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    Mental health

    Mental health: Someone to talk to, wherever you live.

    Nearly one in seven people on Earth, 1.2 billion, live with a mental disorder. Trained lay counselors can treat depression in groups for about $45 a person, by one evaluator's estimate.

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    Ryan K. Hertel · heyitskenton

    The problem

    What we're up against.

    • Nearly one in seven of us.

      In 2023, nearly one in seven people, 1.2 billion, were living with a mental disorder: 322 million with depression and 470 million with an anxiety disorder.

    • Most go without care.

      Only 9.1% of people with major depression received even minimally adequate treatment in 2021, and just 2% in sub-Saharan Africa.

    • Where you live decides your care.

      Adequate depression care reached one in five people in high-income countries, and one in twenty-seven in poorer ones.

    • Pennies against dollars.

      Low-income countries spend as little as 4 cents a person on mental health, against up to $65 in high-income countries, and depression and anxiety alone cost the world economy an estimated $1 trillion a year.

    What works

    Proven, and ready to grow.

    • Healing in groups.

      In a randomized trial in rural Uganda, after sixteen weekly group sessions, 6.5% of people in the therapy group still had major depression, against 54.7% in villages without it.

    • A bench, and someone to listen.

      In Zimbabwe, six sessions of problem-solving therapy from trained, supervised lay health workers left 13.7% of patients with symptoms of depression, against 49.9% with standard care.

    • Even severe depression.

      In India, lay counselors helped 64% of people with moderately severe to severe depression into remission, against 39% with usual care, and the gains held a year later, at lower total cost.

    • Brief help in hard places.

      In a conflict-affected area of Pakistan, a brief program from lay health workers brought clinically significant drops in anxiety and depression.

    • It pays back.

      Scaling up treatment for depression and anxiety would return $2.30 to $3.00 in economic benefits for every dollar spent, by one global estimate.

    What a family could fund

    Where the money goes furthest.

    • Group therapy, at scale.

      StrongMinds offers group therapy from trained lay counselors to people with depression in Uganda, Zambia and beyond, at about $45 a person treated, by the Happier Lives Institute's analysis.

    • Already reaching people.

      StrongMinds says it has treated more than 2 million people for depression, and the governments of Uganda and Zambia each covered about 9% of its program costs.

    • Room for more funding.

      StrongMinds aimed for $12 million in 2026, with $5.5 million of it unfunded. The Friendship Bench, which offers one-to-one therapy, costs about $16.50 a person treated, with a gap of $2.9 million.

    • Free tools, ready to use.

      WHO's Self-Help Plus course is led by supervised non-specialists after a short training course, so money can go to training, supervision and delivery.

    Honest limits

    What money can't promise.

    • Benefits can fade.

      A randomized trial of StrongMinds' group therapy with adolescent girls in Uganda raised the share with no depression by 5.4 percentage points, but the effect was gone by thirty months.

    • Evaluators disagree.

      After adjusting for biases in the studies, GiveWell judges StrongMinds about 25% as cost-effective as the programs it funds, and the Happier Lives Institute calls the lack of a relevant randomized trial a core uncertainty.

    • Published effects run high.

      Across trials in non-Western countries, the measured effect of therapy fell from 1.10 to 0.73 on a standard scale once unpublished results were allowed for.

    • Not every setting works the same.

      In India, lay counselors made a clear difference in public clinics, but not in private ones.

    • Serious illness needs more.

      Only 12% of people with psychotic disorders in low-income countries receive mental health care, and their treatment includes medicines, not talk therapy alone.

    Hard questions

    Asked and answered.

    1. You might ask

      Can a lay counselor really help?

      Ryan

      For common conditions like depression, yes, when they're trained and supervised: in Zimbabwe's trial, 13.7% of Friendship Bench patients had symptoms of depression, against 49.9% with standard care.

    2. You might ask

      Isn't this a rich-country problem?

      Ryan

      No. Anxiety and depression are common in every country; what differs is care, which reaches one in five people in high-income countries and one in twenty-seven in poorer ones.

    3. You might ask

      Do the effects last?

      Ryan

      Sometimes. Gains held a year later in India, but faded within thirty months for adolescent girls in Uganda, and GiveWell doubts lasting effects for this kind of group therapy.

    In the slider

    See what your fortune could do here.

    Mental health

    The slider prices this cause with these numbers:

    • Group therapy from trained lay counselors costs about $45 a person treated at StrongMinds, by the Happier Lives Institute's analysis.
    • The whole need is people with major depression outside the world's high-income regions who get no minimally adequate treatment, about 183 million, by our arithmetic from the study's table.
    • Treated isn't cured: GiveWell judges this kind of program about 25% as cost-effective as its top picks, and in one trial the benefit faded within thirty months.
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    More of the Blueprint

    Keep reading.

