
The Moral Urgency of Mental Health - arikr
https://www.project-syndicate.org/commentary/mental-health-spending-pays-for-itself-by-michael-plant-and-peter-singer-2017-11
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pdkl95
> Overall, the researchers claim, eliminating depression and anxiety would
> reduce misery by 20%, whereas eliminating poverty would reduce it by just
> 5%.

Why are these framed as independent factors? For many people the lack of
financial stability is a primary source of depression and anxiety. When you
truly don't know how your are going to afford next week's
food/medication/rent, survival instinct kick in causing anxiety and huge
mental burden that can make it difficult to focus on anything else.

One of the easier ways to fix a large amount of depression and anxiety _is_
financial stability.

> If your neighbor becomes richer, you feel poorer.

While, I completely support increased funding to mental health services for
everyone, as someone trying to figure out how to pay for a new $100/month
_insulin_ prescription with a laughably tiny disability check and a medicare
"donut hole", this is pretty offensive. Feeling bad because you can't keep up
with the consumerism rat race isn't "misery".

~~~
x3n0ph3n3
> Why are these framed as independent factors?

Because people have lived in poverty for thousands of years without
debilitating depression and anxiety.

~~~
Raphmedia
One can live in poverty without living in misery.

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DanBC
> In the United Kingdom, it costs about £650 per patient to provide
> psychotherapy, which is effective for about 50% of patients. That figure
> indicates how much governments would need to spend, but does not take into
> account what they might get back.

they don't appear to provide a source for this. The English NHS collects, and
publishes, a lot of data for the IAPT (Improved access to psychological
therapies programme). IAPT provides access to short forms of therapy such as
cognitive behaviour therapy (which would normally be about 7 weeks).

[http://www.digital.nhs.uk/catalogue/PUB30153](http://www.digital.nhs.uk/catalogue/PUB30153)

> In August 2017 there were:

> 113,541 new referrals

> 83,330 referrals entered treatment

> 47,100 referrals finished a course of treatment, of which:

> 88.5 per cent waited less than 6 weeks and 98.9 per cent waited less than 18
> weeks to enter treatment

> 43,922 started treatment at caseness, with 50.8 per cent moving to recovery

there's a large unweidly spreedsheet with results for each provider.

the latest figures are here:
[http://content.digital.nhs.uk/iaptmonthly](http://content.digital.nhs.uk/iaptmonthly)

~~~
jorgec
psychotherapy is less than 10% effective. In fact, its almost no science.

~~~
phkahler
And when it goes wrong the practitioner will lie in your medical records to
cover it up. When it goes even more wrong and the person is dead they'll just
say "s(he) had serious issues". Having said that, I've seen it do wonders for
some people.

~~~
jschwartzi
It worked really well for me, but I probably wasn't as mentally ill as a lot
of people who would seek psychotherapy. Either that or my therapist was just
really good or we had a good working relationship.

Trying to act on how I feel continues to be the hardest thing I have ever had
to do.

~~~
phkahler
Not sure if you're religious it not, but let me phase it like that. God put
you on Earth to be you and do it your way. In an evolutionary context, it's a
random process where the value of an individual can only be determined in
hindsight after you're gone. Hence you need to be you and leave judgement to
the ages. If you're at all concerned about that, you're a long way from being
cluster B or dark triad, so don't sweat it.

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aaavl2821
This doesn't touch on a potentially even bigger barrier to adoption of better
mental health care: that those who benefit from better mental health care
often aren't the people paying for it, and that it is really really hard to
measure the specific financial benefits of improving mental health in a way
that will convince payers / employers / government to actually put real money
on the line

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chris_wot
Mental Health for those in crisis is fucked. If you feel suicidal, you get
locked up. It’s as simple as that.

~~~
mjevans
My own personal theory on this matter is that a lot of emotional state is
feedback loops.

Have a positive environment where things tend to go well and everyone else
likes you? Then you share in to that same environment (drink the Koolaid).

Have a mostly neutral or slightly negative environment? Then you end up
circling the drain hoping to have an energy exchange that allows you escape
velocity in to the above rather than...

Having a mostly negative environment; even if it's just a little. The slow
crushing weight of reality and those around you chips away at every part of
your being and self until there is nothing left but a broken and hateful
individual. May become either a neutron star (hermit) or go supernova (usually
leading to jail or death).

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alfithehermutt
Mental health needs to be a huge priority.

I have several teenager relatives all depressed. The constant social media and
comparisons to the top 10% of people in beauty, intelligence, money, and etc
are destroying them. Ive caught my teenage nephew and niece watching tons of
plastic surgery qa on youtube.

We really need to get our primate impulses in check. Im hoping the research on
brain implants will help overcome our ugly genetic history.

------
jes
I am hopeful that we will soon see AI-based psychotherapy available at scale
at a price such that anyone who wants it will be able to get it. I can imagine
that it would be more or less like having a telephone conversation with a real
therapist, except in this case the therapist is an AI application running in a
datacenter.

I think we will see something like this in the next five to ten years.

Thoughts?

