Dealing with mental health is now a growing business because of the pandemic. As demand swells, digital mental healthcare start-ups, backed by venture capital (VC) investors, are stepping in
The pandemic poses a direct threat to the physical health of people the world over. This we know, as healthcare professionals have sounded alarm bells at a fever pitch for close to two years now.
But a subtler danger is looming. Some call it pandemic fatigue, a sense of stagnation and emptiness brought on by repeated lockdowns and social isolation.
In April, a New York Times story put a name to this exact set of symptoms. In an article, organisational psychologist and author Adam Grant diagnosed citizens as “languishing”, with those affected muddling through each day, looking at life through a foggy windshield and suffering from an overall lack of interest in life.
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But this is not just an affliction unique to the West. As Singapore transitions — however haltingly — towards reopening, reports released earlier this month brought up some startling statistics about our own community.
Singapore’s healthcare system and the wider society pay $1.7 billion per year for those struggling with six common mental health disorders.
The six disorders identified in the study by the Institute of Mental Health (IMH) are major depressive disorder, general anxiety disorder, bipolar disorder, obsessive compulsive disorder, alcohol abuse and alcohol dependence.
The study places healthcare costs and productivity loss at $3,938.90 a year for an individual with these conditions. IMH says that 13.9% of adults aged 18 and above face these common mental health conditions — an estimated 433,000 people here. In total, 6,126 participants were interviewed in person between 2016 and 2018.
The study was led by IMH in collaboration with the Ministry of Health (MOH) and Nanyang Technological University, funded by MOH and the Temasek Foundation.
But those are only financial figures, and the true human cost is sobering. Singapore reported 452 suicides last year, the highest count since 2012.
Last year’s case count was a 13% increase from the 400 cases recorded in 2019, according to data released by the Samaritans of Singapore (SOS) in July.
While case counts increased across all age groups, 154 cases were aged 60 and above, representing some 34% of all cases.
Cases among youth aged 10 to 29 and adults aged 30 to 59 both rose 7% from 2019.
President Halimah Yacob is “particularly concerned” about mental health struggles among the younger generation.
Between 2015 and 2020, the number of adolescents presenting at IMH for depression rose by about 60%. “Anecdotally, we also hear of more students facing stress-related issues over time. We need to do something urgently as a community to arrest this trend,” she said.
Speaking at the Asia Pacific Conference and Meeting on Mental Health 2021 on Oct 7, she also called for a “whole-of-nation effort” to help Singaporeans with mental health struggles.
“With the necessary support, social service agencies may be in a good position to provide care in a community setting to persons with mental health conditions, given their close proximity to homes and connection with the ground. This is an area where I hope our social sector can step up and help to amplify government-led efforts,” she added.
Those across the Causeway report similar statistics. By the end of last year, the Malaysian Mental Health Association (MMHA) recorded a more than two-fold increase in people seeking help for stress-related issues, compared to the year prior.
As the pandemic dragged on this year, the situation has only worsened. In the first half of 2021, helplines managed by Malaysia’s Ministry of Health and other departments reported that 89.4% of calls were related to mental health issues. Malaysia’s police recorded 468 suicides in the first five months of 2021, compared to 631 in 2020, and 609 in 2019.
In July, Malaysia’s then-Health Minister Adham Baba revealed that the country’s psychiatrist-to-patient ratio was just one-tenth of the rate recommended by the World Health Organization (WHO).
Where there should be 3,100 psychiatrists in Malaysia, there were only 400.
Economic uncertainty loomed over many Malaysians, said Consumers’ Association of Penang president Mohideen Abdul Kader to The New Straits Times in July.
“Never have Malaysians witnessed the despair of so many jobless, hungry and homeless people, having to depend on soup kitchens for their meals,” said Mohideen. “Such a situation causes despair and hopelessness, besides the feeling of loneliness during the pandemic.”
Sparing a thought
Last year, The Edge Singapore spoke to Joan Low, founder of the Southeast Asia-based digital mental health start-up ThoughtFull.
As a student and later a professional working in the US, Canada, London, Paris and Hong Kong, the former JP Morgan banker started her company in 2019 after she returned to her native Malaysia and noticed a dearth of mental healthcare channels there.
