EA - About 'subjective' wellbeing and cost-effectiveness analysis in mental health by LondonGal

Welcome to The Nonlinear Library, where we use Text-to-Speech software to convert the best writing from the Rationalist and EA communities into audio. This is: About 'subjective' wellbeing and cost-effectiveness analysis in mental health, published by LondonGal on July 30, 2023 on The Effective Altruism Forum.Hello everyone,I was first 'sucked in' to this forum when I was directed to a post I might find interesting - it was about a research organisation with EA endorsement that was straying into my area of work, mental health. I'm a UK doctor specialising in psychiatry, with some research experience. To be honest, I was baffled and a little frustrated by how far this organisation strayed from what I would expect from mental health research - hence the (perhaps overly) technical diatribe I launched into on a website I hadn't visited before, about an organisation I hadn't heard of prior.However, that's not usually my style, and once I took a step back from my knee-jerk reaction, I wanted to understand how people with the same goals could arrive at completely different conclusions. It's led me to do a lot of reading, and I wanted to see if I could try on a makeshift 'EA' hat, with most of my philosophy knowledge gained from The Good Place, no economics experience, and see where it went.What I wanted to understand:Where has the interest in 'wellbeing' arisen from, and what does it mean?What are 'subjective wellbeing' (SWB) measures, and are they useful?Are we at a point of putting monetary value on SWB (e.g. like QALYs) for the sake of cost-effectiveness analysis (CEA)?When people are in this space talking about mental health, are we talking the same language?Why are RCTs the 'best' evidence for subjective wellbeing?What would I come up with from my perspective of working within mental health for a way of comparing different interventions based on their intended effects on wellbeing? a. Spillover effects b. Catastrophic multipliersHow does my guess stack up against existing research into wellbeing?How could my framework be helpful in practice?What would I be suggesting as research areas for maximal gains in wellbeing from my biased perspective?I'm aware this might be well-trodden ground in EA, which would make me embarrassingly late to the party, and consequently a complete bore. To lay my cards firmly on the table, I did approach these questions from the perspective that mental health is desperately underfunded, I spend a lot of time with patients who are severely affected by mental illness and therefore I'm biased towards seeing 'wellbeing' as an opportunity to rebalance this scale and acknowledge the impact mental illnesses have on people. I also feel the term 'mental health' is used in a way which is often confusing and occasionally unhelpful or stigmatising.This is not meant as an attempt to further an argument against any person or organisation; it will also not be high in tech-speak as this was the first lesson I learnt very quickly on my journey - while jargon is a useful shorthand for talking with people in the same field, as an outsider it is exhausting. This post does not reflect the attitudes or opinions of anyone but me - this is my personal quest for common ground and understanding, not a representation of 'UK psychiatry' - I'm speaking in an entirely personal capacity and, accordingly, I'm assuming I've gotten a lot of it completely wrong.To make this less self-indulgent, I've arranged this post to follow that question-and-answer format. For the sake of transparency, this was how this work came to be: I started with a long piece of writing about my concerns with assumptions made about mental health interventions in low- or middle-income country (LMIC) settings. I then did a quick Google on the WELLBY and wrote a lot about the idea of asking people to rate their 'satisfaction with life' on a scale from 0-10 which was essentially just entirely critical. I subsequently wrote out my concept of wellbei...