What’s the inspiration behind the name Trusst?
As a psychologist and professor, my career has focused on solving the problems of affordability and accessibility of mental healthcare in the United States. In early 2016, I began thinking more about text message-based psychotherapy as a potential solution, but there were many questions: Was it possible to establish a strong therapeutic alliance if the therapist and client couldn’t meet face-to-face? Could one therapist text with multiple clients, opening up their schedule and expanding their client base to provide service to those in need? Was there clinical data instructing us about how to translate psychotherapy to texting? At the time, there was very little research to prove messaging was an effective method of intervention.
This realization prompted me to partner with researchers from the University of Washington to run the first randomized controlled trial of texting-based psychotherapy. Our study was led by our now Chief Science Officer, Dror Ben-Zeev, PhD, and focused on the efficacy of messaging-based therapy on those with serious mental illness. After training clinicians and coding thousands of messages, I knew we were on to something. We demonstrated that this approach was successful, with particularly promising results for those with depression and psychosis.
That study was the initial spark that led me to start Trusst, a research-backed, clinician-built, effective message-based mental health service. We decided to name the company “Trusst” because we wanted to build a science-backed, efficacious service that could start addressing the biggest problems we face in mental health, in a scalable way.
This is not your first time founding a company in the mental health industry. How did your past experience influence your approach to Trusst?
When I co-founded Incente in 2012, I had no experience running a business. I have a background in computer science, so my initial role was technical. I faced a steep learning curve in understanding how to build a successful business. However, over time I took over as CEO of Incente and ultimately sold it to Voi Inc.
Both Incente and Voi taught me invaluable lessons about the importance of teams, the balance between economics and good clinical care, and the many working parts that are required to execute a vision. While both of these companies were successful in their own right, I don’t think that I could have built a large-vision, scalable company like Trusst without these great experiences.
When did you first become interested in mental health issues?
When I was in college I was initially on a pre-med track. Then I took chemistry...I hated chemistry! When I realized that organic chemistry was next, I had to reconsider if this was the right path for me. That's when I noticed that I naturally gravitated toward philosophy, sociology, and particularly psychology. I have always been fascinated by how people work, and I was drawn to the idea of using my knowledge to help others. Toward the end of my college career, I committed to pursuing my Ph.D. in Clinical Psychology from Vanderbilt University. Ever since that time I have devoted my life to helping those in need of mental health support. That path has led me to publish research articles, teach thousands of students, treat patients, train clinicians, and ultimately shift my focus to industry to have an even larger impact!
How do you handle risk and competition?
Risk is a part of life. There are risks in every aspect of business and my approach has been to methodically analyze the risk and take chances that are likely to result in the best outcome. Being a part of a startup means that you have to be willing to take some big, but calculated risks, which often pay off.
As for competition, winning a market is often about differentiation. The tele-mental health space is rapidly growing because the market potential is huge. I have high confidence in our model because we are the only company that is clinician-led and science-backed with a sole focus on messaging. Our deep expertise has allowed us to create a new, incredibly scalable model of care that is not just about connecting patients remotely with care, but also about changing what is possible with tele-therapy. As insurance reimbursement codes for messaging become available in the near future, I believe our strategy will propel us towards incredible growth and significant M&A opportunities.
Have you learned anything new or surprising about yourself through this process?
Since I launched my career, I have been passionate about transforming the mental health system. What has surprised me since entering the commercial world is how much I am driven by competition!
My competitive side is nourished by the startup environment. It drives me to win the market and make the best mental health solution on the planet.
How has COVID-19 impacted your business?
First of all, we’ve had to apply our mental health expertise to our own team. This has meant promoting good mental health hygiene for our employees, like increasing team check-ins, allowing more flexibility with schedules, keeping a sense of humor in the face of adversity, and of course offering our own service to team members!
As for opportunities, COVID-19 has led to a seismic shift in the acceptance of remote psychotherapy for both patients and clinicians. This has been a great opportunity for our company, and has enhanced our ability to provide better mental health access across the country.
What’s been the #1 (or two) top challenges you’ve faced while launching your company?
Though there has arguably never been a greater need for increased access to mental health services, the pandemic has also led to budget restrictions and sales challenges for our company. It is well known in our industry that the customer acquisition cost in the direct-to-consumer business is high. While consumer acceptance of our solution is increasing, we are still working to decrease our price point, as much as possible, to help our customers who are in need.
How would you redesign traditional approaches to therapy and other mental health services in this virtual world?
