From Practice to Innovation: Conversations with Mental Health Tech Leaders
An interview with Sarah Adler, PsyD, Founder and CEO of Wave
The integration of technology into mental health care has ushered in a new era of innovation and accessibility. From mobile apps offering mindfulness exercises to virtual therapy platforms connecting individuals with licensed professionals, the landscape of mental health tech is rapidly evolving to meet the diverse needs of users.
The rise of mental health tech companies has allowed licensed clinicians to move from the clinical setting to corporate leadership. In this monthly post, we will chat with professionals from the mental health tech industry to learn more about them, their current job, and the path they took to get where they are now.
Sarah Adler, PsyD, is the Founder and CEO of Wave, a behavioral health solution that focuses on an evidence-based approach and outcomes data to provide quality patient care. Drawing upon her extensive background in finance and entrepreneurial ventures in the mental health space, Dr. Adler seamlessly navigates the complexities of mental health startups, consistently elevating standards and fostering innovation.
Lindy: What made you decide to get involved with Therapists in Tech?
Sarah: Grin, the founder, reached out to me very, very early on. I think I was one of the earlier adopters of thinking about new care delivery models, using technology, using data, and using different ways to provide evidence-based care through my fellowship and my work at Stanford. Grin reached out and said,”Hey, I’m founding this thing, want to come join?” and I was like, “Yeah, let’s do it.” There’s some other communities in the area, but this one felt super inclusive. It resonated with me, the mission and vision, and it was cool to be considered to be an early part of that.
As one of the early founders of the Therapists in Tech, what do you see for the future of this organization?
I am incredibly excited to see where Dave Cooper [Interim Director] takes it. We have been trying very hard to be a space where folks entering the industry can really be connected with folks who are already in the industry. We fundamentally believe that the clinical voice needs to be loud, heard, and valued in the tech industry as digital mental health and all of these new care delivery models are becoming monetized.
I’m really hopeful that we can become an even louder, more prominent voice and the go-to for companies to turn to when they need clinical advisory, when they need to make sure that their culture is one that is supporting clinicians, and while focusing on outcomes. I think we’re in a really interesting macro paradigm shift right now where there’s a reckoning between what’s happening on the business side, where we’ve seen this hyper-growth of companies that are not actually demonstrating efficacy or outcomes. We’re seeing this reckoning from folks who are paying for these programs saying, “Well, if you’re not actually demonstrating outcomes, then how are you demonstrating return on our investment?” So I think there’s a real shift in the employer space, the broker space, and the health plan space to say, “No, you can’t just build something that is cheap. You actually have to build something that is effective and impacts our bottom line.” This is where the opportunity lies for the clinical voice to be incorporated into building these solutions.
Does it make these companies more reputable if clinicians are involved? If clinicians understand their clients, would patients be more likely to work with these organizations?
You would think, but we’re in an interesting moment where getting access to any care is so hard. The consumer doesn’t know what good care should look like. This is an opportunity for bad actors to take advantage. We know what evidence-based care looks like. We also know that evidence-based care is severely hampered by racial socioeconomic and other biases like the DSM-5. We know that people really don’t understand what happens in therapy. The consumer coming in is highly under-educated about the options.
We also know that most therapists don’t look at their own outcomes data. They rely on training and experience to provide care without really assessing or holding themselves to quality control. We also are starting to see a world where there are different ways to impact mental health beyond just psychotherapy. We’re kind of in the Wild West. There isn’t a lot of good data. We’re just at the start of this nascent understanding of what is effective for whom.
Can you share a little bit about your career path and how you got to where you are today?
I sort of jokingly say, don’t try to follow my career path. It’s not repeatable. I started off my career as a hedge fund analyst. I worked in finance for almost eight years out of undergrad. I’d always wanted to be a psychiatrist, that was my dream. I was premed in college, and then ended up in finance. I did that for a bunch of years and found it incredibly unfulfilling. When my husband and I moved to Silicon Valley, to the Bay Area for his job, I took the opportunity to take a step back and reassess my own values and what I wanted to be doing. I went back to grad school at age 29 to become a clinical psychologist as my second career. The program at Stanford opened my eyes to the creation of evidence-based interventions, which I fell in love with.
I also did a postdoctoral fellowship at Stanford where I spent a year using user-centered design to build new care delivery models that were better, faster, cheaper. That was a huge opening of my eyes in terms of how the healthcare system worked and the misaligned financial incentives that keep us stuck. We designed all these new care delivery models and I learned the process of how to design and build, and then how to sell into health plans and self-insured employers — a very needed experience for what I do now.
After post-doc I joined the faculty at Stanford, where I helped redesign some of their ambulatory care practices and build up their measurement-based care system. I was doing research, teaching, and seeing patients. I also at that time, started sitting on a lot of advisory boards for digital health companies. I learned what not to do in those early days.
Then I founded a group private practice of my own, that still exists today, which focuses on the dissemination of evidence-based care (they now say evidence-informed care, which is more DEI friendly), because we found that outside of academic medical centers, there were few practices that were like-minded to deliver treatment that works. I then joined a national healthcare venture-backed startup called Octave Health Group and helped them build out their care delivery model. I learned a ton about product and engineering and fundraising and then I decided I wanted to do it on my own. So I founded Wave in 2021.
So you have seen every different aspect of these new business models?
I have, definitely. At this point, I have seen a ton and yet I vacillate between being a natural optimist in terms of the kind of levers we can pull to change things systemically and equally dialectically overwhelmed by the misaligned financial incentives that keep perpetuating models that are really sucky.
