Stan Pinsent

Researcher @ CEARCH
679 karmaJoined Oct 2022Working (6-15 years)London, UK



Director of Research at CEARCH: https://exploratory-altruism.org/

I construct cost-effectiveness analyses of various cause areas, identifying the most promising opportunities for impactful work.

Previously a teacher in London, UK.


Mental Health Report (CEARCH)


Topic contributions

Can anyone convince me that this is a robustly good move for donkey welfare? Working donkeys seem to have quite bad lives, so a falling population because people are deciding to sell donkeys for slaughter might be a good thing.

my guess is [...] you could counterfactually save 1-5 more lives per day by volunteering and being great at your job. 

I'm skeptical. That would mean that your average hotline volunteer is speaking to 1-5 new people per day who subsequently take their lives, but would not have if the call were handled better. This seems implausible purely on the basis that most suicide attempts fail (5-11% of people who ever attempt end up ever succeeding). Added to this, I suspect that some (most?) people who call are thinking about suicide but not literally about to do it, some (most?) are making multiple calls to the hotline, and that some of the worst cases may be possible to save today but will take their lives in a few months' time. Basically, I suspect that each call that a volunteer successfully handles would be worth more like 0.001 or 0.01 of an averted suicide.

I did (non-suicide) helpline training once and was struck by how formalised it is. Volunteers were supposed to be listeners, reflecting the callers' thoughts back to them and avoiding giving advice. This is likely a strategy to minimise the harm caused by layperson volunteers interacting with very vulnerable people. I would suspect that suicide hotlines have fairly rigid guidelines on how to handle calls, probably with more specific training on how to help the caller de-escalate their suicidal thoughts in the moment. My concern would be that this leaves little wiggle room for being "great at your job", and anyone trying to be significantly more effective may actually do damage by going off-script.

Would love to hear from someone with direct experience!

I think you could build a very compelling case for this. Even if official data sources do underestimate key numbers like overdose deaths, they are still a stirring call to action.

  1. Drug problems have got considerably worse in the past decade. This CDC source implies that overdose rates have more than doubled since 2015. Much of the increase came during the pandemic, which could add a little narrative spice to your argument.

2. Other "similar" problems are not getting worse. Other "despair" indicators like suicide and depression appear to be stable. Road accidents and violence have fallen. On one hand it's a bit sneaky to pick and choose comparisons like this, but it could be argued that they are all societal problems that often cause (very) early death. They're tragic.

3. Vaccines/ other pharma interventions may offer an unusually tractable and scalable solution. Addiction and all of the other problems in the chart above are very difficult problems to fight. At best, interventions usually take a chunk out of the burden but offer no hope of big change. Drug interventions can be controversial, with effects of uncertain sign. If you can show that your ideas are significantly better, you are doing well.

I expect that a major difficulty is that your solutions involve developing new vaccines/drugs, which is of course an expensive, unknown and long process. Will pharma companies see potential for a profit? Is there scientific grounding for optimism on these new drugs being possible?

Unfortunately I don't have the spare capacity to volunteer much time. I'd be interested in giving feedback on any future work. Good luck!

Also, do you have any recommendations for estimating the disvalue of a policy that curtails people's freedom (eg. by increasing the price of a good they value)?

Interesting! Can you link to any (reasonably simple) example CEAs where this process is applied?

Thanks for the recommendation! I came across something similar recently: Action for Happiness, which is recommended by Founders' Pledge. I think the theory of change is that people can meaningfully improve their wellbeing by applying some evidence-based changes to their lives. Most who start will probably drop out, but those who persevere will likely benefit. Costs could be kept low by relying on centralised resources, voluntary donations and possibly volunteer labour.

Unfortunately my report didn't explore this avenue for change as I only looked at preventing and mitigating mental illness (+ pain + suicide), but I wish I had done more on simply improving wellbeing.

I would say that although self-help is, on the face of it, basically free, the cost of reaching new people through marketing is likely to be a huge determinant of how cost-effective it is.

I don't know why they say it is a problem. I'd be more concerned about trapped water taking up more space in garbage trucks, landfill, etc. Even then, the extra cost may be small.

My take is that (1) the preciousness of water depends heavily on location and (2) a small number of activities represent the vast majority of water use.

In some places there is loads of rainfall and if shortages happen, they could maybe just be solved by improving infrastructure (more reservoirs and treatment plants). Places with a large population for the amount of water available (possibly including Texas, I don't know) need to be more sparing with their water. Often most water, especially in arid places, tends to go to plant cultivation. That includes crops (for human or animal consumption), parks & golf courses, back yards etc. If you want to save water, that is where most of the gains can be made. Turning off the tap/faucet while you brush your teeth is nice but it won't do much.

Thanks for your comment, Derek. This has been really useful.

Some changes I have made in response:

  • Changed "death" to "being dead" in my explanation of the DALY scale
  • Now say that DALYs likely underweight pain, but QALYs may not:

DALYs appear to weight pain very lightly. For example, terminal illness with constant, untreated pain has a disability (DALY) weight of 0.569, which is only 0.029 more than the weight for the same condition with pain medication. QALYs are better at capturing pain: physical pain is the dimension given the highest weight in the EQ-5D, and instrument used to measure quality of life.

  • Mention that even sufferers may underestimate the badness of depression [with a link to your comment]

A question:

  • I see from the summary you linked that IHME have used sequelae to identify ailments that are present in multiple health conditions. That seems sensible. I guess the kind of problem I often face is "What will be reduction in someone's disability weight if they are - protected from getting diabetes / cured of depression / etc. ?" 
    • In the diabetes example, it seems fair to count DALYs averted by not having diabetes and DALYs averted by depression-caused-by-diabetes. Maybe not fair to count, say, obesity, since the increased risk of obesity associated with diabetes is likely to be correlational, not causal. Am I thinking along the right lines? 
    • If we go with the depression example, it seems fair to count both prevented suicide and prevented depression (but not prevented depression-while-dead-by-suicide)

Taking a couple of litres of water out of the cycle is not a big problem. If everyone on earth sequestered 100 litres of water in this way, that would remove enough water to reduce the level of Lake Superior by 1cm.

[8*10^9 people. Lake superior has an area of 8*10^10sqm. The volume of a sqm of water with depth 1cm is 10 litres. Hence 8*10^11 litres divided between 8*10^9 people, which gives 100 litres each.]

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