Mental health is one of the most widespread, impactable, yet neglected global health issues of our time. Even knowing mental health conditions are generally under-reported and/ or misrepresented, evidence still shows widespread effects of mental wellbeing on physical health, life satisfaction, and productivity, however it has still not taken off as a major cause area in many EA organizations I have talked to. Why is this?
G’day Madeline, I run an EA mental health org in India. The reason for this is simply that existing mental health interventions do not compare with GiveWell’s grants on a DALYs/$ basis. In my opinion, the reasons are:
DALY moral weights may be biased against depression
The moral weights of different diseases in the Global Burden of Disease study, which informs DALY estimates, are determined by asking the general public whether they’d prefer to have one disease against another. When you do this with depression, people who haven’t experienced it tend to prefer to have it to many other conditions. However, when you ask people who have experienced it, they choose many very painful conditions over depression. This is one of the widest gaps in the moral weight data. See Pyne et al. 2009 and this post.
Psychotherapy is usually modelled as a short-term effect
Psychotherapy is typically modelled as a treatment, and not a ‘skill’. What I mean by this is that a dose of psychotherapy is assumed to only have effects that decay over a period of time and zero out after that in most CEAs, including those from the Happier Lives Institute. However, many psychotherapy patients will tell you that they learned skills that were useful long after the therapy ended, and there is some limited evidence that psychotherapy’s effects may last decades, or potentially never zero out. If this were true, the effects could be very long-lasting and therefore it would be much more valuable to treat a case of depression.
Suicide prevention isn’t cost-effective if it’s only a short-term effect
Consider that for most of GiveWell’s top interventions, the bulk of the DALYs averted come from ‘saving’ a life—i.e., preventing a death from a disease in a way that allows the person to then go on to live a healthy life, such as preventing a malaria case in an under-5 (which they might die from), even if they go on to catch it after 5 years old.
As a short-term effect, psychotherapy can only postpone a suicide by the length of the treatment effect. But if it were a skill and had some durable long-term effect, it may genuinely prevent one, which would tremendously increase the value of suicide prevention interventions.
Existing interventions haven’t been cheap enough yet
With the exception of some incredible policy work in, for example, reducing toxicity of pesticides commonly used for suicide, existing interventions are still quite expensive. The Happier Lives Institute’s top charities cost ~$40 to treat a single person, while a bednet costs $7. I’m fudging the numbers a bit here, but if we stick with DALYs, psychotherapy is still about an order of magnitude more expensive than it needs to be to look great for EAs.
However, there is work being done to improve that! My charity, Kaya Guides, treated people for $20 each in April, at what we estimate is a similar effect size to the best charities, and we’re confident we can get below $10. We’re using a technique called guided self-help that allows us to dramatically reduce contact hours per participant (and being all-digital helps a lot, too).
Conclusion
Orgs like the Happier Lives Institute have done a lot of advocacy work too, to raise the profile of mental health within EA, and there are plenty of funders that take mental health seriously (in a way that apparently wasn’t true a decade ago). It is, after all, still a nascent space.
In addition to @huw’s great comment, there’s a branch of EA which focuses on well-being, and with that focus mental health interventions often look really effective. Check out the happier lives institute Huw mentioned, times the “WELLBY” and @MichaelPlant
Mental health is one of the most widespread, impactable, yet neglected global health issues of our time. Even knowing mental health conditions are generally under-reported and/ or misrepresented, evidence still shows widespread effects of mental wellbeing on physical health, life satisfaction, and productivity, however it has still not taken off as a major cause area in many EA organizations I have talked to. Why is this?
G’day Madeline, I run an EA mental health org in India. The reason for this is simply that existing mental health interventions do not compare with GiveWell’s grants on a DALYs/$ basis. In my opinion, the reasons are:
DALY moral weights may be biased against depression
The moral weights of different diseases in the Global Burden of Disease study, which informs DALY estimates, are determined by asking the general public whether they’d prefer to have one disease against another. When you do this with depression, people who haven’t experienced it tend to prefer to have it to many other conditions. However, when you ask people who have experienced it, they choose many very painful conditions over depression. This is one of the widest gaps in the moral weight data. See Pyne et al. 2009 and this post.
Psychotherapy is usually modelled as a short-term effect
Psychotherapy is typically modelled as a treatment, and not a ‘skill’. What I mean by this is that a dose of psychotherapy is assumed to only have effects that decay over a period of time and zero out after that in most CEAs, including those from the Happier Lives Institute. However, many psychotherapy patients will tell you that they learned skills that were useful long after the therapy ended, and there is some limited evidence that psychotherapy’s effects may last decades, or potentially never zero out. If this were true, the effects could be very long-lasting and therefore it would be much more valuable to treat a case of depression.
Suicide prevention isn’t cost-effective if it’s only a short-term effect
Consider that for most of GiveWell’s top interventions, the bulk of the DALYs averted come from ‘saving’ a life—i.e., preventing a death from a disease in a way that allows the person to then go on to live a healthy life, such as preventing a malaria case in an under-5 (which they might die from), even if they go on to catch it after 5 years old.
As a short-term effect, psychotherapy can only postpone a suicide by the length of the treatment effect. But if it were a skill and had some durable long-term effect, it may genuinely prevent one, which would tremendously increase the value of suicide prevention interventions.
Existing interventions haven’t been cheap enough yet
With the exception of some incredible policy work in, for example, reducing toxicity of pesticides commonly used for suicide, existing interventions are still quite expensive. The Happier Lives Institute’s top charities cost ~$40 to treat a single person, while a bednet costs $7. I’m fudging the numbers a bit here, but if we stick with DALYs, psychotherapy is still about an order of magnitude more expensive than it needs to be to look great for EAs.
However, there is work being done to improve that! My charity, Kaya Guides, treated people for $20 each in April, at what we estimate is a similar effect size to the best charities, and we’re confident we can get below $10. We’re using a technique called guided self-help that allows us to dramatically reduce contact hours per participant (and being all-digital helps a lot, too).
Conclusion
Orgs like the Happier Lives Institute have done a lot of advocacy work too, to raise the profile of mental health within EA, and there are plenty of funders that take mental health seriously (in a way that apparently wasn’t true a decade ago). It is, after all, still a nascent space.
In addition to @huw’s great comment, there’s a branch of EA which focuses on well-being, and with that focus mental health interventions often look really effective. Check out the happier lives institute Huw mentioned, times the “WELLBY” and @MichaelPlant