This post appeared first on the EA Coaching blog.
While the oft-cited statistic is that 20% of adults have a mental illness, I estimate the true number who would benefit from therapy or mental health self-help resources at some point in their life is closer to two thirds (see footnote)
I personally benefit enormously from taking an antidepressant and understand myself better from having seen four therapists over the past decade, yet somehow it never occurred to me that I should try either until friends shared their personal stories. There’s probably a whole post’s worth of words on how it’s hard to match our internal experiences to labels.
But I’m not writing that post, so I’ll just say this: Maybe it helps to think of mental health as understanding and being able to manage what your brain does, instead of a diagnosis wielded by doctors about a specific disease. So when I’m putting time into mental health, I’m investing in training my brain.
I’m not saying mental illnesses aren’t real illnesses - instead I’m pointing at the broad spectrum of internal experiences between “diagnosable major depression” and “I feel and think things that I don’t like and don’t know how to deal with.” Mental health resources can help with both of those places.
So here are the best resources I have for investing in your brain. I’ve bolded the most useful ones, so focus on those if you’re short on time.
If you’re severely depressed enough that you don’t have the energy to wade through answers or you are currently suicidal, call a helpline or schedule an appointment with your doctor.
Otherwise, start with the Slate Star Codex posts Things that sometimes work if you have anxiety and Things that sometimes help if you have depression. Scott Alexander put together great summaries of the lifestyle, professional, pharmaceutical, and last resort interventions you can try.
The Patient Health Questionnaire (PHQ-9) asks a few questions that let you check how likely it is that you’re depressed. If you score above 10, you should probably think about seeing a doctor. If you score 5-9, you may still benefit from medication (which would require seeing a doctor) or self-help. Additionally, you can actually get a pretty low score even if you're thinking about suicide all the time, as long as you don't have other symptoms. So go see a doctor if that’s you.
Feeling Good: The New Mood Therapy by David Burns introduces self-administered cognitive behavioral therapy (CBT) with worksheets. The book has even stood up against medications when studied clinically.2 If you have recurring thoughts that feel true and make you feel depressed, this book might help you check those beliefs against reality. One big caveat, ignore everything Burns says about medication. (It’s important to actually do the exercises - when I’ve tried using the worksheets with clients, the main failure mode is not filling the exercises in consistently.)
If you’re considering trying medication, you’ll need to talk to a doctor. You might also want to do your own research - Scott’s posts above are good places to start getting information. This sheet has quick facts on side effects of various antidepressants, and I appreciated Rob Wiblin’s thoughtful write up about his experience with Wellbutrin.
Among effective altruists, there’s a particular pattern of mental health problems related to feeling guilty about not doing enough to help the world: feeling guilty setting personal boundaries, or worrying that you’re not smart enough to make a difference, or thinking that what you’re doing is good but just not “good enough” to matter. Desperation Hamster Wheels is a great description of one EA’s experience with this, Helen Toner’s sustainable motivation talk is good, and the Replacing Guilt series on Minding Our Way seems to be particularly valuable in helping find a healthy balance to these thoughts so that you actually make progress toward your goals.
If you want more resources, Scott Alexander’s new psychiatry practice has a growing database of mental-health-related resources. Ewelina Tur, an EA therapist, has a list of mental health resources here, including workbooks, mental health apps, and audiobooks. The EA Mental Health Navigator website has a list of virtual mental health resources here.
A quick note: even if you’ve tried the self-help strategies above and they didn’t work for you, you may still benefit from therapy. It’s often worth trying the self-help stuff (because it’s cheaper if it works), but a good therapist will have a perspective that you likely lack. So base the decision about trying therapy on how much benefit improving your mental health would have on your productivity and quality of life.
This section is mostly US focused, plus a bit of UK.
Finding a therapist you like can be challenging. Therapy is a big time investment with high variance outcomes, but the expected value is often quite high.
Advice on selecting a good therapist
Kate Donovan, an effective altruist and therapist, wrote this concrete 4-part guide to starting therapy, which includes email templates for reaching out to therapists.
Damon Pourtahmaseb-Sasi, another EA therapist, wrote his suggestions for warning signs to look out for in his post The Bad Therapist.
Finding a therapist
There is a pilot program to help EAs navigate the hurdles to accessing mental health support. If you’re interested, you can reach out to the EA Mental Health Navigator here.
Slate Star Codex has a list of community-recommended therapists. Note, information on price and sliding scales seem to be out of date for some therapists on the list, and most don’t accept insurance.
For therapists specific to the bay area, Anisha put together this list of therapists recommended by community members, and Howie Lempel put together a second list of recommended therapists. Again, most therapists on these lists don’t accept insurance.
If it’s important to find a therapist who accepts your insurance, Psychology Today has a directory of therapists that you can search in your area. You can filter by insurance, specialty, etc. Note, if the therapist claims to take thirty different insurances, they probably mean they will send you a superbill for out-of-network reimbursement. This means that you will likely owe half to the full price.
Most health insurance companies also have a tool to search for in-network therapists on their website, although the tool may be a pain to use.
I haven’t checked out therapy matching websites, but they might be better than having to go through a long process of searching yourself. I would love to hear feedback on readers’ experiences. Were you matched with a therapist you liked and found helpful? Was it covered by insurance? How annoying/effortful was the process?
If you’re in the UK, you can search for therapists on this website.
However, 71% of responses to the EA Mental Health Survey reported having or suspecting they had a mental health condition. I checked among a sample of 20 responses to “Do you suspect you have or have you ever been diagnosed with depression, anxiety, ADHD, or another mental health disorder?” that I ask potential clients, and the response was about half (two thirds if I count mild conditions). Anecdotally, this seems reasonable based on my observations of friends in the EA community.
I suspect this discrepancy is because:
- The National Survey on Drug Use and Health doesn’t include ADHD, which the EA Mental Health Survey and my intake question both did. This increased the total by about 10 percentage points.
- The National Survey on Drug Use and Health only asks about the present year, while the EA Mental Health Survey and my intake question both ask about past diagnoses.
Note: The mental health survey likely had significant sample bias in who decided to take it.
With all of that, it seems quite possible that above 50% of adults will deal with a mental health problem at some point in their lives that is worth addressing.
Many thanks to Ewelina Tur, Nora Ammann, Julia Wise, Mary Wang, and Peter Knu for their feedback.
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