It was little more than a month ago that Germanwings co-pilot Andreas Lubitz deliberately crashed his commercial airliner into a mountain in the Alps in France, killing himself and 149 passengers and fellow crew members. News coverage at the time focused on reports that Lubitz suffered from depression - an assumption supported by the discovery of antidepressants and a doctor's note in his home, and claims that he had been treated in psychiatric and neurology clinics.

The New York Times reported that Lubitz "had a medical condition that he hid from his employer."

The BBC attributed the German media with disclosures that Lubitz's pilot training was interrupted in 2009 because he was being treated for depression. The Washington Post went further by identifying depression as the leading cause of the Germanwings crash and other so-called "aircraft-assisted suicides."

Concerns raised

In the wake of this and other news reporting that consistently links depression and mental illness with horrific violence, concerns have been raised about the prejudicial effects such links have on public perceptions of mental illness, and ultimately on hiring practices and employment policies in the workplace.

Ian Panyko, assistant director of The Lodge, a café and mental health halfway house in South Bethlehem, said, "My worry is that you see these tragedies and hold on to them as a standard for mental illness."

Program Director Jackie Teitsworth added, "The vast majority of persons with a mental health diagnosis do not commit violent acts, but when a tragedy strikes, that is what the public hears."

Violnce link slight

A commentary written for The Atlantic by Julie Beck on March 27 reported: "Though the link between violence and mental illness is slight at best, the public tends to believe otherwise. One report found that 'between 1950 and 1996, the proportion of Americans who describe mental illness in terms consistent with violent or dangerous behavior nearly doubled.' This attitude persists today.

A 2013 Gallup poll conducted shortly after the Washington, D.C., Navy Yard shooting found that 48 percent of people blamed the mental health system 'a great deal' for mass shootings. Thirty-two percent blamed it a 'fair amount.'"

Testing pilots

Predictably, public discourse about the Germanwings crash turned quickly to what were implied as being deficiencies in the psychological testing of airline pilots, with little discussion of solutions. Air &Space magazine noted that although "the Federal Aviation Administration requires physicals every year for commercial pilots under 40 and every six months for those older, the FAA does not require psychological checks. The FAA-approved doctors order testing only if they think a pilot needs it."

While new hires will be "thoroughly tested in body and mind by the carrier," self-policing among pilots was cited by the magazine as the primary method of identifying any later problems.

Another source quoted in USAToday Network on March 26, said doctors do ask pilots about stress during their routine annual examinations. However, according to Erin Bowen, chair of the department of behavioral and safety sciences at Embry-Riddle Aeronautical University, "the tests aren't sophisticated enough to give the doctors the confidence to prevent someone from flying."

Minimal testing

Bethlehem resident Jack Norman, a retired commercial airline pilot who flew the majority of his almost 34 years with Continental Airlines, recalls undergoing only one "psychological" test when he was first hired in 1978. It was "in the form of exercises to measure mental capacity to remember a string of details, and the like. I guess you could not call that 'psychological testing' in a sense to measure mental stability."

Nine years later, when returning to Continental after being furloughed for several years and flying for another airline, Norman said he had a brief interview with a psychiatrist.

"He was primarily trying to assess any hang-ups a pilot like me might have for coming back to work on the property that had undergone a bitter strike. He was looking for the 'going postal' mentality."

Job stress not issue

Reflecting on the Germanwings crash, Norman said he personally doubts that stresses of the career contributed to the crash. Lubitz had flown only about 650 hours.

"The responsibility of the job is not one I would call stressful," Norman said. "In general, the career is a wonderful job that most pilots would admit is not particularly difficult."

'Suicial' misleading

"Don't Blame It on Depression" psychiatrist Anne Skomorowsky admonishes in a March 29 article in MedicalExaminer posted online. "Bad behavior - even suicidal behavior - is not the same as depression," she writes.

Even calling the pilot's actions suicidal is misleading.

