🔥 Burned Out
The startups hoping to replace doom-scrolling with digital mental health apps
Introduction
It goes without saying that taking care of your mental health is important. But like most things, it's easier said than done. In terms of prioritization, it's typically low on the totem pole because (a) it requires effort and (b) people simply don't want to talk about it. And therein lies the problem with cultural taboos: they exist because no one can bring themselves to talk about it but are difficult to overcome due to the lack of open discussion. It's a vicious circle, a snake eating its own tail. Thankfully, we've seen a more general acceptance and public discourse on the subject in recent years, though in some cultures it's still a bit tricky. Particularly in a professional setting.
Mental health is a nuanced and very serious issue that merits a much broader discussion than I can offer in one article. But it's also a relatively personal issue for me, as someone who has a family history of mental illness and is currently prescribed medication for depression. For some of you, this may be a familiar subject, for others less so. Regardless, this past year we have collectively (as a species) been introduced to some form of mental health issue: be it increased anxiety, isolation or depression. In a way, Covid-19 may well have been the biggest awareness campaign for modern mental health treatment.
The technology industry has worked its way into nearly every conceivable crevice throughout the global economy. Healthcare, in the broadest sense, is a sizable market that has only recently found itself directly in the crosshairs of "big tech" due to the challenging nature of the vertical. Mental health surely fits into this scope, and it appears there is significant opportunity to improve people's lives and wellbeing through technological innovation.
Today, we'll examine our relationship with mental health and try to understand the impact of a global pandemic on cultural norms surrounding the topic. Next, we'll take a look at where technology can be effective across the spectrum of care, which startups are looking to be first to market, as well as the strategies they employ to get help to those who need it. Lastly, we'll speak with the CEO of one of these ambitious (and noble) companies to get her take on the perceptions of mental health in France, the best approach to preventative care, and putting a psychologist in the pocket of every employee in the country.
So, as my therapist would say: let's expand on that...
A Crisis is a Terrible Thing to Waste
The Burnout Generation
Mapping Mental Health
Can Technology Overcome Taboo?
Spotlight: Teale
The Pursuit of Happiness
A Crisis is a Terrible Thing to Waste
You don't need me to tell you that the pandemic has been a challenging, terrifying and sometimes grief-stricken period for the vast majority of people. But if there is any silver lining on this dark cloud hovering above humanity, it's the fact that we've accelerated our thinking on a lot of critical issues. One of the issues that's been front and center of late is mental health in the workplace.
How do we adjust to working from home?
Can we be as or more productive?
How do I set boundaries between career and personal life?
Where is the true source of fulfilment in my life?
We've all had some sort of internal dialogue questioning our habits, decisions, relationships and career choices. Luckily, so have many researchers that have been exploring exactly these types of questions through a rigorous scientific lens. This exogenous event (the pandemic) has simply brought into full focus the nature of our existence and simultaneously given those studying the subject a global "laboratory" to explore the impact.
Coincidentally, a number of the companies we'll cover today have commissioned exactly these types of surveys to collect quantitative data during these extraordinary times and their second order effects on mental health. Never before has the intersection of mental health and work been explored at this scale. As a result, this may just be the best opportunity to introduce previously underserved and undervalued markets to mental health and wellbeing platforms for the modern workplace.
This is a pretty encouraging number (above). Of course, there's a slight disparity in what CEOs are saying and what employees are feeling, but it's a testament to the fact that mental health is a high priority for CEOs. That's valuable real estate in the minds of some of business’ most influential leaders. Combined with the fact that workers are expecting change and support from their employers (read: to retain talent CEOs will need to follow through), this could be the opportune moment to destigmatize mental health and foster some unity on the issue. After all, a crisis is a terrible thing to waste.
The Burnout Generation
It's hard to miss the media commentary on burnout. It's prevalent across many professions: banking, consulting, tech, medicine. I read an article in the Atlantic from 2014 that I think captures it best:
Burnout is the sum of hundreds and thousands of tiny betrayals of purpose, each one so minute that it hardly attracts notice.
Oftentimes, it's a combination of factors that lead to burnout. The symptoms tend to sneak up on you. Disappointments at work lead to compromises in personal relationships which leads to frustration and self-esteem issues which leads to… you get the point. But the bigger question is: why does this happen and how can we mitigate or flat out prevent it?
The ongoing public dialogue around burnout would seem to imply that it's a relatively new phenomenon. My immediate instinct is to blame "screentime" (which, by the way, almost certainly factors into the equation here). I recall periods in my early career where I woke up to my iPhone alarm, listened to a podcast during my commute to the office, arrived at my desk to spend the next 8+ hours staring at yet another screen only to return home to order food and boot up Netflix to wind down before bed. On top of all that, we've got to reckon with the always-on, performative nature of social media constantly reinforcing our personal doubts or driving us to work more, achieve more, be more to avoid getting left behind. These are all legitimate problems and give a glimpse into the modern machinations leading to burnout. I was surprised to discover, however, that the term burnout was coined nearly 50 years ago.
