Richard Jacobs: This is Richard Jacobs with Finding Genius Foundation, now part of the Finding Genius Foundation. Today, I have Dr. Adam Chekroud. He’s the Chief Scientist and co-founder of Spring Health. We’re going to talk about what Spring Health and he does.

Tell me about your background. What got you into working with people that have mental health issues? Also, tell me about Spring Helath.

Dr. Adam Chekroud: I came to the US to get my PhD. I’m mostly working in a Psychiatry Department at Yale. I was pretty interested in big opportunity for impact in mental health. I think that as many people, who have either gone through treatment themselves, or a friend or family member has gone through, there’s a lot of opportunity for us to do a better job. Over the years, problems have got worse, even more during COVID. Though, long before that things, like suicide were rising and the opioid epidemic were also on the rise. For me, the mental health was just a huge area of opportunity for to do something better. So I came to get my PhD on mental illness and ways that we could treat it better.

Richard Jacobs: Obviously, there are different classifications of mental illness. But there’s people that are told something like, you have cancer, somebody wants to divorce, you lost your job as a man dies, and it throws you instantly in an acute form of depression or mental disturbance. Also, there are chronic people that have it for years and decades, but then there are seriously mentally ill, like with schizophrenia, bipolar disorders, psychosis, or suicidal ideation. How do you divide up the different mental conditions you see?

Dr. Adam Chekroud: Those are all definitely examples of ways that you can do it. Sometimes people think about different diagnosis based on the kind of symptoms or problems that people have. If they’re really concerned about their eating habits or body image, then there are certain kinds of conditions called Eating Disorders. If they have signs of depression or anxiety, you can carve it up kind of based on the types of problems that people have. But you mentioned a couple of other ways you can carve it up. You could think about kind of how people got to that point. Do we think that there might be biological causes? Do we think that it might be primarily attributable to a situation? Grief would be a great example of one of those. The third one that you mentioned, mental illness, that’s also another way that you can think about mental health.

Particularly the way that we treat mental health conditions based on the level of care. So whether someone is primarily going through something, it’s a self-guided program, like all of these apps that allow you to practice and learn skills on your own. A slightly higher level of care would be when you go and see a professional like a counselor, a psychiatrist, or a therapist, but you still live at home and you still have your normal job. In that case, we’d call that Outpatient Care. The higher levels of care on that maybe days where you have to spend some time at a hospital every day, but you still go home and spend the night with your family all the way up to people who might need medical supervision all the time and so they might have to stay in hospital for a little while.

Richard Jacobs: Is your research based or is it all clinical? What the premises of Spring Health are lik?

Dr. Adam Chekroud: When we got started, it was very much in the research field. Actually, it one of the reasons why we decided to found Spring Health. As a researcher and an academic, we’ve done so much work and published all these really exciting studies showing that we can do things better. But in academia, you kind of write papers about it. There’s really no reward mechanism, there’s very limited opportunity to actually bring that technology to patients. The whole point of founding Spring Health was that we had all of these things that we could do better and we actually wanted to go and do it. For me, I kind of transitioned from academic or research background quite quickly into this clinical situation, where now everyday we’re delivering 1000s and 1000s of visits for people across the US and globally.

Richard Jacobs: Does the Spring Health have a certain protocol that you follow? How does your mental health work nowadays?

Dr. Adam Chekroud: We are partner with large organizations, such as Dolby, Pfizer, Pepsi, Gap, and Whole Foods. All of the companies pay Spring Health to take care of mental health for them. They pay us, so that we can go and give a free mental health benefit to all of their employees. If they do have any kind of concerns related to mental health, they can go to Spring Health. We can help them to better understand what their issues are, help them set goals for treatment, and helped them figure out what kind of solutions are. According to the right level of care for you, we pair them with a care navigator. This is actually someone who’s kind of your sidekick on a road trip that’s just support you through that journey. If you do need care, you can see one of our counselors, psychiatrist or therapist. No matter really what kind of treatment you need in mental health, we can get it for you. It will be free or certainly will be covered by your insurance.

Richard Jacobs: What are some of the innovative protocols or things that you figured out in regards to mental health? Is there any breakthroughs that you’ve figured out in your protocols and treatment?

