Nov. 26, 2020

Mental health innovation starts here

Get an in-depth understanding of the roles entrepreneurship, cutting-edge technology, and user experience can play in disrupting our deeply broken mental healthcare system in the U.S.

We’ve applied long-held principles of technology startups to industries across the board, from adult entertainment to transportation to retail. How come we can’t take the best the tech world has to offer and use it to improve our mental healthcare system?

It’s high time we do just that. Today, get an in-depth understanding of the roles entrepreneurship, cutting-edge technology, and user experience can play in disrupting our deeply broken mental healthcare system in the U.S.

And do it with Ariela Safira, founder and CEO of therapy startup Real. She’ll explain the impact the coronavirus has had on our mental health and why we can’t waste any time rethinking our traditional expectations of therapy in a post-Covid world.

If you or someone you love is struggling with mental health, we encourage you to seek out professional help or find resources from the National Alliance on Mental Illness.


Kinsey Grant, Morning Brew business editor and podcast host [00:00:05] Hi there, everybody, and welcome to Business Casual. It's me, Kinsey Grant, and I am so happy that you are joining me today. So let's get into it. [sound of a ding]


Kinsey [00:00:16] I'm probably not the first to point this out, but we're all incredibly stressed out right now. And that stress—it can give way to heightened anxiety and depression and other debilitating mental health challenges that result from isolation and the myriad other curveballs 2020 has thrown at us. That's a problem. But if you've ever listened to this show before, you know that we are all about exploring the ways smart and talented entrepreneurs and business minds are solving problems. 


Kinsey [00:00:43] So that's why today, we are going deep on the ways entrepreneurship best fits into the mental health space. Can tech-ifying the ways we maintain and improve our mental health lead to better outcomes for more people? What are the risks of taking therapy from analog to digital? And what does the future of mental healthcare look like in a post-COVID world? Those are some of the many questions I would like to ask my fantastic guest today. I'm so excited to welcome to Business Casual Ariela Safira, founder and CEO of Real. Ariela, welcome to the show. 


Ariela Safira, founder and CEO of Real [00:01:16] Thank you so much. I'm very excited to chat today. 


Kinsey [00:01:18] Me too. I'm thrilled to have you here, especially as a follow-up to our last episode. I had Stephen Hays from What If Ventures on the show, and Stephen really opened my eyes to how big this conversation about mental health as an industry, as a business, really is, and also how outdated so much of our solution-oriented [chuckles] ways of approaching this problem actually are. They don't really make a whole lot of sense anymore. 


Kinsey [00:01:40] And I want to get deeper into why that is, how that is, and also just how much room there is for innovation in this space. Companies like yours, especially, I think are really taking that problem head on. So before we start answering all these questions, you want to just give me the quick elevator pitch for Real? What Real does, why you do it, and how you do it? 


Ariela [00:01:58] Yes, of course. Real is a mental healthcare company really reinvisioning the way we [indistinct] and the times at which we interact with mental healthcare. We're changing mental healthcare from this system that we only access in moments of crisis—most people only go to therapy when they've hit rock bottom, when they've lost a loved one, gone through a divorce, attempted to take their life—changing it from that crisis response tool to instead this ongoing healthcare system. 


Ariela [00:02:27] In this system, we're always taking a part of—taking part in—such that we're always engaging with our mental healthcare, always improving our mental health, not just at rock bottom. And to do that, we really have this omnichannel approach to care. So both a brick-and-mortar studio platform—our first studio is in Flatiron in New York City—as well as the digital platform, which really democratizes care and affordability, accessibility to those so beyond the four walls of a brick-and mortar-studio. 


Kinsey [00:02:58] Right. This dual approach to providing healthcare, mental healthcare for those who need it, is really interesting to me. And I think something that is a byproduct of what we have experienced in the last several months here, that remote is a possibility in a lot of ways. And I think that mental healthcare is certainly one of them as well. 


Kinsey [00:03:16] And I know that this was not always the plan for Real—that Real had to make a lot of changes and pivot pretty hard in the early days of COVID. And I do want to get into that in just a little bit. But before we do get started with the Real experience and your experience in building this company, I want to know a little bit more about why it was so necessary to innovate on the existing system of mental healthcare as it has existed for a very long time now. What is the traditional model for mental healthcare treatment? 


