Rethinking mental health: wellness startups and apps on the upswing

A year of lockdowns, remote working and prolonged periods of physical distancing has driven consumers' demand for healthcare at their fingertips. Digital tools centered on mental health and wellness, in particular, have been rising in prominence. In Singapore, several such platforms have emerged over the last few months, with many closing significant funding rounds over the same period. Elsewhere in the world, US mental health startups saw record amounts of capital inflows last year, similarly driven by demand amid the Covid-19 pandemic.

In May last year, Singapore-headquartered data science and health technology firm Holmusk net US$21.5 million in a Series A round, led by Optum Ventures and Health Catalyst Capital, two venture capital funds focused on digital health based in the United States. Holmusk, which was started in 2015, raised almost US$10 million in seed funding in 2018.

Safe Space, an online platform that connects users to qualified mental health practitioners, bagged US$250,000 via an equity crowdfunding platform, while CARA Unmask, a mobile app offering peer support and professional help, raised about US$100,000 from a sole angel investor.

Figures from private market database PitchBook in October showed that venture capital funding of mental health startups in the US totalled US$1.37 billion through the third quarter last year, and had by then already outpaced the US$1.06 billion invested in the previous year.

Founders of these startups and their corporate users point The Business Times to several factors that have fuelled the upswing in behavioural and mental health investments thus far - a trend they believe has staying power beyond the pandemic.

For one, the long-drawn and isolating nature of Covid-19 and its resultant economic recession have exacerbated latent stressors, as well as created new ones.

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Lynette Seow, Safe Space's product manager, says her team has seen many new users air the stresses of working from home and financial uncertainty, but a larger pool of users are those already dealing with underlying issues but have struggled to overcome stigma and seek help.

"We believe there has always been a lot of latent demand that wasn't acted upon. Circumstances this year have prompted people to become more open to sharing their stories or looking for therapy," she notes.

Theodoric Chew, co-founder and chief executive officer of mental health app Intellect, highlights the surge in corporate interest in digital solutions. "Pitching to companies has been a far different experience today as compared to a year ago. Right now, when we talk to prospective clients, most have mental health on their agenda as Covid-19 has shone a huge glaring light on the subject," he says.

Both Intellect and Safe Space offer two products - a consumer app targeted at individuals and an enterprise platform that employers can offer as a staff benefit.

Intellect's enterprise platform supports users with a range of interventions, while the consumer app offers self-guided programmes developed by an in-house team of psychologists.

For Safe Space, which brands itself a "B2B2C digital mental health provider", the enterprise solution offers three tiers of services for corporates, at various price points.

Its "free tier" gives employees of partner organisations access to self-help resources, the "basic tier" allows corporates to top up digital wallets for staff to attend counselling sessions when the need arises. Corporates that pay for the "premium tier" will have specific programmes curated for their employees.

Another factor driving the uptake of digital mental health tools is their promise of accessibility and privacy - especially crucial in Asian communities where stigma often forms a barrier to mental healthcare.

"Mental health care has traditionally been very difficult to access, even here in Singapore for a couple of reasons, one of which there is a very strong stigma around seeking help," says Holmusk's chief of digital therapeutics Yau Teng Yan.

Dr Yau adds that Employee Assistance Programmes (EAPs), which offer help for personal or work-related problems that may have an impact on staff's job performance and emotional well-being, tend to be underutilised as many employees worry the content of their counselling sessions will be shared with supervisors, and can adversely affect their prospects.

Holmusk has an existing solution called mConnect that serves those clinically diagnosed with major depressive disorder, and will launch a new app in April called mHaven, targeted at the larger, non-clinical population.

Ang KY, who co-founded CARA Unmask, said digital solutions can help individuals to kickstart conversations about mental health but are not meant as substitutes for physical therapy or counselling. Such platforms add value especially where the alternative was to not seek any help, or in situations where a user is mentally or physically immobile, he adds.

Increased corporate demand

With the pandemic taking mental and emotional distress to new levels for employees trying to stay productive outside the office, corporate demand for mental health services - many of them virtual, due to the nature of this pandemic - has surged.

According to Safe Space's Ms Seow, the platform saw an increase in uptake leading to a revenue hike of over nine times in the fourth quarter compared to the first quarter last year, while Intellect reported 10,000 employees using its enterprise product, and one million users overall, as of early December.

The founders of remote patient monitoring platform Cogniant, which has been serving clinically-diagnosed patients in the market since 2016, say employers' notion of "wellness" has changed.

"When we started, the corporates were more interested in the health, fitness, and lifestyle kind of well-being, but less interested in mental health," shares Neeraj Kothari, Cogniant's co-founder and chief technology officer.

But the firm saw an increase in interest among corporates and insurers last year, Mr Kothari says, prompting them to look into designing a solution for the non-clinical population.

Former Nominated Member of Parliament Anthea Ong, who runs the WorkWell Leaders Workgroup which brings top executives together to discuss workplace wellness, says the pandemic has led to more conversations around and action from the top, toward better mental health.

"Working from home removes certain sources of social support and disrupts team culture, and that causes stress for some people. So, in a way, Covid-19 has made mental health pretty 'trendy'," she adds.

During a virtual breakfast dialogue in December last year, several members of the workgroup cited the de-stigmatisation of mental health as a priority for 2021.

Some, like the executives of elevator company Otis, also committed to revisiting its medical insurance package "so that it covers mental health the same way it covers physical health".

Other company leaders BT spoke to also reflected on 2020 as the year when their organisations took new, tangible steps to prioritise employees' well-being.

