EA Talks

EA Talks Exclusive: Could treating depression be a top intervention? | Convo with StrongMinds CEO Sean Mayberry

August 31, 2022 Peter Gebauer and Patrick Brinich-Langlois
EA Talks
EA Talks Exclusive: Could treating depression be a top intervention? | Convo with StrongMinds CEO Sean Mayberry
Show Notes Transcript

We discuss how Sean got into mental health, StrongMinds’ work-life balance, the benefits and cost effectiveness of group interpersonal psychotherapy, how treating depression can improve other interventions, what it takes to found a charity and change the world, the number one thing Sean wants people to know, and more! 

StrongMinds is a social enterprise founded in 2013 that provides life-changing mental health services to impoverished African women. Since many African women cannot even begin to tackle issues like poverty and economic development until they overcome depression, StrongMinds provides treatment for women who suffer from this pervasive and debilitating mental illness. By providing group talk therapy delivered by community health workers, StrongMinds is the only organization scaling a cost-effective solution to the depression epidemic in Africa.

Effective Altruism is a social movement dedicated to finding ways to do the most good possible, whether through charitable donations, career choices, or volunteer projects. EA Global conferences are gatherings for EAs to meet. You can also listen to this talk along with its accompanying video on YouTube.

[00:00:00] Welcome to EA Radio. This is our first interview and I've taken over the podcast from Patrick. My name is Peter Gebauer and we have a really interesting interview today with the Strong Minds ceo. So why don't you introduce yourself, Tell us a little bit about how you got into this. Thanks so much, Peter.

It's great to be here. It's a total honor. Um, yes, I'm the founder, uh, and CEO of Strong Minds. I founded Strong Minds back in in 2013, so it's really interesting. We're coming up, uh, in a few more months on our 10th anniversary. Uh, our mission in Africa is to improve the mental health of women of all ages, and we do that by focusing on depression, which I think a lot of our readers understand is the number one mental illness in Africa.

It's the number one cause of disability, uh, and it's just a huge problem. It's really at epidemic levels in Africa, and that's what Strong Minds does. We work to solve this. Number one mental illness on the subcontinent. Amazing. [00:01:00] So, Sean, tell us a little bit about how you got into this kind of work. Like why mental health?

Like what got you interested, What lit the spark for you? Yeah, it's a great question, Peter. Um, a lot of reasons. You know, I, I think if we go way back, uh, I've never actually suffered from depression, so I'm incredibly just blessed from that perspective. But I've, I've had a front row seat to depression my whole life.

I, I grew up, uh, yeah, I'm honest about it. I grew up in a really poor family. Both my mom and dad were severely depressed, you know, at the time. I didn't really understand that that was. Normal state. Uh, but when I look back on it, I, I really understand now as a child, what it's like to have parents who are depressed, who are less engaged and can't be as active and supportive parents, uh, as say, uh, you or I can, or our neighbors.

So for me, that was my, my sense of normal with kind of like, you know, quotes around it. Um, and then now as an adult, you know, I'm, I, I'm, you know, married, I have four beautiful children. I still have depression in my house today, so now I [00:02:00] understand what depression. To siblings and to parents and to entire family units.

So I really understand, uh, you know, on the receiving end, if you will, how debilitating and how serious, uh, depression is. You know, I've also, uh, lived and worked in Africa, gosh, for about a dozen years. And, um, most of that time I was focused on health interventions, hiv, aids, malaria, sexual reproductive health, not mental health.

But throughout that time I was always seeing, uh, the mental health struggles of my African friends, neighbors, colleagues. And it was really so frustrating as a public health professional at the time, not to be able to help my friends who were suffering from a mental illness where I, whereas I could help them with hiv Yeah.

But I could do nothing for depression or anxiety or even schizophrenia. So that's my background. And so for me, understanding, uh, the impact, negative impact of depression and the need in Africa, Ultimately, there's a lot more to that story, uh, but [00:03:00] ultimately led me to start, um, strong minds with the mental health focus.

Amazing. So you guys, would you say you mostly focus on depression or We only focus on depression. Okay. Yeah. And there's a number of reasons for that. Well, number one, mental illness, as I've mentioned, uh, we have a very simple form of group talk therapy that's highly effective and just, uh, also incredibly cost effective.

So for us, we believe we can make the greatest impact and really achieve the greatest return on investment. If you think of, uh, philanthropic gifts as in investments, the, the greatest return on investment by focusing on the biggest mental illness, kind of a bang for buck perspective. So that's why we focus on depression.

And I thought it was really interesting. There's many ways you could. An organization to tackle this issue, but you guys chose a social enterprise model, so could you tell us a bit about why you chose that model as opposed to a pure non-profit model or some other kind of model and what [00:04:00] advantages it might have?

Yeah. You know, 10, 15 years ago, social enterprises were mostly defined by, are they bringing in some kind of, uh, product revenue or, or program income, some would call it that. That's somewhat gone away. You don't see that that often anymore. For me, a social enterprise is something that is really just, it's really using for profit business techniques to achieve, uh, some kind of impact.

For, for some lines it's health impact, mental health impact. I think, um, I'm just really fortunate. Yeah. I've had, uh, a diverse career before, uh, mental health, public health. I worked for the Intel Corporation making microchips on the west coast of the US and in a lot of countries in Asia. So, you know, it's a high tech startup, not startup, but high tech company, very bottom line focused, uh, kind of, uh, you know, known for their, their, their results and achievement as is that whole sector.

So for storm mine today, I think we've really been able to infuse so much of our DNA with that bottom line focus. You know, so many of our values are about thinking big, acting fast, uh, really [00:05:00] making a difference as quickly as we can. So that for me, that's what a social enterprise is. You know, non-profits themselves are great, so there's no judgment there, but we actually find ourselves sometimes struggling when we're partnering with non-profits.

It's a bit of a, kind of a values mismatch. We're going at, you know, 80, 90, a hundred miles an hour, and some of our non-profit brothers and sisters are kind of struggling to stay, to keep up with us. Um, but for us it was about, again, how do we achieve the greatest impact, uh, as quickly as we can. Oh, okay.

Cool. Is there something in particular you think that makes your mo your organizational model more agile? Oh, I, that's a great question. Why are we, I would, well, it comes down to the team. You know, we have a highly passionate team. We all share the, you know, think big, act fast DNA or that, that mindset. And so for us, uh, you can see the whole team when we start to get frustrated and when things aren't moving quickly enough, particularly with the partner side where we just get kind of antsy because we know [00:06:00] we can move faster and we just work with the, uh, the mandate that, you know, in Africa there, we conservatively estimate there's at least 66 million women suffering with depression.

Most of them have no access to care. So for us, every day we lose waiting our, you know, hundreds, thousands, millions of people who aren't receiving care. So I would say it's really a, about the team that's able to get this done and just a highly passionate team. That's cool. Uh, there's a lot of talk in effective tism right now about hiring and like, should there be a dedicated ea hiring organization and like, uh, trouble sort of finding people with the right skills.

Do were, have you been able to find, like, it seems like you have a really great team. Do you have any thoughts on sort of hiring and like, if you wanna start your own organization, like how do you find, how do you recruit people? That is, that's, I think most leaders would tell you that's absolutely the hardest thing.

And it's, it's, it's definitely got harder post pandemic for some [00:07:00] reasons that are clear and some that aren't clear. Um, you know, through our almost 10 year journey, uh, our team today has never been strong. But it's been a 10 year journey to get to this point. Um, you know, a lot of times with teams it's uh, kind of mixing and matching.

You'll get some great team members and then they move on for whatever, for whatever reason. Then you get some team members who actually aren't exactly, uh, as you had hoped, and they perhaps will move on as well. So it's a bit of mixing and matching. There's a lot of movement on the chess board, but for us, after 10 years, we feel we have a good team.

But I, I know in six months, some of the current team will start to move on. You know, people don't stay on their jobs very long anymore, and so it's a constant kind of iteration and, and tweaking of that. You know, early on, uh, you know, when I think back to starting Stoneman in 13, it was really about finding people just really have passion for what you're doing.

Um, you know, there's people who are looking for jobs and there's people who are really looking to make a difference. And I think the people who come in with a passion are just, they think bigger, they [00:08:00] get things done faster, and they're just a lot more fun to be around, you know, when you can share that positive, passionate energy, uh, versus someone who maybe is just doing a nine to five job, and, but that's okay too.

You know, that could just be their life, their life position at the moment. Um, but, uh, yeah, so early on, higher for, for passion and then just know, yeah, a team takes a long time and it's under constant, uh, iteration. Awesome. So that, now I have like a million questions. Uh, so what would you say is like the work life balance at Strong Minds?

Like is it the kind of place that, is it like an ideal workplace to you, or is it more about like, this is the place where I can work? I can really pour my soul into like, as much as possible working on what I think is the most important problem or like, what, what do you think about that sort of, I, I, so, I'm so glad you asked that question.

Um, work life balance is incredibly important for Songlines. I, I always say here that no matter how long someone works for [00:09:00] us, if it's a year or five years or 30 years, once we hit the 30 year mark, I, I want them to be able to look back on their time as strong minds and say, That was the best job I ever had.

We're not there yet. You know, it takes a, we still feel we're in a startup, and, and sometimes the, the HR principles can kind of not be forgotten, but, you know, missed or, or not achieved in time. But, uh, work life balance is super important to me, and I, I feel I'm effective at role modeling that for others.

