TIME Innovation

Five Best Ideas of the Day: December 22

The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

1. To meet the growing need for marketable skills in college, technology companies are launching metric-driven accelerated learning programs.

By Shawn Drost in TechCrunch

2. NASA just e-mailed a wrench to the International Space Station.

By Mike Chen in Medium

3. By analyzing Twitter content, researchers are gaining a better understanding of mental illness trends.

By Phil Sneiderman at Johns Hopkins University

4. Law schools are struggling to teach students how to deal with rape, and survivors of sexual assault could suffer.

By Jeannie Suk in the New Yorker

5. As USAID is employed around the world to address political crises, the agency’s true mission might lose focus.

By Nathaniel Myers at the Carnegie Endowment for International Peace

The Aspen Institute is an educational and policy studies organization based in Washington, D.C.

TIME Ideas hosts the world's leading voices, providing commentary and expertise on the most compelling events in news, society, and culture. We welcome outside contributions. To submit a piece, email ideas@time.com.

TIME Mental Health/Psychology

Most People With Depression Aren’t Getting Treatment, Survey Finds

The latest depression report shows that the majority are suffering in silence

The latest statistics on depression in the U.S. don’t paint a picture of progress, though the condition is common. Nearly 8% of Americans over age 12 have recently been depressed, finds the new report from the National Center for Health Statistics (NCHS) at the Centers for Disease Control and Prevention, but the vast majority aren’t actively getting treatment.

Of those surveyed between 2009 and 2012, about 3% with depression reported having severe symptoms, and nearly all of these people (90%) said their depression made it difficult to work, go to school or participate in their normal activities at home and in other social settings.

Women are more likely than men to be depressed at any age, and women between 40 and 59 years old had the highest rates of depression among the adults studied. While the survey did not delve into the possible reasons for depression, other studies suggest that for many women in this age group, the pressures of balancing work and family responsibilities, including children as well as aging parents, may lead to added mental health burdens.

Poverty seems to be a factor in depression as well. Those living below the federal poverty level were more than twice as likely to be depressed than those living above the line; this trend applied regardless of race or ethnicity.

But what was most concerning to study co-author Laura Pratt, an epidemiologist at the NCHS, was that 65% of people with severe symptoms of depression were not getting help from a mental health professional. “The fact that people aren’t getting treatment is disturbing,” she says. “People with severe depression should be getting therapy from a mental health professional, and they should also in a lot of cases be on a more complicated medication regimen that requires a psychiatrist to treat them. The fact that only 35% have seen a mental health professional in the last year was pretty alarming.”

The data should raise awareness about the prevalence of depression, she says, and hopefully stress the importance of encouraging those with depression to seek help. “It’s serious, it really affects your life and we need to figure out a way to get people treated appropriately,” she says.

TIME Crime

Texas Plans to Execute a Schizophrenic Man Who Tried to Subpoena Jesus

Scott Panetti
In this Nov. 19, 1999 file photo, Texas death row inmate Scott Panetti talks during a prison interview in Huntsville, Texas, where he is on death row for the 1992 murder of his wife's parents. Panetti's execution is set for Dec. 3, 2014. Scott Coomer—AP

Scott Panetti, who is scheduled to die Wednesday, has a long history of severe mental illness

In 1992, Scott Panetti shaved his head, dressed himself in camo and fatally shot his in-laws in front of his wife and daughter. Afterward, he put on a suit and surrendered to police.

At his trial, Panetti wore a cowboy costume and acted as his own lawyer, waiving his right to counsel. He applied for 200 subpoenas that included John F. Kennedy and Jesus Christ. He asked prospective jurors whether they had any Indian blood in them. His opening statement referenced demons. And he referred to himself as Sergeant Iron Horse when he confessed to killing his wife’s parents. It wasn’t Scott who killed them, he said. It was Sarge.

