MONEY health

These Mental Health Charities Have the Most Impact

140813_FF_CHARITIES
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 metal 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

Depression Is a Risk Factor for Dementia, New Research Says

The two have been linked before, but the new study says depression may be an independent risk factor for the disease

The link between depression and dementia is puzzling for researchers. Many studies have noticed a correlation between the two diseases and a 2013 review of 23 studies of about 50,000 older men and women reported that older adults suffering from depression were more than twice as likely to develop dementia and 65% more likely to develop Alzheimer’s. But these have often only been associations. The newest study, published Wednesday in the journal Neurology, takes it further. The researchers believe that their findings, while not definitive, show that depression is in fact an independent risk factor for dementia — and not the other way around.

Researchers looked at 1,764 people with no memory problems around age 77 and followed them for about eight years. They discovered that people with mild cognitive decline as well as people with dementia were likely to have higher levels of depression symptoms before they were diagnosed, and that having these symptoms was associated with a greater decline in memory. Depression symptoms, the researchers estimated, accounted for 4.4% of the difference in memory decline that could not be caused by brain damage.

The reasons for the link between the two diseases are more unclear. Some research suggests that people with depression may have high levels of hormones that interfere with the region of the brain responsible for learning and memory aptitude. Gary Kaplan, an osteopath who runs the Kaplan Center for Integrative Medicine, as well as a handful of other researchers, has another theory: that inflammation caused by hyperreactivity of immune cells can hinder blood flow to — and impact neural pathways in — the brain.

Kaplan, who was not involved in this research, views depression as a symptom of inflammation in the nervous system, and not a disease in itself. “Depression is manageable,” says Kaplan. “We can modify risk for depression by lowering neuroinflammation. And these findings are completely consistent with depression as an inflammatory disease.”

It’s also possible that depression adds stress to the brain, and that can play a role in its deterioration.

If it was possible that treating depression could curb dementia risk, that would be game changing, medically speaking. That hasn’t been proved yet, but it’s an active area of research. The Mayo Clinic recommends that patients opt for treatments that are safe for both issues — for instance, taking antidepressants for depression, though “these medications may not be as effective at treating depression with Alzheimer’s as they are at treating depression alone,” they write. Kaplan thinks treating depression can be done with practices like meditation and getting more sleep — activities thought to calm the brain and improve overall brain health.

If the new research is right, finding new ways to treat depression may have an impact on dementia risk — even if it’s small.

TIME Mental Illness

Schizophrenia Linked to 108 Genes

In a groundbreaking study, researchers reveal a host of new genes involved in schizophrenia, making it possible to develop desperately needed treatments

It took 80,000 genetic samples, seven years and the work of 300 scientists from around the world, but scientists now have the most complete dossier on schizophrenia ever.

In an historic paper published in the journal Nature, the Schizophrenia Working Group of the Psychiatric Genomics Consortium identified 108 new regions on the genome linked to the psychiatric disorder, which is associated with hallucinations and psychotic episodes and affects about 1% of people worldwide.

The genetic clues are the most dramatic hints that experts have gotten so far about what causes that mental illness. Schizophrenia has had a rocky history in the psychiatric community, with some doctors early on not even recognizing it as a disorder, and others debating whether its origins were biological or caused by traumatic events or other experiences. Now, by comparing the genomes of people with and without the disorder, it’s clear that at least some of the psychotic symptoms can be traced to changes in the genes.

“For the first time, we are starting to see the underlying biological basis of the disease, and that can lay the foundation for understanding the disorder, and eventually developing treatments,” said Eric Lander, founding director of the Broad Institute of MIT and Harvard, where about one third of the DNA samples were sequenced.

MORE: Older Fathers Linked to Kids’ Autism and Schizophrenia Risk

The study used genome wide association, a technique that sequences the genomes of affected and unaffected individuals, and then compares where they differ. Those DNA differences may be hints about why people develop schizophrenia in the first place, and therefore lead to new drugs or treatments.

The 108 genetic regions aren’t all located in specific genes, nor is it known yet if this is what actually causes schizophrenia. But, like evidence at a crime scene, they may point to certain molecular pathways that are responsible for the mental illness. It’s already known that some of the identified regions, for example, are involved in how adaptable or plastic the brain is, and in regulating the immune system, a connection that experts have previously not investigated before. Other genes may also reveal new ways to potentially treat the disease, a significant improvement over the existing therapies, which only address one brain system, involving dopamine. “Thorazine was approved in 1954 as the first anti-psychotic medication, and every antipsychotic since then has relied on the same fundamental mechanism of action,” Steve Hyman, director of the Broad Institute’s Stanley Center for Psychiatric Research and professor of stem cell and regenerative biology at Harvard University said. “And their efficacy has plateaued since the 1960s.”

