I’m very pleased to see public health become a distinct part of OP’s portfolio. In particular, the continued support for suicide prevention is very welcome.
I’m curious about how you model the future wellbeing of the people whose suicides are prevented. Given that your focus is on LMICs, it’s very unlikely they’ll receive mental health treatment, so what happens to them? Do they make a full recovery or do they (and their families) continue to suffer?
I don’t think this was your intention, but this post implies that OP only cares about reducing the deaths and you’re not planning to do anything to alleviate the suffering.
Within the field of global mental health, there is growing interest in how to influence social determinants of mental health. Lund (2023) makes some tentative suggestions for public health interventions which may be of interest to you.
At GiveWell (where I was working when we started the suicide prevention work), we discounted the impact to account for people who would otherwise die by suicide potentially living somewhat worse lives than a typical person in their context. Given the empirical and moral uncertainty, that estimate was based on a deliberative process and preference aggregation of different staff views rather than a single bottom-up model. Open Phil hasn’t yet decided whether to incorporate a similar discount.
An overview of how GiveWell thought about it is available on this page and a selection of the evidence considered is in this Google Doc.
Speaking for myself, the evidence in that doc did update me towards valuing suicide prevention through means restriction highly. Interviews with survivors and psychological autopsies suggests that suicide (particularly pesticide suicide) is often impulsive and in response to short term life events. Under 5% of suicide attempt survivors go on to die by suicide in the next 5 years, which suggests that most survivors regret their first attempts and prefer to be alive.
I agree that, all else equal, addressing the social determinants of mental health would be preferable to preventing suicide by means restriction. But means restriction has empirically been very successful at reducing suicide rates.
Thanks for providing such a thoughtful response. These value judgments are extremely difficult and it looks like you did the best you could with the evidence available. I haven’t looked into the subjective wellbeing of suicide survivors but, if there’s enough data, this could provide a helpful sense-check to your original discount rate.
Although means restriction is very successful at reducing suicide rates, I’m curious how it compares to social determinants (or psychotherapy) if the goal is DALYs/QALYs/WELLBYs. It seems plausible that public health interventions that focus on improving quality of life could lead to a larger overall benefit (for a larger population) than ones that focus solely on reducing suicides (depending on philosophical views of course!)
I’m very pleased to see public health become a distinct part of OP’s portfolio. In particular, the continued support for suicide prevention is very welcome.
I’m curious about how you model the future wellbeing of the people whose suicides are prevented. Given that your focus is on LMICs, it’s very unlikely they’ll receive mental health treatment, so what happens to them? Do they make a full recovery or do they (and their families) continue to suffer?
I don’t think this was your intention, but this post implies that OP only cares about reducing the deaths and you’re not planning to do anything to alleviate the suffering.
Within the field of global mental health, there is growing interest in how to influence social determinants of mental health. Lund (2023) makes some tentative suggestions for public health interventions which may be of interest to you.
Thanks Barry,
At GiveWell (where I was working when we started the suicide prevention work), we discounted the impact to account for people who would otherwise die by suicide potentially living somewhat worse lives than a typical person in their context. Given the empirical and moral uncertainty, that estimate was based on a deliberative process and preference aggregation of different staff views rather than a single bottom-up model. Open Phil hasn’t yet decided whether to incorporate a similar discount.
An overview of how GiveWell thought about it is available on this page and a selection of the evidence considered is in this Google Doc.
Speaking for myself, the evidence in that doc did update me towards valuing suicide prevention through means restriction highly. Interviews with survivors and psychological autopsies suggests that suicide (particularly pesticide suicide) is often impulsive and in response to short term life events. Under 5% of suicide attempt survivors go on to die by suicide in the next 5 years, which suggests that most survivors regret their first attempts and prefer to be alive.
I agree that, all else equal, addressing the social determinants of mental health would be preferable to preventing suicide by means restriction. But means restriction has empirically been very successful at reducing suicide rates.
Thanks for sharing the Lund paper!
Thanks for providing such a thoughtful response. These value judgments are extremely difficult and it looks like you did the best you could with the evidence available. I haven’t looked into the subjective wellbeing of suicide survivors but, if there’s enough data, this could provide a helpful sense-check to your original discount rate.
Although means restriction is very successful at reducing suicide rates, I’m curious how it compares to social determinants (or psychotherapy) if the goal is DALYs/QALYs/WELLBYs. It seems plausible that public health interventions that focus on improving quality of life could lead to a larger overall benefit (for a larger population) than ones that focus solely on reducing suicides (depending on philosophical views of course!)