WHO defines mental health as “a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community”. This multi-dimensional and comprehensive definition in the backdrop of our complicated lives explains why individuals across all backgrounds and geographies are faced with mental health challenges. Even before the COVID-19 outbreak, the United States was already in a state of mental health crisis driven by the lack of access to affordable and reimbursable care.
60% of counties in the U.S. lacking a single psychiatrist and one third of ZIP codes in New York City designated by Oscar Health as “mental health deserts” with fewer than 3 providers. This situation will only worsen by the projected provider shortages of nearly 15,000 psychiatrists and 58,000 psychologists by 2025 in the US.
A patient’s ability to pay further influences their access to care with just 55% of psychiatrists accepting commercial insurance and dozens of mental health solutions locked behind paywalls, only available to patients fortunate enough to have a sponsoring employer or health plan.
The COVID-19 pandemic brought these issues to a breaking point as demand for mental healthcare surged during the crisis. According to the CDC, prevalence of depression increased 3x in 2020, anxiety rates went up 4x and the lockdowns have led to a doubling of the feeling of loneliness.
The current landscape
Over the past decade, hundreds of companies have worked on addressing the gaps in the mental healthcare ecosystem. We have seen companies successfully deploy technology innovations like telemedicine, artificial intelligence and also leverage conventional approaches within mental health therapy like meditation, CBT, and commonly used psychotropic medications. Rock Health estimated that startups targeting mental health raised $1.8 billion in 2020.
When we examine the subset of virtual-first mental health companies, we saw two cohorts begin to emerge.
Cohort 1) Meditation and Wellness
The first group includes startups like Calm and Headspace, which offer guided meditation and aim to help the widest range of consumers, often with the lowest acuity levels.
Defining characteristics of this segment include marketing directly to consumers. They also maximize their distribution through employer benefits, payer channels, and creative partnerships, such as Calm partnering with American Express and Headspace joining with Netflix and the American Medical Association. This approach has proven successful for these companies enhancing their reach, revenues and valuations.
Cohort 2) Therapist led models
The next group of virtual-first mental health startups are focused on bringing established provider-led techniques to a targeted audience of patients.
Companies such as Lyra, Ginger, Talkspace, and AbleTo offer a range of telemedicine visits with coaches and therapists, medication prescription management and also solving for more acute care needs. These are typically paid for by the employers as a part of the wellness programs owing to their high costs.
All of these companies have done well in their own right satisfying their user base and also gaining financial success in the process.
The “Missing Middle”
There emerges a clear opportunity to help users who need more individualized support than a one-size-fits-all guided meditation, but may not need (or be able to afford) provider-led services at their current costs.
As we were discovering and defining this segment, there was a trailblazing startup creating an incredible product to address this very gap. We found them, loved them and Wysa-versa!
Wysa, is an AI-enabled mental health platform that provides support to patients via evidence-based therapies like CBT, meditation, and motivational interviewing exercises.
Wysa uses technology to not just tweak, but instead transform the care continuum and offer high quality treatment to millions of patients at an affordable price with a 24-hour coverage. Named one of the best apps of 2020, Wysa has been a trusted resource to 3.5M+ patients in over 60+ countries, especially during the COVID-19 pandemic.
Wysa was a perfect fit for our investment thesis of supporting companies that leverage technology to transform healthcare delivery. Outlined below is an adapted version of our internal investment memo.
i) Addressing gaps in mental health landscape
In terms of competitive positioning, Wysa fills an underserved need, “the missing middle”, by providing support to patients with low/medium acuity conditions who need support beyond basic meditation apps. Wysa is not a replacement for therapy and doesn’t position itself as such.
