#39: Transforming Traditional Mental Health Services

Hi friends,

Most mental healthcare is not delivered by startups.

It’s delivered by “traditional” organisations, many of which have been around for a long time. Organisations like community mental health centres, private clinics, hospitals, health centers, non-profit organisations, and even correctional facilities.

Startups can offer alternatives to these organisations, sure. That’s important.

But these organisations aren’t going anywhere and they play a hugely important role in delivering care to society.

If we want to improve how we deliver mental healthcare to everyone in society, we also have to think about how we empower these traditional organisations.

That’s exactly what Isar Mazer is doing with Tacklit.

Tacklit provides an end-to-end operating system used by organisations to deliver mental and behavioural healthcare. I wrote a deep-dive on the business last year if you want to check it out.

Today, Tacklit works with about 100 of these large, traditional organisations around the world and supports over two hundred thousand people with their mental healthcare.

Isar is the Co-Founder and Chair of Tacklit and he has a lot of experience both leading technology businesses and as an investor in the space.

I wanted to catch up with him to see what we can learn about how these organisations are approaching digital transformation, what opportunities exist and what lessons Isar has learned from building Tacklit.

We discuss;

• The problems faced by traditional MH organisations

• How he sees technology solving these challenges

• The barriers preventing adoption - and how to overcome them

• Isar’s thoughts on facilitating point solutions in mental health care

• Isar’s lessons on business model design and Go To Market

Let’s get into it.

THR Pro

If you want to join a community of mental health founders, executives and investors, consider becoming a THR Pro member.

As a THR Pro member, you’ll get access to additional insights and data each month, including my most recent deep-dives on whether AI will lead to the unbundling of therapy and The Eight Major Trends Shaping the Mental Health Tech Industry in 2024. We also run monthly events to bring the community together and discuss the most interesting topics in this space.

Steve: Isar, so great to chat. Before we dive in, how do you describe what Tacklit does?

Isar: Hey Steve.

So, Tacklit is an end-to-end operating system for the delivery of mental and behavioural healthcare. Existing systems and services just aren’t able to cope with the current avalanche of mental illness. We need new models of care and they will need to be underpinned by new, flexible technology. Our mission is to build and deploy that technology, amplifying the impact of the organisations and people who provide care.

We work with mid to large organisations, with 30-1000 front-line staff and the majority are traditional, large, mental health service providers that have been around for some time.

Steve: Got it. What are some of the challenges these traditional mental health organisations face today?

Isar: The main issue they face is how to meet the huge demand for their services with constrained resources.

Traditional, large service providers are funded by government, philanthropy, and commercial payors such as insurers. Regardless of funding source, there is significant pressure to deliver high volumes, at a high standard, with little money. And even when there is money, organisations cannot hire enough qualified people, because they simply do not exist in sufficient numbers.  

So there are major issues with waitlists, and people going without support. Often, organisations know they must create new service delivery models where more people can be effectively supported, but are prevented from doing so due to systems and other constraints. 

Another big issue is poor consumer experience. Service navigation and overall experience are typically below that of many other industries, existing systems don’t cater for consumers, with many people with lived experience reporting being lost in the process or giving up because friction is too great.  

Lack of clinician efficiency is also an important area. Too many manual steps could be automated meaning valuable staff is wasting time which would be better used in front of the people receiving care. AI tools are already helping here but without a robust data and workflow fabric to hang tools onto, improvement will remain below potential. 

Finally, there is the risk of falling short of funder expectations. Funders such as government and philanthropists recognise the need to evolve and are increasingly accounting for outcomes in their funding decisions. We see increased emphasis on outcome data collection and reporting, and some funding pools are specifically earmarked for digital interventions. I can see the same coming for AI-based interventions. Providers who cannot respond will miss out on funds for their services.

Steve: A lot of the people reading this work in tech-focused mental health businesses. They may not have much insight into this world of traditional MH provider organisations. What do you think would surprise them most about these organisations?

Isar: These organisations are often not-for-profit or government organisations. This means they can be more focused on access and quality of care than commercial considerations, if compared to private enterprises. I think there can be this perception coming from the private sector, and in particular from the start-up sector, that these organisations - and the people within it - are slow, not dynamic, uncommitted, or even lazy. This could not be further from the truth! I am always amazed at the people I meet working with our customers: bright, hard-working, and committed to helping others over and above money or benefits for themselves. They are very inspiring. They do a stellar job, considering the huge demand they must deal with, and the limited resources. 

Steve: How do you see technology solving some of these challenges?

Isar: There are many ways the right technology can transform mental health services. We recently published an article on this, so people can read that if they want all the details, but I’ll give a summary here. With the right tech, we can;

• Capture the right data, bring it all together and create insights so you can improve your service.

• Efficiently create, deploy, test and optimise clinical pathways and supporting workflows.

• Create delightful consumer experiences.

