The DALYs calculated for mental health don’t factor in the huge effect that mental health has on physical health. This may be laboursome to estimate, but should at least be considered. And you mentioned that people with MNS issues are often treated horrendously by their family/society, but that also hasn’t been factored into the DALY cost estimate. An MNS disorder with a 0.4 DALY could really have a 0.9 DALY when you factor in mistreatment. I realize this is probably impossible to do, but it important to recognize that socialization side effects have huge impacts on DALYS.
Sri Lanka pesticide ban cost per DALY: $1000 is pretty high. Eddleston estimated it at $2 per YLL using the actual costs of running Sri Lanka’s pesticide regulation department. That figure doesn’t even factor in savings in health care costs. Also, Sri Lanka and other countries have only banned a few HHPs. A total ban of HHPs could yield drastically different cost estimates. I should note that only a fraction of pesticides are classified as highly hazardous. A total HHP ban still leaves farmers with lots of choices to buy pesticides, in addition to non-chemical forms of pest control.
No choice for donating to advocate for pesticide bans: Later this year, I expect that the Global Initiative for Pesticide Poisoning Prevention will begin our anti-HHP campaign. It takes a long time to do the initial steps of receiving charity status and input from all the experts in the field.
Room for more funding for a program like StrongMinds doesn’t make sense because it can be scaled up to LMIC around the world.
I don’t understand what the mental health charities have to do with children. Do StrongMinds and BasicNeeds treat children?
Yes I agree. This is important but very hard to quantify. Of course the causal relationship goes both ways (poor physical health poor mental health) but it’s probable that mental health disorders have worse downstream effects than most physical health problems (economic productivity, stigma, impact on carers, physical health). We tried to capture these qualitatively at the beginning of the report but could have been clearer that they weren’t included in the cost-effectiveness calculations.
Agreed kind of. Room for more funding is a tricky one. In the long term, the treatment gap is so high that there’s a LOT of room to scale. But we’ve also included StrongMinds forecast expenditure based on current plans as it may be relevant for short term ability to productively use more funding. In any case, conclusion is the same. The organisation can absorb more funding in the short term, and in the long term there’s huge room to scale.
Should have been more clear. Fit with key themes was evaluated as: Evidence generating] AND [Preventative child health OR Task-shifting model]
We’ll be updating this before sharing it more widely. Would be great to chat more about pesticide bans if you’re available?
Very good report, James. I have a few comments:
The DALYs calculated for mental health don’t factor in the huge effect that mental health has on physical health. This may be laboursome to estimate, but should at least be considered. And you mentioned that people with MNS issues are often treated horrendously by their family/society, but that also hasn’t been factored into the DALY cost estimate. An MNS disorder with a 0.4 DALY could really have a 0.9 DALY when you factor in mistreatment. I realize this is probably impossible to do, but it important to recognize that socialization side effects have huge impacts on DALYS.
Sri Lanka pesticide ban cost per DALY: $1000 is pretty high. Eddleston estimated it at $2 per YLL using the actual costs of running Sri Lanka’s pesticide regulation department. That figure doesn’t even factor in savings in health care costs. Also, Sri Lanka and other countries have only banned a few HHPs. A total ban of HHPs could yield drastically different cost estimates. I should note that only a fraction of pesticides are classified as highly hazardous. A total HHP ban still leaves farmers with lots of choices to buy pesticides, in addition to non-chemical forms of pest control.
No choice for donating to advocate for pesticide bans: Later this year, I expect that the Global Initiative for Pesticide Poisoning Prevention will begin our anti-HHP campaign. It takes a long time to do the initial steps of receiving charity status and input from all the experts in the field.
Room for more funding for a program like StrongMinds doesn’t make sense because it can be scaled up to LMIC around the world.
I don’t understand what the mental health charities have to do with children. Do StrongMinds and BasicNeeds treat children?
Re: DALY’s for physical vs. mental health, in our full report we cite Vigo 2016 ( http://www.thelancet.com/journals/lanpsy/article/PIIS2215-0366(15)00505-2/abstract ) which lays out a strong argument for using a 2x adjustment for mental health DALY’s. That’s the approach we take in the paper.
Thanks Austen. This is really helpful feedback.
Yes I agree. This is important but very hard to quantify. Of course the causal relationship goes both ways (poor physical health poor mental health) but it’s probable that mental health disorders have worse downstream effects than most physical health problems (economic productivity, stigma, impact on carers, physical health). We tried to capture these qualitatively at the beginning of the report but could have been clearer that they weren’t included in the cost-effectiveness calculations.
Thanks—this is really interesting. The $1000 figure came from here: http://dcp-3.org/sites/default/files/resources/15.%20Self%20Harm%20Pesticide%20Ban.pdf but that excludes morbidity. I’ll check out the Eddleston paper.
This is exciting
Agreed kind of. Room for more funding is a tricky one. In the long term, the treatment gap is so high that there’s a LOT of room to scale. But we’ve also included StrongMinds forecast expenditure based on current plans as it may be relevant for short term ability to productively use more funding. In any case, conclusion is the same. The organisation can absorb more funding in the short term, and in the long term there’s huge room to scale.
Should have been more clear. Fit with key themes was evaluated as: Evidence generating] AND [Preventative child health OR Task-shifting model]
We’ll be updating this before sharing it more widely. Would be great to chat more about pesticide bans if you’re available?