Google, for example, partnered with New York-based Talkspace to introduce text-based therapy, while its staff have also formed a peer support group. Still, there is a "certain level of stigma and hesitation" when discussing mental health here in Asia, says Anny Tampling, Google's human resources director for Asia-Pacific.

"While we have seen increased awareness around the topic this year, we need to continue creating a safe space for employees to have open conversations about mental health and build a deeper understanding about taking care of one's mental well-being," she notes.

Delivery platform foodpanda is exploring a pilot with Intellect to allow staff to access the latter's services via the foodpanda platform. However, delivery riders, who are freelancers, will not be included in this service.

Virtual platforms offer accessibility and privacy, allowing users to reach out to someone from their "safe space", says foodpanda's head of human resources Judit Hordai.

Driven by corporate demand, insurers are also starting to roll out coverage for mental health conditions. For instance, Mercer and Aviva joined forces in August last year to offer current corporate clients cover for outpatient psychiatric and psychologist services under a Mental Wellness Plan. Also last year, Chubb launched a Work from Home plan which covers, among other things, psychological counselling expenses for employees diagnosed with stress disorders due to work-from-home arrangements; while AXA partnered with digital therapeutics firm Naluri in a coaching programme that focuses on mental well-being.

Amitabh Deka, who heads Aon's wellbeing practice in South Asia, says the insurer is partnering with an "up-and-coming Singapore startup" to help corporates care for their employees' well-being. Its recent survey shows that about four in 10 companies in Asia-Pacific have "considered" introducing EAPs due to prevailing circumstances.

Blended model of mental healthcare

Practitioners suggest that the future of mental health will comprise a "blended" combination of online and in-person care.

Local psychology consultancy Mind What Matters, for example, is in talks with a mental health tech company that can offer virtual stress management tools and a voice-mood tracker to their clients.

Particularly in countries like Singapore where stigma remains prevalent, virtual platforms can help individuals kickstart conversations around mental health. But practitioners acknowledged areas in which digital tools fall short.

It could be harder for patients and doctors to forge a relationship via mediated platforms, says Holmusk's director of strategic partnerships Paul Feldhausen. He also flags the need to minimise disparities due to varied access to virtual equipment. "For example, will the care for one patient not be as good as that for another who has a high-resolution camera displaying vivid facial expressions? Does that reduce the ability of the practitioners to provide care in an equitable way?"

Dr Jessie Chua, a senior clinical psychologist at Resilienz Clinic, adds that initial assessments may not be as quick nor accurate, if done virtually. Virtual tools are also not ideal for managing mental health crises.

In line with this proposition of telepsych tool as supplementary - not substitutionary - to in-person mental health services, California-based venture fund Rock Health notes that funding has gone to companies with a range of product features, from fully automated chatbots to video chat platforms with additional tools that augment patient-clinician interactions.

Data is another crucial piece that can amplify the benefits of this influx of teletherapy tools. Almost all telepsych players BT spoke to highlighted plans to harness data to improve user experience, management decisions, and clinical outcomes.

CARA Unmask, for example, aims to serve as an "anonymous employee mental wellness dipstick" for their respective companies, says co-founder Mr Ang. "CARA has plans to share anonymised data with the companies. Some numbers can be very telling and with such data on hand, senior management can make better-informed business decisions for the betterment of staff's welfare."

Holmusk is looking to amass patient-generated information including wearable devices, as well as chats with counsellors, to develop digital biomarkers that can serve as indicators of users' mental health status.

"Unlike some chronic diseases which can be diagnosed through blood tests, there is currently no marker that can really tell me what my mental health status is, and we are looking to build and develop that data. That can help us deliver mental healthcare in a scalable and cost-effective manner," says Holmusk's co-founder Dr Yau.

More to be done

In addition to spurring a groundswell of start-ups, Covid-19 has also brought issues of mental health and wellness to the fore of local authorities. The Singapore government convened a task force late last year to review the psycho-social impact of the pandemic on the population.

A committee was also set up to look at mental healthcare for low-wage migrant workers, who experienced prolonged lockdowns and still face stringent movement restrictions.

Advocates hope to see the regulators' efforts on these fronts continue post-pandemic.

Cogniant's Mr Kothari and co-founder Mairin Reid call for a regulatory body to drive reforms and manage standards.

"I think there is a real opportunity for someone to take on a regulatory role to drive the change that needs to happen, and to ensure that discussions around the population's mental health happen proactively, rather than retrospectively," says Ms Reid. "Right now in Singapore, there are bits and pockets of grassroot organisations, but we lack a central coordinating body which drives the mental health agenda."

Agreeing, Ms Ong says: "While it's encouraging to see the groundswell of startups and new solutions focused on these issues, are we really solving the mental health challenge at a national level?"

Some challenges cannot be solved by the private sector, she notes, citing as an instance the affordability of mental health services.

Ms Ong herself founded Hush in 2014, which started as a tea bar run by the deaf, and also works with corporate organisations to promote diversity, inclusion and mental health. 

Within organisations, top executives can also do more to model healthy behaviours and train managers to support employees who might be facing mental health issues.

"Beyond saying you support mental health, model it so that team members feel they can prioritise self-care and set boundaries. (This can be done by) sharing that you're taking a walk in the middle of the day or having a therapy appointment," says Google's Ms Tampling. She adds that corporates can also offer employees' training, workshops and other resources to help them recognise triggers and intervene where necessary.

"While mental health awareness has been gaining traction in Singapore, many still struggle with speaking about such issues, or even identifying them to begin with," says Manu Tandon, Aviva's head of Group Life and Health Distribution. "Corporates must ensure that when employees reach out about the problems that they face, their managers are prepared to listen with empathy and without judgement."