Hey @Dvir, mental health is a (not-professional) passion of mine so I am grateful for any attention given to it in EA. I wonder if you think a version 2.0 of your pitch can be written, which takes into account the 3 criteria below. Right now you seem to have nailed down the 1st, but I don’t see the case for 2 & 3:
Great in scale (it affects many lives, by a great amount)
Highly neglected (few other people are working on addressing the problem)
Hi Uri, thanks for your reply. :) While Mental Health is neglected in terms of government funds, it is not neglected at all in terms of the number of people who are interested in this field. Many are. So by this criteria it doesn’t line up with the EA mindset. Regarding the highly solvable or tractable, I think this is very challenging to evaluate.. But this could and should be a further discussion. Regarding the Happier Lives Institute, I have read some of their posts and reports, but admit that I am not familiar enough. Mental Health Innovation Network is also a great organization in this space.
From a broad enough perspective no cause area EA deals with is neglected. Poverty? Billions donated annually. AI? Every other start up uses it. So we start narrowing it down: poverty → malaria-> bednets.
There is every reason to believe mental health has neglected yet tractable and highly impactful areas, because of the size of the problem as you outline it, and because mental health touches all of us all the time in everything we do (when by health we don’t just mean the absence of disease but the maximization of wellbeing).
I think EA concepts are here to challenge us. Being a clinical psychiatrist is amazing, you can probably help hundreds of people. Could you do more? What’s going on in other parts of the globe, where is humanity headed towards in the future? This challenge does not have to be burdensome, it can be inspiring. It should certainly not paralyze you and prevent you from doing any good at all. Like a mathematician obsessed with proving a theorem, or a physicist relentlessly searching for the theory of everything, they also do other work, but never give up the challenge.
That’s a great perspective, appreciate it!! Inspires me. Tiny side note—clinical psychologist not psychiatrist (psychiatrists are also in mental health, but are medical doctors, and can prescribe medications).
Stumbled upon this great post, just adding a minor comment: On certain occasions, it might be even more convincing the build the pitch around an example of an intervention such as Strongminds (which HLI often compares to Givedirectly in terms of cost-effectiveness). It helps make the pitch more concrete.
Thanks for writing! It sounds like part of your pitch is that there are some types of therapy which are much more effective than the types in common use. Scott’s book review of all therapy books makes me pretty pessimistic about that. If you’ve read that post, do you have any thoughts?
I read now, well.. it’s a pretty cynical post. While there are obviously those books that give you false magical hopes for instant relief, and it’s fun to joke about them, I am not a fan of the cynical tone. Some people say cynicism is the opposite of hope, and I kinda agree. While it’s good to criticize, Mental health and health in general are supposed to be fields of hope. Obviously not false hope, but there are objective and subjective reasons for hope in treatment. However, there are still some important points in the post which I am definitely noting down.
Hey guys, took some time to revise my post—clarifying bullets, adding a few examples, and most importantly—making a true “elevator pitch” section before my elaboration.
I think all the problems with involving EA with causes that require political changes (increase gov funding for mental health...even all Gates’ billions wouldn’t go very far if he tried to directly fund a substantial slice of the mental health healthcare expenditures for first world) apply to changing gov funding and many of the issues are even harder because they derive from hard to shift societal attitudes. These make even direct funding of many types of research difficult.
For instance, a big problem (imo) with the way depression drugs are researched is that it sets as it’s goal finding a drug that makes depressed people feel better without improving the mood of non-depressed individuals (is we impose a higher standard in terms of safety and risk of abuse for these drugs than similarly serious conditions). Yes, I agree that depression involves a cluster of symptoms but you could say the same about the disorders that result from the failure to produce various growth hormones but it doesn’t follow that the treatment of such conditions should be possible using medications that wouldn’t make normal people grow larger or produce more muscle or whatever.
Sure, those drugs will likely have side effects when taken at high levels (mania has lots of drawbacks even when without the depressive part) and concerns about abuse aren’t unfounded but if we were willing to treat the loss of QALYs from depression as seriously as we take those from a heart attack there would be no question we would risk it. As is, however, we have a culture in which doctors which treat mental health are more responsible to the families of those suffering (who may sue if their loved one uses medication to commit suicide...but more importantly will be seen as having failed their patient in the way the oncologist whose patient dies because of well-judged risks they took wouldn’t be).
Unfortunately, I think the combination of general discomfort with anything that sounds transhumanist (would it be so bad if some ppl were a bit unnaturally happier) plus the fact that the majority of society is more interested in what makes them feel good (lack of guilt and keeping that friend or family member around) than in making the depressed feel better when that involves risk.
And I’m afraid this is a broader issue in EA for mental health. Too often the real limitations are hard to change social attitudes and hard to fix with charitable donations.
Thank you for your comment. I would like to address your first point. While gov. funds do need a political push, and that societal change is trickier than thought, general innovation in Mental Health that could benefit society does not require any grand political change or push. There is meaningful innovation already both in non-profit and for-profit sectors. And your example of Gates’ funds that if he tries to directly fund health in general he will run out of money, it’s obviously true. But that doesn’t mean that careful capital couldn’t be allocated to promising health innovations for-profit and non-profit, similarly to many other fields.
