contrast to the anxiety disorders, individuals may not be aware that they are depressed and not functioning at an optimal level. Suicidal ideation or intent may be present. There are scientists and studies that state that being suicidal and taking the risk of killing more people through the suicidal act don’t go together, this was reaffirmed after the Germanwings crash.

2.3.2.4 The essential feature of an Adjustment Disorder is a psychological response to an identifiable stressor (a critical incident in an ATC environment) that results in the development of clinically significant emotional or behavioural symptoms. The symptoms must develop within three months after the onset of the stressor(s). The clinical significance of the reaction is indicated either by marked distress that is in excess of what would be expected given the nature of the stressor(s) or by significant impairment in social or occupational functioning. Adjustment Disorders may occur in conjunction with depressed mood, anxiety, anger, disturbance of conduct or a combination of these.

2.3.3 Personality Disorders

2.3.3.1 Personality disorders represent the most subtle form of dysfunction. They are not considered primarily as a mental illness themselves. Rather they are a description of the individual in which a mental illness may occur. A personality disorder is defined as a fixed and maladaptive individual style. The individual’s emotional and behavioural reactions always occur within a very narrow range of style. Though individuals suffering from a personality disorder look and sound superficially normal, their lack of adaptability produces problems in both work and social functions. Their rigid and narrow style represents their attempts to cope with stress. Thus the problems of their characteristic style are exaggerated under stress. Personality disorders are often found in conjunction with major or minor mental disorders or substance abuse.

2.3.4 Substance Related Disorders

2.3.4.1 Substance related disorders are prevalent throughout society and controllers are not immune to this due to the high stress environment that they work in. It results in decreased work and school performance, accidents, and absenteeism. Men are more at risk than women (U.S. National Survey on Drug Use and Health, 2008). Substance related disorders must be looked for in any individual working in an SCP. It often exists concurrently with other mental disorders, and requires assessments and treatment plans from a specialist in abuse disorders, and long-term (often years) formal and informal support.

2.4 Treatment of Mental Disorders

2.4.1 Mental disorders can be treated and significant improvement can be expected in the majority of cases. Treatment is three-pronged along biological, psychological and social lines (the so-called bio-psychosocial approach).

2.4.2 Biological Interventions

2.4.2.1 Biological interventions include any treatment which is effected through physical means. There is a wide variety of such treatments, ranging from massage therapy or acupuncture to medications, electro-convulsive therapy (ECT) and even surgery.

2.4.3 Psychological interventions

2.4.3.1 All the psychotherapies aim to alter the individual’s patterns of thinking and feeling. Many different kinds of psychotherapy are designed to improve insight and to introduce alternative patterns of behaviour. Cognitive behavioural therapy (CBT) works differently. Here, the focus is on altering the individual’s perception and reaction to distress in the here and now. The underlying whys and wherefores are not addressed. CBT is an extremely effective treatment for panic disorder, obsessive-compulsive disorder and some forms of depression.

2.4.4 Social Interventions

2.4.4.1 The effect of stressors on a variety of mental disorders is tremendous. Those stressors usually occur in the individual’s social milieu: marital, occupational, financial, etc. Effective therapy for such disorders will take into consideration the individual’s surroundings.

2.5 Fitness in Aviation Medical guidelines

2.5.1 The determination of “fitness to execute your licence privileges” is a complex process. It has been said that the aviation license is a privilege not a right and is governed by a set of rules and requirements. The rules are encompassed in ICAO Annex 1 “Personal Licensing” and DOC8984 “Manual of Civil Aviation Medicine”. The requirements include proof of age; proof of having met the knowledge requirements; proof of having met the skill requirement; proof of having met the experience requirement; payment of the appropriate fees and proof of medical fitness.

2.5.2 The medical fitness aspect is outlined by the states and applied using polices, guidelines and acceptable practices, all in accordance with accredited medical opinion. Many factors are considered but paramount is the safety of the flying public, the public in general and the aviator him/herself. A risk assessment process is applied to every decision concerning medical fitness to exercise license privileges. Factors, such as risk of sudden or subtle incapacitation or degradation of decision making, judgement, or information management, coupled with the operational aspects of the controller, exposure to other hazards, to name a few, are factored in to the disposition equation.