• Expand delivery modes and match interventions to need, so that people who are in need of urgent, face-to-face care can actually get it because those who can be supported in a group or online setting are not being overrated.

• Enable new workforce models involving lived experience, and peer workforce, in a productive and coordinated manner with the clinical team.

There is no shortcut or silver bullet, but the benefits of digitally enabling these organisations can be huge. 

Steve: So there’s a bunch of great reasons for these organisations to adopt new technology, but a lot of them still run on legacy systems (if they use any system at all). Why? What are the barriers stopping these organisations from adopting these kinds of solutions?

Isar: In our experience, senior leaders in mental health organisations are fully aware of the inadequacy of their current systems, and of the promise that new technology holds for their staff and people under their care. However, many are loath to embark on the technological effort required to capture it. And for good reason.

Firstly, their existing technology environment is highly complex and fragmented. It is made up of many disparate systems. Some have been built internally, or custom-built by third parties, and have become increasingly difficult to maintain. Externally provided systems might have been customised, and are no longer supported by the original vendors. The landscape has evolved organically over many years, it is hard to understand, and almost impossible to change.

Secondly, there is often no support within their organisation for change. Staff usually dislike existing systems, but are deeply sceptical of any efforts to change. They have seen multiple vendors promise the world, only to fall short in delivery. They have observed their colleagues’ careers, and perhaps their own, be negatively impacted by their involvement in yet another failed technology project.

Finally, the organisation simply cannot afford the cost and risk of a large technology initiative. Caseloads are high, budgets are tight, and the idea of a long, expensive, risky technology project is just not realistic in this environment.

Steve: Gocha. How do you get past these then, when you’re working with them?

Isar: First, it’s important to recognise that there is no cookie-cutter approach. Each organisation is in a different situation, and context matters. There are however a few principles that have served us and our customers well. 

1. We work with each of our customers in a true spirit of partnership. We make sure they realise we really care about their organisation, the service they provide, and the people they support. We explain our founding story so they realise we get lived experience and truly care. This level of trust is essential if they are to embark on a risky technology project with us. 

2. We make sure everyone is clear that technology is always at the service of clinical goals, and not the other way around. We explain we are technologists, and are there to amplify the care they provide, to enable their care vision. They remain firmly in charge of intervention design, evidence collection and substantiation, risk management and other clinical parameters. We make sure they have flexible, modern technology. All of us together, the magic happens. 

3. We ensure we have a broad and robust service offering. Sure we provide cloud software, but with it, we can offer just about any technology-related service: data migration, experience design, and sometimes we even get involved in process reengineering and change management. We are there to make sure things ‘just work’. 

Having said no situation is the same, we actually have observed a pattern and developed an approach that we have seen achieve repeated success. We’ve co-written a case study about this with one of our customers if people want to learn more about how it works in practice. 

Steve: Most pure-play tech businesses will shudder at the idea of providing services, but I can see how important it is to drive adoption in this market.

On another note, there’s so much conversation about how technology can transform mental healthcare - for most people reading this, it’s why they go to work every morning. But some people remain sceptical. Do you have any tangible examples of where technology has improved a client’s treatment and outcomes?

Isar: We actually have so many examples from our customers. A main benefit we see is that services have been able to significantly reduce the time needed for admin tasks, allowing them to dedicate more time to delivering care. We have cases of organisations that would take 6-12 months to design, test and implement new clinical pathways, who are now deploying in weeks. We’ve got many other examples, but I will share one case I really like.

The Raise Foundation is a not-for-profit organisation based in Sydney, Australia. As is often the case in the sector, it has a touching and tragic founding story, in this case involving youth suicide. They launched a program where adults can volunteer to mentor vulnerable teenagers. Schools identify youth at risk, and Raise recruits, train, and manage the mentors. As you might imagine, pairing an adult with a vulnerable youth has a high inherent risk. Traditionally, the risk was managed by only allowing the mentor and mentee to meet on the school grounds, at specific dates and times, under the direct supervision of a co-located Raise staff member. The supervisor literally walked the playground monitoring the pairs, and a mentor would raise their hand if they needed help, for example when suicide ideation or other risks were flagged. This need for co-location was a significant constraint on the size of the program. Many people wanted to mentor, but could not commit to being every week at a particular location and time, for 16 weeks. Still, after many years of hard work, they reached an admirable scale of 2,500 teenagers mentored per year.

They have come to us with the vision of delivering the program online, but are very concerned with risk management. If video calls between mentoring pairs were going to happen at all times, how could they be supervised? We worked together to develop a comprehensive solution, which includes the ability for a mentor to communicate risk flags in real-time, including inviting a supervisor into a video call if needed. We trained an AI agent to listen to all conversations, and immediately report all risk signs, for example, the exchange of cell phone numbers. With the confidence that their care goals and risk parameters were appropriately supported by the technology, the Raise Foundation has launched its digital mentoring program, which aims to mentor 15,000 youth per year, a 6-fold increase in people supported!