MORE: Most Common Psychiatric Disorders Share Genetic Roots

Having a greater suite of potential areas of inquiry, the researchers hope, will attract pharmaceutical companies back to the field of mental illness. “We now have more than 100 genes pointing to distinct pathways – calcium channels, glutamate, the immune system – this is concrete stuff, and it means that the pharmaceutical companies who left [this area of drug development] because they didn’t have anything concrete to work on, are beginning to get their toes in the water, and are thinking of jumping back in the water,” says Lander.

The genetic windfall can also help scientists piece together how genetic changes may work in tandem to cause symptoms of psychoses. They warn that these advances, and new treatments, may not come in the next year, but they may be able to provide better answers to questions about which drugs may work better in which patients, and in finding ways to detect and hold off symptoms of schizophrenia earlier, before they become debilitating. All of the genetic information released in the paper will be deposited in a public database for researchers to access and advance the understanding of the disorder.

TIME PTSD

Here’s What Happens To The Mind After 5 Years of Captivity

Captured US Solider
Sgt. Bowe Bergdahl in an undated image provided by the U.S. Army. U.S. Army/AP

Sgt. Bowe Bergdahl has a lot of healing to do after five years of captivity. The physical scars may fade, but the emotional ones can sometimes be too deep to heal completely

U.S. Army Sergeant Bowe Bergdahl, the last known American POW, was finally returned home over the weekend after five years held in captivity in Afghanistan. Since Bergdahl’s return, curious details have emerged about his mental state before and after capture. And it all begs the question: What does five years in captivity do to the human mind?

Bergdahl’s repatriation is going to be a challenge, and piecing together the psychologically and physically broken veteran is a delicate process. After all, an abduction is the ultimate exchange of power, spurring the start of a complicated relationship based on both deep distrust and reliance, say experts. “He’s to some degree merged with those who held him,” says Brian Engdahl, professor of PTSD Research and Neuroscience at the University of Minnesota. “He was totally dependent on them for food, shelter, clothing. It can reduce a person to a weak state where their entire life revolves around how their captors are treating them.” A morsel of food becomes a generous gift, only to be withheld at the next feeding.

Many POWs find physical and mental strength by relying on their fellow captured soldiers, but Bergdahl was alone. Speculation about whether he suffered from Stockholm Syndrome—the phenomenon where captives identify with their captors—are not unwarranted, though so far evidence hasn’t suggested this to be true.

Studies of POWs from the Korean War show that the psychological injuries from captivity stem from two types of trauma. The first is physical and usually short-term, caused by malnutrition and injury. The more persisting trauma is, of course, psychological. At Landstuhl Regional Medical Center in Germany, which treats U.S. vets from Afghanistan and Iraq, Bergdahl is likely being tested for depression, anxiety, and PTSD, says Engdahl. “Beyond that, he could be feeling deep guilt, shame, bewilderment, and a lost sense of identity,” says Engdahl. If his English is poor, as has been reported, it’s likely from lack of speaking.

Once home, psychological challenges won’t likely abate overnight, says Barbara Rothbaum, the associate vice chair of clinical research in the department of psychiatry at Emory School of Medicine. “But even if the trauma is over, it’s not really over,” she says. POWs often experience flashbacks, and will wake up in the middle of the night thinking they are still in captivity. Many victims become avoidant and don’t want to talk about their experience because they are afraid it will trigger memories, she says. It’s one of the reasons many will forgo treatment.

“I’ve had veterans tell me they were drunk for a year,” says Rothbaum. But avoidance is one of the worst ways to deal with the harsh return, and Rothbaum’s research has shown that talking about experiences early can actually help prevent the onset of PTSD.

“People want to avoid talking about the worst parts, the most shameful, the most embarrassing,” says Rothbaum. “But it will help.”

TIME Crime

Mental-Health Lessons Emerge from Isla Vista Slayings

UCSB Victims Memorial
Jose Cardoso, 50, cries in front of a makeshift memorial for 20-year-old UCSB student Christopher Ross Michaels-Martinez outside a deli in Santa Barbara, Calif., on May 25, 2014 Lucy Nicholson—Reuters

Police missed an opportunity to thwart Elliot Rodger’s plans before he killed six people

When a mad man goes on a killing spree, a few questions immediately bubble to the surface. Who’s to blame? What should we do now? Could this have been prevented?

In the case of Elliot Rodger, who police say killed six people and himself in Isla Vista, Calif., on May 23, there are no definitive answers to any of these questions — at least not yet. But what’s clear is that a few weeks earlier, police missed an opportunity to thwart Rodger’s plans.

On April 30, deputies from the Santa Barbara County Sheriff’s Department, which has jurisdiction in Isla Vista, visited Rodgers at his home to assess his mental state. They had been indirectly summoned there by Rodger’s mother. Reportedly disturbed by videos her son had posted on YouTube, she called a therapist who had been treating him, who called a mental-health hotline, which contacted the authorities. The deputies interviewed Rodger and determined that he was shy, according to Santa Barbara County Sheriff Bill Brown — but polite and did not pose a risk to himself or others. Absent that, they had no legal right to take him into custody. They urged him to call his mother and they left.

