Joy Bittner: Tackling Depression Among Ecuadorian Poor & Refugees

Summary:

In this episode, we speak to Joy Bittner. Joy Bittner is the founder of Vida Plena, an organization invested in building strong mental health in Latin America. Vida Plena does this by training local communities to provide mental health care for depression. Joy majored in psychology for her undergraduate degree, then proceeded to do a master’s in social work in which she focused on social service administration. Later she did a second master’s in nonprofit management and has over 15 years of experience in non-profit management.

Some things we touch on in this episode:

• What it is like working within the mental health field.

• Why we should care about mental health as Christians.

• The intersection between faith, effective altruism, and mental health. 

• The lack of mental health care among the Latin American poor and how to provide it.

• Joy’s career advice for Christians looking to work in mental health and to be impactful. 

Articles, organizations, and other media discussed in this episode

• Vida Plena (which is Spanish for flourishing life) is an organization invested in building strong mental health in Latin America through training local communities to provide mental health care for depression.

• Friendship Bench is a non-governmental organization in Zimbabwe that provides sustainable community-based psychological interventions that are evidence-based, accessible, and scalable.

• Strong Minds is an organization that provides free group talk therapy to low-income women and adolescents with depression in Uganda and Zambia.

• The UN Refugee Agency strives to ensure that everyone has the right to seek asylum and find safe refuge in another State, with the option to eventually return home, integrate or resettle.

• CARE works to fight poverty and achieve social justice working with women and girls at the center.

• Happier Lives Institute connects donors, researchers, and policymakers with the most cost-effective opportunities to increase global well-being.

• The Patient Health Questionnaire is a standardized instrument that screens, diagnoses, objectifies, monitors, and assesses the degree of depression.

• The Global Mental Health Lab aims to reduce the burden of mental illness and improve well-being in under-resourced communities around the world.

• Task-shifted therapy is an evidence-based model of therapy that is a locally adapted version of evidence-based mental health trauma-focused Cognitive Behavioral Therapy.

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Episode Highlights:

It’s like really being able to help people to be able to experience life to the fullest because I think and again, as a Christian space, that is what God desires for us.

[00:08:30] “But when you're suffering from depression or other mental illness, that means you're not able to enjoy that. You're not able to be there for other people in your community. And so it's wanting to really help people to have that full live that full life…But and then putting them at some sort of neutral baseline. It's much bigger than that. It's like really being able to help people to be able to experience life in the fullest because I think and again, as a Christian space, that is what God desires for us.”

I think there's a little bit of self-evaluation of what's going to be most impactful for me.

[00:18:55]“And so it's in some ways, I think sometimes people find it somewhat deceptive, they want to help people, but then there's like the sense of helping people is an abstract way, so I'm not interacting with people as directly. And so I think there's a little bit of self-evaluation of what's going to be most impactful for me. Because at the end of the day, if you choose something like decide abstractly, this is going to be the most impactful thing, but then you are not happy in the day-to-day work, it's not going to be that impactful.”

People are learning the skill, not just fixing the symptoms of what they're going through, but actually learning the life skills to be able to address that in the future

[00:34:17]“It makes the program cheaper, easier to kind of run, whereas if you were prescribing medications then you'd have to have that aspect. And I think also the benefit of talk therapy and specifically, the way we're setting it up about people learning the skill, not just fixing the symptoms of what they're going through, but actually learning the life skills to be able to address that in the future.”

Just giving people permission to be really honest about the struggles that they're going through and then to feel that support from other people.

[00:37:42]“I think what it really is is there's something really special about people coming together and being vulnerable. I think we've all experienced that. And imagine in a lot of the conversations with each, it encourages that as well. Like being able to come together and have a space where like this is you're supposed to be vulnerable here. And then once you do, it's amazing. And so that is what the group magic of the group is. Just giving people permission to be really honest about the struggles that they're going through and then to feel that support from other people…just being that supportive person makes such a huge difference, much more than you think it might, just having that person knowing that they have someone who's interested in their lives and caring about them will make a huge, tremendous difference.”

If you can help one person, you're not just impacting their immediate life, you're actually impacting a brighter range of people.

[00:56:12]“If anybody has someone in their immediate family where it may be a parent or a sibling who's been suffering from a mental illness, you know how much that impacts your family. And so there's also that sort of like overall sort of like impact. If you can help one person, you're not just impacting their immediate life, you're actually impacting a brighter range of people. So that's also kind of interesting. They're also small kinds of statistics in terms of like, investment. I remember seeing one place was like just like the return on investment.”

Developing your foreign language abilities would be a very specific strong piece of career advice I'd give somebody and just like looping that around.

[01:17:24]“For anybody interested in international development it is critical to have a foreign language and think about where you want to work and if you want to be in Africa then it's going to be like French or Swahili or somewhere with a specific local language or so Latin America is Spanish. But being able to communicate locally with people is absolutely critical and so that would be another thing to kind of focus on as you're interested in that is developing your foreign language abilities would be a very specific strong piece of career advice I'd give somebody and just like looping that around.”

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• Full Transcript (expandable)

  [00:00:02.890] - JD

  I'm JD and this is the Christians for Impact podcast. We talk to Christians about the world's most pressing problems and what you can do to impact them during and after university. Today we're speaking with Joy Bittner about the lack of mental health care among the Latin American poor and how to provide of it. I don't know about you, but I personally know many people who struggle with anxiety, struggle with depression, and that's at a very high prevalence here in America and in Western Europe. Now, looking at places where there are many refugees and many other issues with poverty and violence and crime, we only see these rates going up and up. So the question is, what do we do about that? And as Christians who want to bring healing, restoration and redemption, how can we help restore relationships also that people have with their own minds and their own bodies? Joy is really doing pioneering work, it seems, in this space. She has a lot of experience with nonprofit management over 15 years, and she recently founded an.org called Vida Plena. A meta analysis of 45 peer reviewed studies showed that Vita Plana's style of mental health intervention can be nine times more cost effective than direct cash transfers.

  [00:01:27.990] - JD

  So we talked with her about that and also about how her Christian faith informs her model of effective mental health. And additionally, in this episode, I'll be joined by my colleague Asha.

  [00:01:38.850] - JD

  Joy, thanks so much for coming on.

  [00:01:41.090] - Joy

  Thanks so much for having me. Looking forward to having a bit of a chat conversation.

  [00:01:45.350] - JD

  We are too. Thank you again. So you are calling in from Ecuador, is that right?

  [00:01:50.290] - Joy

  That is correct. So I am based in Keith of the capital and it's high up in the Andes Mountains looking out for my window. There's a volcano in front of me and just kind of part of the overall landscape of where we're at.

  [00:02:05.800] - JD

  I wish we could get that through the podcast interview somehow, but maybe we can post links later. It sounds wonderful. How did you end up in Ecuador? Did you move there for Vida Plena or were you already there?

  [00:02:19.550] - Joy

  Yeah, so first I guess I should explain so Vida PETA means a flourishing life in Spanish and it is a nonprofit that I have founded with the goal of being able to provide mental health to low income populations and refugees. So I've been in Ecuador now for ten years and kind of working around Latin America for 15 in total. And I didn't come here originally for this, so I really was interested after college and working in the international development space and with that just was able to get initial job, kind of working in the big republic. Did some different community development projects for a couple of different years, different places, dominic Republic and Bolivia and Honduras. The other places ultimately came to Ecuador to run a fair trade company in which we were working with indigenous artisans who made handmade jewelry. And so as part of that experience, it EAS like, the kind of accumulation of different experiences I had led me to founding Vida PETA. Just really the opportunities I had. I was able to spend time with people and get to know their lives and see the day to day challenges that they were facing.

  [00:03:41.910] - Joy

  And there was like a few notable experiences in which some of the artists and women that we were working with, they had some serious problems. I think I like to talk about, like, mental health. This is the type of thing that people experience everywhere in developing spaces, in kind of quote unquote rich countries. Mental health is very much universal. And I think sometimes we have this idea in the west west we have this idea of either that people are poor but happy. And I think people sometimes they make on a volunteer trip or missions trip, and they have these nice interactions with local people and they're like, wow, they're poor but they're happy. Which I think that says speaks to people being really sociable or really friendly, but especially if there's a language barrier. And just even when you're just meeting somebody the first time, they're not going to tell you all of their personal woes and problems, right? Because that's not how people interact. And so I think sometimes we have like, a superficial understanding on the other side. Sometimes I think I also hear that people think that poverty is going to be the cause of all mental health problems.