Former JP Morgan banker Joan Low (pictured above) started ThoughtFull after she returned to Malaysia and noticed a shortage of mental healthcare channels there
“In the US, most people had mental health professionals they spoke to regularly. It was almost a status symbol, to be very honest,” says Low of her time as an undergraduate at Middlebury College, where she studied international politics and economics. “But in Asia, it is not something that is common,” she adds.
To meet this need, ThoughtFull offers two mobile apps — ThoughtFullChat and ThoughtFullChat Pro — which connect users to mental healthcare professionals who provide “personalised, best-fit mental healthcare”.
ThoughtFullChat is the first port-of-call for users, says the company, with self-serve tools and one-on-one coaching with certified mental health professionals.
Conversely, ThoughtFullChat Pro lets mental health professionals build a digital practice that is “insights-based, data-driven and scalable”, says the company.
The app mimics the discovery journey from mental health awareness to action. An algorithm matches users to a “best-fit” mental health professional based on their preferences, and users text therapists through an asynchronous chat platform. This allows users to leave messages for professionals to respond to at their own time.
“We wanted to make sure that we had something for everyone, regardless of how ready they were to engage,” says Low.
The pandemic has also provided tailwinds to employer demand and ThoughtFull’s enterprise business has grown more than tenfold since launch. Low says ThoughtFull’s employee assistance programme (EAP) use rates can reach as high as 46%.
“This is significantly higher vis-à-vis current industry benchmarks of 1% to 3% for traditional employee assistance programmes.”
Apart from cost savings for employees, Low adds that for nearly 80% of users, ThoughtFullChat is their first experience in coaching or counselling. “This is significant as ThoughtFullChat is able to reach employees who usually won’t engage with their mental health in the first place — a struggle most HRs face in engagement. These are giant leaps we are taking in our mission to make access to mental healthcare seamless and affordable for all.”
ThoughtFull’s vision is to make access to mental healthcare more seamless and affordable for all, says Low. “Hence, for the price of a typical one-hour counselling session, users get full access to a mental health professional for an entire month.”
Prices range between $169 and $199 a month, depending on the user’s preferred subscription package.
“Since ThoughtFullChat’s launch in 2020, we have grown exponentially to serve users across 43 countries with a professional network spanning 14 locations,” says Low. “ThoughtFullChat’s app is now available in English, Malay, Bahasa Indonesia, Mandarin and Cantonese; [and our] coaches are fluent in four additional languages: Tamil, Thai, Vietnamese and Tagalog.”
ThoughtFull is currently available in Singapore, Malaysia and the Philippines, with plans to expand further into Southeast Asia.
On Oct 12, ThoughtFull announced the close of a US$1.1 million ($1.49 million) seed round backed by The Hive SEA from Silicon Valley-based The Hive, Boston-based venture capital (VC) Flybridge and Singapore-based Vulpes Investment Management, in addition to several family offices and angel investors across the Asia Pacific.
See also: ThoughtFull brings therapists to your smartphone
“Even before the pandemic, ThoughtFull has always set out to change the conversation around mental health from awarenessto action. However, the infrastructure is still nascent and there is much to do to smoothen out the process for people to proactively engage with their mental well-being,” says Low.
“We are thus thrilled to receive such overwhelming support to build a future where access to end-to-end mental healthcare is not only affordable, but seamless,” adds Low.
Syed Haizam Jamalullail, managing director of The Hive Southeast Asia, says: “When the Covid-19 pandemic hit, anxiety levels skyrocketed and businesses, including those of mental health professionals, were shut down overnight. ThoughtFull’s work in bringing greater access to mental healthcare for all and digitising the mental health industry is fundamental to nations the world over.”
“The Hive Southeast Asia, along with Penjana Kapital — a wholly-owned subsidiary of Malaysia’s Ministry of Finance — is proud to partner with ThoughtFull to future-proof the delivery of mental healthcare in Malaysia and beyond,” he adds.
Surveying attitudes
At home, Safe Space is a Singapore-based digital mental healthcare provider, available since March 2019. “By the time Covid-19 hit, we already had a solution that was easily rolled out to both consumers as well as corporate clients,” says Antoinette Patterson, founder of Safe Space.
