The problems in the mental health space are clear from the statistics we see and the unfortunate passings of famous figures and our personal loved ones. As an investor at Pascal Capital and a team lead at Hack Mental Health, I often ask what the necessary drivers for the much-needed changes are. Thankfully, talking with entrepreneurs throughout this year allowed me to become more optimistic about the future and that a paradigm shift is coming. Here are some new shifts that I have been seeing and the novel solutions mental health startups are bringing to lead that change. #1) Mental health needs a standardized protocol provided for physical treatment. Mental health patients struggle with getting the personalized service they need as the psychiatrist only has a short monthly (or in most cases, every 2–3 months) hourly sessions to know and understand your condition. While this may work in the physiological model, where we have advanced diagnostics tools, standardized datasets, and ER for severe conditions, there are none of those support systems in the mental health system. is looking to change this by becoming the ER for severe conditions by capturing digital biomarkers that can monitor for changes in mood and cognition.  If the person is found to have symptoms of being at risk from their interaction with their phone, the app will alert the user and connect them to a mental health professional who can serve the immediate need and be there for the user at all times. Mindstrong This system is critical as there are currently not many apps that can help those with serious mental health illnesses and a lack of a standard for people to know when they need to really seek out for help. They will normally be referred to the hotline, which makes the user miss out on all the benefits a digital service can provide. Mindstrong changes that by reaching out to the user when it detects any negative symptoms so that they can intervene and ensure that the patient can readily get the treatment they need when they need it. #2) Mental health needs the scarcity of mental health professionals to match the economic value that comes from its asymmetric demand. Software engineers normally cost a fortune due to the scarcity of programmers who can add value to a company. Likewise, a lot of other services and goods (i.e. bitcoin/gold) follow the rule that when the demand outstrips the supply, the cost of such goods will be high. However, this model that applies to engineers currently does not apply to mental health professionals. Instead, mental health supporters are normally quite underpaid. For example, the average annual salary of mental health therapists in California is $63k, which is a bit more than half of what an entry-level engineer will get in Silicon Valley. Meanwhile, the psychiatrists cost users $500 for initial visits, making it highly unaffordable to many users. This gap is significant, as there are over . This means that psychiatrists only make up 4% of the mental health professional space, which explains why there’s a 3 month wait time for follow-ups and a high cost for meeting psychiatrists. 577,000 mental health professionals, while there are only 25,250 psychiatrists In order to solve this gap, is connecting therapists and psychiatrists to work together through its app. By having the care coordinator work on the daily care with the clients while the psychiatrist or the nurse practitioner only comes in to provide the necessary medication, the user is able to get the treatment they need while significantly reducing the cost of treatment. Cerebral This also means that the therapists who work with Cerebral can now access more consumers, as they can work with those who need medication and add value to more people, which in turn will lead to a higher economical value for the therapist. The health professionals who have the capacity to prescribe drugs can then focus on quick drug prescriptions so that they can treat more patients. Their traction so far clearly shows that the users have been waiting for a service like this, with tens of thousands of users currently subscribed and seeing the benefits of Cerebral today. More than 75% of Cerebral clients have achieved meaningful reductions in their symptoms in less than 2 months of care and with a brand new raise recently, their expansion to increase the value of therapists will only continue. #3) Mental health startups need governmental  support Governments spend millions for mental health support and research, but the startups normally work independently with private investors. While this model may work for other industries, mental health is different because it is a global pandemic that is slowed by the legacy laws that were made without mental health taken into account. Governmental support is crucial for this reason. If telemedicine regulations were not passed this year, telehealth companies may not have been able to expand their services and provide necessary treatments to those who need it during this difficult time with COVID. However, it’s once again a physical illness pandemic, not the care for mental health that is driving the government officials to work with the health professionals to change the laws. A company that has managed to successfully work with the government to quickly expand its outreach is , the leading anonymous telemental health platform in Thailand that provides counseling services via video calls with mental health professionals. The platform attracted over 72,000 users with over 100 psychiatrists from Thailand now on the platform, which already represents ~10% of the psychiatrists in Thailand. Ooca After starting in 2017, they were recognized by the government by receiving the Government procurement award, NIA in 2018, and in 2019, signed an MOU with the Ministry of Public Health and the Department of Mental health through the Wall of Sharing Project to provide free counseling service for university students around Thailand. Their works with the government continue today, where they are now offering free service to Thais living in Japan, Malaysia, Germany,  Hong Kong, Macau, and the United States through a