🧠 The Quantified Mind

The latest on the business of mental health and wellness

Welcome to On The Mind, a collection of stories, news, and analyses on the startups, investors, and thought leaders in mental health and wellness.

Here’s what’s included in issue No. 2:

  • How a Harvard dropout is quantifying mental health

  • Overview of digital phenotyping and digital therapeutics

  • Gratitude practice using mental subtraction of positive events

🎙️ Interview with Razi Syed, Founder and CEO of mettleAI

Conversations with founders, investors, and thought leaders in mental health and wellness.

“Mettle” means “a person's ability to cope well with difficulties or to face a demanding situation in a spirited and resilient way.” After learning more about Razi Syed and his mission at mettleAI, the name fits pretty well.

Originally from Toronto, Razi studied business technology management at Ryerson University before dropping out after two years. He started working as a software developer, but after a while, it felt stagnant. He was interested in the theoretical side of computer science and didn’t think he could learn that on his own. He decided to give university another try, this time enrolling at Harvard to pursue a Bachelor’s in Computer Science. It was there that he developed the idea for mettleAI. And then, after his first year at Harvard, he dropped out again.

Why did you decide to drop out of school to work on mettleAI?

I built mettleAI passively in school until it became more work than could be completed without affecting my own personal mental health. I wasn’t set out with a preconceived idea to build a company. I was personally really passionate about the mental health space. I’ve battled mental illness and hard drug addiction, attempted suicide, and struggled to recover from treatment despite years of trying.

At school, I began drilling down into what issues exist in psychiatry today and kept coming back to one major problem: it’s very difficult to measure mental health. When I reached out to researchers, professors, and clinicians in the field, I realized there was a lot of demand for something like this. We were hitting on some unmet need that other companies weren’t, which encouraged me to pursue this full time.

The need for objective measures in mental health is clear. How do we do it?

The way we measure mental health today is quite broken. We rely on patient self-reported data points, which leads to subjectivity and recall bias, and is burdensome for patients to complete.

Providers then have to make decisions with poor data. With this lack of information, providers have largely avoided showing mental health metrics because they’re very bad. If you really dig into the success levels of treatments, 50% of people with a serious mental health illness fail to recover.

We’re hoping to change this through continuous, objective data collection. We’re not looking to reinvent the wheel completely. By tying data to existing mental health assessments, we can procure data for a patient every two weeks, comparing results to their baseline scores and looking at behavior patterns that led to changes.

At mettleAI, we’re not developing new measures - we’re collecting already validated data points existing within every phone and wearable out there, that are just not being utilized. We collect over 40 different data points, including things such as step count, calorie expenditure, heart rate, and sleep phases. We aggregate that raw data into a platform that quantifies things like stress, appetite, energy, and mood to equip healthcare providers with a richer picture of an individual’s mental health.

What does the mettleAI product actually do?

Initially we focused on the direct-to-consumer model as an app that patients could use to track their mood and other data. We quickly realized that market was already saturated, and that it’s difficult for new entrants to really stand out, especially with players like Calm and Headspace throwing millions of dollars at the problem.

Instead, we saw an opportunity to build out a SaaS platform to help providers track patient outcomes over time. I’d call it a B2B2C platform; we’re working directly with providers to share data and insights on their patients, but patients also have their own interface to view treatment plans and medications, connect with providers, and access curated resources. With our platform, providers can see more patients, deliver better care, and more precisely track and improve outcomes.

We’re largely focused on data aggregation, but we also provide some analytics. Still, we leave the intervention up to the mental health professionals. We do, however, help measure the effectiveness of the chosen intervention. This puts us outside the scrutiny of the FDA and other regulatory bodies, since we’re not a digital therapeutic.

How are you thinking about growth?

For one, we’re in the process of planning out clinical studies in Canada and the US. With our upcoming study at McMaster University and St. Joseph’s Healthcare Hamilton, we’re looking to prove that our platform can actually work in a clinical setting. Is it effective? Can we measure and track outcomes? Can we decrease ER visits or lower scores on mental health screening tests like the PHQ-9 or GAD-7?

We’ve also started focusing a lot more on sales. With barely any outreach, we’ve secured 14 LOIs [Letter of Intents] and have a few additional customers in our late-stage pipeline, so we’re optimistic about what we can achieve with a dedicated effort. We’re starting with smaller, private practices with 1-2 providers.

As we scale and generate the data we need to improve, we’ll look at larger health systems, and could eventually take the path of FDA approval as a digital therapeutic, which could open up reimbursement revenue from health plans.

Where do you see the future of mental health going?

I’m hoping we continue to see a shift to preventative mental health care. Medications for one symptom can have side effects that increase other symptoms, which leads to reactive prescriptions of cocktails of drugs that can do more harm than good. I don’t remember two years of my life because I was on six pills, three times per day.