Ariela [00:03:44] Definitely. So, taking a step back, when we think of traditional mental healthcare today, that really presents itself as one-on-one therapy. And there are a few issues with one-on-one therapy. One is what I had just mentioned—this issue around most people only access it at moments of crisis. And what that comes from is the fact that, one, it's very expensive. You know, in New York City, you're paying $300 to $400 per hour. 


Ariela [00:04:10] Outside of the price, it's very heavy-weight in terms of our schedules. It's asking for an hour of our time once a week regularly. There isn't really an experience design to it. There isn't a digestible or consumerized pathway to describe what journey are you embarking on. And as a result, people tend to drop off really early because they don't understand what the system is. 


Ariela [00:04:32] You go to a therapist today and your therapist pretty much tells you, hey, I have no idea how long it'll take you to feel better. I don't know what we're going to talk about. I have no previous examples of my work, but trust me, you'll feel better eventually at $300 an hour. 


Ariela [00:04:48] And it's not the $300 an hour that's so startling for people. It's this black hole of an experience. This lack of clarity of what they're actually signing up for. And as a result, most people either go once and never again or they don't even try. So really, the system itself, for those who interact with it or learn about it, is failing them. 


Ariela [00:05:08] And outside of that, there's this brand associated with mental healthcare. I'm sure everyone listening knows. It's very stigmatized, associated with depression, with hitting rock bottom, as opposed to being associated with working on yourself and understanding yourself and being more real. 


Ariela [00:05:23] And outside of brand, there's also this operational issue, which is the one-on-one therapy appointment is constrained by the ratio of the one-on-one appointment, which means, I should say, that one-on-one therapy requires, if we were to scale that across the entire country, it requires enough therapists for every single person in this country to have care regularly. 


Ariela [00:05:43] And we don't have that. Even putting cost aside, we do not have enough therapists in this country for every single person to go to therapy. And so, if our goal is to build a mental healthcare system that our entire country engages with, we have to build something more scalable than the one-on-one therapy appointment. Right? 


Kinsey [00:06:00] Right. 


Ariela [00:06:00] So those are a few of the issues. 


Kinsey [00:06:02] Yeah. [laughter] And to your point, [indistinct] and a number of them here that are incredibly prohibitive to people who need to make sure that your mental health is in a good space, regardless of whether or not you are hitting rock bottom, to your earlier point. To make sure that every day that we go through our lives, we're prioritizing mental health, we're prioritizing talking about mental health too, is so important. 


Kinsey [00:06:22] But when we think about how pricey it is, how time-intensive it is, the bad design, the lack of people to make these one-on-one therapy sessions actually happen, the therapists themselves—so much of it is prohibitive. And I think that that really speaks to the way that we have sectioned off communities in terms of who can and can't access mental health resources when they need to. 


Kinsey [00:06:42] It's another example of this, like, classification of the world around us in a way that doesn't really always feel fair. Everybody has a brain. Everybody needs to take care of their mental health, but not everybody can. 


Ariela [00:06:54] Yeah. I do think that so often the narrative associated with mental healthcare is, we will associate it with the wealthy. With those who can financially afford it. And I think that actually misses a very important nuance here, which is that certainly the price point is one that only a very small subset of the country can afford. And that is a huge problem. But that isn't the real gatekeeper. 


Ariela [00:07:16] There is even a smaller subset of those individuals who actually access mental healthcare today because the actual experience, the therapy appointment, was really built for what I call the emotionally elite. Think of therapy today. Going to therapy today and doing it well or effectively requires one, having the language to talk about what you're going through. Literally knowing the words to use and to say to describe your recurring nightmares, your insecurities, your childhood traumas, which we were never taught. 


Ariela [00:07:49] At best, we were taught how to say our jobs suck and dating sucks. [indistinct] we heard our parents and movies say growing up, but we've never been taught how to talk about how we feel about our stomachs, or how awful that one—or the first time we had sex really felt, right? Because we don't have that language. That is what's debilitating us and stopping us from going to the therapy appointment. 


