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Airline crew member mental health in spotlight after captain's breakdown

Clayton Osbon, who had been flying for nearly 25 years, allegedly began yelling at air traffic controllers and later ran toward the cockpit door after getting locked out. He has been charged with interfering with a flight crew. NBC's Tom Costello reports.

Two recent incidents in which airline crew members behaved alarmingly and had to be restrained by passengers have raised questions about when and how aviation workers are screened for mental health problems.

On Tuesday, JetBlue captain Clayton Osbon, 49, was locked out of the cockpit by his co-pilot after he began acting erratically on Flight 191 from New York to Las Vegas. The captain, since charged with interfering with a flight crew and now getting medical care, was upset when he couldn't get back into the cockpit and began yelling about an unspecified threat linked to Iran, Iraq and Afghanistan.

Osbon "became increasingly agitated," and several passengers grabbed the pilot, "tackled him to the ground" and sat on him, passenger Tony Antolino told TODAY's Ann Curry.

It is not yet clear if anxiety or mental health issues led to Osbon's behavior. JetBlue said in a blog post that it will not share further details about the captain's "private life."

Osbon's last medical exam was four months ago, the Federal Aviation Administration (FAA) told msnbc.com. "He has a clean record, no incidents or accidents and the FAA has not taken any type of enforcement action against him," the agency said in a statement.

JetBlue CEO Dave Barger called the pilot, who was suspended on Wednesday, a "consummate professional."

JetBlue CEO Dave Barger speaks out after a JetBlue flight made an emergency landing due to a pilot's mid-air meltdown.

Earlier this month, an American Airlines flight attendant was removed from a flight after becoming combative and talking about the airline's bankruptcy and 9/11 on the plane's public-address system. Officers were also told that the 43-year-old woman was bipolar and was not taking her medication at the time, according to a police report on the incident.

John Cox, an aviation safety consultant and former airline pilot, told the Associated Press that incidents in which pilots become mentally incapacitated during a flight are "pretty rare." He said he could only recall two or three other examples in the more than 40 years he has been following commercial aviation.

While uncommon, these incidents have shown how crew member mental health is an important aspect of flight security and can be exacerbated by the high-stress environment of commercial flying.

The FAA requires that airline pilots have a medical certificate, which must be renewed annually if the pilot is under 40 and every six months if the pilot is older than 40. To receive the certificate, pilots undergo a physical examination by an FAA-designated physician. A psychological assessment is not part of the evaluation, but the physician can order testing if deemed necessary. The pilots are responsible for disclosing all existing physical and psychological conditions and may have their certificate revoked if they withhold that information. 

The FAA grounds pilots who disclose that they are being treated for depression or request treatment. The pilot has to be "stable" for 12 months before returning to the cockpit.

A pilot undergoing treatment for depression is required to provide a report from a psychiatrist which details the diagnosis, course of treatment and possible side effects from medication. The pilot also has to submit to psychological testing and prepare a written statement describing his or her use of antidepressants.

The FAA can make an exception for pilots who take one of four antidepressants approved by the agency as safe to use for treating mild-to-moderate depression. In these instances, medical certificates are given on a case-by-case basis. 

Tony Antolino and Laurie Dhue, passengers aboard the JetBlue flight that made an emergency landing after the pilot had a mid-air meltdown, talk to TODAY's Ann Curry about the bizarre incident.

Of the 120,000 U.S. commercial airline pilots, 27 have taken advantage of the anti-depressant policy and have been permitted to fly while using the approved medications, according to the FAA. Anxiety disorders and medications are evaluated on an individual basis.

The FAA, which has said that depression "can lead to distraction and make it difficult for a pilot to focus," implemented the anti-depressant policy in 2010. 

“I’m encouraging pilots who are suffering from depression or using antidepressants to report their medical condition to the FAA,” said FAA Administrator Randy Babbitt in a statement at the time. “We need to change the culture and remove the stigma associated with depression. Pilots should be able to get the medical treatment they need so they can safely perform their duties.”

The Air Line Pilots Association and the US Airline Pilots Association, both pilots' unions, have yet to respond to msnbc.com's requests for comment.

Dr. David Ballard, an expert on mental health policies in the workplace at the American Psychological Association, says the FAA's policy is fairly unusual because it must balance airplane and passenger security and the rights of the individual employee. Still, Ballard says, requiring employees to disclose mental health disorders can lead to a chilling effect and prevent them from seeking treatment in the first place. 

When addressed, a mental health disorder can be very treatable. "You obviously don’t want someone who is going to be unable to perform their job duties safely and effectively," Ballard said, "but just because someone has a mental health disorder, that doesn't mean they won’t be able to do their job well."

Unlike pilots, flight attendants do not undergo a medical examination, and airlines are not permitted to ask about mental health conditions. Flight attendants are certified by the FAA after completing a rigorous training program that emphasizes first-responder skills in emergency situations. Should a flight attendant seek treatment for a mental health condition, his or her FAA certification will not be endangered.

Corey Caldwell, a spokesperson for the Association of Flight Attendants, a union with nearly 60,000 members, says that training and a probationary period provide many opportunities to identify crew members who might have debilitating mental health conditions that could be triggered by tense situations. 

"I think it’s important to remember that the American Airlines flight attendant was a 23-year-veteran," said Caldwell. "Over two decades she'd been performing that [first responder] role. These two high-profile examples ... are not necessarily systemic of the population at large, but they do highlight extremely stressful situations [crew members] undergo on a daily basis."

Caldwell says that union members have increasingly reported in the past years that the stress of their profession is "escalating." Between the post-9/11 focus on security threats, the strain of airline bankruptcies and labor negotiations, and the fatigue that results from tighter schedules, the job now takes a greater emotional toll than it once did.

AFA offers members access to an employee assistance program, which provides mental health resources on request. Members can also report concerns they may have over the behavior or well-being of fellow attendants and, if needed, the AFA will get that individual help without involving airline management.

JetBlue and American Airlines crew members do not belong to the AFA, though JetBlue said on Wednesday that it does offer an employee assistance program, and that, "crew members are also able, and expected, to call a safety time-out should they need it, and the company will support them 100 percent."

"I don’t think these instances will stigmatize the profession," said Caldwell. "They’ll help shed light on the seriousness and stressfulness of this job on a daily basis."

The Associated Press and NBC 5 contributed to this report.

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Rebecca Ruiz is a senior editor at msnbc.com and a Rosalynn Carter Mental Health Journalism Fellow.