In India, as elsewhere, some of the people most in need of mental health services are least able to get them.
Wysa, with offices in Boston, London and Bengaluru, India, reaches at least seven million people in more than 95 countries with a free, user-friendly chatbot that detects a user’s mood or intent and guides them through a program of positive approaches. For a fee, clients can unlock customized wellness packages in a mobile app.
Most of Wysa’s revenues have come from B2B sales, to companies that want to improve the mental health of their workforce, with most of its customers English speakers able to comfortably access the mobile application.
Two years ago, the company took a step back from its mobile app and online model to develop a pen-and-paper version of its services for remote, hard to reach places.
“Think of an adolescent girl sitting in a part of rural India who [only] speaks her language,” says Wysa’s Rhea Yadav, who is leading the company’s efforts to reach users without English-language skills or who have little to no access to technology. “For her to benefit from this service… she is not going to be online.”
Wysa pursued its physical-plus-digital, or “phygital,” model as part of the second cohort of the 100x social impact accelerator, housed by the London School of Economics and funded by the British hedge fund manager and philanthropist Paul Marshall. The accelerator takes in startups and non-profits that have achieved some sort of traction within their markets, with a focus on emerging markets through a program to help them scale their impact.
“Good mental health is a skill that can be built within people,” Yadav told ImpactAlpha. “The ability to [cultivate] self care and build that skill of resilience is something that needs to be democratized in the world.”
Democratizing access
Scalable care models are crucial for addressing what experts warn is a mounting global mental health crisis. While public health attention has largely focused on infectious and, more recently, chronic disease, mental health has become the No. 1 global health challenge, affecting well over one billion people and costing the world economy multiple trillions of dollars in both lost productivity and direct costs. Mental disorders account for one of every six “years lived with disability,” or YLDs, globally.
The Covid pandemic boosted already-common conditions such as depression and anxiety by more than 25%, according to the World Health Organization’s 2022 World Mental Health Report. Among the other stressors: Economic precarity, social polarization, public health and humanitarian emergencies, forced displacement and climate catastrophes.
Evidence is strong that school-based social and emotional learning and a range of clinical interventions can help people manage their conditions. Bans on hazardous pesticides have proven effective in reducing suicides; Sustainable Development Goal No. 3.4.2 calls for a one-third reduction in suicide rate by 2030.
A decade ago, Jo Aggarwal and Ramakant Vempati joined up to launch a mental health app after both grappling with depression themselves and among immediate family.
Their thinking behind Wysa was that mobile phones were the key to democratizing access to mental health support, especially in places like India where professionals are in short supply and mental health conditions are still widely stigmatized.
Several years ago, Wysa has realized it had to go even further to reach more people, especially in rural areas.
Wysa moved to expand its language base to include Hindi and Marathi, some of India’s widely spoken languages. Offering services in only one language “entirely leaves out the base of the pyramid of underserved communities,” Yadav says.
Other online therapy platforms in India are offering their services in local languages as well. BetterLYF for instance links its users to counselors who speak primarily in English and Hindi, though they can engage users with other languages such as Bengali. Another app TickTalkTo allows users to chat online or directly call therapists, who support over ten local languages.
Wysa developed a model that combines physical workbooks with scannable codes, for young users to follow through as they would in customized therapy sessions. The interactive books incorporate therapy techniques and flow in a way that a user using a mobile app would use. These books have been rolled out in Marathi language, to over 250 girls’ high schools in Maharashtra in India with the help of the government and some local non-profits. Wysa wants to reach three times as many schools by December this year.
At school teachers help keep the girls accountable for going with the programme. These books also include a QR code, for those who are able to scan and access Wysa online without going through the app.
“The distribution channel to serve that user is entirely new as well. It meant working with government systems. It meant working with grassroots nonprofit organizations and more,” Yadav says.
Follow-on funding
With the reach and cost advantages of technology come new risks. AI-based therapy at times has gone wildly off-course, with cases of AI chatbots nudging users to self-harm and even suicide, under the guise of therapy.
The most recent case involves a teenager suffering from anxiety who disclosed to ChatGPT his intention to commit suicide. The teenager’s family alleges that the AI chatbot went on to guide him on how to hide his plans and how to go about it, eventually taking his own life.
Last year, a lawsuit filed against Character.AI alleges that the chatbot nudged a teenager to commit suicide when he was contemplating it and that there weren’t any proper guardrails to prevent it.
The safety issue was a risk that the Wysa team recognised. Wysa guardrails include pre-written and approved responses by clinicians, when the intent of self harm is detected. Prompts to users are validated against evidence-based techniques.
“You can’t do AI for mental health without guardrails around privacy and clinical safety. It’s just a no brainer,” she says. “It’s a deal breaker for any AI in the market, small or big, that’s claiming to be for counseling, therapy, mental health, but doesn’t have an AI policy or an AI model openly available that shows their guardrails.”
Wysa received an unrestricted grant of £150,000 ($198,000) to help the company expand its language base and kickstart its phygital model or therapy in workbook form. The company is among those in contention to receive follow-on funding from the UBS-Optimus Foundation, which is working with 100x to provide flexible financing including patient equity and long-term debt apart from grants, to eight ventures from 100x’s cohorts. As part of the partnership, UBS-Optimus is financing the accelerator’s expansion into Southeast Asia.
“The ventures in our portfolio have collectively unlocked over $100 million in various types of catalytic investments,” 100x’s Kieron Boyle tells ImpactAlpha.
UBS-Optimus has been an active grantmaker in health, climate and education in developing countries (see, for example, “Building a local solution to East Africa’s medical oxygen shortage”). Yadav said Wysa is a good fit for the foundation’s aim to help ventures raise follow-on support after completing the accelerators program.
“We’re especially open to blended types of financing that link payments to outcomes, because we’re so data driven, anyway,” she said. “Everything we do has outcomes attached to it for funders to also see that rigor and that comfort.”
