(MONEY Magazine) – On Oct. 6, some 100,000 Americans sat down in shopping malls, in hospitals and on college campuses to talk about sadness, anxiety and fatigue. Why all the gloom? The national introspection was part of the fourth annual National Depression Screening Day, one of the useful public education programs sponsored by this year's most cost-efficient health charity, the $78 million National Mental Health Association (NMHA). Over the past three years, the NMHA has kept fund-raising costs to less than 2% of income by relying on the government and the work of an estimated 50,000 volunteers to raise money.

Unlike some of the larger health groups on Money's list that provide clinical services and fund research, this Alex-andria, Va.-based charity is mainly an education and advocacy organization dedicated to spreading the word that mental illness is treatable and not shameful. To do that, the NMHA sends out free informational publications to anyone who calls its toll-free information number (noted below). It also lobbies Washington lawmakers effectively. Last year, for example, the charity worked with the White House's health reform task force to make sure that treatment of mental illness would be covered in President Clinton's health-care plan. It was. Of course, it also doesn't hurt that a big NMHA supporter is Tipper Gore, a group volunteer.

Rounding out this year's health-charity list are ALSAC-St. Jude Children's Research Hospital and Shriners Hospitals for Crippled Children, which spent an average of just 54% and 48% of income respectively on programs over the past three years. Officials at Memphis-based St. Jude say their percentage is fairly low because, since 1988, they've been putting aside part of their income to build a new $132 million hospital expansion. Tampa-based Shriners, a group of hospitals that provide free medical care to the needy, regularly spends about half of what it makes on patient services. The rest goes back into an endowment where, says Lewis Molnar, the hospitals' executive vice president, it will produce enough income to keep up with inflation and expenses. Daniel Borochoff, president of the American Institute of Philanthropy, points out that the Shriners' $4 billion endowment fund could cover the group's annual expenses for more than 13 years, the greatest asset-to-expense ratio of any of the 300 charities he analyzes.

HEALTH RANKING

Rank/charity/telephone number Okay with the top two watchdogs (HH); one (H); none (-) Income in millions; Program spending as a % of income Comments