Founder of Overcome, an EA-aligned mental health charity
John Salter
Karma: 1,868
It seems that part of the reason communism is so widely discredited is the clear contrast between neighboring countries that pursued more free-market policies. This makes me wonder— practicality aside, what would happen if effective altruists concentrated all their global health and development efforts into a single country, using similar neighboring countries as the comparison group?
Given that EA-driven philanthropy accounts for only about 0.02% of total global aid, perhaps the influence EA’s approach could have by definitively proving its impact would be greater than trying to maximise the good it does directly.
I’d be keen to get more diversity of thought in general, including conservatives! I think self-funding charities / impact-orientated for-profits are neglected, especially in donor funding constrained areas.
It’s great how transparent you are with your reasoning and how clearly you expressed it
Some have argued that saving lives in developing countries does not actually raise the size of the population because people have less children when they feel more of them will likely survive or due to some other mechanism.
This would refute the central point of your case if true. What are your thoughts?
With respect to other causes areas:
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Animal advocates seem to spend a lot of energy engaging in mutually destructive conflict with one and other.
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Even accounting for the above, mental health seems unusually poor and willingness to use existing services is low
How open are you to funding related interventions?
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I’ve forwarded a few people towards community health and feedback has been universally good.
What could EA do better to help earn-to-givers maximise their impact?
Which donations do you think had the highest EV in retrospect?
You and Jeff could’ve easily scaled back your donations when your income decreased—no one would’ve questioned it, and it would’ve made total sense. But instead, you stuck with giving half. The only logical explanation is extreme selflessness! It’s really inspiring to see. Thank you for writing this post :)
Vikram Patel and Shekhar Saxena are pretty prolific researchers in this space too. Both are relatively easy to contact—I reached out to both and both got back to me pretty quickly
Fascinating idea! I suspect general access isn’t going to be cost-effective enough, but there’s likely a niche demographic with a niche issue that this would work wonders for. I’d love to hear ideas anyone has for what those niches might be.
Impact = intervention chosen—what would have happened anyway
EAs often ignore the latter altogether, especially in terms of donation / volunteer source.
Overcome: Growth and Marginal Cost-Effectiveness Data
This is helpful, thank you!
I think this post would be more compelling if you shared more data (e.g. cost per participant, leading indicators of impact), how much money you got from EAIF etc
Thank you for thinking critically about my work! You’re right, it is not a direct comparison.
It shows an effect size of just over 0.6. The typical for most psychotherapies is 0.8. (see the Perplexity.ai summary below of the PTSD meta-analyses in the literature)
I did 0.6 / 0.8, which is 0.75. That equates to 75%.
As this is pretty approximate, especially given that it didn’t directly compare the same groups against one and other. I included the ~ before 75% to show that it shouldn’t be used as a precise figure. In hindsight, I regret not making this more explicit.
That being said, the near equivalency between laypersons and trained therapists is widely accepted. Every single EA mental health charity uses laypersons rather than professional therapists for this reason
and maybe newcomer?
I am! Just under two years delivering psychotherapy interventions, ~5 years in mental health more generally
Could you tell me more about the length, intensity, and duration of a typical treatment program?
We offer a minimum of six weeks, with no arbitrary cap. It’s once (or rarely twice) a week for ~1 hour at a time. I’d suggest that six weeks is the most cost-effective if you are limited by supply, but in practice it tends to be longer because often you have spare capacity.
Less sessions is a reliable way to reduce cost, but my understanding is there’s a U-shaped curve to cost-effectiveness here. 1 session doesn’t have enough benefits but 100 sessions costs too much and doesn’t add more benefit.
That sounds about right.
Also, are you targeting specific conditions? I see improvement in insomnia but that can arise from a sleep intervention or a general CBT course too
Depends on the client. Mostly our counselling is bespoke, but we have some programmes for more specialised issues (e.g. chronic insomnia, addiction, phobia)
I’m going to assume you mean comparison not experiment as we did no experiment comparing the two demographics.
The comparison was to show how much easier it is to treat high-functioning western demographics than it is to treat lower-functioning LMIC demographics. One common misconception I run into a lot is that treating people in LMICs is easier because there’s still “lower-hanging fruit” yet to be treated. I wanted to show some statistics illustrating that this was not the case by comparing two similar pilots with different demographics
The higher income, higher functioning demographic was easier to recruit, triage, maintain and got comparable results. I think this violates most funder’s expectations.
Two questions I imagine prospective funders would have:
Can you give some indication as to the value of stripends? It’s not clear how the benefits trade off against that cost. It’s tempting to think that stripends are responsible for >80% of the costs but bring <20% of the benefit.
What would your attendees have been doing otherwise?