Herbert Freudenberger, a psychologist in New York City, has been credited with coming up with the term and introducing it to the research community in 1974. His initial observations and research focused on individuals in "caregiving" roles: teachers, nurses, doctors, social workers. Generous and oftentimes optimistic professionals committed to a cause were developing symptoms of depression, expressing cynicism and ultimately losing their ambition.
Longer term research identified that people were suffering from similar symptoms independent of their role. Twenty years later, Christina Maslach, a professor at UC Berkeley, ended up conducting seminal research in the area of occupational burnout. Her legacy is the Maslach Burnout Inventory, her namesake framework for evaluating the syndrome. The model outlines 6 key components to the workplace environment that contribute to burnout: workload, control, reward, community, fairness, and values.
If burnout isn't a new phenomenon, can this generation really be the burnout generation? My guess is that each generation suffers a burnout period, typically during their most productive years in the workplace (18-44).
A study conducted by the CDC outlines the prevalence of adverse mental health outcomes resulting from the pandemic. The columns represent varying degrees of symptom severity and the rows break down gender and age cohorts. While there was little to no correlation between genders, the age cohorts were particularly revealing. There was practically a linear relationship between age and impact: the younger you were, the more you were likely to suffer from some sort of negative mental health outcome.
There are a number of ways you could interpret the data, but applying Occam's Razor (simplest answer is likely the correct answer): younger cohorts, in the prime of their life (and career), are anxious about the future, financial security and therefore have "more to lose" as a result of lockdowns and restrictions. The inputs that lead to burnout have almost surely evolved over time, but it seems clear that no matter the era, younger cohorts are most affected. In that sense, all generations at some point or another are the "Burnout Generation."
Mapping Mental Health
If you were to go about solving the mental health crisis with a technology product, where would you start? I've been reflecting on that very question over the past week and come to several conclusions.
It depends on the region and culture I'm solving for
It depends on which segment of the "spectrum of care" I plan to treat
It depends on who consumers rely most on for healthcare (employer or government)
Running through these questions will help articulate the most viable point of distribution (B2C or B2B) and product design strategy.
In my very first article, Insuring the Future, I broke down the French healthcare system. While healthcare is fairly comprehensive and universally available, most employees pay into a supplementary insurance plan for wider coverage (most plans don't cover psychologists). In the US, health insurance is explicitly tied to employment in most cases, but mental health coverage can still be spotty if it exists at all. As I mentioned, attitudes towards mental health tend to be more progressive in the US which would imply that people are more open to seeking it out individually (and if it happens to be affordable outside of your insurance plan, all the better). In France, the subject has started to enter the cultural lexicon, but historically there are expectations on government to supply healthcare.
Lastly, the ability to service across the spectrum of care plays an important role in how you structure the business. For example, the shift from guided resources and talk therapy to prescription medication introduces an entirely new dynamic to the model.
🇺🇸 US: Predominantly B2C with access to the full spectrum of care ranging from content and mental health exercises to talk therapy and online prescription medication. B2B models have proven to be quite successful as well.
🇫🇷 France: Majority B2B(2C), accessing end consumers via employers who often provide supplementary healthcare products. A focus on preventative care, personalized tracking tools, with telemedicine as a last resort.
In the chart above, you've got a meditation app, coaching tools, telemedicine, and direct-to-consumer prescription medication startups. In France, it seems that the first foray into mental health-tech will be through the workplace. Ultimately, there is coverage in both countries across the map, but it's interesting to see how cultural differences, healthcare systems, and the spectrum of care can dictate where startups decide to invest resources in the mental health and wellness space.
Can Technology Overcome Taboo?
Taboo is typically reserved for sex, religion and politics at the office. Mental health, however, may be an unspoken item on this list. I remember leaving early one day and catching glances from colleagues whose jaws nearly hit the floor when I shrugged and said "what? I've got therapy today…" This was in France. In the US, it's a somewhat different story. Our history with mental health is complicated but it seems we've reached a point where going to your therapist or taking strides towards personal wellness are perceived as a badge of honor. In place of a judgemental scowl is a tacit applause, implying you're in control, you are adulting. There's probably a middle ground between sanctimony and silence, but that's neither here nor there. The truth is, despite broad public acceptance of mental health issues (and willingness to support others who share their stories), there is still trepidation to speak openly.
As depicted above, more than half of CEOs say that talking about their own mental health makes them a better leader. Yet they still hold back from sharing due to the perceived risk to their credibility. Not sure I could fabricate a data set more clearly stating that mental health at the workplace is still stigmatized, no matter how much progress has been made.
What can we glean from this chart? For one, the general consensus is that talking openly (or at least being open-minded) about mental health is a net-positive. Despite overwhelming support for others to share their story, most people would prefer (justly so) some privacy as it pertains to their own struggles. To get both buy-in from employers to sponsor a tool that would help alleviate or prevent mental health issues and get employees to use it would require a thoughtful mélange of features:
Privacy & Anonymity
Easily accessible, ideally mobile-first without the need to request content from HR
Engaging, dynamic and well designed
Frictionless transition from passive content to medical outreach/intervention
I had a chance to speak with the CEO of one of the companies listed above who shared her vision for creating exactly that.
