Investigators say it is not easy to balance patients' privacy rights with public safety

Seeking to ensure that suicidal pilots can't crash their jets, French authorities investigating last year's Germanwings crash are urging new reporting requirements for doctors treating pilots, and new measures to keep pilots from hiding mental health issues.

The recommendations are delicate. The investigators from France's BEA air accident agency acknowledged on Sunday that it's not easy to balance patients' rights to medical privacy and public safety, and said they don't want to stigmatize people suffering depression.

But they argue that aviation authorities around the world need clearer rules, after Germanwings co-pilot Andreas Lubitz locked his captain out of the cockpit and slammed Flight 9525 into an Alpine mountainside on March 24, 2015. All 150 people aboard were killed.

Lubitz had suffered from depression in the past, but authorities and his airline later deemed him fit to fly. What they didn't know is that his mental health troubles had returned.

The final crash report released by the BEA on Sunday lays out in chilling detail how bad things had become.

Lubitz consulted dozens of doctors about perceived vision troubles and sleeplessness in the months leading up to the crash. One doctor prescribed antidepressants, including one whose side effects can include suicidal tendencies. Another doctor referred Lubitz to a psychiatric clinic two weeks before the crash, suspecting a potential "psychotic episode", said Arnaud Desjardin, leader of the BEA's Germanwings investigation.

Lubitz reported none of this to Germanwings or its parent Lufthansa. Neither did the doctors, citing Germany's strict medical confidentiality laws.

The BEA said those rules need to change.

Among a list of 10 safety recommendations to international, European and German aviation authorities, the BEA said they should draw up new rules requiring medical workers to warn authorities when a pilot's mental health could threaten public safety.

It suggested more rules like those in the United States and some other countries, which allow use of some antidepressants under medical supervision, to encourage pilots to seek treatment and come forward about depression.

Germany's confidentiality laws prevent sensitive personal information from being widely shared, though doctors are allowed to suspend patient privacy if they believe there is a concrete danger to the person's safety or that of others.

Desjardin said German doctors fear losing their jobs or potential prison terms if they unnecessarily report a problem to authorities. The doctors who treated Lubitz for depression and mental illness also refused to speak with the BEA investigators, citing medical privacy - and complicating the investigation.

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Johann Reuss of Germany's air accident investigation agency said "there is no need to change the law". Reuss said "it might not be easy" to loosen the privacy rules and suggested that authorities instead focus on giving doctors checklists to prevent similar scenarios with pilots.

The BEA safety recommendations also include special insurance options and peer support groups for aviation workers, to ease concerns about losing a job that pilots with mental health issues face.

Even though Germany's medical privacy laws are stricter than those in the US, it's hard to imagine a US doctor reporting mental health concerns about a pilot to an airline or the FAA without his patient's permission, said John Gadzinski, an veteran US airline pilot and safety consultant.

The underlying problem is that society hasn't figured out how to deal with mental health in a way that protects both the patient and society, Gadzinski said.

"I think the Germanwings accident is more of a symptom than the major issue," he said. "The major issue is how do we deal with mental health."