You know, I, I view it as any full-time person via, if they're in the US team, the Uganda team, the Zambia team. I, I'm really only buying 40 hours of your life with my salary. If, if you wanna give me anything more than 40, I appreciate the donation. Um, But it's really up to you. Um, I, I want people to have a rich, uh, personal life.

Uh, I want them to be able to come into the office and, and give a great eight hours or so, not counting hours, but you know what I'm saying. Uh, but I want them to [00:10:00] have other interests and, and a real life outside of work. And I, I feel that allows them to give us more energy when they're, when they're giving us those 40 hours.

Um, yeah, I try to role model that. You know, uh, just love turning off the phone, not doing email after I leave work and just kind of disconnecting, uh, unless it's a super emergency. And, and I feel that also just helps us. Uh, I think we've been successful at avoiding, uh, a lot of burnout for the staff. But, you know, a lot of people will talk to work life balance, but then the reality is they're not really practicing that.

Um, but for us, I, I'm, you know, I think for Songlines we have a number of achievements inside and outside, but inside, I just love the fact that I, I think we're good at work life balance, that we care about people, um, and we, we practice what we preach. Awesome. And you know, mental health organization, you kind of have to do it.

Not that we have to, but Is that, that's also . Just thought of that. Yeah, that would be ironic. People there don't have, aren't mentally healthy. Um, so that makes sense that you'd want people who are passionate cuz even if they're both [00:11:00] giving 40 hours, the passionate person's probably gonna like, have a more productive 40 hours.

But how do you gauge whether someone is passionate? Cause it's, it's kind of easy, you could say like, Yeah, I'm really passionate, but like, do you have, maybe you don't wanna give away your trade secrets for hiring, but is there ways of gauging that You try to hire for it, but it's incredibly impossible.

Right. We know the, the hiring mechanisms, no matter what kind we're coming up with, can be really artificial. People somewhat know what they need to be saying in interviews. We haven't solved that one yet. I think it's almost like a self-selecting thing, right? When we have a group of people who are passionate and someone comes in, if maybe they're not passionate, maybe they will become passionate or they'll just self-select and they'll leave because they're like, Yeah, these, these strong minders are just, they're, they're too good for me.

They're way too passionate. You feel like a fish out of water and, and then maybe they're going on to find their right match and their right job. So you try to look for it and there's some little things you can be looking for in interviews and things even early on. [00:12:00] Um, but ultimately I, I think the passionate, uh, search out and find their, their brothers and sisters and, uh, it keeps growing.

And, and again, it's like building a team. It doesn't happen overnight. Uh, it's a constant iteration. Um, but you keep looking for the passion and, and, you know, the, the high achievers at strong lines, they're clearly so passionate. And, and again, it's just a joy to be.

10 years is a long time. So what is it personally keep you going? Like what is the source of your passion or when you don't have as much passion, your drive to continue this work? Yeah, that's a great question. Uh, I'm still super passionate. It's hard to believe it's 10 years. I feel like we just started.

So, uh, yeah, I've assured my colleagues in board, I'm around for the long haul. They're gonna have to throw me out or chase me out. Um, you know, but I'm a human. I, I have low points. Um, you know, I spend, um, I'm based in the US but I spend a lot of time traveling. I think what really helps me to get [00:13:00] a booster shot, if you will, for my passion, is just going out to the field, being in Uganda or Zambia, uh, with the team out on the ground, you know, attending our groups, uh, our depression groups, meeting with, uh, our patients who are recovering, hearing their stories, you know, any, any, uh, manager can get lost in their email and their Excel sheets and kind of lose, lose.

Focus on what it is he or she is really doing with the organization. So I, I make sure I get out to the field a lot and every time I leave the field, you know, that flight home, I'm just super pumped in charge and come back with a ton of ideas. Um, so that's how I keep going. Um, yeah, that's great. It's like really important to actually see firsthand what's going on.

Cause my God, a lot can be lost in reports and stuff. Yeah. And you know, maybe we'll get to it later today, but, um, we're about to launch our work here in the United States through something called Strong Minds America. And now our depression groups for me won't be a 24 [00:14:00] hour plane ride. They'll be about a 12 minute Uber ride away.

So I'm excited for that. Yeah. Can you tell us a bit more about that or is it like, is it under wraps for now? No, I'm happy to. I, I appreciate, uh, the question. Yeah, it's strong Mind America. It's all about, you know, for years we had been hesitant to launch in the United States for fear of, we didn't wanna defocus ourselves from Africa.

But, you know, the pandemic allowed all of us across the planet to really kind of look at our, our decisions and assumptions and, and think about them again. And we just decided as an organization and about two years ago, you know, we have a great effective model to treat depression. There's a huge need in the United States, which is really our, our home country in the sense of where we started.

Um, and that we feel almost obligated, uh, to launch our, our model here. So spent a lot of time doing the research, really making sure there, there was an opportunity, our model would work. Um, and then this year launch a small pilot. Uh, we're [00:15:00] launching now after starting in January, we're actually, we'll be treating our first patients in the next couple of weeks, in the month of September.

It's really exciting. Yeah. We're focusing in Newark, New Jersey, which is, uh, just outside of New York City. It's very close to our office focusing on black indigenous people of color. Uh, 18 to 25 men and women. That's a target population that's typically very underserved, uh, but yet in great need, uh, in terms of depression.

So we feel we can make a, a great impact. We have a great team. Uh, some early, uh, funders, supporters have joined us and, uh, and we're excited to see what we can do this year, which is our pilot year, and then next year we hope to have great results and, and really start to, to scale it up here as well.

That's awesome. Yeah. I believe, uh, give directly is also going to start doing cash transfers in the United States. So it's interesting that there's more ea focus here now that is, I didn't know that about Give directly, so that is interesting. Yeah. I'm glad to hear that. That can add a lot of value. [00:16:00] Yeah.

So how do you, um, Identify like who you want to include in these interventions? Yeah, that's one of the hardest things. Uh, we do, You know, when you think about, and I'm talking about Africa. When you think about someone who's depressed, you know, there, there's a standard symptoms, you know, lack of focus, you know, fatigue, et cetera.

Um, the, that individual I is very hard to get to. You know, they're not going to self volunteer. Um, so there's a lot of different ways, uh, we can reach those individuals. In an area where we've been working for a while, we have deep roots. Uh, a lot of graduates of our depression, uh, group therapy, will bring us people who they think are depressed.

They'll bring their friends, neighbors, brothers, sisters, um, so that they're a great, almost like, uh, radar system, if you will, in areas where we're new and we don't have a lot of, uh, graduates who really act as like a referral system. It's a slower process. [00:17:00] We'll work with. Local community, uh, leaders, um, a lot of times like where we work with the Poors or the poor and slums, they have like a community leader system.

It, it's a, quite often it's a male and that person is in charge of maybe like one city block of the, the slum. So, we'll, we'll get in touch with, with him, explain to 'em what we're doing, the impact that we can have on their community, you know, kind of help him to understand the value. And then over time he'll help us to reach his community.

We'll do some small, just, uh, you know, setting up, uh, you know, a little group in the middle of the slum, talking to 20 people, telling them what we're doing. Uh, and then those people will go home and the next day they may bring us people who they think match the symptoms that they were just educated on.

So slowly you start finding people and then over time those community leaders become huge supporters cuz they really start to see after years the positive impact. There's less depression in their community. The community is stronger, more productive, happier, less conflict. And so [00:18:00] they, and then, you know, they'll start referring patients themselves.

You know, in other areas where we work, we're doing a lot more teletherapy now, so it's not in person groups, but just on the phone that was, uh, sparked by the pandemic. In those cases, a lot of people are finding us. We'll do, uh, radio spots, uh, social media, and uh, we'll have a call in number where people will call in, maybe self-identify that they're depressed.

Generally though, a lot of times they'll say, Hey, my brother is depressed. Here's his phone number. Can you call him and screen him? So it's um, a lot of different methods, a lot of different ways we cast the net. Um, but finding, um, depression suffers is still after 10 years is the hardest thing we do. We have many new ways, as I've explained, um, uh, but it's still a big challenge.

And have you guys been able to compare much, uh, whether there are differences in the effectiveness of. Tele inter interventions versus in person. Yeah, no, absolutely. We started teletherapy, [00:19:00] uh, almost, uh, two years ago. So we've got good data now. Uh, at the end of the day, we're seeing our teletherapy groups are just equally effective as our in person groups.

There's a number of factors we measure that on. But for the, the simplest, what, what we'd call is our depression free ray, uh, they're roughly about the same, roughly in the, the 70, uh, percentage or percentile. That really surprised us. When we started teletherapy, we were just thinking, you know, this is gonna be much less effective.

You know, people weren't gonna have the benefit of the face to face. Um, but, uh, a lot of learnings there. We learn that not having that face-to-face contact wasn't, uh, a negative. It was actually a positive in the sense that because people weren't seeing you eye to eye, they were more likely to open up earlier in terms of, you know, there's very difficult discussions and in a depression therapy group talking about.

Life challenges, maybe difficulty with a spouse or a neighbor or illnesses. Um, so the teletherapy has, uh, been beneficial to kind of [00:20:00] speed up the process and I think it balances out and makes up for the lack of in-person physical contact. So we're really grateful for that. It really gives us another tool in our tool chest.

You know, you know, if, uh, I hope not, but if another pandemic were to happen, we have a tool, uh, that we could really expand our reach today. About 25% of our patients in Uganda now, um, are reached on the phone. That's very interesting. I wouldn't have expected that, but it kind of makes sense that if you're not in person, you might be less shy or reserved about sharing really personal things.

