Why Charity Entrepreneurship is Researching Mental Health and Happiness

Cross­posted from Char­ity En­trepreneur­ship’s Bloghere

Introduction

There has been re­cent dis­cus­sion within effec­tive al­tru­ism around global men­tal health as a new cause area. In the 2018 EA sur­vey, it was in­cluded as a po­ten­tial top cause area, and around 4% of EAs iden­ti­fied it as their top pri­or­ity [1]. This has led us to think about whether Char­ity En­trepreneur­ship (CE) should do pri­ori­ti­sa­tion re­search on men­tal health as a po­ten­tially high-im­pact cause area. Many of us at CE have been con­vinced that this is a promis­ing enough area to in­ves­ti­gate as one of the four ar­eas for our 2020 in­cu­ba­tion pro­gram. In this post, I will ex­plain which fac­tors con­vinced us to ex­pand our port­fo­lio of cause ar­eas for the next in­cu­ba­tion round to in­clude men­tal health.

Top Rea­sons to Fo­cus on Men­tal Health

The huge dis­ease bur­den of men­tal illness

On broad con­sid­er­a­tions of scale and ne­glect­ed­ness, it is shock­ing to see how lit­tle gov­ern­ment fund­ing is spent in this area rel­a­tive to the size of the prob­lem. Self-harm, men­tal, neu­rolog­i­cal, and sub­stance use di­s­or­ders ac­count for 12% of the global bur­den of dis­ease when mea­sured in DALYs [2]. How­ever, in 2016, the me­dian gov­ern­ment spend­ing on men­tal health­care was 2.4% of all health­care spend­ing. This level of spend­ing “rep­re­sented an im­bal­ance in the ra­tio be­tween dis­ease bur­den and effi­ciently al­lo­cated spend­ing, rang­ing from 3:1 in Canada and the USA to 435:1 in Haiti” [2]. The lack of suffi­cient gov­ern­ment funds ded­i­cated to this is­sue means that 78% of those with men­tal ill­ness in high-in­come coun­tries—and up to 96% in low-in­come and lower-mid­dle-in­come coun­tries—do not re­ceive treat­ment [3]. This mas­sive treat­ment gap in­di­cates the need for more or­gani­sa­tions and fund­ing to solve the prob­lem.

De­spite a strong ev­i­dence base, men­tal health is not well prioritised

As with global poverty, there is already a well-es­tab­lished ev­i­dence base that we can use in our pri­ori­ti­sa­tion work as there have been nu­mer­ous pi­lot stud­ies and ran­domised con­trol­led tri­als con­ducted in global men­tal health. Or­gani­sa­tions such as the Men­tal Health In­no­va­tion Net­work [4] com­piled a library of pre­vi­ous pi­lot pro­grams dat­ing back at least six years. Many of these pi­lots performed well, and now only lack pri­ori­ti­sa­tion to chan­nel the tal­ent and fund­ing nec­es­sary to bring them to scale. Thus the prob­lem is not a lack of well-ev­i­denced, effec­tive treat­ments; it is that they are not be­ing im­ple­mented or pri­ori­tised ad­e­quately in the non­profit sec­tor.

Men­tal health in­ter­ven­tions could be cost-effec­tive in both low- and high-in­come countries

Gen­er­ally, the most cost-effec­tive char­i­ties work in lower- and mid­dle-in­come coun­tries, but men­tal health may be a cost-effec­tive area even in high-in­come coun­tries. When con­sid­er­ing which char­i­ties to sup­port, many foun­da­tions and fun­ders are fo­cused on a par­tic­u­lar coun­try in which they’d like to see in­ter­ven­tions take place. For this rea­son, men­tal health char­i­ties op­er­at­ing in high-in­come coun­tries may be able to ac­cess a pool of re­sources not available to other effec­tive char­i­ties. The ex­ist­ing op­por­tu­ni­ties available to these fun­ders are much less cost-effec­tive than the av­er­age global health pro­gram. How­ever, it might be very difficult to switch their dona­tion from one cause to an­other. Pro­vid­ing them with more cost-effec­tive giv­ing op­por­tu­ni­ties within their preferred field and ge­og­ra­phy would drive money away from less effec­tive men­tal health pro­grams. This means that even if men­tal health in­ter­ven­tions turn out not to be as cost-effec­tive as the best global health pro­gram, there is still a sub­stan­tial op­por­tu­nity for im­pact, par­tic­u­larly as a char­ity en­trepreneur.

