A beautiful mind: Mapping the rise of digital mental healthcare

Career burnouts have been known to typically happen to young people in their early 30s. Gauri Joshi ran smack into one at 22.

She had joined a reputed agency after completing her post graduation from the Indian Institute of Mass Communication last year, amidst Covid lockdowns. It wasn’t easy, for her or her employer. 

“Online working and online inductions were as new to companies as to new employees. That made hand-holding difficult, leaving feelings of worthlessness and inadequacy,” says Gauri. “There were personal issues as well due to spending long hours at home and not being able to cool off through social engagement.”

That’s when she realised she could avail corporate therapy, thanks to her company's tie-up with Trijog, a mental health organisation.

“In a bid to overcompensate for the lack of physical presence, I, like many, overworked round the clock. I felt burnt out for the first time in October. I was told the work I was doing was not enough. There were unhealthy comparisons drawn. I felt worthless by the day, till my therapist intervened in January and we began deliberating on (my) resignation for two months.” 

In India, two out of every five professionals experienced increased stress, burnout or anxiety owing to the pandemic, as per LinkedIn’s Workforce Confidence Index ‘mental health’ edition survey at the end of 2020.

While companies switched to remote work, only one in five professionals in India were offered more time off for their well-being, including emotional well-being. 

Several were reported to be locked in at homes with perpetrators of abuse. The condition of people with existing mental health issues worsened due to increased loneliness, anxiety and panic attacks. In fact, within a week of the first lockdown in 2020, reported cases of mental illness in India had increased by 20 percent, as per this survey conducted by the Indian Psychiatry Society. From frontline workers to students, professionals, Covid survivors, young adults, and the elderly, everyone was at risk. 

For several, awareness about their own mental health condition–including the need for active self-care, prioritising their happiness, addressing their vulnerabilities, and acknowledging their pain–is itself a privilege. 

It is tougher for many to reach out for help because of a lack of time, financial resources, opportunity and privacy. This is especially true in India, where intersectionalities of socio-economic conditions, gender, regional geographies, caste, class, and religion often act as barriers to healthcare, let alone mental healthcare. 

Innovations and online interventions

As the pandemic accelerated a mental health epidemic that organisations and communities could no longer ignore, a digital disruption began gradually altering the landscape of mental healthcare.

Online therapy has been a respite for many, including the always hustling breed of startup entrepreneurs, who could not afford time, or even resources, to avail help for their emotional needs. 

“More than saving time and resources, (online therapy) de-stigmatises the experience and there is more privacy and safety when one is in their own space,” says Gauri, who now works in the female hygiene space, comfortable in her company’s hybrid workplace. “Huddling with the team over a cup of coffee gives me more energy and ideas than over virtual calls.”

For entrepreneurs, storytelling as a tool

Speaking on the psychological juggernaut an entrepreneur has to navigate, Sinjini Sengupta, founder of leadership development platform Lighthouse that leverages storytelling as a tool, says, "As an entrepreneur, we almost have seven voices in our head talking to each other at the same time. The pressure is immense; there is no guarantee at the end of the month or the quarter. It requires a different kind of consciousness, awareness and proactive behaviour as an entrepreneur to be cognisant about our mental health, to ensure that we have our heart in it, we derive joy from it, and we prioritise our mental health towards building our brand." 

A number of Sinjini's clients are entrepreneurs in the social impact space as well as women coaches, and somewhere in the equation the mental quotient shows up in the vibe, the passion, the purpose and the energy that the entrepreneur is bringing to the table. 

She advises her clients ask themselves these questions: 

• What do I feel stressed about? 
• What drives me? 
• What gives me joy? 

These eventually become part of the stories during her sessions with entrepreneurs, which often get curated to shape an authentic personal brand of the founder. The more authentic the brand, the more customers get invested in the brand.

Sumeet Singh, founder of mental health initiative Enso Innovation Lab, says mental health organisations are increasingly combining digital tools and virtual care for end-to-end patient care, including steering patients to in-person care when needed.

“Among the primary reasons people choose our platform is the easy access to the right mental health providers and the flexibility in availing services. We do a preliminary consultation and match users to the right therapist according to their needs.” 

But as more people flocked to digital platforms for help, Sumeet saw his helpline for frontline workers often unable to manage all the queries. “We realised there are not, nor will there ever be, enough mental health providers for each of us to  get the care we need from traditional models,” he says.

Which is why in April, Enso launched a daily mental health app called Sage Turtle, condensing “the therapy experience into a gamified self-help toolkit”.

“Most of the people who were reaching out to us were at a stage where medicalisation was not something they were ready for, and mindfulness was not going to be enough. This made us understand the need for a solution to empower people to support their own mental health needs.”

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Social media, stigma, and the joy of tech

Awareness on mental health has gained wider currency in part owing to famous personalities opening up about their own stories. And with social media churning out frequent content on self-care and online communities engaging with intersectional mental health, the tech-led digital mental healthcare and healing space has also gained traction. It’s a space that provides anonymity and accessibility, and is perceived to be safer and non-judgemental than traditional ones.