We are currently in discussions with both legislators and payers about the importance of insurance reimbursements for messaging-based psychotherapy. I anticipate that reimbursement codes will become available for this mode of treatment by the end of 2021 or in early 2022. When this shift occurs, it will have a tremendous and positive impact on our field. It is my longer-term vision to redesign treatment around tools that augment clinician abilities in ways that have never been possible. These tools might include passive phone sensing capabilities, AI-augmented message prompting, and automated feedback for clinicians about service delivery options that enhance client outcomes.
In addition to serving as CEO, you’re also a professor at Dartmouth. Are there any surprising similarities between teaching and running a company?
One of my favorite axioms as a professor has always been “don’t teach someone what to think, teach someone how to think.” I love this saying because it reminds me that good science is about uncovering truth, and that what we know about truth today may be different tomorrow. By instilling a curiosity and a love for the process of discovery in my students, I hope to equip them with the skills they need to be great thinkers and innovators in their lives.
I find that this approach to teaching also applies well to business. What we know about our product or the market today might be different tomorrow. There's no better example of this than how COVID-19 affected us all!. Encouraging our team to work hard on our current truth while also recognizing that we need to be flexible and adapt to new information is an important framework that allows for a flexible and healthy business.
Lastly, teaching has always been a pleasure for me because I love learning. I think good education is an interaction between the educator and the learner, where both parties have important information and perspectives to share. Both my teaching and my clinical work has taught me to be a good listener, which is something that I think is critical to good company culture.
Why did you decide to raise from the crowd?
Republic is my first experience with crowdfunding. In the past I have raised capital from friends and family, angel investors, and venture capital firms. What attracted me to Republic is the idea of democratizing investment. At Trusst, we believe strongly in equity and accessibility of mental healthcare, which means that crowdfunding is a natural extension of our values. I love the idea that almost anyone can make a meaningful contribution to what we are building without having to be either wealthy or an expert in investing.
What’s your team culture like?
Team culture is very important to us. Our entire team has been known to work long hours, but we also like to play hard! Whether it’s our Product Manager, Zoe Snow, who will go on a 10-mile ski adventure before 7AM (she is a near-Olympic level Nordic skier), or Dave Allen, our COO, who will lead overnight trips for the Appalachian Mountain Club, or Dror Ben-Zeev, our Chief Science Officer, who lies to go scuba diving with sharks, our team is all about adventure and life balance. We value transparency, good communication, compassion for ourselves and with each other, and fun! These team members (among many others) make Trusst a wonderful place to work.
What is your superpower?
I think I bring an interesting mix of clinical experience, technology background, and business acumen to our team. If I had to pick a superpower, I’d say it’s my ability to approach business problems with a scientific rigor that promotes success. It may not qualify as a superpower, but I think I’m also pretty great at whistling (a little known fact)!
What’s your kryptonite?
It has been said that your greatest strength can also be your greatest weakness. I’d say that one of my greatest strengths is my optimism. However, over time I’ve learned that it is also my kryptonite. It is my natural inclination to find the good in even the most difficult of situations. While I believe that this optimism can be a positive force as a leader, it can also lead to blind spots. Given my predisposition, I have intentionally tasked some of my team members with keeping my optimism in check to make sure that we have a fair and balanced appraisal when difficult business decisions are required!
Do you have any unusual routines or habits?
I love Dr. Pepper. If left unchecked, I would have 5 a day. Thankfully, I’m not left unchecked. My loving wife wants me around for a long time, so I limit it to 1 a day.
Do you have any other hobbies/things you like to do in your spare time?
I’ve never been short on interests outside of work! I love music and have played guitar for almost 40 years, I enjoy hiking, fishing, biking, most sports, and strategy games of any kind. Most of all, I spend every extra minute with my wife and incredible daughters.
If you could give yourself one piece of advice 5 years ago, what would it be?
That’s easy: stop what you’re doing and start Trusst now. A pandemic is almost here and Trusst can help!
What’s the best piece of advice you’ve ever received?
This was the hardest question to answer! There are so many people who have helped guide and shape my character and decision-making with their wisdom. After much consideration, I kept thinking of a quote that my grandfather imparted to me when I was young because I have returned to it often in my mind over the years: “Do what is right, not what is easy, nor what is popular,” a quote attributed to Roy Bennett. I place a high value on integrity and character in both myself and in others.
I have found throughout my life that there are so many small moments where you can choose to do what is easy, but wrong. In those moments, I remember my grandfather’s wisdom, and I understand that these “easy” choices most often lead to negative outcomes and self-dissatisfaction.