(We've talked about most of this outside of the public view, but I can't restrain myself from commenting none-the-less)
Legibility
I agree with you strategically that people who care about mental health need to make their case in a way that's legible to more traditional metrics like income, DALYs, etc. But the general thing this points to is greater legibility --> greater uptake --> impact blah blah.
On this general point, one thing we've been thinking about and piloting is just trying to make WELLBYs more legible, especially for MH interventions by converting them to years of depression averted (YODAs).
So I could say that a fictional charity Gaya Kuides generates 1,000 WELLBYs per $1k donated. Or given that the typical case of depression (moderate depression) is associated with a -1.3. lower wellbeing compared to low depression symptoms -- this implies that actually GK averts the equivalent of 1000 / 1.3 =769 years of depression per $1k donated. FWIW we explain the YODAs more here and we're looking for feedback on whether this seems like a useful communication device.
It just seems way easier to imagine the value of a year of depression averted compared to "WELLBY".
2. Long-run effects of psychotherapy
This is very important and understudied. The effects of psychotherapy could last much longer, and we could maybe make these interventions benefit people for much longer than we. But we don't care much about LR effects in general in the research community and we do not have much understanding of the mechanisms that support long-term benefits. I obviously wish that we'd change on both accounts.
I think the Cuijpers stuff is interesting, and I think the results are consistent with the existence of the long-term effects of psychotherapy. I take this from ignoring the splines and just seeing that there are observations of effects years later.
Sure it doesn't rule out indefinite effects. But you could say the same thing about finding positive effects after 1 month, so I'm less gung-ho on the language.
Some methodological concern with Cuijpers et al. they only present and discuss one sort of unconventional model (why not a linear model? It looks like a linear model would predict decay but I obviously can't tell). They also don't do a lot of (any?) tests like seeing how stable these are when we remove studies or whether there's publication bias where you only do a follow-up when you think you're going to find something (you could interrogate this by seeing if earlier effects are higher than effects in that same time window). Basically I'd be more reassured if they ran and reported a lot of different models and robustness tests.
Mechanisms! Why do the benefits of mental health interventions persist and decay? I'd guess that the mechanisms are some mix of A) access to and utilization to new tools for thinking. These require practice and memory so I expect we will see decay without some structure to continue maintenance. B) A change in believes around mental health or in one's agency to affect their MH. This seems like this part is something that could plausibly last much longer as a result of a short intervention. If you make someone believe this is a solvable problem, then that could benefit them for life. But note I expect that the belief mechanism is probably more important in LMICs where stigma and traditional believes around mental health (it's demons or curses, etc) is more common. This would make me think it's likelier that the benefits last longer in LMICs than HICs. But this is the opposite of what our meta-analytic results suggest (effects last 2-6 years in LMICs) versus Cuijpers implied you treat someone in HICs and it benefits them indefinitely.
I guess back to Cuijpers... one thing that could explain the LR results is that in HIC after you start getting treatment even if the RCT ends you may just keep getting therapy. That presumably doesn't happen in LMICs and may explain the discrepancy. But I'd need to dig into the Cuijpers data to interrogate that.
Mechanisms part 2: treat the young. It seems plausible that you can potentially change lifelong trajectories by treating earlier. This is commonly assumed but there's not too much evidence I've found (e.g., Bhalotra et al., 2025 seems to suggest LR positive effects but I think there are some other econ papers that find null LR results for natural experiments increasing access to MH treatment for youth).
Mo, I love this! I can't wait to hear what you think of what I come out with. I think I will steal some of these points (and acknowledge you).
