As featured on StartUp Health
At StartUp Health we’ve written at length about the macro challenges within the mental health market. At the top of the funnel there’s the scale of the problem. According to the National Institutes of Health (NIH), one in five US adults lives with a mental illness of some kind. This massive number has created a need for more accessible solutions, and tele-mental health companies have proliferated as a result, a trend accelerated by COVID-19.
But there are multiple complicating factors beyond the scale of the mental health crisis. The first is affordability. Generally, when it comes to healthcare services covered by insurance, the 80/20 rule applies. Eight out of ten healthcare providers are covered by insurance and the other 20% are not — think cash-pay services like elective surgery or concierge medicine. In the mental health space, those numbers are reversed. About 80% of mental health providers are not covered by insurance and patients have to pay high rates in cash. As a result, in the United States alone, tens of millions of people report they need mental health services but don’t get it because of cost. That’s the kind of barrier to care that costs lives.
And the hurdles to care get even higher. In poor and rural communities, even if the care is affordable, there might not be any healthcare providers available. Just like there are food deserts and pharmacy deserts, there are mental healthcare deserts. Finally, there’s the issue of stigma. In many communities, seeking mental healthcare is still looked down upon and people end up suffering alone.
That feeling of being alone, it turns out, is the icing on this cake that no one wants to eat. A person can overcome all of the hurdles to receiving care for a mental health challenge and yet still be left with the pain of feeling alone in their struggle. There is a sense that ‘no one understands what I’m going through’ because it all stays in the therapist’s office. Of course, the therapist knows the truth: that thousands of people are working through the same issues, but they’re just not talking about it.
The scale of our current mental health crisis compounded by issues of affordability, access, and stigma have created a perfect storm. That storm has in turn sparked a wave of health innovation that goes beyond tele-therapy. Enter Erik Nielsen, CEO & Founder of TAG, an interactive platform that makes the tools and strategies from in-person therapy available to the masses in an engaging, data-driven way.
Like so many health tech founders, Erik Nielsen started TAG because it was personal for him.
Nielsen was working as a successful advertising exec when, at 35, he went through a rough divorce. The experience rocked him in ways he couldn’t understand and left him in such a deep depression that he could barely keep his head above water. At the same time, he was launching The Saffron Project, a digital marketing company that grew from two people to 30 and landed clients like Oprah, FedEx, and P&G. None of the business success dulled the pain.
He reached out for help and first landed in the office of a psychiatrist who began trying him on different antidepressants, seeing what might be effective.
“That game is ‘trial and error’ because everyone reacts differently,” says Nielsen, shaking his head. “There’s nothing wrong with medication, but the process of finding the right medication is really challenging.” None of the medications worked for him. Instead, he fell into an even deeper hole and had suicidal thoughts for months.
Finally, three years after the divorce was finalized, Nielsen reached out to a therapist. In these sessions he began to have breakthroughs and dig down into the root causes of his depression.
He was so encouraged by what he was learning — much of it rooted in cognitive behavioral therapy (CBT) — that he couldn’t help sharing it with people around him. With his experience in advertising, product development, and game design, it wasn’t long before he came up with an idea for bringing these mental health lessons to the broader world.
In early 2020, thanks to some backing by friends and family, Nielsen launched an alpha product, a proof of concept. After getting great initial feedback, TAG solidified as a bona fide company and they were off to the races.
“For me, this is totally personal,” says Nielsen. “There were so many years of pain and anguish and despair. Your brain just goes to the dark. If I’d had something like TAG, I wouldn’t have been in that awful place. I wouldn’t wish that on my worst enemy.”
Under the Hood
TAG has a straightforward framework. A real person — not an actor — agrees to share their specific struggles with mental health on video. These “storytellers” are people who have dealt with everything from bipolar disorder to depression to trauma. They look at the camera and share their challenges and experiences in a transparent way that is rare in mental health.
Watching the storytellers has the immediate positive effect of helping people realize they’re not alone. But that’s just the first layer. At important moments during the person’s story, the video pauses and a licensed therapist from TAG comes on the screen. Not unlike the way a coach might pause and analyze a game film for their team, the therapist walks through the experiences being shared and highlights important points. They identify nuances and themes and then offer practical tools and coping strategies to the viewers.
This is more than just a taped therapy session, though that can have value as well. The therapists are specifically tasked and trained to extrapolate the lessons within a session to a larger audience, so that more people can benefit. The therapist is looking at the camera, directing their attention to you, the audience. In this way, the therapist lets the audience know that they’re not alone and gives them immediate tools to apply in their lives.
“We’re trying to take what is normal, dry science and package it in a completely different and engaging way, so that people can get informed and learn the techniques,” says Nielsen.
The next phase for TAG, says Nielsen, will be to add in a layer of AI and gamification. Instead of a linear progression through one story and one therapist’s commentary, the therapist’s wisdom will be chunked into modules that can be moved around. You’ll watch a segment, then answer some questions, and then you might be taken to a different scenario or therapist. This more nuanced approach to scaling therapy builds on Nielsen’s experience as a board game designer.
TAG has a partnership with the University of Texas at Austin, working with the founder of the university’s Anxiety Lab. They’ve developed a model that TAG is weaving into their product that allows users to track their mood and progress week to week. They’ll then combine that information with reported data on the platform to deliver content recommendations, not unlike recommended shows on Netflix.
“We’re complementary to therapy, versus competing with it” says Nielsen. “If we do our job right, people will be much more likely to connect with a therapist when they need it. We’re upstream a bit, trying to head off a crisis before it happens and deliver the benefits of therapy much earlier.”
Why We’re Proud to Invest
When we met Erik Nielsen it quickly became obvious that he had that all-important combo of market expertise and personal passion. Nielsen knows media, business, and product development, having scaled up a digital marketing firm and worked with top-tier clients. Balanced with this experience is the gut punch of his personal bout with deep depression. That period of his life, and the upswing he experienced from therapy, fuels his mission every day.
We’re also excited to back Nielsen and his TAG team because they’re leveraging the platform for the vulnerable populations. There are more than 1 million suicide attempts each year in the US alone and the biggest risk group is in ages 18–25. It’s Nielsen’s plan to use revenue from their enterprise subscriptions to offer free therapy to at-risk groups.
“It’ll eventually be crowd-funded healthcare for the most at-risk patients,” says Nielsen. He uses the example of a school shooting. After a traumatic event like this, Nielsen envisions immediately offering all of the students free access to the platform, to run through modules around trauma, anxiety, and grief.
We love that Nielsen is thinking differently about scalable mental healthcare. We often think of therapy sessions as being so unique and each person’s problems as theirs alone. However, mental health therapists by and large learn the same set of tools for dealing with these challenges. There’s a consensus on how to counsel and guide people through mental health crises. With platforms like TAG we can remove some of the mystery of therapy and share those strategies directly with the world.
There are thousands of mental health apps on the market that are basically the user interacting with the algorithm. Then there are a host of new, great telemedicine companies focused on mental health. But TAG lives in a unique space, bridging the worlds of automation and personal therapy.
We’re excited to watch as Nielsen increases TAG’s user base and builds out platform functionality because we believe it could be an important piece in multiple health moonshots, bridging access, cost, and mental health. Please join us in welcoming TAG to the StartUp Health portfolio!
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