2.5.3 Each disposition decision is unique in its own way and cannot be cited as the “rule” for the next case. Precedence is set with each case but cannot be used precisely to measure the merits of the next case.

2.5.4 The development of protocols arose from the recognition that the prevalence of depression in SCP is estimated to be about 6%, similar to the general population. Crosssectional surveys have shown the anxiety disorders to be even more prevalent in the general population, even though depression is seen more frequently in clinical settings. Unfortunately, the number of aviation professionals coming to the attention of aviation medicine authorities does not reflect the prevalence data. This could be a reflection of several factors. Policies related to this issue have traditionally required immediate medical suspension, often for extended periods or permanently and limited the opportunities and options for return to duties. The argument has been made that this approach inevitably leads many aviators to forego treatment and suffer in silence. Alternatively, they seek medical care without revealing to the treating physician that they are in aviation in order to avoid a report to aeromedical authorities. Some others use herbal remedies and antidepressant medications, acquired via the Internet or other sources, without proper psychiatric or aeromedical supervision. Such avoidance behaviours are often aided and abetted by physicians who are unaware of their responsibility under Aeronautical Acts to report to relevant authority any medical condition or treatment that might have implications for flight safety.

2.5.5 The clash between inflexible medical regulation and advances in medical therapies, coupled with the dilemma of no treatment or non-disclosed on the aviator’s side have led to develop risk management strategies to preserve aviation safety and aviator’s resources.

2.5.6 The wide spread use of medications for these disorders in the general public and even in other safety sensitive occupations has raised the question about their use in the aviation community. To that end aviation authorities have embarked on a carefully controlled approach to allowing the use of medications for certain medical conditions in carefully selected circumstances. The watchword is individual consideration not blanket authorisation or acceptance. The evidence upon which to base a permanent solution has not been gathered fully in the aviation environment. Some countries have taken the initial steps to test the hypotheses and have not seen any signs that the industry or the public has been affected adversely by the decision to allow stable depressed aviators to continue to work while taking medications.

2.5.7 The use of medications has always been a concern for aviation. There have been many advances over the years in a number of specialty areas where previously medication use was extremely limited (hypertension), and where simple combinations were once forbidden. Currently, combination therapy with complex medications is the norm.

2.5.8 In the realm of treatments for psychiatric disorders, there have been many changes. The risk to aviation safety from an untreated aviator or one not disclosing treatment must be weighed against the acceptable use of newer psychotropic medications with well-established records of efficacy and minimal side effect profiles in a well-monitored situation.

2.5.9 Previous antidepressant medications generally had side effects quite incompatible with SCP duties, including fatigue, drowsiness and marked anticholinergic effects. In the past decade, increasing experience has been gained with the new generation of antidepressants (selective serotonin reuptake inhibitor (SSRI) and serotonin and norepinephrine reuptake inhibitors (SNRI)) whose effect is to modulate the intracellular action of various brain neurotransmitters, whose imbalance is thought to be a causative factor in anxiety and depression.

2.5.10 There is an increasing consensus of medical opinion that it is possible to allow the use of these medications in aviation, in circumstances that would not compromise safety or operational effectiveness, and, on the positive side, would allow the preservation of trained SCP resources. On the negative side, there is widespread recognition that medical personnel sometimes collude with patients and choose diagnoses or treatments to avoid raising regulatory barriers to flying or controlling. This has led to inappropriate diagnosis (e.g. diagnosing adjustment disorder when depression is more appropriate) to avoid lisence suspension, or using bupropion (Bupropion is a medication primarily used as an antidepressant and smoking cessation aid. It is marketed as Wellbutrin and Zyban among other trade names. It is one of the most frequently prescribed antidepressants in the United States and Canada) under the pretext of smoking cessation in order to treat depression. Efforts to avoid prolonged license suspensions may also contribute to under treatment, avoiding the use of medications and thereby adding to morbidity, which may paradoxically extend the time required before return to aviation duties is possible. There is often considerable overlap between the clinical syndromes of depression and anxiety, leading to co-morbid diagnoses and similar treatments, with SSRIs, currently the mainstay of treatment for both.

