🎂 Karan Singh & Janet Van Huysse Fireside Chat

Hi everyone and thanks for joining with Cloudflare's birthday week. You know we're spending the week talking with leaders that we admire from companies we admire and so I'm really happy to have Karan Singh here with us today who's the co -founder and COO of Ginger. So welcome Karan, thanks for being a part of our birthday programming. Thanks Janet, honored to be here. Great awesome and just a little bit for those who are joining that don't know what Ginger is. Ginger is on-demand mental health support and they actually provide support to millions of people around the world. You're now in 30 countries yes and in full transparency Cloudflare is a super happy customer so it's one of our definitely like valued benefits that we give to our employees around the world so super good to have you here. Likewise Janet, thank you. So I've heard that the origin story for Ginger is actually a very personal one for you and I was wondering if you were comfortable sharing that with us today. Yeah I'm happy to share it and share a little bit more so thank you again for the invite. This is a fun week I can't believe it has been a decade. We're actually approaching a decade as well and so our origin story is that just over a decade ago I was on the other end of a phone call after a loved one tried to take their own life and that really just shook me to my core till death when I when I bring it up. I've always just thought of myself as you know emotionally in touch a really good read on people and I had no idea I was just completely blindsided and the deeper I dug into this space into the space of mental health the more I realized that just culturally socially even you know emotionally mental health was this tough topic to broach not only with my family and my friends but let alone in the workplace and so you know fortunately my loved one's still here but the system hasn't changed a whole lot for them and so you know I couldn't shake the feeling I wanted to try to do something about it and I was working in in the health care world actually prior to this. I went back to graduate school out at MIT Harvard Business School Medical School my co -founders and the rest of the team we launched Ginger about a decade ago now with this sort of core insight or core hypothesis that we could bring data and technology to a space that was thoroughly lacking it that we could start to bring level of objectivity and rigor. There is no blood test for your depression and no easy way to measure stress and we thought we could actually help in moving that forward. So you went back to school with Ginger in mind? I didn't know it at the time. I knew I wanted to do something. I didn't quite know exactly what it would look like and you know looking backwards now kind of virtual care and mental health care certainly having their moment but a decade ago that certainly was not true. Both were very much in the shadows and you know we started originally as a technology platform basically selling into hospital systems and then about four or five years ago decided that we actually needed to become a hospital system health system so we became a virtual clinic set up in all 50 states and now 30 countries internationally delivering mental health care 24 hours a day seven days a week and typically 57 seconds and so you know a far cry from sort of the traditional care model which is you wait weeks if not months to try to see someone and if you're lucky enough to get through the door 70 percent of the time it's subpar quality and when you walk out the door most of the time they don't accept your health insurance so you get charged you know hundreds of dollars for per session so wanted to try to flip that all on its head and eventually kind of got to where we are today and the business model we have today. Yeah so if we could just spend the time kind of looking back at the first 10 years like what would you say are the biggest surprises or the things that you've learned in the first 10 years? I'd say our vision is a world where mental health is never an obstacle and we uncovered a lot of ways and reasons why it's an obstacle it's been an obstacle for so many people I think I think the biggest I think learning has just been access to care is just incredibly hard you know and you have to start by admitting to yourself that you have a problem and so it really starts with the sigma which is even a step before access and being willing to even take some action and then if you if you get the courage to actually take that first step and try to seek out some help you know it's hard to figure out if you need a psychiatrist or a therapist or a coach or something else and you know figuring out what what resources to actually tackle or use is so much of the problem and then you have all the challenges we were just talking about which is finding that provider who's available is incredibly hard so I'd say that was a big learning which is to say that we were using technology I think in the early days sprinkled at the end of a broken system just wasn't going to fundamentally rewire how people operated the way they were compensated the way they acted and so a broken system with technology doesn't necessarily lead to better outcomes exacerbate existing kind of inefficiencies and inequalities and I think one of the biggest lessons you learn is that if you rethink it from the ground up and actually start to set up the right incentives at every step in the process and you create an experience that's ultimately geared for the end user the member in our case we call it which is employees who might have access to ginger you can start to actually make a dent in that but that was that was a lesson I think we learned over the course of a number of years through a lot of trial and error and seeing how care was delivered well I love the point you make too that I think once someone gets in your system right then you have so much that you can