Dr. Adam Chekroud: Yes, definitely. The exciting thing about mental health is actually that we can keep on learning for years. We have so much further to go. Initially, we developed these technologies, really similar to what you see when you buy things online or when you go to Netflix, where in the background are these kind of recommendation engines to try and figure out what content or in our case, what treatment is most likely to work for you. We initially focus very much on trying to personalize treatment decisions by using things, like machine learning that would look at the kind of the background (socio demographic), the symptoms, the goals, or the issues that you have, and really try and personalize the treatment decisions that we make. Since then, we have continued to implement that work and continue to do research like that, but I think that the scope has really broadened. It’s now really more about trying to bring data to the point of care throughout mental health care so that providers can make more informed decisions, ultimately.

Richard Jacobs: What does it mean? What data and how does it help?

Dr. Adam Chekroud: A good example will be, say a patient comes to you. In general or in mental health care, you’ll ask the patient, how can I help you? They’ll tell what’s been going on, what some of their problems are, they’ll tell you, the ones that are top of mind, which is great. This is a great heads up, but you’ll usually focus the conversation on the things that they tell you and a really well trained clinician might use these kind of checklists or diagnostic manuals that help them pass a more thoughtful set of questions to try and understand if there are anything else, for instance, are there any other problems going on in their lives? But the providers are only human, they may forget, they may not have time, or there just not be an opportunity to cover that in that session. It’s the way that it works at Spring Health, so that everyone would come through.

You would take a short questionnaire about problems that you have and that questionnaire is structured, but it’s dynamic. It asks you more questions about your broader mental health. It’s not just focused on things, like depression or anxiety, but it’s actually thinking about lots more things in the background, which is useful because then when you go and see your provider in the background. We give that provider all of the information we have about you. We tell them, “This is Richard and these are the things that he told us that he wants to focus on.” But you may want to look at this as well, because we saw some other signs, for example, eating disorders or alcohol use. It’s really informative, because it means that the providers can make much more accurate diagnosis. They can also have a much more informed conversation with you right off. Generally, patients will feel much more heard. The provider will be able to make a much more accurate diagnosis, just by having a fuller picture and much more data.

Richard Jacobs: What are some of the interesting nuances of data that you collect? What are some of the most important points that you’ve observed? They’re really giving you more insight into what’s going on with people then maybe other analyses or less completed analysis.

Dr. Adam Chekroud: Some good examples would be symptoms over the last two weeks. Also the things, like very specific phobias or anxieties. Maybe being afraid of standing in lines, thinking very carefully about types of sleep problems that people have. A lot of people experience sleep problems, such as waking up in the middle of the night, repeatedly, you can’t fall asleep initially, or you wake up too early and then can’t fall asleep again. All of these things can be really informative at an aggregate level. When you actually train these machine learning algorithms to try and predict what treatment is most likely to work. It’s kind of goes into this core issue of mental health. 

If there was just one symptom that could tell you the right treatment, I think we would already know that. Clinicians have been trying to do this for a long time. They kind of do it in their own practice. If it was as straightforward as just looking at this one symptom and making this one treatment decision, I think we would have already done it. Instead, what we see is that it’s more like patterns of effects across many different variables like income, education, status, employment status, as well as all of the symptoms we have.

Richard Jacobs: What about therapies and treatments? Does this suggest to you, new treatments, new therapies, or different ways to do things?

Dr. Adam Chekroud: Definitely, different ways to do things. In mental health, it’s kind of paralysis of choice. There are dozens and dozens of different, even just specific medications amongst dozens of different kinds of therapy that you can do. Those are all quite different. So definitely helping providers understand what approach is going to work best for you versus for me, is incredibly powerful. In the original Lancet paper that we published, we actually showed that we could increase the recovery rates by about two times. People who took a treatment that was recommended for them for about two times more likely than average to recover. We’re actually talking about pretty significant improvements in treatment outcomes just by doing a better job of using the resources that we already have today.

Richard Jacobs: Any trends that you’re seeing in mental health, especially after or during COVID? How has that changed the patient population? What bothers them?

Dr. Adam Chekroud: Burnout has been a huge one as well as grief and bereavement. A lots of people unfortunately, did die during pandemic and sometimes lost. Actually, the individual level phenomenon has really been lost. Another thing that I would say that is really interesting is for a long time, a lot of people would think that mental health care really was about face to face connection. You have to go and sit in the couch next to the provider and talk about your problems. COVID really has turned that upside down. I think before we saw a trend towards people being willing to do treatment over video or by the phone, everyone’s job became remote overnight or at least majority of people had to work from home. It kind of really accelerated a trend in mental health care towards trying to do as much treatment as possible by video. So that trend has been super interesting to see to the point where now actually, if you go and speak to providers, many of them are not willing to do face to face care anymore. They’ve already been doing this for nearly 2 years. They’ve found it very effective. The flexibility that their patients get is really something that they’re not looking to give up anymore.