Exactly. And we had never anticipated that that was one of those, uh, unintended, uh, un unsought for learnings. Um, and I, I think it just goes for the Strong minds model. We, we test a lot of new approaches all the time. Uh, you know, we try to vet them as most as we can, but then we just kind of get out there and try to understand, will this work?

How do we expand care? And the great thing about Teletherapy, it's really expanded our geographical reach. You know, in the old days [00:21:00] of just in person groups, we were limited with transportation. Somebody can only move so many miles in a day. Versus now in Uganda, we're literally conducting groups in every geographical corner in some areas of the country that we would never have gotten to because there's so remote, but beneficially, most of Uganda is covered with their, their mobile phone network.

So again, and we're able. Uh, you know, include almost anybody in a group, hundreds of kilometers apart, as long as they just have the same language. So great benefits. And for the groups, what size do you pick or have you experimented with the sizes of them at all? Lots of experimentation. Uh, and it just depends on teletherapy.

Our group size is typically about five. If I'm the group. I'll have five other people on the line who are in my group. Uh, an in-person group will have typically about 10 or 12. Uh, the, the phone group is smaller cuz there's only so many, uh, faceless voices one [00:22:00] person can kind of manage and really understand.

Um, but we have some in-person groups who are led by two leaders, co-leaders, and those groups can be up to 18. Um, so yeah, we've, we've done everything we can to figure out, uh, the max size. So it's kind of a 5, 12, 18. And, uh, and for us it's bottom line focus, right? We're really focused on our cost, our cost per patient.

Uh, the more patients you have in a group, uh, reduces your, your cost per patient or cpp, but you also have to balance that with quality. Um, you know, you, you could, you could have 25 people in a, a, a dual LED group, but it's not gonna be as effective. So of course we would never. That's interesting. Um, obviously a lot of training goes into, I guess, being able to do, to give therapy and, and carry out these interventions.

Is there any interest in the future, maybe like deputizing or like training people locally to do this kind of work or to help with it? Uh, absolutely. It's actually a big part of our [00:23:00] program. Uh, you know, in the early days we were conducting groups just by our, our strong minds. Uh, salaried full-time staff members.

Uh, but even early on we started, uh, training, uh, what we call peers, which is what you're saying. Uh, in the early days, those were people I graduated from our groups. We trained them to run our groups, and that has really just, uh, taken off in the last 12 months. In Uganda, for example, we have nearly 1000, um, community health worker volunteers in Uganda.

They call 'em, uh, BHTs, but you know, uh, globally it's more of a chw uh, terminology. Um, so today, you know, we have a thousand volunteers conducting groups in Uganda, and our staff employees in Uganda, number only about 60. Uh, so most of the patient volume in Uganda, you know, Uganda this year will treat about 90,000 patients.

Most of that is coming through volunteers. So we've really learned in the years how do we train, uh, volunteers, How do we maintain quality control, [00:24:00] uh, for somebody who's not your employee? Um, and how do you do that now at a distance on the phone? Uh, and it's working incredibly well and again, allowing us to expand our geographical reach and the number of patients we reach.

So, um, yeah, the whole volunteer approach is now core to core to our model. Oh, that's very cool. I'm curious, like if, and how you'll be able to adapt that to a US context, cuz there's some very strict regulations here. Yeah. You know, it's funny, uh, working in strong lines here in the us, which we call Strong Lines America, it's, uh, it's much harder than Africa.

I've spent so much time with lawyers this year. Um, we'll get to the peer level in America. Uh, this year in the pilot, we're just using licensed professionals, uh, what we call in the US CSWs, licensed clinical social workers. But we'll get to the peer level. Uh, there's a lot of just legal definitions, how we talk about it and how we deliver it so we can make those [00:25:00] modifications so that we can legally of course, use peers.

Uh, it'll be a little harder to. But again, that's really the only way we see ourselves scaling, be it if you're in Kampala, Uganda, or Newark, New Jersey, or Manhattan, New York City, it's really going to be through peers. Um, you know, it's very similar to the, the AA Alcoholics Anonymous model, which is really peer-to-peer.

Now I know that model can be somewhat of a lightning rod, but at the end of the day, uh, their use of, uh, peers, helping peers, uh, is certainly undeniable.

And so is all of your work in Uganda or are there other, uh, countries as. Yeah, no, we started in Uganda, so we've been there since the beginning. We expanded into, um, Zambia in 2019. So, uh, uh, just wrapping up year four in Zambia. We just launched in Kenya, uh, about two months ago, down in the mumbasa region, uh, region on the coast, Uh, optimistic that we'll be launching in, um, South Africa next [00:26:00] year.

The Kenya launch is interesting. It's, you know, in Uganda and Zambia, we have our office, I i, we have the storm mines flag planted in the ground, if you will, in Kenya. Our newer model now is working with partners who are already there. We go into their organization, train their organization, support them, do quality control.

Um, so in that way we don't have all of those, uh, same startup costs of creating a new entity in any country can be a bureaucratic exercise. So now we kind of, we go in more quickly, uh, via partnerships and that's how we hope to also get into South Africa next year. So that's, that's working really well.

That's cool. So my background's in social sciences, so I'm very curious if you've noticed differences, uh, in the populations, either within countries or between them, or like concepts of what is depression or, uh, certain parts of the therapy that might work particularly well with certain people or others, or even personality differences within groups.

That's a million questions. . Yeah, there's a [00:27:00] lot of difference. Um, I mean, yeah, we have an adapted modified mile model that fits the clientele. Although there, there's certainly more similarities than differences, be it if you're in Northern Uganda or down in Southern Zambia or on now on the coast of Kenya and east of the Co East African coast.

Um, you know, some of the differences you'll see like in Uganda, if you're up north. Uh, most of the times we're in, in refugee, uh, well, they call them refugee settlements. You know, the rest of the world would think of it as a refugee camp. Um, that's a much, that's a very challenging population. There's a lot of, uh, comorbidity, there's a lot of trauma t s that you won't find, say, in a city region of Kampala or, or Luaka and Zambia.

So that takes a different kind of approach. You know, when someone has trauma and there's trauma in a group, you have to manage that differently. Um, we'll also just see differences in, in age, right? We now treat, um, adolescents. We go down to about age 12 at our, at our lowest. Uh, there's [00:28:00] no maximum age. You know, we can treat a, a 90 year old woman, and we have, but you can't necessarily include that 90 year old woman in a group with a 12 year old because they have such different reference points and life experie.

And when you think too about adolescents, those groups are very different from a group for a 35 year old. You know, when you think, uh, there, there is a lot of similarity. A 16 year old in Kampala and the 16 year old here in my house in northern New Jersey are very similar in the sense of really short attention spans just glued to the phone and, and really want to be impressed constantly.

So our, our groups for younger folks in Africa are a lot more vibrant, a lot more, almost what you could think of, like bells and whistles to keep attention. Um, and there's also a challenge too. Younger people tend to be a little less emotionally open, so you have to have mechanisms to kind of open those doors and, and, and create some level of emotional literacy so you can, they can talk about how they're feeling and talk about their triggers of depression, otherwise the groups would, [00:29:00] would take, uh, much longer.

So lots of differences. Uh, I could talk all day about the differences and how we try to manage 'em. So, yeah, it's a great question.

Well, if you think of something in particular you wanna share about it, like definitely Go ahead. Uh, yeah, my next question is gonna start getting into the, comparing this first other interventions . Great. What would you say to someone who's like, Well, this sounds really interesting, but look, with deworming, I know there's worms and then there's no worms.

It's very open and shut. I know exactly what happened. Uh, mental health seems kind of harder to measure. Like how do you measure that? How do you know it's having an impact? Great question. And no, we, you know, I come from a world from in, in former, uh, NGOs before strong minds where we were very bottom line focus.

We were doing things like mosquito nets and condoms and family planning injections. So I come from that world. Uh, deworming, right? Having very clear deliverables, very clear. O r roi. And so when we were designing [00:30:00] strong minds, that was my mindset. I was, I wasn't even aware I was designing it, but for me it was just like, well, it has to be very clear and time-bound and deliverable.

So for us, you know, that's, we deliver that when someone, you know, today our, our cost per patient, what it costs us to find and treat a patient, uh, cpp, if I use the acronym, uh, is about $85, uh, as of today. Um, and that's because we measure everything. And so if you give me $85, Peter, I can tell you with a high degree of certainty, I can deliver to you one successfully treated depression patient.

Um, so what we're doing is taking away that ambiguity that some donors misperceive around mental health. They think mental health is gonna take millions of dollars. You gotta build hospitals, train psychiatrists, and treat people for years. And I'm never gonna see my bottom line that's. Absolutely not what we do.

So we measure our impact, our costs. We know what we can deliver, and we quantify everything in depression. You know, depression, it's never about, How are you feeling? It's [00:31:00] about using a very standardized, globalized, uh, measurement diagnostic tool that can quantify, uh, depressive symptoms, beginning, middle, and n.

And we track those obsessively, not just during, uh, our groups, which today lasts eight weeks. Uh, but it's also going back to those, uh, patients six months later. What is the longstanding impact? We've also measured our impact up to two years later, longitudinally. And we see that after two years, our, our dep, our, uh, our impact has maintained itself.

