Revolutionizing Mental Health Care in the Digital Era: A Conversation with Ariela Safira — CEO & Founder of Real
On April 6th, members of the Princeton E-Club had the opportunity to meet Ariela Safira — Founder & CEO of Real, a mental health startup that aims to revolutionize the healthcare industry using technology. Through personalized and goal-oriented experiences, Real provides users with an accessible tool kit to take care of themselves and celebrate mental health care.
From my conversation with Ariela, I was able to have a closer look at the inspiration behind Real and what makes it a successful startup. So, dearest PiE readers, please read on as I am excited to share these insights with you!
The conversation was edited for clarity. Content warning: suicide.
What inspires you to fully devote your time and energy to mental health care?
When I was an undergraduate student at Stanford, a friend of mine attempted to take her life, and it was a horrifying experience. That was the first time I had ever really seen the mental health care system up close. It was the first time I ever saw a rehab, and the first time I had someone close openly share their experiences with psych meds and therapy, and I didn’t think it made sense, so I threw myself at it.
At the time, I wasn’t thinking of starting a company; I was just disappointed by how the system failed to do anything. It didn’t equate to a company at 19. But I haven’t stopped working on it until I actually got in touch with David Kelley — founder of the global design company IDEO. He is also the founder of Stanford’s Design Thinking program. We hit it off immediately and ended up spending a few years working on how we can redesign mental health care together.
When I left Stanford, I thought I would drop out entirely to found Real, but after a year away, David convinced me to come back. So I came back to finish up my Math and Computer Science degree, and then continued working on mental health care from there.
What do you think are some of the most urgent issues the mental health care industry is facing right now?
One of the biggest issues I saw then was that the first time my friend engaged with the mental health care system was when she attempted to take her own life. I just immediately felt like that was a little too late, right? Imagine if the first time you saw primary care physicians was when you had cancer, that’d be crazy. We know the system did not work if you didn’t even know it existed until a crisis.
The second issue was how broken the system seemed. My friend had one provider prescribing medication, another provider meeting her weekly after she left rehab, and a different one meeting her while she was in rehab. A whole care system that existed in the rehab and had no relationship with anything after that made me question what’s tying this all together.
Those are a few of the issues and, transparently, she didn’t get better. I just watched her care journey to this day, and to be honest, it seems like a very hopeless one. And yet so far no one has been rioting for change; we kind of just let someone silently die.
When it comes to mental health, we don’t, you know, care. And I think because mental health care is so not integrated into our system, many families are left confused and speechless as to what to do. I have seen people be far more proactive and engaged in the physical health of their loved ones, but for mental health, it is just this confusion and complete lack of awareness.
Since the foundation of Real is digital, do you think there are any cons in steering mental health care away from the traditional, face-to-face client-therapist approach?
I mean, the way I see it is through the lens of opportunities. We currently have about 500,000 mental health professionals in America. So for the majority of people in America to go to therapy for 12 to 15 sessions a year, which is allegedly what Cognitive Behavioral Therapy (CBT) says one needs to go to for care, we can only offer therapy to 7% of Americans. So first and foremost, we don’t have enough therapists for that.
But second, and this one is what I care so much more deeply about is it will take you years to realize something is going on before you can name it out loud. There are countless examples of people who are showing up to therapy weeks after weeks and not openly sharing they’re gay, or talking about their recurring nightmares. And it’s not a flaw; maybe it’s part of the human experience. We just have to understand that sometimes we have to go through that experience internally before knowing how to say it out loud, especially when it is something that is often stigmatized. And that’s where we’re going to meet people.
I think technology has given us really amazing tools like Reddit, which has done a far better job of building a sense of connection and understanding and allowing people to feel heard than a whole lot of healthcare today.
And so, I obviously think by the numbers, we just simply do not have enough practitioners to offer therapy to the masses. But outside of that, there’s a less technical problem, which is people need a way to understand themselves before they are ready to say it out loud.