2.5.11 Virtually all of the medications used to treat this class of psychiatric disorder have similar effectiveness. They also have similar side effect profiles, including potential discontinuation symptoms, but may vary somewhat in the relative frequency and severity of these side effects. Adverse effects tend to occur early in treatment and diminish as the patient becomes physiologically accustomed to the medication. This individual variability obviates the need to specify a preference for approval of one medication over another, especially since personnel will be required to be demonstrably free of symptoms or neurocognitive side effects no matter what the medication. The most common side effect with prolonged treatment is sexual dysfunction, which may not be aero medically significant but may lead to cessation or alteration of therapy.

2.6 Aeromedical Concerns

2.6.1 This Guideline applies to all aviation personnel and applicants with a recent history (within the past two years) or current use of any SSRI, or diagnosis of mood disorder for which treatment included medication. (Closely related medications, such as SNRIs and Selective Monoamine Reuptake Inhibitors (SMRI) with similar efficacy and minimal side effect profiles (e.g. bupropion, venlafaxine) will also be considered).

2.6.2 This Guideline applies to psychiatric disorders such as, but not limited to:

• Major Depressive Disorder,
• Dysthymia,
• Depressive Disorder NOS,
• Medication use in support of Adjustment Disorder with affected mood,
• Posttraumatic Stress Disorder,
• Acute Stress Disorder,
• Generalized Anxiety Disorder,
• Anxiety Disorder NOS,
• Premenstrual Dysphoric Disorder (PMDD) treated with a SSRI.

2.6.3 Consideration may be given to other situations where these medications have been prescribed, such as for eating disorders, obsessive-compulsive traits, and social phobias, etc.

2.6.4 Those persons who have had a previous history of minor (non-psychotic) mental problems requiring medications and who have now ceased the medication may be considered after an appropriate period off medication and demonstrated continuing stability.

2.6.5 To be considered for these protocols, one’s treatment must generally be limited to a single agent in a class that has been approved by Authorities for treatment of the listed disorders above. An exception to monotherapy may be the addition of appropriate medication to a therapeutic dose of an SSRI for the management of medication-related sexual dysfunction.

2.6.6 The process for approval to fly or return to duty may be a lengthy one and will often take more than 6 months, due to the requirement for being on maintenance therapy for at least 4 months prior to submission of a request for acceptance.

2.7 Challenges in Mental Assessments

2.7.1 There are many challenges in assessing mental fitness, which include the;

• variety of psychiatric conditions that exist,
• diversity of presentations,
• potentially rapid fluctuations in severity and,
• lack of firm statistical data about the effects of these disorders on one’s function.

2.7.2 The prevalence of these conditions is rising and is more often reported due to society’s more open approach to them.

2.7.3 Within the aviation population, factors contributing to a greater concern and susceptibility of such conditions include but are not limited to the;

• lack of support,
• working with authoritive people,
• different racial, social, religious groups of co-workers,
• irregular hours and sleep,
• dangerous working conditions,
• expectations to function in emergency situations,
• difficulty for ongoing psychological treatment and support,
• unavailability of replacing medication.

2.7.4 A balanced approach is necessary to allow competent individuals back to work without compromising safety.

2.7.5 Mental health is crucial as it can have a significant impact on cognition, thought processes, judgement, reaction time, motor function, and perceptual changes. Individuals may become aggressive, erratic, reckless, and feel invulnerable, to name a few.

2.7.6 Always consider, if medication is used, side effects and the consequences of a missed dose that could hamper ATC with their safety-critical jobs.