Instead, Wysa can play a complementary role for patients in need of therapy via waitlist management, triage, and self-directed exercises as “homework” following therapy sessions.
ii) Differentiated product offering
Even within the chatbot segment, most offerings are limited by pre-selected responses rather than free text inputs. The ability to let users type their heart out and then map it to the right intent, process it and then respond to that text in a clinically validated workflow is the work of Wysa product and technology genius.
iii) Clinical validation
Mental health support needs added level of scrutiny for being clinically accurate and validated. Wysa uses proven, evidence based techniques and also uses on ground data points to offer practical solutions to its users. Wysa is actively engaged with the academics and researchers to continuously enhance its products and algorithms.
Wysa is designed to respond to self-harm, abuse, suicidal thoughts or trauma. If a user’s responses fall into those categories Wysa prompts the user to call a crisis line.
There are ongoing studies of Wysa’s ability to help people cope with mental health consequences from chronic pain, arthritis and diabetes at The Washington University in St. Louis and The University of New Brunswick.
iv) Strong product market fit and growing traction in B2B space
Wysa offers a D2C app on Android and iOS devices, incorporating a freemium model: free conversations with the AI chatbot and premium offerings for specific modules that address topics such as relationship stress, sleeping difficulties, and many others. Wysa’s D2C business grew to 2.5 million patients without any marketing spend, primarily through word of mouth among patients and providers alike.
Wysa also provides a B2B solution to serve as a “digital front door” for mental health resources offered by employers, health plans, and other enterprise customers. For B2B partners, Wysa offers a flexible solution that can easily integrate with existing mental health resources, as well as engage employees through tools such as Slack and email. This helps Wysa drive employee engagement as much as 5x higher than standard corporate offerings.
Wysa has only recently begun to formally build out its business development and partnership capabilities and has already become a trusted partner to leading companies. Wysa’s current B2B clients include Accenture, Aetna, Ascension, Ministry of Health (Singapore), National Health Service (UK), Travelers, and WakeMed.
v) Mission-driven, entrepreneurial team
This needs another article of its own! The co-founders Jo and Ramakant are a perfect package: great educational and professional pedigree, entrepreneurial zeal and an unwavering commitment to the cause. As personalities they complement each other like Yin and Yang.
From our first meeting with cofounders Jo and Ramakant, it was clear that they understood user needs at a fundamental level. Wysa began as an effort to treat mental health challenges faced by the founders, giving the team a special level of empathy for patients.
Jo and Ramakant have recruited an incredibly talented and diverse team to drive Wysa’s growth. Many of Wysa’s functional leaders have been at the company since inception and were founders of other startups prior to joining Wysa. The company’s clinical leaders (Emma Selby and Smriti Joshi) are internationally recognized, award-winning experts in their field and have enabled Wysa to maximize patient impact while ensuring the highest level of safety.
When the second wave of the pandemic hit India, the team offered its entire suite of digital offering for free to support the nation through the devastating mental health consequences of Covid-19. This brings us to our last and most important point.
vi) The right side of healthcare
Wysa prioritizes metrics such as improving treatment efficacy and patient satisfaction, rather than focusing on gamification to maximize daily active users (DAUs) or minutes spent on the app, which promotes mindfulness and prevents patients from becoming addicted to and dependent on Wysa.
What next in Mental Health
We see that all solution providers in the mental health space recognize that treating this enormous unmet need will require a combination of solutions, as well as collaboration among a variety of stakeholders. Creative partnerships such as those between Lyra and Calm, as well as Ginger and Accolade, will continue to grow as companies seek to expand their patient base. Optum’s acquisition of AbleTo and its venture funding of Groups, Holmusk, and Mindstrong highlight the importance of mental health treatment in reducing overall cost of care.
In conclusion, expanding access to mental health is not a zero-sum game and we’re unlikely to see a single, “winner take all” company emerge in the space. Existing channels like employer-based solutions and payers may be supplemented by marketing directly to innovative provider groups who share a financial incentive in improving patients’ health while reducing cost. Given the staggering amount of unmet need and fallout from COVID-19, we expect there to be plenty of opportunities for existing players as well as new entrants to deliver the care that patients need.