  [00:04:49.640] - Joy

  And so if we could have solved poverty, then, like, there wouldn't be any mental health problems, which makes sense only until you think about it and you're like, wait, but that would mean then there'd be like, no depression, no mental health problems in the US. Or UK. Which we all know is not true. So really, like, mental health problems, depression, it's much more tied to a mix of genetics and life circumstances and those conditions exist universally wherever you're based. So kind of a long explanation, so kind of coming around. EAS what the big difference, though, however, is the lack of access. In the developing world, there is a significant lack of access, particularly the Pan American Health Organization. About three out of four people in Latin America aren't able to receive any type of care. And so that is a significant difference and I saw that personally. So how it EAS working with this one woman, very tragically, her husband had committed suicide and so she was facing a lot of the things and her children were going through a lot of things. I was really trying to help get them connected to a psychologist and couldn't find one that was going to work for them, even, like, offering to pay the cost, which is, again, above and beyond her ability to pay.

  [00:06:02.770] - Joy

  But just with the logistics and the distances, there was no feasibility there and just kind of like those types of experiences just help you to see like there's needs here that aren't being met and they have a significant impact on people's quality of life because that's what it kind of comes down to. I think this is like a longest answer, but I think sometimes people think of mental health and it's kind of like over this face we put in the bucket of mental health. But there's physical health and there ara, other things, especially as a Christian, I think it really just comes down to people are suffering and people are in a really difficult place. It just feels like it is our responsibility as Christians specifically to care for people. And so addressing that through the lens of mental health is one way to do that.

  [00:06:54.290] - Speaker 4

  Thank you so much for this explanation. And I think the first kind of question I would have would be how did you come to cure about that cause ara mental health specifically in the first place? Like what role did those like Christian motivations and what role did your Christian background play in that? But also just why did you start caring about that? Why was it something that you wanted to spend your career on doing and supporting others.

  [00:07:29.530] - Joy

  As? It's makes a lot of sense. I think again, it's kind of coming back to that sense of like our colleagues as Christians are caring for people and just caring for people who are in a place of some kind of suffering. And you see that very acutely with people who are all of us know. If you think about your friend or someone in your family who you've seen go through a mental health problems, depression perhaps, I think if you take a picture of that person, you walk alongside them, you're kind of like trying to help them through that. You see how much like they are very distinctly suffering. And that is like our calling as Christians to help people. And so we can put like a lens on it and again, we can put that lens on it, kind of call it mental health and give it that official title. But really what it is, is like caring for people who are in a place of hurting. And so that was kind of just like I kind of came from that broad space background of wanting to be helped. People kind of be able to live the lives that have a world of opportunity.

  [00:08:30.050] - Joy

  Because I think IFP you think back to that good friend of yours you've seen struggle or maybe yourself, it robs people of what they couldn't be and it takes the sucks away people's like energy and their ability to be able to live their fullest potential. And one of the defining features of depression specifically is that it takes away pleasure in everyday activities. And I think that's just like there's so much in the world that is good and beautiful. But when you're suffering from depression or other mental illness, that means you're not able to enjoy that. You're not able to be there for other people in your community. And so it's wanting to really help people to have that full live that full life. And that is actually the name be. The plan again, means a flourishing life. It is coming from that motivation. It's not just like limiting it to like, mental health in the sense of like, we want to help people, like be cured, quote unquote, if that was even possible. But and then putting them at some sort of neutral baseline. It's much bigger than that. It's like really being able to help people to be able to experience life in the fullest because I think and again, as a Christian space, that is what God desires for us.

  [00:09:35.350] - JD

  So beautiful. Thank you for sharing. So you're an American, you have a lot of experience in Central America and Latin America. And you first went to do work with Fair Trade startups, is that right?

  [00:09:49.470] - Joy

  Yeah. So I've been doing a number of different community projects kind of in the health space. I started a small organization that did public health projects in Honduras and then here in Ecuador. We were working again with the indigenous artists doing fair trade.

  [00:10:05.730] - JD

  How did you transition from fair trade to mental health? Was that a seamless transition? Was that just by way of meeting this friend who you mentioned their spouse had died and seeing the weight of that burden on them? Or was that a characteristic moment or was there some other way that that came about?

  [00:10:28.170] - Joy

  Yeah, so my background professionally is I EAS a psychology major undergrad and had this idea of wanting to do international development, didn't quite know how to get into that. And then did a master's in social work in which I focused on social service administration. And then later, a little bit later, I did a second masters in nonprofit management. And so I'm kind of coming in it at the angle of more of like project management and program development. That's how I was able to kind of step from Fair Trade over to mental health in the sense that I didn't come in it with as expert, as a therapist or a mental health expert. I had some broad strokes orientation but never done clinical work before. And so really what I'm doing then is like partnering with people who are the experts. And so specifically I've developed a partnership with Columbia University out of New York and the Global Mental Health Lab there who are actually the experts in this model of therapy, which is looking specific model of therapy that we're working with, which is recommended by the World Health Organization. It's the technical term for people interested.

  [00:11:48.760] - Joy

  It's called task shifted therapy. But what that really actually means, it's a great model in that it means you can train local people non specialists. They don't have to have a degree in psychology or anything, but you can train people to be able to provide a very effective form of therapy. And this model has been kind of this model grew out of sort of the recognition that there's more demand and more need than can be recognized than can be met by the existing number of professionals that are out there. And this is particularly true in the developing world. And so this model sort of grew up out of a great organization called Sam Gap that would go to India. There's also the friendship bench out of Zimbabwe. And sort of like these movements kind of happened parallel about 1015 years ago, really began this shift in the mental health space of recognizing the value of they call it the lay health worker. And so it's really just like people who receive some training, but they don't have like, say, a psychology degree, they're not psychologists certified, but they're able to provide this type of therapy that is still really impactful and really effective.

  [00:13:00.070] - Joy

  That's where I'm coming at it. It's like, okay, so if community members can learn how to do this, I can as well. But then more importantly as myself. And my particular role is that I'm really just like bringing together the different pieces, the different actors who are then able to make this program happen. And so kind of developed this interest in mental health based off of my experiences. But I was not personally a psychologist or seeing patients or anything to that extent before this. It was just more like I think there's a lot of ways that one can apply your skills in different areas. And so if you have, to some degree, some generalist skills, they can be taken a lot of different directions.

  [00:13:41.030] - JD

  That's really good to hear. I think a lot of us in university have this sense that if I want to focus on mental health, then I need to study psychology. And that's what I have to do. And if I don't do that well, then I have to work on some other problem. But, yeah, it's so exciting to hear your story of how working in project management give you the skills to work with people, to work with the experts, and you were able to transition later in your career to this cause area. And I'd love to get more into what you're doing with Columbia University and some of the solutions you're finding. Can we talk a bit first about the problem of mental health in general and then maybe also in particular in Latin America, actually, since you talked about it earlier. But how about specifically in Latin America? How does that compare to other regions in the world regarding mental health? Maybe some of the listeners are familiar with other programs in other parts of the world. For instance, Strong Minds, which works in SubSaharan Africa. How does Latin America compare to sub saharan Africa in terms of mental health needs and in what ways is it greater or less?

  [00:14:48.960] - JD

  In what ways are the distinct needs? I'd love to hear more about that.

  [00:14:54.270] - Joy

  Yeah, actually going back a little bit, what you said a bit earlier, JD, about the idea of people as they're thinking about building their career and how to kind of frame it and the impact. I'd have to say I just want to touch on that because I think it kind of makes a lot of sense, I'm sure for yourself too, I imagine. You never imagine you'd be in this kind of exact role, this space where you are, but kind of there's these things that kind of come together. When I EAS in my master's program in social work school specifically, EA wasn't that they get a little bit older and so there was no EA. But I had this broad feeling of like I was kind of looking at it and just kind of have this feeling of like, okay, in the best case scenario, maybe I can see 30 patients a week as a therapist and well that's very significant for those 30 people in their immediate family. The people that affects it is not that many people in terms of how you can affect them. It's like a deep impact. And so that is actually why part of the reasons why I chose to go more program and administration and thinking about took my career that direction was because I had this hope of being able to have a wider reach.

