Psychiatry and Fitness to Fly After Germanwings.

In March 2015, a co-pilot flying Germanwings Flight 9525 deliberately pointed his airplane into a descent, killing himself, five other crew members, and 144 passengers. Subsequent investigation and review teams examined the incident and considered potential lessons to maximize air safety. In this article, aviation industry clinical leaders, including the U.S. Federal Air Surgeon and Chief Psychiatrist from the Federal Aviation Administration (FAA), along with a professional pilot and collaborating forensic psychiatrists, discuss suicide-by-plane, evolving themes related to public safety responsibilities for psychiatrists treating pilots, and forensic trends in pilot evaluation for medical certification from an aerospace psychiatric perspective. We explore how psychiatric aspects of pilot fitness and aviation safety are examined across perspectives, including unsafe acts, preconditions, organizational factors, and unsafe supervision. We explore practices for civilian pilots and offer information related to military pilot fitness. Lessons from Germanwings are presented, as is the need for increased support for pilots who might be concerned about revealing mental health challenges for fear of loss of medical certification and pilot employment. The Air Line Pilots Association Pilot Assistance Network is highlighted as one example of pilots supporting pilots to increase airway safety.