Panetti’s defense appeared to be that of a seriously ill man. And by most accounts, he was. First diagnosed with early schizophrenia in 1978, Panetti had been in and out of a dozen mental hospitals over 14 years, regularly determined to have paranoia, depression, delusions and hallucinations and eventually deemed disabled by the Social Security Administration, qualifying him for monthly benefits before he turned 30. Since that first diagnosis, Panetti came to see life as a cosmic battle between good and evil, one in which he—or Sarge, or the other voices in his head—played a role.

In one instance, Panetti’s first wife came home to find that he had buried his furniture in the front yard because he believed he needed to purge Satan from the objects. In an affidavit, she said she believed her husband should be involuntarily committed and that he had become “obsessed with the idea that the devil was in our house.” Panetti’s explanation for killing the parents of his second wife was similar, according to his lawyers and court documents: the shootings were “Sarge’s” attempt to get rid of the devil he believed was inside his in-laws.

(MORE: Ohio Looks to Shield Lethal Injection Drugmakers)

In 1995, a jury found Panetti guilty and sentenced him to death. That sentence comes due Wednesday, when Panetti is scheduled to die by lethal injection. To some, it will be justice finally being served. But to Panetti’s lawyers and other supporters, the planned execution is unconstitutional, and evidence of a capital punishment system in dire need of reform.

Panetti’s attorneys are appealing to the Fifth Circuit Court of Appeals for a last-minute stay of execution, arguing that Panetti doesn’t understand he’s being executed for the double murder. They say Panetti hasn’t been given a competency hearing in seven years, and they believe his mental state has deteriorated since then. Panetti’s attorneys are challenging an earlier denial by an appeals court to hold a competency hearing, while also seeking a stay of execution from the Supreme Court on the grounds that putting to death someone who is mentally ill is unconstitutional under the Eighth Amendment’s ban on cruel and unusual punishment.

So far, courts haven’t been receptive to those arguments. Several witnesses for the state of Texas have testified that Panetti is competent and has an understanding of his crime. The state has provided hours of audio recordings of Panetti discussing the murders in which he “spoke rationally, demonstrated a fairly sophisticated understanding of his case, and discussed in an intelligent manner the death penalty and its moral implications,” according to court documents.

Kathryn Kase, executive director of the Texas Defender Service who is representing Panetti, questions those accounts and says that his history with mental illness alone should be enough to prevent him from being executed.

(MORE: Utah Looks to Old Execution Method: Firing Squad)

“This is not a situation where a guy gets admitted to a hospital once and comes out and commits a crime,” Kase says. “These were multiple hospital admissions over a 12-year period. This is a pretty astonishing and well-documented history of mental illness. Nobody exists for 36 years like this in an effort to get off the hook of criminal responsibility.”

Dozens of mental health professionals and organizations have come out in support of clemency for Panetti, including the National Alliance for the Mentally Ill and Mental Health America. But time is running out.

Panetti would be the 11th inmate executed in Texas this year, the most of any state. For years, Texas has killed more death row inmates than any other state.

Kase, who visited Panetti a couple weeks ago, says his mental health is worsening, possibly due to stress related to the upcoming execution date.

“He is extremely paranoid, and he is delusional,” Kase says. “And these delusions are that the prison wants to kill him to prevent him from preaching the gospel on death row or telling others about corruption at TDCJ [the Texas Department of Criminal Justice]. We’re not psychologists. We’re not mental health professionals. But we do know we’re seeing something really terrible happen.”

Read next: 103-Year-Old Texas Woman Fights to Keep Her House

TIME Education

Don’t Segregate My Special Needs Child

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andresr—Getty Images

But by not integrating children with mental illness into the general school population, we contribute to the ongoing stigma

This week, all my friends are posting Facebook and Instagram pictures of their adorable children, whose forced grins and too-neat clothes suggest that the kids aren’t quite as thrilled as their mothers about the inevitable return to school. But for parents of children who have a mental illness or a developmental disability like autism, back-to-school preparation feels more like manning a war room, complete with strategies, maps and complex diagrams. The enemy? Unfortunately, it’s likely to be the very people tasked with helping your child to succeed: his teachers and administrators.