  [00:16:08.450] - Joy

  And so I think that would be something I'd even just suggest like students who are thinking about it. EA is always very much thinking about impact, impact. And I think impact can go to different directions. You can go deeper, wide. And so if you're thinking about mental health and specifically you can go deep and be like that person, that individual who is going to sit alongside them and walk through their problems and really spend that time and invest in a few specific individuals or you can kind of go wide. And I'm doing something like what I'm doing is a little bit more like program administration and building out those services. I would say what I think people should do is think about what they personally find most motivating and their personal skill set. I was actually listening and doing this morning. Even, I think in EA, people who take EA very seriously, I think really hard about their impact, which I think is great. But I think you should do that, especially if you're younger and starting out or even if you're further, but along actually the same impact isn't just like an abstract concept of like, okay, this is the most impactful thing.

  [00:17:13.720] - Joy

  It's really like, what is the most impactful thing for you personally? And I was thinking about that actually in the context of you talk about the church body and how there's different parts of the body and not one of them are better than the others. And I think in EA there can be this little bit of minimizing like, oh, that's less impactful. So it's like not as good of a role we think of, I don't know, the kindergarten teacher just to cut.

  [00:17:36.610] - JD

  In here, because maybe not all of our listeners know what EA is. By EA we meet using evidence and reason to find the best ways to do good. Right. The EA idea and the community around that. Just to clarify, as a footnote, oh.

  [00:17:49.540] - Joy

  Yeah, sorry about the Belgian world. Yeah, the cliche might be like, oh, the kindergarten teacher is not going to be the most impactful career. And so you could say the same thing for a therapist. But I think you have to really look at and think about what is it for me that will be in my most impactful career and my personal most impactful life path. And so for some people, that really might be like that person who is going to sit down alongside and be the psychologist, be a therapist and the social worker and actually spend that time with individuals and that's where they're going to find the most meaning and that's really where they personally will have the most impact. And then, whereas somebody else in my particular rule, I don't spend my time doing therapy with people, I spend my time doing spreadsheets and budgets and fundraising and working out bank account details and transfers and a thousand other things. And so it's in some ways, I think sometimes people find it somewhat deceptive, they want to help people, but then there's like the sense of helping people is an abstract way, so I'm not interacting with people as directly.

  [00:18:55.510] - Joy

  And so I think there's a little bit of a self evaluation of what's going to be most impactful for me. Because at the end of the day, if you choose something like decide abstractly, this is going to be the most impactful thing, but then you are not happy in the day to day work, it's not going to be that impactful. So it's a little bit like knowing yourself. So that's a little long aside. I just wanted to share those thoughts because that's something I've been thinking about. So it's really recognition of what makes you the most impactful. Going back to the question then, about mental health rates, if I could say something here.

  [00:19:28.470] - JD

  I thought that was so on point. And I think oftentimes, yeah, we do think about impact in this kind of blackboard model sort of way. Like, oh yeah, if I could theoretically see the secrets of the universe and unlock the hidden doors to really make the biggest impact possible, what would that be? And that's just for many people, a bit out of touch. Right. You have to start with who you are, who God made you. Like, you mentioned what part of the body did God make you really like to use the body of the church as an analogy? Did he wire you to be more like the hands of service or more like the thinking head that strategizes the operations? And I think that's a beautiful analogy and a really healthy and holistic one as well.

  [00:20:12.850] - Speaker 4

  I just want to add is that thinking about impact as an undergrad is such a stressful thing to do. You have all those chat with people advising you on career, and yeah, that's what they're trying you to think about. What's the most impactful career that anyone, to some extent could take, given your background in your studies. But I found that really reassuring what you said about thinking what's the most impactful job that I could have as myself, given not only my background, my studies, but where I am at, like, people I know and thinking kind of more broadly about that. So thank you for that. From an undergrad perspective.

  [00:20:57.810] - Joy

  When I was an undergrad, I remember just feeling like, this immense pressure. I don't even think it EAS an impact on it. What's your life going to be? You have to pick the thing. And all of a sudden, it's so scary. It feels so overwhelming. And then I remember I talked started talking to some older people a little bit further along in their careers. And something I noticed was occasionally you bump into somebody they like. I knew I always wanted to be a teacher. I became a teacher, and I knew I EAS going to be a doctor. You bump into a few of those people. But most people had taken some interesting twists along the way, and maybe some people had done complete career shifts, or some people had kind of wide off. They kind of like, specialized as they went along. They kind of fell into something, and then that became their niche. But it was a little bit less intentional. And I think it's great if you have that clarity, but if you don't, I think what it makes sense to just take the next best step. It's just like, take that next step that makes the best moment the best thing you can do for the next phase.

  [00:21:55.320] - Joy

  And if you don't have that big picture, long term thing clear, that's like, okay, just took that next best thing you can do. And that's when I realized that took some of the pressure off of me. And I feel like that has really played out. And so I'm a little bit older. I'm 37, and so I'm starting this organization now. And so it feels like for a number of years that I wasn't really quite sure what I was supposed to be doing. I didn't really know I'm on the right path. I was doing different things, and they all felt like overall good, but it wasn't like, oh, this is my thing. And when I look back now, I can see that it was definitely guiding and shaping my life and setting me up to be able to have the right set of skills and experiences to be able to do this. And that wasn't clear in the moment, but looking back with a little bit of experience, I see that, like, oh, that's why that opportunity came up, and that's why that rule, or that's like, why that one didn't work out. In some ways, sometimes there's not such clarity, but you can kind of in the big picture sense, I do see that, and I do see God having shaped things.

  [00:22:58.620] - Joy

  And so it's okay if, like, in that individual moment, IFP like, I don't know if this is quite right, but if you're alerting things and you're getting experiences, it will contribute to the next step. And so I think that's also helpful. That was always helpful for me to think about it that way. You don't have to have the whole thing figured to figure out that next piece. I know for you, JD. I'm curious how you've now come on with each and how that path is. Do you also see that in your own life, the way that's kind of come together?

  [00:23:27.650] - JD

  Yeah, I think that thinking not in terms of always the best possible thing in this chapter, but is just a great next step to position me down the path God wants me, I think. Yeah, that has been true in my life. I think you run into this decision paralysis when you're open to anything and you end up having to make decisions and you also realize that life gets very complicated and you're balancing so many different factors. When I was thinking about career choice, I was also thinking about a long distance, long term relationship, and you end up having to be very open in terms of timelines. And I definitely found myself not being able to plan for more than a couple of years at a time or whatever my next visa term was. I don't know if you've run into any similar issues with your travels and working in Ecuador as an American, but yeah, I definitely think that for some people, it does not make sense to look for that one career, lifelong career. Yeah, I definitely would not have guessed three or four years ago that I would be doing what I'm doing today.

  [00:24:39.680] - JD

  It sounds like very much the case also for you.

  [00:24:43.050] - Joy

  Yeah, I'd say so. Kind of looping it back around to Latin America and how I ended up here. So, like I mentioned, I was interested in international development work and that was kind of what I wanted to do. Didn't know how to break into it and kind of my broad strokes idea was like, well, that happens mostly in Africa, so I'll go to Africa. But then initial opportunity became available to go to the Dominican Republic. And then one opportunity leads the next opportunity kind of. Then next thing I've built my career in Latin America and I've never been to Africa. I think there's also a sense of sense of that letting life unfold the way it does and kind of going then back to the high impact. So as I did become more aware of effective altruism and became more involved, some kind of the questions came up with why are you starting vida plena in Ecuador, in Latin America? Is that the highest need place and is that the most cost effective place that you could be doing this? And kind of if you were just to put together spreadsheet of tables and numbers?

  [00:25:52.400] - Joy

  Perhaps not, but my competitive advantage at this point it is. And so that's again, going back to a little bit of like the body of Christ and just also your own personal abilities. So after having developed a career in Latin American, spending only ten years in Ecuador, I speak Spanish fluently, I have a large network and connections within academia and the startup world and things like that. And so Ministry of Health, it just made sense. Like perhaps if you were to put together a spreadsheet, you could say that India is going to be a higher impact for an abstract person, perhaps. But for me personally, there's clearly going to be no advantage for me to start over in a different, totally different language and culture. And so that is a little bit like part of that reality. And I think that is just knowing where your personally best advantage makes sense to kind of focus on that and being okay with that. So kind of with that though, I just put some numbers around it. Latin America in terms of depression is relatively on par with the US. So that means basically, if you look at overall depression rates, they're about 5% to 7% of the population at any given point.

