“In some ways, one of the things that's really frustrating is that mental health is kind of become this luxury, where if you have the money, you can get great psychiatric care. If you can't afford that, then the system kind of breaks down and it becomes much more challenging.” – Mike Clare
Mike Clare is Founder and CEO of Mood Health, an online platform providing psychiatry, talk therapy, and medication management for depression and anxiety. Mike was previously Director at Juxtapose, the design firm responsible for the branding of trendy companies like Care/of, Orchard, and Great Jones. His background in experiential design helped him create an inclusive customer experience at Mood Health.
Topics discussed with Mike Clare
- 00:02:38 – Mike’s background and founding Mood Health
- 00:07:19 – How the current mental health care system is broken
- 00:10:07 – Defining mental health care
- 00:12:04 – Psychiatry vs. talk therapy
- 00:19:55 – The mental health care experience in America
- 00:26:40 – Mike’s personal motivation in mental health care
- 00:32:43 – The customer experience at Mood Health
- 00:40:13 – Mood Health’s payment model
- 00:48:45 – Designing for Mood Health
Mike Clare Resources
- Connect with Mike Clare: Twitter | Instagram | LinkedIn | Mood Health
- Mood Health
- care/of
- Orchard
- Tend
- Calm
- Headspace
Terminology from This Episode
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How Obamacare improved mental health coverage
Mike and Daniel discuss how the Affordable Care Act improved access to mental health for Americans; this article outlines how.
Increasing Access to Psychedelic Medicine with Jack Swain of Mindbloom
Check out our interview with Jack Swain about using psychedelics for mental health; Mike notes that this realm is a current fascination of his.
Transcript
Daniel Scrivner:
Hello, and welcome to another episode of Outlier Academy Spotlight series, where every week, we sit down with a founder, operator, or investor working at the edge of what's next, all to learn more about what the future holds and how it's being built today. I'm Daniel Scrivner, and on the show today, I sit down with Mike Clare, founder of Mood Health, to understand why 50% of Americans live in a mental healthcare wasteland and how Mood Health is opening up access to anyone with an internet connection.
Daniel Scrivner:
In all of my years of investing, I'm not sure I've ever seen a better example of founder market fit than Mike Clare. At the age of eight, Mike's mom passed away suddenly, which left him grappling with depression that often felt crippling. He spent years seeing therapists and psychiatrists around the country, seeing firsthand just how broken the current system is.
Daniel Scrivner:
So after spending a number of years at Juxtapose helping launch and scale incredible companies like Care/of, Great Jones, Perch, and Tend, he knew exactly what problem he wanted to tackle next. Which is building a modern, mental and emotional wellness platform to give everyone great care at an affordable price, with the best clinicians, all accessible from anywhere.
Daniel Scrivner:
In this episode, we'll explore why 50% of Americans live in a mental healthcare wasteland, why the current mental healthcare system is broken, including why seeing a therapist or psychiatrist typically isn't covered by insurance, and why they typically set their own prices and also require out of pocket payment. We talk about how Mood Health is re-imagining mental health care, including why they refuse to make any money prescribing medication and how they've created an entirely new patient experience from the ground up, and a whole lot more.
Daniel Scrivner:
If you want to understand the future of mental healthcare, this episode is the best place to start. You can find the notes in transcript for this episode at outlieracademy.com/86. For more from Mood Health, visit moodhealth.com. And with that, please enjoy my conversation with Mike Clare of Mood Health. Mike, thank you so much for joining me on Outlier Academy. I'm so excited to have you on the show and appreciate you taking the time.
Mike Clare:
Yeah, thanks for having me. Great to be here.
Daniel Scrivner:
So today, we're going to go deep on the future of mental health care. And we're going to pause in a second to talk about what that is. Some of the other terms we're going to be diving into and going deep on. But we're going to be focusing on your work on Mood Health, which is a company that you founded in 2018 that's focused on making expert psychiatry specialists and therapists available to everyone digitally, including the 50% of Americans that don't have access to any mental healthcare locally. To give everyone a sense of kind of who you are, can you just share a quick sketch of your background and a little bit about why you founded Mood Health?
Mike Clare:
Yeah. So, my background is actually originally as a designer, so grew up terrible in high school, awful grades but pretty good at art. Went to design school and became an industrial designer. But then over time, transitioned away from that into more design strategy and then eventually into company building. So spent a few years at a startup studio, building companies from scratch. Some great companies, including Care/of, which is D to C vitamin supplements, orchard, which is buying and selling houses, and Tend, which is a network of dental practices.
Mike Clare:
But reached a point where I realized that I wanted to put the company building skills to use on something that I was really passionate about. No offense, to dentistry or vitamins, but-
Daniel Scrivner:
Totally okay things.
Mike Clare:
Yeah, they're great, but my passion is really around mental health. Story there is, depression is something I've always had to deal with. So when I was eight, my mom abruptly passed away. And I very quickly transitioned from who I was to a very depressed eight year old. And then at 12, started seeing a psychiatrist, was diagnosed with depression, and started taking antidepressants. And it was incredibly helpful. But I'd go in for these monthly sessions where they'd always ask, "Hey, how's everything going?" And a lot of times I'd be like, "Look, not great."
Mike Clare:
We have a lot of financial issues growing up. And I remember in one visit telling my dad about how... or telling my psychiatrist about how I had to lend my dad money for rent and how that's pretty tough, when you're 12. And he would say, "Wow, I'm so sorry. That's so hard. Also, that's going to be $200. Come back next month." And I'd hand him a check for $200 and walk outside past his Porsche with novelty license plates, with his last name on them. And even at a young age, I was like, "This is messed up."
Mike Clare:
Second part is, I then moved around and had a bunch of different primary care doctors. Each time, they'd ask me what medication I was on, tell them about the antidepressants. And they would just keep prescribing them, literally, no questions asked. And that continued until I was about 25.