Re if not growth: Regarding freedom, the weird(ish) thing is it's about perceptions of freedom. When you look at objective indicators for democracy it seems really null which I find very puzzling. I think I will dedicate some time to the hypothesis that we may not need to Swedenify but Latinify the world because it is just so striking and obvious that the LATAM countries clearly have a different intercept in the GDP <> LS relationship. The rural-urban thing is interesting. I assume that's mostly just a proxy for income in developing countries? I had urbanization as a predictor for trying to predict the wellbeing of the world throughout history but it seems colinear with GDP per capita. Altruism is interesting -- the animal welfare correlation is pretty striking -- what paper is this from? I wonder how much of altruism loads onto religiosity / a strong civic life? If I had to predict another big important factor for wellbeing that's the most orthogonal to GDP per capita it'd be something something a vibrant society and culture which I have no idea how to operationalize or optimize.
Hm! Yeah I'm planning to look at inequality which objectively, doesn't seem to matter much on a within country basis. I haven't thought about cross country comparisons because I guess I don't expect people to spend much time thinking about those comparisons unless maybe you're WEIRD. One funny, but in retrospective obvious things is that the literature seems to find that a subjective sense of inequality or being treated unfairly seems to be strongly predictive (in contrast to frequent nulls for objective stuff). Now, this also is much messier because you need to have some view of the generative process of those views to know what to think of it. Sadder people probably think the "world is rigged against me". But it also seems quite plausible that people are picking up a fuzzier factors that are harder to capture like media or culture.
Perhaps I should have said "semi-conventional within EA". GiveWell and FP, in their moral weights treat 1 doubling = 1 doubling regardless of the baseline income. Presumably AIM follows them? However, GiveWell (and probably FP) adopt a very strong wealth effect of η = 1.59 for their time discount. So they aren't necessarily consistent about how they use it. They are also aware of this.
It also seems pretty conventional, although much more implicit, in the wellbeing space, as the log-income cross national wellbeing gradient looks very linear (implying each doubling has the same effect).
Amongst economics, I assume "convention" is more about median than average? Drupp et. al (2018) surveyed views from over 200 discounting experts. For η, they gave a mean of 1.35 and a median of exactly 1.
I don't think it's that weird with the above values of η, considering that even in low income countries the effects of cash are significant but not immense, see this previous thread
Well yeah one implication is maybe should move towards consistently using a higher η? This would be a moderately sized deal. I'm going to partially frame the effects in terms of what's compatible with different values of η if we're assuming consistency between cash transfer experiments in LMICS and HICs.
Things I've done some work on that I plan to publish more on that seem relevant to some EA conversations in global health and wellbeing :
Does each doubling have the same return to wellbeing? The convention (outside of time discounts) is to assume that going from $500 to $1000 is the same return on wellbeing as $500k to $1,000k. I think that's probably not true. This affects how we think about improving incomes in high versus low income countries.
How effective are cash transfers in high income countries? So far, it seems like cash transfers that improve annual income by 10-30% in the USA have pretty much no effect on wellbeing. Weird. Not sure why yet. Seems bearish for UBI, but I'm not quite sure what's a better idea yet.
Does economic growth make countries happier? Richer countries are happier, richer people are happier, and people getting richer are happier, but countries getting richer has reportedly been a more mixed blessing for people. I expect to find something like growth is probably good but less good than you would expect based on looking at country cross sections. However, it's possible there's some weird scale use stuff that'd make growth look growth look like a miracle for human wellbeing.
If not growth in incomes, then what? I'll look at what if any reliable predictors there are of increases to national wellbeing -- an area I feel like we know surprisingly little about. There's some work suggesting that increases to social capital and social spending are better predictors than economic growth. Something like social capital seems plausible but social spending seems likelier to be confounded by the requirement that you need to make money to spend money (on welfare systems). But there's some evidence that trust and social capital is increased in societies that experience high growth, so it's all a bit messy.
Some less relevant things I'll work on: what does the causal evidence say about social media and mental wellbeing? -- it's somewhat bad, probably. How happy were our ancestors? -- Either about as happy as we are or, or as happy as people are in Afghanistan -- Which is to say teetering on the cusp of having negative wellbeing on average. Not sure which yet. Is it the psychology, stupid? I'm also curious to understand the psychology of populism, and if a non-material lens gives us a better sense of how to predict and maybe prevent populist driven destablization to the institutions we'll need to preserve to have any chance at governing during these wacky next few decades.
