All of Barry Grimes's Comments + Replies
You may be interested in this recent meta-analysis on the efficacy of mental health apps. The authors conclude that: "apps have overall small but significant effects on symptoms of depression and generalized anxiety, and that specific features of apps – such as CBT or mood monitoring features and chatbot technology – are associated with larger effect sizes."
I recommend The Elephant in the Bednet as an accessible introduction to the different philosophical theories for the badness of death.
This comment helps to highlight the importance of language when discussing this topic. Happiness and wellbeing are not the same thing and it can lead to confusion when the two terms are used interchangeably.
This post explains the three main theories of wellbeing: hedonism, desire-based views, and objective list views. If you're a hedonist, then failing to optimise for happiness would be a mistake. However, as Owen points out, people often trade off happiness for other things they value which is more consistent with the objective list theory.
Over recent dec...
I'm feeling confused by these two statements:
Although there are other problems, those I have repeated here make the recommendations of the report unsafe.
Even if one still believes the bulk of (appropriate) analysis paths still support a recommendation, this sensitivity should be made transparent.
The first statement says HLI's recommendation is unsafe, but the second implies it is reasonable as long as the sensitivity is clearly explained. I'm grateful to Greg for presenting the analysis paths which lead to SM < GD, but it's unclear to me how much ...
I recently discovered that GiveWell decided to exclude an outlier in their water chlorination meta-analysis. I'm not qualified to judge their reasoning, but maybe others with sufficient expertise will weigh in?
...We excluded one RCT that meets our other criteria because we think the results are implausibly high such that we don't believe they represent the true effect of chlorination interventions (more in footnote).[4] It's unorthodox to exclude studies for this reason when conducting a meta-analysis, but we chose to do so because we think it gives us an ove
I recently discovered that GiveWell decided to exclude an outlier in their water chlorination meta-analysis. I'm not qualified to judge their reasoning, but maybe others with sufficient expertise will weigh in?
...We excluded one RCT that meets our other criteria because we think the results are implausibly high such that we don't believe they represent the true effect of chlorination interventions (more in footnote).[4] It's unorthodox to exclude studies for this reason when conducting a meta-analysis, but we chose to do so because we think it gives us an ove
[Disclaimer: I worked at HLI until March 2023. I now work at the International Alliance of Mental Health Research Funders]
Gregory says
these problems are sufficiently major I think potential donors are ill-advised to follow the recommendations and analysis in this report.
That is a strong claim to make and it requires him to present a convincing case that GiveDirectly is more cost-effective than StrongMinds. I've found his previous methodological critiques to be constructive and well-explained. To their credit, HLI has incorporated many of them in the update...
Thanks for providing such a thoughtful response. These value judgments are extremely difficult and it looks like you did the best you could with the evidence available. I haven't looked into the subjective wellbeing of suicide survivors but, if there's enough data, this could provide a helpful sense-check to your original discount rate.
Although means restriction is very successful at reducing suicide rates, I'm curious how it compares to social determinants (or psychotherapy) if the goal is DALYs/QALYs/WELLBYs. It seems plausible that public health interve...
I'm very pleased to see public health become a distinct part of OP's portfolio. In particular, the continued support for suicide prevention is very welcome.
I'm curious about how you model the future wellbeing of the people whose suicides are prevented. Given that your focus is on LMICs, it's very unlikely they'll receive mental health treatment, so what happens to them? Do they make a full recovery or do they (and their families) continue to suffer?
I don't think this was your intention, but this post implies that OP only cares about reducing the deat...
Thanks Barry,
At GiveWell (where I was working when we started the suicide prevention work), we discounted the impact to account for people who would otherwise die by suicide potentially living somewhat worse lives than a typical person in their context. Given the empirical and moral uncertainty, that estimate was based on a deliberative process and preference aggregation of different staff views rather than a single bottom-up model. Open Phil hasn't yet decided whether to incorporate a similar discount.
An overview of how GiveWell thought about it is ...
This is a very half-baked idea, but most trust-based services (e.g. Uber, Airbnb, Trustpilot) seem to have settled on five-star ratings and/or reviews as a solution. Perhaps you could experiment with adding similar functionality to EA Forum profiles for orgs and/or individuals, although I'm sceptical the benefits would outweigh the potential downsides.
I noticed that much of the political tractability discussion has focussed on counterfactuals involving other diseases (e.g. malaria) but I'm more confused why the government prioritised treatment over prevention.
