CABIN PRESSURE
We reveal the untold mental health struggle of air crew
For those of us who associate aeroplanes with holidays, they become vessels of excitement, relaxation and perhaps a little anxiety should you be a nervous flyer. But when it comes to the employees for whom flying is a day job, the emotions – and long-term health issues – are far more perilous. WH peels back the smiling facade masking a mental health crisis at 30,000 feet
Closing the door of my hotel room behind me, I let my bags fall to the floor. I collapsed on the bed with my uniform jacket still buttoned, cabin shoes still on, ID lanyard around my neck. As I ripped off my Velcro scarf, my mouth formed a silent wail. The tears streamed down my face until my eyes were strained and puffy. I’d managed to paste a smile on my face for the past 16 hours as I served coffee and paced the cabin, checking on passengers thousands of feet above Central Asia, but, having finally reached the solace of my Singapore hotel room, I fell into turbulent free fall. I barricaded the balcony door, 20 floors high, overlooking the pool, fearful I might open it sleepwalking if I did manage to ever nod off. I was so low, I was scared of what I might unconsciously do. Fatigue enveloping my very bones, I had hit a wall. Six months later, I worked my last flight, and it took me a year to claw my life back.
It’s not an uncommon story among those who fly for a living. Studies on mental health and suicide have been carried out on pilots, with a 2018 systematic review identifying commercial airline pilots to be at similar or potentially increased risk of experiencing depression as the general population, though research into the occurrence of mental health issues in cabin crew is scarce. Within the community, there’s a rumoured statistic that one cabin crew member takes their own life every month. The latest figures from the Office for National Statistics reveal that four flight attendants in England and Wales alone took their own lives in 2017, but don’t account for Scottish, Northern Irish and European crew who commute from their home towns to work for Uk-based carriers, let alone the hundreds of thousands of crew around the world. Indeed, a US survey of over 11,000 American airline crew by The National Institute for Occupational Safety and
Health (NIOSH) in September 2012, found that deaths of flight attendants from suicide
were found to be one and a half times higher than those among the general population. In March 2018, a survey of over 5,000 female flight attendants who participated in the Harvard Flight Attendant Health Study reported increased prevalence of adverse sleep and mental health outcomes, as well as associations between tenure and anxiety, depression, sleep disorders and alcohol abuse.
Sick and tired
For a career that exudes glamour – from the preened hair and perfectly made-up face to the exotic destinations – the reality is far from it. Sleep deprivation is an obvious risk factor – and a very real one.
Over months and years, cabin crew are plagued by disrupted sleep patterns, constantly acclimatising to new time zones and working long and unsociable hours, with little opportunity to establish any semblance of sleep-hygiene rituals or spend a prolonged period sleeping in their own bed. ‘There are three types of sleep deprivation,’ explains Dr Carina Eriksen, a former cabin crew member who is now a registered aviation psychologist and advises airlines on pilot mental health, cabin crew relationships and implementing peer-support programmes.
‘One is the disruption of your circadian rhythm, where your body clock becomes out of sync because you’re at work through the night. Acute is where you go consecutive days (say, three) without accumulating any sleep. The third is cumulative sleep deprivation: building over time – symptoms include reduced performance, cognitive impairment, emotional processing issues, low levels of motivation and lack of energy – and setting in gradually.’ Even short-haul crew members can be beholden to 4am starts and 11pm home times.
The past few years have seen a swathe of research linking prolonged interruption of the sleep-wake cycle to the development of mood disorders like depression. ‘In the short term, you’ll have a shorter attention span, be more prone to making mistakes and experience less emotional control,’ explains Dr Aarti Jagannath, an associate professor in the medical sciences division at the University of Oxford. ‘In the longer term, a disrupted circadian rhythm precipitates a number of disorders, depression being one, anxiety another. We also know that crossing time zones can increase risk of manic episodes in individuals who are prone to them.’ It’s the reason cabin crew working hours are strictly
controlled under an Eu-wide flight-time limitations directive. While some long-range duty shifts can be as long as 19 hours, the stringent directive rules that duty times must not exceed 60 hours in any one week, or 2,000 hours a year. Despite these rules, in February, the European Union Aviation Safety Agency published a report highlighting the increased probability of high fatigue levels during nights and periods with late finishes, among both pilots and cabin crew, recommending the implementation of further measures to prevent fatigue.