If your child has behavioral symptoms associated with his or her diagnosis, it’s likely that you’ve experienced that painful phone call—probably right in the middle of an important work presentation–unleashing an arsenal of assessments and tests and meetings with teachers, counselors and administrators. The end product is likely either a Section 504 plan, named for that section of the Rehabilitation Act of 1973, or the dreaded Individualized Education Program (IEP), which is essentially a contract with your child’s school to ensure that he or she receives a free and appropriate public education (FAPE) under The Individuals with Disabilities Education Act (IDEA).

Have I lost you with the acronyms yet? Even if you earned your Ph.D. in astrophysics, you may soon discover that getting an appropriate education for your special needs child is harder than rocket science. Parents are forced to become instant experts, not only in the complexities of their child’s condition, but also in disability rights. I hate to break this to you, but the school district is not your ally in this fight for your child’s education. Neither are the parents of so-called neurotypical children, who don’t understand why their children’s learning environment should be disrupted by your “weird kid” (yes, I have heard that phrase more than once about my bright, funny, sensitive boy).

Combine that already adversarial relationship between parents and schools with well-intentioned but misguided zero-tolerance policies, and you find school districts creating IEP solutions like the one they used for my child: pull-out programs for all children on behavioral IEPs, complete with padded isolation rooms. At first glance, this might seem like an ideal solution: the neurotypical kids get to learn without disruptions, and the students with mental illness and/or developmental disabilities have a safe environment with additional dedicated support from teaching assistants. And since it’s a contained program, it saves the district money in the short term—and we all know how thin most school districts are stretched.

But I would suggest there is an uglier word for this approach to education: segregation.

What is the logical consequence of taking 100 students with behavioral and emotional symptoms between the ages of 12 to 21, 95% of whom are male, and putting them together in a program that will not allow them to earn a high school diploma or to learn to interact with neurotypical peers?

In our society, too often the consequence is prison.

Zero-tolerance policies were developed in the wake of the 1999 Columbine shootings as a way to reassure parents that their children were safe in public school. Statistically speaking, they are safe, and they were safe before zero-tolerance policies too. Just like your chances of dying in an airplane crash are far less than the chances of dying in a car accident, we ascribe far more risk to the school environment than actually exists because of the media ever-presence of statistically rare mass shootings like Columbine or Newtown.

But by not integrating children with mental illness, which admittedly sometimes manifests through challenging behavioral symptoms like unpredictable rage, into the general school population, we are contributing to the ongoing stigma of mental illness. Worse, more often than not, we are condemning these children to prison.

Children like my son are not “bad” kids; in fact, with the right support and treatment plan, they can survive and thrive in public school, and beyond. As a society, we should be investing our resources in educating all of our kids. Early prevention and treatment can change the entire course of a child’s life. Instead of a life on the streets or in jail, a child with mental illness can graduate from college and have a successful career. This school year, I hope that parents, teachers, administrators and legislators will do the math. By complying with IDEA and providing appropriate education to all children, we can save money—and lives—down the road.

Liza Long is a mother, educator and author of The Price of Silence: A Mom’s Perspective on Mental Illness, from Hudson Street Press.

TIME Parenting

ADHD in Adulthood: To Prepare for a New Baby, I Had to Prepare My Mental Health

The author with his son Jack.
The author with his son Jack. Courtesy Timothy Denevi

Soon enough we’ll find ourselves short on sleep and patience—in anticipation I’ve been trying to make the necessary preparations

This fall I’m expecting the birth of my second child, a daughter. Over the past months she’s grown from the size of a kumquat, to the size of a banana, and recently achieved the esteemed gradation of cabbage. From what I can tell the final step is cantaloupe—and then, having triumphed through the full prenatal catalog of produce, Sylvia Denevi, the newest member of our family, will be here.

For now the focus is on preparation. My wife and I live in a suburb of Washington, D.C., with our seven-year-old son, Jack. Together we’ve begun to make the expected adjustments. The guest room is now a nursery. The garage has been searched and reorganized, its assortment of baby gear emerging again like relics from a previous life.

