Germanwings tragedy puts mental health advocates on defensive

For the past decade, advocacy organizations have sought to demonstrate that people with depression and other mental illnesses can lead normal lives. Their campaigns have employed popular public figures to “out” themselves as dealing with illnesses, and parades like “Mad Pride,” which was held for the first time in Paris last year.

Their work has largely paid off, with polls in Europe indicating greater public acceptance of the mentally ill. 

But that was before Germanwings pilot Andreas Lubitz apparently decided to crash his aircraft into the French Alps, killing all 150 people aboard. A German prosecutor said Thursday that the copilot had researched methods of suicide and cockpit security in the days before the March 24 crash. 

Even before the official investigation is completed, news media, medical experts, and politicians are already engaged in heated debate over the role that “severe depression” may have played, and whether depressed pilots should fly or if doctor-patient confidentiality should be waived in such cases. Headlines are shrill; pundits tend to oversimplify. And all this is threatening to roll back years of progress in battling such stigmas, says Maria Nyman, the director of Mental Health Europe in Brussels.

“People are just using the word depression as if depression itself makes you do this kind of thing,” she says.

Now mental health advocates are scrambling to undo the damage by issuing public statements, citing research papers, and offering opinions that right now most of the public doesn't want to hear. One lauded Lufthansa for employing a pilot that had suffered from depression – instead of discriminating against him.

'Terrible shame and embarrassment'

Many countries in Europe, especially Western Europe, have made strides in convincing the public that those with mental health issues pose very little danger. British anti-stigma campaign Time to Change says since they began their work in 2007, there has been an overall 6.4 percent improvement in public perceptions toward people with mental health problems.  

Attitudes were generally less embracing a decade ago, with more saying they’d feel uncomfortable living near someone or willing to hire someone with mental illness. Myths about mentally ill people being dangerous or needing to be locked away abounded. As a result, those with mental disabilities were less willing to speak out, and crucially, seek care.

A turning point came in 2006 when the European Union decided to sign the UN Convention on the Rights of Persons with Disabilities, which includes those with mental illness. It was the first UN Human Rights Treaty to which the EU, as opposed to member states, signed, giving civil society new tools to put pressure on countries to advocate for the mentally ill, says Ms. Nyman. 

Sue Baker, the director of Time to Change, says that taboos are still rampant, as is “the terrible shame and embarrassment that people still face." Public campaigns, including those in which real people and public figures share their own personal experiences battling mental illness, can help society realize that “people can hold down really responsible jobs … even as pilots,” she says.

Depression has become so widespread that some companies consider it their business. Peter Fenkl, the CEO of Ziehl-Abegg, a German company that manufactures industrial fans, says a year ago he hired an external psychiatrist, or “perspective coach,” to help address issues like workplace burnout. Employees can make an appointment without the company knowing who or why. “As company managers, we don't even care to know who uses this service. It doesn't interest us in the least,” Mr. Fenkl says.  

Advocates favor community-based approaches that move away from generations of institutionalization. Hans Georg Ließem, the director of the Association of Sociotherapists in Germany, is developing a state-funded program that encourages those with psychological disorders to work in groups and discuss their interests and potentials. "It's about developing a way for them to learn to reengage with their social surroundings and to feel ... that they're not defined by their disorder," he says.

Fighting against overreaction

The community psychiatry movement has provoked some backlash, worsening public perceptions of schizophrenia, for example, says Wulf Rössler, an anti-stigmatization expert in Switzerland. “People say, 'we don’t want to have these people in our communities,'” says Dr. Rössler.

He now sees the same risk in the wake of the Germanwings story. “Until now we weren’t afraid of depressives, now we have to be afraid of depressive people as well,” he says.

Ulrich Hegel, director of the German Foundation Against Depression, has taken his message to the airwaves as often as possible, he says, to warn society not to overreact with new regulations, which some politicians have suggested are needed.

“More rules, more legislation, and more obstacles to get certain jobs, the risk is that people feel more stigmatized, will less often seek help and treatment, and finally we will have more tragic deaths than before,” he says.

And the head of Germany's Federal Chamber of Psychotherapists, Rainer Richter, even has gone so far as to congratulate Lufthansa – at a time when many people blame the company – for allowing its former trainee to complete his pilot’s license even after he revealed that he had battled with depression. “They said, 'He was sick, now he's healthy – we have no reason to reject him.' Lufthansa didn't discriminate,” Dr. Richter says.

Advocates are now focused on making clear that those suffering from depression are not to be feared. Isabella Heuser, the director of their psychiatry and psychotherapy department at Berlin's Charité hospital, says the professional society she belongs to is drawing up a statement explaining that depressed patients are rarely dangerous and that depression is treatable.

“Majorly depressed patients, who are suicidal, they usually don’t take anyone with them, and if they do, that is mostly psychotically depressed patients, like a mother who takes her children,” she says.

In France, Stephanie Wooley, a volunteer for Advocacy France that helped organize last year's “Mad Pride” march, says that for this year’s parade – planned for June 13 – one message is crucial to communicate about the mentally ill in the current environment.

“They are more likely to be a victim of violence than a perpetrator of violence,” she says.