Project Access: Is it Possible to do Something in the Name of Good for Free in the U.S. Healthcare Ecosystem?
Recently, I had the pleasure of participating in Hack Mental Health, dubbed Silicon Valley’s inaugural hackathon devoted to all things mental health. This was the brainchild of Stephen Cognetta,
a Princeton grad and former product manager at Google who is also an admit at Stanford’s Graduate School of Business, and a team of passionate people whom he recruited to realize his vision: to bring together people in the tech world and those in the world of mental health. Let me start off by saying that this was by no means your average hackathon. Hack Mental Health was meticulously conceptualized and planned for many months in advance.
Stephen had reached out to me in mid-October, 2017 after learning that I had been on the judging panel for a hackathon organized by the San Francisco chapter of Health 2.0 just a few days earlier. We met at my private practice office in Cow Hollow a week later and talked about our mutual interest in digital mental health. I could tell that he was a good soul, a kind-hearted and well-intentioned individual who was passionate about bringing together bright minds from the tech and mental health worlds, people who would be unlikely to cross paths otherwise. I was sold on his idea and helped the planning committee in a minor advisory role in subsequent weeks until the time of the hackathon.
Because I had already been a mentor and judge in the preceding hackathon, I decided that I wanted to get a taste of something different this go around. I told myself that I would be part of a team this time and get my hands dirty with the assortment of Bay Area developers, designers and entrepreneurs who would be attending — rather than advise a team or judge the event. Part of my motivation to do so was that I had an idea of my own that I very much wanted to pursue, something that I had been mulling over for a rather long time. But, of course, not possessing robust and up-to-date coding skills, I would need the help of developers and designers to bring my idea to fruition.
So often, when I’ve worked with entrepreneurs and technologists with genuinely good ideas to bring to the mental health world — the world that I inhabit day in and day out — I’ve seen good intentions and brilliant ideas morph into, well, the plainly ludicrous. None of this is shocking, of course. When you accept venture capital funding to help build and grow a solid company, you do so to secure a favorable return on investment for the investors and, at the end of the day, to make money and build wealth for all the shareholders, really. Not surprisingly, the calculus of a growing a successful venture-backed company is not the same calculus as simply doing good for the community.
But, I was at a point in my career in mental health that I felt a burgeoning need to give back to the community in some way. I wondered, “What if you could provide enough manpower to a health technology solution in the form of passionate and motivated volunteers alone?” I resolved then to use Hack Mental Health as a sort of social sciences experiment to test this idea.
For some time now, I’ve felt that San Francisco lacked a basic screening and referral service for mental health concerns that was technology-enabled. This seemed absurd to me. Here we were, in one of the most technologically sophisticated cities in the world, the home of so many brand name tech behemoths, the hotbed of venture capital, yet we did not have any easy way for mentally distressed, treatment-seeking individuals to coherently navigate the world of mental health treatment.
Over the years, many a patient has inundated me with their woeful tales of unreturned telephone calls from mental health providers, of not being able to find providers on their insurance panels accepting new patients, or of having to wait months to have an initial appointment. I’ve also cataloged my share of stories of patients having negative experiences with mental health providers. These unfortunate souls have had to endure some combination of frustration and bewilderment, on top of the distress with which they were already dealing on account of their mental illnesses.
Moreover, not infrequently, when I speak to prospective patients on the phone, what I end up doing really is trying to understand their particular situation so as to steer them in the direction of a provider with whom they might be able to treat. You could say that I play the part of a care navigator in these situations. Over the years, I’ve learned that many people simply don’t know how to navigate the mental health system to find treatment providers who might be a good match for them. People may be constrained by the need to use health insurance, the need to see an in-network provider, or the need see a specialist who has particular expertise in a distinct clinical area (e.g. treatment-resistant depression, complex PTSD, severe OCD, ADHD, substance use disorders, etc.).
Surely, there’s way to automate this entire process, right?
As Hack Mental Health approached, I fleshed out my idea in my mind and started to recruit a team through the Slack channel that Stephen had set up for the event. What I wanted to build was a one-stop solution for mentally distressed, treatment-seeking individuals in the San Francisco Bay Area to receive comprehensive screening for the most common mental disorders and to find treatment providers who would be 1) available to them (i.e. affordable, accepting new patients) and 2) particularly knowledgeable about the conditions from which they may be suffering. I also envisioned giving people the opportunity to filter provider results based on geographic location, gender, familiarity with LGBTQ issues and types of therapies provided (e.g. cognitive behavioral therapy, acceptance and commitment therapy, psychodynamic psychotherapy, medications, transcranial magnetic stimulation, etc.)
As the idea further took shape in my mind, I thought, “Why not also make this a venue for people to learn more about mental illnesses from which they may be suffering?” What if my team and I could also curate high-quality educational materials about various mental disorders and treatments, as well as video narratives of individuals going through mental illness struggles? Finally, what if we could also host a chat platform for people to ask others with similar struggles any question they wanted to?
So, this was my ambition: to create a one-stop solution for mentally distressed and treatment-seeking individuals to freely explore the world of mental illness and treatment options and find providers with whom they could treat. When I pitched the idea on the Hack Mental Health Slack channel, Mariana Prutton, a care navigator at Lyra Health
expressed an immediate interest in the idea and the desire to create a team. Mariana ended up recruiting Simon Xiong,
a software engineer originally from Toronto working at Mixmax. Next, I received notification of interest from Derek Guillemette,
a UI/UX designer who was a recent transplant from NYC. Then, on the first morning of the event, we recruited Sophia Liu, another UI/UX designer,
and Judy Zaratan,
a software engineer who was making a career change from systems engineering. (Unfortunately, Marianna fell ill with the flu on the day of the event, so we were a team of 5 heading into hackathon).
