Revolutionizing Mental Health

5.11.2022, Dr. Inga Grossmann

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How and What to Scale

Why do It

How to Scale

3

What works

2

Revolutionizing Mental Health

1

Taking Action

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Why Do It

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How Bad is Global Mental Health?

Help is neglected �

• Untreated: ~ 2/10 HIC, 1/10 LMIC
• Spending/DAILY: ~ <10x LMICs, <2x HICs
• >3x than for physical illness for both

Many suffer�

• ~ 970 mio. affected (~13%), ~ 1/7 YLD
• Leading cause of suicide, misery

social & economic consequences

We could, but do not yet solve the issue cost-effectively.

(Global burden of Disease, Our World in Data, 2021; WHO, 2022; Happiness Research Institute, 2020; Ormel et. al, 2008; HLI, 2021; Mekonen et al. 2021; )

It is tractable. Exemplary cost-effective treatment: Strongminds 9x cash transfer.

Mental illness brings an extreme burden of disease, is heavily neglected, and could be solved cost-effectively.

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What About Your Wellbeing?

Go to www.menti.com �use the code 7363 5970

and answer the questions

Lost productivity in EA

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• ~35% of every affected person
• ~5-10% affected in EA movement
• EA members untreated: 50%

Beck et al., 2011; EA Survey, 2021; SSC Survey, 2020; Moran, 2016; Schoechlin & Engel, 2005; Snyder, 2013

What is a Good Life?

Flourishing: when you can tackle the opportunities and challenges your life brings well with the internal and external resources you have.��

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(Fredrikson & Losada, 2005; Dunn & Dougherty, 2008)

Fig. Vulnerability-Stress-�Model (in accordance with Ingram, & Luxton, 2005)

How can we improve Mental Health?

Prevalence-treatment paradox

(Ormel et al., 2022)

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How to maximize cost-effectiveness

Cost-effectiveness = impact per cost

Impact = solution quality x implementation quality

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https://www.poverty-action.org

Retention

Reach

Reaction

Response

Resources (Cost)

What Works

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(Prevalence-Treatment Paradox (Ormel et al., 2022)

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Impact = solution quality x implementation quality

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One Side: Treat Individuals�Build up internal coping resources by using effective treatment components.

Gaps

• non-or low-effective ones spread
• effects lost after few months
• the longer one waits, the harder to treat

(e.g. Royal College of Psychiatrists (UK), 2022; Patel et al. 2015 page 75-76; Griner & Smith, 2006; Wildeboer et. al, 2016; Li et al.,2021; Kimberly at. al., 2022; Kim & Mierzwinski-Urban, 2018; Luoma et al., 2020; Newby et al., 2015; Steinert et al., 2014; Kovács, 2022; Izett, 2021; Hennemann et al., 2018; Cuijpers et al. 2021)

What works: time, technique and tailor

use most effective psychological & psychopharmaca treatments

tailor interventions to culture, preferences, case etc.

engage in early prevention, + ongoing support

One Side: Treat Individuals�Build up internal coping resources by using effective treatment components.

measure outcomes

train relationship skills

learn latest best working methods

Gaps

varying quality

don’t get better over time

(e.g. Graßmann et. al, 2019; Miller et al. 2018; Norwood et al. 2018; MWampold et. al, 2017)

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What works: tie, & test

Other Side: Shape Settings

Build external coping resources, reduce stressors and barriers.

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Environments

Gaps

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• many vulnerable groups not reached
• loneliness, and social exclusion
• highly stressful settings

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Shape workplaces, schools, neighborhoods, homes in need-aligned way

Setting- and community-based interventions

Basic safety: programs reducing mobbing, crime and discrimination

What works: programs for daily settings

(based on: Report WHO, 2022 ; Harandi et al., 2017, Werner-Seidler et. al., 2017; Ryan, & Deci, 2000)

Local Communities

Action for Happiness

Other Side: Shape Settings

Build external coping resources, reduce stressors and barriers.

