Experts: Mental health screening not foolproof

There's no foolproof way to predict on-the-job mental breakdowns like the one apparently suffered by a JetBlue pilot last week, according to experts in occupational mental health.

Psychological screening is common in "high-risk" occupations that involve responsibility for other people's lives, such as pilots, law enforcement officers or surgeons, they said. But its effectiveness has limits.

In part, that's because breakdowns so severe and sudden in the jobs that require highly developed skills and the steadiest of nerves are relatively rare, and thus hard to study and predict. Besides, people can change, however they sailed through psychological screening in the past.

"Psychologists struggle with this. How do you prognosticate the future?" said Curtis Reisinger, a psychologist and head of North Shore-LIJ's Employee Assistance Program, which offers mental health services to the system's more than 40,000 doctors, nurses and other employees. "People are dynamic and their roles change."

JetBlue flight captain Clayton Osbon, 49, was locked out of the cockpit by his first officer and then subdued by passengers on a flight from Kennedy Airport to Las Vegas on Tuesday after he began rambling about religion, Sept. 11 and Iran, according to an FBI affidavit. Osbon is now hospitalized.

Friends and neighbors said they saw no warning signs, even in retrospect. JetBlue president Dave Berger called Osbon a "consummate professional" whom he had known for years, and had seen nothing in his 12-year record flagging him as a risk.

"How do you deal with mental difficulties among a group that's not supposed to have them?" said Rodney Lowman, an organizational psychologist at the California School of Professional Psychology in San Diego. Such incidents "are newsworthy because they are so bizarre."

However, they are not unprecedented. On Jan. 28, 2008, the co-pilot of an Air Canada flight from Toronto to London became so incoherent and "belligerent" that he had to be dragged from the cockpit and handcuffed, an investigation found.

The Federal Aviation Administration requires pilots under age 40 to have a medical exam every 12 months; those over 40 like Osbon must have one every six months. The FAA said the exam includes psychological questions, and examiners can order additional psychological testing.

That's generally more mental health testing than the average employer requires, even in jobs defined as "high-risk."

Robin Inwald, who pioneered tests that are widely used for jobs in fields like law enforcement and corrections, said they are usually performed at hiring. Those promoted to an elite unit like a SWAT team may undergo additional psychological fitness tests, and a police commander can order a mental exam for an officer acting erratically, she said.

But the tests are better at assessing who will turn out to be a poor-performing employee than who will develop mental illness after years of strong performance. Another drawback is a "false positive" rate of 15 percent to 30 percent for those who take it -- meaning a wrong prediction of bad performance, she said. Moreover, "that evaluation may be good for a year," Inwald said. "Events can occur in an individual's life that can result in negative behavior patterns."

Peer support programs -- commonly used in law enforcement -- can help the odds of identifying someone with "extreme performance problems," she said. In these programs, employees volunteer for special mental health training.

Just as JetBlue first officer Jason Dowd intervened, employees at many hospitals, including North Shore-LIJ, are encouraged to call a timeout if they see behavior they think is wrong, Reisinger said. "The obligation is that the process be stopped and people can then confer about their concerns," he said.

If someone tips the FAA that a pilot may have a mental health issue, the agency can direct the pilot to undergo a psychological evaluation.