Ariela [00:08:10] And outside of having the language to talk about care, you have to have the comfort to do so in front of a stranger. And so even if you have the $300 to show up, so many people drop off because the therapy appointment is asking for a caliber of education that the vast majority of people don't have because we've never been taught it. But we really need us to take a hundred steps back and think of the principles, if you will, the basic principles of what does it mean to understand yourself. 


Ariela [00:08:40] And what does it mean to work on yourself, and what's required of that? And I have found that that concept is very easy to understand. We compare it to physical health. The reason why today I'm able to differentiate between when I have a fever versus a headache versus a stomachache is because I've gone to a doctor every year of my life, starting at childhood. And starting at a very young age, I was informed of what are general symptoms for a fever versus a headache. 


Ariela [00:09:05] And then I was taught what are my personal symptoms for a fever versus a headache. I was given the language to use even before I could then apply it to myself and understand what's a broken arm versus a twisted ankle versus a broken ankle. Right? 


Kinsey [00:09:18] Right. I remember from my childhood, my early, early childhood—they teach you to, on the scale of, like, a sad face to a happy face, what's your pain level right now? We were taught from day one to communicate that it hurts or I don't feel good, and we can't quite communicate that in this all-important way. [laughs] 


Kinsey [00:09:36] It's not every day that we break an ankle, but it is every day that we have to deal with the trauma of being alive. Like this exists at every level. I'm approaching this from two separate directions here. I think on one hand, there's this moral obligation to talk about these things because it's so, so sad that the system has failed us in such a huge and enormous way, and such an impactful way, such that we can't communicate these things. 


Kinsey [00:09:59] In the year 2020, people aren't trained from day one to communicate their mental health the way they would their physical health is incredibly sad and just jarring, you know. To really give that a whole lot of thought is, it's a lot. 


Kinsey [00:10:12] But then I also think about this from a business perspective. [chuckles] This is a huge amount of white space that if you could blow the top off of this, teach people how to talk about it, you don't have to charge them as much as a traditional model does. There's still a lot of money to be made, which is compelling, I think, from an entrepreneurial standpoint. 


Ariela [00:10:27] Confirmed. [laughter] I mean, I think something that is very rewarding—I think it's quite disappointing when you see how long this has taken, but also very rewarding to work on this, seeing that today's system is not only experientially or clinically not ideal, but it's also not a financially good business. It's not like today's one-on-one therapy model. It's a really hard business to keep up for an individual therapist. 


Ariela [00:10:55] And I think even for startups that are trying to, like, build platforms that bring more people to one-on-one therapy, it's a very limited business. And that means it's very rewarding to work on this because you're not just building more clinically effective care, more approachable care, more affordable care, you're also building a better business in doing so. 


Kinsey [00:11:15] Why is the model—the more traditional one-on-one therapy model—not fiscally responsible or advantageous for the clinician? 


Ariela [00:11:23] Yeah. It's really difficult to retention, if you will, or LTV for clients. It's very hard to keep that high. As I had mentioned before, the majority of people in New York City actually drop off after a single therapy appointment. It's a very hard narrative to sell someone on. I have no backing and no guarantees to provide you with. But I promise you, if you keep coming, you'll eventually feel better at $300 an hour. That system loses people very quickly. 


Ariela [00:11:48] And then not only are you constantly losing people, but it's very exhausting and hard to get new people in the door. You're dealing with—you're managing your own schedule and trying to fit people into random time slots. And, you know, they let you know three hours before your appointment they've canceled that appointment. And this is the case, I think, for a lot of self-employed practitioners, but especially working on mental health. 


Ariela [00:12:10] Imagine being the therapist who is working with you through your financial insecurities or anxieties. And is working with you on how your anxiety manifests and not being able to show up on time. And that same therapist is the one who next week has to hear you say, I couldn't make it on time. How dare you charge me for that appointment? Because you know my anxiety causes this, right? 


Ariela [00:12:31] I truly think it's this, like, human experience. If it's very challenging for the clinician who's helping you cope with these issues that make you unreliable, that make you have trouble with finances, et cetera, for that clinician to also represent money collector at the end of the day. And as a result, it's a very common phenomenon for therapists to not charge their clients 100% of the time. To reduce their fees. 