Under pressure
With thousands of members of cabin crew working across each major airline and rotas largely generated at random, it’s far harder for staffers to form lasting friendships than for the average office worker. A lack of stable social networks only serves to exacerbate feelings of isolation and provides no light relief from the job at hand; that job being customer service at its ugliest. ‘It’s a running joke that cabin crew have it easy, offering drinks or duty-free gifts every few hours, but that isn’t the case at all,’ says crew member Janice*, 62. ‘No one flight is the same, so you never know what’s coming – some passengers are fraught before they even reach the aircraft door, others get frustrated with crying babies or need medical attention – so you’re constantly alert to drama and often treated badly. It can be like a customer complaints line – but face-toface.’ The fact that employees are eyeballed by their customers in person means the friendly facade must never drop. ‘We’re expected to leave any issues at home and paste on a smile, for customers as well as the rest of that flight’s team, regardless of how we feel,’ says Amanda*, 50, who’s been flying as cabin crew for 25 years. This mask goes further than acting for the customer – despite it being 2019, the stereotype still exists that cabin crew will be composed in looks as well as manners. Remember that 2009 Virgin Airways TV advert? It celebrated 25 years of flying not by announcing feats of success, but with a video objectifying the ‘red hot’ stewardesses and poking fun at comparatively dull passengers who found them unattainable. Prescriptive uniforms, make-up guidelines and instructions to wear heels when walking through airport terminals still stand, all adding to the pressure to conceal the reality of life as cabin crew.
The closed working environment does crew no favours, either. Worlds away from fresh, cabin air is recycled – sucked in through the plane’s engine, then siphoned off into the air-conditioning unit before being pumped into cabins, having potentially collected and carried unhealthy traces of toxins. Trade union Unite confirms that, at present, legal action has been served in 51 court cases against five UK airlines in relation to causing ‘irreversible neurological damage and chronic illness among susceptible individuals’ from toxic cabin air. Plus, flying at altitude can reduce oxygen levels in the blood, linked to behavioural changes, headaches and confusion. And medicating with healthy food is a difficult option at 30,000 feet, as crew are only provided with food on certain flights. ‘I try not to eat airline food as there’s little nutrition in it,’ says Amanda. ‘The company provides sandwiches, fruit and cheese for pre-take-off, but there’s rarely enough for every crew member.’
As with the majority of mental health sufferers, employees’ symptoms tend to develop slowly over time. For me, I signed up as cabin crew in my twenties, seeking adventure and an escape from the dreary nine-to-five, having seen both my dad and brother enjoy careers in flying. A job with British Airways delivered. One week, I’d be landing in São Paulo and the next I’d be heading to the beach in Sydney. I was social on trips, trying to make the most of every moment – I hated staying in my hotel room and would actively encourage others out of theirs, heading out to explore the destination and meeting fellow crew for a drink or dinner. There were so many opportunities to take advantage of; hiring a taxi in Calcutta to catch a boat across the Ganges, visiting an island in Hong Kong to have dinner at a restaurant the captain recommended, day-tripping to the Great Wall of China and attending an annual rodeo in Calgary. All perks of the job, all enjoyed with colleagues I barely knew. But after three years, the lifestyle affected me more and more. I began to isolate myself, too exhausted to engage with others and too scared to let anyone see I was struggling. That night in Singapore was the beginning
‘We’re expected to leave any issues at home and paste on smiles, no matter how we feel’
‘An erratic work schedule means seeking treatment is difficult’
of the end, the culmination of those sleepless nights and an accelerating fear of feeling alone so far from home. On my 30th birthday, a friend told me that I didn’t seem like myself any more, and my six-year relationship with my partner was falling apart. In the months that followed, sleep became harder still – if I did drift off,
I’d wake in a blind panic, grabbing at my throat, believing I was choking – and six months later, I unknowingly worked my final flight, to Tel Aviv. When I returned home, my partner left me, and I hit rock bottom. I was signed off work by my GP with depression and crippling anxiety, and took voluntary redundancy.
If stress used to be thought of as ‘feeling a big frazzled’, it’s now a recognised risk factor for poor physical and mental health. Pilots consistently appear in top-five and top-10 lists of the most stressful jobs in the world, and if that comes from the idea that they’re in control of the safety of a planeful of passengers, doesn’t some of this rub off on to cabin crew? ‘Dealing with difficult passengers is stressful enough, but there’s always the niggle at the back of your mind or on a subconscious level that, should anything go wrong, all of those passengers will look to you for help or safety,’ says Janice. ‘That, at any moment, someone could be taken ill and it’s on you or your colleagues to save them.’ A busy inbox pales into insignificance.
