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The crash of Germanwings Flight 9525, brought down by a pilot with diagnosed mental illness, raises red flags about how airlines evaluate, regulate, and address such issues among employees.

Andreas Lubitz, who was at the controls of the jetliner that crashed in the French Alps Tuesday and killed all 150 people aboard, that he kept hidden from his employers, according to reports. Investigators had found notes from two doctors among other ripped up medical documents attesting that Mr. Lubitz was unfit to fly the day of the crash, German officials said.聽

While airlines and aviation regulatory agencies 鈥� both in the United States and abroad 鈥� have processes that examine pilots鈥� mental health for illnesses that could affect their ability to fly a plane, these procedures rely heavily on pilots volunteering information about any disorders, .

In the US, both airlines and the Federal Aviation Administration (FAA) require pilots to undergo annual physical examinations, background checks, and medical certifications. But tests focus largely on physical issues, with mental illnesses identified only via the pilots鈥� own admission of the problem, or their overt behavior.

鈥淭here鈥檚 no formal psychological testing that is done routinely,鈥� Dr. James Vanderploeg, whose practice includes performing FAA examinations, .

According to , medical examiners are not required to perform full psychiatric evaluations, but are expected to 鈥渇orm a general impression of the emotional stability and mental state of the applicant.鈥� Doctors are charged with reviewing medical histories for any signs of depression, anxiety, suicidal tendencies, or substance abuse, as well as gathering information that might reveal the pilot鈥檚 state of mind through conversation.

Mental health issues for being denied an aviation license, which is why disclosure remains taboo among employees who fear discrimination or lack of trust from colleagues and bosses. that the medical notes discovered in Lubitz鈥檚 apartment came from at least two doctors 鈥� suggesting he may have been shopping around for a favorable diagnosis.

Some studies have shown that among adult Americans, 18 percent experience an anxiety disorder in any given year, while 9 percent have symptoms consistent with major depression, . Worldwide, depressive disorders are the second-leading cause of disability, the latest , and .

Having airlines require rigorous psychological testing of pilots is, however, considered by some to be impractical. According to Wired, there are 50,000 airline pilots in the US and Canada alone.

Testing each of them annually simply is not feasible, says Dr. Diane Damos, who holds a doctorate in aviation psychology and has been working on the pilot selection process since 1970. Having a tool that would reliably root out and prevent the exceedingly rare instance in which a pilot might commit suicide by crashing a plane is 鈥減robably beyond our capabilities.鈥�

If every pilot was tested rigorously, it would inevitably generate false positives, Damos says. 鈥淵ou鈥檙e gonna flag a lot of people who are normal but for some reason or other, on that day, give you a strange response.鈥� You鈥檇 have to follow each one, check up on them, monitor them, 鈥渁nd that鈥檚 a tremendous cost and effort.鈥�

There is some self-policing among pilots when it comes to one another鈥檚 state of mind.

Members of a carrier鈥檚 pilot corps tend to take note when troubling events such as death, divorce, or finances might affect a colleague鈥檚 performance or behavior, Dave Funk, a former Northwest Airlines captain now with aviation security consulting firm Laird and Associates, .

鈥淏efore 1990, that was not the case,鈥� Mr. Funk said. "But things like pilots flying drunk changed all that. We鈥檝e gotten very good working with management and senior management, and the company [recognizes] that we鈥檙e people, not machines.鈥�

Unfortunately, it seems that Lubitz 鈥� like JetBlue captain Clayton Osbon, who in 2012 鈥� was among those who slipped between the cracks.

Though Lufthansa chief executive Carsten Spohr told The New York Times Thursday that Lubitz 鈥渨as 100 percent flightworthy鈥� when he was hired in 2013, Mr. Spohr also noted that the pilot had taken a months-long break from his training six years ago. that according to German media, Lubitz had suffered from depression in the past. Germany's strict medical privacy laws may have prevented Lufthansa from fully knowing about his health problems.

At the time of the crash, Lubitz was also being treated by neurologists and psychiatrists for his illness, , citing an unnamed source.

One solution appears to go back to the idea of encouraging employees to disclose their mental disorders. Depression 鈥� or mental illness in general 鈥� needs to become something a pilot can be open about, and receive treatment for, without fear of discrimination, Dr. Damos told Wired.

鈥淸T]hat鈥檚 something we can encourage,鈥� she said. 鈥淚t incurs very few costs, and I think would be very beneficial.鈥