Oster's article argued that prevention would be a better bet than treatment and that was written in 2005 when Congress had approved the budget and the prices of the drugs had come down. You also highlight the importance of, "the evidence from those who had worked in the field that antiretroviral drugs and preventive measures could be deployed effec...
That's good to know, thanks for clarifying. A democratic process is definitely better than a top-down approach, but everyone who participates in that process will be subject to affective forecasting biases too. That's why I favour using subjective wellbeing data, but I'm keen to hear about alternative options too.
Hi Henry. Thanks for your feedback! I'll let Joel respond to the substantive comments but just wanted to note that I've changed the "Appendix D" references to "Appendix C". Thanks very much for letting us know about that.
I'm not sure why Appendix B has hyperlinks for some studies but not for others. I'll check with Joel about that and add links to all the papers as soon as I can. In future, I plan to convert some of our data tables into embedded AirTables so that readers can reorder by different columns if they wish.
Just to explain why I downvoted this comment. I think it is pretty defensive and not really engaging with the key points of the response, which made no indication that would justify a conclusion like: „You seem to be prioritising the options based on intuition, whereas I prefer to use evidence from self-reports.“
There is nothing in the capability approach as explained that would keep you from using survey data to consider which options to provide. On the opposite, I would argue it to be more open and flexible for such an approach because it is less limited...
Thanks very much for writing this. It’s helpful to have a clear and succinct summary of the capabilities approach on the Forum and I thought the post was constructive and well-written. It provides a nice counterpoint to HLI’s post, To WELLBY or not to WELLBY?
However, the capabilities approach (as you describe it here) strikes me as deeply paternalistic. How do we decide which capabilities to prioritise without asking people how much they value them? We can’t just defer to Nussbaum.
In the post you say:
...The third approach, which I personally prefer, is t
Thanks for these questions.
I think that there are two main points where we disagree: first on paternalism and second on prioritizing mental states. I don't expect I will convince you, or vice versa, but I hope that a reply is useful for the sake of other readers.
On paternalism, what makes the capability approach anti-paternalistic is that the aim is to give people options, from which they can then do whatever they want. Somewhat loosely (see fn1 and discussion in text), for an EA the capability approach means trying to max their choices. If instead o...
That first point could be rephrased as "an exclusive SWB focus prioritizes providing resources to people who are less able to psychologically adapt to bad circumstances.". That seems like a good approach to me.
In the example you give, I'm not sure the previous circumstances are relevant to the question. In that situation, I would prioritise the person who was suffering the most (all else equal).
If you found this post helpful, please consider completing HLI's 2022 Impact Survey.
Most questions are multiple-choice and all questions are optional. It should take you around 15 minutes depending on how much you want to say.
If you found this post helpful, please consider completing HLI's 2022 Impact Survey.
Most questions are multiple-choice and all questions are optional. It should take you around 15 minutes depending on how much you want to say.
If you found this post helpful, please consider completing HLI's 2022 Impact Survey.
Most questions are multiple-choice and all questions are optional. It should take you around 15 minutes depending on how much you want to say.
If you found this post helpful, please consider completing HLI's 2022 Impact Survey.
Most questions are multiple-choice and all questions are optional. It should take you around 15 minutes depending on how much you want to say.
If you found this post helpful, please consider completing HLI's 2022 Impact Survey.
Most questions are multiple-choice and all questions are optional. It should take you around 15 minutes depending on how much you want to say.
If you found this post helpful, please consider completing HLI's 2022 Impact Survey.
Most questions are multiple-choice and all questions are optional. It should take you around 15 minutes depending on how much you want to say.
If you found this post helpful, please consider completing HLI's 2022 Impact Survey.
Most questions are multiple-choice and all questions are optional. It should take you around 15 minutes depending on how much you want to say.
If you found this post helpful, please consider completing HLI's 2022 Impact Survey.
Most questions are multiple-choice and all questions are optional. It should take you around 15 minutes depending on how much you want to say.
If you found this post helpful, please consider completing HLI's 2022 Impact Survey.
Most questions are multiple-choice and all questions are optional. It should take you around 15 minutes depending on how much you want to say.
If you found this post helpful, please consider completing HLI's 2022 Impact Survey.
Most questions are multiple-choice and all questions are optional. It should take you around 15 minutes depending on how much you want to say.
If you found this post helpful, please consider completing HLI's 2022 Impact Survey.