Ariela [00:12:56] I mean, we've so normalized this idea of sliding scale and expect every therapist to offer a sliding scale. When a single office costs the therapist $50 to $100 per hour, and they give you a sliding scale option of $90 per hour for an appointment, they are indeed losing money on that appointment. It's for any person, especially a deeply empathetic one. It's a very hard business to see any margins on a single appointment alone, and even harder when you're trying to convince people to show up week after week, not charge them cancelation fees, et cetera. 


Kinsey [00:13:28] Yeah, absolutely. I think it, to me, boils down to a lot here, this misalignment of incentives that a lot of the clinicians who are going into therapy or any related field are often people who are doing it because they want to make people feel better. They want to help people. They want to make the world a better place theoretically. 


Kinsey [00:13:44] And that motivation is very different from the motivation to make money. They can exist. They can coexist. But I think it's a little more difficult to pin that down than it would be, you know, a more—and I say this with a grain of salt—like, our more traditional understanding of medicine is a lot easier to say, you got an X-ray. I have to charge you x number of dollars. Your insurance will figure it out or you'll pay $100 where you can. 


Kinsey [00:14:09] But that's not how it works with this traditional model. So then the logical next step here is that these clinicians join a platform or a marketplace or something like that who can be the money person. To make their jobs a little easier so they can do what they wanted to do, do what they set out to do, but not have to also serve as their own CFO. 


Ariela [00:14:30] Yes, though we have a few of those platforms that exist today. I should also give the context that I'm not a practicing therapist myself. I went to grad school and left grad school, just found Real. I want to become a therapist and left. 


Ariela [00:14:43] So much of my findings, both in terms of proper use of research and also just in conversations with therapists, will reveal that part of the difficulty is not having enough of a guaranteed income. And to be frank, the business acumen to be able to invest in these technologies and tools, even if they're just costing a few hundred dollars a month. 


Ariela [00:15:03] What I have found is countless number of therapists who, rather than promising this technology platform they're going to pay $200 to $300 per month for scheduling and billing help, instead of that, they'd rather have a scheduling notebook in their pocket or a scheduling calendar where they handwrite their schedule. And they'd rather handwrite their notes and send emailed receipts. 


Ariela [00:15:23] And as I mentioned, this isn't—it's not for lack of effort on the technology side, it's a lack of understanding who is the therapist. And what is the extra income they have to work with, which isn't much. This idea of, like, investing. And these technologies, these tools, don't guarantee they're definitely going to make a certain income later. 


Ariela [00:15:44] And so for someone who's struggling to keep up their 15 or current clients, it's a big risk to take on if I have to guarantee I'll be on this platform for six to 12 months and therefore give you over a $1,000, when in a single holiday season, I could lose all my clients. They leave the city, they, like, forget this habit. And next thing you know, you now to find 10 additional people who will come to me every single week and pay $300 an hour. 


Ariela [00:16:10] I think that, in my experience, people are so under the impression that therapists are falling out with hundreds of thousands of dollars a year. And it doesn't take very long to stop and imagine yourself getting a website and waiting for people to just find your website and call you and pay you $300 an hour weekly. 


Kinsey [00:16:29] Right. To do something deeply personal. [chuckles]


Ariela [00:16:31] Right. 


Kinsey [00:16:33] To like share your traumas and talk about your anxiety. It's a big hurdle. There are a lot of barriers to entry here. 


Ariela [00:16:39] Yeah. And it's a difficult [indistinct] I've even found from therapists, no matter how kind, empathetic, generous a person is—a therapist is—t's really hard to disassociate the carrier delivering with the amount of money you're making off this client. I would probably venture to say at least 90% of the therapists I've spoken to have said, yeah, the clients who pay the most money, I do deliver the most attention to it because I don't want to lose them. 


Ariela [00:17:06] I do not make enough income to disassociate myself from the realities. My rent is paid because of this client. Whereas someone who I was generous enough to give a sliding scale price to and was paying $50 an hour, I don't bring the same level of attention, empathy, et cetera. And I think that should be met with, like, understanding — 


Kinsey [00:17:24] Right. 