What led you to transition into the industry roles?
I moved into industry for a couple of reasons. One is that academia is just really slow. I have a massive bias towards action. It’s in my personality. I have ADHD and am definitely someone who is very comfortable with risk and want to see things move quickly. I was unsatisfied with how slow things went in research. I know that there are great reasons to take things slowly and to go through peer review processes and to go through grants but the level of bureaucracy was annoying. It doesn’t need to be quite as slow as it is. I think there is room for ethical innovation done correctly, responsibly demonstrating outcomes measured outside of academia and I think that’s really what pushed me outside. I can make an impact faster.
What education or certifications did you get to help you get roles in the industry?
I think that the combination of my finance background and my clinical training is what made me appealing to be funded. There’s something called founder-market fit. Investors are looking for what this particular founder does to convince them that they will understand all the different pitfalls that are going to come. And as we all know in the mental health space, the financial side is always in tension with the clinical side, which causes a ton of problems, so having clinical leadership is unique and fundamentally very important. I think that probably made me somewhat appealing to investors.
What skills or qualities do you think have been most important to your success?
I’m highly risk-tolerant. I think it’s really important in my role to be able to flex between the big picture, the macro, and the micro effortlessly, multiple times a day. It’s really important to be able to see both the forest and the trees in the work that I do. I actually think it’s what made me a good clinician. It’s useful to be able to non-judgmentally listen, assess data, and come to conclusions quickly.
I’ve been told I have a very fast processing speed, which I think has been really helpful too. I once heard a statement that really good CEOs make very quick decisions, with 60% conviction. I actually don’t like that at all because I need a lot more data. I am very data-driven. Data can be my gut, data can be numbers on a spreadsheet, data can be what my clinicians are telling me, or what a client is telling me. But being able to aggregate the data and act is useful.
I think it’s very important just to have that quality. You have to think on your feet a lot with clinical practice and in industry too.
I’ve always said that it is a lot easier to teach clinicians the business side than it is to teach the business folks the clinical side. I’d really love to see a lot more clinical leadership. But it’s really tricky. If clinicians who are entering industry do not understand the business side, they’re putting themselves at a massive disadvantage to go unheard within an organization. I think understanding basic business is really important for any clinician who’s going into industry so they can be more effective in terms of managing from within the system.
It’s actually something I tell my postdoctoral fellows at Stanford as well when they’re negotiating their jobs. Like most clinicians, most of my postdocs will say, “I’ve been offered this job at this rate.” Understanding how this hospital system works from a financial perspective actually gives you a sense of what your value and your importance is within the organization and will help you leverage yourself. We as clinicians aren’t trained to talk about money or think about money and it’s a problem. It is imperative that we can talk about it so that we can understand our own value and understand how to effectively navigate the systems we’re in.
Clinicians are the ones who can really go with the data and say, “Hey, this is something we need to improve on.” We’re worth a lot more.
Right? And I think it’s all well and good to say we’re not being treated fairly. It’s really different to say if you treat us fairly we will deliver a better ROI. I think when you’re talking to the business side of the house, arming yourself with the language and the understanding prevents a divide I’ve seen happen a lot, which is like, “Oh, clinicians don’t understand that we’re a business.” And to some extent, I think it’s true, isn’t it? I’ve had those conversations with my own employees that, if the lights aren’t on, you will not have a job. And so there is a real tension there.
Most of the companies that are out there have taken venture-backed dollars. I started doing a presentation for every clinician who enters my company, to highlight the understanding that the minute you accept a job in a venture-backed startup, you are committing to being part of an organization that has promised at least 10x return to their investors. Fundamentally, it’s important for clinicians to know that that’s what they’re committing to, and that’s something I try to be really upfront about because I’ve seen it backfire miserably in other organizations where the CEO just talked about the mission. If the mission is not actually constructed to be in line with being a successful business, the clinicians are going to feel like they’ve been baited and switched. They’re going to feel like they’ve been lied to when they don’t are being treated properly, or when there are decisions that don’t feel mission aligned.
What advice would you give to someone who wants to get into mental health tech?
Think about why and think about your timing. Right now, it’s hard because we’re in this correction I talked about before. ROI is going to become very, very important, demonstrating outcomes is going to be very important, and the clinical voice is going to become important. But clinical teams, especially clinical leadership, are the first to get cut when money gets tight. Think about the timing of entering any business. Think about why, from a values perspective, do you want to get into industry and be very careful to vet the companies you want to join.
There are not a ton of positions out there right now. And for folks who want to enter this space, it’s highly competitive. Folks who are coming in for the first time don’t feel like they can negotiate, have value, or interview. I always tell people that job-seeking is a lot like dating in the early stages. Don’t just pay attention to the person who’s paying attention to you. Really evaluate whether or not this is a good fit based on what your goals and values are. Is there career progression? How are the clinicians being compensated? Is there a clinical leader who has a real voice and is not just a figurehead? How transparent and open is leadership around the tradeoffs of listening to clinicians and the business side? How do they address that real tension?
Talk to the clinicians. How do they feel? I think how the lowest level clinician in the company feels is a really, really good indicator of how the clinical voice is heard at the company, so assess that too. How often do they have to rehire clinicians? How long is the tenure of clinicians? These are all really good questions and also really hard questions to ask in an interview process, right? Because we’re scared that they won’t like us. Understanding yourself and what your values are is always a great exercise to assess whether you will like the job. If you aren’t feeling comfortable having your questions answered in the interview, what does that say about the company you’re working for? Pay attention and be discerning.