In fact, people have been doing this for centuries. Before it was Reddit, it was reading books, it was art: people have been looking for ways to better understand themselves and hear others’ stories. And I think technology enables companies like Real to build a safe and monitored space for that.
What are some challenges that you encountered while building Real?
In retrospect, I raised the first round of funding when I was 24, and to an extent, that really benefited me because I did not fully know what I was getting myself into. And I think it continues to exist for me. You know, fundraising at a very young age when you don’t have your parents putting in a few million is hard. It is very literally pitching an idea that hasn’t yet been proven out and attaching a few hundred thousand to a few million dollar price tag to it.
At the time, I did not approach the process as such. But the fundraising experience is just having to endure a lot of rejections and still picking up the phone right after rejection and selling it to the next person with as much enthusiasm and authenticity as if you had never been rejected.
We were actually at our first round of funding. Our first idea of Real was a brick-and-mortar concept that was meant to open in April 2020. So probably a far greater challenge was pivoting the company within that same month, all the while having a bank account that’s reaching zero because you are an early-stage startup.
But when I look back, I could story-tell these things as challenges because on paper, they were challenges, but I really didn’t feel that at the time. I think it is a combination of so emotionally caring about what is being built and being around people who make me feel like I am capable. And while some things were more difficult than others, I felt pretty good at the moment.
This is going to be an interesting question. Using three adjectives and three verbs, how would you describe your team at Real?
Kind, really freaking smart, and creative.
Then this is kind of a statement and less of a verb. One of our values is that we are one team or acting as one team. And the thing that really makes Real successful is that everyone understands that a full team is needed. Everyone is really good at their job, and each department shines.
And that’s quite challenging in health tech. Often, there is a perception that either the doctors are doing it or the tech side is doing it. We build either a product first or a healthcare first organization, and I think that is what drives results in a poor healthcare system. Meanwhile at Real, at least from where I sit, we want to have stellar teams across the board in a respect for one another’s teams, and a true belief that this whole thing works because of all of these teams, as opposed to there is only one that is driving the company’s success.
And so I don’t think I gave you three verbs. I gave you acting as one team for words. Maybe, innovating and iterating as well.
How do you define entrepreneurship? What does it take to be an entrepreneur?
I actually hate the word “entrepreneur”… But you know that saying of David Foster Wallace when he gave the speech at Kenyon College and shared how often a fish does not know it’s in water. And I think being a founder or an entrepreneur requires being constantly aware of the water you’re in. The only way you can reinvent this water is if you recognize that the vast majority of people think that the way things are is how they should be, and that there is a good reason for everything that is happening.
But a founder is someone who, one, can articulate really well what the things around them are, and two, ask themselves if they are being done the right way. And I think the reason why immigrants usually end up being great founders — I don’t know if it’s a statistic or an anecdote I follow — but it is because they are so consciously aware of the waters. Since the water wasn’t ingrained in them at birth, it became much more noticeable to them.
What is one piece of advice you would offer for young college students who have a very faint idea of what they want to do but don’t quite know where to start?
At that point in life, we’re not entirely sure of what’s ahead. There’s no way for you to know if the decision in front of you is going to make you feel any type of way. What you do need to be really good at, however, is constantly asking and earnestly knowing how you feel about a decision, and then having the drive and confidence to do something different if you don’t feel well. And I don’t think most people know how to feel, let alone how to act on those feelings.
And so my recommendation here would be, none of us knows if the next decision we choose is going to make us feel good. You think you know, you think you’re going to love McKinsey but in reality, you don’t know that right? You have to be there to figure it out; you won’t know until you try. And when you try, please earnestly ask: How do I feel? What am I enjoying? What am I not enjoying? And then act on those feelings. Be willing to say, I’m going to do something different because this doesn’t make me happy.
I think unfortunately, it takes people so long to ask themselves those questions. And you know, we have made movies and talked about the midlife crisis that comes out of that and now the quarter-life crisis. It is mainly because we did not necessarily have any role models for that, and we are never taught to check in with ourselves. I would recommend people to trust that if you follow your feelings and be able to pay rent then you’ll end up in a place you feel good about.