Hack Mental Health was a 2-day event hosted at California Institute of Integral Studies, a progressive mental health educational outfit in SoMa that was founded by the Bengali integral philosopher, Haridas Chaudhari. Over the years, I have been thoroughly impressed by the programming that CIIS has offered to the public. Here was an organization that could bring to San Francisco a mesmerizing performance by Anoushka Shankar as well as host evening events with Nadya Tolokno of Pussy Riot and Chelsea Manning.
On the morning of Saturday, February 3rd — the first day of the hackathon — a small army of friendly volunteers greeted attendees in the brightly decorated lobby of CIIS.
Their job was to hand us our name cards and answer any questions that we might have had. The actual event, itself, unfolded on the 3rd floor of the building. I had about 45 minutes with my team in the morning to talk about my vision and to invite each of the team members to introduce herself and talk about her interest in mental health. Then, we headed back to the large, meeting room called Namaste Hall to listen to the two keynote talks, one by Jennifer Akullian, Founder and Coach at The Growth Coaching Institute, and another by Kelsey Crowe, author of There Is No Good Card for This: What To Say and Do When Life Is Scary, Awful, and Unfair to People You Love.
After this session, we were free to hack. My team decided that we would whiteboard our ideas first and outline the user flow experience.
Once we were sufficiently satisfied with the initial user flow diagram that we had outlined, Sophia and Derek worked diligently in Sketch to design the entire front end. Sophia also deftly whipped up with the illustrations that would eventually find their way into the prototype application. Meanwhile, Simon set out to scrape databases to come up with a list of treatment providers; he also coded the provider search functionality for the application. Judy coded the front end of our web application. I worked on copy for the project.
As a team, we worked until the very end of day one and then we came back together the next morning to work several more hours to complete a prototype of the solution that could be demoed in a pitch. Eventually, on account of time constraints and the relatively short period of coding time at this hackathon, we decided to demo our prototype in inVision.
To market the project initially, we decided that it was reasonable to start with Google Adwords and social media campaigns to target mentally distressed, treatment-seeking individuals. So, for example, if someone searched on Google for “depression treatment in San Francisco”, our project would return as a sponsored advertisement on the initial page of results. From there, a potential user could be directed to our web application, which we decided to call Project Access.
From the landing page, the user could learn what we were all about:
Users could take a comprehensive mental health screening if they were new to treatment and didn’t know, yet, which conditions may be affecting them.
Or, they could bypass this step and simply search for providers with whom they could treat (say, if they had been diagnosed previously with ADHD, but recently moved from New York City and needed to find a new psychiatrist to prescribe stimulant medications for their ADHD).
Users could also watch videos of people with lived experiences describing their struggles with various mental illnesses or find high-quality educational materials about various mental disorders, such as Major Depressive Disorder, Bipolar Disorders, Post-Traumatic Stress Disorder, Generalized Anxiety Disorder and Alcohol Use Disorder.
And, finally, users would have the option of joining an online chat community of fellow ADHD sufferers, for example to ask questions about various medications, support groups, or therapists/coaches specializing in the treatment of ADHD.
None of the individual component ideas of Project Access are especially complicated, of course. But, I was proud of the work that we had done and felt confident that we could take it to completion with time and additional volunteer effort.
When it came time to pitch our ideas to the judges in the initial round, we were selected to pitch to Seth Rosenberg of Greylock Ventures. I couldn’t help but be amused by this turn of events. Here we were building a community-based project with absolutely no monetary incentives and powered by volunteer enthusiasts pitching to someone whose job was to help fund startups with the best chances of becoming the next unicorn. I had no idea what he was thinking, naturally, but the whole while I imagined that he must have thinking, “What planet are you from, guy?” when I presented to him the vision behind Project Access. Still, Seth heard us out, nodded along, asked some questions and told us that there were others working on similar solutions.
I firmly believe that it will be feasible to launch Project Access in the next year and make a difference in San Francisco to people who are mentally distressed and treatment-seeking. It’s my hope that Project Access will become the first point of contact for these individuals, so that the navigation of care in the mental health system here doesn’t remain so convoluted and needlessly nebulous.
My next steps include forming a steering committee for Project Access and recruiting advisers who could provide their expertise and insights to achieve the mission of the project. Maggi Yang, a UI/UX designer at Hackster.io,
joined our effort after the hackathon. She and Derek Guillemette continue to work out the user experience flow for the time being. Simon Xiong will build the initial comprehensive database of all mental health providers in the San Francisco Bay Area. I plan to recruit undergraduates in psychology from institutions such as U.C. Berkeley to help create a volunteer staff that, among things, will contact each of these providers to verify contact information, determine if the provider is accepting new patients, identify the provider’s areas of expertise, specialized training he may have received and treatment modalities employed, and determine the provider’s current fees for service and status with insurers. We will also be recruiting people from the community to make short video narratives describing their mental illnesses and how they cope with them. In the future, we hope to host free, web-based treatments for various conditions for our users, such as an avatar-based computerized CBT application for depression.
I see this as just the beginning. By the time of the next Hack Mental Health hackathon, my hope is that the initial goals of this project will have been realized and that I could begin to work on something new.