2.7.7 With most medical conditions, supporting documents are essential. This is especially true for mental health, since it is unrealistic to be able to assess any significant mental health issue at only one brief visit, which also includes the individual’s entire health review and physical exam. The Safety Critical Position’s Family Physician, Psychiatrist, or Substance Abuse Professional is a valuable partner that can provide critical information on the individual’s condition and status.

2.7.8 However, keep in mind that many of these providers are frequently advocating for the patient and may not recognise their patient’s safety-critical role, the inaccessibility of medical support and services, and the challenges of the job.

2.7.9 This is why, despite supporting documents being a critical part of the assessment, one must carefully consider;

• Function,
• Risk of recurrence,
• Risk of a mild condition worsening,
• Co-morbidities,
• Ability to function in an Emergency Situation,
• Side effect of medications,
• The patient’s insight, responsibility and compliance with management,
• Overall risk to safety.

2.8 Suicidal ideation

2.8.1 Suicidal ideation is defined as “having thoughts of suicide or taking action to end one’s own life, irrespective of whether the thoughts include a plan to commit suicide”. (University of Calgary, 2016) Studies indicate that more than 90% of all suicides are associated with psychiatric disorders.

2.9 Prevalence

2.9.1 There are substantial variations at country level in the prevalence of adults who had suicidal thoughts, made plans to attempt suicide, and attempted suicide. Geographic differences in prevalence might be attributable to selective migration, sociodemographic composition of the population or the local social environment (e.g. social relationship indicators such as divorce rates or resources for access to health care).

2.10 Effect on functional ability in Aviation

2.10.1 Suicidal ideation with psychiatric disorders is an important consideration in aviation because of the risk of suicide.

2.11 Insight

2.11.1 For individuals with psychiatric disorders, insight is an important factor in their ability to adhere to treatment and respond appropriately to their condition. In general, people with sufficient insight are those who are aware of any cognitive limitations caused by their disorder and who have the judgment and willingness to adapt their lives to these limitations.

2.12 Affect

2.12.1 Emotional control – the ability to manage frustration, agitation, impulsivity – is an important functional component of safety critical performance.

2.12.2 Affect includes;

• emotional intelligence,
• impulse control/emotional control,
• frustration threshold,
• agitation, and,
• impulsivity and/or mood control/management.

2.13 Guidelines to Mental Fitness

2.13.1 Mental fitness is just as important as physical fitness, especially as one ages. Incorporating mental dexterity exercises into one’s life can help keep mind and body healthy. Exercises that help to relax are just as useful as those that stoke brainpower. Physical fitness gets plenty of attention, and for good reason. A healthy body can prevent conditions such as heart disease and diabetes, and help to maintain independence as one ages.

2.13.2 Mental fitness means keeping the brain and emotional health in tip-top shape. It doesn’t mean training for “brain Olympics” or acing an IQ test. It refers to a series of exercises that help to;

• slow down,
• decompress,
• boost a flagging memory.

2.13.3 The Mind-body connection has no surprise that, ‘the more you help your body, the more you help your mind’. Physical activity increases the flow of oxygen to the brain. It also increases the amount of endorphins, the “feel-good” chemicals, in one’s brain. For this reason, it’s not surprising that people who are in good physical shape also tend to enjoy a higher level of mental agility. Engaging in a vigorous physical workout can help to battle depression and gain a more positive outlook on life. It’s also a great way to beat stress, which can harm a person mentally and physically.

2.13.4 Mental exercise is just as beneficial. According to a study in the Proceedings of the National Academy of Sciences, certain memory training exercises can increase “fluid intelligence,” the ability to reason and solve new problems. While exercise is good for the brain and the body, so is meditation. Meditation, in conjunction with other methods, is an alternative way to treat depression. Calming the mind allows one to problem solve in a more relaxed way.