"Lubitz did not die quietly at home. He maliciously engineered a spectacular plane crash and killed 150 people. Suicidal thoughts can be a hallmark of depression, but mass murder is another beast entirely."

Like Panyko and Teitsworth in Bethlehem, Skomorowsky says she is afraid that the association of the Germanwings crash with depression will further stigmatize the mentally ill, leading "those in need to avoid treatment."

Focus on physical

Another concern is potential discrimination against the mentally ill in the workplace.

"To date, companies have focused on physical health much more than they have on mental health," according to John A. Quelch, the Charles Wilson Professor of Business Administration at Harvard Business School. Part of the reason, Quelch says, is because "Mental health conditions aren't so readily identifiable."

Writing about the crash in the Harvard online newsletter Working Knowledge on April 6, Quelch concludes: "On the one hand, it focuses tremendous attention on mental health in the workplace," but overreactions could result in costly and ineffective ramp-ups of mental health screening that stigmatize those whose mental health issues are entirely manageable.

Quality vs. quantity

Panyko says screening is a matter of quality screening rather than quantity. He prefers the testing to consist of sessions where a person sits down and has a discussion face-to-face with a professional, rather than just relying on standardized questionnaires. If questionnaires are used - and there are even some online - "The questions would have to be proven to be clinically useful."

Teitsworth says the key is standardization. Everyone would have to be screened, and the questionnaires would have to be standardized for every employee.

Privacy issues

Yet another question is what is done with screening information once it is obtained?

"I worry about people viewing people by their diagnoses," Panyko explains. Someone is not bipolar; she has a diagnosis of bipolar. If someone has cancer you don't say he is 'cancer.''

He advises that employers should treat any form of mental illness, such as depression, the same as any physical illness."

Modify screening

Coming back full circle, the larger question is will the airlines actually modify their current screening practices. While it may still be too early for the industry to respond, the likelihood is that things will remain pretty much the same. On the PBS NewsHour after the crash, Judy Woodruff interviewed Dr. Warren Silberman, a physician and former manager of aerospace medical certification for the Federal Aviation Administration. She asked him if he thought regulations in the United States were sufficient, or did they need tightening.

Silberman, who is now in private practice, replied: "Ms. Woodruff, it's actually an interesting thing, because back in - when that pilot on JetBlue had a psychotic reaction - that was March 27 of 2012 - we, the members of the Aerospace Medical Association, which is the largest organization of aerospace medicine specialists, got together and had a working group to decide, is the exam - are we missing something on the exam?

"And we came up that, since something like that is so rare that you don't want to put your money on that, and it's better to put the emphasis on mental health education, education at the airline, that kind of stuff."

Pilot fatigue

The Airline Pilots Association (ALPA), the world's largest pilot union, representing more than 51,000 pilots at 30 airlines in the United States and Canada, was instrumental in getting legislation passed last year that addressed pilot fatigue. It posted the following statement on its website after the Germanwings crash, seemingly in support of the status quo in terms of mental health screening: "Airline pilots in the United States and Canada are subject to rigorous screening and evaluation prior to being hired, including an assessment of the pilot's mental and emotional state.

"Once hired, pilots are evaluated continuously throughout their careers through training, medical exams, and programs, such as the Line Operations Safety Audit, as well as by the airline and during random flight checks by the Federal Aviation Administration and Transport Canada. In addition, all flight and cabin crewmembers monitor and evaluate each other while on duty, and procedures, processes, and programs exist to respond should a concern arise."

Small impact

Jeffrey Swanson, a professor of psychiatry and behavioral sciences at Duke University, where he studies violence and mental illness, summed up the debate in quotes published in The Atlantic and posted online on March 27: "Better screenings, earlier intervention, improvement of the mental health system all-around - these are noble goals. But, unfortunately, the impact they could have on preventing future violence is probably small."

Noting that people who commit mass murder "are really atypical of people with mental illness," Swanson concluded, "The vast majority of people with schizophrenia, bipolar disorder, or major depression are not likely to do anything violent and never will."