control about that experience and making it a positive one but what has anything changed about that kind of the getting admitting you have a problem part like what have you seen over the last 10 years around people kind of ready to take that first step has that changed at all do you feel like we're still kind of the same story 10 years later I would I am I am I'm hopeful I'd say hugely so in the last few years I think the curve I'd say of mental health adoption feels like it's been you know relatively flatline but in the last 18 months certainly 24 months early but in the last six months especially as COVID has hit I think you know we're all in each other's rooms bedrooms and you know home and so so much of work and life has really just kind of gotten mixed together and that means that we're all bringing just our increasingly bringing our full selves to work and so you just see it you see how messy it is I'd say that's sort of one trend the second I'd say is there's a there's more conversation within you know celebrities athletes I think you know NBA and the NFL both have some pretty big programs where they're talking about you know train the mind and the body will follow or you know the importance of mindset to really be able to bounce back from a loss and all these things that are you know euphemisms and code for I need to take care of my mental health and I needed to use that to be a better athlete or better you know better actor or better productive worker and so I think that conversation is happening more and more and I think the last trend we're seeing in the last six months has been we're seeing that mental health in the workplace is now just not just an HR topic but actually a topic that's being addressed at the CEO level or at least some executive sponsors which is which is exciting because the reality is most everyone is going through something and you've got to really be able to do something about it for all of us to support yeah so you really feel it sounds like it's been maybe a series of things you know that have really kind of made that hockey stick for people accessing the health or removing the stigma maybe yeah I think so I think I think it's a combination of a variety of these factors that are going to come together and I should say with that hope still is the reality that you know for a vast majority of of the U.S. and frankly the world you know this is something that people won't talk about it's just so ingrained culturally as as a weakness and a vulnerability that we're not comfortable because it creates it creates kinks in your armor and I think that's changing and I'm hopeful that it's going to start to accelerate faster yeah I feel like you know when you said in the beginning you have to admit you have a problem and or is it more sometimes like now there's this fine tuning or this fitness element to it you said right kind of you know be at your a game whether it's an athlete a celebrity whatever your job may be and so it feels like that is a bit of a shift yeah I think it's a it's a reframe right it's it's sort of thinking it's thinking beyond just the you know one in five Americans who have a mental health diagnosis depression anxiety it's a huge number you know 60 million people 70 million people but it's actually the double if not triple of that that don't have a diagnosed condition but have workplace stress relationship issues sleep and a variety of other life that are like you can miss the life that might not you know fit the standard definitions of mental health but are actually just as important or as important if not more important because a precursor is ultimately getting to that state of of a diagnosis yeah one of the things I'm curious about curious about too is I feel one of the things that we all love about ginger is how accessible it is it's just so easy it's you know mobile on your phone and it doesn't seem like it's quite the barrier of like make an appointment going in and seeing a doctor or you know waiting weeks like you said so do you think that that kind of easy access has played a part in its accessibility or yeah I think so I think that was sort of from a design principle when we we made the call a number of years ago to to read just rethink how a member might get access to care that was step one which was you can't jump through a bunch of groups you should be able to access care confidentially privately securely and you should get it whenever and wherever you need it and you know that was true again pre-covid uh and and certainly true in covid when you're scheduled with this all over the place and I'll just I'll say you know finishing the origin story um this is about prevention this is about preventative mental health moving upstream catching things early that's you know really why we're called genders and my mother uh used to feed me ginger and honey before I got sick earlier the first signs of any sort of sickness she kind of knew me better than I knew myself and I think that's really what we aspire to be is to be able to catch people early and get them in much faster than they were traditionally in a traditional health system you can use kind of non -clinical interventions to support them like talking to a coach accessing content accessing reading exercises cognitive reframing exercises that are incredibly powerful have a ton of evidence to show that they work and are really helpful for a vast majority of people who are you know just going through life yeah awesome um all right let's talk about covid so I imagine that has changed things at ginger changed things around mental health um the uncertainty the fear of the pandemic the disease worried about your loved ones your own safety just thinking about it is making me want to reach out all of the above I know I remember doing an interview just as covid was hitting when you know didn't know what this was going to look like but it felt like in three to six months we'd be on the other side and I