Really cool work. It's striking how much higher mental health is in importance and support than GHD. Do you have any insight into why this is and what people are imagining when they're referring to mental health?
I interpret this as very weak evidence that there's an audience for global mental health / mental health related EG that is non-overlapping with GHD (that is, there are MH givers that wouldn't otherwise give to GHD). But of course 1. most philanthropy is domestically oriented, and presumably that's what people mostly have in mind here as well. 2. It's in my self interest to read the data this way, so wondering what y'all think.
Do you know how hard it'd be to tease our real answers to these questions if you couldn't answer them with current data? E.g., by adding questions to the next round of the pulse data.
This is super helpful to have explained and makes more sense now.
So what is your best guess of the cost per student educated given Malengo's expected ability to recycle costs and leverage? What is the cost per person Malengo educates / facilitates the immigration of that you would put into my BOTEC?
I'm going to focus on the funds recycling since this seems like it may be the most important bit.
Since you're assuming $1mil recycled for a budget of $5mil does this imply that you will recycle 20% of costs? If so, that seems low given everything else you've said, so I assume I'm missing something.
The leverage point is really interesting. Do you have any current prospects for making the leverage work? I would guess you have to wait (how long?) to see if the default rate is sufficiently low for the ISA?
What has to be true for this to work out financially? Something like the real rate of return on $ / euro invested in students has to be equal or greater than the interest rate on the loan?
It'd be great to hear more about this!
When you mention $2k and $400 per student, could you explain how this differs from the $30k listed as the best guess in the spreadsheet. Sorry for all the questions, I just want to understand!
(We've talked about most of this outside of the public view, but I can't restrain myself from commenting none-the-less)
I agree with you strategically that people who care about mental health need to make their case in a way that's legible to more traditional metrics like income, DALYs, etc. But the general thing this points to is greater legibility --> greater uptake --> impact blah blah.
On this general point, one thing we've been thinking about and piloting is just trying to make WELLBYs more legible, especially for MH interventions by converting them to years of depression averted (YODAs).
So I could say that a fictional charity Gaya Kuides generates 1,000 WELLBYs per $1k donated. Or given that the typical case of depression (moderate depression) is associated with a -1.3. lower wellbeing compared to low depression symptoms -- this implies that actually GK averts the equivalent of 1000 / 1.3 =769 years of depression per $1k donated. FWIW we explain the YODAs more here and we're looking for feedback on whether this seems like a useful communication device.
It just seems way easier to imagine the value of a year of depression averted compared to "WELLBY".
2. Long-run effects of psychotherapy
This is very important and understudied. The effects of psychotherapy could last much longer, and we could maybe make these interventions benefit people for much longer than we. But we don't care much about LR effects in general in the research community and we do not have much understanding of the mechanisms that support long-term benefits. I obviously wish that we'd change on both accounts.
Mo, I love this! I can't wait to hear what you think of what I come out with. I think I will steal some of these points (and acknowledge you).
Re if not growth: Regarding freedom, the weird(ish) thing is it's about perceptions of freedom. When you look at objective indicators for democracy it seems really null which I find very puzzling. I think I will dedicate some time to the hypothesis that we may not need to Swedenify but Latinify the world because it is just so striking and obvious that the LATAM countries clearly have a different intercept in the GDP <> LS relationship. The rural-urban thing is interesting. I assume that's mostly just a proxy for income in developing countries? I had urbanization as a predictor for trying to predict the wellbeing of the world throughout history but it seems colinear with GDP per capita. Altruism is interesting -- the animal welfare correlation is pretty striking -- what paper is this from? I wonder how much of altruism loads onto religiosity / a strong civic life? If I had to predict another big important factor for wellbeing that's the most orthogonal to GDP per capita it'd be something something a vibrant society and culture which I have no idea how to operationalize or optimize.