  [00:27:08.090] - Joy

  And that's yeah, similar in Ecuador. In Latin America, as the US. Broad strokes. There's some other places in the world that ara higher. There's some of the places that you might expect to have like more there's more like civil unrest and war. They do have higher rates of mental illness and depression because some of those circumstances do then influence that. So yeah, that's a little bit like Latin America specifically. What is interesting though about Latin America is I think there's this growing openness that people are aware of mental health illnesses and the importance of addressing them. However, there's just again, that real strong lack of access that people have. What is available here for example, is there are some private healthcare, mental health care. You could go to a private psychologist and that's what people may be in the upper class would do. However, for people in the bottom of the proverbial pyramid, that is completely unaffordable. They are just being underserved. There's a few government options, as you would imagine. It's really difficult to get an appointment, long waiting times just. Really inadequate based off of the need. So, yes, that is a little bit like kind of like both sides of the coin of why Latin America.

  [00:28:33.910] - Joy

  Other thing I noticed, so I decided to modeling my program after you mentioned Strong Minds, which is a really fantastic organization that's based out of Uganda. And they are using that model of therapy that I mentioned before where you train community members and then specifically in a group therapy model. So it is like very cost effective. And so I'm replicating that here in Ecuador and then going back to that partnership with Columbia, working with the team who originally trained Strong Minds and they've also worked with a number of different organizations around the world. UN, refugees, Care International High is a lot of these kind of like very big development organizations. And they're also now training my team here. So really excited about that collaboration. I feel like the ability to count on the experts to make sure we're really setting up things right from the beginning has been crucial. So, yes, that's a little bit kind of a rat.

  [00:29:32.870] - JD

  So there's definitely a need. There's definitely an undertreated need. Right. I think you said that three out of four people in Latin America go untreated. So that means in Latin America, there are millions of people who are suffering from depression who don't have any kind of treatment or therapy or medication. And so there's a lot of different ways that we can meet this need. So maybe one would be to work within the government to maybe increase funding for government sponsored therapists. Maybe there's a private sector need where maybe more people could just specialize in this within these individual countries. Then there's this nonprofit approach where you provide these services at below market or at no cost. Right. And that sounds like that's the approach you're going for. That's the approach that the World Health Organization and others that you've worked with Ara going for. Strong Minds has gone for this talk therapy approach. Can you help us get a sense of which approaches seem most effective and why talk therapy of all? Why does that seem particularly helpful?

  [00:30:53.890] - Joy

  Yeah, I'll give a kind of like a broad overview of the way our program works. So what we do is we train local community members to be able to be group facilitators. And specifically we're using a model of therapy called interpersonal therapy, which is on par as kind of the top evaluated. Therapies cognitive behavioral therapy might be familiar to other people through that space, and it's considered one of the gold star therapies for treating depression. It has an immense body of evidence behind it demonstrating its impactfulness. And so the way we do that is we have actual community groups that come together, local community people in their actual neighborhood, and they spend then eight weeks it EAS a short term therapy, and they spent eight weeks meeting together and just being able to kind of grow and learn. And I want to really highlight that group aspect because I think that is absolutely critical of what we're doing. Because again, what we're trying to do is we're starting with mental health, we're starting with treating people for depression. But the idea is then that rose from there the experience of Strong Minds and a lot of other organizations who use this model is that a lot of the groups after the official meeting period decide to continue meeting together informally without the facilitator who's guiding them.

  [00:32:18.250] - Joy

  And that's because they have found that that community support is so critical. And so what we're really doing is we're emphasizing that as a way for people to be able to develop those stronger networks. I think so much that this is the case, especially the western world, but also here even more as well, society kind of goes forward is we're increasingly separated and we are losing some of those previous contacts. But even in different rural areas you see that there's this need for human connection and when you provide that for people, it becomes such a source of strength. And so then these groups, what we're really trying to incentivize here is that these groups then transform not just for being like a depression support group, but then it becomes like as people are able to really kind of come out of some of the depression that really they're really intense levels of depression. And going through the experience of Strong Minds, like about 85% of people that go through their program do see a significant reduction in their symptoms. And so as people improve, they're able to focus on other aspects of their lives and other aspects of how they can give back to the community.

  [00:33:27.430] - Joy

  And that's really what we're working to do is build these strong networks of people who have come together around a specific issue and then when they're at the right place is to be able to turn that around and that it can be such to be able to transform society at a broader level. And so really kind of building from the ground up. It's very much like a community life model.

  [00:33:48.170] - JD

  It sounds quite good. So group talk therapy in the case of Strong Minds was able to reduce symptoms by 85% among those treated. So can you help us get a picture of what that means for somebody personally? Right. So does that mean that they just feel a little bit less depressed or I guess what would qualify or what would be like an average person before and after going through this group talk therapy?

  [00:34:17.250] - Joy

  Yeah. So reason also kind of group talk therapy opposed to the other model that people might use, they'd use some sort of pharmacological assistance, right? You're taking antidepressant pills and a lot of the evidence there's kind of broad body of evidence that is very effective and for a lot of people the best best is kind of like maybe it might be a combination of the two. However, with a lot of people might be familiar. Like antidepressants also come with a negative range of side effects and there's all of those pieces as well access in developing world. And so there's just like less risk focus IFP you're just doing talk therapy opposed like mixing antidepressant pills in as well. You don't have to have like a psychiatrist who's overseeing that. It makes the program cheaper, easier to kind of run, whereas if you were prescribing medications then you'd have to have that aspect. And I think also the benefit of talk therapy and specifically the way we're setting it up is about people learning the skill, not just fixing the symptoms of what they're going through, but actually learning the life skills to be able to address that in the future.

  [00:35:25.500] - Joy

  So it's not just like, okay, this is like this particular moment, it must be sustainable, right? Yeah. How do you kind of go forward from there, right?

  [00:35:34.570] - JD

  Take someone who's depressed, who starts this talk therapy. How does that process work, how long does it take, what does that look like?

  [00:35:46.750] - Joy

  It's eight sessions, an hour and a half each. And kind of like I'll just talk about someone that I had worked with initially and when we started working with her, she had a lot of social anxiety, so much so that we have maybe do a little small homework assignments in between sessions. And an example for her was going to the local corner store and just talking to the cashier. Just like a way to kind of build that up. And then she did a great job. She did a lot of work on herself and really put the effort in. And so it got to the point by the end that she had developed a strong friendship with another woman and she had always kind of had these like ongoing problems with her boyfriend and so she was telling her friend about her friends like, oh, you should talk to your therapist. And she said she went and she had the conversation with her boyfriend able to work through their problems. And then she said that the reason she was able to do that was because she realized she had developed like a struggle network of people around her that she didn't just her boyfriend wasn't the only person in her life.

  [00:36:49.120] - Joy

  And so being able to talk toxic him and dealing with that problem, that conflict, she could take that head on and it's like a very small transformation but in some ways and for her experience that was huge. It was huge because she was able to actually deal with her problems because she knew there was other people in her life that were going to be there to support her.

  [00:37:08.230] - JD

  Right? In this program, it gives you those people. Right? So it's an eight week program, I think you said, or is the eight session program with a group of five, six, seven other people or what's an average group size?

  [00:37:21.300] - Joy

  Yeah, six to eight people.

  [00:37:23.070] - JD

  Okay, six to eight people. And then you go in and you have one trainer who guides the discussion, is that right? And you've been actually been training some of these trainers. But what are these trainers taught and what exactly did they do to create this community bond, this support system?

  [00:37:42.530] - Joy

  I think what it really is is there's something really special about people coming together and being vulnerable. I think we've all experienced that. And imagine in a lot of the conversations with each, it encourages that as well. Like being able to come together and have a space where like this is you're supposed to be vulnerable here. And then once you do, it's amazing. And so that is what the group magic of the group is. Just giving people permission to be really honest about the struggles that they're going through and then to feel that support from the other people. And so just as a side thought of as you have friends or somebody who's going through that, just being that supportive person makes such a huge difference, much more than you think it might, just having that person knowing that they have someone who's interested in their lives and carsing about them will make a huge, tremendous difference. And that is really what's happening in the group. And so the Facilitator's job is to just create that space very intentionally. So giving people permission, quote unquote, like, please talk about this. Let's talk about what happened this week, tying that into their symptoms, tying that into what's going on in their depression and how they're kind of looking at very much the bi directional relationship of depression and their relationships and their symptoms.

