By Alice Park
April 2, 2015

We hold certain professions to a higher standard when it comes to the mental health of their workers, and for good reason. Doctors, police officers and pilots, for instance, have jobs that put others’ safety in their hands. So as evidence mounted about the psychological condition of Andreas Lubitz, co-pilot in the March 24 Germanwings plane crash, it raised important questions about how to safeguard against such tragedies.

Lufthansa, the parent company of Germanwings, says Lubitz had informed the airline of a “serious depressive episode” in 2009, back when he was training to be a pilot. Investigators say Lubitz’s record also indicated “suicidal tendencies.” While it’s not clear why Lubitz apparently drove the plane into a mountainside in the French Alps, his case puts a spotlight on the imperfect system for screening–and supporting–pilots who are depressed or suffer from other psychological conditions.

In the U.S., commercial pilots over 40 must submit to a physical and mental evaluation every six months; before age 40 it’s once a year. Physical health is easier to quantify than mental wellness, however. “You somehow try to see if the pilot is well, and it’s not the easiest thing,” says Dr. Alpo Vuorio, a physician at the Mehilainen Airport Health Center in Finland who has studied depression and suicide in pilots.

Most airlines have psychological-support programs for its crews; it’s a matter of persuading pilots to take advantage of them. “It’s a macho thing. You don’t want to admit you need help,” says Scott Shappell, a professor at Embry-Riddle Aeronautics University and a former pilot. That may be why, according to one psychiatrist who evaluates pilots for the U.S. Federal Aviation Administration (FAA), only about half of the pilots who experience depression report their symptoms. “It’s one of the most difficult things in aviation medicine,” says Vuorio.

Experts say the vast majority of depressed people pose no harm to themselves or others, and most can be successfully treated–but stigma remains. Until 2010, the FAA had a ban on antidepressant use, making it an automatic disqualifier for pilots. After studies convinced officials such drugs don’t compromise pilots’ alertness or mental faculties, the FAA changed its position.

The FAA and the European Aviation Safety Agency (EASA) require commercial pilots to self-report any medical or mental-health issues, along with a list of recent doctor visits and any medications they’re taking. Still, not all pilots do. “Pilots know if they self-report, it will be a black mark” on their record, says Shappell. Any pilot reporting depression for the first time is automatically grounded before being re-evaluated and cleared to fly.

As with depression in any field, it’s hard to detect unless people seek help. “If they’ve not been honest, we just don’t know,” says Vuorio. If a pilot is caught hiding a medical or psychological issue, the FAA issues stiff punishment: large fines and a revoked license.

–WITH REPORTING BY MANDY OAKLANDER/NEW YORK CITY

Contact us at editors@time.com.

This appears in the April 13, 2015 issue of TIME.

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