Mike Clare:
And then at one routine visit, my primary care doctor, who'd been prescribing, was like, "Look, I know I've been prescribing these, but to be honest, I really shouldn't be." And she just explained that as a primary care doctor, you're often running from appointment to appointment and you don't have the time to really sit down and do an hour long discussion about your mental health. And then also, antidepressants are tricky. They're not one size fits all. So, she recommended I find a psychiatrist.
Mike Clare:
Went to find a psychiatrist and learned what a mess that whole space is. So didn't have the stats back then, but there's an extreme shortage of psychiatrists in the United States. So as you mentioned, half of U.S. counties don't have a single psychiatrist. And because there's such high demand and such low supply, they really don't need to take insurance and instead, can charge cash, pay, whatever they want. It's awful.
Mike Clare:
And so a lot of times, it's like 300 to $500 for first a visit. And so for most Americans, that's just not an option. And so for myself at 25, it was also not an option. Kept looking around, finally found a psychiatrist. And in my first session, they reviewed my charts in some intake forms I filled out, and they were like, "Look, on a scale from one to 10, your emotional wellbeing is at like a six. And if you get on the right treatment, we could probably get you up to an eight or a nine."
Mike Clare:
And I thought I was doing well, but if there's a chance to feel better, might as well do it. Tried a different medication, had a side effect known as, brain zaps, or it feels like you're being electrocuted from within your brain, and then stopped taking that medication and then started a different one. And all of a sudden, it just worked. And it was this incredible period of my life where I remember looking around just being like, "Holy crap, this is what the world is supposed to look like? This is amazing." And this was about eight years ago.
Mike Clare:
The last eight years have been incredible, but I look back at my middle school, high school, college, half my twenties, where I was in this depressive fog that it turns out, I never really needed to be in, had I been matched with the right treatment. And what's so frustrating about it is, the whole time, I'd been getting clinical care, doing exactly what my doctors were telling me need to do. But it just, it turns out that the way that antidepressants are prescribed and overseen in the United States, is deeply flawed. And so, that was really the origin of Mood Health, is building a system of care that is high quality, high efficacy, but then also affordable and accessible, specifically for those who had been traditionally ignored.
Daniel Scrivner:
That's an incredible story. I mean, one of the things you touch on there is, it sounds like the system, quote, unquote as a whole, is just badly, badly, badly broken. But there are still exceptional people, it's just, you may or may not be able to find that person. Is that kind of the right way to think about it?
Mike Clare:
Yeah. I mean, I think in an ideal world within psychiatry and medication management, everyone would be able to go to a psychiatrist. And you could spend an hour every month or every week talking to them. And that over time, they'd be able to figure out what medication works for you and everything would be good and lovely. But there's, again, this just extreme shortage of psychiatrists.
Mike Clare:
And the other challenge is that people want to get paid for their time. And so, it's a pretty time intensive process in the ideal state. And so, making that affordable and accessible then becomes really difficult. So in some ways, one of the things that's really frustrating is that mental health is kind of become this luxury, where if you have the money, you can get great psychiatric care. If you can't afford that, then the system kind of breaks down and it becomes much more challenging.
Daniel Scrivner:
Yeah. And that's obviously where a model... and we'll get into more of your particular model, but that's obviously where I think the kind of digital working with a psychiatrist or a therapist, is obviously enormously powerful. Not because it's digital to be digital, but because digital allows it to be universally accessible in a way that's not otherwise.
Mike Clare:
Yeah. Especially again, in these geographies where there's just no psychiatrist in a county. And some of our customers prior to working with us, their only option was to drive literally two hours to the closest city just to see their psychiatrist just to get a refill of meds. And for a lot of folks that's, again, just not an option.
Daniel Scrivner:
Yeah. Well, and to put it in context, that's not like a normal doctor visit. The equivalent, it seems like, I'll probably do a terrible job at this, but the equivalent in medicine would be like, you literally have a broken leg. You need to go get checked on as you're midway through treatment and you now need to drive two hours to go do this. It's not like they're doing this for fun, they're doing this for their mental health. And oftentimes, for things that are required, that need oversight, that need supervision, that need help.
Mike Clare:
Yeah, definitely. And it's, again, like... One of the things that's really tragic about being depressed is that texting your friends becomes hard, getting out of bed becomes hard. So then all of a sudden, should do your research to figure out which psychiatrist exists within a three hour drive of your house, which one takes your insurance, and then motivating yourself to do that, becomes-
Daniel Scrivner:
It's probably not going to happen.
Mike Clare:
... incredibly different. Yeah. It's-
Daniel Scrivner:
Wow.
Mike Clare:
... hard.
Daniel Scrivner:
So, we have a ton of ground to cover. And I wanted to just, kind of before we go too much deeper, stop and talk a little bit about some of the terms that will come up. And I wanted to have you try to give your best definition or your best framing of these things. And I want to start by just talking around mental healthcare. What does that encompass, what does that mean? What are the different things that kind of fall under that umbrella?
Mike Clare:
Yeah. So, it's a really exciting time for mental healthcare because there's a lot going on. That also causes a lot of confusion. But I think most broadly, I think of mental health like physical health. Like just as in physical health, there's a wide range of physical health products. It's everything from sneakers from Nike, to an organic grocery store, to weight loss programs, to your doctor. There's just a lot of different things that touch on physical health.
Mike Clare:
Similarly, within mental health, there's a lot, which is both incredible, because there means there's a lot of options for people. But then also, it can be overwhelming, confusing. So I think broadly, mental health is everything that you can do to improve how you feel emotionally and mentally. And so again, extremely broad definition, but I think of everything from antidepressants and medication, to therapy, to having plants in your house, or spending time with a dog. There's a lot of things that can be impactful for mental health that are beneficial.
Mike Clare:
Huge caveat with all this, is that I am not, myself, a doctor. And I'm sure a doctor would have a... everyone has their own definition. But I think from talking to a lot of customers and people, just everyone has their own thing to do to help manage their mental health in a really broad way.
Daniel Scrivner:
Yeah. There's no one size fits all. It's very much a personal kind of solution. Taking that one step further, can you just talk a little bit about the difference and also just share kind of a super basic definition of psychiatry or a psychiatrist versus therapy and a therapist? Because I think that's something that, again, we all know those words very superficially. What does that really mean in a little bit more depth?
