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Global Mental Health and the Ethics of Happiness

If we want to improve people's lives, mental health is a good place to begin.

Key points

  • According to the WHO, depression is the world's leading cause of disability.
  • Some organizations strive to provide mental health services to under-resourced countries impacted by poverty.
  • Participants in one program self-reported life satisfaction increased by 0.8 points.

The philosopher Jeremy Bentham proposed that "it is the greatest happiness of the greatest number that is the measure of right and wrong." If we aim to act according to this kind of moral theory, standardly called utilitarianism, we should try to do things that create a lot of happiness for a lot of people, if we can.

Chris Rodriguez/Pexels
Source: Chris Rodriguez/Pexels

There are many ways to do this, at least for those of us who have some disposable income. The charity research site GiveWell describes several charities that prevent diseases in the developing world, thereby preventing early death or morbidity and making many people much happier than they were otherwise. This is a good thing to do with our spare income, even if we are not utilitarians.

Interventions like these do a tremendous amount of good in increasing human happiness. On reflection, however, it is worth asking: why not approach the problem of happiness still more directly? Why not also invest resources in making unhappy people, such as people living with chronic depression, somewhat happier?

There is no lack of need. A 2017 WHO report proposed that approximately 322 million people live with depression – almost 5 percent of the world's population. About 60 percent of these people are women. Depression is, according to this report, the world's leading cause of disability.

There is also no lack of effective interventions. While there is extensive academic debate about the best treatments for depression, most research suggests that scalable and straightforward interventions such as cognitive-behavioral therapy (CBT) and acceptance and commitment therapy (ACT) have a real and lasting impact on people's levels of depression, as measured by self-report. These interventions are especially important because (unlike medication or treatments such as electroconvulsive therapy) they do not require extensive medical expertise, which is often under-resourced in countries most impacted by global poverty.

Advocates have made these kinds of observations of effective altruism. This movement brings the hard-nosed quantitative analysis to the question of how we can most benefit other people. Effective altruists seek to understand, as rigorously as possible, how we can do the most good. We can then ask: do we create more happiness by (for example) preventing disease or by promoting happiness directly through the kinds of psychological interventions just considered?

An extremely helpful discussion of this question comes in a 2018 report from the philosopher Michael Plant. Among other things, Plant attempts to compare the effectiveness of GiveDirectly, a Givewell-endorsed charity that makes direct cash transfers to Kenyan farmers, with a charity called StrongMinds. StrongMinds provides, in their own words, "free, group talk therapy to low-income women and adolescents in Uganda and Zambia."

By any account, both of these charities are remarkable programs that do a lot of good in the world. Plant asks: which does good more efficiently?

Plant observes that both programs lead to a significant improvement in the life satisfaction of their participants. He further argues – via some admittedly arguable premises – that StrongMinds may actually be even more cost-effective than GiveDirectly in improving the life satisfaction of its participants.

As Plant notes, there are several complications here, and the complications become still more fraught when one considers charities (such as the Against Malaria Foundation) whose effects on human happiness are still more difficult to quantify. Nonetheless, his report makes a prima facie case for the proposition that, if one wishes to improve human happiness, one should consider making contributions to organizations, like StrongMinds, that intervene on happiness directly.

These considerations make it plausible that anyone concerned with the sum total of human happiness ought to devote some attention to thinking about how to provide mental health services to the hundreds of millions of people who currently have depression. This issue is especially acute, I believe, for those people concerned with these questions who are themselves, mental health providers. How should such professionals think about their work in light of these considerations?

One thing to be noted is that these professionals, even when working in relatively wealthy countries (as most of them are), are doing something to address the problem of global mental health. After all, therapy and psychiatry improve mental health outcomes, and wealthy countries are part of the globe. In this sense, they are already doing something.

Speaking for myself, however, it feels like I could still do more. One way I have shifted my thinking in light of these considerations is to give more weight to, as it were, scalability. Whenever I learn some intervention or share some skill, I try to give more attention to the following question: is this the sort of thing that could be inexpensively provided to lots of people, and how might that be done?

Often the pressures of mental health work pull in the opposite direction. There is a certain prestige to the bespoke intervention, which fits one's patient and no one else. A world where interventions like this had less prestige and effective and scalable interventions had more might be a world where the global mental health problem was a little more tractable, and that seems a world worth working towards.

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