Ariela [00:17:24] Regardless of how caring you are. That's just the realities of you need funding to pay for your rent. 


Kinsey [00:17:31] Yeah. It's [chuckles] in a word, like, shitty, you know. [laughs]


Ariela [00:17:35] Yeah. [laughs] 


Kinsey [00:17:35] That this is the reality that so many of us are facing. You have to put a roof over your head. It's hard for everybody. We often don't want to be like the capitalist monsters that we can turn into. But at the end of the day, this is just reality. So we touched here on implementing tech from the provider standpoint, from the clinician standpoint. 


Kinsey [00:17:54] How do you think that the tech should be properly implemented to benefit the patient as well? What is the next frontier here in terms of technology in the mental healthcare space? 


Ariela [00:18:05] As I mentioned earlier, it really requires taking those five steps back and questioning what is mental health and what does it take to improve that mental health. And on one hand, in my opinion, it largely involves this, like, psycho-education [indistinct] had mentioned, which is very different from the one-on-one therapy appointment. 


Ariela [00:18:22] It's actually taking a hundred steps back and saying, we need to educate people on what are different words to describe our feelings. And what are common themes and trends seen in these different life experiences we're all familiar with. Teach me. Like, if you ask me what I think about my body, I'll say, somedays good, somedays bad. I don't have more language than that. 


Ariela [00:18:42] I'm not being lazy or cowardly and afraid to share more with you. It's that I need a menu of options because I've never had this conversation and I've no role models who have shown me how to have this conversation. So really, I think step one is being able to, in a very approachable way, which often requires, you know, beautiful design and branding in that approachable way, offering a menu for people to learn, to understand this. 


Ariela [00:19:08] Because the reality is it's not my job or a therapist's job to teach you why you're feeling the way you're feeling. It's a therapist's job, and my job, to give you the opportunity to learn that yourself. And to give you all the tools and to give you all the examples such that you can use that to then say, got it, this is who I am, and this is why I am. And we all are unique and nuanced in our own ways. 


Ariela [00:19:29] There's no dictionary or clinician who could tell you exactly who you are. What they can do is ask enough questions and give you enough different examples such that you can put those pieces together yourself. I think that's really what's missing in the system. And really outside of that, obviously, is bringing that at a price point that America could afford, not just the top 1%. 


Ariela [00:19:50] I think today's model, 1% of Americans could afford traditional therapy model. So building a system that 100% of people can afford, and even outside of that affordability, ensuring it's a system that comes with the level of branding and experience design that ensures an individual is eager to take part in this system regularly, not just when they've hit rock bottom. So really building a culture shift or a societal shift, moving this from a system of crisis and kind of feels like an emergency room to your weekly check-in with yourself.


Kinsey [00:20:27] Yeah. I love the borrowing of some of these words that we often would associate with, like, a tech startup, of branding and user experience. And making this something people can enjoy doing at a reasonable price are a lot of tenets of tech that have migrated away from just like social media apps and what have you into so many other avenues of the business world that I think is honestly for the better. And I think that's incredible. 


Kinsey [00:20:51] But I also do just wonder what, in fairness, are the drawbacks of relying on telemental healthcare, if you will? What are we missing by not having that one-on-one conversation in that more traditional model? I think there is something to be said for sitting across the room from somebody and having an in-person, genuine conversation. So what do you think the drawbacks might be? 


Ariela [00:21:12] Yeah. It sounds like you're asking for the drawbacks of a one-on-one therapy appointment held virtually versus an in-person, one-on-one therapy appointment, right? 


Kinsey [00:21:22] Sure, sure. 


Ariela [00:21:23] So between those two, the first thing comes to mind is accountability. There's a different sense of I need to show up when I know there's a place waiting for me, a room that's empty that's waiting for me, versus I can just flip open my phone, as if I have a flip phone [Kinsey laughs]. I can turn on my iPhone and video chat in so that your accountability looks very different. 


Ariela [00:21:42] And two is the therapist's ability to reach you beyond the words that come out of your mouth. Be able to read, you know, you're foot fidgeting or even you're hand tapping on something, and even having a clear visual of what you look like. 


