When Glen Moriarty launched 7 Cups in late 2013, the psychologist-turned-entrepreneur was a ball of stress. He sought support on the very platform he was creating: a free online network of “listeners” trained to anonymously lend an ear to people experiencing emotional distress.
“I would say ‘I’m really struggling right now,’” said Moriarty, who battled with significant anxiety. “Of course, they didn’t know it was me.”
Moriarty’s 7 Cups is among a wave of apps and other digital interventions that are rapidly changing the way mental health care is delivered. They are extending therapy beyond traditional in-person sessions to offer around-the-clock support from remote psychiatrists or tech-driven tools that can reach patients wherever they are by messenger, phone or video. Major health care providers are beefing up mental health care offerings, often by partnering with the startups. Meanwhile, more employers are adding new benefits, making services available that can address their workers’ mental health needs.
The need for better access to care has never been greater. Amid scores of star-studded awareness campaigns featuring the likes of Olympian Michael Phelps and actress Glenn Close, young adults in particular are seeking mental help at unprecedented rates. A report by the Blue Cross Blue Shield Association documented a 47 percent spike in depression claims from millennials between 2013 to 2016.
Overall, 46 million Americans suffer from mental illness, and yet barriers to traditional therapy persist. Many psychiatrists are outside insurance coverage, pricey or simply not taking any new patients. The American Psychiatric Nurses Association expects that by 2025, the U.S. will experience a shortage of about 250,000 mental health care providers.
Along the way, the longtime social stigma that discouraged many people from seeking mental health care is easing, though it remains far from evaporated. Everyone involved agrees that’s a huge change in and of itself. “We’ve decreased stigma, which is awesome,” Moriarty said. “But now there’s not enough supply.”
Enter technology
At unparalleled levels, venture capitalists and companies are investing in platforms testing just how far into mental health care the connected world can extend. Artificial intelligence-powered chatbots, telemedicine, guided meditation apps, digital platforms specializing in Obsessive-Compulsive Disorder or PTSD, and more — are gaining traction within company benefits and mainstream providers. They are also beginning to show clinical success.
In 2018, U.S. digital mental health saw $378 million in VC funding, the most ever. Forty percent of that money went to Bay Area startups, according to Rock Health. This February, San Francisco-based mindfulness app Calm snared $88 million, elevating it to unicorn status, the first mental health-related startup with a $1 billion valuation.
Just as it has for e-learning platforms and dating apps, Moriarty saw huge potential for technology to move mental health services online. With $2.1 million in seed funding from a stint at Y Combinator, the Palo Alto-based company has swelled to 32 employees and 340,000 volunteers providing active listening via anonymous messaging across the globe.
The company has also cultivated a network of 200 paid therapists that users can be referred to if distress intensifies. The company now does licensing deals with universities, and increasingly partners with health plans and governments. Sacramento-based health system Sutter Health said it has a collaboration with the app; the city of San Francisco is kicking off a pilot program using 7 Cups for young adults and transgender people in early 2020.
“We’re in hyper growth,” said Moriarty. “There’s a lot of pain and loneliness out there, and so there’s a lot of demand (from organizations that) clearly see that and are reaching out.”
Even still, some startups in the shiny-new field are fizzling out or being acqui-hired as they struggle to turn a profit. Last July, San Francisco-based Lantern closed its doors after a few potential buyers of the mental health startup fell through, according to TechCrunch.
And while cheaper models are great for patients, some digital platforms are seeing high turnover for therapists who are constantly connected for less pay, noted Danielle Ramo, an adjunct professor of psychiatry at UCSF and director of research operations at Hope Lab. Many newer variations are turning to a mix of AI-powered tools and lesson modules to ease the emphasis on solely human therapists, she added.