2.14 Benefits of mental fitness

2.14.1 When going to bed after a long day, the body begins to relax. But the mind doesn’t always follow and visualisation can help to achieve this. A sense of peacefulness can often been achieved through imagery, the process of picturing a tranquil scene or location. This practice can reduce tension in both body and mind by challenging neurons in the less-dominant area of the brain. The less-dominant side of the brain is the area that controls feelings of selfconfidence and optimism. When thinking about something other than daily worries, activity increases in the neural structures of that area of the brain. Ultimately, visualisation can boost emotional well-being and calm a person down mentally. Keeping one’s mind mentally fit isn’t as difficult as getting ready for a marathon, but it’s a good analogy. Mental exercises to the many activities you already perform can be added, such as;

• Reading,
• Daydreaming,
• finding humour in life.

2.14.2 The following approaches to life might increase mental fitness.

2.14.3 Stop multitasking – one may think that multitasking enables oneself to get more things done at once, but it actually creates more problems than it solves. Focusing on one task at a time will improve concentration and help to be more productive. It has been proven that humans cannot multitask, we have the ability to switch between tasks extremely fast and air traffic controllers has mastered that skill extremely well.

2.14.4 Positive affirmation is one avenue to increased mental proficiency. Affirmation, or talking to oneself in a positive way, involves strengthening neural pathways to bring self-confidence, well-being, and satisfaction to a higher level.

2.14.5 One does not need to be perfect, set goals for what you want to improve and start small to avoid becoming overwhelmed. Start off by making a list of your good qualities.

2.14.6 According to the Alzheimer’s Association, research shows that keeping one’s brain active increases its vitality. Doing new things in new ways appears to help retain brain cells and connections. It may even produce new brain cells. In essence, breaking out of routines can help the brain to stay healthy.

2.14.7 Games are a great way to build up the brain muscle. Even fast-paced action video games may boost the ability to learn new tasks, according to a study in the journal Current Biology. The study found tentative evidence that video games may increase one’s attention span, reaction time, and task-switching ability. In addition to video games, try any game that employs the use of;

• Logic,
• Reasoning,
• Trivia.

2.14.8 Reading is good for the brain. Even when reading this sentence, the brain is processing each word, recalling the meaning instantly. Beyond the mechanics, reading helps to visualise the subject matter on the pages, and imagine what voices sound like in a written dialogue. This can also be a great relaxation technique. Reading is a excellent activity because it can stoke the imagination and ignite so many different parts of the brain.

2.14.9 Mental fitness doesn’t have to take up a lot of your time. Spending a few minutes on it every day can help to feel better and think more clearly. Remember that relaxation and visualisation are just as important in a mental workout as the more energetic activities, such as memory exercises or game-playing. Try adding one or two activities at a time to mental workout, such as;

• relaxing,
• visualising,
• affirming,
• memory exercises,
• game-playing.

2.15 10 Tips for Mental Health (Better Health Channel, 2016) (Annex A)

2.15.1 Enjoying mental health means having a sense of wellbeing, being able to function during everyday life and feeling confident to rise to a challenge when the opportunity arises. Just like in physical health, there are actions one can take to increase his/her mental health. Better Health Channel advises: Boost your wellbeing and stay mentally healthy by following a few simple steps.