The im­por­tance of men­tal health may be un­der­rated by other metrics

Another fac­tor to con­sider is the con­tin­u­ing de­vel­op­ment of mea­sure­ments of sub­jec­tive wellbe­ing (SWB)—mea­sures of self-re­ported hap­piness and life satis­fac­tion—over the past 40 years. In the past, we thought the best proxy mea­sures for some­one’s qual­ity of life were in­creased in­come, dis­abil­ity-ad­justed life years (DALYs), and lives saved. How­ever, we tend to think that in­creas­ing in­come or re­duc­ing dis­abil­ity are just in­stru­men­tal goals that we value for their effects on in­di­vi­d­u­als’ over­all wellbe­ing. In­stead, it seems plau­si­ble that we should be try­ing to mea­sure SWB di­rectly, as this bet­ter cap­tures what we care about.

Here, I will briefly sum­marise the main ar­gu­ment for us­ing SWB scores as a di­rect mea­sure of wellbe­ing [5]. Sub­jec­tive wellbe­ing is some­thing that can be mea­sured through self-re­ports and cap­tures some­thing differ­ent from con­ven­tional mea­sures. When con­sid­er­ing in­ter­ven­tions through a SWB lens, work­ing on men­tal health stands out as an even more sig­nifi­cant and ne­glected way of im­prov­ing SWB, be­cause it has rel­a­tively lit­tle fund­ing, and the effect that men­tal ill­ness can have on our qual­ity of life ex­tends far be­yond what is cap­tured by DALYs. When com­par­ing cash trans­fers to in­ter­per­sonal psy­chother­apy group (IPT-G) on SWB met­rics [6], some es­ti­mates of IPT-G sug­gest that it could be four times as cost-effec­tive as just giv­ing out cash, which is a stan­dard poverty alle­vi­a­tion in­ter­ven­tion car­ried out by e.g. GiveDirectly.

Work on men­tal health is ro­bust to changes in moral views

If you are un­cer­tain about which eth­i­cal sys­tem is cor­rect and you sub­scribe to a moral par­li­a­ment model [7], men­tal health may be a good cause area. Im­prov­ing hap­piness di­rectly is viewed pos­i­tively by vir­tu­ally all eth­i­cal sys­tems. Re­gard­less of your views on pop­u­la­tion ethics or how much weight you give to non-hu­man an­i­mals, who may be nega­tively im­pacted by other in­ter­ven­tions (e.g. the meat-eater prob­lem [8] for global health in­ter­ven­tions), im­prov­ing the qual­ity of hu­man lives is good. This means that the benefits of work­ing on men­tal health as op­posed to other cause ar­eas are more ro­bust to changes in your views on ethics. There­fore, even if it does not ap­pear to be the most effec­tive given your cur­rent moral views, it may still be valuable to work on men­tal health, as it is more likely to main­tain its value re­gard­less of fu­ture moral up­dates.

The Effec­tive Altru­ism move­ment is in­creas­ingly in­ter­ested in men­tal health

The de­ci­sion to eval­u­ate men­tal health and sub­jec­tive wellbe­ing char­ity ideas was also af­fected by the re­cent in­flux of in­ter­est from the EA com­mu­nity. Anal­y­sis of the 2019 ap­pli­ca­tion round [9] in­di­cates that ap­pli­cants with an EA back­ground are more likely to be ac­cepted to our in­cu­ba­tion pro­gram. Thus, this in­creased in­ter­est has ex­panded the num­ber of good char­ity en­trepreneur­ship can­di­dates that want to work in this area. Beyond alle­vi­at­ing a limit­ing fac­tor for Char­ity En­trepreneur­ship, this in­creased in­ter­est within our epistemic peers can be seen as ev­i­dence for the promis­ing­ness of the cause area.