~~~
aaavl2821
It would be great if that were possible, but a lot of the value of therapy
comes from the therapeutic relationship rather than a specific type of
therapy. Most types of psychotherapy tend to have the same level of effect in
studies, suggesting there is no "recipe" for the type of therapy that works.
This phenomenon also suggests (but does not prove) that the human
relationship, rather than therapeutic program, accounts for the measured
improvement in outcomes

Not to say an AI tool wouldn't be helpful for some people, but it isn't clear
it would be that useful. And i don't know of any evidence or plausible
hypotheses that an AI tool could work for anything other than mild anxiety or
depression

AI + human therapy could potentially be better than human therapy alone
however

~~~
DubiousPusher
I thought Cognitive Behavioral Therapy was actually the only kind of talk
therapy that showed greater effect than placebo.

~~~
aaavl2821
Cognitive behavioral therapy is a more standardized and measurable type of
therapy than things like interpersonal therapy or problem solving therapy or
psychodynamic therapy, and thus it is easier to study in a controlled setting.
So there are more studies of CBT than other types of therapy just because it
is easier to study

I don't have references offhand but there are controlled studies that show
benefit of other types of therapy

Overall all though, all psychotherapy studies are messy

~~~
DubiousPusher
That makes sense. If you want to go beyond self reporting, you have to use
very long term measures like employment, incidence of suicide, etc. And of
course it's very hard to guarantee that an individual pursued and sustained a
specific type of therapy for a substantial amount of a long term study period.

------
DoreenMichele
_Overall, the researchers claim, eliminating depression and anxiety would
reduce misery by 20%, whereas eliminating poverty would reduce it by just 5%.
If we want to reduce misery in the developed world, then mental health is the
biggest challenge we need to overcome._

Everything I have ever seen suggests that the chronically poor have
intractable personal issues, such as medical problems, mental health problems,
learning disabilities or other personal issues. So this seems like a false
dichotomy to me.

~~~
pacaro
I would see it as less a false dichotomy than just recognizing that these
issues are not always orthogonal.

~~~
DoreenMichele
I don't really understand that use of the word orthogonal.

But for clarity's sake: I have read about issues like poverty for decades. In
any given year, about 10 to 15 percent of Americans are below the federal
poverty level. But only about 2 percent of Americans are _chronically poor._
This is typically defined as below the federal poverty level for at least 5
years out of 10.

In fact, I have even seen stats that suggest that being in the bottom 20
percent in one year is actually a reasonable predictor for being in the top 20
percent the following year. Some people below the federal poverty level in a
given year are temporarily unemployed and job hunting. In some cases, they are
actually starting a new business. So, most folks don't stay below the poverty
level.

The people who are chronically poor are the ones that have significant
personal challenges. These personal challenges both make them miserable and
are also a root cause of their poverty. If they can't resolve their personal
issues in some manner, they remain poor.

I have not only studied such things, I have lived it. Misery is not just
having X problem, but knowing that you may never be able to resolve it and
that the world does a really sucky job of providing some means for people like
you to have some kind of baseline level of comfort. It is a kind of personal
hell.

~~~
jschwartzi
> I don't really understand that use of the word orthogonal.

You can imagine a two-dimensional graph with the quantity "intractable
personal issues" on one axis and "chronically poor" on the other. But when the
level of chronic poorness varies, sometimes the level of intractable personal
issues varies as well, leading to the motion of the quantity along both axes
at the same time.

That is moving the measurement in one dimension sometimes results in its
motion in the other dimension, so there is no way to move completely
orthogonally(perpendicularly) to one axis. This is what is meant by "not
completely orthogonal."

~~~
DoreenMichele
Thanks. One of the great mysteries of HN may have just been solved for me.

