Psychological evaluations of pilots are under scrutiny following recent claims from French prosecutors that the co-pilot of Germanwings Flight 9525, Andreas Lubitz, intentionally crashed the passenger plane into the French Alps last week.

According to French prosecutors, documents found in Lubitz’s home reveal he was being treated for a medical condition he hid from his employer, with one doctor’s note showing he was excused from work on the day of the crash that killed 150 people on board. In a press conference last week, Carsten Spohr, CEO of Germanwings’ parent company Lufthansa, maintained Lubitz passed both his medical and psychological tests and his pilot abilities were never questioned.

How airlines screen pilots for physical and mental health varies widely by both country and company. Lufthansa carries out in-depth psychological testing and interviews before candidates begin the company’s two-year pilot training program. Once pilots qualify, the company has no formal psychological testing program, but has a self-monitoring and reporting system that encourages pilots experiencing problems with themselves or observing issues with their colleagues to report them to the company without punishment. No report was filed from or for Lubitz.

The United Nations’ air safety body, the International Civil Aviation Authority, mandates screening procedures before and during training but has few rules concerning psychological testing after a pilot qualifies. In the United States, the Federal Aviation Administration requires pilots to state any mental disorders and health issues during annual or biannual medical reviews. The doctor conducting the examination can order formal psychological testing if deemed necessary.

However, according to Erin Bown, chairwoman, department of behavioral and safety sciences at Embry-Riddle Aeronautical University, in a USA Today report, the tests are not involved enough to provide doctors with the confidence to prevent someone from operating aircraft.

“It’s not like a blood test that tells you you’re sick,” Bowen told USA Today. “That level of ambiguity, between the legal liability and the moral liability of telling someone they can’t do their job because you think that a test said they might be a risk — the field is not there yet.”

As more becomes known about Lubitz’s mental state, airlines around the world and aviation authorities are reviewing and reassessing psychological screening procedures for pilots.

To better guarantee in-flight safety, Lufthansa and its subsidiaries as well as many other European airlines are implementing procedures that require two people in the cockpit at all times. The “rule of two” is already in place in the United States.

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