  [00:38:50.180] - Joy

  And so if you're having a stronger moment of more depression, that's going to negatively affect your relationships, or if there's problems or relationships, of course that's going to cause more depression. And so the Facilitators helping make those connections. They're also doing things like, let's talk in great detail about maybe the conversations you're having, how those communications can be improved. Maybe there's like decisions that need to be made and kind of weighing the pros and cons some ways. Again, because this is like a non specialist, it's not something that a very good friend might be able to do. If you have a very thoughtful, considerate, emotionally intelligent friend, they might be able to do some of these things for you. But unfortunately, a lot of people don't have that person in their life. And so then again, this is like facilitating that intentional space. So then people come through being able to learn really new skills that they're then able to apply in other areas of their life.

  [00:39:42.090] - JD

  So just being in this group where people are intentionally vulnerable, intentionally open, while in a pretty sensitive state, right, these are people who are suffering with depression, who also likely in other respects have difficult lives. I mean, we all do. But I imagine the people here have even more so, their own challenges and struggles. And just being in a space with five, six, you said six to eight other people, where everybody's opening up about those struggles they're going through. And is it just opening up, or is there any specific recommendations people are giving each other? Or is it simply just being vulnerable that creates relief? Where does the relief come from? I guess I can speak from experience, from Bible studies and from talks with pastors that opening up is I mean, there there does come relief from that, right? And we read in scripture, of course, the truth will set you free. And sometimes that's a very freeing, liberating experience. But are there any other aspects of of this group talk therapy that provide that 85% reduction in symptoms that you mentioned earlier?

  [00:40:54.530] - Joy

  I think part of it, huge part of it is knowing that you have that sense of support and that you have other people who are coming alongside you. And then there's also a critical aspect of learning to be able to build networks of support even outside of the immediate group, whether that's within your family, extended family, your contacts, your neighborhood. So knowing people like knowing that you're not alone and not being social isolation is one of the kind of newest and most kind of modern ills that I think is getting more attention, but still needs more so helping people build those sort of connections. So specifically with the Vita Planet, we are focusing on people who are very low income or refugees, and so their life circumstances are exceptionally challenging. I was working so Ecuador is within the region, there's a lot of refugees who have come specifically from Colombia and Venezuela. So for people are not geopolitics very specific, but Colombia has a lot of problems with gangs related to drug wars and problems with that. And so a lot of people have been affected, have been become refugees because there's a lot of intense violence.

  [00:42:05.130] - Joy

  And then in Venezuela, their entire national government system has melted down, and there's like exceptional levels of economic problems. And because of that, then it also organized crime there too. And so a lot of people have fled. And throughout different parts of Latin America, ecuador particularly, has received a lot of refugees. And people have very real tangible problems. They maybe don't have papers, they have difficulty getting work, they face discrimination, they can't get their kid in rolls, quarters, like very concrete problems that people are facing. And so I do like to point out, mental health is not going to be the cure all of all their problems. If you can't get a visa to be able to work legally, that's not going to be fixed. However, if you have depression on top of that, then you don't have the emotional resources to be able to face that problem and be able to take it on. And I think that's kind of, it's kind of like that compounding effect. And so what we're really trying to do with you, the plan is partner with other organizations who are offering those other kind of wider range of services, whether it's legal support or housing or livelihoods for getting work.

  [00:43:12.990] - Joy

  Because if you're at a point where you can't face these problems that are already so overwhelming because you're suffering from depression on top of it, then it's like you just won't have the emotional resources necessary to be able to deal with them. So it really needs to be kind of like part of this broader package. I don't like to highlight that's going to be the fix all for that, but it is like a key part of the overall services that somebody needs. And so yes, that is just kind of like a sense of who we're working with. It's a very great example. Small thing. This is where people are coming from. A girl comes to mind. She was living in Venezuela and she started like a small micro business and she was selling cakes out of her home. And then very common, there was armed groups that began to extort her and she didn't have the money to be able to pay for it. And so she, so they were then threatening her life and she's like in Venezuela, that's not, that's not a joke. That's like if you're getting death threats that's because they're serious.

  [00:44:12.580] - Joy

  And so she, she had to flee and so obviously having to leave her family and those circumstances are going to be very hard. But then really what we did specifically going back to your question, like what do we do? Helping her to process some of those feelings of like, hey, she's had to leave her family behind. Now she's in this new place. How does she build up a new network of people? How does she make connections? And sometimes they're like these small things, but it's like helping her realize she does have people she can call. And then helping her build and kind of strengthen those connections helped her to be able to accept this news place that she's in and start to feel like, okay, this is a place where I can see myself living, and I can kind of build up a good life here. That's a little bit of like some of the pieces that we might be processing. Every individual is different and everybody's circumstances are different but it's like those would be some of the pieces that we'd be working on in the therapy.

  [00:45:10.450] - Speaker 4

  And so given how complex and just I would say how much mental health depends on each individual, like the context and everything, given how difficult it is to measure mental health, how does Vida Planet do that and how do you think are the best ways to measure mental health and measure the improvement.

  [00:45:40.190] - Joy

  Yeah, so we're using actually not that hard to measure. You could just ask people it's actually very concrete. You ask people, how do you feel? And they will tell you. And so there are specific psychological measurements and instruments that have been verified across cultures, across contexts.

  [00:46:01.330] - JD

  Can you give us some examples of those?

  [00:46:03.240] - Joy

  Yeah, so we specifically use what's called the PHQ nine, which is a standardized instrument for the patient health qualification, nine questions on depression. So we do that and then a whole range of other instruments at the beginning of like, the person's therapy. And then specifically every single week, we use this nine question survey about people's depression symptoms. And so you're actually able to see very concretely how they change from week to week as people answer it. You could argue there's the criticism, like, well, it's a subjective scale. Of course it's a subjective scale. It's like how someone feels. We're talking about people's emotions, so it's like subjective, but it's also the most subjective thing possible is like how someone actually feels. And so with that, you're able to actually to see. So the girl that I mentioned before, she started out with a very high score of being like semi high to medium to high levels of depression. And then by the end of the time that we were working together, she was consistently no symptoms, no symptoms, no symptoms. And so you actually really are very tangibly able to measure that progress and track it on a graph of how that person has changed.

  [00:47:16.410] - Joy

  And so in that sense, it is very much evidence based therapy and using those sorts of instruments. So Beck is another common one, the gad, the Gad another instrument, those are all very common within the mental health space and they're broadly been verified.

  [00:47:33.490] - JD

  Do we have a sense of how long this effect lasts? So take this woman you were describing with the extortion issue, who went through the group talk therapy and she had a relieving of her symptoms of depression. Do we see that persisting in the longer term future or have we measured consistently that far with these group talk.

  [00:48:01.450] - Joy

  Therapies yeah, I think there's definitely kind of worth pointing out. There's broadly kind of major two different types of depression that you could kind of categorize. There's chronic depression and then there's major depressive episodes. And so chronic depression is very much, as the name suggests, people who have suffered for depression for a very long time and they often will have more often have relapses. And so that is normal. But then what we will work with then in that space is how to mitigate the symptoms so they're not as severe every time. I do want to point that out, this is not magic. And there are people who do suffer for depression for a very long time, and that is very real. And so it's more like for those people learning how to manage the triggers and also kind of manage what are the circumstances that help it to not be as extreme. For people who have what's considered then another category is a major depressive episode that's a little bit more triggered by a circumstance often. And that could be like in the case of the woman I mentioned, her transition as a refugee could be from a loss of a loved one, could be from a loss of an important relationship, whether it's death or breakup.

  [00:49:25.180] - Joy

  And so what's important there is helping the person to work through that specific experience so that it doesn't transform that into a chronic depression. And chronic depression doesn't always have to be triggered by an event. It could also be hormonal different things, but genetic. So those people specifically ara more focused on a major depressive episode. We do see that the impacts are quite lasting. And that's not to say that the problems somebody does have life problems, they don't have low moments, but it doesn't transform itself into a crippling depression.

  [00:50:05.490] - JD

  Yeah. If I can interject is group talk therapy. Is it mostly aimed for people who are suffering bouts or more seasonal episodes of depression, or are they equally also targeting as helping people suffering from chronic depression? My guess is it's more the first and the second. Is that right?