Ariela [00:21:56] Think of anxiety for so many people manifests in even like picking at hairs, and probably in an iPhone screen, you couldn't tell if I picked some hairs off of my eyebrows. And I would like to think you could tell if we were in person. So accountability and just understanding who you are and how you're feeling beyond the words that are leaving your mouth. 


Kinsey [00:22:16] Yeah. And that's a huge part of getting the most beneficial and advantageous experience possible out of one-on-one therapy, is being accountable and honest and open with someone. And so much of the reason that we're talking about telehealth as much as we are right now is because of the nature of the last six months. We can't ignore the fact that, in a lot of ways, telehealth had tons of promise prior to COVID, but now it's really become the only option for a lot of people and a lot of ways. 


Kinsey [00:22:41] So, I want to take a quick break. We're going to hear from our sponsor. And when we come back, we will talk a little bit more about the impact of COVID-19 on mental health. — And now back to the conversation with Ariela Safira. Ariela, let's talk about the impact of COVID on mental health and entrepreneurship. This pandemic totally derailed Real's plans for opening a brick-and-mortar studio in New York in April. 


Kinsey [00:23:04] Obviously, that could not happen. It did not happen. But, you started a digital therapy alternative almost immediately. So do you think that being digital first, like you are now, is as effective as your original plans, which were to provide services in person? 


Ariela [00:23:19] There are many definitions of the word effective. I think the biggest reason why it's more effective because it reaches far more individuals. And I should say for context, you know, we had plans to open the brick-and-mortar and knew we would scale digitally. We raised venture funds. Had many hypotheses as to how that would manifest. 


Ariela [00:23:37] But COVID-19, the pandemic, forced us to learn quickly and honestly to be more open-minded and creative than we otherwise would have been. I think regardless of how open-minded we credit ourselves for being, there's nothing like a sudden global pandemic to force you to listen. But there's no assumptions. We had no— 


Kinsey [00:23:58] Yeah. 


Ariela [00:23:58] There were no preconceived this is how we think people are going to do. We didn't have the time, let alone experience, to assume the sort of mental healthcare someone needs at this time. And as a result of that, we had to distribute more feedback surveys. We had to listen to members in a way that we wouldn't have been as cornered to or forced to in a brick-and-mortar offering. 


Ariela [00:24:18] So I do think, you know, obviously we built a product that far more people can engage with. And to be frank, is far more—is that a price point I'm more proud of. I can say openly that Real studio plan was—99% of it was my dream and really a manifestation of everything I'd wanted to bring to the world. And what it was lacking was accessibility. 


Ariela [00:24:40] And it's just the nature of a brick-and-mortar offering, and the cost of rent, and the cost of these rooms and one-on-one appointments—results in a price point that so few people can have access to. And this really accelerated us into building a product that is more accessible, both because tech allows multiple geographies to touch Real and also because of the price point. 


Kinsey [00:25:01] Yeah. Accessibility has been such a huge theme in talking about and better understanding the mental health space on the broader scale. For me, and I've liked to get a better understanding of all of this, you know, that there are people who can, there are people who can't. 


Kinsey [00:25:15] And for all of the terrible, terrible havoc that COVID-19 has wrecked on the economy, on the people, on everything, there have been some silver linings. And I think this accessibility and maybe a little bit more recognition of some of the problems that we're facing in terms of accessibility has been perhaps a small silver lining in a lot of ways, which it's [chuckles] kind of weird to think of, like, the benefits of a global health crisis. But this might be one of them. 


Kinsey [00:25:44] But at the same time, COVID-19 certainly has brought to the fore just how debilitating these mental health crises can be for people. Do you think that beyond just your experience at Real, what has the sort of state of mental health been in 2020? Has it shifted a lot for the average, everyday person because of the experiences we've been through? What is our state of mental health right now? 


Ariela [00:26:10] Poor. 


Kinsey [00:26:10] Not great. [light laughter]


Ariela [00:26:13] Maybe you can empathize; I certainly can empathize. I think it's far deeper than, far more nuanced and deeper than are people more depressed? Are they more anxious? Both of which they are. But it's people feel more distant from reality. And I've talked about this a few times this past week alone. 