Most questions are multiple-choice and all questions are optional. It should take you around 15 minutes depending on how much you want to say.
If you found this post helpful, please consider completing HLI's 2022 Impact Survey.
Most questions are multiple-choice and all questions are optional. It should take you around 15 minutes depending on how much you want to say.
Hi Nick. I found more details about the Baird et al. RCT here. I've copied the section about the 'cash alone' arm below as I know you'll be interested to read that:
...One of the issues that can cause difficulties in the interpretation of the findings from this study comes from the fact that it does not have a classical 2x2 factorial design that includes a “cash alone” arm. While it would have been ideal, from a study design perspective, to have such a design, which would have enabled us to experimentally reject (or not) that cash alone would have been as effe
Love this! I found it really valuable to be reminded of all the posts I’ve read this year and to reflect on how they’ve shaped my thinking. Big props to everyone involved in making this.
Thanks for explaining your reasoning for the downvote.
I don’t expect everyone to agree with my comment but if you think it is false then you should explain why you think that. I value all feedback on how HLI can improve our reasoning transparency.
However, like I said, I’m going to wait for GWWC’s evaluation before expressing any further personal opinions on this matter.
"Happiness/Wellbeing GiveWell" is a fair description of HLI in my opinion. However, I want to push back on your claim that GiveWell is more open and balanced.
As far as I can tell, there is nothing new in Simon's post or subsequent comments that we haven't already discussed in our psychotherapy and StrongMinds cost-effectiveness analyses. I'm looking forward to reading his future blog post on our analysis and I'm glad it's being subjected to external scrutiny.
Whereas, GiveWell acknowledge they need to improve their reasoning transparency:
...Where w
To clarify, the bar I am suggesting here is something like: "After engaging with the recommender's donor-facing materials about the recommended charity for 7-10 minutes, most potential donors should have a solid understanding of the quality of evidence and degree of uncertainty behind the recommendation; this will often include at least a brief mention of any major technical issues that might significantly alter the decision of a significant number of donors."
Information in a CEA does not affect my evaluation of this bar very much. For qualify in my ...
I read this comment as implying that HLI's reasoning transparency is currently better than Givewell's, and think that this is both:
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False.
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Not the sort of thing it is reasonable to bring up before immediately hiding behind "that's just my opinion and I don't want to get into a debate about it here".
I therefore downvoted, as well as disagree voting. I don't think downvotes always need comments, but this one seemed worth explaining as the comment contains several statements people might reasonably disagree with.
I'm seeing a lot of accusations flying around in this thread (e.g. cynical, aggressive, enemy action, secret info etc.). This doesn't strike me as a 'scout mindset' and I was glad to see Bruce's comment that "it's important to recognise that everyone here does share the same overarching goal of "how do we do good better".
HLI has always been transparent about our goals and future plans. The front page of our website seems clear to me:
...The Happier Lives Institute connects donors, researchers, and policymakers with the most cost-effective opportunities t
It's still not clear who is making the claim unless you click on the link. Here's my suggested wording (feel free to ignore).
In GiveWell's 2019 conversation with StrongMinds, it was noted that “People in targeted communities often incorrectly believe that StrongMinds will provide them with cash or material goods and may therefore provide misleading responses when being diagnosed.”
Thanks for clarifying. I think it would be helpful for readers if you edited the post to make that clear.
Here's the full exchange between Özler and Haushofer:
JH: Whenever someone meekly suggests that one might not leave those with the lowest incomes entirely alone with their mental health struggles, the “it’s not that simple” brigade shows up and talks about the therapy-industrial complex and it’s so tiresome.
BO: Thanks, Johannes. That thread & and recommendation is outrageous: there's no good evidence that Strong Minds is effective, let alone most effective. It's 20-year old studies combined with pre-post data provided by SM itself. People should p...
“People in targeted communities often incorrectly believe that StrongMinds will provide them with cash or material goods and may therefore provide misleading responses when being diagnosed.”
I noticed there's no reference for this quote. Where did you find it? What is the evidence for this claim?
Sean Mayberry, Founder and Executive Director, and Rasa Dawson, Director of Development on May 23, 2019.
From the Givewell discussion linked.
I’m going to leave aside discussing HLI here. Whilst I think they have some of the deepest analysis of StrongMinds, I am still confused by some of their methodology, it’s not clear to me what their relationship to StrongMinds is. I plan on going into more detail there in future posts. The key thing to understand about the HLI methodology is that follows the same structure as the Founders Pledge analysis and so all the problems I mention above regarding data apply just as much to them as FP.