partnership with Consular Affairs Department. It is thus no surprise that after successful partnerships with the government, the . Medical Council of Thailand has drafted a regulation to show official support for teleconsulting #4) We need hospitals to work with a new system of EMRs The machine learning algorithms can only be as meaningful as the data that we have to train the system. While there are better algorithms that are being developed to work with less data, for critical problems where the room for error can’t be large like diagnosing one’s brain health, the stakes for correct diagnosis gets much higher. This is why is working to help onboard more doctors to use the cloud. As the leading platform that collects consistent comorbidity and comprehensive multifactorial data on every patient that goes through their hospitals in psychiatry, having a consistent data collection process are critical for their success. Trayt As a thought leader in this space, they are taking the active steps of leading a coordinated effort to convince hospitals to make their EMRs compatible with their platform so that clinicians can get the outcome data to make better care decisions. By having Trayt be the standard of how EMRs should be integrated, it could accelerate the number of hospitals that could all connect together to offer the best treatment the patients deserve. #5) We need more healthcare professionals, as the current system will never supply enough supply to meet the overwhelming demand Leveraging apps in the mental health space have traditionally been an upward battle, as apps made in hospitals have shown a significantly low retention rate. Training professionals is a struggle as well, since training to be a licensed psychologist is a lengthy process that doesn’t have an immense financial incentive like that of a software engineer. is looking to reduce the demand for mental health professionals by providing digital cognitive behavioral therapy that leverages content that people can emotionally connect with. They overcame the hurdle that self-care wellness apps provide by bringing top storytellers, filmmakers, producers, and animators of other industries. In doing so, they have managed to reduce anxiety and help users with their sleep. Big Health They even announced a partnership with CVS Health last year to bring in more clients, which currently includes Target, Comcast, and Home Depot. With over 100 companies signed up and casting a net to over 5.5 million people, this fast-growing startup is showing positive signs that they can reduce the heavy demand for mental health professionals. is also looking to reduce the demand by increasing the supply of those who can provide mental health help. By ensuring secure end-to-end encryption on both sides, they protect the privacy of the volunteers who want to use their experience to be a listening ear to those who need help. It’s truly a safe space for those who need it at any time. Cara Unmasked By providing this Cara friends program on top of their therapist program, they are expanding the pool of options that people can utilize to get the help they need. It also helps reduce the financial burden for those who may not necessarily have the means to see a professional, but need someone to talk to. It could also help reduce the stigma, as the Cara friend could be someone near you or even you one day. #6) We need mental health talk to come early so that people grow up knowing about how their mental health is and get regular check-ups Regular health check-ups are mandatory when children grow up, as parents want to take early measures to prevent any serious illnesses from affecting their child as any problems early on could lead to a serious problem in the future. However, there are no efforts to diagnose their child’s mental state, as many assume that their child will be fine. Considering that we are all born with different brains that stem from not only how we are nurtured, but also from how we are born due to our different DNA structure, it is nonsensical that we expect the brains of humans to somehow be one standardized organ across all babies. The startup that recognized this asymmetry and is working towards bringing a change is , a Korean edtech startup that creates powerful content that even treats cognitive delay caused by mental health disorders. Their CEO was a former cognitive therapist who worked with North Korean children who had escaped and had developmental delays as a result of Adverse Childhood Experiences (ACEs). DoBrain Working with the academic experts in education, she created a new digital content using animated characters that build upon the curriculum that she created for North Korean children and a diagnostics tool to predict the child’s cognitive state. By bringing the data to their parents and the progress they are making through the interaction the child has with the app, they have impacted 300k children so far and are looking to change the narrative around children’s mental health. These startups are showing signs of encouragement that we may be able to overcome this mental health pandemic, but there’s still a long way to go. As this Nature article states, “ .” only a small fraction of the available mHealth apps had been tested and the body of evidence was of very low quality However, we are seeing an increasing number of quality papers coming out of these projects and the rigor of random controlled trials strengthening and making it to some of the top mental health journals. There are also a growing number of initiatives by these teams to provide help to those suffering from COVID, with Big Health, Ooca, and Intellect all offering a form of free service. We are yet to see what the new normal will be, but the advancements of these projects show that digital therapeutics are being disrupted globally and that the narrative around mental health is slowly changing. With technology opening up new solutions, I am excited to see what the new “normal” in mental health space will be and look forward to working together with founders to push this industry forward.

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