In a departing manifesto, Rodger wrote of the April 30 encounter: “For a few horrible seconds I thought it was all over. When they left, the biggest wave of relief swept over me.”

As became painfully clear weeks later, Rodger posed a grave threat. He had recently purchased several guns, along with hundreds of rounds of ammunition. And he had been plotting for several years to exact revenge on “humanity” — particularly women — for rejecting him socially, according to a final YouTube video and a manifesto he wrote before stabbing his two roommates and another man to death and then fatally shooting three others. He wounded 13 more.

A spokeswoman for the Santa Barbara Sheriff has said the department was not aware of Rodger’s YouTube posts until after he went on his killing spree. If they had been, it’s possible the outcome might have been different. “They should have definitely been made aware of those videos in my opinion,” says Kenton Rainey, chief of police for Bay Area Rapid Transit (BART) in San Francisco and a board member at the National Alliance for Mental Illness (NAMI) in California. “It would have been impossible for them to make an informed assessment without those.”

An official from a local chapter of the National Alliance on Mental Illness said there was a program in Santa Barbara County to provide officers with so-called crisis-intervention training (CIT) that has been utilized elsewhere to help officers detect signs of mental illness, but it’s unclear whether the deputies who check on Rodger had received this training. Only about 30 law-enforcement personnel in the entire county receive such crisis intervention training annually, according to the NAMI chapter official.

“Crisis-intervention training is a national movement,” says Dr. Kenneth Duckworth, medical director for NAMI and a professor at Harvard. “But even that may not be enough to respond to this from an upstream perspective.”

If the deputies who met Rodger had been specially trained, it’s possible he could have simply fooled them into thinking he was mentally stable.

“My guess is he was on the best behavior possible for him,” says Kristine Schwarz, executive director of New Beginnings Counseling Center in Santa Barbara. Schwarz, who has no direct knowledge of Rodgers or his mental state adds, “It’s not out of the ordinary or out of the question that somebody could miss something in a wellness check like that. There are always people who are able to present perfectly functional.” Schwarz says law-enforcement officers in Santa Barbara County regularly collaborate with mental-health professionals and appear well trained. “But it depends on the individual law-enforcement officer and the individual client,” she says.

Jessica Cruz, executive director of NAMI California says programs like CIT are helpful, but that “more importantly, we should be able to call somebody other than the police for our loved ones going through a mental-health crisis.” NAMI is among the organizations that regularly lobby to train more mental-health professionals and provide more services, including prevention and treatment. Funding for the latter is often inadequate, says Cruz. California, for example, has less than half the number of hospital beds dedicated to in-patient mental-health care than recommended by a panel of psychiatric experts convened to study the issue.

There have also been efforts to reach more mentally ill people in outpatient settings, but here too, intentions sometimes fall short. Laura’s Law, passed in California in 2002, would allow counties to mandate outpatient treatment for some mentally ill adults, but the law includes no dedicated funding, most counties have not adopted it and the criteria for applying the law is very strict. (Laura’s Law would likely not have applied in Rodger’s case.) Cruz also points to a program in San Diego County that sends mobile teams, including clinicians, to the homes of severely mentally ill people who are reluctant to get treatment. Such non-law-enforcement approaches, if adequately funded, are often more effective, says Cruz.

As for Rodger’s parents, it appears they took appropriate steps to help their son and keep him from hurting others. They called police upon seeing his manifesto and final YouTube video, in which he outlined his plans to “slaughter” sorority members and kill others. They raced to Santa Barbara County in hopes of intervening directly, only to find their son and six others already dead.

“The family did everything they could have done,” says Cruz. “If a family is worried about their loved one and they call who they think they’re supposed to call, what else can you do?”

TIME Mental Illness

Higher Doses of Antidepressants Linked to Suicidal Behavior in Young Patients

A new study based on suicide risk by drug dosage, involving 162,000 patients aged 10 to 64, finds that younger patients starting off with a higher-than-recommended dose of antidepressants have an elevated risk of suicidal behavior

New research on suicide risk by drug dosage has found that doctors should avoid prescribing high quantities of antidepressants to young adults. Younger patients starting off with a higher-than-recommended dose elevated their risk of self-harm compared with those who started at lower doses, according to a study from the JAMA Internal Medicine based on 162,000 patients ages 10 to 64.

Nearly 18% of patients in the study started on doses higher than normal for drugs including Celexa, Zoloft and Prozac. Researchers checked patients’ medical records to see how many had deliberately self-harmed within a year of starting their medications.

Patients younger than 24 taking higher doses harmed themselves more than twice as frequently as those taking lower amounts — 32 incidents of self-harm per 1,000 young patients on high doses, compared with only 15 incidents within the same number on the recommended dose.

“If I were a parent, I definitely wouldn’t want my child to start on a higher dose of these drugs,” study author Dr. Matthew Miller, associate director of Harvard School of Public Health’s Injury Control Research Center in Boston, told WebMD.

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