Rise of mental health benefits
With major depression alone affecting more than 9 million commercially insured people in the U.S., large tech companies in particular have stepped up with support for the slew of mental health issues plaguing the industry. Tech workers experience high levels of burnout, anxiety disorders, depression and substance abuse, especially with stimulants while working excruciatingly long hours, said Ramo.
Burlingame-based Lyra Health sells its technology solely to large employers, including tech giants Uber, Lyft, eBay and Facebook. The smart scheduling tool builds off the experience of many people seeking out therapists, including Lyra’s head of partnerships Sean McBride. In his mid-20s while suffering from anxiety, he spent what felt like forever trying to find a therapist that would give him an appointment.
“It was a draining, frustrating experience,” McBride said.
Serving as the connective tissue between patients, providers and employers, Lyra streamlines everything from the paperwork to the matching process for its growing network of therapists and coaches to treat patients both in person and over video. In this fashion, Lyra preserves a personal relationship between patients and therapists that could be lost in an era of virtual care.
Bigger players join in
Many larger digital health companies, as well as health providers, are also expanding their behavioral health capabilities, partnering with smaller tech outfits and in some cases even acquiring them. One reason that virtual mental health is so appealing for growth is that it’s one of the few fields that doesn’t require a physical, noted Jeff Cutler, chief commercial officer at Ada Health.
In January, Mountain View-based Livongo bought one of the biggest digital behavioral health companies, myStrength. Omada Health, a San Francisco-based diabetes digital therapeutics company, also moved into the space, snapping up the core technology behind defunct startup Lantern.
Market leader Teladoc Health snagged Mountain View-based startup BetterHelp back in 2015, adding the virtual therapy service to its gargantuan telemedicine arsenal. In 2019’s first quarter alone, Teladoc did 1 million virtual care visits across 400 different specialties via call, messaging and video, according to CEO Jason Gorevic.
Over the past year, its behavioral health services in particular have taken off, split between BetterHelp’s network of 4,000 virtual therapists and mental health services integrated into the Teladoc platform. Boosted by Teladoc, BetterHelp, now 50 employees strong, has also grown exponentially in its own right. The platform’s $200-per-month subscription model offers unlimited virtual counseling to individuals, couples and teams all over the globe.
That’s about the cost of a single hourlong therapy session in expensive cities like San Francisco, noted Alon Matas, BetterHelp founder and president, adding cost to the long list of roadblocks to traditional care.
“If you’re sick, you’ll probably see a doctor,” Matas added. “But what happens in mental health is most people who need to see a professional counselor don’t.”
Kaiser Permanente is also working to open a virtual front door for mental health and simplify the process of seeking care. Last June, the Oakland-based health care giant kicked off its “Connect to Care” program in Northern California. The initiative allows Kaiser members to call a phone line manned by therapists if they have a mental health concern. To date, the program has logged almost 15,000 telephone and video appointments.
“That’s something we’ve really expanded for our patients — to meet them where they want,” said Sameer Awsare, associate executive director of The Permanente Medical Group. “The advantage that we have is that it’s integrated. All your health symptoms are available to us.”
Handling Higher Risk Scenarios
Many new mental health platforms have needed to bolster their handling of higher risk scenarios, such as suicidal thoughts communicated via text. Between 1999 and 2014, suicide rates in the U.S. rose by one-quarter. And after national crises, such as the Parkland shooting, many online platforms experience a flood of activity.
Before logging into the 7 Cups app, users must indicate that they’re not in crisis, homicidal, suicidal or abusing anyone. Certain keywords in messages direct people straight to a hotline rather than to the listener, according to Moriarty.
Mental health accounts for about 25 percent of activity for Berlin-based Ada Health, a virtual care chatbot freshly partnered with Sutter Health. The platform has significantly ramped up its artificial intelligence in detecting suicidal ideation — swiftly referring patients to hotlines, human interventions and immediate care.
“We’re trying to intervene more readily,” said Cutler of Ada Health. “People are very direct. They will type in, ‘I’m thinking of killing myself.’”