    17 more chapters on the way

    Back to Keep 100

    Sources

    Every number in this chapter, and where it came from.

    1. Source 1: Mental disorders (opens in a new tab)

      World Health Organization, 11 September 2026. Checked 16 October 2026.

    2. Source 2: 2025 Giving Season Charities Update (opens in a new tab)

      Happier Lives Institute, 8 December 2025. Checked 16 October 2026.

      A charity evaluator. Its costs rest partly on the charities' own data.

    3. Source 3: Service coverage for major depressive disorder: estimated rates of minimally adequate treatment for 204 countries and territories in 2021 (Santomauro and others) (opens in a new tab)

      The Lancet Psychiatry, December 2024. Checked 16 October 2026.

      Minimally adequate treatment means a month of medicine with four doctor visits, or eight visits for therapy.

    4. Source 4: Undertreatment of people with major depressive disorder in 21 countries (Thornicroft and others) (opens in a new tab)

      British Journal of Psychiatry, December 2016. Checked 16 October 2026.

      WHO's World Mental Health Surveys.

    5. Source 5: Over a billion people living with mental health conditions: services require urgent scale-up (opens in a new tab)

      World Health Organization, 2 September 2025. Checked 16 October 2026.

    6. Source 6: Group interpersonal psychotherapy for depression in rural Uganda: a randomized controlled trial (Bolton and others) (opens in a new tab)

      JAMA, 18 June 2003. Checked 16 October 2026.

    7. Source 7: Effect of a Primary Care-Based Psychological Intervention on Symptoms of Common Mental Disorders in Zimbabwe: A Randomized Clinical Trial (Chibanda and others) (opens in a new tab)

      JAMA, 27 December 2016. Checked 16 October 2026.

      The Friendship Bench trial.

    8. Source 8: The Healthy Activity Program (HAP), a lay counsellor-delivered brief psychological treatment for severe depression, in primary care in India: a randomised controlled trial (Patel and others) (opens in a new tab)

      The Lancet, 15 December 2016. Checked 16 October 2026.

    9. Source 9: Sustained effectiveness and cost-effectiveness of the Healthy Activity Programme, a brief psychological treatment for depression delivered by lay counsellors in primary care: 12-month follow-up of a randomised controlled trial (Weobong and others) (opens in a new tab)

      PLOS Medicine, 12 September 2017. Checked 16 October 2026.

    10. Source 10: Effect of a Multicomponent Behavioral Intervention in Adults Impaired by Psychological Distress in a Conflict-Affected Area of Pakistan: A Randomized Clinical Trial (Rahman and others) (opens in a new tab)

      JAMA, 27 December 2016. Checked 16 October 2026.

      A trial of WHO's Problem Management Plus.

    11. Source 11: Scaling-up treatment of depression and anxiety: a global return on investment analysis (Chisholm and others) (opens in a new tab)

      The Lancet Psychiatry, 12 April 2016. Checked 16 October 2026.

      A model of 36 countries.

    12. Source 12: Q2 2026 Report (opens in a new tab)

      StrongMinds, August 2026. Checked 16 October 2026.

      The organization's own count.

    13. Source 13: Q4 2025 Report (opens in a new tab)

      StrongMinds, March 2026. Checked 16 October 2026.

      The organization's own account.

    14. Source 14: Self-Help Plus (SH+): a group-based stress management course for adults (opens in a new tab)

      World Health Organization, 23 September 2021. Checked 16 October 2026.

    15. Source 15: Therapy, mental health, and human capital accumulation among adolescent girls in Uganda (Baird and others) (opens in a new tab)

      Journal of Development Economics, September 2025. Checked 16 October 2026.

      A randomized trial of a StrongMinds and BRAC program with about 1,900 girls.

    16. Source 16: Assessment of Happier Lives Institute's Cost-Effectiveness Analysis of StrongMinds (opens in a new tab)

      GiveWell, March 2023. Checked 16 October 2026.

      A charity evaluator, more cautious than the Happier Lives Institute.

    17. Source 17: Psychotherapies for depression in low- and middle-income countries: a meta-analysis (Cuijpers and others) (opens in a new tab)

      World Psychiatry, February 2018. Checked 16 October 2026.

    18. Source 18: Effectiveness of an intervention led by lay health counsellors for depressive and anxiety disorders in primary care in Goa, India (MANAS): a cluster randomised controlled trial (Patel and others) (opens in a new tab)

      The Lancet, 13 December 2010. Checked 16 October 2026.

    19. Source 19: World mental health today: latest data (opens in a new tab)

      World Health Organization, 2 September 2025. Checked 16 October 2026.