So going back to that person who was kind of challenging us, if you will, fictitiously on deworming, I would. I can deliver you exactly what you're looking for, depending how much money you have. And I can practically guarantee you the impact after intervention and post intervention up to two years later.

And that I think it's a pretty good, uh, argument, if you will, for a great ROI for $85. Yeah. And you guys have a great study with the Happier Lives Institute, but before we get into that, how did you, uh, come into [00:32:00] contact with them? How did you guys form this partnership? Yeah. You know, Happier Lives, it's just a fantastic organization.

Uh, you know, for us first, uh, Meeting with their, their founder Michael, and then, uh, you know, just understanding, you know, how we can work together. I think a lot of times for what we do for storm lines, our whole approach is it's really talk to everybody. Never say no, what can we learn? It's, uh, planting a lot of seeds.

It can be from the fundraising perspective, it can also just be, Hey, how can we learn, uh, about what we're doing, what you're doing? So never saying no to a meeting. Uh, I think we first ran into Michael many years ago. I remember just having a coffee with him somewhere in, in London and just getting to know him, his background and vice versa.

And just understanding, you know, his goals, uh, in professional life. And, and then for us, you know, we have a lot of great roots in the entire effective altruism kind of community and network. So that's another way that people can connect us. Um, and then we just started realizing that, you know, we were struggling in [00:33:00] terms of getting our message out and making good comparisons for, for mental health to, uh, deworming, for example, or in this case, uh, cash transfers.

So it's just, it's a great friendship that it has really, um, sprung for us. Awesome. So you guys have a randomized controlled trial, which I was gonna try and explain it, but I feel like you might be able to better explain that to me. So just quickly, like what is a randomized controlled trial? Like, how does that show the impact of your work?

Yeah. Randomized controlled trial typically is what's going on is you'd, you'd have it in, in our case, you'd have, uh, a depression intervention. You'd have, let's say 500 individuals who are depressed, and were going to treat those individuals. And then you'll have a, what's called a control group, 500 individuals who are also depressed.

But you won't treat those individuals. You're not mixing the two. Uh, and then we're really just tracking, um, you know, what is happening, uh, for the population who's being treated and what's happening for the population, uh, who's not being treated. That's a great simplification [00:34:00] without the, the randomization aspect.

Um, but that's really what it comes down to. And so it's really trying to understand is in this case, is the intervention that we're providing to our group of depression sufferers, uh, creating a greater positive impact than what's happening for a group who has no, uh, treatment? That's really what it comes down to.

Uh, and just a comparison sake. So you might have a community where 500 people are depressed, and then you'd randomly pick half of them to get the treatment and half don't. And then you'd compare them. Exactly. Right. And you have to, you have to take some other kind of, uh, safeguards to make sure that they're not mixing and matching.

And then you're also just in terms of the control, you're trying to do what you can to, uh, you don't want something else coming into the community that can, uh, hide the results. You know, if all of a sudden six months into this, and it's a one year randomized trial, six months later, another NGO comes in and covers the community with some kind of aid or the government, it's election time, and the government gives out free bicycles to everybody, which used to [00:35:00] happen in India.

Um, that can impact the results. You can't stop that. And sometimes the trial has to stop because while it's been contaminated. So there's a lot of structure, a lot of planning, and a lot of crossing your fingers and hoping as well for those to, to, to finish correctly. Yeah. It's a, it's a really powerful tool, but it's also like a really high bar.

The high bar. It's clear. Expensive. Yeah. Yeah. It's also very expensive. Yeah. But, you know, we're big fans. You know, we're based, uh, orig, uh, our, we use what's called group interpersonal psychotherapy as our, our, our, our modality. It was first tested, it was the first form of psychotherapy tested successfully to treat depression in Africa, ever back in 2002.

And it was an R C T, you know, we found the RC t 10 years later. And, and that was really the, the, the core idea we had is, let's, let's scale this R C t, this approach. So for us, our model is based on a, a 2002 R C T. Granted it's 20 years old. Um, and we certainly have plans in the next year or so [00:36:00] to do another more, uh, Very, a larger R C T we're still working on, you know, who would do that?

What are the core questions we wanna be asking and answering, What's the, where's the funding for it coming from? Um, but we feel it's certainly time to, to redo that now, 20 years later. Because, you know, the model is still roughly the same that we use today from 2002. But, you know, the opera, Opera opera operationalizing it, uh, and now with teletherapy and bigger groups, it's, it's, it is in many ways also different from the model that was tested on the rct.

So we look forward to doing that. Basically, if I recall correctly, your therapeutic interventions for treating depression could be up to nine times as effective as give directly cash transfers. So can you tell us a bit about how you came to that? Maybe if you have any reservations about it. ? Yeah. Uh, I'll clarify a little bit.

Yeah. So Happier Lives Institute, uh, took all the data from Give directly, and they took our data. They didn't perform a randomized control trial, [00:37:00] so they were taking the current data and running an analysis all. Thank you for clarifying. Yeah. Just to clarify for the reader. So there, they didn't, no one did in R C T, um, but a happier lives.

You know, I, I think neutrally looked at all the data, looked at, you know, what is, when you think of Give directly, give directly his model, which is a great model. I support it. And this isn't a competition. You know, if they give out a thousand dollars cash, uh, transfer or gift, if you will, uh, to, uh, a Ugandan woman in a, in a remote village, what happens to that woman, her life, her family, uh, you know, over the weeks and months to come?

What is the positive impact? Some people would call it spillover. Um, and then they compare it as well for strong minds. If. We had the same impact treating another woman kind of across the way who was suffering from depression, treated her for depression. What, what happens to her life and her family over the long term as well?

And what happier lives was able to figure out, um, is that, you know, if [00:38:00] you give a thousand here or treat depression here, the overall impact, um, from the depression sufferer who is treated is greater for her and her family, including all those spillover effects like her children are better taken care of, et cetera.

That's spillover. Uh, those that impact those effects are nine times greater. Than what you see with the family that received the $1,000. And I think capital lives, I'm not biased, but I think they did a good job on it. You know, originally they had came, they came out and showed our impact would've been 12 times greater.

There, there was some kind of just new information that came out. They expanded, how they viewed it reduced the number down nine x. Um, so I think it's just, it's informative to have this information. It. People on the sidelines who don't understand, uh, mental health that well or still think that it's a slow intervention without the big return, that, you know, it gives us credibility that, you know, a mental health intervention on depression, like strong minds is highly [00:39:00] impactful and you can get a great roi, uh, give directly is impact.

Uh, and their model is still a wonderful model, uh, and important and, you know, one doesn't replace the other. Um, so it's just helpful for us to have those numbers, that understanding and for strong minds where we're so data focused, it, it's just great to, uh, help us understand that we are having a great impact.

And to have an external neutral organization to determine that is, is certainly beneficial. So nine times is like pretty impressive. Uh, and that's about the bar. They adjust it, but that's about the bar for Give Well's, like top charities is like something that's around 10 times as effective as. Give directly.

That's what Give Well, Will recommend have, Has anyone talked to anyone at Give Well, Or like is there a chance you guys will one day end up on the list? Uh, we certainly hope so. Uh, we've talked to them a lot in the past. Uh, I'm in San Francisco next week, so that might be a helpful meeting. Um, yeah, no, [00:40:00] we're hopeful that that that'll change and that giveaway would recognize us, uh, and, and we're optimistic for that and, uh, it hasn't happened yet, but, uh, you have to be an eternal optimist in, in, in this business.

Right. Yeah. And I don't know if you can share, I don't know how these meetings go, but like, are there things they've said they want to see that like might inform future studies? You try. Or like, um, I, I, I, they've said something to us that I think they say to everybody, you know, they're very data focused.

That's why we speak the same language and just love being with them. Uh, you know, they really, uh, I think for them it's important to have a more recent R C T, which is totally understandable cuz again, ours is 20 years old. Uh, and that's coming as well. So, um, no, we've had great discussions. You know, the Give Well team, um, uh, the one that I've spent time with in San Francisco is incredibly smart, supportive, uh, love 'em to death.

And yeah, we'd love to be able to more, more officially partner. Absolutely. Awesome. Uh, there's many things I'm curious about. One is, do you have treatment failures like ? [00:41:00] Does that happen? I'm guessing it does happen. It happens with pretty much every intervention. Yeah. Yeah. I guess it depends what you call a failure.

Um, Of the patients we treat about, call it 75 on average, 75% will become depression free, which for us is getting down to the lowest, uh, range on the diagnostic scale from zero to four. Um, so about 75% will reach there. Now, on one hand you could say, Okay, then you've failed with the other 25%. Well, there's actually a lot more nuance in that.

Um, if you look at the next level of kind of indicator on that, you know, on that 75%, um, you know, most of those people are probably having an 11 point reduction on their depressive scale. That scale goes from zero to 27. So 11 is a huge percentage of that. The remaining 25% may have only had a seven or eight point reduction.

So we may be a little too hard on ourselves in terms of saying, who's depression free? And if you don't get into that range, then not that you don't count, but we don't [00:42:00] claim credit. But still, those people are seeing a significant improvement in their life. They've seen a massive reduction in depression.

We need to do a better job at including them in our impact. You know, if you, here in the us, um, uh, if you have a four point reduction, uh, on our diagnostic tool, that's considered clinically significant. So we have some people having an a point reduction and sometimes they're not being counted as impactful, so we have to fix that.

So now there, there will be some patients who maybe just don't succeed in the groups that they're in. Uh, you know, that's very rare because once you come to the group, the group starts to support you. We'll have cases where someone will just start, stop coming in, in week three, But the groups are community based.