I also hope to see objective measurements bring us answers to some of the big questions that exist in psychiatry today: Why are certain folks more predisposed to mental illness? Why do some people relapse more than others? How do mental illnesses manifest differently in individuals?

Are there any other companies you admire working toward that future?

There are a growing number of companies working to commercialize digital phenotyping. Some great examples are Mindstrong, which is looking at typing patterns and has actually created its own smartphone keyboard, and Winterlight Labs, which is developing cognitive assessments using vocal biomarkers.

I also really like Prairie Health. I like their personalized approach, starting with genetic testing and then providing high-touch treatment.

Whether it’s genetic testing, analyzing the gut biome - I even recently came across a study where they developed a method to measure cortisol levels from earwax - I’m a fan of any company working to build an evidence-based mental healthcare system.

The movement to objectively quantify mental health is fully underway - you can’t manage what you can’t measure. It’ll be interesting to see which companies emerge here, and what new insights we can gain about the mind with better data.

💰 Recent Investments

Rundown of recent investment news in mental health and wellness companies.

📖 Interesting Reads

Sometimes mental health-related. Sometimes just things I find interesting.

  • The Game Awards are the Oscars for video games; the Games for Impact category often captures games addressing mental health. Prior winners include Celeste (2018) and Gris (2019) - 2020 winner will be announced on 12/10 (Link)

  • Snapchat reports on friendship during a global pandemic (Link)

  • Technology innovations that changed mental health this year (Link)

  • TechCrunch’s gift guide for your stressed-out, sleepless friends (Link)

  • Robots are helping to curb the pandemic’s mental health needs (Link)

  • The US is on pace to be the world’s biggest consumer of alcohol (Link)

  • Ginger beer, music, work stations. Japanese laundromats are 🔥 (Link)

  • Resurfacing the 30 (most disappointing) under 30 list (Link)

  • Unexpected coverage of Dave Chappelle from Stratechery (Link)

  • The role of psychedelic drugs in the “mental health revolution” (Link)

🩺 Clinical Coverage

Clinical concepts, studies, or perspectives on mental health and wellbeing.

Digital phenotyping and digital therapeutics are prevalent in digital health at large, and especially in mental health. What do they actually mean?

A phenotype is just an individual’s observable traits, a mix of nature (the genetic component, the genotype) and nurture (environmental factors).

Digital phenotyping extends that definition to the observable traits in our digital data. More formally, it refers to the “moment-by-moment quantification of the individual-level human phenotype, in situ, using data from personal digital devices, in particular smartphones.” Digital phenotyping is used to develop meaningful insights that can explain, influence, or predict health-related outcomes, all via data collected passively from smartphones or wearables. There is a wide spectrum of mental health applications being explored using digital phenotyping. Some examples:

  • Automatic natural language processing has been used successfully to identify individuals at risk of self-harm or suicide

  • Passive detection of changes in accelerometry, GPS, and phone utilization data has shown promise for identifying individuals at risk of depression or anxiety

  • Changes in location patterns, keyboard interaction dynamics, number of calls placed/received, and voice analysis from calls have been used to predict both manic and depressive states for bipolar patients

A digital therapeutic is “an evidence-based software intervention that is intended to prevent or treat a disease.” Sean Duffy, the CEO of Omada Health, lays out some characteristics of digital therapeutics in this helpful overview. Digital therapeutics have become increasingly prevalent; there is even a dedicated trade association. One important feature is that, at least in the US, FDA approval is typically sought so that clinicians can prescribe them and so that they will be eligible for reimbursement from payers. The FDA has had to completely revamp its regulatory oversight process to the needs of the digital world.

Companies developing digital therapeutics for mental health issues include Mindstrong (depression and anxiety), Pear Therapeutics (substance and opioid use disorders), Akili (pediatric ADHD), Big Health (insomnia), and Headspace Health (stress-related chronic diseases), among many others.

🧠 Mindfulness Tip of the Week

Tips to improve your mental health and wellbeing.

I was introduced to a gratitude practice called Mental Subtraction of Positive Events a few weeks ago. The exercise is designed to help you increase feelings of gratitude for positive events in your life by visualizing what your life would be like without them.

Take a 15-minute break and follow the steps here.

There’s evidence it works. In a study, participants were asked to think about what their lives would have been like had a positive event never happened; other participants simply thought about the event. The participants who practiced “mental subtraction”—they considered their lives without the positive event—reported feeling more positive states and more gratitude than the other participants did.

On Your Mind

Let me know what’s on your mind - email me at tarockoff@berkeley.edu.

If you’re working on something in mental health and wellness, let’s talk. You can book some time with me here.

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Written by Daniel Tarockoff, an MBA student at UC Berkeley and former healthcare strategy consultant exploring the future of mental health. Born in Michigan. Based in Berkeley, CA.