  [00:50:26.250] - Joy

  I'd say both. It helps both. I think people that definitely is meant to be both people are able to benefit from a group talk therapy. Absolutely. People who have a long term chronic depression, they will probably be like, maybe a little bit less of a change, but they are still able to actually truly benefit from that as well. Anecdotally, I just wanted to point out that to your question, how does that work? And so are the impacts lasting? I mentioned a little bit earlier a different woman who had, like, she started with the social anxiety and how she developed a network of people. And I just actually just saw her yesterday, and we were kind of catching up informally. And I just mentioned, I was like, oh, and how are things going with your boyfriend at the moment? And she's like, oh, yeah, we broke up last week. He decided whatever circumstances. And I was just like, Wait, we've just had a half hour conversation, and you haven't even mentioned that. You seem like you're doing really well. I'm kind of shocked because before she talked about codependency issues, and I was just shocked. And she's like, yeah.

  [00:51:30.560] - Joy

  She's like, it was pretty hard the first couple of days. But she's like, I've developed. I've got a lot of things going on my life. I've got her work and her study, all these other things and all these other positive things. And she's like, you know, so it was hard. I definitely had a couple of hard days, but then it's okay. I was just like, this is incredible because in the past, she had talked about every single breakup, had just let it hurt, this terrible depression, and it was really hard. And I was like, this is really incredible how it just changed that space. So again, it's not that she didn't have a hard moment when that breakup happened, but it didn't suck her down into the ongoing sort of depressive episode. And that is because of the skills she was able to learn and apply.

  [00:52:09.850] - JD

  I can definitely see how the skills you would learn from a group therapy session like that could become lifelong skills. I think it must also be hard to measure. Right. I can see how it would impact someone's longer term future, but I can also see just thinking of cases of friends and acquaintances who kind of slip back in the same depressive episodes, instances where people seem to have a harder time learning how to get back on 2ft. Right. And I am quite curious how that effect persists not just after one year, but after five years or ten years, like the really long term future for people's lives. Do you know anything about that in particular? And has HLI done anything in the past researching those longer term outcomes?

  [00:53:04.570] - Joy

  Yeah, HLI specifically hasn't done that. HLI has been looking at really interested in kind of cost effective analysis, comparing different interventions to kind of like the GiveWell standard of give directly and direct cash transfers. And so just as I get specific, they did look very carefully at Strong Minds. Again, the organization I'm replicating, and they found that Strong Minds is nine times more impactful than direct cash transfers such as give directly for those people who are not familiar, often in the effective altruism world in some development spaces, direct cash transfers where you just give somebody cash. It's kind of considered like the baseline in terms of cost effectiveness because you're just giving money away. And that's considered to be kind of if you can't have a program that's more effective than that, well, you might as well just give away the money. So they were looking at Strong Minds and yeah, found them to be nine times more effective specifically in terms of subjective well being. And what subjective well being is there's this whole range of studies where people act people subjectively like, so how does this affect your life? How do you feel about it?

  [00:54:17.510] - Joy

  And that's just like a way of being able to compare interventions opposed to using metrics such as Income or Dallas, which are health based sort of focus. And so Happier Lives Institute is very much interested in looking at subjective well being as a way to be able to compare interventions in terms of cost effectiveness. So that's kind of like that sense. But then to go to your question, JD, about long term effects of talk therapy, I know specifically for gaming pill, if you're able to there's higher rates of depression, especially in young adults, adolescents and young adults. And if you're able to address that early, it really does make a transformational difference in that not developing a tool of chronic lifelong depression. So someone, especially in that age frame of adolescent young adult is able to get help. It makes a big difference in kind of changing their life trajectory. On the other hand, we do see also high rates of depression at the other end of the life spectrum of older adults, people who are then retired. They've kind of like lost some of their social connections. They're no longer working, maybe somewhat isolated.

  [00:55:22.250] - Joy

  There's also at the other end of the age spectrum, higher rates of depression. So I think that really takes.

  [00:55:29.690] - JD

  Yeah, definitely. So it sounds like HLI's estimates of subjective well being, improvements from group talk therapy sessions, from strong minds, some of the ones that you're doing, it sounds like these are then measuring shorter term improvements and maybe it could even be better. Right? It sounds like these are maybe more conservative estimates based off of shorter term measurements. But longer term measurements could also show that those effects continue into the future. Is that correct or are there just assumptions being made about the longer term that they haven't measured, but they're just they're just making these assumptions?

  [00:56:12.310] - Joy

  Yeah, absolutely. I mean, there are definitely like, I know HLI and their estimates are somewhat conservative and try and not extending too far out just because they want to be able to be more conservative in that impact. But one of the other interesting things to look at is also called spillovers. And that's basically the impact on immediate family and kind of like their surrounding community. If anybody has someone in their immediate family where it may be a parent or a sibling who's been suffering from a mental illness, you know how much that impacts your family. And so there's also that sort of like overall sort of like impact. If you can help one person, you're not just impacting their immediate life, you're actually impacting a brighter range of people. So that's also kind of interesting. They're also small kind of statistic in terms of like, investment. I remember seeing one place was like just like the return on investment. Like for every dollar invested in mental health, the World Health Organization estimates that there's a four dollar return. And that's where people are interested in the economics of it. And that really comes down to loss of productivity in workplaces, the cost of treatment, things like that.

  [00:57:21.970] - Joy

  And so it's really interesting, just as economics like, to look at these kind of like, numbers into the broader economy, addressing mental health issues does really have that payback in the broader society.

  [00:57:33.970] - JD

  Speaking of economists, I was actually talking to an economist this weekend who was talking about RCTs, and I know you mentioned that we've done RCTs with group talk therapy in sub Saharan Africa, in Uganda. I think that's. Where it was. Now, one thing we know from RCTs is that we can do these randomized control trials. We can do these sort of ABC and so forth tests to see whether we're having the impact that we want to have with an intervention with the program. And we can control everything else and just change one thing to see if we're having that impact. One thing this economist is telling me is that with RCTs, we have to keep doing them. Because when we try to do nonprofit interventions at different places in the world, we realize that conditions are actually very different and sometimes in ways we don't expect. Are there conditions that are present in the depression and in the mental health issues of the poor in Latin America that maybe wouldn't be present in the poor in Uganda? And how does Vita Planet's approach adapt to that?

  [00:58:44.390] - Joy

  Yeah, I 100% agree on the importance of what you're saying of being based on evidence. And that is, like, one of the key values that I've developed that via the planet is based off of, is having a strong evidence base for the work that we're doing. And that kind of comes from, like, two sides. I feel like there's a lot of nonprofits out there that have really great intentions, and Ara probably doing good. They probably are doing some kind of good. But there's also this sense of people who are poor, their lives are already fairly complicated. They don't have access to public transportation. Everything is just a lot more complicated for them. And so I don't want to burden them with an intervention, a program that isn't that certain to help them. It just seems like absolutely disrespectful. And then on top of it, if it's somebody who's struggling with depression and mental illness, to give them a false promise would be absolutely terrible. I want to be certain. Again, you can't guarantee 100% everybody, but guarantee that most people who go through this program will see a significant benefit. And so part of that is very strong, like, shutdown criteria.

  [00:59:54.170] - Joy

  We don't see people improving at the rates we expect, then we'll have to either seriously pivot or consider reshaping the organization, potentially even shutting it down. So I think that is like, a strong, strong focus of having that and measuring carefully along the way. And so then kind of your question of how do you adapt based off of local circumstances? What we're doing, again, is, like I said, it's just like, partnering with local organizations who are the experts and very much relying on their feedback on, like, okay, here's how culturally, what's appropriate and how people expect to react and things like that. So it's very much relying on locals. And so actually, on the Vida PETA team, I am the only non Ecuadorian that we're working with. And so just as a side note, so I think that is very much like, relying on that kind of local expertise and people who really understand the population that we're working with.

  [01:00:57.250] - JD

  I think this is really interesting. It's, of course, a really complicated problem. How do you replicate group talk therapy that worked in Uganda, in Ecuador and so forth. And I definitely second what you're saying about the importance of evidence based interventions. I want to dig a bit deeper into one thing you said, which is that your team is almost exclusively Ecuadorians, that you're the only I think you said the only non Ecuadorian on your team. And I think one benefit of this is that you can provide the service for much less money. Right? I know strong minds can provide group talk therapy for around last time I checked, maybe around $120 per person.

  [01:01:36.910] - Joy

  For.

  [01:01:37.310] - JD

  All the sessions, with an 85% success rate of lowering symptoms of depression. But you were saying you can do it for less. So how much can you do it for? And why can you do it for so little?