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Gaps

• stakeholder are badly connected
• stigma, lack of information etc.
• lack of access to services

What works: evidence-based regulations

(e.g.: Report WHO, 2022; Waquas,2020; Charity Entrepreneuship, 2020)

Policies against suicide, unequal access

advocacy and awareness for mental health (anti-stigma)

mental health promotion in health and social services

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What About Your Wellbeing?

1:1 Discuss survey results with your neighbor (3min)

Based on what you just heard, how might one improve the community member's mental wellbeing?

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Resources

Flourishing

Individual

Health

Knowledge/Education

Internal Coping Capacity

Setting

Relationships

Money

Time

Your life

How to Scale

3

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Impact = solution quality x implementation quality

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Four Promising Levers

To scale, task-share with digital and human assistants, distribute via key life settings and decision-makers.

(Baumeister at al., 2014; Pfeiffer et al., 2010; Karyotaki et. al, 2021, Musiat et al., 2014).

(e.g. Feiss et al., 2019, Johnstone et al., 2018; Cuijpers et al., 2008; Creed et al. 2011; Curran and Wexler, 2017, Durlak and Weissenberg, 2007)

(Andersson et. al, 2019, Andrews et. al, 2018, Sander et. al, 2016; Baumel et al., 2019, Torous et al., 2020, Wouter van Ballegooijen et al., 2014; Lindhiem et. al, 2015; Zhongfang et. al, 2020; Pauley et. al, 2021; Cuijipers at. al, 2010)

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Examples: Digitize Where Possible

WEEK 1

Weekly Modules using Cognitive Behavioral Methods

Elective Module, e.g. �Strengthening self-esteem�Less ruminating�Social support�Social skills training�Coping with separation�Dealing with death & illness

Typical components�psychoeducation

tracking and diaries

problem-solving

goal attainment

behavior change

rethinking

Apps for Daily Usage: Headspace, Cogito�

Online Diagnostics

Canopie, Mindease, ClearerThinking (no RCTs yet)

• Psychoeducation,
• Tracking & Diaries, Problem Solving, Goal attainment, Behavior change

WEEK 8

EA orgs digitizing treatment:

Weekly Online Course: Moodgym

Why do we need to embed digital mental health tools?

Fig

Mental health apps. % nb. of users who opened app from day 1 to day 30 out of the nb. who installed and opened the app on day 0.

How many still use

them after few weeks

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(Torous et al., 2020, Baumel & Edan., 2019; Wouter van Ballegooijen et al., 2014; Giovanetti et al., 2021)

65-75% 1:1 treatment

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50-75% guided digital treatment��10% unguided app in the field

Examples: Train Laypeople

Examples: Train Laypeople

Task-Sharing (EA adjacent):

Friendship Bench, Strong Minds

Digitized Peer-Support:

7Cups TogetherAll

Examples: Train Laypeople

Examples: Train Laypeople� Digitally

World Health Organization: Academy

Four Promising Levers

To scale, task-share with digital and human assistants, distribute via key life settings and decision-makers.

(e.g.Rahman, 2007; Feiss et al., 2019, Johnstone et al., 2018; Cuijpers et al., 2008; Creed et al. 2011; Curran and Wexler, 2017, Durlak and Weissenberg, 2007)

(Baumeister at al., 2014; Pfeiffer et al., 2010; Karyotaki et. al, 2021, Musiat et al., 2014).

(Andersson et. al, 2019, Andrews et. al, 2018, Sander et. al, 2016; Baumel et al., 2019, Torous et al., 2020, Wouter van Ballegooijen et al., 2014; Lindhiem et. al, 2015; Zhongfang et. al, 2020; Pauley et. al, 2021; Cuijipers at. al, 2010)

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Examples: Use existing structures

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Workplace

Coachhub Wellbeing.

School

KIVA Antimobbing

No EA orgs so far that offer blended setting-programs

Overcome (EA): Blended Care in LMICs

Examples: Help Decision-Makers

Center for Urban Design and Mental Health (global)

Mentally Healthy Schools (UK)

Happier Lives Institute (EA): �Research, & Policy

Taking Action

4

Status of Mental Health as an EA Cause Area

Infrastructure and initiatives are slowly forming, it needs more.