Richard Jacobs: What do you see as the future of Spring Health’s protocols? Any changes coming up or research that you evaluating that’s going to change how you do things?

Dr. Adam Chekroud: I’m really excited about two things; being able to broaden the type of care that we offer. Although, it’s awesome that most people can make really good progress in this outpatient setting. Speaking to a therapist or a psychiatrist, lots of people do need much higher levels of support. When we think about helping people get residential treatment or things like rehab, that’s really challenging for people. It’s certainly financially prohibitive for a lot of people. It’s very hard to get access to that and it’s very hard to understand the quality of the facilities. We’ve been going really deep on trying to help people get higher levels of cash through Spring Health. We’ve build out all of those networks, so that we can actually help people in a much more comprehensive way, no matter the level of care that they need. The more of the lower end of things or maybe a more common issue is really understanding how exercise can help mental health. It’s important that we understand that mental health really is a whole spectrum. People can have very different needs and levels of impairment.

There are things that we can do for everyone, like exercise, meditation, or mindfulness. It can really help a lot of people, especially when we think about the context of burnout. I’m also really excited about that and building out protocols where we can think about how do we put together structured exercise programs for people that are particularly tailored towards their mental health? How does that play into people’s motivation, for example, does it help them engage in that, feel less stressed or burned out, help them out with their family, friends or their family life.

Richard Jacobs: Do you feel like you’re able to help a significant number of your patients or is this something that it’s very difficult to help people as a low success rate?

Dr. Adam Chekroud: The ability to help is probably my favorite thing about the job to be honest. We see when we launch with new populations, even these large distributed retailers or manufacturers, we’re opening up mental health care and mental health services to a population that historically has not had access to them. Even if they tried to go and get access to mental health services. The wait times can be tremendously long, it can be financially prohibitive for them to do it. So opening up access to this much broader population is really huge. We see massive levels of engagement, like 1-in-4 employees at company, in places like General Mills. When they do go into care or treatment, if they do need support, therapy, or medications, we kind of continually track their progress, like whether they’re actually reaching their goals, or their symptoms are getting better clinically. Those results are actually world class as well. So on the order of 70% to 80% of patients making improvement in the mental health are better compared to what you might see in a clinical trial, where maybe 40% to 45% of people would see improvement. So yes, I’m really proud of both opening up the access and also increasing the quality of the care that we deliver.

Richard Jacobs: What is it that really tasted success rate up to 40% to 80%? Is it the follow up the personalization? What do you think it is?

Dr. Adam Chekroud: If you look at large scale studies, you see that some kind of operational things can be really detrimental to people’s mental health, for example, wait times, people try to get care, then they’re not able to get care. The national average in the US actually try and get health mental services. The average wait time is about 21 days. It has been shown to be really detrimental to people’s recovery rates. We should start by helping people get treated. We help them get treated much earlier, both within by eliminating the wait period, but also by being more aware of mental health services by reducing stigma and increasing access to those services so that people can get treatment before the problem escalated and gotten a lot worse. It starts by reducing improving the awareness around mental health care, helping more people get services quicker. When they do get into care, just be more thoughtful about the type of tablet that we give them to try and do a better job of sizing their care and personalizing it to them. Tracking their progress once they’re in care is also tremendously effective to kind of some of the things that we’ve learned from other chronic disease management or other chronic illnesses, like diabetes. In conditions like that we would continue to track someone’s blood sugar all the time. You kind of tailor your treatments based on how good or bad the blood sugar is. We’re definitely bringing those exact same principles over to mental health care so that we can tailor the treatment for someone’s mental health problems are in the same way during treatment.

Richard Jacobs: Are there any mental conditions that seem to be intractable? What would you say are some of the most difficult mental conditions to help people with?

Dr. Adam Chekroud: Anything’s intractable, there are certainly things that are more challenging to treat, but the treatment can generally be pretty helpful across the whole board, regardless of the condition that people have. There are certainly some personality disorders that are pretty difficult to treat. Certain addictions that might be difficult to treat, such as eating disorders can be extremely challenging to treat. It’s important that things can get better, and that we do have tools to help people get better. The sooner those they seek those tools, the better the chance we have of dreaming.

Richard Jacobs: What’s the best way for people to find out more about Spring Health and about you?

Dr. Adam Chekroud: You can definitely check out our website, www.springhealth.com or you can shoot me an email. My email is just adam@springhealth.com.