A lot of times the group will go to that person's house after two weeks and knock on the door and just encourage. They don't drag them back to the group. But when you're suffering from depression, you've stopped going to the group and someone comes and says, I want to help you. I want you to come back to the group.

That's a huge draw. It's [00:43:00] probably like the, what you want to hear most said to you. So in that sense, the group helps itself to not fail. Which is really positive. And I could go on forever just talking about the benefits of the power of a, of a group in general. Um, but yeah, we don't see a lot of failures and her really talked about, or used that word in my tenure as, as so mine.

So I'm gonna be thinking about how do we define and think about the word failure. So thank you, Peter. Yeah, you're welcome. Excellent. I'm very curious. Um, so that's pretty remarkable that even, uh, like most people see some kind of benefit, even if they don't become totally oppression free. Right. Um, and then Four Points is considered significant, the United States.

I did not know that. Um, so would you say that your biggest obstacle, it doesn't seem like it's, it's how effective it is per person, but it's reaching more people. Would you agree with that? Yeah, the model itself is very effective and we continue to, [00:44:00] to iterate, improve it. This week we're going from eight, uh, this year we're going from eight week duration down to six weeks.

When we started in treating patients in 2014, we're at 16 weeks. So we've done a great job, slimming it down. The biggest challenge for us is, is just continuing. How do we scale, you know, for a scale? How do we reach many more people? At the end of this year, we will have reached about 210,000 people. Yeah, it's pretty good, but there's still 66 million suffering.

So that 200 to 10,000 over 66 million is a percentage that I don't wanna know, you know, 0.00 something. Um, but how do we scale more? And, and there's a number of impediments to that. It's, uh, it's really two ends, right? We need more support from NGO partners and governments to partner with them. But on the other side of that spectrum, we need more funding for it from things like, you know, from U S A I D, and we need like a global fund for mental health.

For example. We need funds coming in because. When we begin to convince a, an Africa and Ministry of [00:45:00] Health that this is a great intervention, they're not going to have the money, even if we get it down to a dollar. A patient, their budgets are hugely constrained. A lot of competing priorities. So they can agree to it, but ultimately they're gonna need external funding to to, to fund it.

Right. When you, when you look at the success in Africa on HIV and putting people on retrovirals or reducing the incidents of malaria, I mean, I pushed 10 million mosquito nets in my five years in the Congo, so I know I have some experience here. You need the ministries of health to support you, but the funding for those big changes didn't come from the Congolese Bank, it came from external funders.

The big improvements in HIV and Africa, putting people on ARVs came from the huge initiatives spawned by the Bush administration. Um, That's what we need. We need the governments to support us and want this, and then we need the funders to support us and want this. And it's not just strong minds, it's mental health in general.

We're kind of like the, the, the interlocutor in between, you know, we can deliver it. So for us [00:46:00] it's about creating more awareness, more advocacy, getting the governments to sign up, the NGOs to sign up, and then the funding to be available. So that's the biggest challenge for us as a small, almost 200 person outfit on planet Earth, trying to move all those, uh, levers we can, we will, we have plans to, But that's the problem because until we solve those two like obstacles on two ends of the spectrum, we can't scale.

And if we don't solve those problems, it's almost like our head is buried in the sand. Oh, we're gonna scale. We're gonna scale. Yeah. But in your heart, you know, you can't scale until the government sign up. And if they sign up and you don't have money funding for it, you can't scale. So let's openly. Talk about, um, sorry for all the metaphors.

Talk about the elephant in the corner of the room and get it solved. . Hey, I love metaphors, so no worries. It's a metaphor, right? I confus all those words. So anyway, . So when you say, um, support from the government, obviously there's funding, but are there other kinds of support, like maybe [00:47:00] legitimacy or what kinds of support, like what kinds of things can you get from governments and other large organizations?

Well, I talk about support from government in a general sense of that, yes, it's a ministry of health. We want to do, we want to implement depression intervention in our country. We see the value and we're gonna adopt your model. Can you help us learn the model and, and, you know, give us, teach us how to fish, if you will.

That's the support I'm talking about. There's many like sub-components of that, you know, okay, let's do some pilots, let's have discussions about it and things like that. But ultimately, yeah, we, we, we as the go. Recognize the value and importance of treating depression and we want to do this. That's for me, like the high level support, idealistic support, if you will.

Um, so basically like this is a real problem, this approach works, we're gonna start using it. Exactly. That's what I'm talking about. Yeah. And the same for NGOs, right? Cuz NGOs can reach hundreds of thousands of people. The same for them, right? Wanting them to understand that incorporating, if there's an NGO and it's doing a livelihood intervention, it's [00:48:00] training hundred thousand people in a catchment area, new livelihoods, they have to treat depression in that community, right?

Because if you have a hundred thousand people, based on the data that we've seen, at least 20, maybe 25,000 will be suffering from depression. You can't change their behavior and you can't teach them something new when they're suffering from all those symptoms. So our kind of, you know, Pitch, if you will, to the NGOs is treat depression first.

Get these people back to strong, healthy minds and then they're gonna be more receptive, uh, in terms of the behavior change that you're trying to implement. So we work with NGOs that in essence our program will make their program better. Um, so getting their support for them to understand why good mental health is good for the community and good for their program.

So we need their support as well. All in the name of reaching more people now, even if you get their support. Again, if there's not enough funds coming into the NGO or funds supporting a very underfunded ministry of health, then you [00:49:00] know, a lot of support is great. But if there's no gas in the car, you tend to not be able to go far

Oh yeah. And before I forget, uh, I did want to ask how long, what is the max you've followed up with people? So you were saying earlier like, it's pretty effective for most people, but how many times do you check in? Is there, are there any relapse? Yeah. In, in the normal case, uh, today we'll treat people for eight weeks.

You know, we, we measure them continually before the group beginning, middle end of the group. Uh, and now we've always then me, uh, measured them again six months later, the longest we've ever done. A few years ago, we went out two years after the completion of the group. Uh, and again, uh, you know, we, we didn't really see any degradation of their, their depression free status, uh, which is consistent with some other RCTs we've seen, uh, using our interpersonal psychotherapy or i p t methodology, that it tends to have a longstanding, uh, uh, impact.

Um, [00:50:00] are there any cases like that you know, of like maybe like a one off or like where someone. was like, Hey, I think they're, you know, depressed again. Or like, is there a kind of alert system or you haven't really heard that so far? Some people will come back, You know, some people maybe didn't in internalize the skills that we taught.

Uh, maybe they, they're not still in touch with their group, which is another way to battle back depression. If you can't manage it well, you can go to your former group members and well, almost 80% of our groups keep meeting so that, that longstanding. So those connections are there. Sometimes somebody just, uh, you know, just is, is really just struggling with a big life change.

Um, they're welcome to come back to the group. Uh, after or when the pandemic hit, we saw an increase in former patients coming back. We certainly welcome them. Um, it, we don't see it a lot, so for the most part, we don't see ourselves having to retreat any significant number of patients, which for us, again, sh I think [00:51:00] validates our model and it just allows us to continue to try to reach.

More people of that 66 million. It's not like some sand is slipping back in. And we have to kind, you know, ret treating these patients before we can treat new patients.

Very cool. And speaking of your model, uh, could you tell us a bit more about it? Like, what is this therapy like, how does it differ from other kinds of therapies or interventions in mental health? Yeah, happy to. I p t interpersonal psychotherapy, um, it was created, uh, in the 1970s. It's a great model. You know, it's, it's, it's formally recco, uh, formally recommended by the World Health Organization as an effective treatment for depression and, and, and, uh, lesser developed countries.

Uh, it really comes down to the, the model. Believes or practices, the fact that depression will have, uh, anyone suffering from depression. If when you're in a group, for example, uh, the depression, the triggers of depression can be quite similar, if you keep asking, Why are you depressed? Why [00:52:00] are you depressed?

Who gets down to common triggers? Some of those triggers can be like a life change. You know, I just, I, I just moved to the city from the village and I'm missing my family. Um, another trigger can be disagreement. I'm, I'm arguing with my spouse over how to use our, our $2, uh, of income. It can be, uh, grief, you know, coming from, uh, the loss of the loved one.

It can also just be from social isolation, uh, loneliness. Um, so what we do in the groups is it's really helping sufferers to understand you have a manageable disease. It's not, it's not a curse. And it's not just you that, unfortunately many people on the planet suffer. Um, but that if you come to the group, we'll help you.

You'll learn the skills to identify your trigger. Or triggers, and then you can come up with techniques to minimize those triggers, kind of dial them back and thereby dial back your depression. So we're helping people to understand that depression is manageable, it's within your power. It's understandable.

So [00:53:00] like if I'm, if I'm a group member and I'm my juror is a agreement arguing with my spouse over how to spend the $2 we earn a day. You know, one of us wants to use it for school fees and one of us wants to, uh, just buy food. Or one of us wants to go drink beer, for example. Um, not to make light of it, but you know, just different kind of, you know, needs that people have to spend the money.

So in that disagreement in the group, that's causing me depression and I don't know how to manage it, but what we do in the group, it's not the group leader telling people, you know, thou shall do this. It's more leveraging the group. Well, what does the group think that I should do differently? In my disagreement with my spouse over the $2.