Ariela [00:26:35] It's so easy to think our lives are on pause right now. And that manifests in a very poor mental, like, poor mental health. And this lack of understanding this is life, and we should feel this distance from reality, this, almost like I'm floating, is a bit scarier than the sadness of depression. It's detachment. And it could result in like loosening weakened friendships and relationships because we're not quite validating this time is real. 


Ariela [00:27:05] And I know a therapist, I've talked about that, but even more so, I feel it personally. I've seen it and talked about it with friends experiencing it. I think that's something where in many ways, things like suicide rates are already going up, but I think it might result in greater suicidality [indistinct] people, period, and people don't feel a connection to tangible life. And it's something we're working on and certainly a continuous effort given that it's not like a broken arm one could just fix with a surgery. 


Kinsey [00:27:36] Yeah, exactly. I think we can't dwell enough on just how important it is to recognize that this is still life for everybody. And I have been certainly guilty of joking about this being like a made-up year. And like, we're all just waiting for it to be over. But that's not reality. 


Ariela [00:27:53] Right. 


Kinsey [00:27:53] People have to go about their lives every single day. And 2020 isn't just going to disappear. This is something — 


Ariela [00:27:59] Right. 


Kinsey [00:28:00] That we have to recognize. So let's take a minute to think about that and we'll be right back. —


Ariela [00:28:06] And now back to the conversation with Ariela Safira. So, Ariela, we have spent a decent amount of time here understanding the state of mental health right now, how 2020 has impacted it, what businesses are doing to try to improve that mental health and to prioritize mental health and prevent mental health crises from happening. Where do you view the future of the mental health startup space moving? Where do you see the most opportunity, the most promise? What is exciting you right now? 


Ariela [00:28:35] There's so much that's exciting. I think one of the biggest pieces is moving the narrative away from a clinical one and into a much more relatable, real one. You know, they get real. We often use this clinical jargon, if you will, to describe what we're doing. Words like therapy, words like clinical efficacy, because that's what people understand. They know the word therapy. 


Ariela [00:29:01] They don't really know what is mental healthcare product. And while we are using those words, I think it's so important to think of it not as a tool for depression or a tool for anxiety, but instead, a mechanism to build a more real society. And a society that has depth beyond, how are you? Fine. I think in far more ways than we realize, we really, really have an on-the-surface culture. 


Ariela [00:29:25] A culture where family dinners are composed of conversations like, how's your job? Good. How's yours? Not so great. OK. How's the marriage? Fine. And it's so much more than what's clinically happening within us, depression, anxiety, etc. It's more than that. It's forming deep connections with others and with ourselves. And feeling life more fully. Feeling life more vividly because we actually feel it beyond these simple, one-syllable words of good, fine, bad. [chuckles] 


Ariela [00:29:55] And I think that what's so exciting is we're living in this time, like, if we're going to use startup jargon or investor jargon, sure, it's about, like, evolving the brand, evolving the narrative. And really, that is what I think is so thrilling—to move this away from a therapist, Freud, couch—move it away from that lingo to, like, no, it's not about [indistinct] or even being diagnosed. 


Ariela [00:30:18] It's like, do you know yourself? Are you living with any perception of who you are and who you want to be? And the word therapy—therapy might be something that helps you get there, but the real goal is getting you to a realer you. And that's something that I'm really excited—I'm really excited for our society to have more depth. 


Kinsey [00:30:37] Yeah. It's certainly a bit of a medical when we think about, like, how can I wake up every day and have a better understanding of who I am. But it's so important. And I think it's got to be a priority. But from a business perspective, how do you feel, and how do you reconcile, improving people's lives and helping them to be able to better relate to themselves with also making money off of those improved outcomes? Is that a difficulty? Is that something you consider in your space? 


Ariela [00:31:06] Yeah. It's a big reason why we have such a low price point. We were very much encouraged to charge $55 a month. And for many reasons, like, we're giving people number one clinicians or chief medical officers as high quality as high quality gets. And the fact that people have access to her care, her knowledge, et cetera—that typically comes the price point of $2,000 an hour, not $28 a month. 


