With the coronavirus pandemic causing unprecedented levels of stress and grief, companies offering virtual mental health care say they’re seeing a massive surge in interest — and are scrambling to meet that demand by introducing new services, accelerating launch timelines, and bringing more staff on board.
Covid-19 could prove to be a breakout moment for these businesses, which had been trying to address the shortage of in-person mental health care by providing virtual coaching, monitoring, and educational content long before the coronavirus outbreak. If the companies can bring in more users and corporate customers now, they might convince them to stick around after the pandemic is over. But that depends on whether the companies —whose mental health offerings have been relatively small in scale up until now — can handle the uptick in demand.
Most of these companies make money by charging employers and health plans to provide mental health services to their workers and members. Other startups charge individual users an out-of-pocket fee. Many are offering some of their services and content for free during the pandemic.
Take Ginger, a San Francisco startup that uses messaging and video to connect people with its army of hundreds of behavioral health coaches, therapists, and psychiatrists. The company mostly sells its services to large employers who pay for their workers to get access to Ginger.
Ginger’s business grew significantly in 2019, but the boom in demand since the start of the pandemic has been unlike anything the company has seen before. During February and March, Ginger saw a nearly 50% increase in the number of workers actively using the platform compared to the previous six months.
Not only are there more people using Ginger, but those individuals are also using the platform more often than they previously did. The company reported a 50% increase in its number of weekly virtual therapy and psychiatry sessions since the start of February. Their visits are also more intense, according to ratings Ginger’s coaches assign to their conversations.
So far, Ginger has been able to handle the increased demand, according to Ginger’s chief executive officer Russell Glass. The company’s average wait time for coaching is now around 72 seconds, up from 60 seconds before the pandemic. And the time for a first available appointment with a therapist or psychiatrist remains between five and nine hours on average, Glass said.
The demand for mental health services has long been higher than the supply of available sit-down appointments. The coronavirus pandemic has only exacerbated this dynamic, by making in-person counseling nearly impossible, while also intensifying existing symptoms of depression and anxiety for some people and causing new symptoms for others.
Virtual mental health services could fill part of that gap, but the format also creates new challenges. People sheltering in place with family members or roommates for weeks on end, especially in a cramped living space, may lack a private space where they can do a video or audio chat with a therapist without being overheard. That may be fueling demand for smartphone apps that allow users to chat via text messaging and to access educational content.
At Kaiser Permanente, the health insurer that runs 39 hospitals and has medical groups around the country, over 90% of mental health visits are now happening virtually, said Don Mordecai, a psychiatrist who serves as the system’s national leader for mental health and wellness.
“We had been pushing telehealth options for a long time,” Mordecai said, but the rapid uptake over the past few weeks “is something that would have taken years, under normal circumstances.”
Earlier this month, Kaiser Permanente started offering its members access to a smartphone-powered behavioral health program from Livongo, a company best known for offering diabetes coaching. That deal was already in the works before the crisis and had even soft-launched prior to the pandemic. Thousands of Kaiser Permanente members downloaded Livongo’s app in the past week, Mordecai said.
Kaiser Permanente is testing out the offerings from Ginger and Livongo, as well as several other vendors, for clinical use. Kaiser Permanente clinicians can try out the different mental health apps with certain patients and assess which apps they like best and how beneficial they are to both patients and providers.
Livongo’s behavioral health program centers mostly around digital content, though it also makes use of human coaches to chat with users to help them navigate the resources. When appropriate, the app escalates users to a telehealth consult with doctors from companies like MDLive or Doctor on Demand. In response to the pandemic, Livongo recently added new content to its app on topics including “Keeping Your Relationship Strong During COVID-19,” “Managing Time at Home With the Kids,” and “Staying Connected While Social Distancing.”
Livongo said it saw a 140% increase in utilization of the behavioral health program in March compared to last September, as measured by unique online or mobile logins. Based on how they’re using the app, Livongo users appear to be concerned about the cratering economy and ballooning unemployment numbers. Many of them are also struggling with substance abuse, interpersonal relationships, and parenting, said Jennifer Schneider, a physician who serves as Livongo’s president.
If that demand stays at those record levels, “that potentially creates a real scalability challenge” for companies, said Andrew Matzkin, a partner at the consulting firm Health Advances. That’s particularly true for offerings that rely on human coaches, because scaling up such a workforce is time-intensive and requires recruiting, training, and retention efforts.
Omada Health — which offers virtual coaching and education for diabetes and other chronic conditions — relies on an army of human coaches to lead its behavioral health program. Those coaches message back and forth with people seeking mental health support and moderate online discussion groups.
Omada has added new discussion groups amid the pandemic that quickly drew in hundreds of members, including ones centered around eating healthy at home on a budget and staying active at home while sheltering in place. But more discussion groups means there’s a need for more coaches. The company has a few hundred coaches across its different programs, but it’s now cross-training those who specialize in other areas to handle mental health needs, said Carolyn Bradner Jasik, a physician who serves as Omada’s chief medical officer.
“We’re staffing up for this program. We’re expecting a pretty big surge in participants,” she said.
The pandemic has also driven several companies to speed up their timelines to launch digital mental health services that were already in the works. That includes a new company being launched by Tom Insel, the prominent psychiatrist who previously directed the National Institute of Mental Health and now advises the state of California as its mental health czar.
On a webinar with reporters earlier this month, Insel said he is starting a company to be called NEST Health — short for Network to Engage, Support, and Thrive. He had planned to launch the company in the summer, he said, “but with Covid, everything has been expedited so we’re trying to get this live by the end of April.”
NEST will deliver online, single-session psychotherapy visits with licensed providers and peer support volunteers. It will offer a “digital walk-in” clinic where a patient can see a licensed provider for a consultation that ends with a “social prescription,” which involves building an online community around the patient. Insel said that NEST will be like “[Alcoholics Anonymous] online” or “Peloton for mental health” — a membership-based community in which people get coaching, information about mental health, and access to short videos Insel calls “micro-therapeutics.”
The coronavirus crisis has also sped up plans at Hims & Hers, the San Francisco company best known for offering online prescriptions for treatments for conditions like erectile dysfunction and hair loss.
The company had originally been planning to roll out new mental offerings this summer, CEO Andrew Dudum said. But because of the pandemic, the company last week launched the first of those offerings: anonymous support groups powered by Zoom.
The 10-15 person groups, which are run by a therapist and last an hour, are centered around subjects like sleep, managing anxiety, relationship management, grief management, mindfulness, self care, and, of course, Covid-19. Participants can choose whether to turn on their audio or video, and they can use an anonymous name. These groups will be free for the next few months. After that, they’ll cost about $15 per session out of pocket.
Hims & Hers plans to soon launch more intensive mental health offerings, including individualized therapy sessions which can be conducted by text, phone, or video and will start at $50 per month out of pocket. The company is also planning to roll out virtual psychiatric evaluations with licensed psychiatrists who, if appropriate, may prescribe medications for anxiety or depression.
In the last couple of weeks, Dudum said, “the company has been in a full-out wartime execution mode to bring forward the timeline of getting this out as quickly as possible.”
Casey Ross contributed reporting.