And then you're really leveraging all this life experience in the group. Well, I used to have that problem and have you done this? Have you asked them that? Have you tried to negotiate this? And we give people homework every week. Go back and try this. Does the disagreement lesson, If it, you come back next week and it does great, and if you come back next week and the disagreement has lessened, um, and then it's, Well, how are you feeling now?

And generally it's like, I'm [00:54:00] feeling less depressed. And you see the connection between events. Yeah. Uh, or triggers dialing it back and dialing back your depression. And it starts to give you ownership over, you know, I can, I can influence this. Um, and that's, you know, the model is much more complex than that.

You know, we meet for eight weeks now. Every week has a very clear curriculum, uh, deliverables, outcomes. You know, we, we assign homework. We're always track. How people are feeling. We don't do the formal diagnostic test every week, cuz that's somewhat lengthy for weeks. When we're not doing the formal tool, we have a very simple like, pictogram of one to five, how are you feeling?

So it's a quick check in to understand, are you getting better? If last week you were a five, this week you were a four, that's better. But if last week you were a three and now you're down to five, we're slipping back. And that's how it's a group leader that we should spend more time with that person because it's, it's almost like a red alert.

So we're using a lot of data, a lot of science. Um, but, you know, I'm going on here, but you know, I, I've met, so I've been in so [00:55:00] many groups and have met so many, uh, great. People in Africa suffering from depression. And so many of the women have told me, uh, talking about their depression, that they thought they were the only one suffering.

I've heard that phrase almost verbatim so many times. Yeah. And, and you know, here in the United States, right, we even know what depression is and you know, you, you Google it, it's right there. You can learn about it, but we don't have that access in Africa. So for these individuals who think they're the only one feeling this way, um, and to come to a group and to see there's 10 other people who feel like you, and that you can connect it and understand it, connect it to your life events, your interpersonal events, hence the, the, the terminology, uh, I think is really empowering for individuals.

To what extent are you guys thinking about testing the current therapy you've chosen against other ones? Or were there studies on other ones, or was this the only therapy you saw in R c t in Africa for, or like, what's your thinking around that like. [00:56:00] Do you think it's worth it to try and do that, or it's just like a, it would be nice to test against other therapies, therapeutic interventions, or, Yeah.

Uh, yeah, we're open to testing. You know, we'd love, we love our model. We think it's highly effective. Uh, but if there's another model that comes out and is better, we would change to it, uh, overnight. Um, so for, for that, we're somewhat agnostic to the model, but really happy with it. You know, there are some great things other groups are doing.

There's some great things groups are doing that no one else knows about. Uh, that's one of the, the challenges we have in global mental health. There's no real movement or sharing of information. It's highly fragmented. We're, we're, we're working to, to solve that. Um, no, I would welcome, you know, challenge, not challenge, but compare I P T to A A C B T, cognitive behavioral therapy intervention.

For example, what is working best, Or do you even just combine, uh, compare them and actually, you know, a hybrid of the two would actually work really well. . Um, so for us, we're really happy with the model, but if we found something, uh, to change, we [00:57:00] would, you know, when you, you look at the original model, as I mentioned, from four to 2014 to today, it's gone from 16 weeks, almost down to six weeks.

We're doing it on the phone through peers. It's massively changed just in our own genesis. I think that's evidence that we're, we're, you know, we're not stuck on the model. Um, but if something else came out, and, you know, we also think ahead. What I didn't mention in the teletherapy that we're. It's all using dumb phones, like flip phones.

There's, there's very low penetration of smartphones in Uganda, and even if you have a smartphone, you probably don't have wifi access to it. So kind of what's the point of it. Um, but, uh, you know, for us, with all these different technologies, but we know in the years ahead there will be more smartphones and access will increase.

You know, Kenya has a great penetration and availability of smartphones that'll happen in Uganda as well. So we have to be ready in the years ahead, kind of like skating to where the puck is gonna be. But when poor people in our slums have smartphones that are wifi enabled, how will we support them, uh, and to be [00:58:00] ready for that?

So I, I think we're always, you know, trying to look around the corner, uh, getting better open to new ideas, you know, even this year, We launched for the first time. We now have an official innovations laboratory where we bring our new ideas and test them out and kind of throw rocks at them and figure it out.

And it just goes to the core of who we are of, you know, don't, don't be so committed to your current model if a new one is better. So I'm glad you asked the question, but it's right down our alley, and I think it's one of the keys to our success. If we were still 10 years later at 16 weeks, man, our cost per patient would be, I cannot, I don't know, several hundred dollars, I probably wouldn't be sitting here.

We probably wouldn't have continued to be funded by something so expensive. So is there any. Interest in expanding beyond depression? Like are you guys considering treating other problems or you think it's best to focus squarely on depression and maybe a different organization should try different mental, uh, issues?

That's a great strategic question that [00:59:00] some on my team love to challenge me on, and I love being challenged because I'm very wedded to the idea of it's depression that we can make such a great impact. And unfortunately there's still such demand for it. Yeah, as you said, there's unfortunately, there's plenty of other mental illnesses that need to be addressed.

Um, we would be open to it down the road, you know, can our approach of getting things done fast and being data focused be useful for a, uh, some intervention for another illness? We'd be happy to look at it. Um, you know, one of the, one of the, the bright spots here, right, is that we are able to have a very simple cost effective model that solves the number one mental illness.

So that's a great match. You know, kind of low, low resources for a great impact on the number one. Now, if depression was like number eight on the list, it'd be harder. You're like, well, you know, because you're skipping one through seven. Cuz it's really hard. And I'm not saying depression is hard, but, uh, we've just been fortunate that there are simple cost effective solutions for the number one mental illness.

So that's a big, bright spot. [01:00:00] And again, that allows us to, will continue to allow us to make the greatest impact and change the most lives. So in psychology there's like different. Kinds of depression, or there's like also bipolar, which can involve phases of depression. So do you guys deal with patients like that or is it like only major depression disorder or, Yeah, we focus just on depression just because things can start getting complicated, right?

We're not trained to deal with, you know, bipolar or schizophrenia. We are trained to identify that in our screening process. So when we see that, We don't want that person to come to the group because we're not gonna be able to help that person and that person's not gonna be able to help the group. But we certainly don't walk away, you know, like a hot potato.

We make sure that person's gonna get a referral or, or even somebody on our staff can talk to that person and try to figure out how can that person be helped. Um, but we do just focus on depression. Um, and we really just keep it simple in terms of, you know, what kind of depression is it, et cetera. We don't worry about it.

We just screen for depression using a globalized tool and keep it very simple and then measure it at the end. Um, you know, there [01:01:00] can be all sorts of discussion, Almost disagreements over is depression a chemical imbalance in the brain, which is a bit of a can of worms to get into? Some believe it is.

Yeah. It's not, I would tell you it's not. Um, but, and that they're very simple intervention. So we kind of avoid all that and just screen for depression, treat for it, and see the difference in people's lives after the groups and months later. And the, the difference in their lives, not just in their mental health, but you know, we track.

What's happening in their lives. We know that when people are no longer depressed, they go back to work, their productivity increases, their kids go back to school. Nutrition improves in the home. Good mental health. Being depression free is such a huge lever in the center of the sufferer's life. And you know, as you've heard, I've done hiv, malaria, et cetera.

I've never seen any, um, public health intervention that has such a great impact as mental health. Are there any, um, peers or like competitors that you guys have or whispers of people who wanna start like a similar [01:02:00] organization, like maybe for bipolar or for anxiety or something, or who think they could do depression better?

I wish. You know, it's funny, uh, that's one of the things we kind of, uh, you know, when we look back on almost 10 years, excuse me, almost 10 years strong minds, um, is that no one else has kind of jumped into the pond. Uh, you know, for us, we're happy to train anybody on this. You know, i p t is not, uh, you know, intellectual property.

It's, it's taught in public health schools. Uh, you know, we're good at implementing and operationalizing it. Um, no, we're really disappointed that in the 10 years, no one else has jumped into the space, uh, anywhere. And, uh, and that hurts us, right? Because like when we want to start a new program to treat depression for refugees or for under 14 year olds, right?

There's no one that we can learn from. We have to figure out ourselves, uh, and we have to design it. So it takes us much longer. Now, if there was a, a, a similar organization in West [01:03:00] Africa or in Vietnam doing this, well, okay, let's look at their model, adapt it to our context, and we can go. So for us, it hurts us and it also hurts in the fact that, you know, funding for mental health is still a huge challenge, I think for understandable reasons.

Um, So many times for at strong race, we feel like we're the only one trying to educate many donors and individuals on the value. I I would love to walk into a donor or potential donor or funder and my, my doppelganger, right? Someone else who started mental health was just there, just educated them and now the funder totally gets it.

I don't have to explain anything about mental health, I just have to explain our model. Cuz now with funders, I really have to explain twice. I have to explain why mental health matters. That's one pitch, Orick. And then I have to pitch strong minds. Most, most funders don't wanna hear two pitches. They'd only wanna listen to one.

Um, so you, you've, you've touched the, uh, a sensitive nerve on that one. But yeah, I, I wish there were a lot more organizations, uh, joining up. [01:04:00] And why do you think that might be, that there aren't more organizations like Strong Minds or like what could be done to change that? Do you think part of it is like a funding issue or it's just people don't realize how big of an impact they could have doing this?

It's definitely funding. Funding's not easy, but we've just gotten good at it. Um, but again, yeah, it's not like we, we hide anything we're doing. If someone were to reach out and say, I, I wanna start a similar organization, tell me all your secrets. I'm like, Okay, when can you meet? Um, yeah. Awesome. You know what, why isn't that happening?