Mike Clare:
Yeah. And these are definitions that I'm sure a therapist and a psychiatrist would hate my version of it. But what's most understandable to folks is, with a therapist, it's like talking. And you think of the cliches of lying on a couch, talking about your feelings and your childhood, and of the Freud stuff. That is the world of therapy, where it's... you're conquering your mental health or treating your mental health through conversation with a trained expert. Psychiatry is a mix of therapy and the ability to prescribe and oversee medication. Because of a lot of the systematic issues, a lot of psychiatrists have gone push to just focusing on the medication prescription and oversight. But technically, they're trained to do both, talk therapy and medication management.
Daniel Scrivner:
And under that kind of umbrella of medicine, obviously we talk about antidepressants, what are... We don't have to go super deep here, but just to flesh that out, I'm assuming it's not just that it's antidepressants and that's it. So, what are some of the other, I guess, kind of range of medications that they might be able to prescribe?
Mike Clare:
Yeah. So for a fully licensed psychiatrist, they're a full medical doctor. So technically, they can prescribe any medication that exists. But they are experts in medication for depression and anxiety. So, that could be an antidepressant or things... medication for bipolar or schizophrenia or psychosis. And not only be able to prescribe, but then oversee a treatment plan. So be able to look at, beyond medication, what else might helpful for that individual?
Daniel Scrivner:
Yeah, that makes sense. I want to talk for a second and... or stop for a second and just paint a little bit of a picture of what mental healthcare looks like today. And we talked about that stat around 50% of Americans, which just for context, because 50%, I don't know, it might sound large, it may not also sound large, but that's 166 million people in the United States. So, there's an enormous number of people that are affected by that limitation. Just want to call out that number.
Daniel Scrivner:
But can you paint a picture of, what is it like for people living in the U.S. to get access? What are some of the common things that people struggle with? And what is treatment quality like? And you can do this through the lens of, what are you hearing from patients of what they've gone through or what their experience has been like previously, or it can just even be your own experience.
Mike Clare:
Yeah. I think the... What I've heard from customers... So, have a lot of customer interviews and conversations. And then also, not customer, it's just starting a mental healthcare company, you end up talking to a lot of people about their mental health challenges and what they see. It's been a tough couple years. COVID has really... it's really surfaced the challenges that a lot of Americans are having.
Mike Clare:
But even before COVID, it was there. And again, millions of Americans feeling depression, anxiety, just feeling like crap, and not really knowing what was going on. And it's hard, because you reach that point where you realize you feel like crap, and then you need to figure out what to do about it. And so to your question of the landscape of mental health care and treatments, it's really confusing. A lot of people grew up with the idea that therapy equals mental health, and so a lot of folks who start feeling bad start...
Mike Clare:
... and so a lot of folks who start feeling bad, start looking for a therapist or start going to a therapist. And therapy is amazing, but again, it's not one-size-fits-all, doesn't work for everyone. So then a lot of people either stop going to therapy or can't afford it in the first place. It's, again, people's time is expensive, and an hour of someone's time every week or every other week, you're paying 1/40th of their salary. So it ends up just costing a lot.
Mike Clare:
So then a lot of folks start to look for the next thing to try. And I think this is where the variety of treatments for mental health become really confusing is that there's just so many different things. So people might download the Calm app or Headspace and start experimenting with that, or breath work or yoga or exercise. And what's incredible is that all of these solutions have scientific credibility and are proven as potential treatments.
Mike Clare:
But that process of wading through everything, trying to figure out what works for you, trying something, finding out that it doesn't work. It's really deflating. And again, if you're already feeling depressed or already feeling anxious, calling around and finding like, okay, maybe I'll try mindfulness. And you like to call around, try to find a mindfulness place. You finally find one, you go to your first class and then you're like, oh, it didn't really do anything for me. Do I do it again? Do I do it again and again and again? And then three months later being like, I still feel like crap. And then feeling like you start at the beginning, it's just deflating.
Mike Clare:
So for a lot of people, it takes about 10 years to figure out the right treatment. And it's tragic because there are treatments out there. There are solutions, but it's just so hard to find what's right for you.
Daniel Scrivner:
10 years is a staggering stat. And that process you just described, literally, I feel like the best way to describe that is you're brute forcing to try to find a solution, which is just another way of saying you have to pour in an enormous amount of energy and effort with no idea of what's going to work with the hope that something eventually works. And as you talked about, maybe that's okay if you're firing on all cylinders and if you've got a ton of energy. It's not okay at all if you're in a place where you're just not doing okay at stasis.
Mike Clare:
Yeah. And I think it's hard for a lot of people who haven't experienced depression to really understand what it might feel like. And I have this conversation with folks all the time where they're kind of uncomfortable with asking it at first, but they're like, look, I'm sad sometimes, but I don't think I'm depressed. Like it's ... I don't know. If people just tried harder or were more positive, wouldn't they be able to get out of it?
Mike Clare:
There's no real good comparison for depression besides experiencing it yourself. But in some of just how crappy you might feel, it's kind of like having the flu, where, it could be your birthday party and you're surrounded by friends, but you have the flu. It's not going to be fun. And you could go to work, but it's going to be hard to get yourself out of bed. It's going to be hard to get yourself throughout the day. And all you're going to want to do is go home and go back to bed. So the idea of doing this whole process of trial and error and finding things and research and wading through confusing science and evidence about what works, it's just hard enough to do. But imagine doing that while you are sick with the flu, it gets 10 times harder.
Daniel Scrivner:
Yeah. And well, to your point, I think, which is really important, is that it's not just feeling sad sometimes. It's much, much, much, much, much deeper. It affects everything. It affects the way you feel. It affects the way you perceive things. I think it's important for people to know that.
Daniel Scrivner:
I want to ask a question on that 50% stat. So basically that 166 million Americans don't have access to a psychiatrist, a licensed psychiatrist that's nearby. And they may have to drive hours to find one, if there is one nearby. Why is that the case? And what is the underlying factor that's made that so?