think the not really knowing when we'll be on the other side is really exacerbating it I think you know stress and anxiety were increasing prior to covid and it's just been amplified to really new heights with covid19 with the conversations around racial injustice with the current election season and the upcoming election you know I remember 2016 when we saw a 400 percent increase in utilization the day after the election uh we're getting seeing an increase pretty significant increase we're already seeing in the last um six months now we've seen close to 150 percent increase in utilization of our coaching services and almost double that for our therapy and psychiatry services so access to a video session with a licensed therapist or psychiatrist and so yeah we are um we're also international and so we started to see covid take shape if you will in terms of kind of the conversations that our members were having with their clinicians and the ways in which they were using their app it's frankly the beginning of the year and uh let's continue to increase yeah I was going to ask because it's a global platform like what are the differences you see in regions is there anything that's kind of pronounced that those of us who don't have access to this would not know you know we were actually looking at the data about a couple weeks ago different language different words same problems so um you know might might describe situations slightly differently in different countries our membership our members do but oftentimes it's the same core issues of workplace stress relationship issues we you know family balance particularly with school certainly the United States and and elsewhere and um and so I think though that that's a that's a thread for sure um I'd say that the flip of this though is what's what's been exciting to see is the the novel ways in which uh members are are engaging with their coach uh or engaging with the platform I I we just had a um one of our coaches share in a typical client way one of the members in which they're working with and um this member was getting married they were going to walk down their virtual aisle it was a zoom um wedding and uh right before they were about to go on they they wanted to talk to someone and so they were they were actually in the back room changing in their wedding gown texting uh with a coach uh just before they were about to go on and I had another member which I thought was just fun too is they were on an airplane and flying cross -country incredibly nervous and had a panic attack and they got wi-fi and they were able to access the app and they were talking to one of our coaches and we talked them through a set of exercises to help them do that experience and so you know that's very different than the going to the doctor's office right so different and so accessible I love that um okay we have a question from one of our listeners from Kelly um and she's curious um she said I would like to know your thoughts on the increasing rates of suicide there's been an increase of 56 percent since 2010 among 10 to 24 year olds what are your thoughts on the correlation between Internet usage and these statistics yeah lots of thoughts it's a great question and definitely a a concerning trend um I think we were continuing to see an increase in suicidal ideation or even homicidal ideation thoughts of self-harm or harm to others uh you know prior to COVID and we're seeing that more broadly not just in the kind of adolescent population um but but seeing it even more pronounced spike and that's data outside of out of ginger we're certainly seeing just more members who are more acute or who might be closer to crisis for just a whole host of reasons as you can imagine um and all of us being online all the time can help and can hurt uh it can it's it's definitely uh it can be challenging I think something that our coaches are working with many of the members on those who are you know you work with generally speaking 18 and above although we're rolling out to adolescent population next year that um a lot of this has to do with how you use uh technology and the Internet and other platforms and so the developing some good hygiene around that and when you might have you know underlying mental health conditions um they can exacerbate it unless you're you're treating them and supporting them appropriately so I think it's um it's too bold it's a trend that's that's was started before well before COVID and is only going to continue and so I think the best thing I think our take we can do is is to support it but think very specifically about how do those kinds of members and that stage in their development cycle need to engage and help because they can create really addictive patterns so we're spending a lot of time thinking actually about that how to create a product that can work well for them yeah and just like what you learn right along the way that can then help others it's you know the more time we spend with it the more we get to learn so um she had a follow-on question too I'd love your thoughts on she said what are your thoughts on mental health forms being hosted by people who are not educated in mental health Kelly good questions um um yeah it's challenging you know I think that there's no question that a professional um can be a trained professional with the right set of support and resources uh can be really helpful really powerful and a non-traditional provider right and you think about or when rather when most people think about seeing a seeing a clinician they default to psychiatry just because they hear that's what you see on tv and other places you talk to a psychiatrist and some might talk to a therapist but you know the concept of a coach for instance is relatively new and you know our our thought here and one of the fundamental problems we're trying to tackle at ginger is it's supply and demand index supply demand for all the reasons we're talking about is going through