I see my preparation for Sylvia’s arrival as love: the first opportunity I have to tell her I love her, that she’s precious to me, that I’ll do whatever it takes to be the best father I can be. I’ve also been taking the steps to prepare myself, within the context of mental health, for the change that’s about to come.

Growing up in the 1980s and 90s, I was part of the first generation of Americans to be diagnosed with Attention Deficit-Hyperactivity Disorder. There was never really a question of whether or not I had ADHD, and after years of being the most active, over-sensitive, and impulsive person in the room—after a childhood of psychiatric and psychological treatments, some of which helped, others making things worse—I graduated from college and entered the workforce, at which point my personality no longer seemed as exaggerated and out-of-whack as it had once been. In the end I figured that whatever ADHD was, it was a part of the past.

That understanding changed when Jack was born. At the time I was 27. All at once I found myself surrounded by an enormous amount of conflict—the same kind I used to experience, growing up, when my behavior would drive the people around me crazy. It was uncanny: my wife would say something, and I’d overreact, and she’d say something else, and then I’d be shouting, and glaring, and shouting again. We argued constantly over the new demands: diaper changes, midnight feedings, who got to take a midday nap and who had to do the grocery shopping. Soon enough our lives began to resemble a ledger. I did this and you didn’t do that. My time is just as important than yours! You want to go to the gym for an hour but I can’t play softball tomorrow night? Instead of finding a way to share the new amount of work that was required of us, we spent hours fighting.

My wife is a scientist, thoughtful and logical, traits that have always fit well with my more energetic demeanor, and up until Jack was born our relationship was steady. But now it seemed as if our personalities had switched; at the end the day she’d be yelling at me and I’d turn sullen and depressed.

I felt overwhelmed. Like I couldn’t do the simplest things. It was as if I was underwater, gazing up toward a normal reality—one in which every other new parent seemed to deal well enough—while I was the abnormal one, a failure, once again a problem for the people who loved me. It was the most distant I’d felt from my wife since we’d been together.

“You’ve never been like this,” she told me. And while there were other variables involved—we’d moved across the country right after Jack was born, were at precarious points in our careers, and didn’t have extended family around to help—it was clear that if I didn’t act soon I’d run the risk of damaging my relationship with my family in a way that couldn’t easily be undone.

Eventually I went to see my family doctor, and then a psychiatrist. When I explained my moodiness and agitation they said the same thing: ADHD, even in adulthood, tends to make you much more sensitive than other people to your surrounding environment. If you’re constantly feeling restless and impulsive, you might react to demands in a disproportionate way—and there are few things more destabilizing than the birth of a child.

There wasn’t one thing I could do to magically make things better, they told me—that’s not how mental illness works. Instead, they recommended a series of steps. For the first time I started exercising regularly; I paid careful attention to my sleeping and eating habits; I even went on a low dosage of Adderall, which helped to make everything seem less drastic and overwhelming.

Eventually things improved, but not right away. It was a genuinely hard stretch for my wife and I—part of the reason, no doubt, we’ve waited a while to have another baby. But now, seven years later, as the summer turns to fall and Sylvia continues in her ascension through an aisle at the grocery store, we can take solace in the fact that we both have a much better idea of the changes to expect.

Soon enough we’ll find ourselves short on sleep. And time. And stamina. I’ll be less resilient in terms of mood and patience. In anticipation I’ve been trying to make the necessary preparations.

I started psychotherapy, visiting a psychologist regularly both by myself and with my wife. I’ve set up my exercise schedule with an emphasis on cardiovascular activities like running and tennis, the most beneficial to mental health. I’m trying to cut down on social events and alcohol—two things I very much enjoy. And I find myself making observations about my own sleeping and eating that are usually directed at seven-year-olds: Do you really think it’s a smart decision to start another television show this close to bedtime? If you’re sweating and your stomach already hurts, maybe that fifth piece of pizza isn’t the best decision…

I’ve also talked with my psychiatrist about the possibility of making a medication adjustment. (I hate being on medication anyway, and prefer to take as low as dose as possible.) The Adderall I’m on is the instant-release kind; my current approach is to take it ahead of time when I know I’m about to find myself in situations that are especially overwhelming or agitating—a birthday party for one of Jack’s friends at Chuck E. Cheese; driving through an unfamiliar snarl of D.C. traffic—but what happens when the foresight necessary for such an approach is already eroded by a lack of sleep and/or a screaming infant? I can try a time-release version, or a new medication.