It's hard to say, you know, Uh, I think a related factor, one of the hardest things in a non-profit startup, a social enterprise startup, uh, is there isn't a lot of money out there for startups. Most philanthropists, Like it or not, have a low risk for appetite and they will fund you when they see the results.

Oh, that's interesting. Come back to me when you have results. I'm like, [01:05:00] Okay, but you know, you know, results cost money. So how would I actually, it's like chicken and egg. I'm like, I'll come back to you about, you know, I also wanna like feed my children. So how can I come back to you if you're not gonna fund me?

And you see that constantly. I saw that in the early days of Strong Minds Africa. We had some great funders who believed and in their opinion, gambled on us and got us going and kept us alive until we could really thrive. And we almost died. I mean, we became super close because the funding was enough. I was using my own, I used all my retirement money to keep it going.

Wow. And then it worked. But I see the same thing again today with Strong Minds America, which is a separate organization. We don't mix and match. Same thing. Uh, funders are interested and some have signed up for the pilot year, but many are, are very interested. Come back to us when you have results. I'm like, Yeah, but those results kind of cost money and how will I get there and how do I keep people employed?

So I think, I don't think, sadly, I don't think the philanthropic industry, if you call it that, is very good at spurring innovation or startups. Um, so for that [01:06:00] reason, you know, to start a new non-profit in mental health isn't easy to do because how will you know they're gonna have to go through the same stuff I went through.

Unfortunately, 10 years later, I don't think it's changed. They'd have to struggle. Uh, and, uh, you know, some people don't have that fortitude. So what advice would you have for someone, and obviously if they reached out, they might get more details, but like, just for anyone listening who's curious and like, maybe I'll start a nonprofit.

Yeah, it's, uh, Or social enterprise. Yeah, there's a couple, like younger folks. Yeah. I'm 55. I'm an old man, but there's a couple younger folks that, uh, I know that I've been trying to mentor and, you know, my advice to them is, uh, you know, come to a, you know, do your startup when you have some connections in the funding world, make sure you have a couple funders already lined up who believe in you will take a risk on you.

Uh, if you come to it with almost no money, it's going to be inordinately difficult to find that money. Um, so your, your chances of success, you know, you need to have a couple people already signed up for it. And I had that, but I [01:07:00] was, you know, when I started this, when I was almost 45, you know, I had a lot of connections.

A lot of former funders from former lives believed in me, took a bet on me without having results. So the question is, for the startup, who do you have? Who's gonna take a bet on you? That's just reality. Or if you're independently wealthy, that would be a lot easier. But you know, , Yeah, it's like interesting that there's a lot more money for like startup incubators for for-profit companies, but there's not, we don't really have the same thing for non-profits or social enterprises as much.

No, there's a, there's a few like competitions that, you know, tens of thousands people apply to. Um, some organizations say they fund startup, but they don't really, they, they're a number of years down the road. Um, yeah, and particularly in mental health, right? When you, I forget the numbers I saw last year.

There are, I think, like something like 600 mental health startups now in Silicon Valley, and there'll be billions of dollars flowing to them, and they're all pushing the same mental health app, so [01:08:00] you're like, Oh, come on, , shake it out and put some of that money on real investment, you know, over here in Africa.

But, so there is money. Um, but yeah, for the, for profit, but that, that's a much longer discussion. You know, nonprofits, uh, don't get the, the, the appreciation they deserve, uh, in our, in our society. You know, running a non-profit or social enterprise hugely difficult. It's really two businesses, right? You have your core intervention product or service.

But then you also have to be able to raise money, which by itself is an entirely different business. Now, if I was just selling widgets, I would do a good job, sell widgets, make money, and invest that money, make widgets, sell them, do well at strong minds. I have to do a great job running a team that does a great strong mental health intervention for depression.

Great, Okay. I also have to do a great job at communicating, finding, and getting funding for that. And the two are almost independent. You know, the more people I treat doesn't necessarily bring me income at the front end. I have [01:09:00] to go to the back end. So if you're good at one and not good at the other, you won't succeed.

You can be a great funder, but if you're selling, uh, a crap product, it's not going to work. Um, so I, I think the non-profit social enterprise space is much more difficult. And I've been in the for-profit space, so I, I'm able to say it. I'm sure some people listening say, Oh, that's not true, but that's my opinion.

So, So it seems like my understanding is the top three things you need or one, you gotta be good at fundraising. Two, you gotta be good at hiring people, finding people can do all these different jobs and building a team. And then three, you gotta have something that's really helping people and that you can show, so that you can get those funds and attract that talent.

You are a great listener and distiller. Thank you for saying that. You're absolutely right. Yeah, you're welcome. And, uh, for anyone listening, like there's, I know of Charity entrepreneurs, they help incubate charities. I think they recently did one for lead exposure, so it's, That's pretty cool. And then non-linear, I think is becoming a long termist incubator, so focused on long term wellbeing.[01:10:00] 

Um, I hear that. Yeah. And I'm curious, like, there's a lot of discussion in psychology about like deficit approaches and like the emergence of positive psychology. And so you guys are treating depression obviously, but like, uh, do you have any thoughts about like, to what extent this intervention focuses on like, positive things or like flirt mental flourishing, aside from just like overcoming the depression or.

Does that question make sense at all? ? Yeah, no, I understand where you're coming from. I, I'm, I'm big into me into the meditation space. So, um, we don't really go there directly. We get there indirectly. Right? When, when you look, if you're, if I took you to Africa computer for, for two months, you, you, you could sit in group week one.

Uh, when the groups are just meeting, they're intensely emotional. You can, even if it's a different language and you don't have a translator, you can feel the pain. Yeah. Uh, but then if I, and then if you watch that group through a, by week seven, week eight, [01:11:00] if I parachuted you into a group in week eight and didn't tell you what it was, you'd never believe as a depression group, the women are happy, joyous, uh, effusive.

And you see their life has changed because they're feeling better. Not only have their symptoms gone down, but they now have the confidence that they can deal with it if it comes. Um, so that's really empowering and you can just see the change in their demeanor. So we don't have to like, encourage, uh, happiness or, or things like that.

It, it's a natural byproduct of just reducing these nine dreaded symptoms of, of depression, if you will. That's how we look at it. Awesome. And so what would you say is the top area that strong minds could improve in if you're looking from a bird's eye? Um, you know, for us it is, uh, it kind of goes back to one of those earlier points is we need to get better at connecting, uh, you know, a, we want the ministries and NGOs to be supportive and we want funding available, but we have [01:12:00] to solve that in the middle.

So what we have to get better at is how do we solve that in the middle. It's not about treating more patients, it's a different kind of skill set and approach. In essence, it's about, you know, do we need a stronger global advocacy, uh, mental health advocacy movement to kind of bring those together and educate them, which I really believe we do.

So we have to get better at figuring out how do we, we solve those two obstacles on the two ends that will always keep us back from scaling. Um, you know, for us, we, we think we can figure it out, not ourselves, but take the lead on it and find partners and really start to, to change that space and move that dial.

Uh, cuz again, if we don't, we won't be scaling. So we just have to get better at doing that. And, you know, typically we're very bottom line focused. Treat patients, treat patient, treat patients. But we know if we don't solve that gap between the two, uh, that will limit how many patients we can treat. So that's where, I dunno if it's getting better at it, but it's certainly a new area that's just critically important for us to, uh, solve so that we can continue to make a difference in the lives of so many.[01:13:00] 

And so you had experience in the global health field before you started strong minds, but is there something in particular that you didn't know before you focused on your work with strong minds that you learned like whether to do with mental health or just starting your own organization? I'm not sure if you ran an organization before this.

No, I ran several. Yeah. Um, well on the mental health side, there's, I dunno if I'm answering your question directly, but, you know, I, I ran big, uh, public health programs, uh, particularly in Congo and, and in India. I never knew then, uh, the impact of depression. Like I was giving you that example, you know, you can't change, uh, livelihoods or the behavior of somebody you know is suffering from depression.

But yet here I was in the Congo for years in India trying to get people to sleep on their nets and to use condoms and to use oral contraceptive pills and would have certain ways to communicate that behavior change methodology. But there was always some percentage of the population who didn't. Change their behavior and you never knew why, and you would just kind of push [01:14:00] harder.

Um, but then in the depression space, it just dawned to me one day I'm like, Oh my gosh, these people are suffering from depression. We didn't know it. We didn't address those symptoms, and we just kept pushing against the wall without really understanding and then solving the core problem. You know, I, I think I've, I've, I've mentioned this I think in some other podcasts where, you know, there were places in, in the Congo where we were trying to get people to sleep on their nets, and there'd be like 25% of the population who wouldn't go into the net.

We changed like the radio spots and the interpersonal communication, and they just wouldn't go into the net. We're like, Why not? And it was years later, I'm back in the States, the depression, and I made that connection. I'm like, Oh my gosh. So for me, it's really important working with NGOs to talk to other well country directors.

I'm like, and I'll ask 'em the question like, Well, okay, what's your intervention? What are you doing? So tell me, is there like 20% of your population who doesn't change and you really just don't know why? And they'll kind of look at me like, Yes, what? What is that? I'm like, Oh my gosh. [01:15:00] And that's part how we try to explain that our model makes their model better.