the roof and the supply is actually dwindling it's it's uh it's we have a shortage of 5 ,000 providers 50,000 providers rather in the coming years and that's only continuing to increase and so we need new kinds of care modalities that are supporting people in new ways to really tackle this so that's a big reason why you know at ginger all of our coaches go through 200 hours of training they're usually master's level if not PhDs they go through a ton of oversight we use a lot of the technology natural language processes and to make sure that we're reviewing the quality of the care they're delivering and iterating on that and so you know we don't think it's um untrained workforce per se we do think that you do need some oversight because of the reason we were just talking about that members have thoughts of self-harm or harm for others and have a lot of other situations where you need to have a professional who knows what to do knows how to get them the right resources at that moment to get them the care they need so a long answer to a short question which is to say i think that there's a huge need so people are turning to whatever they can find i think it's really important that you can connect to someone a professional who can help you and whether that's a licensed clinician like a therapist or psychiatrist or potentially even a coach or the combination of all three which is you know what we believe in at ginger and and can actually get that help and if you see someone who needs that that you can actually connect them to yeah it's incredible the supply and demand um question is an interesting one so do you think that the um the supply is more able to keep up with demand because of technology like ginger that you don't have to have you know a a building with an office space and furniture you know you can just that's exactly yeah i mean so the average wait time to see a provider is um it can be weeks if not months in most parts of the country so most zip codes in the united states don't have available so you don't have an option if you do have an option it's usually a their term but you're at best and so i think what what technology allows is really to match that demand whenever it comes up to the supply wherever it comes up and so um that's for us how we've been able to leverage with a relatively smaller team and provider network really scale that and actually be able to support hundreds of thousands and now millions of people because you don't need you don't need the same equations and the reality is most provider systems they're trying to hire their way out of the problem and that helps but only so so much because you just have a one-to-one match and inevitably you come across the same challenges which is unfortunately there's far too many people who need help yeah i think my next question too there's a bit of this um you know that that answer i'm sure we've baked into this but you know we talk a lot at Cloudflare and you know there's a global conversation about the importance of diversity in providers so having um a clinician who looks like you may have some shared experiences um together how important that is and then you mentioned like the inequalities around um access but even like the disparities and healthcare options or outcomes so how are you think about that at ginger i know that was a lot packed into that question i'm following it's been uh clearly a topic that i think everyone's talking about it rightly so you know it deserves a really sort of fundamental discussion it's foundational to our ability to deliver great care we've got to represent who we serve so um simple at that level that the stats are incredible i mean i was looking at it i think a study from 2016 that talked about i think it was a white middle -class woman who um owns boys got a call back from therapists twenty percent of the time for an appointment so one in five were able to get a call and a black working-class male uh with the same insurance coverage got a call back one percent so 20x and that's you know just to get that's one out of 100 effectively get actually care 99 out of 100 don't and so you know it's foundation boils my blood right there's those same that same research around like resume call uh resume reviews and interview in the hr world comes with sorry interrupt you see it in the hr world completely you see it in all parts you see it in mental health care certainly i mean the access challenges are generally speaking for for you know healthier and wealthier populations and so you know i'd say for us it's both making sure that our providers are representative of the of the populations we serve so i think the current status is about 50 percent nearly 50 percent of our coaches therapists and psychiatrists identify as BIPOC black or indigenous person of color um and that helps with that you just said 50 percent five zero yeah almost five zero and so it's something that you know we've kind of engineered frankly from the start and it's just been a function of as we continue to find great providers a lot of great people out there um and we have increasingly members who are asking for some sort of identification and you know that's one level of dimension of match but there's so many other ways in you might just find someone who's who's a good fit and so you know on the other side of it too is just the broader company whether it's our executive team or there's just even our broader company i think it's currently almost 60 percent you know you know it's just figuring out ways where we can we can come from so we can support and we got to keep doing better uh we got to keep keep uh keep investing here to make sure we can we can develop a great product for people yeah yeah those are amazing statistics i'm so glad i asked um okay so so i'm listening to this and i'm thinking wait i actually have an interest or maybe some experience in mental health and i want to become a coach um and maybe i can help ginger and help