by Chris Keady
16th January 2017
Transforming the way we deal with mental health problems Aspiration ready for take-off?
This (welcome) aspiration from Prime Minister Theresa May comes in the same week in which she acknowledges that “for too long mental illness has been something of a hidden injustice in [Britain]” and she therefore wants to use the power of government …. to transform the way mental health problems [are dealt with] right across society”.
Why should this matter? Well it matters, if justice, humanity, or equality count for anything, and “if lives are not to be destroyed” (the PM’s words, not mine). Bottom line, therefore, we need to see the intentions embedded in the practical implementation of public policy decisions, and in meaningful preventative measures, not gimmicks, which can, in the long run, save money and lives (for example, there are over 6,000 deaths by suicide each year in the UK costing in excess of £10bn)
But what do ‘mental health problems’ look like?
There are a myriad of mental health conditions which affect people in the UK, and indirectly, their families and loved ones, in often very challenging and cruel ways. Many are treatable, some aren’t, with suicide accounting for more than 6,000 lives a year. However, for the purposes of this blog I shall concentrate on depression/severe depression, as it is something I know about, and which is relevant in the context of aviation noise/airspace change. Please let me explain.
A decade ago I was a ‘car crash’. My mental health had unravelled like a ball of wool bringing me to my knees. I languished on secure hospital wards as I failed to respond to treatment for severe depression which was accompanied by several complications. I was in the bowels of hell.
I was reduced to a shuffling husk of the man who had once been so capable and accomplished. I had no hope.
My mind had become my prison. Not only was I afraid of other patients, but I was also afraid of most staff. On my first night on a new ward, having been shifted from another hospital, I had barricaded myself into my room by dismantling parts of a wardrobe: I can still remember the fear. Every night I would lay awake waiting for something awful to happen once lights went out. Every night I would hear the roar of what I imagined were furnaces into which patients were dispatched….
My family eventually saved me by providing a supportive and caring environment, taking me home when everyone else had given up. I was still very far from well, and it was thought that I may never recover. Then the ‘hard yards’ began, but there was always someone to pick me up, to reassure me. One step forward, two back sometimes. Small victories on good days, such as walking to the bottom of the road by myself and coming back unscathed, swapping Velcro trainers for lace ups (laces were considered a suicide risk at one time), going on public transport and finding one’s way home without a crisis, going to the local shops or the local park. All this would be routine for most people, but for me they were ‘Everests’ – giant steps, on the road to recovery. Eventually I returned to work, helped by a compassionate employer, supportive colleagues, and a thoughtful and extended rehabilitation programme.
I am desperate to stay well – who wouldn’t in the circumstances? Besides the prospects of recovery from a further relapse are unlikely. But I am now alarmed by the possibility of what I‘ve described as ‘the mental health car crash’ that airspace change (a national programme) may unleash, unless great care is taken. Such airspace change has been described as a ’once in a lifetime opportunity by the Civil Aviation Agency’, and so it is. But the opportunity must not be driven purely by economic interests, and it requires a more balanced, humane approach than that currently signalled by the industry.
I have several, including:
- Wrong balance
If the wrong balance is struck in the case of over concentrating aircraft and noise along narrow corridors and selective strands of communities. In such a case noise may be excessively compressed and concentrated on parts of communities, instead of sharing it around more equitably (dilution), where feasible.
- Fair flight paths who decides
Who calibrates flight paths? Is – to use skiing terms – the flight path a ‘black run’ or a novice, significantly easier, ’green’ run? How are they equalised? I’ll have a ‘green run’ by the way, please, if I must have one at all.
The idea that one can consult noise away is flawed. While it may help if designed and implemented well, it ultimately merely shifts noise around. There is, therefore, a real risk that the weakest, those who are not well represented, either individually or collectively, or those with noise sensitive health conditions, will end up under ‘noise ghettos’ that airspace change may have had the opportunity to design ou
- Independent Noise Regulator
There needs to be an independent noise regulator as there is too much at stake. The regulator needs to adjudicate on flight path changes, amongst other things, and command the trust and respect of the overflown – the most important stakeholders of all.
- Mental illness (depression) from over concentrated aviation noise
The use of concentrated flight paths at Frankfurt Airport gave rise to significant levels of depression among the overflown. The Norah Report suggests that respite may help. This is very welcome, as it is a very under researched and under recognised area. For example, what dose is safe?
It is unclear, though, if anyone studied had or was prone to severe pre-existing depression or a history of such, and how they were affected, or helped. I’m mentioning this here, not as a ‘show stopper’ or ‘spoiler’, but genuinely because this is potentially a high-risk category. Such ‘hotspots’ are likely to require further treatment where they are identified.
Every effort should be made to use continuous climb outs, curved approaches, and other techniques to mitigate noise, also.
- Least harm versus fewest people
The present approach is to design flight paths to affect fewest people. This should be used as a rule of thumb perhaps but not an inviolable principle; since minimising people overflown maximises the impact on those that are. To be candid, this is hardly fair, and therefore greater flexibility is likely to cause least harm (noise doses will be less concentrated).
John Stewart, Chair of HACAN, has initiated and/or collaborated on a range of important initiatives over the past 12 months. Notably these include:
- HACAN’s work in promoting awareness of aviation noise and its impact on mental health through seminal blogs and the ‘high’ of a shared platform with the Aviation Environment Federation (Aef) at the House of Commons, ‘Aviation Noise and Mental Health’, event (July 2016);
- HACAN and Heathrow Airport promoting the role of an independent noise regulator; and
- Respite studies to inform thinking and debate around airspace change, its potential application and possible benefits.
This is to be applauded, and while nothing is ‘settled’ the work-in-progress could contribute towards a portfolio solution (usually there is no panacea). Such a portfolio might embrace further mitigation opportunities, pilot ‘quiet home’ schemes, and, in exceptional circumstances’ supported exit strategies for the seriously health affected, if a more widely available scheme is unavailable. These last few points may lead to eyes rolling and guffawing in some quarters, but those reacting in such a way are likely to be those who do not have to involuntarily consume what’s ‘dished up’ above their heads. There is a raft of ways, some innovative, to address this, with thumbnail outlines provided in HACAN guest blogs, and an entreaty to the Mayor London.
A message to the Prime Minister
Your statements about mental health in the past week have been enormously welcome, and frank. You have struck a common chord in so accurately pointing out that mental health is an area which remains stigmatised, and a hidden injustice for far too long.
Acknowledging this, and that ‘lives can be destroyed’, is refreshing, and I sense genuinely sincere, as is the commitment to use the power of government to transform the way mental health problems are dealt with across society.
The litmus test, however, must be to see the intentions embedded in the practical implementation of public policy decisions, and meaningful preventative measures, not gimmicks, which can, in the long run, save money and lives.
In the context of aviation, and airspace change policy/strategy, therefore, one will need to see clear, practical measures designed to prevent mental illness, both generally, and more selectively for any high-risk groups.
This will not compromise the drive for economic growth but it will genuinely show that we are a ‘Great’ Britain and a ‘shared society’ that is not only ‘open for business’, but is one which can, and does, look out for, and after, the vulnerable.
Therefore may we please push the envelope of possibility, and strain every sinew to deliver fair and appropriate solutions for those who may otherwise be expected to pay for aviation expansion and airspace change with their lives.