Lovisa Tengberg: current view, StrongMinds

This is part of a series of posts where each research fellow describes their reasons for favouring a certain recipient of our final donation, as described further in the full post on Version 0. 

Name: Lovisa Tengberg
Date: 2017-02-14

My current best guess is that we should donate to intervention/organisation:
Mental Health (most likely StrongMinds, but also want to look further into the Alderman Foundation, AEGIS Foundation, and Network for Empowerment and Progressive Initiative, as these have been recommended by Harvard EA Student Group in a report, suggesting that they “show potential in leadership, scalability, cost-­effectiveness of programs, and proven success”)

My cost-effectiveness estimate for the intervention/organisation is:
MH is a large-scale issue which is highly neglected:
As mentioned in my previous reports on 2017-01-26 and 2017-02-06, up to 10% of people worldwide are affected by MH problems. It represents 7.4% of the world’s total global burden of disease, accounting for 22% of all days lived with disability (as measured in DALYs). The DALYs due to mental illness grew by 38% in the twenty years between 1990 and 2010, and is expected to continue on this trajectory

New info: From the Harvard EA group’s report, the burden of mental illness (excluding Parkinsonism, dementia, epilepsy etc.) is actually “underestimated by more than a third using current approaches”. They believe this underestimation is from: “overlap between psychiatric and neurological disorders; the grouping of suicide and self­harm as a separate category; conflation of all chronic pain syndromes with musculoskeletal disorders; exclusion of personality disorders from disease burden calculations; and inadequate consideration of the contribution of severe mental illness to mortality from associated causes....Therefore, mental health is a pressing and growing issue in Sub­Saharan Africa as more research and insight into its true burden is revealed.”

Further, like Konstantin and Michael Plant, I suspect QALYs/DALYs very likely underrate the badness of MH on happiness (Plant: “Once you revise the $/DALY cost-effectiveness figures to take into account how DALYs underrates happiness, it's possible treatments for depression at around $1000/DALY...are in roughly the same ball park as AMF, which is $100/DALY”), which influences my decision.

MH is largely neglected at a national level and by the international donor community, with only ~20% with severe mental disorders accessing treatment in low-income countries, and according to a review which measured diagnosis rather than severity, there is a treatment gap for mental disorders of ~55%.

For the reasons above, I believe a donation to a cost-effective MH intervention (assuming one is found) could have a large potential impact, possibly more than other interventions we have looked at.

StrongMinds is a charity that treats women in Uganda with depression through a ‘unique’ depression intervention, based on Group Interpersonal Psychotherapy (IPT-G), a low-cost, scalable and cost-efficient community based methodology.  

StrongMinds seems to be one of few charities where extensive external research has been conducted to test the effectiveness of the program, with successful results. According to a report by the Center for EA, “it outperforms typical interventions aimed at improving mental health through direct treatment”.

CEA has done a very detailed cost-effectiveness analysis of StrongMinds here, and further I have received information on their funding gap from the organisation directly. Key metrics:

  • (Cost-effectiveness (from MHIN): $34 / DALY averted (seems v. wrong to me, must have misunderstood something, but wanted to include nevertheless))

  • Cost-effectiveness (from model): $676.9 / DALY averted, with expected drop to $404 / DALY averted (seems in line with the DCP-3 report’s estimates of interventions)

  • Funding gap:

    • 2017: $250,000 (USD)

    • 2018: $1.6m (USD)
  • Women treated: nearly 10,000

  • Plans:

    • Within next 3 years: reaching 100,000 women

    • By 2025: reaching 2 million women

    • Expansion to Kenya in 2018

  • 82% depression-free at conclusion of treatment

  • 80% depression-free 6 months post treatment

  • 67% decrease in unemployment

  • ~75% of groups continue to meet after formal sessions conclude

What would change my mind:

  • Depends on the cost-effectiveness - should speak to StrongMinds to see what figures they have (assuming these are relatively accurate), and when and to what a ‘drop’ in $ / DALYs averted is expected

  • Long-term effects of IPT-G are relatively unknown. If it is shown that the results from the studies done by John Hopkins on StrongMinds don’t hold up in the long run, I would change organization / cause

  • If shown (once examined) that one of the other MH organizations recommended by the Harvard EA community are more cost-effective than StrongMinds - need to look into them further, although I am skeptical

  • Similar to Konstantin and Plant, my decision is based much on the fact that we should aim to reduce misery rather than poverty, and (as mentioned by Konstantin), if it is proven that there are other cause areas with effective organizations where hedonic adaptation does not take place (like with chronic pain), I would reconsider.

  • I would consider existential risk and animal welfare (given (supposedly) no adaptation) as causes in case cost-effectiveness and tractability were proven convincing

  • Happy to hear other people’s views and be convinced otherwise

My current best guess for a runner-up is:
Against Malaria Foundation (as a default, based on GiveWell's current recommendation.