Charity Entrepreneur-

ship (CE): mental health as category

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Few established orgs

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Some new projects such as Vivid, Effective Peer-Support, Better mazSelf-Help

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Cause area reports, e.g. HLI (2021)

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High-Impact Psychology, High Impact Medicine, HLI are working on more relevant materials including career advice

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Few upcoming:

Open Philantrophy,

Schmidts Futures

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Few existing:

CE Mental Health Funders,

Regranters,

Agency Fund

High-Impact Psychology might host events soon

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Online-Groups: Slack “EA Mental Health”, facebook “EA, Mental Health, and Happiness

Organizations and projects

Information Infrastructure

Funding opportunities

Network Infrastructure

What you can do for High-Impact in Mental Health?

hack your own mental health

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help projects that care for community mental health

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treat community members

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train others to support

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improve by getting feedback, and measure your success

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use digital tools

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join forces with people working in the field

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show funders mental health can be tackled cost-effectively

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fund, make grants

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engage in scalable approaches

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address an existing gap (one vulnerable group, LMICs, HICs)

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do it in an “EA-way”, e.g. ,cost-effective

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Take care of the EA community

Be an effective coach or therapist

Help to build the infrastructure

Found or join an EA-adjacent org

Help us to help you increase your impact

5 min to fill out this form to

• give talk feedback
• pre-sign up for resources �in the EA mental health space

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You want to contribute �or be hired by HIPsy?

Let us know!

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Summary: maximize cost-effectiveness

Impact = solution quality x implementation quality

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Reaction: effect duration

Retention

Reach

Reaction: effect size

Response

Resources

Your checklist 2 * 4 Ts for easier memorizing:

Improve solution

• Techniques (use integrative, multiple proven ones)
• Time (include prevention, aftercare)
• Tie (focus on relationships to treater, community, peers etc.)
• Tailoring (adapt to culture, case, context, preferences, etc.)

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Improve implementation

• Technology (outsource educational and diagnostics content to tech)
• Trained laypeople (teach them to execute interventions)
• Territory (embed in existing settings, e.g., daily settings)
• Transmission (work with multipliers and decision-makers)

Thanks!

Do you have questions?

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inga_grossmann@gmx.de

+49 1520 9828 014

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CREDITS: This presentation template was created by Slidesgo, including icons by Flaticon, infographics & images by Freepik and illustrations by Storyset

Backup Slides

CREDITS: This presentation template was created by Slidesgo, including icons by Flaticon, infographics & images by Freepik and illustrations by Storyset

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IPA’s path to scale

Impact = solution quality x implementation quality

https://www.poverty-action.org

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Case Analysis: StrongMinds

• StrongMinds provided group therapy (interpersonal therapy IPT) to 160,000 women low-income women with depression in Uganda and Zambia.�
• The interventions are delivered by lay community workers in person over 8-10 weekly sessions. �
• They work with governments and NGOs to layer mental health services into existing livelihood, food security, healthcare, and education programs

What would you advise as a consequence of walking through the checklist?

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Case Analysis: StrongMinds

Rate with yes/partly/no/don’t know (Mentimeter)

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1. Improve effectiveness
1. Techniques (integrative: setting + individual)
2. Time (prevention, aftercare)
3. Tie (relationship-focused)
4. Tailoring (to culture, preferences etc.)

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1. Improve implementation
2. Technology (assisting or topping)
3. Trained laypeople (as executors)
4. Territory (embedded in existing context)
5. Transmission (working with local multipliers)

What would you advise as a consequence of your assessment?

Why is it so Bad? �There are vast gaps and demands for improvement.

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• many vulnerable groups not reached
• social exclusion, stigma, loneliness
• highly stressful settings

• varying quality
• too few
• don’t get better over time

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• non-or low-effective ones spread
• often too late
• effects lost after few months

• poorly informed decision-makers
• stakeholders don’t work together
• lack of access to services

Environments