One of the most difficult aspects of mental illness, especially within the context of parenthood, is finding a way, when it comes to your life and its influence on the people you love, to do more good than harm. In the end you can’t possibly predict what’s really coming: the moment in the future that will dislodge you from the balance you’ve worked so hard to achieve. It might be a random calamity, or one you’ve personally brought about. But the incredible truth is that it’s already on the way. And against such a prospect, what good can something like a therapist or exercise or a low-dosage pyschostimulant actually do?

This isn’t to dismiss the idea of effort. In fact it’s the opposite: imagining all the things that could go wrong or right for my family, I can’t help but find solace in action. I’m lucky that there are steps I can take, and that often enough they do tend to help. What matters is the act itself: an expression of love for the most important people in my life. After all, there are many ways to show how you feel; is it so terrible that one of mine happens to take the form of self-preparedness?

A few weeks ago, when Jack was looking through the toys in his closet and trying to guess which, if any, his future sister might enjoy, he turned to me and said, “Daddy, I have a question.”

I could tell by the line of his mouth that it was something he’d been considering for a while. “Yeah?”

“What do you think Sylvia will be like?”

Briefly the image of a pumpkin with very long eyelashes flashed into my mind, but in the next instant was something outside the parameters of size and shape: an emotion similar enough to anticipation. “A little like you,” I said. “And like Mommy. A little like me, too, I think.”

He nodded.

“That’s the exciting part,” I added. “Whoever she’s going to be, she’ll be herself.”

Hyper, by Timothy Denevi Courtesy Simon & Schuster

Timothy Denevi is the author of Hyper: A Personal History of ADHD, out this week from Simon & Schuster. He received his MFA in nonfiction from the University of Iowa. He lives near Washington, DC and teaches in the MFA program at George Mason University, where he’s a visiting writer.

MONEY health

These Mental Health Charities Have the Most Impact

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BEVERLY HILLS, CA - JULY 29: Robin Williams arrives at the Television Critic Association's Summer Press Tour - CBS/CW/Showtime Party at 9900 Wilshire Blvd on July 29, 2013 in Beverly Hills, California. (Photo by Steve Granitz/WireImage) Steve Granitz—WireImage

One way to pay tribute to Robin Williams is to contribute to these top-rated charities that help people who struggle with depression and suicidal thoughts.

The suicide of comedian Robin Williams shows just how hard a battle with depression can be, and just how high a toll it can take. And while we may be tempted to share our favorite scenes from his movies, standup specials, or TV shows as way to pay tribute, perhaps another way would be to reach out and help those also struggling with mental illness.

With the help of Charity Navigator, MONEY identified mental illness and suicide prevention charities where your dollars will be put to good use. These organizations received high ratings for their extremely high levels of accountability and transparency for donors, how well they have sustained their programs, and the high percentage of their revenue spent on programs and services rather than administrative or fundraising costs.

So if you would like to donate to help those struggling with mental illness, consider one of the following groups.

American Foundation for Suicide Prevention
This national charity works to understand and prevent suicide by supporting research looking at the causes of suicide, helping those who have suicidal thoughts or those who have lost someone to suicide, and working with federal and state government on policies to prevent suicide and care for those at risk.

Brain & Behavior Research Foundation
This foundation awards scientific grants to those working to make discoveries in understanding the causes and improving the treatments of mental disorders, such as depression, schizophrenia, anxiety, autism, and bipolar, attention-deficit hyperactivity, post-traumatic stress, and obsessive-compulsive disorders. They’ve awarded close to $310 million to more than 3,700 scientists in the past 25 years.