Mike Clare:
Yeah.
Daniel Scrivner:
That's a bummer.
Mike Clare:
Yeah, it is. At the core, it's that there aren't enough people becoming psychiatrists. And so on your route to becoming a doctor, you go through a certain number of years of school, and then you have to decide what you want to specialize in. And some people decide that they want to do oncology, or they want to become a neurosurgeon. And then other people decide that they want to become a psychiatrist. And a lot of what's happening is just a lot of young doctors to be are deciding to do other things.
Mike Clare:
Anecdotally, from what I hear from other doctors and psychiatrists is that there's a couple challenges. One is that there's just this huge lack of data and evidence around psychiatry. So if you look at the rest of medicine, it's very facts-based. And it's the scientific process of getting to a truth about what works and what doesn't. And with mental health, it's, again, it's like, no one knows, if there's 10 people who have depression, no one knows which one of those 10 will most benefit from medication, therapy, mindfulness, exercise.
Mike Clare:
And a lot of it's really based on individual preference of the person who's doing it or of the provider and what they kind of believe works the best, but the pure science and data isn't really there today. And so from what I've heard, a lot of doctors and doctors to be look at psychiatry, and they're like, this is different from the rest of medicine, and not really my thing.
Mike Clare:
The other thing I've heard is just again, with how much demand there is, and little supply. So many psychiatrists are just getting pushed into prescribing medication after medication, after medication, after medication. And a lot of them got into it because they care about people. They want to talk to people. They want to build a relationship with humans. It's like a very human-to-human profession, but because of the extreme need, they've had to distill their job down. Not all, but some, to just prescribing after prescribing, after prescribing. And it's not really what they're extremely passionate about.
Daniel Scrivner:
Yeah. Yeah. Which I can completely understand. If that was my day-to-day existence and I got it to help people, it'd be a little bit of dissonance there. When you talk about just that example of, you have a psychiatrist, you have 10 patients that they're seeing that have depression, and the fact that they really don't know what is going to be the answer for any of those 10. Because that just makes me wonder, is that because we've underinvested on research? Is it because it's just a much more inherently multidimensional problem and so it's never going to be as straightforward? What is your assessment in terms of why that's the case and if that will improve?
Mike Clare:
It's both. It's hard, because one is studies are just expensive. So most studies that are done are paid for by pharma companies and are kind of designed to prove that a treatment works and then they're like, that's enough. And then they move on. So I think part of it is underfunding more broad studies.
Mike Clare:
The other challenge is mental health is entirely subjective. So again, with a lot of physical health or just physical science, if you think back to science class, you have a Petri dish and you have some sort of colored mold on it. You take a Q-tip with some sort of medicine on it, swipe it on there. And then you can see that it kills the mold, and bada boom, bada bang, proof. Mental health, you provide a solution, and there are all these studies around medication. One counterargument to the efficacy of medication is like, is this medication actually working? Or is it that you had a bunch of people who were sad, and then all of a sudden you gave them someone to talk to once a month and you're paying them and so they have less financial strain, and also they just have more time to kind of deal with whatever it was that was bothering them? And it's hard to isolate what it is exactly that is helping and not helping.
Mike Clare:
And so the way that science works is just not incredibly conducive to mental health. But then I think the third part is there's just not enough data. So with studies, again, they're expensive. They tend to be smaller scale. So less than 100 people. There are all these meta studies, but I think what's exciting about some of the new technology around mental health is the ability to gather data at a huge scale, like anonymized data, but that can allow people to start looking for patterns in how different treatments impact different outcomes and how different diagnoses or feelings can then lead to matching with the right treatment.
Daniel Scrivner:
Yeah. It sounds like we'll likely never have a solution just because it is much more inherently ... It's like you have a bunch of factors that are always interacting against one another. Even to that point you were just saying, it's like food, sleep, environment, income. Are you getting enough vitamin D? It's like, there's so many factors, so many different inputs.
Mike Clare:
Yeah. And it's fascinating. Because if you think of the people that you know in your life and interact with, everyone knows someone who is a huge advocate for one of these treatments, whether it's like, oh my gosh, everyone, for their mental health, they just need to start running. It's incredible. It changed my life. It's the best thing ever. Or someone's like, oh my gosh, everyone should do therapy. It's amazing. Or everyone should do mindfulness. It's incredible. Or everyone should try antidepressants. It's the best. But the reality is, is they work incredibly well for some people. And it's the challenge of matching the treatment with the person that it will actually work for is really hard. But then I think there are just incredible outcomes that can happen if you do find the right treatment.
Daniel Scrivner:
Yeah. To your point, even in that story that you shared, you obviously had this aha moment after, what, a decade plus of treatment?
Mike Clare:
Yeah, yeah, man.
Daniel Scrivner:
Which must have been amazing, but also brutal to then think back on all the years that you hadn't found this solution and what your life would've been like.
Mike Clare:
It was truly like putting on glasses for the first time and being like, oh man, I couldn't see anything before and now like, oh, the world is actually pretty sharp and crisp and it's wild. I didn't know that was an option. And so going through that transformation, people start believing.
Daniel Scrivner:
Yeah. So I want to switch and talk about the kind of business model and get more into just a bunch of things that are interesting about the model that you're falling at Mood Health. But I first wanted to talk a little bit about, you obviously already shared your own story and your own journey with mental health. And I remember the first time we talked about that. As an investor, one of the things you think about all the time is like, is this CEO, founder, the right person to solve this problem?
Daniel Scrivner:
And that's sometimes referred to as founder market fit, which is super cringe-worthy. So I'll throw out there, especially when we're talking about a problem as serious as this, but I do think in all the years of kind of thinking about that and wondering about that, I've never seen an example of where it's clear that you're the right person to solve this problem based on your background. How does that show up? I'm guessing part of it is just endless motivation to solve this problem. A deep understanding of the need, even though you obviously are still spending an enormous amount of time interviewing customers. I think it would just be great if you could share a little bit of, what is it like to be solving a problem that you have deep, deep, deep, deep experience with?