I'm like, it's depression. And you know, many of us running country programs aren't trained in mental health. So we don't know to look for it. And even if we find it, we don't know how to solve it. So that's how we try to add value. And so for me, that's been a bit of like, you know, I was in the Congo many years ago, so it's like a journey over what, 15 years and now how I'm trying to help others to speed up their similar journey.

So I'm gonna put you on the spot now, but I hope you'll humor me. . When the R c t is done for strong Minds, how many more times effective do you think it will? Than give directly his cash transfers. , what is your forecast? I'm gonna play it safe and say we're, we're gonna stick with the happier lives and, and come in at nine, nine x would be fantastic.

That would be fantastic. Yeah. So yeah, we can, we can, we can, we can shoot for that. Awesome. Okay. And is there anything else you wish I had [01:16:00] asked you about or that you'd like to speak to or that you don't often get asked about regarding strong minds and its work? Uh, no, you know, we really hit on everything.

You know, you've asked some great questions. You know, one of the thing, what typically is not asked is why is. Uh, they're not a lot of support, uh, for mental health or funding. Why is were we in this in between space? And that came up, Uh, and it's just helping people to kind of connect how, you know, the, the value chain of it.

Uh, it generally doesn't come up. So I'm glad it did. I love talking about it and helping people to understand that, you know, we're part of a larger kind of dynamic here. So I'm, I'm grateful that it came up. Um, no, you asked some great questions. I think you're the first person to ask me anything about work life balance and I think a lot of my strong minds colleagues know that I'm really passionate about it.

Um, but I think about a lot. So the fact that you asked it, I think on the third question, uh, when we're done today, I'll be telling all my colleagues, he asked me about work life balance, . So thank you. Yeah, of course. And do you have any advice for people who are interested in global health or even specifically [01:17:00] global mental health?

Like how could they get into this area? Like maybe they're a college student or something, or maybe they want to transition careers? Yeah. Uh, if you're interested in it, Yeah, some general advice. You know, I'm not a mental health professional, right? I have an MBA business background. Uh, I learn a lot of what I do by surrounding myself with mental health experts and having some mental health mentors.

So I think it goes to, you know, any field you want to go into now, I don't know if you can go into aerospace engineering without the qualifications, but on the mental health side, you know, surrounding yourself with the right people, the smart people, and you can learn. Um, so that's great. I think the mental health movement just benefits from people who can get things done and who are passionate.

Um, so that would be one piece of advice is that, well, I don't think you have to have a PhD in, in some field of mental health to get into the mental health space. So, you know, let's not. Keep these doors shut to people who are smart and, and, and can make great achievements. I think that's important advice for them to understand.

Um, but you know, there's, I think there's a [01:18:00] lot of great mental health organizations out there. Many of them are very small. You know, if you're interested, you know, how can you add some value there? It's not always just about giving money and making a donation, which is always appreciated. Um, it could also just be asking them, you know, you know, what would help you?

For us, it's about getting the word out that, you know, mental health is a great investment and why there should be more funding and just more awareness around it. Um, but yeah, so don't let you know. Maybe a lack of mental health credentials keep you back. There's a lot, lots of roles, uh, in all these mental health organizations.

Uh, we need more, We need more smarter people in the global mental health movement. So please join us . . Awesome. And then my last question before I get to like silly bonus questions, , uh, if people listen to this, what is the one thing you want them to take away today and not forget? I want them to know that today there is a simple cost effective way to treat depression [01:19:00] and it's not medication.

And that we already have the silver bullet answer. We don't need more research, we just need more, uh, support, uh, to get this out. We have the knowledge to solve depression, not just in Africa, but, but in the US and around the world. We know how to do it. We just need, um, the commitment, uh, to get it there.

And we just need to be able to, to roll it out. We have the answer. Um, I think sometimes foundations and others are always looking for like silver bullets. I like the bullet is there, we just need to. To, to use it. So that's what I want people to know is that we have the answer now, let's get angry about it and demand that it be implemented and that we use, we put the support where it belongs and that we can really just reduce.

And I would tell you, we can end depression with this simple solution. I know some people would roll their eyes, particularly in the mental health field, thinking, I don't know what I'm talking about. But, you know, we, we need changes. There is a thing like a depression industry that holds some [01:20:00] of us back that doesn't expand access.

And, and we need new thinking and we have that thinking today, and we have a simple model, so let's just use it. Okay. Thank you. Now for the bonus questions. bonus round. Yeah. What's the funniest thing that's happened to you since starting this work? , You know, I don't know. I, I, I consider myself a closet comedian.

One of the things when we're recruiting people, we always, one of the characteristics we put on the job ad, like in job finders and stuff, is you must have a world class sense of humor. I don't know if my humor is world class, but I'll say it is. A lot of people once I was at a conference and, uh, I was gonna be up on the stage, like on a panel, and they wired me up, you know, with the little thing on the side and the thing in your ear at like 20 minutes early, right?

They wired me up and, you know, I forgot it was on and I went to the bathroom. While I'm in the bathroom. They turn it on, and so I'm like, miked and I, I didn't , no, it's not a, it's not a bathroom story. So I was like, coming outta the bathroom. I'm with a friend and I've [01:21:00] been trying to partner with him and we were trying to get some joint funding and we were just feeling like really macho and I didn't know I was wired.

And in the meantime, the whole conference. 200 people is there. And the, and I'm a little bit late getting the panel, so they're all listening. And I have like, maybe, I don't know, like 30 yards to walk from the bathroom to the conference. And they're listening and my friend and I are just totally beefing it up.

Like, Yeah, we need to get funding for this. We really need to, you know, we need to get this funded so we can do the research. And yeah, man, I'm gonna do this. And we're just like being like, too bros. Uh, luckily we didn't like the language, didn't get too crazy if you know what I'm, I'm saying and stuff like that.

But I walk in the room and everybody just turns and starts laughing. And the guy on the stage, Sean, you've been miked the whole time, was like, Oh my God, it was so funny. , even now, years later, I'll run into the, um, the founder and he's like, Yeah, remember when you were live on the mic? He's like, You could have said some really bad stuff.

I'm like, Yeah. But anyways, it was just funny. Uh, so now I'm all great. Anytime I get micd from then on until it goes live, I just, I just, I zip my mouth shut. So anyways, I [01:22:00] felt really funny. So, yeah. So my next question is like, what's your favorite hobby? Oh, thank you for fun. I love this. Uh, I do tons of stuff for fun.

Uh, I play a lot of tennis. Um, I'm huge into meditation. I meditate an hour a day. Uh, I'm big into going to silent meditation retreats a couple times a year. It really keeps me grounded. I'm really into, uh, I just love the whole aspect of loving kindness and being in the moment. Uh, for me it's not so much a hobby as a way of life.

Um, but, uh, yeah, and just, uh, yeah, I, I, I mentioned before, I'm a dad. I have four sons. I just love being a dad and spending time with my kids who are getting a little bit older and in college now. Um, so they're, they're a lot more than a hobby. Uh, there are a couple full-time jobs, but those are some things I do.

And finally, do you have a favorite book or other kind of media if you don't prefer books? I, I don't. I feel like, uh, yeah, I'm a dinosaur. I love books. I love my Kindle. I love heart Outies. Depending where I am when I'm traveling, you know, the Kindle's a lot easier. Um, I [01:23:00] read tons. I probably read 5, 6, 7 books a month.

Um, Last year I fell in love with, uh, The Grapes of Wrath by John Steinbeck. I had been, I had been trying to read that book my entire life. I had started that book Endless Times, and finally last year I just devoured it and put it down and said, It's the best book I ever read. And I'm still trying to figure out why it took me so long for me to get, I read the first hundred pages of The Grapes of Ralph many, many times.

It was a great book. But lots of books. I'm a big fan too of, uh, uh, the, uh, the Vietnamese, Buddhist, uh, t Han, uh, his meditative books are, are fantastic. Uh, and I'm also a nerd. I love any kind of sci-fi, so. Awesome. Awesome. Yeah. And, uh, actually, what's your favorite thing about working at Strong Minds? Oh my God.

Millions of things. You know, from being able to chat with, uh, someone who's overcome depression and seeing. Seeing how happy they are and how their life has [01:24:00] changed just motivates me. You know, when we started Strong Minds, it was really hard because my family and I had to spend our own money on it, and we took, we, we, we made a lot of sacrifices.

So in many ways, strong minds is almost like a family affair. My kids cared deeply about our successes. My wife was like, I, she went to, when I started to minds, I quit my job and started to mind. So she went to work. So I always say she was our first funder. Um, so for me, I love coming home with these stories and reminding my family of, you know, the sacrifices we've made over almost 10 years have really made a difference in the lives of so many.

So I, I love the fact that we've been able to change so many lives. Um, and that also goes back to the team. One of the things I love too, is that I just love working with passionate, smart people. I learn from my team every day, uh, and, and I am inspired by them. And it just helps us to change more lives.

And, uh, you know, I'm just, uh, I'm the luckiest man in the world. Wow, that's so inspiring. I want to go do, Found a ch a charity that changes the world now. Go [01:25:00] for it. I, I'll mentor you, . Well, thank you so much for coming on Sean, and um, I wish you the best of luck with this work. I hope the RC t comes out and shows it's super effective.

No, thank you Peter for having me. No, it is such a joy, uh, to be chatting with you. Great questions and no, I appreciate, uh, yeah, spending time with you today and the opportunity just to share. So thank you so much. Very grateful. Yeah, of course. And if you know anyone who might be interested, send in my way.

I'll do an interview. I'm happy to.