I’ve been pretty skeptical that mental health is something EAs should focus on. One thing I see lacking in this report (apologies if it’s there and I didn’t find it) seems to be a way of comparing it to alternatives, since I don’t think that mental health is a source of suffering for people is in question, but whether it’s compares favorably to other issues.
For example I’d love something like QALY analysis on mental health that would allow us to compare it to other cause areas more directly.
Thanks for raising this—comparing things is a cause very close to my heart!
First, the report wasn’t trying to compare the importance of mental health as a cause area to other things, so I understand that you didn’t find that, because it wasn’t central.
Second, the report (p8) does compare the impact of depression and anxiety to various other health conditions, as well as to debt, unemployment, and divorce in terms of 0-10 life satisfaction, a measure of subjective well-being (SWB) - the other main measure of SWB is happiness. We, as in HLI, are pretty enthusiastic about comparing different outcomes in terms of SWB rather than anything else, e.g. QALYs. The obvious issue, if you use QALYs, is it’s a measure of health, and even if you thought it was an excellent measure of the impact of health on well-being, you still need to compare health to non-health outcomes.
Third, the report also mentions (p26) that I’ve previously done a fairly basic analysis, including in my PhD, using SWB to compare a mental health charity (StrongMind) to those recommended by GiveWell—on that mental health looks rather promising. Further, it notes (at p36) that HLI is now working on a more empirically sophisticated SWB analysis of the same type. We have some provisional results for this latter analysis and should be putting out those reports within a couple of months, and which point you are welcome to dive into that comparison!
Speaking of comparing to alternatives, I can’t resist making a pedantic note for posterity that the fact about “per DALY lost, spending on HIV is 150x higher than spending on mental health” is not necessarily a sign of irrational priorities. After all, HIV is contagious in a way that mental health problems mostly aren’t!
I’m sure Taiwan is spending much more on covid-19 prevention right now than they are on cancer treatment per DALY being lost (they have almost no covid cases but are willing to constantly apply severe anti-covid restrictions), but it’s a rational decision because covid has the potential to rapidly spiral out of control in a way that cancer can’t do.
I don’t think the report was trying to use the fact as some kind of instant knockdown argument in favor of mental health vs HIV spending—they were just using it as an illustrative comparison (which it is) to a well-known existing category of international health spending, to show that mental health spending is much smaller. So, the report is totally cool by me (and indeed we probably should be spending more on mental health globally, regardless of whether it’s a #1 EA issue or a lower priority). I just wanted to make a note here for anyone interested in the 150x fact in the future.
that the fact about “per DALY lost, spending on HIV is 150x higher than spending on mental health” is not necessarily a sign of irrational priorities
I agree! At the start of section 4, on neglectedness—the one which later compares HIV to mental health spending—we make the same point (emphasis added):
In terms of national spending, in every country the proportion of the health budget spent on mental healthcare and research is disproportionate to the burden of mental disorders (see figure 4) (Patel et al., 2018). To be clear, this by itself does not show more should be spent on mental health, if the aim is to have the biggest impact using scarce resources: if interventions in other areas were more cost-effective, then this allocation would be justified. However, as we go on to argue, it seems likely mental health has been unduly neglected due to reasons such as stigma.
Sort of aside: there is this ongoing confusion inside the EA community about the importance of ‘scale’, ‘neglectedness’ and ‘tractability’, something that’s been discussed on this forum before—see e.g. this summary of two chapters from my PhD thesis. I recommend that people think of scale (size of a problem) and neglectedness (resources going to a problem) as background information that might later be relevant to the cost-effectiveness of a problem, but that they don’t by themselves tell you anything about cost-effectiveness.
No problem. It’s always a challenge that you want to put the attention-grabbing stuff at the top whilst knowing that you can’t properly caveat it and many won’t read anything else!
I’ve been pretty skeptical that mental health is something EAs should focus on. One thing I see lacking in this report (apologies if it’s there and I didn’t find it) seems to be a way of comparing it to alternatives, since I don’t think that mental health is a source of suffering for people is in question, but whether it’s compares favorably to other issues.
For example I’d love something like QALY analysis on mental health that would allow us to compare it to other cause areas more directly.
Thanks for raising this—comparing things is a cause very close to my heart!
First, the report wasn’t trying to compare the importance of mental health as a cause area to other things, so I understand that you didn’t find that, because it wasn’t central.
Second, the report (p8) does compare the impact of depression and anxiety to various other health conditions, as well as to debt, unemployment, and divorce in terms of 0-10 life satisfaction, a measure of subjective well-being (SWB) - the other main measure of SWB is happiness. We, as in HLI, are pretty enthusiastic about comparing different outcomes in terms of SWB rather than anything else, e.g. QALYs. The obvious issue, if you use QALYs, is it’s a measure of health, and even if you thought it was an excellent measure of the impact of health on well-being, you still need to compare health to non-health outcomes.
We mentioned SWB in a recent post about Our 2020 Annual review, this post about using SWB to compare averting poverty to saving lives, I argue explicitly for in this 2018 post, and it’s raised in so many other places I’m starting to feel embarrassed about repeating myself, which is why it wasn’t featured prominently here(!)
Third, the report also mentions (p26) that I’ve previously done a fairly basic analysis, including in my PhD, using SWB to compare a mental health charity (StrongMind) to those recommended by GiveWell—on that mental health looks rather promising. Further, it notes (at p36) that HLI is now working on a more empirically sophisticated SWB analysis of the same type. We have some provisional results for this latter analysis and should be putting out those reports within a couple of months, and which point you are welcome to dive into that comparison!
Speaking of comparing to alternatives, I can’t resist making a pedantic note for posterity that the fact about “per DALY lost, spending on HIV is 150x higher than spending on mental health” is not necessarily a sign of irrational priorities. After all, HIV is contagious in a way that mental health problems mostly aren’t!
I’m sure Taiwan is spending much more on covid-19 prevention right now than they are on cancer treatment per DALY being lost (they have almost no covid cases but are willing to constantly apply severe anti-covid restrictions), but it’s a rational decision because covid has the potential to rapidly spiral out of control in a way that cancer can’t do.
I don’t think the report was trying to use the fact as some kind of instant knockdown argument in favor of mental health vs HIV spending—they were just using it as an illustrative comparison (which it is) to a well-known existing category of international health spending, to show that mental health spending is much smaller. So, the report is totally cool by me (and indeed we probably should be spending more on mental health globally, regardless of whether it’s a #1 EA issue or a lower priority). I just wanted to make a note here for anyone interested in the 150x fact in the future.
I agree! At the start of section 4, on neglectedness—the one which later compares HIV to mental health spending—we make the same point (emphasis added):
Sort of aside: there is this ongoing confusion inside the EA community about the importance of ‘scale’, ‘neglectedness’ and ‘tractability’, something that’s been discussed on this forum before—see e.g. this summary of two chapters from my PhD thesis. I recommend that people think of scale (size of a problem) and neglectedness (resources going to a problem) as background information that might later be relevant to the cost-effectiveness of a problem, but that they don’t by themselves tell you anything about cost-effectiveness.
Nice. Foolish of me to nitpick an executive summary—it’s a summary!
No problem. It’s always a challenge that you want to put the attention-grabbing stuff at the top whilst knowing that you can’t properly caveat it and many won’t read anything else!