People (including I think some of the research at the Happier Lives Institute) often distinguishes “serious mental illness (SMI)” which is roughly schizophrenia, bipolar I, and debilitating major depression, from “any mental illness (AMI)”, which includes everything.
The term “mental health” lumps together these two categories that, despite their important commonalities, I think probably should be analyzed in very different ways.
For example, with SMI, there are often treatments with huge obvious effects. But the side effects are bad, and patients may refuse treatment for various reasons including lack of insight. Treating these diseases can have a huge impact—the difference between someone being totally unable to work or care for themselves and then dying young by accident or suicide, vs. being able to live an independent and successful life. But they are fairly rare in the population.
Whereas it seems that with the set AMI minus SMI, like generalized anxiety, etc., effect sizes of treatments are small and hard to measure. There’s often so much demand for treatment that rationing is required. Impairment and suffering can be really bad but not, I think, typically as bad as SMI. But these diseases are much more prevalent so even if effect sizes are smaller, maybe the total impact of an intervention is much greater.
This distinction is obvious, but I want to point it out explicitly, as I think even though everyone kind of knows this, it’s still underrated, and probably important for thinking about expected impact.
Somehow, the 1-life-vs-1000 thought experiment made part of my brain feel like this was decision making in an emergency, where you have to make a snap judgment in seconds. And in a real emergency, I think saving 1 life might very well be the right choice just because—how sure are you the chance is really 1%? Are you sure you didn’t get it wrong? Whereas if you are 99.9% certain you can save one life, you must have some really clear, robust reason to think that.
If I imagine a much slower scenario, so that I can convince myself I really am sure that the probability of saving 1000 lives is actually known to be 1%, it seems like a much clearer choice to save 10.
My brain still comes up with a lot of intuitive objections for utility maximization, but I hadn’t noticed this one before.