Mental health programs are often only funded when they can demonstrate gains in education, employment, or income. This is a standard not applied to other areas of health. Reduced distress and depression should be treated as a valid and sufficient outcome in its own right.

Across the Co-Lab, organizations are running into the same structural problem: funders want mental health work to justify itself through other outcomes. Programs are forced to prove they improve test scores or employment rates before they can secure support for treating depression or building hopefulness, even when the evidence for those mental health outcomes is strong on its own terms.

The double standard

Sean Mayberry of StrongMinds, which has treated 2 million people for depression across East Africa, names the double standard directly:

In practice, though, even StrongMinds must work around this double standard. The organization collects "a whole range of wellbeing indicators, in terms of people's time, hours worked, meals consumed, classes attended, grades improved" because donors require it. The core of the work is treating depression, but to maintain funding, the organization must continually demonstrate that treating depression also leads to something else.

Cynthia Steele of EMpower, whose foundation funds 150 local organizations in 15 emerging-market countries, sees this pattern across the field. Mental health receives on average just 2% of national health budgets, and Steele believes part of the reason is how funders rank it against other needs:

Steele has seen this play out concretely. Organizations that skip over mental health in pursuit of outcomes that funders find easier to measure often find those outcomes don't materialize. "A program might start by thinking, we're going to have links for young people to get into good jobs," she explains, "but if the young people first don't have the self-confidence to try for something, they won't have a sense of how to work in the workplace. Those results are not going to be achievable." The irony is that by refusing to fund mental health on its own terms, funders may be undermining the very outcomes they are asking for.

Hopefulness and recovery are outcomes worth funding.

A young person who is less depressed, more hopeful, and better able to cope with daily life has experienced a meaningful change. Funders don't require malaria programs to demonstrate improvements in school attendance before they'll invest in treatment. The same logic should apply to depression, anxiety, and hopelessness.

Rob Morris of Koko, whose digital interventions reach users in 199 countries, keeps his focus on a single measure: hopefulness. "If you have hope about your life and the future, you will have resilience," he says. His organization has demonstrated through randomized controlled trials that brief, single-session digital interventions can produce measurable improvements in mood and hopefulness in as little as 10 minutes. Morris doesn't treat those gains as a stepping stone to something else. They are the destination.