  [01:01:54.530] - Joy

  Yeah, we expect so I should just step back. We're in the process right now. We're in fall 2022, running our very first pilot. And so we have just hired our first round cohort of community facilitators, and we're going to be starting training with them this Saturday. So it's very exciting. And so what we expect to be able to do that is it is like, we're still in the process of being able to figure out, like, what our exact costs will be. I have some strong estimates right now. I do think we'll be about on par with strong minds, maybe a little bit slightly under. And I think the main reason that we're able to do that is exactly what you mentioned, is the fact that I'm relying on local expertise. And so our overall structure is that we are registered as a nonprofit in the US. But all of our operations and then the entire operating operations team is going to be based in Latin America, currently in Ecuador. So we're starting in Ecuador, and then the plan is in the next three to five years, then to be able to expand other countries within the region.

  [01:03:01.770] - Joy

  But throughout that, there is, like, a really just great group of people in Latin America who are highly educated, a number of people who have even master's degrees from the US. And Europe. And so really talented group of people that I can rely on to be able to run all the day to day operations and at a competitive local salary that is then still much cheaper than, like, a US. European salary. So I think that's kind of where we're able to have kind of come out competitively, a little bit different. But yeah, that's not to say I think there's different kind of costs and different street places, and as effective algers are always looking at kind of cost and the cost effectiveness of different regions. It is, like, an important consideration for sure. But what I really like to emphasize again is kind of that sense of like because just because it's like maybe more cost effective in one place doesn't mean you want to neglect people somewhere else. But our focus is really being able to tie into that local expertise and then as that focus, like making sure the majority, not all of our staff as much as possible is Latin American.

  [01:04:12.630] - Joy

  So that's kind of where we're coming in.

  [01:04:15.460] - JD

  Yeah, you're doing really good work there and I definitely want to encourage you to keep up that good work of working with local expertise but also working with eminem experts. You mentioned some researchers from Columbia. I'm also just curious like how this compares to treatment in the US. I certainly would never want to discourage anyone from seeking treatment in the US. But if you're listening and you're considering maybe earning money to give it away or just giving away a portion of your income, it does sound like at least on face value you can provide relief from depression at a much lower cost if you're working with Vida Plena or with Strong Minds. Right, because that's maybe $120 per person compared to many thousands, many thousands of dollars in the US or the UK. Is that about right?

  [01:05:07.670] - Joy

  Yeah, I believe last I agree. I think Strong Mind is about $120 and we're estimating to be right about there as well, which feel very good about giving up their first year of operations. Costs are always a little bit higher as you're setting things up and then hopefully as we go in year two and three we'll definitely be able to come in lower. That said, I don't have to play the comparison game of criticizing other organizations. I think Strong Minds is doing really important work. It's just a different context. Different context, right.

  [01:05:37.500] - JD

  And how many people are we talking about here? I know you mentioned you would need to train something like 60 Facilitators to lead these group talk therapy sessions. How many people does that translate to receiving treatment?

  [01:05:52.270] - Joy

  Yeah, so we're hoping so right now we're doing our pilot and we're kind of starting initially smaller to be able to set that up properly. But the goal is then for next year to be able to start to expand pretty quickly and one group Facilitator is able to reach a number of people and so one group Facilitator in any particular cycle could be working with about 50 or so people every eight weeks. So that does like translate. So we're hoping to be able to reach like a couple of thousand pretty quickly and so we're going to see exactly the right way to like scale up. But that's like broadly kind of the direction we're taking it in terms of cost effectiveness and scalability. It is like absolutely, it's really exciting kind of where it can go again, relying on that local expertise of these.

  [01:06:49.910] - JD

  Local community members are there any bottlenecks in this? Is it maybe training the facilitators? It sounds like you're doing that all by yourself. Maybe there's some other bottleneck in the pipeline, but I imagine that takes quite a lot of time. Or is the bottleneck more funding or is it more marketing these group talk therapy sessions, marketing these services to the Beneficiaries, where is it exactly that prevents this from scaling another ten X?

  [01:07:19.490] - Joy

  Yeah, I think right now we're focusing on really developing the program model correctly, but once we're really able to scale so we hope in 2023 to reach about 2500 people. So again, that's not huge, but it's like your full year one and being able to do that for about $100 a person. So really at that point, once we have our Model 100% set would be kind of implementing at scale, would be running a number of trainings and then organizing the groups. The trainings, they last seven days total and then there's like ongoing weekly follow ups of course. And yeah, I think so. For us for scaling is wanting to feel like we have our structure set up really well in place and then it does feel like it'll be the type of thing that can really move quite quickly.

  [01:08:14.910] - JD

  Are you excited for that? Are you ready for this to grow or are you happy with where it is right now?

  [01:08:23.970] - Joy

  It feels like the most exciting thing I've ever been part of. So we're here kind of getting the pilot really right off the ground actually working with people. We've kind of done some we've had some pre pilot groups.

  [01:08:37.710] - JD

  Who is it that you're working with at Columbia? You might have mentioned it earlier, but I think I missed it.

  [01:08:42.710] - Joy

  Yeah, I'm working with it's called the Global Mental Health Lab. Specifically their director and founder is Leonard Bradley. And then I have a local team of four psychologists that I'm working with and then I have a local partner organizations and nonprofit called Alex, which is The Wings of the Hummingbird, which is specifically focused on working they help people in low income situations and refugees be a more private kind of this broader suite of services. And so we've partnered with them some other smaller groups that are specifically focused on refugees as well. And so when I say we, this is kind of like this growing team that have been able to put together different organizations and kind of a few specific key individuals. I should also mention that I have a local psychologist that working with and she and I went through the charity entrepreneurship program as co founders, Anita Castlen, that's kind of like the Wii team of not just myself at this point. I definitely couldn't be pulling all of this off and then have had a really great number of volunteers who have also given some of their time. So Sam from Happier Lives has helped with like a CA and some different volunteers who've helped with web sites and different aspects.

  [01:10:03.430] - Joy

  And so really huge number of people. It's really 100% not me. It is really a great group of people have come together around this idea of how can we make this happen.

  [01:10:15.670] - JD

  Awesome. I would love to dig in just for a couple of minutes that we have left here into advice. Advice for Christians at university who want to make a difference in this space, who feel called to help those who are suffering from mental health issues. You mentioned earlier that you don't have to study psychology to make an impact in this space. Now let's just say you're a generalist, you can do a lot of different things and the most important thing is that you help as many people suffering from mental health problems get better as possible. What paths would you recommend if someone was just completely open? What are some things they should consider in terms of degree programs for undergrad and then maybe also graduate programs? Yeah, let's start first with studies.

  [01:11:14.510] - Joy

  Yeah. I think even stepping back from like what major should we want to pick or something like that. I think the most important career thing that I've ever is just actually doing as many internships and practical experiences EAS possible. I think that's like it almost matters less what those internships are as much as you actually do them opposed to picking a course of study because that will then give you a sense of what work looks like in the real world and do you like that type of work or not? Is that a good fit for you? Do you see that as being interesting work?

  [01:11:51.730] - JD

  So what are some internships and work experiences that someone who's still in undergrad that they could get that would give them a good sense of what would be a good fit for them?

  [01:12:04.070] - Joy

  Yeah.

  [01:12:04.250] - Speaker 4

  Do you have any names like in mind of any organizations that people should check out or just apply to?

  [01:12:13.530] - Joy

  Yeah, I think that's going to really depend. You'd be able to give specific organizations going to pen so much like where you're personally based, but I would say is just more like actually seeking out those opportunities through your career office. And so I think you could do things like sometimes they'll be like local social service. If you ara interested in working more directly with people, you could look for opportunities working with social services that are working directly, social service programs. And so you're trying to get as much hands on experience there also. But to think even a little bit broader is like maybe you don't want to become that therapist but there's a lot of different support services, maybe not even a generalist, but you were working for the overall good of the organization. So you'll be able to focus on marketing or you're focusing on the accounting and the finance. You can develop like specific skills and then decide that you're going to apply them working for a mental health organization, but you're not going to be the quote unquote therapist yourself. That said, people looking very specific career advice in the US. IFP you're interested in mental health, I would say beyond considered social work EAS.

