Adding a model of mental health to the game

Today I stared work on adding a new simulation value (blue bubble) for mental health. The output from this is basically an impact on healthcare demand, because obviously people with serious mental health issues will put a greater burden on healthcare. I have no yet made a final decision about whether it should impact productivity too.

Some of the influences to this value include:
High crime rates
High poverty rates
Alcoholism & Drug addiction / consumption.
Very high, or very low levels of working hours.
Universal Basic Income (reduces stress, so boosts mental health).

I plan to add a new situation (social media addiction) which reduces mental health, and is triggered by high technology and gdp, and which can be mitigated by a policy that regulates social media.

I suspect this will be a situation that triggers in later terms, when the player is doing well, with high GDP, high technology and everyone has a smartphone. It will be one way to reflect the negative side effects of a technology boom, and should feed into higher healthcare costs, which will help with late game balance.

Any thoughts on this general area of the game are much appreciated!


Glad to hear mental health is going to be a simulation. Separating stats like this or the crime ones (Crime/Violent Crime/Corruption) does have several benefits like making it harder to eliminate problems with a handful of optimal policies without much consideration. I expect such from this addition so that players can have something to deal with after finishing picking up the low-hanging fruits.

While I’m not really sure whether the existing countries in the game will experience a drop in smartphone ownership, I see that some dynamic difficulty mechanics are needed. Maybe this can also make it possible to increase the chance of Fake News or Polarization under Social Media Addiction situation and add another difficulty whrn unaddressed. Polarization & Fake News shouldn’t be that punishing for 2nd/3rd term players.

Regarding regulation policies, you may be possible to refer to the controversies over the proposed revision of section 230 of the Communication Decency Act in U.S. While this doesn’t directly address the issue of addiction, requiring contents moderation can be a way of dealing with it.


DALYs while not perfect and masking less-known illnesses like maternity health at birth and so on, reflect the impact on work from disease burden, including mental health. Among other similarly imperfect indices.

  1. Disease burden - Wikipedia
  2. Disability-adjusted life year - Wikipedia (DALYs)
  3. Quality-adjusted life year - Wikipedia (QALYs)

Might as well model all of media as well, as depiction of violence also has an impact on mental health (fictional or non-fictional).

  1. fulltext.pdf - Google Drive

Could tie into mean world syndrome and the frequency paradox (FP mentioned in above study).

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OMG, hold the front page… this has just made me realise that there is a phenomena that we are not modelling…or its late and I forgot we already did it :smiley:

The technological impact on the cost of long term care!

To explain: Medical technology in rich countries is very good at keeping people alive. Thats good…and expensive, because it means we have people living years, if not decades, with severe disabilities that are very expensive to live with, because so many people require long term care.

To be more blunt:
If everyone in the country dies 5 minutes after retiring, this would be awesome news for keeping health care and social care costs down!

Currently the only modeling of this is a 5% boost to HealthcareDemand based on lifespan, but its a linear impact and minor. Short of introducing a new situation, I think there is a good argument that this effect should be much stronger, and steeper. If your country gets technology high enough to max out lifespan, this should be very, very expensive. (Also lifespan should have an impact on social care and healthcare and pension costs)


Oh, I thought that you had already modelled this in. Sure, it could use more balancing.

About the blunt part. Will social care really be down? Grandparents look after grandchildren more if they retire early, they may have their private pension plans, even their state pension plans mean that they will keep spending and consuming goods and services (making the economy grow, that’s why you can be seated at home and do nothing but exist and make the economy grow, i.e. technically nobody is a parasite or a burden, unless you go out of your way to do so). Elderly people have institutional knowledge, training the next generation, so retired medical professionals would drive training costs in healthcare down. Elders also do consulting and other such activities, they mostly pass their generational wealth down to their descendants, or even give it to them while they’re alive, hence boosting the economy, etc. So, no, if the elderly died 5 mins after retiring (especially in an aging country), it would tank the economy (especially the US, where ~$25,000 are spent on every senior citizen) and cause severe institutional decay (and if your answer is books, then no, books capture a moment or period in time, experience is eternal and dynamic).


By God Cliff! You’re an economist, man! You Should Know This! :smiley:

I think my next post should be on how it makes no economic sense to kill the poor or elderly or wish for their demise.


Oh I don’t wish ill on anyone! I’m old enough to have solidarity with the retired now :smiley:

But although the retired consume goods and services, they do not produce any goods or services that get counted as GDP (granted they can provide childcare etc, although less no now that families are more geographically mobile).
As far as economic growth is concerned, its production that counts, not consumption, which will always globally match production.
So if the state retirement cost drops because the elderly die young, that money is either spent elsewhere by the govt, or returned to the working-age citizens through lower taxes.

Also generational wealth will be passed down regardless of what age people are when they die, surely?


I find it hard to agree that the elderly who don’t work are economically beneficial just because they consume goods & services. While some historical cases show that some inefficient investment of production inputs can be improved by inflating consumption, economic growth has always been a matter of production. In economical perspective, there’s no difference between the government handing out pension & benefits to the retired to let them spend and it just buying products directly and burning them in the desert. Obviously anyone would see the latter is just a waste of resources (unless the country is in a massive recession). But we are not abandoning those retired because doing so will massively undermine social cohesion and bring about unrest. And economists wouldn’t just say it’s good because of faster growth, as the ultimate goal of economics is maximizing utility with limited resources, not just producing more like machines.

