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- John Halstead
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Mental Health Executive Summary and Giving Recommendation
Mental illnesses such as depression, anxiety, and dementia are a daily reality of suffering for millions of people across the world. In total, mental health, neurological and substance-abuse (MNS) disorders account for 10.5% of the global disease burden, second only to cardiovascular disease. In addition to their health and wellbeing costs, MNS disorders impose a large economic cost: a 2012 report estimated the annual global cost of mental health conditions at $2.5 trillion. Lastly, there is still a large stigma on mental health: those suffering from mental health problems often face marginalisation at both the social and institutional level.
Our research produced three key findings, which helped to guide our search for impactful charities:
1. Mental health is chronically neglected, especially in low- and middle-income countries
Most low- and middle-income countries spend less than US$2 per year per person on the treatment and prevention of mental disorders, compared with an average of more than $50 in high income countries, and international aid has done little to fill the funding gap. As a result of this funding gap, the treatment gap – the proportion of mental illness sufferers that go untreated – in low- and middle-income countries is much greater than the treatment gap in high income countries.
2. There is a strong case for task-shifting in low- and middle-income countries
There is currently a severe lack of mental health practitioners in most developing countries. This lack of skilled personnel means that resource-intensive mental health interventions in developing countries are often not suitable. In this context, development economists and public health practitioners have called for the increased use of task-shifting in countries without the necessary skilled personnel. Task-shifting refers to specialised tasks being undertaken by people with a lower level of training than physicians or psychiatrists. The existing evidence suggests that task-shifting is effective and lowers costs significantly.
3. Evidence generation is of high priority
There is limited evidence on the effectiveness of mental health treatments in low- and middle-income countries. It is therefore crucial that charities working in the space try to generate new evidence.
Our charity search was guided by these key findings. Other things equal, we preferred charities which work in low-income countries, engage in task-shifting, and seek to generate evidence.
Charity recommendation: Strong Minds
Following a search through over one hundred mental health charities, we decided to recommend StrongMinds as the best donation opportunity in the space that we were able to find.
What do they do?
StrongMinds implement Interpersonal Group Psychotherapy (IPT-G), training laypeople to treat women suffering from depression in Uganda.
Does the intervention work?
Evidence for the efficacy of IPT-G in low-resource settings comes from two randomised controlled trials (RCTs) and StrongMinds’s own quasi-experimental impact assessment.
Is the intervention cost-effective?
We estimate that StrongMinds prevent the equivalent of one year of severe major depressive disorder for a woman at a cost of $200–$299, with a best guess estimate of $248.
What are the wider benefits?
There are indications of improvements in employment, nutrition, physical health, housing, and children’s education.
Are they a strong organisation?
They have a good track record and a strong focus on generating evidence. They are transparent about their mistakes and lessons, and are committed to continuous improvement.
Is there room for funding?
StrongMinds could productively use an extra $5.1 million in funding through 2020.