Mike Clare:
Yeah. Yeah. It's fascinating. It's the first time I've really designed for myself. In all other cases, it's like putting yourself in other people's shoes and trying to imagine, and this the first time that I've been almost forced to be like, oh wait, no, I do have a deep knowledge of this. I think it's a lot of ways.
Mike Clare:
So one is I look at founders who start B2B SAS businesses. And starting a business is so hard. And you have periods that are amazing and you have periods that are incredibly hard and stressful and demoralizing. And I look at some folks that are starting businesses that aren't necessarily deeply passionate about it. And I'm like, how do they keep going? But for me, I think it really feels like, no matter, what this needs to happen and this needs to succeed and we need to help people get the right care. And I think that is really motivating to me. And then also for the team.
Mike Clare:
So a lot of the team has had their own experience with depression and anxiety. And I think because I've felt so profoundly the impact of having the firsthand experience, we've hired folks who are deeply mission-driven and deeply understand the problem and what it feels like. And I think how it's impacted actually building the business is we've made some decisions that from the outside seem counterintuitive or like a bad idea, that some investors, especially in our earlier rounds, really questioned. And it just felt so obviously right to us because we've been there. I think that's starting to play out now, we're seeing some of our competitors who have made different decisions and seeing that ultimately some of these choices were the right ones and are having an impact in just much better customer retention, customer satisfaction, and being able to attract customers that they might not be able to.
Daniel Scrivner:
Yeah. I think everybody has a lot more intuition than we all give ourselves credit for. And my guess would be that a lot of customers can feel that you guys truly understand the problem. And not to put words in your mouth, but part of how, I guess, I think about that when I think about you is, I think anybody can, from the outside looking in, come to a problem and think about an interesting future state of it. So maybe be able to have a vision of what this could be. I think it's very different when you understand the gritty, ugly, not so fun, not so awesome parts of it. Because ultimately, that's where I feel like all of the meat is, and if have that experience, as you clearly do, and as the people that you've hired on the team do, I just think you bring a lot more realism and empathy and, I don't know, kind of a holistic wholehearted approach to trying to solve the problem.
Mike Clare:
Yeah, totally. And I think one of the major ways it's played out is just in our care model and how we interact with customers. I think a lot of competitors, and even when talking to people, a lot of people just assume that because we're focused on antidepressants, the value we're providing to the world and to our customers is that we can prescribe antidepressants. But then for folks internally, and for me, we really see the antidepressants as like 10% of what we do. And 90% of it is giving people a place to come when they know they feel like crap, they don't know what to do about it. And then being able to match them with a really ...
Mike Clare:
And then being able to match them with a really empathetic caring clinician who can build a long term relationship with them and become their guide over time to help them figure out what works best for them, whether that's antidepressants or something else. I think that's, again like a counterintuitive decision where a lot of our competitors are just prescribing people medication when trying to minimize any interaction with clinicians. I think we deeply believe and know that really that's not why customers are coming to us.
Daniel Scrivner:
Yeah. You guys are building row or keeps for mental health. It's not the prescription forward, simplistic approach.
Mike Clare:
Yeah.
Daniel Scrivner:
Not at all.
Mike Clare:
Yeah.
Daniel Scrivner:
We're going to talk about some of the unique things of your model in a second. But before we do that, I wanted to see if you can paint a picture of what the customer experience is like at Mood. What I mean by that is, walk us through what a customer goes through, where obviously they maybe find out or hear about, or are referred by a specialist to go and check out Mood. They land on the site. They then go through this journey of finding the specialist that's right for them. And then after that I have a lot less clarity of what that looks like. So maybe what is the beginning finding a therapist look like? And what does the ongoing study state look like for a customer?
Mike Clare:
Yeah, so I think the magic really comes after you get matched with the clinician. So to your point, find out about Mood, land on our website, go through the onboarding, which is meant to really be streamlined as much as possible, but just filters to make sure that if we're not going to be able to provide care for you, that you don't waste your time and money on a first appointment. But then so much of it is really built to be about the interaction and relationship that you build with your clinician after that.
Mike Clare:
For those who are doing psychiatry, so medication matching and ongoing relationship and kind of high level coaching about what to do with your mental health, what that looks like is you have a first meeting and it's 45 minutes to an hour long, which is much longer than most of the tech enabled psychiatry providers out there, but is really what you need to not only diagnose for depression, but then also from a clinical standpoint, make sure that there aren't signs of bipolar or other mental health issues. That you could probably do in a shorter period of time. But we make sure that there's also a lot of time just to build a relationship and get to know each other and get into what else is going on in your life. How is your family? How is your relationship with other people? Are there other things that you're dealing with? Are you struggling financially?
Mike Clare:
Because it's again, you really need a complete picture in order to be able to really help guide someone holistically. That's the first visit. And then if medication is part of your plan, which again, it's not for everyone, then we'll either prescribe to a pharmacy of your choice. So Walgreens, CVS, whatever it might be, or we have a mail order pharmacy where you can get meds for usually five to $10 for a month supply. And then there's a period of about two to four weeks of starting the medication and letting it kick in.
Mike Clare:
The amount of time between visits is totally at clinician discretion. So some people are seen more frequently, some are seen less frequently, but you then have follow up check-in to make sure everything's going all right. And then we have some tools and forms to fill out between sessions to make sure that we're helping each customer articulate how they're feeling. And then we are also weaving in a number of, so each month after that we're having deeper dives into other areas of someone's life and helping coach them through different solutions for that. So that might be how to get better sleep, how to incorporate physical movement or looking at intake of coffee and alcohol and how that might impact things. So trying to really get a holistic picture of what's going on in someone's life and make sure that we're approaching from all angles to make sure those are the highest chances of feeling better.
Daniel Scrivner:
Yeah. Both makes a lot of sense, but it is super helpful and interesting to kind of get a clear picture of what it looks like after that first assessment and this idea, it sounds like the idea is obviously at those sessions, you're going to talk about some of the same stuff, but you guys are also trying to really bring a holistic idea of kind of looking at the problem from different perspectives over time. To try to help somebody I'm sure under themselves, but also help the clinician or the specialist be able to help them.