When The Edge Singapore spoke to Patterson in July, Safe Space had 35 therapists on its platform, located across Singapore, Japan, Dubai and Australia. “Our pool of therapists has grown from 35 to 52. We are expanding our therapist recruitment drive to the Philippines, Vietnam and Thailand due to our corporate clients’ increasing need for these local languages, in order to fit cultural nuances,” she says.
Safe Space’s Patterson: We are recruiting therapists in the Philippines, Vietnam and Thailand as our corporate clients increasingly need these local languages to fit cultural nuances
From five full-time staff just months ago, the Safe Space team has tripled in size to 15 members, and Patterson is working to expand into Malaysia by establishing a physical office there.
For greater awareness on mental health, Patterson believes more research is needed to uncover attitudes and behaviours among workers.
See also: Safe Space provides easy access to mental healthcare
Earlier this year, the Action Community for Entrepreneurship partnered with Safe Space to launch Singapore’s first report on the mental health of start-up founders.
Safe Space spoke to 150 founders for the study, covering key triggers like stress, coping mechanisms and the impact of Covid-19, while comparing variables like gender and founding party size.
It found that while male founders were twice as likely to agree that running a startup had taken a toll on their mental health, they were only half as likely to confide in somebody about their struggles.
The four common difficulties named by founders are uncertainty, managing relationships, working alone and slow progress. In addition, the problems that weighed heaviest on entrepreneurs’ minds are a challenging business environment (62%), company cash flow issues (35%) and long working hours (34%).
But the work does not stop there; Patterson now wants to hear from people abroad. “As part of an international research project, we’re sending out a survey on mental health awareness, literacy and attitudes in the general public [in] Japan, Hong Kong, Indonesia and Thailand.”
“We’ll be surveying common sources of stress, the impact of Covid-19 on mental health and the mental health literacy of the general public within these countries,” she says. “With these results, we hope to learn more about mental health understanding and challenges in these markets, and use this to design country-specific programmes and initiatives to make an impact in the region.”
Digital substitute?
Such services are not new here, at least outside of the start-up scene. Local social service agency Fei Yue Community Services, for example, has been offering free and anonymous, text-based counselling for youth through its website since 2004.
Speaking to The Straits Times, a social worker said the eC2.sg online counselling service hosted some 1,293 online counselling sessions in 2020. Demand has increased this year, with 1,009 sessions conducted in the first three quarters.
Last July, the Singapore government launched its own mental healthcare platform, named mindline.sg. There, users can perform a self-assessment check and speak to Wysa, an “emotionally intelligent” AI chatbot.
Developed by MOH, the Ministry of Social and Family Development and the National Council of Social Service, mindline.sg has hosted 352,000 visitors in slightly over a year.
While the main goal of such apps is to encourage mental health awareness, they are not designed to be a digital substitute for professional care.
Jeanie Chu, senior clinical psychologist at The Resilienz Clinic, says therapy apps cannot replicate the human connection.
“If this person needs some sort of stress management, anger management — that might be sufficient. But if the person is really suffering from depression, like a major depressive disorder, it might not be enough,” says Chu in an interview with The Edge Singapore last year.
Ultimately, a personal connection is crucial in the recovery process as it creates “a rapport, a bond, a connection with your clients or patients”.
“A psychologist, counsellor or therapist can be really skilful in what they do and they might have adequate knowledge in that field. But if there’s no connection or rapport with the client, it is hard [to help them] in terms of prognosis to recovery,” she adds.
For the psychologist who brought “languishing” to the attention of many readers, Grant thinks today’s state of flux is as good a time as any to rethink how we approach mental health.
“As we head into a new post-pandemic reality, it’s time to rethink our understanding of mental health and well-being,” writes Grant.
“‘Not depressed’ doesn’t mean you’re not struggling. ‘Not burned out’ doesn’t mean you’re fired up. By acknowledging that so many of us are languishing, we can start giving voice to quiet despair and lighting a path out of the void.”
Where to get help:
Samaritans of Singapore Hotline: 1800 221 4444
Institute of Mental Health’s Helpline: 6389 2222
Singapore Association of Mental Health Helpline: 1800 283 7019
Photos: Albert Chua / The Edge Singapore, ThoughtFull, Unsplash
