Maternal Mental Health NOW

Full recipient program annual planning budget of $1.17m, not the $1,513 standalone pre-operation return and not former sponsor total. Modeled continuation year with current successor delivery assumed; actual full recipient expenses unverified. External clinical labor, insurer spending and participant time excluded from donor cost.

LA MSA is Los Angeles plus Orange counties. Sana Sana eligibility is LA County, so peer g=1. Training is available beyond LA and online; training beneficiary share .8 central (.5–.95) is judgment, not trainee/HQ location evidence. No global or state-policy spillovers added.

Q_training_all=T*d*L*r*a*b*q; Q_peer_all=P*e*rP*aP*b*u*(w/52). Q_LA=k*(gT*Q_training_all+Q_peer_all)/(1.03^delay); Q_all=k*(Q_training_all+Q_peer_all)/(1.03^delay); price=10*C/Q_LA. Central T800,d.5,L30,r.1,a.5,b.5,q.002; P150,e.11,rP.25,aP.5,u.1,w12;k.9,gT.8,delay1,C1170000. Training .6 all-pop QALYs and peer .02379808 before overlap/delay; final .54506628 all-pop and .4402119119 LA.

C

1170000 USD/planning year (judgment). Continuation-year full program cost anchored to reported FY25 operating budget, not actual audited expense. [mmhn-impact25]

T

800 training participant records/FY25 (observed). Published 800+ floor; not patients or unique active clinicians. [mmhn-donate]

d

0.5 effective unique frontline trainee fraction (judgment). Allows repeat attendance and nonclinical roles. [mmhn-about]

L

30 unique lower-risk postpartum parents/trainee/year (judgment). Plausible limited annual caseload, not published MMHN caseload; tested 5–100.

r

0.1 clinical-effect transfer fraction (judgment). Brief heterogeneous courses may deliver much less change than intensive health-visitor package. [ponder-clinical]

a

0.5 training additionality (judgment). Other training and existing care reduce counterfactual effect. [lammha-current]

b

0.5 ordinary funding responsiveness (judgment). Funding may preserve uncovered capacity or displace grants; no verified marginal queue. [mmhn-impact25] [mmhn-whitepaper]

q

0.002 QALY/lower-risk postpartum parent over 6 months (observed). Published adjusted randomized economic estimate,95%CI−.001 to .004; not MMHN efficacy. [ponder]

P

150 warmline callers/FY25 (observed). Currentdonationpage; no added group participants or repeatcalls. [mmhn-donate]

e

0.11 absolute reduction in probable depression at 12 weeks (observed). External high-risk RCT rounded 25%−14%; not measured MMHN outcome. [peer-rct]

rP

0.25 peer-effect transfer fraction (judgment). Different baseline risk, intensity and population. [peer-rct] [mmhn-whitepaper]

aP

0.5 peer counterfactual additionality (judgment). Support or treatment may otherwise be available. [mmhn-sana]

u

0.1 utility gain per incremental case (judgment). Conservative illustrative mapping of probable-depression change; not a measured SF-6D result.

w

12 weeks of benefit (judgment). Subjective 12-week benefit-area assumption, not a measured duration inferred from endpoint prevalence. No significant 24-week group difference supports finite extrapolation but does not establish this benefit area. [peer-rct]

k

0.9 cross-route nonoverlap factor (judgment). No linked participant identifiers; prevents full addition of overlapping benefits.

gT

0.8 LA+Orange training beneficiary fraction (judgment). Missionlocal but trainings canextendbeyondregion; no measuredresidence distribution. [mmhn-about]

delay

1 years to mean benefit realization (judgment). Discount future annual delivery and follow-up at 3%; no added lifetime multiplier.