Mike Clare:
Yeah. Again, we also offer talk therapy. That's either combined with that or separate, but a lot of that is again talking about your past and how you're feeling and what's going on and really exploring that. Whereas the version of psychiatry that we offer is really about what are some proactive things that you can do that can help improve how you feel? Again, therapy is great for some people, not for others, different things work for different people. And so again, our goal is to be able to easily serve up those different things so that people can find what works.
Daniel Scrivner:
Yeah. When you talked about that first session and it being 45 minutes to an hour, and that that's a lot longer than some of your competitors, that's really surprising because I feel like even when I'm meeting someone new, it often feels like half an hour is a super short conversation to try to just meet that person, get to know them. So one it's frightening that there are initial sessions that are much shorter than that, but it also feels like obviously to your point, not even from the clinician or the specialist perspective, but from the patient's perspective, it's deeply personal. They want to make sure that they actually know this person and are comfortable with this person and like the way that the sessions go.
Mike Clare:
Yeah, it is terrifying. I think there are so many parts of it that are messed up. So I think a couple competitors that will remain unnamed, but I tried one and my colleague tried another, had a 15 minute appointment. And after that they just asked about questions that would cover the basic medical necessities. And then they were like, okay, we're going to send the medication to Walgreens. It was just like, did not feel like they really thought things through or explored other possible treatments or anything else.
Mike Clare:
And then the other thing that's terrifying is right now, 75% of antidepressants are actually being prescribed by primary care doctors. I mean, every time you go to the doctor, it's like, you go, you wait in a room, the nurse comes in, you spend some time with them. And then the doctor flies in and they're like, "Hey, how are you doing? Good to see you. Here's the diagnosis, here's a prescription. See you." I've talked to countless people who have had the experience of oh my God yeah. I told my doctor that I was feeling a little weird and then they just prescribed me Prozac and sent me on my way. I never filled it or took it because what the hell's going on? I think maybe medically that was the right clinical decision or the, I don't know, but as a customer, that feels just so abrupt and uncomfortable and you really want someone who's going to think things through and be your partner in figuring this all out.
Daniel Scrivner:
Yeah. Even just trying to think about putting myself in that person's shoes. I wouldn't even feel comfortable taking it. I'd feel kind of gross that I basically got a, we don't need to talk about it anymore. Just go and ingest this and it's going to fix the problem for you as opposed to some more I don't know, emotionally holistic experiences is really negative.
Mike Clare:
Yeah, totally. It's a shame because again, medication can be the right solution. But I think as a customer, if you feel like it's been prescribed carelessly, then you're not going to be confident about taking it.
Daniel Scrivner:
And you're going to ingest it and it's going to influence how you feel and everything about how you live your life. That seems like there should be a higher bar. On that note, I did want to ask, I mean, one of the really novel things of the way that you're approaching this problem is that you're not making any money off medicine, which I think is incredible. And part of that, obviously, which I want to flesh out a little bit more is just this idea that the incentive structure is broken. I think even if no one's had the direct experience that you have had, even some of the things you've brought up so far are, it's hard to hear those and listen to them and not think, wow, that's incredibly broken. But talk a little bit about why the current model is broken and why not charging for medicine is so important to Mood?
Mike Clare:
Yeah. So I think when talking about the model, there's the way things were, and then there's this new wave of startups. I think within the way things were, a lot of the issues are just accessibility, not being able to find a psychiatrist, not being able to afford a psychiatrist and doctors and therapists don't make money from medication. There's very good reasons for it. And there's a lot of laws saying that doctors can't make money from selling medication.
Mike Clare:
Recently, there's this weird blurred zone of these companies that can prescribe medication and are selling medication. Some of them have guardrail setup, there's protections around misaligned incentives, but it's pretty weird, right? To have a doctor that's like, "Oh, why don't you buy this medicine from me?" And, or working with a company where the more prescriptions they write, the more medication or the more money they are going to make and we've taken the stance that it just, it gets into weird territory.
Mike Clare:
So for us, we do not make any money off of the medication. We work with a partner pharmacy so that our customers can get meds for five to $10, but it's really a pass through, we don't make any money off of it. It just sets up a situation where as a customer, we want to give customers peace of mind that their clinicians truly are just looking out for what's best for them. And a lot of our customers, they end up coming through. Maybe they want medication and it's not right for them. So our clinicians don't prescribe and that's great. Really it's about getting people the care they want or the care that will most benefit them. And sometimes that's meds, sometimes that's something else and we want to be able to provide whatever it is.
Daniel Scrivner:
Yeah. I mean, I love that call because for a bunch of reasons, but I think one of them is I think even just the notion that our value isn't in prescribing medication. Our value is much, much, much more kind of upstream from that or higher level from that. It's about really solving the issue for the individual. Obviously anytime you have kind of a profit motive or an incentive to be able to do it. I mean there's been one is just common sense, but two, there's been an enormous body of research that suggests that we're very influenced by incentives. So that's around not profiting off prescribing medicine because clearly you still need to do that and to your point, you still, from a being able to deliver a great experience to a customer, you need to be able to fulfill their medication and make it easy for them and make it cheap for them, but you don't need to make any money on it.
Daniel Scrivner:
Kind of then shifting and talking a little bit about pricing in general. I mean, one of the things that you brought up was one that people can free peg their prices. It sounds like just like a lawyer be like, this is the rate I'm going to charge. And then two, just the fact that there's not even pricing. I also don't know. We haven't even covered how much is covered by insurance or not covered by insurance. I know there's a lot under that umbrella, but can you share just a little bit of how pricing works outside of Mood and how you guys are thinking about it and approaching it?
Mike Clare:
Yeah. So I think the general buckets that it falls into are cash pay or insurance pay. Within mental health higher than any other specialty or fewer psychiatrists take insurance than any other medical specialty. Again, a lot of it is just that there is the demand where they don't need to take insurance. And if insurance is going to reimburse them, call it $150 $200 for a first visit or they could charge $500 they're like, I'm going to charge $500 and they do. And so for psychiatry easily, a first visit is $300 to $500, if it's not covered by insurance. Follow ups can be a $100 to $200 depending on who you're getting care from. Again, that's a lot of money.