Spotlight: Teale
“In France, unlike the United States, the mental health sector has long been shunned by investment and innovation. The need had long been identified by HR but it was still taboo. The health crisis has at least had the benefit of lifting the veil on this subject.”
— Julia Néel Biz, Co-founder & CEO, Teale
In the first few minutes of the meeting, it was clear that the Teale team genuinely wants to solve the problem of mental health at the workplace in France. Julia, Co-Founder and CEO, divulged that she'd lost someone in 2018 that prompted her to look more closely at the issue. And what she found was startling. There are tons of resources available, psychological research being conducted, and public statistics that point clearly to a nation-wide problem (45% of people in France struggle with anxiety and stress), yet due to the stigma of mental health, there was a lack of innovation. To unwind this paradox, she had to leverage her background in strategic consulting and technology. I can imagine her working the problem out on a whiteboard:
Efficiency Problem = Tons of resources that are decentralized and difficult to find
User Experience Problem = A psych hotline that few people call (or even know about)
Financial Problem (i.e. value proposition) = Estimated cost of €2K per year per employee as a result of burnout/mental health
Privacy & Security Problem = Sensitive subject that requires trust
What followed was over a year of R&D that went into designing an app that met all of the above criteria. The Mental Health Index, one of their key differentiators, allows users to track their mental health score over time and helps to recommend personalized content based on your needs. With an emphasis on "human-centric" design, the team has built a repository of content aimed at building skills for coping with stress and anxiety and should you need to speak with a therapist 1:1, you can coordinate a session via the app for an in-person or telehealth consultation. Currently, their focus is on small to medium businesses and tech scale-ups who have an engaged workforce but a high propensity for burnout.
Having raised €2M in funding, the team has high hopes for transforming public perception of mental health in France. Already, they've inked partnerships in the insurance space to help "package" their offering through existing B2B channels and they are investing heavily in privacy and security, much beyond the standards typically associated with such an early stage startup, simply because it's foundational to building trust with their clients. In our call, Julia made reference to both Ginger and Modern Health, US-based mental health companies that have raised $220M and $167M, respectively. Drawing inspiration from these startups tells me two things: there's a big market and Teale intends to capture their share of it!
Following our discussion, I immediately took to Twitter. I think the tweet speaks for itself.
Fun fact: Teale = Team + Heal
The Pursuit of Happiness
Even if you aren't personally affected by mental health issues, it's likely you know someone who is. As we move beyond the eye of the storm (of this pandemic, that is), it's important we recalibrate for happiness, fulfilment, and relationships. Burnout has been a persistent issue in the modern workforce and a year plus of lockdowns only exacerbated the problems underlying today's habits. As an individual, take stock of what you can do to optimize for wellbeing. As an employer, try to listen to your workforce and figure out how to promote employee health without compromising productivity. A good start might be to check out some of the apps I covered above. Your teams might not be vocalizing their need for resources, but they sure as hell are Googling it!
P.S. If you thought today's subject was too heavy to contain memes, you thought wrong 🙃
Bonus: a conversation with Boris Pourreau, CEO of mindDay
There was an overwhelming amount of positive feedback on this article. Considering the importance of the subject matter and the apparent interest in the topic, I've been exploring ways to enhance this piece with supplementary material. Shortly after I published Burned Out, I had a chance to catch up with Mindday CEO, Boris Pourreau. Mindday was featured prominently on the cover image, but didn't get a ton of coverage in the piece itself, simply because I wasn't able to connect with the team before publishing. So, today I'm adding an addendum to share another valuable perspective at the intersection of French tech and mental health.
What I found compelling about Boris and his vision for mental healthcare was his commitment to solving the problem. As he describes it, his approach to mental health in his 20s was through sport. He spent his early career developing Sport Heroes: originally a B2C virtual sports community that evolved into a B2B corporate wellness product. They eventually sold to the Decathlon family (France's pre-eminent sporting brand). During his time building this company, he interacted with lots of coaches — both for physical and mental health — and recognized the value in coaching as a psychological tool and preventative care methodology. So when he went to launch his next project, he knew exactly where to start.
We outlined the cultural taboos in France around mental health in the article but Boris doubled down on the thesis: the pandemic has accelerated awareness around mental health and companies don't have the tools or knowledge to bridge the gap. I asked how Mindday planned to differentiate from other offerings. Boris shared a couple of insightful user stats that underpin his vision:
On average, 60% of employees are using the app
70% are using coaching not psychotherapy
90% have never seen a coach or psychologist before
Here's how I interpret the data. First, there's incredibly high adoption within organizations that deploy the app. Second, the majority of users opt for coaching over psychotherapy which could imply lower severity issues are more common or that employees feel more comfortable speaking with a coach than a professional therapist. Third, there is a huge education gap. Based on this information, Mindday emphasizes preventative care and education for their users. They've rolled out a subscription model popular among small to medium businesses and hope to continue moving upmarket as they expand their offerings. Having raised money from Mutuelles Impact, a group of insurance companies investing in the future of healthcare, Mindday is well positioned to better integrate mental health into France's universal coverage.
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