• Connect with others: Develop and maintain strong relationships with people around you who will support and enrich your life. The quality of our personal relationships has a great effect on our wellbeing. Putting time and effort into building strong relationships can bring great rewards.
• Take time to enjoy: Set aside time for activities, hobbies and projects you enjoy. Let yourself be spontaneous and creative when the urge takes you. Do a crossword, take a walk in your local park, read a book, sew a quilt, draw pictures with your kids, play with your pets – whatever takes your fancy.
• Participate and share interests: Join a club or group of people who share your interests. Being part of a group of people with a common interest provides a sense of belonging and is good for your mental health. Join a sports club, a band, an evening walking group, a dance class, a theatre or choir group, a book or car club.
• Contribute to your community: Volunteer your time for a cause or issue that you care about. Help out a neighbour, work in a community garden or do something nice for a friend. There are many great ways to contribute that can help you feel good about yourself and your place in the world. An effort to improve the lives of others is sure to improve your life too.
• Take care of yourself: Be active and eat well – these help maintain a healthy body. Physical and mental health are closely linked, it’s easier to feel good about life if your body feels good. You don’t have to go to the gym to exercise – gardening, vacuuming, dancing and bushwalking all count. Combine physical activity with a balanced diet to nourish your body and mind and keep you feeling good, inside and out.
• Challenge yourself: Learn a new skill or take on a challenge to meet a goal. You could take on something different at work, commit to a fitness goal or learn to cook a new recipe. Learning improves your mental fitness, while striving to meet your own goals builds skills and confidence and gives you a sense of progress and achievement.
• Deal with stress: Be aware of what triggers your stress and how you react. You may be able to avoid some of the triggers and learn to prepare for or manage others. Stress is a part of life and affects people in different ways. It only becomes a problem when it makes you feel uncomfortable or distressed. A balanced lifestyle can help you manage stress better. If you have trouble winding down, you may find that relaxation breathing, yoga or meditation can help.
• Rest and refresh: Get plenty of sleep. Go to bed at a regular time each day and practice good habits to get better sleep. Sleep restores both your mind and body. However, feelings of fatigue can still set in if you feel constantly rushed and overwhelmed when you are awake. Allow yourself some unfocussed time each day to refresh, for example, let your mind wander, daydream or simply watch the clouds go by for a while. It’s OK to add do nothing’ to your to-do list!
• Notice the here and now: Take a moment to notice each of your senses each day. Simply ‘be’ in the moment – feel the sun and wind on your face and notice the air you are breathing. It’s easy to be caught up thinking about the past or planning for the future instead of experiencing the present. Practising mindfulness, by focusing your attention on being in the moment, is a good way to do this. Making a conscious effort to be aware of your inner and outer world is important for your mental health.
• Ask for help: This can be as simple as asking a friend to babysit while you have some time out or speaking to your doctor (GP) about where to find a counsellor or community mental health service. Remember that your CISM peers are also there to help you if you need it. The perfect, worry-free life does not exist. Everyone’s life journey has bumpy bits and the people around you can help. If you don’t get the help you need first off, keep asking until you do.

Conclusions

3.1. Mental health is defined as “a state of well-being in which every individual realises his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community”.

3.2 A mental health condition isn’t the result of one event. Research suggests multiple, linking causes. Genetics, environment and lifestyle influence whether someone develops a mental health condition. A stressful job like air traffic control or home life make some people more susceptible, as do traumatic life events like a serious incident or accident in an air traffic controllers work environment or being the victim of a crime. Biochemical processes, circuits and basic brain structure may play a role in the onset too.

3.3 Mental disorders can be treated and significant improvement can be expected in the majority of cases. Treatment is three-pronged along biological, psychological and social lines (the so-called bio-psychosocial approach).

3.4 In the realm of treatments for psychiatric disorders, there have been many changes. The risk to aviation safety from an untreated ATCO or one not disclosing treatment must be weighed against the acceptable use of newer psychotropic medications with well-established records of efficacy and minimal side effect profiles in a well-monitored situation.

3.5 For individuals with psychiatric disorders, insight is an important factor in their ability to adhere to treatment and respond appropriately to their condition. In general, people with sufficient insight are those who are aware of any cognitive limitations caused by their disorder and who have the judgment and willingness to adapt their lives to these limitations.

3.6 The Mind-body connection has no surprise that, the more one helps one’s body, the more one helps one’s mind. Physical activity increases the flow of oxygen to the brain. It also increases the amount of endorphins, the “feel-good” chemicals, in the brain. For this reason, it’s not surprising that people who are in good physical shape also tend to enjoy a higher level of mental agility. Engaging in a vigorous physical workout can help to battle depression and gain a more positive outlook on life. It’s also a great way to beat stress, which can harm mentally and physically.

3.7 Mental fitness is important to maintaining brain and body healthy, especially as one ages. There are many types of mental dexterity exercises available. They include active ones, such as learning a new song or playing a game, as well as restful ones, such as relaxation and visualisation exercises.

