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Viewpoint:  Mental Illness, Lufthansa, Andreas Lubitz
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Viewpoint: Mental Illness, Lufthansa, Andreas Lubitz

HIPAA and stigma are barriers to sharing mental health information. Both good and bad.

In light of recent news events, Mia Ross BSN RN and Cynthia Jaffe FNP DC open the conversation about mental illness, Lufthansa, Andreas Lubitz, and the health provider dilemma.


There is evidence that the pilot, Andreas Lubitz, who crashed Germanwings Flight 9525 into the French Alps last week, suffered from severe depression and mental illness.  A recent search of Lubitz’s apartment left police officers with notes from a doctor at the time of the crash stating that Mr. Lubitz was too ill to work.  Although Lufthansa (the airline company) found an archived email from Lubitz circa 2009 admitting his mental illness as a rationale for missing a training session, it was never formally discussed.  Should it have been?  Although aviation regulatory agencies have health screening processes that determine the physical and psychological fitness of a pilot, the gatekeeping system has relied heavily on pilots’ voluntary disclosure of mental illness.

Granted, there is fear in sharing personal mental health information, and for good reason.  People suffering from mental illness have been stigmatized with stereotypes, prejudices, and discrimination.  Plus, studies have shown that the majority of Americans consistently hold biased attitudes about mental illness.  Current views of mental illness make it difficult for those afflicted to enter the competitive workforce, get promoted, or simply obtain a raise.  It’s no wonder why confidentiality laws are so stringent concerning personal mental health information.

In the United States, HIPAA (Health Insurance Portability and Accountability Act) is the legislation protecting personal health information.  Passed by Congress in 1996, it stipulates how medical records are used and disclosed.  Under this act, a provider cannot give private health information to an employer or even a family member without the patient’s consent.  However there are exceptions.  Under the Privacy Rule, doctors are permitted to share medical information if it is believed that the “patient presents a serious threat to self or others.”  While doctors are allowed to divulge personal health information in these circumstances, due to liabaility concerns, they are not obligated to.  Another interesting fact is that psychotherapy notes are given special protection. They are not maintained in a general medical record.  Perhaps this is why the pilot’s mental health information was not forthcoming?

It’s no surprise that people, including Lubitz, aren’t jumping at the chance to explain their sensitive mental health illnesses.  With heavy liability concerns, it also makes sense why medical provider’s are hesitant to speak up.  As more information about this tragedy is brought to light, we will hopefully use it as a learning tool for dealing with mental illness in the workplace.  We need brave individuals to be open and honest about their mental health.  We need employers to embrace the fact that mental illness does not mean someone cannot thrive at work.  After all, one in four adults will suffer some form of mental instability.  In order to overcome stigma and prevent tragedies like this (and this), we need to stop blaming individuals and start asking what we can do to help to make discussions around mental illness easier.


  • Great article, Mia.

    I wonder- the NY Times article said he was co-pilot of this plane. Doesn’t that mean there would also be the pilot on board? Also, what actually made the crash happen? Has that been determined? I only ask these things because I wonder if his illness truly impacted the fact that the plane went down or are they just looking for someone to blame?

    It’s true that 1 in 4 will have some form of mental illness, but I also would imagine that it also likely that a pilot with a heart condition (and on medication for it) could have a heart attack while flying.

    I have mental illness and substance abuse in my family. I’ve never been one to hide that. I feel that sweeping things under the rug just make it worse. So what we need is more acceptance of mental illness- have it be as ‘OK’ to have that as it is to have diabetes. Both can kill you; and neither one is ‘worse’ than the other.

    Thank you for such a thoughtful post to help us reflect on these topics.

  • Nurse Mia Nurse Mia says:

    Thanks for your comment, Elizabeth. There are new findings surfacing every day for this case. Hopefully it will allow us to speak more openly about mental illness as a disease. Thank you for sharing your personal story. Let’s continue the dialogue with our patients, families and friends.

  • Thanks for addressing this topic Mia. You are spot on!

    I would like to add that more nurses with mental illness have to be comfortable enough to disclose….so many are “scared silent”.

    In a blog post, I share a novel approach developed by students at Stanford– to encourage open expression of mental health issues though well being teams and artistic expression.
    It may be something nursing needs to consider.

  • says:

    Cynthia Jaffe FNP DC and Mia Ross BSN RN contributed to this article. We appreciate both writer’s efforts in opening the conversation and increasing awareness of mental illness.

  • Mia Ross BSN RN Mia Ross BSN RN says:

    Thanks for sharing your post, Donna. I really like the idea. I agree with you– nurses need to speak up. Empathy only grows stronger with openness and honesty.

  • I appreciate the timeliness of this article. Mental health issues are often swept under the rug, and hidden, as if this is a deep dirty secret, and tied with shame. I live everyday right now with a son who has PTSD and TBI from Iraq. This has contributed to my burnout issues in nursing to be honest. Until I armed myself with tools to have an inner healing, dealing with someone on a daily basis with mental illness is taxing and affects more than the one going through it. This is a very sad issue indeed. So many lives lost. It almost seems somehow conflicting that medical health professionals are ALLOWED to share information if they feel people lives could be in danger, but would have liability issues to deal with if they had a credible belief to be such information to be accurate.

    I found for myself personally, obtaining those tools, including learning about whole-person wellness, has been key to dealing with issues surrounding my son’s state of mental health. I’ve become more compassionate and feel more compelled now to look not at mental health issues as a hidden secret, but as illness that needs to be treated, both medically and holistically.

    Joyce Harrell, RN, OCN
    Wholistic Wellness Coach

    • Gail Ingram BSN RN Gail Ingram BSN RN says:

      I appreciate your heartfelt and thoughtful comment on this post. You are right, there is a lot of shame associated with mental illness. You also bring up a good point about providing self-care while being supportive of a friend or loved one who has a mental health diagnosis. Generally, those with mental health disorders feel shame and don’t disclose their illness with others. Historically, when they do, people don’t understand what is required to be supportive or they simply bail on the situation out of fear. Those who do stick around are often left feeling exhausted by their efforts to care for and support someone with a mental illness. Self-care for both parties is key! I’m glad you are able to share your personal discoveries for others in need. So important.

  • Avatar Cynthia Jaffe D.C., NP says:

    I love the comments. They certainly do help to open dialogues on mental illness. Hopefully, such conversations encourage professionals to develop strategies to reduce stigma and discrimination while encouraging the teaching of clients the how and when to disclose. Thank you.

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