Thanks for writing this Simon. I'm always pleased to see peop...
HLI's relationship with StrongMinds is no different to GiveWell's relationship with the charities they recommend.
From an outside view, I see Happier Lives Institute as an advocacy organisation for mental health interventions, although I can imagine HLI see themselves as a research organisation working on communicating the effectiveness of mental health interventions. Ultimately, I am not sure there's a lot distinguishing these roles.
Givewell however, is primarily a research and donor advisory organisation. Unlike HLI, it does not favour a parti...
We plan to evaluate Usona Institute next year. We still need to raise $300k to cover our 2023 budget if you prefer to fund further research over direct interventions.
...We already have a pipeline of promising charities and interventions to analyse next year:
Charities we want to evaluate: CorStone (resilience training), Friendship Bench (psychotherapy), Lead Exposure Elimination Project (lead paint regulation), and Usona Institute (psychedelics research).
Interventions we want to evaluate: air pollution, child development, digital mental hea
On (2): Here's the section on social desirability bias from HLI's cost-effectiveness analysis.
...Haushofer et al., (2020), a trial of both psychotherapy and cash transfers in a LMIC, perform a test ‘experimenter demand effect’, where they explicitly state to the participants whether they expect the research to have a positive or negative effect on the outcome in question. We take it this would generate the maximum effect, as participants would know (rather than have to guess) what the experimenter would like to hear. Haushofer et al., (2020), found no i
Thanks very much for flagging the issues with the spreadsheet links. I believe I've fixed them all now but do let me know if you encounter any further issues.
Hi Vasco. This is a great question and one that I find personally intriguing (although I am not an expert in this area).
I'm curious about the possibility of identifying biometric indicators that correlate with subjective wellbeing scores in order to make interspecies comparisons of wellbeing. For example, Blanchfower and Bryson (2021) investigated the link between pulse and wellbeing.
At the Wellbeing Research & Policy Conference, Daniel Kahneman noted the increasing importance of 'wearables' for tracking health and wellbeing data. I think this te...
I think there might be a confusion here between quality of life and satisfaction with life.
As you say, the best possible life in 2022 contains many pleasant experiences and time-saving innovations that were unavailable to previous generations. However, it seems to me that modern lives are subject to more unmet desires and expectations are higher than in the past. As such, even though the lives of the current generation are materially better, this doesn't mean that people are more satisfied than their grandparents.
John Clifton, CEO of Gallup, wr...
I am keen to read critiques of Teo's claims but I downvoted this comment for a couple of reasons:
1) Aggressive language - I felt that Teo's comment was written in good faith and I was surprised that you dismissed it in such strong words: "extremely misleading", "not remotely fair or accurate", "an incendiary charge".
2) Appeals to authority - It doesn't matter to me that "pretty much every expert in moral philosophy" disagrees. I want to know why they disagree and be referred to relevant authors or papers that make these arguments.
I'm really delighted to see this project come to fruition. Here are the three best resources on mental health philanthropy that I've come across so far:
World Mental Health Report: A briefing for philanthropic funders (Prospira Global)
Funding the future of mental health: The potential of next generation philanthropists to catalyse action (United for Global Mental Health)
Focus on mental health philanthropy (Alliance)
...[Linkpost] This is what Richard Horton (Editor-in-Chief at The Lancet) had to say about the report:
There are few truly watershed moments in medicine and global health. But the publication this month of WHO's World Mental Health Report is one such milestone. It is the agency's first major global foray into mental health for over two decades. Led by Dévora Kestel, who directs the Department of Mental Health and Substance Use in Geneva, WHO aims, in her words, for nothing less than “a transformation” in mental health. 20 years ago, mental health was completel
Thanks Abby! I haven't had a chance to go through it in detail yet but I'll aim to share some reflections sometime next week.
Welcome to the forum! Thanks so much for taking the time to dig into this question and sharing your findings. The treatment gap in global mental health is enormous and apps are an essential tool for addressing this challenge.
I didn't have time to review your calculations in detail, but I have a few general reflections that may be useful.
1) There is a brand new meta-analysis on the efficacy of mental health apps which includes 176 RCTS (Linardon et al, 2024). They conclude that "apps have overall small but significant effects on symptoms of depression... (read more)