Our commitment to mental health equity

We founded Big Health, way back in 2010, in reaction to what we saw as unacceptable disparities in the provision of mental healthcare. Hundreds of millions of people suffer with mental health challenges globally, and yet only a fraction are able to access evidence-based psychological interventions. This was distilled into Big Health’s mission “to help millions back to good mental health”, the north star which continues to drive all decision-making in the organization. The most vivid example of this is our dedication to “digital therapeutics” that can scale cost-effectively to the huge level of need, without sacrificing quality of care.

Now, in 2021, a year of untold suffering has cast a spotlight on the racism and inequity that has existed throughout our society and institutions for generations. Witnessing these injustices has deepened our awareness. We recognize that cultural and systemic oppression runs through the fabric of our society, infiltrating governmental, educational, legal, corporate, and healthcare institutions, including the tech and healthcare industries. As a result many communities, most specifically people of color, have been living in pain and fear. This is why we believe that we cannot help millions back to good mental health without making a firm and long-lasting commitment to increasing mental health equity.

This commitment requires significant work on both our internal structures and our external impact. Last summer, in partnership with social impact consultants The Justice Collective, we conducted an internal audit to uncover racist processes and systems within Big Health. This highlighted the capabilities we need to create a truly anti-racist and inclusive work environment. To improve our externally-facing impact on mental health equity we have been fortunate to receive advice from leading experts including Dr. Nora Wilson Dennis, Dr. Juliette McClendon and Dr. Ricardo Muñoz, for which we’re deeply grateful.

As a result of that foundational work, we have developed a plan with specific goals across three key domains:

People: building a diverse team & equitable systems

To effectively help millions back to good mental health and increase mental health equity, our team needs to reflect the people we strive to help. So our goal is that, by the end of next year, 30% of our leadership team is from underrepresented populations in healthcare and technology, with a long term ambition for the diversity of our whole workforce to reflect that of our user base. To achieve this will require top to bottom examination and transformation of our systems and processes, to ensure they are inclusive and equitable.

Our internal equity audit highlighted that our values, care for our co-workers, and commitment to our mission are strong foundations from which to build towards this ambition. But today Black, Latinx and LGBTQ+ communities are underrepresented within Big Health, and although the majority of our workforce is female, we have less gender diversity within specific teams – most notably engineering and senior leadership. We also need to make sufficient time to work across our differences and build our anti-racist capabilities to achieve an inclusive and equitable environment.

Product: ensuring our therapeutics are inclusive

In order to help the full breadth of those in need, our digital therapeutics need to be truly inclusive. While we have done a great deal of work in this space, there are some areas of improvement to be addressed in order to better meet the needs of underserved populations. Ultimately, our goal is for our products to treat symptoms of mental health conditions for all, regardless of demographics or socioeconomic status.

Our next milestone in pursuit of that goal is to develop and implement a Cultural Responsiveness Framework in our product development, as soon as possible and certainly by the end of 2021. This will require an evolution of our product and research processes, to ensure that they are inclusive and culturally responsive – from product design to user testing to clinical research. Right now, our products promote inclusion in a number of ways – they are fully digital, allowing users to access them whenever and wherever they are needed, and they are presented in a way that is designed to feel unlike therapy and to avoid stigma. Indeed, we have encouraging data regarding their use and effectiveness within certain underserved populations. However, there is much scope for improvement – for example, whereas Daylight was designed to appeal broadly to many different users, Sleepio is exclusively presented by a white, male avatar. By including underrepresented voices in the product development process, we intend to identify and then narrow those gaps.

Additionally, over the past several months we’ve developed a set of best practices for promoting diversity, equity, and inclusion in our clinical research, with expert guidance from leading equity researchers, Dr. Jessica Graham-LoPresti and Dr. Tahirah Abdullah-Swain of BARE Mental Health & Wellness, and Dr. Ricardo Muñoz. This has resulted in a Research Equity Checklist that we are applying to all of our new and ongoing research studies. We are also asking external investigators who use our products in their research to adhere to this checklist, as a way of further promulgating inclusive research practices.

Populations: reaching & helping the underserved

We generate revenue by providing our products as reimbursed benefits via employers, insurers and health systems. However, this means that we are often not reaching those most in need – underserved populations, who suffer disproportionately from mental health challenges, and yet are less likely to have health coverage, be employed, or engage with our usual distribution methods.

So we are committing to finding ways to offer our products sustainably to underserved populations. Our goal is to provide access to 100,000 medically underserved people by the end of next year, a step towards our long-term ambition of 50% of our users being from underserved populations. To that end, we have begun explorations into how we can partner with our employer customers and other community partners to reach these populations, ahead of launching the first of these initiatives this year.

Delivering this commitment sustainably

The goals above will require sustained company-wide effort, the right expertise, and committed oversight to achieve. To support that, we are immediately creating a new role, VP of Equity & Population Health, who will sit on our executive leadership team, have a voice in company decision making, and be resourced to drive accountability across functions. Additionally, our Board has committed to support these efforts and to be held accountable to these goals. Finally, to keep ourselves accountable and allow others to learn from our failures as well as successes, we will publish a bi-annual report and equity scorecard on our progress.

Our mission to help millions back to good mental health is as true today as it was a decade ago. This commitment to mental health equity provides all of us at Big Health with fresh focus, and a set of essential new challenges to navigate in pursuit of that mission.