  [01:13:25.410] - Joy

  There's a lot of different aspects of social work or different populations that people could work with, whether it's homelessness, drug and alcohol dependencies, a lot of different aspects. Specifically maybe prison populations. It's a little bit cheaper and more direct than say, becoming a psychologist, which has a very long career path that is very competitive. There's also like school counseling programs, educational psychology. There's a lot of different aspects, but I think it usually is kind of like getting your feet wet and trying different things out and seeing what feels like a better fit for you because that will give you real life experience and then also actually help you as you get out in the real world. Like having done something more than just like picking a particular study space.

  [01:14:10.130] - JD

  Did you ever try this yourself? Did you ever shadow a psychologist? Or were you already further in your career and you just went ahead and tried a much different approach? I heard that from friends who were premed, they could shadow a doctor, I imagine, although this might be a bit confidential, right? You could maybe shadow a psychologist or at least meet with a psychologist to talk to them about what it's like, what their cases are like, that kind of a thing.

  [01:14:45.500] - Joy

  Yeah, you might be able to shadow or just like working. So I had internships that through my university they set up. It was a program where it was programmed for people who had been through the court system mandated because of childhood abuse or neglect cases. They had to take this parental course. And so I went along shadow this woman and she went to people's homes and they had to do how to do home inspections about the conditions that the children were living in. And she had to do this like, parenting course with the parents. This is court mandated. So that was like a very hands on interest experience. I was just learning from me to see the reality of people's lives. Or I did like a different in my grad program. I was in New York, so I had an internship at the United Nations that gave me a sense of how bureaucratic big organizations can be. And that was like somewhat EAS an idealistic student, somewhat disillusioning, just seeing the mechanisms of big bureaucracies and how they churn things through.

  [01:15:48.370] - JD

  Can you talk a bit more about that and what your experience is like there? Because right now you're doing very much the opposite, right? You're starting your own thing. You have quite a lot of say so and how things go, and you could have designed the programs very much yourself. But what was that internship and describe some of those frustrations.

  [01:16:06.160] - Joy

  Sure. I guess specifically I was working with the Federation of International Federation of Social Workers as a social work student and they're kind of working at this high level trying to advocate for different positions. And so we'd write position papers on I'm kind of looking back I kind of using but we'd write a position paper on indigenous rights. I don't think I'd ever really met an indigenous person at that point. And so I don't know how this is like a long time ago, but yeah, how that could happen. I think that it's kind of funny looking back at that. I think what's also really valuable students for students also is if they're interested in working in a national development space is like taking those student trips and doing the volunteer thing, because you probably won't be as a student. Volunteer. Maybe not that impactful, but it will help you to have a broader experience for yourself of understanding and seeing different parts of the world and understanding different cultures and just gives you a wider perspective. So I think those trips are 100% worth it. And if you can get a longer term volunteer position like six or four months in a place and where you're actually able to spend time in a community learn language is really critical.

  [01:17:24.830] - Joy

  Anybody interested in international development it is critical to have a foreign language and thinking about where do you want to work and if you want to be in Africa then it's going to be like French or Swahili or somewhere with specific local language or so Latin America is Spanish. But being able to communicate locally with people is absolutely critical and so that would be another thing to kind of focus on as you're interested in that is developing your foreign language abilities would be a very specific strong piece of career advice I'd give somebody and just like looping that around. Again, this is like organizations the effect of alters of the Christians think there's something true member of like we know this but then sometimes we forget is seeing people as individuals that like the individual in the group. And what I'm trying to say is we can think about impact in the face of okay, I can help like these thousands of thousands of people or give you the specific thing. It's like remembering there's like that individual and that individual life tied there. And so with that I guess I'm trying to think about with that is like how to think about your impact in terms of like who are the specific people that are going to be benefiting and not just like thinking of like a big picture abstract number but like caring for the individuals.

  [01:18:50.030] - Joy

  And that could be very much like it is like caring balancing your big picture impact with also just being very involved in the people who God has put in your individual life path and not underestimating the value of that.

  [01:19:04.110] - JD

  Has your approach towards mental health in your vocation? Has it differed in any extreme ways because you are a Christian, do you think that the models of effective mental health for a Christian will be very different than the models of effective mental health for non Christians working at secular charities? So could you speak for a minute or two about that and maybe what a Christian should be uniquely aware of when entering this space?

  [01:19:34.230] - Joy

  Yeah. I think as a Christian or as a person doesn't consider themselves to be a Christian, there's definitely a solid base of wanting to do a therapy that is based on the evidence and is based on solid practice. And that is like a solid baseline. Somebody coming in EA for Christians, then I think the difference would be if you're working with someone who also shares that faith and they've expressed that you can use that as a source of strength and use that as a way to be able to find that commonality and help them to be able to use that as, like, a place to find support, whether it's in their church or their individual relationship with God. And that can be very meaningful. Again, it's like being very respectful of knowing that person also shares that and also is open to that. But I think that can be a place to be able to find those commonalities. If the person is open to it, it's going to be something like again, it's being respectful but you could be praying together or sharing a psalm that's about affliction and using that as a place of support and really focusing, not pushing that on people and keeping overall the therapy based on evidence based practices is key.

  [01:21:06.870] - Joy

  But if there is that openness like that, sharing really just helps it kind of go to the next level sort of space. I think when that does occasionally happen, it's really quite special. So yeah, I think that's kind of weight and then it is I personally and then just privately outside of the actual interactions with the people is very much like seeking God in prayer. And so what that looks like for me is really just praying for the people that we're working with and praying for their individual circumstances and praying that God is working in their life. And overall I think that is where it comes in for me. Just like the overall orientation is that understanding of God cares about people and who are the least of these. And so I think that recognition of everyone, I think that does very much fit in with a mental health approach or an interest in kind of development is like people have value beyond the value of what they might be able to contribute to society. And so I think that is like as a Christian we see the individual as somebody who really matters because God sees them as being valuable.

  [01:22:21.600] - Joy

  And so that's like a unique perspective that Christianity brings.

  [01:22:26.670] - JD

  One final question. So do you have any thoughts about whether somebody who's interested in making an impact in this space should pursue earning to give, to give to effective charities like strong minds like Vida PETA and so forth versus doing direct work, maybe being a start up founder in the space or supporting a startup like yours. Any thoughts on that? And then also related to that, are you hiring now or in the near term future?

  [01:22:57.930] - Joy

  Yeah, we are hiring but we're only hiring Ecuadorians locally as group facilitators. However, it would be great to connect with anybody interested in volunteering, specifically grad students around research or doing thesis research. I think that we would really love to connect with anybody in that kind of space to be able to get better focus on our impact. So that would be kind of that and then kind of like bigger questions. I think going back to the original thought of the body of Christ and your personally love working more directly with people who want to do more of that sort of work. I think that follow that impulse, follow that calling and if you feel that you're like, oh the other side, you're like I'm going to great coder and I really enjoy coding, then maybe just understand those kind of like callings and that there's a space for different people and that one is not better from the other. And I know it's like it's probably a little bit too harsh, hard to like that's maybe not helpful, but it's more just like taking the pressure off of like there's one correct path or the other.

  [01:24:04.210] - Joy

  It's going to be very individual and going back to those intrude experiences, like trying things out and seeing what actually fits and feels good to you.

  [01:24:14.290] - JD

  Yeah, that definitely takes the pressure off. Thank you so much joy, we're really excited about your work. We would love to include a link to your contact info or Vida PETA, whatever you'd like us to include there. But thank you so much for taking the time to talk to us and we look forward to talking again or seeing you at a Christians for Impact or each event in the future.

  [01:24:38.330] - Speaker 4

  Thank you so much.

  [01:24:40.030] - Joy

  Thanks so much to both of you guys and just everyone else listening to your interest in this topic and the great work that you Ara going to be doing. So thanks for both of you this opportunity.

  [01:24:51.470] - JD

  Absolutely, take care.

  [01:24:53.060] - Joy

  Bye bye. Thanks.

  [01:24:55.390] - JD

  Hi listeners. I hope you enjoyed this episode. If you're thinking about being connected to Joy or other Christians who care about effective mental health. If you're considering a career in mental health and you want to help as many people as possible, and help the poorest of the poor to have a restored relationship not only with themselves and their own minds, but with their communities and with God, we would love to help you learn about really promising projects. We would love to help you brainstorm potential projects for yourself. We have mentors who have thought about this. We would love to get them in touch with you. Go to christiansforimpact.org. You can also listen to other podcast episodes we have on similar poverty related themes. Like our episode with Brian Fickert, Paulny House and Katie Fentaguzi. You.

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