All these have helped to normalise seeking therapy. The inherent stigma or bias has always singled out people displaying the need to talk about their emotional state of being. Today, the narrative is shifting. 

“There was a noticeable increase in the number of people seeking help during and after the pandemic,” says Berlin-based clinical psychologist Drishti Jaisingh, who offers online therapy to individuals and couples, mainly professionals or students in semi-urban and urban areas.

“Digital intervention has made mental healthcare accessible for one and all, and I believe seeking help has been normalised.”

Disrupting mental healthcare

Platforms like Sage Turtle are also working to streamline digital mental healthcare with effective efficacy measurement. 

“One of the reasons why people don’t take care of their mental health needs is because they don’t know how to  measure it,” says Sumeet, who has been developing technology products for social impact for over a decade. His co-founder Shuchi Goel is a psychologist with over 10 years of experience as a behavioural and mental health professional. 

“We use science-backed validated tools to determine the  baseline to measure well-being quotients on various parameters. Our coping skills building games/activities are based on positive psychology, neuroscience, and behavioural psychology. These are based on results that come from users after working on activities,” explains Sumeet. 

Digital mental health startups are also working to solve the problem of inadequate datasets, which could prove to be valuable in evaluating the scale of the mental health challenge. Another challenge is the lack of continuity, a barrier that mental health tech startups are aiming to solve with their data-driven approach and integrated services.

There’s another crucial area of concern with anything online that digital mental healthcare providers are addressing: online privacy. 

“As part of our (minimum viable product), we connect end users with the best-in-class therapists via in-app GDPR-compliant audio/video calls,” says Amit Singh, Chief Executive Officer of Lisners, which operates an Android app based on a psycho-social model of health and is powered by research-based voice analysis technology. 

“The user can avail the services without even sharing their contact number with the therapists. We do not use chatbots in any corner of the app for end-user interaction... We do not record any calls. We have innovative and engaging in-app patient tools to collect data/record symptoms at home.” 

‘Work’ing into distress and despair

The following have been some of the top concerns for which care-seekers have reached out to Sage Turtle:  

• Workplace stress (job uncertainty, loss in business, workplace demands) 
• Balancing relationships (spouse, parents and children)/marital discord 
• Stress due to career achievements, pressure of acquiring status symbols (home, car, etc.) 
• Chronic illness (diabetes, hypertension, thyroid) 
• Coping with the loss of a loved one 
• Anxiety due to health issues and uncertain future 
• Excessive negative thoughts 

“One of the most common issues we have witnessed among remote working professionals who have reached out to us is their struggle to unplug from their professional life, leading to  burnouts and other concerns,” says Sumeet.

“Having 24x7 access to work has led to remote working professionals to work constantly. This, over a period of time, reduces productivity and increases the feeling of guilt in the professional for not being able to meet the standards even though they seem to be constantly working.”

A mushrooming, but not without challenges

The online boom has pivoted a mushrooming of mental health startups. But for care-seekers whom to trust remains a big question. 

Trijog, founded by mother-daughter duo Anureet and Arushi Sethi in 2015, addresses this with an extensive recruitment and training process. 

For a therapist to be onboarded, the minimum qualification required is a master's in psychology, minimum three years work experience, and a RCI (Rehabilitation Council of India) certificate, says Sahej Sethi, director at Trijog.

The next round of screening factors in multiple parameters, evaluating how attentive and calm a mental health practitioner is, to their overall suitability in navigating the nuances of identity and culture that a diverse set of clients bring in.

Apart from testing their technical knowledge, Trijog provides prospective therapists with another intensive training factoring in various aspects of digital counselling, from sudden outbursts to stress sessions. 

Drishti, the Berlin-based clinical psychologist, weighs in: “There are lower dropout rates and more enquiries for therapy. At the same time, connectivity issues, confidentiality being compromised, and clients in ‘unsafe’ households have difficulties and prefer offline sessions.”

Gauri points to another challenge: of therapists not being able to pick up on visual cues, or “vibe,” as she puts it, during online sessions. Even so, “there are more merits than demerits of online therapy,” she says.

“In my opinion, the option has democratised therapy economically and socially, without the stigma or costs attached to offline sessions.”

While virtual care and digital tools are emerging as essential or allied care systems rising above boundaries of geography and constraints of time, and proposing lower per-head costs, the missing link of human touch will always be there. 

Tech metrics may provide evidence-based solutions but there are nuances, meanings and multiplicities at play, for the mind is an infinite space. There is also the danger of anyone being called and promoted as an ‘expert’ on online platforms–having empathy is not the same as being a mental health professional. Access to tech itself is complicated by lack of privacy, freedom and equity. Sure, the dream is that of a dynamic, fluid, immersive, and safe future built upon diversity, dignity, and empathy.

Cover image by Aditya Ranade

(Updated with visual on organisations/startups working in mental health)