The Future of Mental Health Care–and the Role of an Inclusive Solution

BY Erika Riley | May 03, 2023

Over half of Americans will develop a mental illness or disorder in their lifetime. Still, more than 50% of adults with mental illnesses do not receive treatment. Even if everyone with a mental illness or disorder wants to pursue care, there aren’t enough therapists. If every one of the 500,000 mental-health specialists in America fully maximized their schedules, they could still only fit in weekly one-on-ones with 7% of the population, says Ariela Safira, founder and CEO of Real.

As Safira puts it, there is no working solution in mental-health care.

“I know so many people who are struggling, really struggling with their mental health. And there’s no care system or care model that’s identifying their needs, helping them to identify those needs, and bringing them to appropriate care,” she said. “The vast majority of people I know are actually struggling in silence.”

Safira spoke on the future of mental health care and Real’s inclusive solution during From Day One’s February virtual conference, “Beyond Good Intentions: Measuring and Accounting for Progress in Diversity, Equity, and Inclusion.”

Safira has worked in the mental health care space for over a decade. After a close friend attempted to take their own life, she saw how the mental health care field failed Americans.

“And while that wasn’t the first time I’d seen mental illness, it was the first time I’d seen mental-health care, which felt hugely problematic for me,” she explained. Not only did I see the mental health care system, but I saw the flaws within it. So I threw myself at it and have not stopped working on it since.”

The statistics are staggering, even more so for marginalized communities; only 25% of Black Americans seek out mental health care, compared to 40% of Americans, and the adult Black community is 20% more likely to experience rates of severe mental health problems than other populations.

“That’s not a problem a startup or a network is going to solve for you, because we just don’t have enough therapists of color,” said Safira.

After dropping out of Columbia University, where she was studying to become a clinician, she founded Real, which launched in 2020. This year, the company is launching “Real for Work,” which allows employers to offer the product to their employees as a wellness benefit.

“Ultimately, you know, I found myself at Columbia thinking, I’ve seen every mental health care solution, and none of them work. And even those that say they’re working aren’t quite working. I look around and no one in my family would ever see a therapist,” she commented.

Real is working to fill in the gaps left by the traditional mental health care market. Often, employers are the middleman between the individual and care, but even those offering benefits don’t always get it right.

“While individuals who go to work every day have always faced mental-health concerns, this issue is really reaching headlines and becoming more and more known. And what workplaces are certainly seeing and I hear a lot about is that today’s mental-health benefits are not addressing employees’ needs.”

Barriers to Entry 
The average utilization rate of mental-health benefits in America is 2%, which indicates that, while most people need mental-health care, next to nobody uses it. Several barriers to entry discourage workers from taking advantage of these benefits.

Time is one such barrier to entry. Many therapists book sessions during the mornings and afternoons, when people are often at work. Traditional therapy scheduling is even more exclusionary of hourly workers, who often do not set their hours and work on-site jobs. Leaving in the middle of the day requires more transit, too.

Ariela Safira, founder and CEO of real led the virtual discussion (company photo)

“We’re talking about demographics that don’t have the luxury to take an hour out of their schedule weekly for care,” Safira said.

The stigma around therapy and mental-health care can also discourage people from seeking treatment, as can the cost. Even with insurance, individual sessions can cost upwards of $120. Some employers give their employees “packs” of sessions they can use, but workers are left with few options when those sessions run out.

In other words, Safira explains, current mental-health care benefits aren’t meeting people where they are. The future, ideally, could look like more scalable, inclusive, accessible, and clinically effective solutions that make it easier for people to make mental-health care an essential part of their well-being.

Offering an Inclusive Solution 
The goal of Real was to build something for everyone, taking diversity of race, gender, sexuality, and economic class in mind. Real, which has a website and a mobile app, aims to meet people at what Safira calls “step zero:” when they feel immense pain but don’t have the language to describe their experience.

“To meet them at that step zero, you have to give them people and stories. They have to hear what this looks like for other people,” Safira said.

These stories and easily digestible bits of content are beneficial for people who are not ready to or are not comfortable with talking to a therapist or who don’t have the language to express themselves.

Real provides tools and lessons from therapists, therapist-led group sessions, guided programs, and on-demand exercises that target various topics, including sleep, anxiety, depression, relationships, and identity.

Receiving this content in digital formats akin to those seen on social media is more accessible for people who don’t have the bandwidth for weekly hour-long therapy sessions or to read self-help books.

Real can utilize user data, such as what content the user is engaging with the most or returning to repeatedly, to personalize the experience and predict future mental-health needs. And the research proves that it’s working; IRB-approved studies showed that Real outperforms one-on-one care in terms of reducing symptoms of anxiety and depression.

“We’re seeing clinically significant reduction in depression across all races after real app usage, which is phenomenal and incredible, given that, particularly for those who do not identify as white, there just isn’t a care option for them,” Safira said.

If other industries have made this evolution in service so rapidly, such as the transition from CDs to iTunes to Spotify in the music industry, there’s no reason mental-health care can’t be the same, Safira says. She welcomes the start of “mental-health care 3.0,” where care is no longer reserved for the few who can access it.

“We’re moving away from the one-on-one therapy appointment in-office, to building CBT worksheets, to putting one-on-one therapy on video chat, to transforming care into a digital-first experience,” she explained. “And it will enable us to deliver scalable and affordable care.”

Editor's note: From Day One thanks our partner, Real, for sponsoring this thought leadership spotlight.

Erika Riley is a Maryland-based freelance writer. 

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