I don’t know about you Steve, but this really rocks my boat. Amazing people and organisation, delivering a fantastic service, and with the right technology and partnership they can grow it 6x. Many lives will be saved.   

Steve: I love that story. Lots of solutions claim to reduce admin time and if you can actually deliver on that claim, it’s definitely impactful. But I think those examples of how you’re helping organisations actually improve their care, by allowing them to easily roll out new treatment pathways and unlock new modalities, is super cool.

Let’s change gears for a moment…

There are so many people building interesting solutions in mental health, from tools to support diagnosis, to improving patient monitoring to the personalisation of treatments. I think a lot about how the tech stack for organisations may develop to facilitate the adoption of these tools and I want your thoughts on it.

Do you think a platform will be needed to facilitate the interoperability of all these solutions? And will Tacklit be that platform???

Isar: In short, yes and yes. For specific point solutions to achieve their full impact within a care environment, they will need to be fully integrated within the clinical pathway, both at the workflow level and at the data level. Service providers will need the right ‘fabric’ onto which to hang specific interventions, efficiency tools, etc. From a front-line worker perspective, it must fit seamlessly into their dashboards and process steps, with data moving from place to place so what we get is a seamless solution rather than a fragmented experience.

From a client or consumer perspective, similarly, it all needs to come together as a great experience. We see Tacklit as the platform that delivers this end-to-end canvas to service providers. We obviously have many tools and features of our own, but equally have an open architecture and are excited for best-of-breed applications to join our ecosystem and then serve our customers and their clients in a seamless fashion.  

Steve: Are there any applications/technology you’ve seen that gets you and provider organizations excited?

Isar: Of course, AI is the main topic being discussed at the moment. There is appreciation for the high potential to improve access to care, but at the same time a high level of concern with associated risks. Organisations want to explore but are very cautious. When we work with our customers on AI adoption, it often makes sense to start in less risky areas such as efficiency tools (scribe tools, report writing etc) before moving to care interventions. For AI to be embraced, vendors must demonstrate they have thought through the ethical and safety considerations. 

Steve: Before we finish up, I want to hear about some of the lessons you’ve learned from building Tacklit. Let’s start with your business model.

What have you learned about choosing the right business model to succeed in this market? 

Isar: In my opinion, in mental health as well as in other segments such as education, B2B business models tend to be more attractive than B2C. As much as people care about their own well-being, they are not always willing or able to invest in this, at least not for prolonged periods of time. This can lead to high churn, and make the unit economics of a consumer-based business model struggle. If, by contrast, you are able to truly meet a critical need of organisations, whether they are in mental health service delivery, payors, or population custodians such as workplaces and schools, you are more likely to build a good business.

Steve: And what about Go To Market? What has worked/hasn’t worked? Any lessons you can share with other founders?

Isar: In the beginning, our main GTM motion was outbound. We worked to identify organisations that could benefit from our platform and looked for ways to get in front of them. As we built out a track record with credible industry players, we were able to expand our inbound motion by sharing case studies and other valuable learnings in the right industry channels. Today most of our new customers come from inbound as well as customer referrals.  

Regardless of channel, in our space you can’t move faster than your prospective customers. They are supporting the mental health of thousands or tens of thousands of people. They are not going to implement your MVP. There simply is no room to move fast and break things. You have to demonstrate that you care deeply about the same things they care about: health outcomes, risk management, and safety. You have to be prepared to invest the time in understanding their issues and co-designing solutions. Above all, you have to respect the pace of their decision-making, even if you and your VC wish it was faster! Mental health organisations are inundated with tech startups promising the world. They are sceptical, and for good reason. But once you win them over, and demonstrate you can really solve their tech-related issues, you are rewarded by loyal, mutually productive, long-term customer relationships. 

Steve: What about funding and investors? 

Isar: In my view, health and VC usually do not mix well. VCs are suitable for situations where speed is the name of the game, and one of the main business risks is not being fast enough. This is not the case in health, as I said, you move at the pace of your customers. Your product is dealing with people’s health from day one. It needs to be right. And sales cycles are long. It does not suit the VC model. I have seen too many promising health startups lose their way trying to meet VC growth expectations. You have reported on some of these. At least in our space, where you are serving B2B customers who are literally dealing with the life and death of thousands of people, you are better off slowing down and committing for the long term. This means you should aim to be very capital efficient, so you can finance your growth mainly from the revenue you get from your customers, and then you can focus on serving them extremely well, and nothing else.  

Steve: Oooh what a hot take to finish on! Isar, thanks a bunch for the chat!

That’s all for this week. Interested in this topic and Tacklit, check the company out here and connect with Isar.

Keep fighting the good fight!

Steve

Founder of The Hemingway Group

P.S. Feel free to connect with me on LinkedIn

P.P.S. If you want to become a THR Pro member, you can learn more here.