Hm! Yeah I'm planning to look at inequality which objectively, doesn't seem to matter much on a within country basis. I haven't thought about cross country comparisons because I guess I don't expect people to spend much time thinking about those comparisons unless maybe you're WEIRD. One funny, but in retrospective obvious things is that the literature seems to find that a subjective sense of inequality or being treated unfairly seems to be strongly predictive (in contrast to frequent nulls for objective stuff). Now, this also is much messier because you need to have some view of the generative process of those views to know what to think of it. Sadder people probably think the "world is rigged against me". But it also seems quite plausible that people are picking up a fuzzier factors that are harder to capture like media or culture.
Perhaps I should have said "semi-conventional within EA". GiveWell and FP, in their moral weights treat 1 doubling = 1 doubling regardless of the baseline income. Presumably AIM follows them? However, GiveWell (and probably FP) adopt a very strong wealth effect of η = 1.59 for their time discount. So they aren't necessarily consistent about how they use it. They are also aware of this.
It also seems pretty conventional, although much more implicit, in the wellbeing space, as the log-income cross national wellbeing gradient looks very linear (implying each doubling has the same effect).
Amongst economics, I assume "convention" is more about median than average? Drupp et. al (2018) surveyed views from over 200 discounting experts. For η, they gave a mean of 1.35 and a median of exactly 1.
Well yeah one implication is maybe should move towards consistently using a higher η? This would be a moderately sized deal. I'm going to partially frame the effects in terms of what's compatible with different values of η if we're assuming consistency between cash transfer experiments in LMICS and HICs.
I've started a living literature review on the relationship between wealth and wellbeing.
Things I've done some work on that I plan to publish more on that seem relevant to some EA conversations in global health and wellbeing :
Some less relevant things I'll work on: what does the causal evidence say about social media and mental wellbeing? -- it's somewhat bad, probably. How happy were our ancestors? -- Either about as happy as we are or, or as happy as people are in Afghanistan -- Which is to say teetering on the cusp of having negative wellbeing on average. Not sure which yet. Is it the psychology, stupid? I'm also curious to understand the psychology of populism, and if a non-material lens gives us a better sense of how to predict and maybe prevent populist driven destablization to the institutions we'll need to preserve to have any chance at governing during these wacky next few decades.
I can’t respond because I don’t know what “significantly reduce” means. 0.01%? 10%?
Hi Jamie and David,
Really cool work. It's striking how much higher mental health is in importance and support than GHD. Do you have any insight into why this is and what people are imagining when they're referring to mental health?
I interpret this as very weak evidence that there's an audience for global mental health / mental health related EG that is non-overlapping with GHD (that is, there are MH givers that wouldn't otherwise give to GHD). But of course 1. most philanthropy is domestically oriented, and presumably that's what people mostly have in mind here as well. 2. It's in my self interest to read the data this way, so wondering what y'all think.
Do you know how hard it'd be to tease our real answers to these questions if you couldn't answer them with current data? E.g., by adding questions to the next round of the pulse data.
I appreciate the caveat and you sharing your best guess!
This is super helpful to have explained and makes more sense now.
So what is your best guess of the cost per student educated given Malengo's expected ability to recycle costs and leverage? What is the cost per person Malengo educates / facilitates the immigration of that you would put into my BOTEC?
Thank you for the response Richard!
I'm going to focus on the funds recycling since this seems like it may be the most important bit.
Since you're assuming $1mil recycled for a budget of $5mil does this imply that you will recycle 20% of costs? If so, that seems low given everything else you've said, so I assume I'm missing something.
The leverage point is really interesting. Do you have any current prospects for making the leverage work? I would guess you have to wait (how long?) to see if the default rate is sufficiently low for the ISA?
What has to be true for this to work out financially? Something like the real rate of return on $ / euro invested in students has to be equal or greater than the interest rate on the loan?
It'd be great to hear more about this!
When you mention $2k and $400 per student, could you explain how this differs from the $30k listed as the best guess in the spreadsheet. Sorry for all the questions, I just want to understand!