Ariela [00:31:33] And so I think, on one hand, we're dramatically lowering the cost of care. And, you know, why isn't it free? It's because these clinicians—and everyone who's not a clinician at Real—needs to pay rent [chuckles] and bring it to life and should be—I think we have a very problematic perspective in this country of if you're building really shitty things for the world, you deserve a fat salary. If you're building good things for the world, you should make nothing. 


Kinsey [00:31:57] Yeah. 


Ariela [00:31:57] It's a very poor incentive system. And maybe after Real, I'll work on that. 


Kinsey [00:32:02] How did you sell your investors on this price point, though, if it is lower than it theoretically should be for a good product? [chuckles]


Ariela [00:32:09] Yeah. Of course, we're always doing price testing, so we're doing that. But obviously, a lower price point means that far more individuals could enter the door. And in reality, certainly a New York City-based investor, anyone who knows Real is probably someone who's gone to a therapy appointment. And yeah, if you're comparing it to a $300 therapy appointment, it's remarkable that you get Dr. Nina Vasan for $28 a month. 


Ariela [00:32:34] But I think if you're actually building a system, shared with them—if you're building a system, they want the entire country to take part in—those are individuals who not only have they never paid $300 for their [indistinct], they don't even know therapy costs $300 an hour. Maybe they've never even said the word therapy. 


Ariela [00:32:49] And to tap into those communities requires thinking so much bigger than New York therapy prices or requires thinking, what is in their line-by-line budget? And what are the costs of those things? How much are they paying for the gym? It's not what a New Yorker is paying for the gym. Or paying for exercise in general. And really, you know, obviously showing a competitive landscape in terms of what are the products those individuals are paying for and how much do they cost. Made it very clear that our price point should be $28 a month. 


Kinsey [00:33:19] Do you think, speaking of competitive landscapes, do you think that that is a competitive advantage for you? There are a lot of startups and apps out there that allow people to reach other people, whether that's a therapist or just a friend to talk to you. They get a lot of headlines. But do you think your pricing is a moat for your business? 


Ariela [00:33:39] Very much so. I think it really helps us out. And I definitely—I don't have numbers for you now, I know our head of [indistinct] just did a bunch of user interviews and shared many people joined because of the price point. So I do think that at the very least, it gives someone the opportunity to say this is low cost enough that it's worth trying. 


Ariela [00:33:58] I think what's really hard is knowing for the majority of Americans, they've never tried any mental healthcare offering. They don't know what a therapist is. They're often afraid of this concept of therapist because how they manifest in the media. And the biggest barrier of entry is it just makes this first step easier. I think it's helped us out quite a bit. 


Kinsey [00:34:18] Yeah. Taking that first step can certainly be the hardest part of getting help. I made the reference earlier in the episode about analog versus digital in terms of our mental health journeys. And I think it's also important to say here that they're also not always linear. It's not always ones and zeros that you get to a certain point and you're like, I'm cured of anxiety, every anxiety I've ever had. It's just not reality. And it shouldn't be. 


Kinsey [00:34:40] I think that's why it's been so enlightening and illuminating for me to have these in-depth conversations about the business side of mental health, but also just the ways we approach it as a topic of conversation here in the United States and even elsewhere. So, Ariela, thank you so, so much for coming on Business Casual today. Your work is certainly inspiring and interesting from a business perspective, from a mental health perspective too. 


Kinsey [00:35:03] And I've just loved hearing more about it and hearing about, you know, more broadly the ways that entrepreneurship fits into the mental health space. And our need to prioritize our mental health is always really important, but it feels especially necessary in 2020. So thank you so much for your time, I really enjoyed this conversation. 


Ariela [00:35:19] Thank you. I really enjoyed chatting. 


Kinsey [00:35:29] Thank you so much for listening to this episode of Business Casual. This was something I care deeply about making. Understanding and prioritizing mental health is incredibly important to me. So, if you want to chat more about the mental health space, tweet at me and let's talk. I am @KinseyGrant. That's @k-i-n-s-e-y-g-r-a-n-t. See you next time. [sound of a ding]