that you know that demand side um how would someone get started um well on the on the supply side is to be a provider we are actively recruiting in all 50 states and and uh so very much looking for and you provide the the training the 200 hours or i do do that on my own and then come back so we were we're looking for uh for coaches typically who have a master's or a phd background in in social work or psychology or related fields so that's that's what we've been recruiting but we definitely have lots of other positions in the rest of the company if this mission is uh you know resonates and want to be a part of this story and this uh this journey uh so i would love to you know anybody can email me i'm just karen.ginger.io i'd love to be able to talk and and connect um and and frankly i think what's exciting you know as i look globally in this space is just there's a ton of interest the activity is exciting which was again prior to covid but it's just really accelerated during covid so a lot of people need help great yeah i figured as people were listening they might think wait i want to be part of the solution how would i get started so that's awesome um all right so um one of the one of the things i'm trying to do in my life for my mental health is to start seeing the silver linings so with all of the kind of uncertainty and lack of travel and social life and other things um i'm just trying to see like oh but here's the upside or here's the silver lining what are some of the silver linings that you're starting to see now i used to have a gratitude journal which all of our coaches and therapists always talk about and i just never did and um i've been i've been keeping my own um for the last couple months now and uh it's been incredibly helpful so i've got i think a couple of things that bubble up part of the most important has been i think uh you know we're talking about just before this call my daughter usually joins me for many of my meetings i just ran through the room one of them i figured i figured and um and that's you know that's far from the course now that's that's life and and i used to what didn't know how to deal with it i i apologize for it i do lots of other things and now i just own it and um i think we've been invited into each other's lives now in such a kind of deep personal level it's i'm i'm excited about that in some ways because some of those lines that were so stark are a bit blurry which is frankly just real life anyway and so i like that uh it's hard but i i like it too that i feel like a deeper level of connection with people i work with um and so i'm hopeful that that won't go away go away and i'm i'm hopeful that you know this conversation on mental health is not going to go away and it's it's not easy it's certainly messy for most people they don't want to talk about it and i i get it and they don't need to talk about it necessarily in a you know big global public forum but talk about it somewhere get help somewhere because you know it's impacting you it's impacting your family your friends and lots of other people you don't even realize and so i think that i see as being a real silver lining is that we're all going to be more real with ourselves and more honest with ourselves which means it's gonna it's gonna advance this conversation yeah well when you and i first met and we were talking about it um you know well first i'm in my children's playroom like we've got a background to celebrate birthday week but um yeah they're down here like building magnet tile structures and i get so over here they're like imaginative play and i never would be able to do that otherwise that's definitely one of my silver lines too i tried the whole graduate journal like i don't i don't have time for that i do i do the two-minute version just off my phone off my laptop just pen and paper yeah i hear you it was hard what did my girlfriend like here's what i want you to do i just want you to end each day with a text like text me one thing you're grateful for i did it like two nights then i'm like uh today was a bad day you know coach she'll show you a hero hold you accountable yeah um but we also talked about you know with mental health and you know i've been in hr in tech for 20 years and this was not part of the conversation around benefits or our employees lives like when i first started in tech in the 90s and it certainly is now one of the things i'm really proud of about cloud flare is we actually have an employee resource group called mind flare that's all about kind of raising awareness around mental health and providing resources and removing that stigma and so i think you know Cloudflare is probably out in front um on this uh compared to many companies but something i'm particularly proud of um okay so in the last minute and a half while we're talking about silver linings what are the things that you're hopeful for in the next 10 years so we kind of look back a bit but looking forward what are the things around mental health or ginger that you're really excited to see 10 years out so it's 2030. So our vision is a world where mental health is never an obstacle and that's a kind of probably never-ending vision uh i don't think that'll be done in 10 years but i am hopeful that in 10 years or even well before that that this whole virtual first birth care paradigm can really start to take shape that you actually start digitally and then progress to an in -person should you need it and for some people who are more acute or in specific situations they absolutely do need to see an in-person provider but for many people starting actually virtual and virtual being the default feels like a more democratic and equitable um experience and world and so i'm hopeful that some of the changes that we've been seeing and just that the change in paradigms and how people interact are going to sustain and that that will actually enable that sort of future future state perfect way to add thank you so much