Training/peer health component; planned full cost: Cost: $1.2M; Los Angeles QALYs: 0.44021191187453323; all-population QALYs: 0.545066280806572. {"d":0.5,"L":30,"r":0.1,"a":0.5,"b":0.5,"g":0.8,"q":0.002,"rP":0.25,"aP":0.5,"k":0.9,"u":0.1,"w":12,"C":1170000} All non-reference clinical conversions are judgment; no statistical interpretation of combined bounds.

low stress scenario: Cost: $1.5M; Los Angeles QALYs: 0.0000816840926064227; all-population QALYs: 0.00009867438386855863. {"d":0.25,"L":5,"r":0.01,"a":0.1,"b":0.1,"g":0.5,"q":0.0005,"rP":0.1,"aP":0.1,"k":0.7,"u":0.05,"w":6,"C":1500000} All non-reference clinical conversions are judgment; no statistical interpretation of combined bounds.

high stress scenario: Cost: $1.0M; Los Angeles QALYs: 85.26811053024645; all-population QALYs: 89.74189693801344. {"d":0.9,"L":100,"r":0.5,"a":0.8,"b":0.8,"g":0.95,"q":0.004,"rP":0.75,"aP":0.8,"k":1,"u":0.15,"w":12,"C":1000000} All non-reference clinical conversions are judgment; no statistical interpretation of combined bounds.

zero stress scenario: Cost: $1.2M; Los Angeles QALYs: 0; all-population QALYs: 0. {"d":0.5,"L":30,"r":0.1,"a":0.5,"b":0,"g":0.8,"q":0.002,"rP":0.25,"aP":0.5,"k":0.9,"u":0.1,"w":12,"C":1170000} All non-reference clinical conversions are judgment; no statistical interpretation of combined bounds.

downside stress scenario: Cost: $1.2M; Los Angeles QALYs: -0.20970873786407765; all-population QALYs: -0.2621359223300971. {"d":0.5,"L":30,"r":0.1,"a":0.5,"b":0.5,"g":0.8,"q":-0.001,"rP":0,"aP":0.5,"k":0.9,"u":0.1,"w":12,"C":1170000} All non-reference clinical conversions are judgment; no statistical interpretation of combined bounds.

Counterfactual: Current grants, commissioned training, other educators, clinical providers and referral services persist without the next ordinary gift. a and aP remove substitution by alternative training/support; b discounts donation-to-expanded/preserved service responsiveness. The 2022–26 LAMMHA grants and enacted screening laws are baseline, not fresh gift outcomes.

Attribution: T is an output floor, d removes duplicate/non-frontline training records, L is a subjective annual unique lower-risk postpartum caseload per effective trainee, and r scales the intensive UK training reference to heterogeneous MMHN courses. Peer rP allows lower intensity and different risk profile than the high-risk RCT. k removes cross-route overlap. No additional LAMMHA, screening, group-attendance or awareness QALYs are layered onto these pathways.

Best-effort partial-health scenario, heavily judgment-driven; no empirically measured MMHN causal conversion. Positive scenarios are not confidence bounds. Reference training QALY CI includes zero; negative case retained. Full policy, anti-stigma, workforce and infant/family outcomes are unpriced, not known to be absent.

Sensitivity

• The positive low/high scenarios are stress tests, not calibrated probability quantiles; training caseload and clinical implementation dominate. Zero additional funding response yields zero benefit.
• The original training Table 5 QALY difference is .002 with 95% CI−.001 to .004. Cost-saving probability is not a 99% probability of improved health; NHS cost savings are not subtracted from this donor numerator.
• Training benefit ends at six-month follow-up for each modeled parent, with only one annual cohort. Peer benefit is .1 utility for 12 weeks per incremental probable-depression case; no persistence beyond 24 weeks assumed. The peer benefit area is a subjective scenario, not the trial's measured duration of improvement.
• At the central $1.17m budget, $1m/10 requires 11.7 LA QALYs; $100k/10 requires 117. Central modeled component=.44021. With other factors fixed, training caseload would need about 835 lower-risk parents per effective trainee to approach $1m/10; do not treat that threshold as observed capacity.
• Cost should be updated from reconciled current recipient accounts; $1,513 is not a cheaper valid scenario. Paid clinical follow-through is a necessary complementary resource and could materially raise societal costs.

Unresolved inputs

• Successor full-year actual accounts, sponsor assets/liabilities transferred, and whether $1.17m includes all sponsorship/transition overhead.
• Unique trainees by role, course completion, baseline competence, LA+Orange beneficiary residence and eligible annual caseload.
• Controlled or credible comparison of training-induced screening, treatment engagement and patient-reported health outcomes.
• Unique warmline and group participants, overlap, dose, baseline clinical risk, attrition and controlled outcomes.
• Marginal staffing/service plan, contractual grant commitments, billing actually collected, and donor substitution.