Description of your proposed project

Project implementers: Kaya Guides is a global mental health nonprofit incubated by Charity Entrepreneurship, an organization in the effective altruism space which launches high-impact nonprofits that are backed by rigorous research. We’re early-stage, having been founded around a year ago.

What we do: We operate a self-help program on WhatsApp to reduce depression at scale in low and middle-income countries, focusing on youth with moderate to severe depression. Last year, we launched a proof of concept with 100 people in India to assess the viability of this work as a long-term initiative. The pilot showed positive results in reducing depression, based on the participants completing a depression diagnostic questionnaire upon starting the program and upon completion.

Why we’re starting in India: Mental health disorders in India account for nearly 15% of the global burden. 200 million people in India suffer from a mental health disorder at any point in time. This is India’s leading cause of years lived with disability, and 40% of all the world’s female suicides take place in India. 85% of people with depression get no help at all, and in a country of 1.4 billion people, there are only 43 government-run psychiatric hospitals.

How the program works: We deliver a self-help course via WhatsApp that teaches youth evidence-based techniques to reduce depression. A WhatsApp chatbot delivers videos in Hindi that teach these techniques. During the 5-8 week course, participants practice the techniques day-to-day and have 15-minute weekly calls with trained supporters.

Evidence base: Research indicates that guided self-help can have the same effects as face-to-face psychotherapy- even if human support is only 15 minutes per week, the supporter has no clinical background, and the program lasts just five weeks.

What we've done: We adapted the World Health Organization's digital self-help program to India's context, built a WhatsApp chatbot, produced 40 videos in Hindi, and implemented a proof of concept with 103 participants. We are the first nonprofit in the world to run the WHO's program in a real world context.

Impact: Delivering on WhatsApp means we can reach those who need it most, at a large scale. The WHO program which we’re using, studied in two RCTs, had moderate to large effects on depression.

Why this matters: In low and middle-income countries, there is virtually no effective mental healthcare available to everyday people. Our model (digital delivery of a guided self-help program on WhatsApp) represents a new way to use technology to improve mental health at scale in places where people with depression have little to no options to get better.

Proof of concept findings: In our proof of concept, we saw significant results for both retention and depression impacts. 26% of participants completed the program, which sounds terrible but is excellent in the context of digital mental health: unguided apps are commonly accepted to have less than 1% retention. The WHO's program, implemented in Lebanon, saw a completion rate of 32%.

Of the participants who completed our program, 72% experienced a 50% or greater reduction in depression (compared to 40% for the WHO's original version of the program), and 36% remitted completely (compared to 21% for the WHO's original version). We are skeptical of these results because they seem too good to be true and it's a very small sample size (25 people); we expect to see smaller effects as we continue. However, these are tentatively encouraging results and we're continuing to collect more data as we implement.

Mental health organizations usually struggle with recruitment, but we got 875 people to message the chatbot in 1 month (similar organizations report getting 1K users in a year), achieved a 12.46% conversion rate from initial message to appearing in a guidance call (in the for-profit world, 2% conversion would be considered good), and only spent $0.96 per user acquisition.

Cost-effectiveness: Cash transfers are effective at increasing subjective well-being and are a reasonable benchmark to use when evaluating interventions that are focused on mental health. Our work has the potential to increase subjective well-being 30x as cost-effectively as direct cash transfers by Year 3.

Scaling potential: As a tech initiative, we can scale rapidly and believe we can treat 100K people in Year 5. Our work over the coming year will set us up for this.

Project

With this funding, we will be able to help 1K youth in India who are experiencing moderate to severe depression. In the process, we will strengthen our backend systems in a way that will make our work scalable.

To treat 1K youth next year, we will:

1) Hire and train two guides to interface with participants

2) Get 8,400 youth to message the chatbot (based on our pilot conversion rate of 12%, this is what will ultimately lead to 1K participants)

3) Execute the program through weekly guide calls and technical backend implementation

4) Address technical issues we experienced during the pilot through improving chatbot design and hiring strong technical talent

How much money do you need?

$30K. This will enable us to treat 1K youth next year, while in the process establishing strong backend tech that can facilitate rapid scaling. $5K would enable us to hire one participant guide- the staff who directly interact with participants. Guides are the key driver of participant engagement with our program.

Describe why you think you're qualified to work on this

1. Kaya Guides was ideated and incubated by Charity Entrepreneurship, an effective altruism organization that 1) Conducts rigorous research to identify underutilized and maximally impactful interventions and then 2) Runs a competitive process to find and then train entrepreneurs to launch those organizations.

2. I’ve worked in the global development sector since the start of my career, in early-stage NGOs, social enterprises, and large development organizations including the world's largest USAID contractor. I have prior experience with many of the areas involved in nonprofit implementation, including program design and management, impact measurement and analysis, partnership development, communications and fundraising, and I've lived and worked in East Africa, Latin America and South Asia.

3. We have a capable team in place. Our clinical director Rashi Sinha is a clinical psychologist and excellent generalist who was a consultant for large global NGOs such as Girl Effect and ran a successful private therapy practice. Tech lead Akashdeep Bhagat specializes in WhatsApp chatbots and has led tech teams for organizations such as Saajha, a reputable Indian education NGO engaging 100K users on WhatsApp. Guide Para Raturi is a psychology student based in Mumbai with prior digital mental health experience and certification in suicide prevention.

4. We’ve already implemented a successful proof of concept which established demand for this in India and promising early results of the program's efficacy.

Other ways I can learn about you

Website: www.kayaguides.com

CE (our incubator) profile on Kaya Guides: https://www.charityentrepreneurship.com/kaya-guides

My profile: https://www.linkedin.com/in/rachel-abbott-851092108/

Links to any supporting documents or information

EA Forum post explaining our work and plans in more detail: https://forum.effectivealtruism.org/posts/CdELxtHgQjzCYPhtm/kaya-guides-marginal-funding-for-tech-enabled-mental-health

Deck: https://drive.google.com/file/d/1xwWsiMDgVefQkH8knu41hZNFpgUP5YK3/view?usp=sharing

Cost-effectiveness analysis (Projected cost per participant at a scale of 15K participants, planned for Year 3 post program launch): https://docs.google.com/spreadsheets/d/1sVm0LHM5GQkIXJdXqaWwLgLV-br3p7rTf--8ZubfHVU/edit?usp=sharing

An example of one of the videos participants watch to learn depression reduction techniques: https://drive.google.com/file/d/1OQe-LrpcJwsx9vxMLAgJVkWphORkvyZl/view?usp=drive_link

The Instagram page we use to market our program to potential beneficiaries: https://www.instagram.com/kaya_guides/