Treatment Advocacy Center
This charity works to improve the treatment of severe mental illness by promoting policies and practices for the delivery of psychiatric care and supporting the development of treatments for and research into the causes of psychiatric illnesses, such as schizophrenia and bipolar disorder.

Trevor Project
This national organization, founded by the creators of the Academy-award winning short film Trevor, provides crisis intervention and suicide prevention services to lesbian, gay, bisexual, and transgender teens and young adults.

 

 

 

MONEY

Why You Probably Have More Mental Health Care Options Than You Think

Rorschach test with dollar signs
Sarina Finkelstein (photo illustration)—William Andrew/spxChrome/Getty Images

The suicide of comedian Robin Williams shows how tough it can be to overcome mental illness. The good news is that mental health care coverage is now more widely available, thanks to recent insurance rule changes.

The apparent suicide of comedian Robin Williams, who had reportedly suffered from depression, shows how tough it can be to overcome mental illness. His struggles are shared by millions of Americans—some one in four adults in a given year.

The good news is that mental health care coverage is now more widely available and at least somewhat more affordable, thanks to recent changes in federal law. And there’s reason to believe these rules can have an impact on suicide rates: Ken Duckworth, medical director of the National Alliance on Mental Illness, told USA Today that about 90% of people who commit suicide suffer from an untreated or under treated mental illness.

Here’s what you need to know:

1. If your health insurance covers mental illness, your benefits must be comparable to medical coverage.

If you’re covered under an employer health plan that offers mental health benefits—and some 85% of company plans do, according to the Society for Human Resource Management—you’re now entitled to coverage that is on par with coverage for physical illnesses. That’s the result of the Mental Health Parity and Addiction Equity Act of 2008—the final provisions of which just went into effect. (The parity act mainly addresses larger company plans.) Yet according to a study earlier this year by the American Psychological Association, more than 90% of Americans are unfamiliar with their rights under this law.

The mandate is even stronger for individuals buying coverage through the health insurance exchanges created under Obamacare. The Affordable Care Act included mental health care as one of 10 essential benefits that must be covered, expanding the parity rules to plans bought in the state exchanges.

“The parity act is a landmark law that creates a level playing field in insurance,” says Ron Honberg, national policy director for the National Alliance on Mental Illness.

2. Mental health care must have the same coverage limits as other medical care.

Before to the new rules kicked in, you would typically have had to get prior authorization for mental health or substance abuse treatment. And you would also have to cope with yearly limits and lifetime limits on treatments that were lower than for medical benefits.

“Now mental health care treatment rules have to be on par with medical care,” says Debbie Plotnick, senior director of state policy for Mental Health America.

That means you cannot be denied coverage for therapy visits or a stay in a treatment center, unless your plan also restricts coverage for comparable medical conditions. And you cannot be charged higher co-pays or co-insurance than you are for most medical and surgical services.

That doesn’t guarantee you’ll find treatment affordable. The sticking point for many people seeking counseling is that their provider may not be in their health plan’s network—far fewer mental health providers are part of an insurance network than other types of healthcare providers. If you’re in a plan that covers out-of-network treatment, you’ll still be reimbursed, albeit at lower rates than for in-network treatment. Note, though, that the entire bill may not be eligible since many providers charge more than insurers deem “reasonable and customary.”

3. Your insurance plan needs to disclose the medical criteria for denial of mental health care.

If you are denied reimbursement or coverage for mental health treatment, you will be entitled to the same appeal procedures as for medical care. The plan cannot simply refuse coverage without providing a detailed explanation that shows why the treatment is not deemed necessary, says Plotnick.

Over the past couple of years, many employer plans have already improved coverage of mental health. And there are early indications that more people are benefiting, particularly young adults who have remained on their parents’ health plans. (Adolescence and young adulthood is often when severe mental illness is diagnosed.) A recent study published in Health Affairs found that among people ages 19 to 25 receiving mental health treatment, uninsured visits declined by 12.4 percentage points, and visits paid by private insurance increased by 12.9 percentage points.