Mike Clare:
And so then the other bucket is insurance and insurance has a lot of special quirks that make it really hard to navigate and even talk about as a general category because it's so varied. But like any other type of medical care it's going to either your insurance is going to totally cover it, or you're going to have a copay that could be 10, 20, 60, 75, a $100, depending on your plan. You might have a high deductible plan and need to pay out of pocket.
Mike Clare:
It's incredibly confusing because a lot of people who go in to get mental healthcare don't really know how much is going to be covered. What's going to be covered. Some have limits in the number of sessions you can have. And so it just the financial side gets really messy. But I think at the end of the day, what's hard about mental health solutions that are human intensive is again, you just need to pay people for their time and that is costly. A doctor's visit can easily be five minutes and that could be the right amount of time. Mental health sometimes a visit can be five minutes and that's fine. Other times you need an hour and it gets pricey.
Daniel Scrivner:
How on the insurance side are you guys thinking about that? I guess even just more or at a higher level, one of the things I don't have any great knowledge on is how much of mental healthcare in general is even covered by insurance versus ailments, versus breaking a knee, breaking a bone or just anything that happens with your body?
Mike Clare:
In theory, health insurance companies need to cover mental health and part of the affordable Care Act. And they also need to pay parity between what they would pay a mental health practitioner and what they would pay a doctor for the same thing. That's in theory. In reality, there are a lot of insurance companies partner with these other groups that do all of their mental health care coverage. What's happening is a lot of those groups just have really terrible reimbursement rates, so no clinicians want to take that insurance. And then they just have these really limited networks. So when you try to find a provider who's a network, there is multi month wait lists, or just no availability and it's pretty messed up.
Mike Clare:
Best case scenario though is you have insurance, you go and you find a provider who takes your insurance and they pay for your care. And so it's, again, one of the things that's really confusing and hard is as a customer, it's like, which one of those insurance plans do I have? We do insurance check to make sure if we have a plan that, or if a customer has a plan that we cover, that we get as many of those details up front, as we...
Mike Clare:
That we get as many of those details up front as we can get so that no one goes in blind, but, otherwise paying out of pocket is kind of the other thing that people might have to resort to.
Daniel Scrivner:
Yeah, just a bummer. I hope that improves. I did not know that under the affordable care act that mental coverage got in improved. I think that's something I should have been covered more because I think that's a relatively awesome thing because obviously even to your point, these psychiatrists are literally doctors. They go through the same training in education. They can basically do anything that a doctor can do. They're just mentally focused. So why would there ever be a world where they would not be paid and compensated the same as a regular doctor, but you know.
Daniel Scrivner:
One of the things I wanted to kind of talk about for a second is I want to dive into a little bit about how your background and design and how your background of being a part of kind of booting up and running these various different companies, that you mentioned at the beginning, informed how you built Mood. I want to start first with the design piece because one, I have a background in design then made my way into business. It still is relatively uncommon. So I want to compare notes, but even for anyone watching the video version of this interview you've got a sweater with this amazing little face on it and you have this little character on your website. So I don't know, maybe we can use that as a lens to get into it, but how do you feel like design has been a tool or been a perspective or a lens that you've used to build Mood from day one?
Mike Clare:
Yeah. Yeah. I think it's interesting because a lot of times I think of what I still doing now as being very similar to design. And I think the core of what design is, in at least the way I've always approached it, is understanding people and then making something that resonates with them. And you could do that through making a really nice poster. Or again, I went to school for physical product design and industrial design. It could be a physical product or it could be a service or it could be an app or it could be a startup. And I think part of my training as an industrial designer is getting into manufacturing and manufacturing techniques and how things actually get made. And so I think of building a company and having a team is just kind of an extension of that. Where to be a really good designer, you need to understand how the thing gets made.
Mike Clare:
I think by partnering with the rest of the team and collaborate on things where I don't need to be able to do it myself, I don't need to actually build the thing, necessarily. But just having that curiosity and desire to understand, I think has lent itself really well to building a business. There's all the obvious things of being able to make something that looks nice. I think that's something that's core to how we approach our digital product and our brand. But then I think there's a lot of less obvious lessons that can be drawn from the world of design that are really applicable here. I think the biggest one is just understanding people and understanding customers and having that empathy and approaching things in a way where you're constantly a student. I think the other important lesson is within design, so much of your work ends up getting thrown out and never makes it out into the world. And also in like the world of critiques, you're just constantly getting beat up and things torn apart. I think if you're a good designer, you kind of learn how to take that feedback, those times of building something and not getting out there, and being able to shift that into a positive outcome or trajectory.
Mike Clare:
I think with a startup there's a lot of like fail forward fast type stuff where a lot of things you try it's, it's not going to work and it's not going to be a success. And I think not letting that get to you is something that design has trained me well for or beat in into me.
Daniel Scrivner:
It's the second order effect.
Mike Clare:
Yeah. But has been really a valuable way of framing how we work as a company and how we operate.
Daniel Scrivner:
Yeah. I love that answer. I love the kind of ... obviously there's the super simplistic, like what boxes does design help you check, like having a decent looking, or good looking website and brand, et cetera. But I think those second and third order effects of like what by doing design for some amount of time at a, at a decently high level, you do develop a lot of these, I think, very powerful meta skills. One of the things I wanted to talk about just in particular and we don't have to belabor the point, but you kind of talked about it or at least you hit the high level of what I wanted to cover, which is for anyone listening, absolutely go to moodhealth.com. And we'll repeat that again at the end and you should go check it out, but I wouldn't just call that a good looking website.
Daniel Scrivner:
I think to me it feels like number one, you deeply understand your customers just in the language that you're using in the positioning that you're using. But I think there's something also very novel of, and I think this is what I wanted to try to see if you could flesh out a little bit is there's so much ... when I look out at the world, there's a lot of design that's used to build beautiful looking consumer products and there's nothing wrong with beautiful looking and consumer products, having a great messaging app and a photo app and an email lap, all that Stuff's great.