Recommendations

It is recommended that:

4.1 This paper is accepted as information.

References

CCMTA Medical Standards for Drivers

CMA Driver’s Guide

Canadian Railway Medical Rules Handbook

Transport Canada Aviation Guidelines

https://www.ucalgary.ca/FTWguidelines/content/mental-health#aviationhealthy – 24 July 2016

https://www.healthline.com/health/depression/mental-fitness#Techniques4healthy – 24 July 2016

https://www.mind.org.uk/information-support/types-of-mental-health-problems/ 24 July 2016

https://en.wikipedia.org/wiki/Bupropion 24 July 2016

Annex A

10 Tips On Mental Fitness

Enjoying mental health means having a sense of wellbeing, being able to function during everyday life and feeling confident to rise to a challenge when the opportunity arises. Just like in physical health, there are actions one can take to increase his/her mental health. Better Health Channel advises: Boost your wellbeing and stay mentally healthy by following a few simple steps.

Connect with others: Develop and maintain strong relationships with people around you who will support and enrich your life. The quality of our personal relationships has a great effect on our wellbeing. Putting time and effort into building strong relationships can bring great rewards.

Take time to enjoy: Set aside time for activities, hobbies and projects you enjoy. Let yourself be spontaneous and creative when the urge takes you. Do a crossword, take a walk in your local park, read a book, sew a quilt, draw pictures with your kids, play with your pets – whatever takes your fancy.

Participate and share interests: Join a club or group of people who share your interests. Being part of a group of people with a common interest provides a sense of belonging and is good for your mental health. Join a sports club, a band, an evening walking group, a dance class, a theatre or choir group, a book or car club.

Contribute to your community: Volunteer your time for a cause or issue that you care about. Help out a neighbour, work in a community garden or do something nice for a friend. There are many great ways to contribute that can help you feel good about yourself and your place in the world. An effort to improve the lives of others is sure to improve your life too.

Take care of yourself: Be active and eat well – these help maintain a healthy body. Physical and mental health are closely linked, it’s easier to feel good about life if your body feels good. You don’t have to go to the gym to exercise – gardening, vacuuming, dancing and bushwalking all count. Combine physical activity with a balanced diet to nourish your body and mind and keep you feeling good, inside and out.

Challenge yourself: Learn a new skill or take on a challenge to meet a goal. You could take on something different at work, commit to a fitness goal or learn to cook a new recipe. Learning improves your mental fitness, while striving to meet your own goals builds skills and confidence and gives you a sense of progress and achievement.

Deal with stress: Be aware of what triggers your stress and how you react. You may be able to avoid some of the triggers and learn to prepare for or manage others. Stress is a part of life and affects people in different ways. It only becomes a problem when it makes you feel uncomfortable or distressed. A balanced lifestyle can help you manage stress better. If you have trouble winding down, you may find that relaxation breathing, yoga or meditation can help.

Rest and refresh: Get plenty of sleep. Go to bed at a regular time each day and practice good habits to get better sleep. Sleep restores both your mind and body. However, feelings of fatigue can still set in if you feel constantly rushed and overwhelmed when you are awake. Allow yourself some unfocussed time each day to refresh, for example, let your mind wander, daydream or simply watch the clouds go by for a while. It’s OK to add do nothing’ to your to-do list!

Notice the here and now: Take a moment to notice each of your senses each day. Simply ‘be’ in the moment – feel the sun and wind on your face and notice the air you are breathing. It’s easy to be caught up thinking about the past or planning for the future instead of experiencing the present. Practising mindfulness, by focusing your attention on being in the moment, is a good way to do this. Making a conscious effort to be aware of your inner and outer world is important for your mental health.

Ask for help: This can be as simple as asking a friend to babysit while you have some time out or speaking to your doctor (GP) about where to find a counsellor or community mental health service. Remember that your CISM peers are also there to help you if you need it.The perfect, worry-free life does not exist. Everyone’s life journey has bumpy bits and the people around you can help. If you don’t get the help you need first off, keep asking until you do.