The new rules don’t cover everyone. Small plans may not be governed by these rules (depending on state laws). If you don’t have a large employer plan or one purchased on the exchanges, and if you don’t qualify for Medicaid, you may have to scramble. In many regions, and for many specialities, it may also be difficult to find a psychiatrist or therapist who takes your insurance. And if you go out of network, you will only be reimbursed for “reasonable and customary” costs that don’t cover your actual bills.

Still, for those suffering from mental illness, these new rules are major step forward. One more reason to, as late night talk show Jimmy Kimmel noted at the end of his Twitter tribute to Robin Williams: “If you’re sad, tell someone.”

TIME Mental Illness

Why We Aren’t Better At Preventing Suicide

Robin Williams attending the Broadway Opening Night After Party for 'Bengal Tiger at the Baghdad Zoo' at espace in New York City
Robin Williams attending the Broadway Opening Night After Party for 'Bengal Tiger at the Baghdad Zoo' at espace in New York City Walter McBride—Corbis

Robin Williams' tragic death re-ignites long-asked questions about why it’s so challenging to identify and help those at highest risk of self-harm

Robin Williams’ death has served as a stark reminder that we have a long way to go in helping people at serious risk for self-harm. Part of the challenge, say experts, is that despite their stigma, suicidal thoughts are quite common, particularly among people who are depressed. “Suicidal thinking is common and widespread, especially among people with mental illnesses,” says Dr. Dost Ongur, chief of psychotic disorders at McLean Hospital and a psychiatrist at Harvard Medical School. “Yet we don’t have good ways of deciding who is at genuine risk, and who is suffering but who won’t go through with hurting themselves. The reality is that there is no established way of saying this person is at higher risk than that person.”

It’s not that anyone is expecting that a simple blood test or brain scan will provide the answer; the machinations of the body and mind are too complex for that. But as researchers learn more about the brain processes that lay the foundation for things like depression or addiction, they are moving toward developing a suite of tools that could help to at least triage people who are most vulnerable to harming themselves. “It’s something that comes over people; it can last hours or days, but not forever. If you can keep somebody safe during that period, it would pass,” Ongur adds. “The depression would remain, and the substance abuse would remain, but the intense feeling of not being able to go on would pass.”

MORE: Suicide in America: The People who Answer the Phone

Identifying people who might be especially vulnerable to those episodes could be a first step in preventing suicide attempts. In July, scientists reported finding that a gene involved in tamping down a stress response is different among those who have tried to end their lives compared to those who had not. The gene is integral to activity in the brain’s prefrontal cortex, which is responsible for things such as impulse control and reining in negative thoughts. It was in short supply in patients who reported suicidal thoughts.

Another group, led by John Mann at Columbia University, is focusing on the brain chemical serotonin, known for its role in mood disorders, and at Harvard, researchers are exploring the use of a bedside test that can probe the brain of patients with mental illnesses for clues to suicidality. All of these strategies, says Ongur, could help to shed more light on the black box that lies at the intersection of thought and action. “We don’t have a good framework for explaining what happens in the moments when a person is preparing to commit suicide.” That provides a window of opportunity for potentially life-saving interventions.

MORE: Robin Williams: The Comic Who Was Hamlet

Mental illness and substance abuse—both of which are correlated with suicide—are treatable, and could be the first step toward shifting patients away from self harm. Strengthening relationships can be another important factor. “The sponsor in AA is an example, a psychotherapist is another example and family relationships are other examples. We live in a relational world and people consider the impact their actions have on people important to you,” Ongur says.

But strengthening such relationships also requires a shift of a different kind, a societal change in how we perceive mental illness and react to those affected. “One of the big issues remains the stigma of mental illness, especially suicide,” says Ongur. “We are still dealing in a very real way with suicide not being something that is talked about openly and commonly. I saw a comment that the best tribute to Robin Williams would be talking more openly about suicide and making it part of a national conversation so that more research can be done and more people can be helped.”

TIME Mental Illness

Robin Williams’ Depression Struggles May Go Back Decades

The storied comedian and actor Robin Williams had spent time at a rehab facility this summer to maintain his sobriety, his publicist said.

