Andreas Lubitz did not hide his severe depression from everyone. He told a doctor – and that doctor wrote a note excusing Lubitz from work.

Tragically, that piece of paper went no further than Lubitz’s pocket.

The Germanwings co-pilot flew as scheduled March 24 and, prosecutors say, deliberately downed the plane into the French Alps. His suicide claimed an additional 149 lives.

Should the doctor have spoken more loudly than letterhead stationery?

Probably, says Charles Myers, associate professor of counseling in the NIU Department of Counseling, Adult and Higher Education.

“I can’t speak for French or German laws,” Myers says, “but in the United States, if we have identifiable potential victims, then yes, we need to let them know and let the authorities know.”

In Illinois, the Mental Health and Developmental Disabilities Confidentiality Act (740 ILCS 110/1) holds that “when, and to the extent, a therapist, in his or her sole discretion, determines that disclosure is necessary to initiate or continue civil commitment or involuntary treatment proceedings under the laws of this State or to otherwise protect the recipient or other person against a clear, imminent risk of serious physical or mental injury or disease or death being inflicted upon the recipient or by the recipient on himself or another.”

U.S. laws vary from state to state, Myers adds, but the generally accepted need for mental health practitioners to sound the alarm about potentially dangerous patients has its roots in a California homicide.

Tatiana Tarasoff, a student at the University of California, Berkeley, was murdered Oct. 27, 1969, by UCB grad student Prosenjit Poddar. Earlier that year, Poddar became angry when Tarasoff refused to engage in a romantic relationship with him. He then sought psychological treatment from Dr. Lawrence Moore, an employee of the university’s Cowell Memorial Hospital.

During their seventh session – Aug. 20, 1969 – Poddar confided in Moore that he planned to kill Tarasoff.

Moore notified police, who brought the grad student in for questioning but soon released him. No one else, including Tarasoff or her parents, was warned about Poddar’s threat.

Sixty-eight days later, Tarasoff was shot with a pellet gun and then stabbed to death.

Her parents later sued in a case that ultimately reached the California Supreme Court, which concluded in 1976 that Moore and his colleagues violated their duty to “use reasonable care to protect” Tarasoff.

It led to The Tarasoff Rule: “When a therapist determines, or pursuant to the standards of his profession should determine, that his patient presents a serious danger of violence to another, he incurs an obligation to use reasonable care to protect the intended victim against such danger.”

Four decades later, though, Myers says the question of whether to report is never easy.

Unless a patient actually confesses that “I’m really thinking about killing myself or crashing a plane into a mountain,” he says, the question of whom to warn is difficult.

Talk of suicide prompts counselors to assess the threats and determine the seriousness of the intent and the danger. In those cases, it’s clear whose life is at risk. When a patient talks of harming others, however, doctors and counselors cannot warn those targets if they do not known specific names.

Furthermore, labels regarding mental health can become irreversible.

“I’m always cautious to only identify those individuals who really are at risk. There’s such a stigma about mental illness,” Myers says.

“Twenty-six percent of Americans in any given year will receive a diagnosis, and almost 50 percent will over a lifetime. It might be uncomplicated, such as a bereavement, or someone might have that one time in their life where they have a major depressive episode,” he adds. “We always want to put things into nice neat packages, but unfortunately, it’s not always that neat.”

Further complicating the equation, at least in the realm of pilots, is an apparent resistance to altering the status quo.

According a story reported April 1 by NBC News, policies for screening U.S. pilots have “changed little in recent decades.”

Meanwhile, the story quotes former Airbus A320 captain John Cox told NBC News as saying that “a knee-jerk reaction to the tragedy in the Alps is not appropriate, wise or necessary.”

“It would be a mistake, a large mistake, to dramatically change the existing process until a careful review, discussion, and evaluation is undertaken,” the NBC News story quotes Cox. “It is not a simple case of a doctor picking up the phone can calling the airline. There is nothing simple about the process whereby a doctor violates a patient’s confidence, or the subjectivity involved.”

But Lubitz’s doctor did not pick up the phone, and Myers says he can’t imagine how that counselor is coping with his decision to not make that call.

“He had some information,” Myers says, “and he’s probably wondering, ‘What if I had made that contact?’ He’s probably dealing with a lot of guilt and probably seeking out some counseling of his own.”

Were the German doctor to visit Myers, he would know immediately the boundaries of the doctor-patient relationship.

“Part of our code of ethics calls for us to be very upfront in the beginning,” Myer says. “We do a professional disclosure. We talk about confidentiality – and its limits. We inform the client that if we feel they’re a danger to themselves and others, then that may be something we need to report.”

Clients to the Department of Counseling, Adult and Higher Education’s Community Counseling Training Center are also presented with a document that details those limits in print. Counselors review every section of the document with the clients and elaborate when necessary to ensure that each client understands each section.

“If I have someone I am concerned about, I would say, ‘Remember when we talked about confidentiality and its limits? This is one of those times when I need to contact someone,’ ” Myers says, “and I would invite the client to be present when I call that someone. Trust is a major thing. If people are going to participate in mental health services, they need to trust their counselor.”