Ann*, 30, began flying in 2013. In June 2016, she experienced what she now recognises as a breakdown. ‘I’ve always been prone to periods of feeling blue, but, historically, I was able to manage it,’ she recalls. ‘However, after three years of long-haul flying, I was having suicidal thoughts. I’m normally quite social, so if I went on a trip and no one wanted to do anything, I’d end up stuck in my room, which would send me to a bad place. I started to feel those low feelings more intensely than ever before. At my lowest ebb, I struggled to communicate, eat and drink. If I had a conversation, I wouldn’t digest what was being said and, later, I’d have no recollection of the interaction at all.
It’s very hazy.’ She continues, ‘I was diagnosed as having had a nervous breakdown, alongside depression, and was initially signed off for seven weeks. On returning to work, I did two trips but, after the second, I had to pull over while driving home or I would have driven into oncoming traffic. I was prescribed antidepressants, struggled with not earning because I was signed off and eventually ended up leaving the airline for an office job.’
Turbulent times
Unfortunately, an erratic work schedule means seeking treatment for mental health problems is all the more difficult. ‘Crew aren’t in the country at the same time every week, so it can be hard to commit to regular counselling or therapy on an ongoing basis, unless their company is prepared to give time off to facilitate that,’ explains Dr Eriksen. Amanda remembers a particularly low time 15 years ago, when working a flight from London to Johannesburg coincided with relationship problems at home: ‘It all got too much and I had a massive panic attack in the hotel bar in front of a fellow crew member,’ she recalls. ‘I knew I needed to leave, so I got up immediately and walked back to my room. My colleague was so supportive the rest of the trip and got me through.’ Amanda was prescribed medication for depression and anxiety, which she continues to take today, knowing how important it is to manage her mental health. ‘As a crew community, you hear of people taking their own lives; a friend of mine committed suicide and everyone was so shocked because she’d never given a hint that she was unhappy. I can’t say for sure what contributed to her death, but I do feel that suicide is a bigger issue within airlines, simply due to the nature of the job.’
In an increasingly competitive marketplace, airlines are being forced to fight for survival, and the challenges of rising costs mean crew wages are being stretched. When my dad started flying in the 60s, the job was well paid, respected and seen as a career. But now, with low wages (recruitment site glassdoor.co.uk lists the UK national average salary for cabin crew at £14,500) and a much younger workforce, there’s a higher turnover of staff. Bringing in a hefty pay cheque can help to ease career negatives – such as crushing fatigue, high stress levels, on-the-hop meals and guilt at leaving children, partners or parents behind for days on end – but when your salary
barely covers the rent? Money worries set in along with everything else, and suddenly international travel doesn’t seem quite so attractive.
Airlines, at least, seem to be catching up with other industries in terms of workplace wellness. British Airways explains: ‘We are introducing a new mental health platform for employees (Unmind) this year – as well as mental health champions and additional support services. In addition, we offer a 24/7 counselling service to all crew members, which is staffed by flying colleagues who are also trained counsellors.’ Last year, Virgin Atlantic launched the Green Ribbon network for its cabin crew community, with ‘the aim being to provide a befriender network for our crew to open up conversations and support those who may need it. We have a subtle green ribbon on the crew name badge to identify those trained as mental health first aiders.’ Both airlines have also signed up to the Time to Change employer pledge, making a commitment to open up the conversation around mental health in the workplace. ‘More and more workplaces are recognising the value of prioritising workplace wellbeing,’ says Time to Change director Jo Loughran. ‘Research consistently shows that when employees feel valued and supported, they tend to have higher wellbeing levels.’ Charter airline TUI and short-haul service Easyjet offer their employees access to an employee assistance programme, which provides free online and telephone advice.
Despite the pressures, Ann missed the job so much once she quit that she returned to flying last year, on a part-time contract in order to better manage her selfcare. ‘Now that I’m a cabin manager, I notice that there’s always at least one person on every trip who doesn’t want to go out, who is quite insular. I make sure I put my phone number on every briefing sheet and encourage anyone to call me if they want or need to talk.’ Amanda has reduced her hours, too, and tries to practise healthier routines when she’s at work. ‘I carry a cognitive behavioural therapy (CBT) book,’ she says. ‘I refer back to it should I need to deal with stress and anxiety on a trip. I also take time out for myself and ensure I try to get rest where possible. I do feel that we’re expected to suppress our emotions, but for those of us who have been here for years, we tend to talk and help each other out. Now, I’m always happy to discuss my own experience with colleagues.’
My own experience ended with a struggle to return to normal life. It took around six months for the tiredness to subside and for me to wake up feeling alert again. I moved house, started a new career in journalism and found calm and sanity in a sense of routine. I missed the weekly travel, exploration and the friends I still had from training. But being grounded gave me back something I’d lost with the demands of constant long-haul flying. Myself.
‘I make sure to notice the crew member who doesn’t want to go out’