Hi Mike, thanks so much for all your support and these thoughtful points.
Yes, there are additional costs associated with geographic expansion, and we believe these costs are justified for several reasons:
Testing Demand and Adaptation: By expanding to more rural locations, we aim to assess the demand for and adaptability of our services. Urban life in Quito is fast-paced, and we've noticed various factors competing for people's attention, making it challenging for group attendance. Most other g-IPT programs operate in rural settings, where individuals may have more time. This expansion allows us to explore whether there are better rates of treatment adherence, with participants completing all eight sessions.
Building a Demonstration Case: As you suggested, this expansion helps us build a demonstration case, primarily for provincial and local governments. Regional government staff are generally more accessible than national government officials, and showcasing the value of providing mental health care can influence policies at these levels (hopefully leading to national government adoption)
Higher Counterfactual Value: In general, the counterfactual value of providing mental health care is higher in third-tier cities and rural communities due to the concentration of government services in larger cities. If we can effectively manage costs and prevent an overall increase, we believe there is a moral imperative to extend support to those with fewer alternatives.
thank you so much again and welcome further questions and feedback!
TLDR: Vida Plena, which provides WHO-endorsed group therapy for depression in Ecuador, seeks $200,000 for behavioral science research, $50,000 for expansion to new regions, $9,600 annually to hire an additional Group Facilitator or $120 to provide treatment to one person.
See our full marginal funding forum post here.
I'm the co-founder of Vida Plena, a nonprofit organization tackling Ecuador's mental health crisis through cost-effective, proven group therapy led by local leaders from vulnerable communities. We do this through the direct implementation of Group Interpersonal Therapy, which is the WHO's recommended intervention for depression. We are the first to implement it in Latin America.
We launched in early 2022 (see our introductory EA forum post) and participated in the Charity Entrepreneurship Incubator program that same year. In the fall of 2022, we carried out a proof concept alongside Columbia University, which found positive results (see our internal report, and the report from the Columbia University Global Mental Health Lab).
So far this year, we've made a positive impact on the lives of 500 individuals, consistently showing significant improvements in both depression and anxiety. Our strategic partnerships with local institutions are flourishing, laying the groundwork for our ambitious goal of scaling our reach to treat 2,000 people in 2024.
For this marginal funding proposal, we seek $200,000 to expand our work and research to apply behavioral science insights to further depression treatment in Latin America. This enhanced therapy model will be evaluated through rapid impact assessments, deepening the evidence base for our work, and culminating in a white paper and a RCT in 2025.
In addition to the "Enhancing g-IPT via Behavioral Science" proposal described above, there are several other ways that Vida Plena could benefit from additional, marginal funding:
Hi Jason, thank you so much for thoughtfully bringing up this important question. While we do concur that the likelihood of Vida Plena increasing suicidal risk is low, we firmly believe in the importance of considering all possibilities.
Firstly, we want to emphasize that we are following the suicidal risk protocols established by the expert team at the Global Mental Health Lab at Columbia University, and we have been fortunate to receive ongoing mentoring from them throughout the course of these cases.
Broadly speaking, research shows this is unlikely. For example, a literature review conducted by Dazzi in 2014 failed to uncover any evidence supporting "a statistically significant increase in suicidal ideation among participants asked about suicidal thoughts." Instead, "The findings of this review suggest that in both adolescent and adult populations, acknowledging and talking about suicide may, in fact, reduce rather than increase suicidal ideation."
More likely, we expect that our cultural context is an influential factor. Several practitioners we consulted with emphasized that due to the stigma surrounding mental health treatment in Latin America, the people who finally reach out to seek treatment are very likely facing more severe levels of mental distress compared to what is commonly observed in the US or UK.
This is a question we'll be able to answer more fully once we conduct further monitoring and evaluation with a control group. We promise to keep you posted!
Thank you Stephen, I feel really blessed to get to be part of this team, and grateful for all the people who trust us to help them.