In summary - Is the country where people die 5 minutes after retiring more efficient in terms of growth? Quite likely. Does it provide happier life for its people? Presumably not even if it is possible to do so without ruining itself.

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Maybe also adding wages as an input?

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Now back to the game design. I agree that higher costs for healthcare, social care, and state pension make sense and will present more difficulties to 2nd/3rd term players. This is likely to force a choice between raising taxes and spending cut. While the Technology simulation itself and the Technological Advantage situation are strong enough to keep people to promote more technological innovations, I think there’s a chance that these state welfare packages become more burdening without providing apparent benefits over just cutting or scrapping them. I already see several just deciding not to spend anymore on state pension & social care. Starting with rather moderate changes might be better if they are not going to be more useful thanks to either reinforcement (through policy effects) or punishment (through bad simulations or situations).

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Huh, I guess I never thought of it like that. Thanks for clearing it up.

By the way Cliff, I know you don’t want that, of course, that’s why all the smiley faces!

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I don’t know enough about this to contradict it through an effective argument.

Except one, maybe. Burning goods creates less jobs, hence, less consumers in the economy. So it’s growth in terms of GDP, but not as much growth as could happen if you gave it to other people. Because the desert doesn’t want more burning goods, but people want more intact goods, plus, you have all those people who will be employed in this process who will go out and buy more goods, etc. So, what you described is deflation, i.e. burning goods. They’ve left the economy, never to come back. But the people who consume the good, will create waste, which is also a good, which can be recycled or turned into energy, goods or services. So, what you described will possibly lead to a bad equilibrium, depending on how long you keep burning that dank kush (the goods) that is a deflationary pressure, while what I described, demand for goods creating future demand for goods, encouraging future production, which as you stated is the most important thing in an economy, reasonable demand for goods as opposed to burning it is reasonable inflation because it encourages future production (or future potential for production). Hence, (reasonable) inflation good (good equilibrium), deflation bad, as it leads to bad equilibrium.

I’m not an expert, so maybe I didn’t make the best sense, or the most appropriate sense, but here you are.

So, as I mentioned in my macroeconomics of austerity post, deflation, unless your economy is compatible, which is rare and situational.

Catastrophism about climate change can also affect mental health (and polarize people).

Natural disasters also affect mental health. This isn’t to say that all Natural disasters are intensified by climate change, but there could be some indirect link between a warmer/colder world and mental health (although in the case of the game, we can’t bring about an ice-age with negative emissions, so for now, it would be about a warmer world).

So, climate change could have an indirect impact on mental health (natural disasters), or a direct one through catastrophism (perhaps this could be modelled as climate change as one of the factors increasing social media use, social media use increasing polarization, polarization impacting mental health).

Just a suggestion, it could function in a different way.

Could foster political extremism too? Through deep green (hard green/doomers/human extinction proponents, etc.) and/or ecofascist movements?

This also ties into the mean world syndrome, natural disasters seem worse in human terms, and in economic terms they could be (absolute adjusted for inflation, not relative to gdp), but better tech and predictive power has reduced deaths from natural disasters by 99.7% since the 1930s in the World, and that happened while the population quadrupled. Things seem worse, but they aren’t really, we’re safer now as a whole than we ever were at anytime in human history.

Not just that, but the number natural disasters have fallen as well by 10-20%, they have increased in intensity, but that is manageable as the data shows. Their impact relative to gdp has fallen as well.

I don’t see any difference between burnt products & consumed products. Producing goods that will be bought & burned is just the same with producing goods that will be bought & consumed. The same amount of workers will be employed, the same amount of money will be given to those who produced. If there’s a difference, it will be that people might start to think the government could stop burning goods at some point once they realize the consumption has been artificially induced by government spending (Rational Expectations). But this is an argument against government intervention.

Also, while deflation means a decrease in general price level, any policy that tries to create effective demand is a typical example of Expansionary Fiscal Policy, which tries to increase inflation. Go read some docs about the Great Depression & New Deal.

I think if it were so beneficial to burn goods instead of consumimg them, that behaviour would predominate, and we clearly don’t see that. Or create artifivial growth like this.

China props up cities to srtifivially boost growth, maybr, but prople have to put greater down payments in China for property and people like to own property in China as well, even if it’s not lived in, so that artificial growth still provides a buffer, but like you said, we sjould fovus on the gameplay now.

You’re not getting my points.

  • Creating consumption is as easy as burning goods.
  • Any other options that create demands are as burdening as it.
  • Economists want people to consume products even though it’s inefficient because the ultimate goal of economics is to maximize utility, not just growth.

+you should have heard about ‘burn products’ approach if you have ever read something about the Great Depression

If you would like to discuss, I suggest we start a separate post.


The whole awareness of natural disasters thing is interesting. I think there is strong evidence that development of communication technologies and always-connected lifestyles have led to a disproportionate awareness of suffering and disasters that previously we would never have even noticed.
When I was a kid, a flood or hurricane in china would maybe get a passing mention on the news, but these days we have thousands of HD-quality phones live-streaming disasters in even the poorest or most remote countries.

Given that we have evolved in small village-like societies, we probably are not able to adjust to this deluge or bad news, and are thus overwhelmed.

Of course… its one thing to say this, and another thing to model it accurately in the game with all the players understanding whats going on!

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Maybe it is an idea to have events related to mental health when mental health is low. Things like: “mentally ill man stabs 4 people in a mall” or something.

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Or constant school shootings if you are too liberal with guns

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Interesting ideas!

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