Conclusion

All these fac­tors lead us to be­lieve that men­tal health is a promis­ing new cause area. This is par­tic­u­larly the case for char­ity en­trepreneurs who can util­ise ex­ist­ing re­search and fund­ing to bring effec­tive, ev­i­dence-based treat­ments to scale. This will help re­duce the mas­sive treat­ment gap in the men­tal health space, and will greatly im­prove the lives of the af­fected pop­u­la­tion.

References

1. EA Sur­vey 2018 Series: Cause Selec­tion—EA Fo­rum [In­ter­net]. [cited 2019 Nov 25]. Available from: https://​​fo­rum.effec­tivealtru­ism.org/​​posts/​​hP6oEXurLrDXyEzcT/​​ea-sur­vey-2018-se­ries-cause-selection

2. Daniel V Vigo Devora Kes­tel PKPPGTPRA. Disease bur­den and gov­ern­ment spend­ing on men­tal, neu­rolog­i­cal, and sub­stance use di­s­or­ders, and self-harm: cross-sec­tional, ecolog­i­cal study of health sys­tem re­sponse in the Amer­i­cas. The Lancet Public Health. 2018;4:89–96.

3. Thor­nicroft G E al. Un­dertreat­ment of peo­ple with ma­jor de­pres­sive di­s­or­der in 21 coun­tries. PubMed [In­ter­net]. [cited 2019 Nov 25]; Available from: https://​​www.ncbi.nlm.nih.gov/​​pubmed/​​27908899

4. | Men­tal Health In­no­va­tion Net­work [In­ter­net]. Men­tal Health In­no­va­tion Net­work. [cited 2020 Jan 21]. Available from: https://​​www.mhin­no­va­tion.net/​​in­no­va­tions?mode=List

5. Plant M. Do­ing Good Badly? Philo­soph­i­cal Is­sues Re­lated to Effec­tive Altru­ism [In­ter­net] [Doc­tor of Philos­o­phy]. Univer­sity of Oxford; 2019 [cited 2019 Nov 25]. Available from:http://​​www.plant­ing­hap­piness.co.uk/​​wp-con­tent/​​up­loads/​​2019/​​11/​​M-Plant-Do­ing-Good-Badly.pdf

6. Cause pro­file: men­tal health—EA Fo­rum [In­ter­net]. [cited 2019 Nov 25]. Available from: https://​​fo­rum.effec­tivealtru­ism.org/​​posts/​​XWSTBBH8gSji­aNiy7/​​cause-pro­file-men­tal-health

7. Mo­ral un­cer­tainty—Effec­tive Altru­ism Con­cepts [In­ter­net]. Effec­tive Altru­ism Con­cepts. [cited 2020 Jan 18]. Available from: https://​​con­cepts.effec­tivealtru­ism.com/​​con­cepts/​​moral-un­cer­tainty/​​

8. The meat-eater prob­lem—Effec­tive Altru­ism Con­cepts [In­ter­net]. Effec­tive Altru­ism Con­cepts. [cited 2020 Jan 18]. Available from: https://​​con­cepts.effec­tivealtru­ism.com/​​con­cepts/​​the-meat-eater-prob­lem/​​

9. Ap­pli­ca­tion Pro­cess for the 2019 Char­ity En­trepreneur­ship In­cu­ba­tion Pro­gram—EA Fo­rum [In­ter­net]. [cited 2020 Jan 21]. Available from: https://​​fo­rum.effec­tivealtru­ism.org/​​posts/​​fNRSGin­hWqPZ­tuo3T/​​ap­pli­ca­tion-pro­cess-for-the-2019-char­ity-entrepreneurship

No comments.