“This morning, I lost my husband and my best friend, while the world lost one of its most beloved artists and beautiful human beings,” Williams’ wife Susan Schneider said in a written statement on Monday afternoon. According to the local sheriff’s office, coroners believe Williams may have committed suicide by asphyxia, and the actor’s representative said he had been “battling severe depression of late.”

While the representative did not elaborate on the potential source of his recent depression, one-third of people with major depression also struggle with alcoholism, and Williams admitted to abusing both cocaine and alcohol during the height of his popularity in the 1970s as alien Mork on Mork & Mindy, which showcased his manic improvisational style. He quit using drugs and alcohol in 1983 and remained sober for 20 years after the birth of his first son.

But in a revealing interview in the Guardian, Williams admitted that while working in Alaska in 2003, he felt “alone and afraid” and turned to the bottle because he thought it would help. For three years, he believed it did, until his family staged an intervention and he went into rehab, he told the Guardian. “I was shameful, did stuff that caused disgust — that’s hard to recover from,” he said then.

He said he attended weekly AA meetings, and this July, People.com reported that Williams spent several weeks at Hazelden Addiction Treatment Center in Minnesota, for what his representatives said was an “opportunity to fine-tune and focus on his continued commitment [to sobriety], of which he remains extremely proud.”

Studies suggest that alcoholism and depression may feed each other. People who are depressed are more vulnerable to abusing alcohol than those who don’t experience depressive episodes, and those who drink heavily are also more likely to experience depression. The latest evidence also hints that the same genes may be responsible for both conditions, and depression is a strong risk factor for suicide. About 90% of people who take their own lives are diagnosed with depression or other mental disorders. Suicide is also more likely among baby boomers, according to 2013 data from the Centers for Disease Control and Prevention.

The coroner’s office is continuing its investigation into Williams’ death.

TIME behavior

This Blood Test Can Predict Suicide Risk, Scientists Say

Researchers report encouraging advances toward a blood test that can pick up genetic changes linked to suicide

Behaviors can’t be reduced to your genes – they’re far too complicated for that. But genes can lay the foundation for making people more or less likely to respond and act in certain ways, and suicide may be the latest example of that.

In a paper published in the American Journal of Psychiatry, researchers led by Zachary Kaminsky, an assistant professor of psychiatry and behavioral sciences at Johns Hopkins University School of Medicine, found reliable differences in the activity of a specific gene among those who had committed suicide and those who had not. They conducted a series of tests to verify their result. First, they studied brain samples of mentally ill people and those not affected by mental illness, and revealed that a gene, SKA2—which is most abundant in the prefrontal regions of the brain that are involved in inhibiting negative thoughts and corralling impulses—was less active among those who ended up committing suicide than among those who had not. If there isn’t enough of SKA2, or if it isn’t working properly, then receptors that pull the stress hormone cortisol into cells to put a brake on the stress response also don’t work. That can lead to unchecked negative thoughts and impulsive behaviors, like a runaway car without brakes.

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The scientists also compared amounts of SKA2 among people with suicidal thoughts or those who had already attempted to kill themselves. Based on levels of the gene’s products in the blood, they could predict with 80% to 90% accuracy whether a particular participant had had suicidal thoughts or had tried to commit suicide.

The differences Kaminsky and his colleagues found isn’t a genetic mutation, but a change in how active the SKA2 gene is. Environmental exposures and life experiences can affect how and when genes are turned on or off. That’s what is happening with SKA2 in those who commit suicide; their gene is inhibited from doing its job of controlling their stress response and modulating it properly.

The work is just the first step in potentially developing a blood test for identifying people at highest risk of harming themselves, says Kaminsky. “We are not going to recommend screening everybody,” he says. “I don’t think that makes sense.” But among those at high risk of suicide, knowing that they also have a possible genetic tendency to react negatively to stress may help to them to get consistent support and more aggressive mental health services to help them cope with their stress and avoid more tragic outcomes.

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