We appreciated the focus on LMICs because the treatment gap for mental health conditions is especially high in these countries (WHO Mental Health Atlas, 2017), particularly in low-resource (e.g. rural) settings.
What do you make of the argument that it’s more important to go from 0 to 1 on mental health, rather than from 1 to n ?
Could imagine that mental health in developing countries will resemble mental health in developed countries more and more as a result of economic growth. Developing countries become more similar to developed countries overall, and adopt the best mental healthcare practices of developed countries as part of this.
If mental health in developed countries currently misses out on a lot of upside, it would be way more leveraged to focus on realizing that upside (0 to 1), rather than propagating current best practices (1 to n), because the best practices will propagate regardless so long as the developing world continues to develop.
I’m not sure what you mean by going from 0 to 1 vs 1 to n. Can you elaborate? I take it you mean the challenge of going from no to current best practice treatment (in developing countries) vs improving best practice (in developed countries).
I don’t have a cached answer on that question, but it’s an interesting one. You’d need to make quite a few more assumptions to work through it, e.g. how much better MH treatment could be than the current best practice, how easy it would be to get it there, how fast this would spread, etc. If you’d thought through some of this, I’d be interested to hear it.
See also Slate Star Codex on the weirdness of Western mental healthcare: 1, 2, 3, 4, 5
how easy it would be to get it there
Quick reply: not sure about how easy it would be to achieve the platonic ideal of mental healthcare – QRI is probably more opinionated about this.
Given how much of an improvement SSRIs and CBT were over the preexisting standard-of-care, and how much of an improvement psychedelic, ketamine, and somatic therapies seem to be over the current standard-of-care, I’d guess that we’re nowhere close to hitting diminishing marginal returns.
how fast this would spread
Quick reply: if globalization continues, the best practices of the globalized society will propagate “naturally” (i.e. as a result of the incentives stakeholders face). From this perspective, we’re more limited by getting the globalized best practices right than we are by distributing our current best practices.
First, all your comments on the weirdness of Western mental healthcare are probably better described as ‘the weirdness of the US healthcare system’ rather than anything to do with mental health specifically. Note they are mostly to do with insurance issues.
Second, I think one can always raise the question of whether it’s better to (A) improve the best of service/good X or (B) improve distribution of existing versions of X. This also isn’t specific to mental health: one might retort to donors to AMF that they should be funding improvements in (say) health treatment in general or malaria treatment in particular. There’s a saying I like which is “the future is here, it just isn’t very evenly distributed”—if you compare Space-X launching rockets which can land themselves vs people not having clean drinking water. There seems to be very little we can say from the armchair about whether (A) or (B) is the more cost-effective option for a given X. I suspect that if there were a really strong ‘pull’ for goods/services to be provided, then we would already have ‘solved’ world poverty, which makes me think distribution is weakly related to innovation.
Aside: I wonder if there is some concept of ‘trickle-down’ innovation at play, and whether this is relevant analogous to that of ‘trickle-down’ economics.
fwiw I don’t think most of this problem is due to insurance issues, though I agree that the US healthcare system is very weird and falls short in a lot of ways.
This also isn’t specific to mental health: one might retort to donors to AMF that they should be funding improvements in (say) health treatment in general or malaria treatment in particular.
I suspect that if there were a really strong ‘pull’ for goods/services to be provided, then we would already have ‘solved’ world poverty, which makes me think distribution is weakly related to innovation.
World poverty has been decreasing a lot since 1990 – some good charts here & here.
M-Pesa and the broad penetration of smartphones are examples of innovations that were quickly distributed. The path from innovation to distribution is probably harder for services.
What do you make of the argument that it’s more important to go from 0 to 1 on mental health, rather than from 1 to n ?
Could imagine that mental health in developing countries will resemble mental health in developed countries more and more as a result of economic growth. Developing countries become more similar to developed countries overall, and adopt the best mental healthcare practices of developed countries as part of this.
If mental health in developed countries currently misses out on a lot of upside, it would be way more leveraged to focus on realizing that upside (0 to 1), rather than propagating current best practices (1 to n), because the best practices will propagate regardless so long as the developing world continues to develop.
I’m not sure what you mean by going from 0 to 1 vs 1 to n. Can you elaborate? I take it you mean the challenge of going from no to current best practice treatment (in developing countries) vs improving best practice (in developed countries).
I don’t have a cached answer on that question, but it’s an interesting one. You’d need to make quite a few more assumptions to work through it, e.g. how much better MH treatment could be than the current best practice, how easy it would be to get it there, how fast this would spread, etc. If you’d thought through some of this, I’d be interested to hear it.
The link in my top-level comment elaborates the concept.
Quick reply: probably a lot better. See ecstatic meditative states, confirmed by fMRI & EEG.
See also Slate Star Codex on the weirdness of Western mental healthcare: 1, 2, 3, 4, 5
Quick reply: not sure about how easy it would be to achieve the platonic ideal of mental healthcare – QRI is probably more opinionated about this.
Given how much of an improvement SSRIs and CBT were over the preexisting standard-of-care, and how much of an improvement psychedelic, ketamine, and somatic therapies seem to be over the current standard-of-care, I’d guess that we’re nowhere close to hitting diminishing marginal returns.
Quick reply: if globalization continues, the best practices of the globalized society will propagate “naturally” (i.e. as a result of the incentives stakeholders face). From this perspective, we’re more limited by getting the globalized best practices right than we are by distributing our current best practices.
A couple of quick replies.
First, all your comments on the weirdness of Western mental healthcare are probably better described as ‘the weirdness of the US healthcare system’ rather than anything to do with mental health specifically. Note they are mostly to do with insurance issues.
Second, I think one can always raise the question of whether it’s better to (A) improve the best of service/good X or (B) improve distribution of existing versions of X. This also isn’t specific to mental health: one might retort to donors to AMF that they should be funding improvements in (say) health treatment in general or malaria treatment in particular. There’s a saying I like which is “the future is here, it just isn’t very evenly distributed”—if you compare Space-X launching rockets which can land themselves vs people not having clean drinking water. There seems to be very little we can say from the armchair about whether (A) or (B) is the more cost-effective option for a given X. I suspect that if there were a really strong ‘pull’ for goods/services to be provided, then we would already have ‘solved’ world poverty, which makes me think distribution is weakly related to innovation.
Aside: I wonder if there is some concept of ‘trickle-down’ innovation at play, and whether this is relevant analogous to that of ‘trickle-down’ economics.
fwiw I don’t think most of this problem is due to insurance issues, though I agree that the US healthcare system is very weird and falls short in a lot of ways.
I don’t think this analogy holds up: we’ve eradicated malaria in many developed countries, but we haven’t figured out mental health to the same degree (e.g. 1 in 5 Americans have a mental illness).
World poverty has been decreasing a lot since 1990 – some good charts here & here.
M-Pesa and the broad penetration of smartphones are examples of innovations that were quickly distributed. The path from innovation to distribution is probably harder for services.