Hey @Dvir, mental health is a (not-professional) passion of mine so I am grateful for any attention given to it in EA. I wonder if you think a version 2.0 of your pitch can be written, which takes into account the 3 criteria below. Right now you seem to have nailed down the 1st, but I don’t see the case for 2 & 3:
Great in scale (it affects many lives, by a great amount)
Highly neglected (few other people are working on addressing the problem)
Highly solvable or tractable (additional resources will do a great deal to address it) (https://80000hours.org/articles/problem-framework/)
I think that is what HLI is trying to do: https://forum.effectivealtruism.org/posts/uzLRw7cjpKnsuM7c3/hli-s-mental-health-programme-evaluation-project-update-on https://forum.effectivealtruism.org/posts/v5n6eP4ZNr7ZSgEbT/jasper-synowski-and-clare-donaldson-identifying-the-most
Hi Uri, thanks for your reply. :)
While Mental Health is neglected in terms of government funds, it is not neglected at all in terms of the number of people who are interested in this field. Many are. So by this criteria it doesn’t line up with the EA mindset.
Regarding the highly solvable or tractable, I think this is very challenging to evaluate.. But this could and should be a further discussion.
Regarding the Happier Lives Institute, I have read some of their posts and reports, but admit that I am not familiar enough. Mental Health Innovation Network is also a great organization in this space.
From a broad enough perspective no cause area EA deals with is neglected. Poverty? Billions donated annually. AI? Every other start up uses it. So we start narrowing it down: poverty → malaria-> bednets.
There is every reason to believe mental health has neglected yet tractable and highly impactful areas, because of the size of the problem as you outline it, and because mental health touches all of us all the time in everything we do (when by health we don’t just mean the absence of disease but the maximization of wellbeing).
I think EA concepts are here to challenge us. Being a clinical psychiatrist is amazing, you can probably help hundreds of people. Could you do more? What’s going on in other parts of the globe, where is humanity headed towards in the future? This challenge does not have to be burdensome, it can be inspiring. It should certainly not paralyze you and prevent you from doing any good at all. Like a mathematician obsessed with proving a theorem, or a physicist relentlessly searching for the theory of everything, they also do other work, but never give up the challenge.
That’s a great perspective, appreciate it!! Inspires me.
Tiny side note—clinical psychologist not psychiatrist (psychiatrists are also in mental health, but are medical doctors, and can prescribe medications).
Stumbled upon this great post, just adding a minor comment: On certain occasions, it might be even more convincing the build the pitch around an example of an intervention such as Strongminds (which HLI often compares to Givedirectly in terms of cost-effectiveness). It helps make the pitch more concrete.
Good idea, added this point to the pitch. :)
Thanks for writing! It sounds like part of your pitch is that there are some types of therapy which are much more effective than the types in common use. Scott’s book review of all therapy books makes me pretty pessimistic about that. If you’ve read that post, do you have any thoughts?
I read now, well.. it’s a pretty cynical post. While there are obviously those books that give you false magical hopes for instant relief, and it’s fun to joke about them, I am not a fan of the cynical tone. Some people say cynicism is the opposite of hope, and I kinda agree. While it’s good to criticize, Mental health and health in general are supposed to be fields of hope. Obviously not false hope, but there are objective and subjective reasons for hope in treatment.
However, there are still some important points in the post which I am definitely noting down.
Thank you, I will definitely definitely read.
Hey guys, took some time to revise my post—clarifying bullets, adding a few examples, and most importantly—making a true “elevator pitch” section before my elaboration.
I think all the problems with involving EA with causes that require political changes (increase gov funding for mental health...even all Gates’ billions wouldn’t go very far if he tried to directly fund a substantial slice of the mental health healthcare expenditures for first world) apply to changing gov funding and many of the issues are even harder because they derive from hard to shift societal attitudes. These make even direct funding of many types of research difficult.
For instance, a big problem (imo) with the way depression drugs are researched is that it sets as it’s goal finding a drug that makes depressed people feel better without improving the mood of non-depressed individuals (is we impose a higher standard in terms of safety and risk of abuse for these drugs than similarly serious conditions). Yes, I agree that depression involves a cluster of symptoms but you could say the same about the disorders that result from the failure to produce various growth hormones but it doesn’t follow that the treatment of such conditions should be possible using medications that wouldn’t make normal people grow larger or produce more muscle or whatever.
Sure, those drugs will likely have side effects when taken at high levels (mania has lots of drawbacks even when without the depressive part) and concerns about abuse aren’t unfounded but if we were willing to treat the loss of QALYs from depression as seriously as we take those from a heart attack there would be no question we would risk it. As is, however, we have a culture in which doctors which treat mental health are more responsible to the families of those suffering (who may sue if their loved one uses medication to commit suicide...but more importantly will be seen as having failed their patient in the way the oncologist whose patient dies because of well-judged risks they took wouldn’t be).
Unfortunately, I think the combination of general discomfort with anything that sounds transhumanist (would it be so bad if some ppl were a bit unnaturally happier) plus the fact that the majority of society is more interested in what makes them feel good (lack of guilt and keeping that friend or family member around) than in making the depressed feel better when that involves risk.
And I’m afraid this is a broader issue in EA for mental health. Too often the real limitations are hard to change social attitudes and hard to fix with charitable donations.
Thank you for your comment. I would like to address your first point. While gov. funds do need a political push, and that societal change is trickier than thought, general innovation in Mental Health that could benefit society does not require any grand political change or push. There is meaningful innovation already both in non-profit and for-profit sectors. And your example of Gates’ funds that if he tries to directly fund health in general he will run out of money, it’s obviously true. But that doesn’t mean that careful capital couldn’t be allocated to promising health innovations for-profit and non-profit, similarly to many other fields.