Daniel Scrivner:
It's very different when you think about something like the problem that you're solving, where it's very emotional, it's also medical and the reason I'm saying that is number one, there's this inherent qualities of it that I think design should actually move much more forward, because you should realize that you're dealing with this sensitive thing. But the other point is I think if you look at Mood's site and then go to kaiserpermanente.com or go to any other site, there's a very stark difference between medical clean, kind of soulless, doesn't even feel like they want to sell you soylent, and I think what you guys are doing where there's cute characters and you really do understand that. I've kind of done a terrible job of setting it up, but can you take that and run with it? And I guess talk a little bit about what that's like.
Mike Clare:
Yeah. So I think one of the things that's really incredible about design is that it allows you to not tell and kind of put your money where your mouth is. There's this whole world of ... if you think about the opposite of what we're doing, to your point, like Kaiser Permanente, lots to respect about it, but something that we hear a lot from customers is that they don't want to find some old dude in a lab coat to tell them about what it feels to be a 22 year old, bisexual, African American. You want to have someone who you feel like you will start with a baseline of understanding that they'll believe you and not doubt what you're saying. And so what we've tried to build with the brand, but not just the brand and how it's visualized, but truly who we are is like, we've been there. This shit sucks. It's fucking hard. And you're not going to be like happy go lucky cheery the next day. What we try to show through our brand is again, that idea of we get it, we've been there. And so the character on our site, which we call the funk-
Daniel Scrivner:
I love that as a name, that's a good name. It's very cute.
Mike Clare:
Well, thank you. The goal with that, a great illustrator, Stephanie Davidson, who's a good friend from college, an incredible illustrator, worked with her on it. And a lot of what the goal was was how do we show people that we've been there? And I think talking to people about something that's hard, whether it's when I talk to people about the fact that my mom passed away, or I have depression, if someone hasn't had a parent pass away or they haven't dealt with depression, there's this kind of like, oh wow, I'm sorry, that must be really hard. And then it's like this kind of uncomfortable, nervous energy. If I talk to someone else who's had a parent that passed away. They're like, oh my dad's dead too. And it's like, anyone outside is like really uncomfortable with it. It's really awkward. But it's this kind of shared language of, yeah, it sucks. It's hard. And I've been there too.
Mike Clare:
And so with the funk and with the way that we've done our brand, it's really about like, yeah, being depressed sucks. Sometimes you're going to be sad. Sometimes you're not. There's going to be ups and downs and throughout all of it, we can joke about a little and like we can make it kind of fun and not make it weird because we've been there, you've been there and we get it. And again like the funk is one example of that. But then like through our onboarding, we try to not ask really abrasive clinical questions right away, because we're just getting to know each other. And then the clinicians we hire are incredible and incredibly empathetic. And again, a lot of them have been there and we hire from a diverse range of backgrounds so that people can match with someone that they're comfortable with. Again, at the end of the day, it's about how do we match people with someone who they feel comfortable with and they trust can guide them through this journey.
Daniel Scrivner:
Yeah. I love that note that a part of it is once someone's gone through onboarding that they don't show up and it's an old crusty dude in a white lab coat. I think that says a lot about one, I think the way that just this generation wants to experience life and go through the world and they want it to be less hierarchical and more a meeting of peers and people that kind of beneficially respect each other. But I think it also is that is the power of what you're building and I think this like latest wave of companies like Mood that are solving very, very hard problems that have been around for a long time, but I think are taking, in some people's eyes, it's probably a different approach and it probably, they might think it's too casual. They might have all these opinions about how it's being executed. But I think a big part of it is just people want to feel comfortable. There's no reason that their experience dealing with mental health shouldn't be just as great as going into Instagram or going into another app. And so I think just bringing out big level of quality into everything that you do.
Mike Clare:
Definitely agree.
Daniel Scrivner:
Well, that's a great note to end on. This has been awesome, Mike. I so appreciate you taking the time to come on. For anyone that's listening, you can find Mike on Twitter @MikeAClare, you can find Mood health on Twitter, @Mood_health and I highly encourage anyone that's listening that this resonates with you, whether you just want to look at Mood as another company doing something really interesting, or if you're grappling with anything yourself and you think Mood could help absolutely go to Mood health. And I'll just want to ask, is there any kind of final closing words, closing thoughts you want to share Mike for everyone listening?
Mike Clare:
Yeah. Mental health is hard and it can be a crappy journey, but different things work for different people and if you find what works for you, it can be really transformative. And then I think with that, a lot of times if someone themselves isn't feeling depressed or highly anxious, or isn't struggling with mental health, almost everyone knows someone or someones who are. And I think the theme of just different things work for different people. I think that the most kind thing you can do as a friend or a loved one to someone who's struggling is, at the very least, just be supportive of whatever they're trying. And maybe it's not the treatment that you would want to do or that worked for you, but just encourage them to get help or, at the very least, just support them in whatever they are doing to feel their best can mean a lot.
Daniel Scrivner:
That's a perfect note to end on. Thank you so much for the time, Mike.
Mike Clare:
Thank you.
Daniel Scrivner:
Thank you so much for listening. For links to everything we discussed, as well as the notes and transcript for this episode, visit outlieracademy.com/86. At outlieracademy.com you can also find incredible interviews with the founders of Superhuman, Levels, [Rell-ee], Common Stock and primal kitchen, as well as bestselling authors and many of the world's smartest investors. You can now also find us on YouTube at youtube.com/outlieracademy. On our channel you'll find all of our full length interviews as well as our favorite short clips from every episode, including this one. You can also follow us on Twitter, Instagram, and LinkedIn under the handle outlieracademy. From our entire team. We hope you enjoy the show and we hope to see you right here next week on outlier academy.
On Outlier Academy, Daniel Scrivner explores the tactics, routines, and habits of world-class performers working at the edge—in business, investing, entertainment, and more. In each episode, he decodes what they've mastered and what they've learned along the way. Start learning from the world’s best today.
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