As a student and later a professional working in the US, Canada, London, Paris and Hong Kong, Joan Low had grown accustomed to a cosmopolitan lifestyle. But when she returned to Malaysia after more than a decade abroad, she found much had stayed the same in her hometown.
There were also no advancements in the mental health space, either. “Twenty years ago, as you can imagine, no one spoke about mental health and it was not a commonly used term. Mental health literacy was, and still is, low and access to certified mental health professionals remains challenging,” Low tells The Edge Singapore in a recent interview.
It was reported that an estimated 264 million people around the world are suffering from depression. In Malaysia, for example, one in three adults are grappling with mental health problems. “In the US, most people had mental health professionals they spoke to regularly,” says Low of her time as a Middlebury College undergraduate, where she studied international politics and economics. “It was almost a status symbol, to be very honest. But in Asia, it is not something that is common,” she adds.
Sensing a gap in the market, the former JP Morgan banker started ThoughtFull in 2018, which then began offering workshops and mental health assessments to corporations and universities in Kuala Lumpur and Singapore. “Immediately, we got traction with the [mental health] professionals, as many were seeking innovation within their field.”
Over 10 months, Low and her team of more than 100 volunteers reached out to some 1,000 people across various organisations, even working directly with Hannah Yeoh, then Malaysia’s Deputy Minister of Women, Family and Community Development. They also found that a third of the participants exhibited symptoms of severe or extremely severe depression, anxiety or stress. Low and her team offered to follow up with this group. To their surprise, many were open to receiving professional help.
“But one of the biggest challenges we experienced was that even if we matched them to a professional who fits their budget, is located five minutes away, and has the appointment already confirmed, they still wouldn’t show up,” she recalls.
No-show rates were high, says Low of the clients from her then-fledgling start-up. “To be physically seen going to a clinic, for example, is something that is still quite intimidating for a lot of people.”
Apart from the social stigma surrounding mental illness, many were also concerned about the affordability of regular sessions, with private sessions costing about $150 to $250 an hour in Singapore, says Low. “It’s something that people weren’t quite ready to part with, or maybe it isn’t within their means.”
Those sessions formed the main driving force behind ThoughtFullChat, a platform connecting users to mental health professionals. In the third quarter of last year, Low’s team began testing the program with a pool of their clients and found that 80% of them hit metrics and milestones set out by the team, such as improved sleep. “That’s when we decided that okay, this is worth building,” she said.
When Covid-19 began its slow march across the globe earlier this year, Low saw employers and employees grapple with a paradigm shift. Working from home not only exposed the strength of corporations’ tech infrastructure, but also revealed how equipped they were to handle employee welfare.
“The dialogue today has changed at a very fundamental level among corporates compared to two years ago or even up to a few months ago. Before, a lot of the dialogue we had with corporates was around the idea of awareness. The nature of these initiatives were usually more one-off, rather than deep engagements,” says Low.
She continues: “Since the pandemic hit, the conversation has now progressed from just awareness and education to action. ‘How do we ensure that our people have the resources and tools to build resilience or to reach out if they need support? How do we ensure that our managers are empowered to support our people in a more empathetic way?’”
This is where the chat app comes in. It mimics the discovery journey from mental health awareness to action. Apart from daily “bitesized coaching” and an algorithm that matches you to a mental health professional based on your preferences, the main feature of the app is an asynchronous chat platform that allows users to leave messages for professionals to respond to at their own time. “We wanted to make sure that we had something for everyone, regardless of how ready they were to engage,” Low adds.
As there was a demand, Low and her team expedited the development of ThoughtFullChat. With prices starting from $169 a month for individuals, the subscription-based app was made available to the public in May, more than a month earlier than scheduled. “We actually signed on our first corporate client even before the app was launched,” she explains.
ThoughtFullChat currently hosts mental health professionals in the “double digits”, located in six cities across Malaysia and Singapore, says Low. The app also supports five languages, namely English, Malay, Tamil, Cantonese and Mandarin.
The main goal of the app is to get people to be more aware of their mental health and help prevent more serious mental problems from developing. But Low also adds that it is not meant to be a digital substitute for professional care. Jeanie Chu, senior clinical psychologist at The Resilienz Clinic, agrees. “If this person needs some sort of stress management, anger management — that might be sufficient. But if the person is really suffering from depression, like a major depressive disorder, it might not be enough,” she explains.
According to Chu, the app is useful as it allows psychologists to have more insights into the patient they are treating. While the user can also check in their symptoms daily, she says such apps ultimately cannot completely replace professional mental health services as the efficacy of mental health treatment requires a personal connection with the client — a process she calls “therapeutic alliance”.
This is crucial in the recovery process as it creates “a rapport, a bond, a connection with your clients or patients”. She explains: “A psychologist, counsellor or therapist can be really skilful in what they do and they might have adequate knowledge in that field. But if there’s no connection or rapport with the client, it is hard [to help them] in terms of prognosis to recovery.”
While ThoughtFullChat is a good way to reach out to people and raise awareness about their mental health, Chu says a user needs to seek professional help if their mental health affects their physical functions and well-being. For example, if one is prone to self-harming when suffering an anxiety attack, that is a sure sign to seek professional help.
Meanwhile, things are looking good at ThoughtFull. Being funded only by an angel round in the first quarter of the year with investors across Hong Kong, Malaysia and Singapore, ThoughtFull has been exceeding even their own growth projections.
“We are proud and grateful to have surpassed everything that we had aimed to achieve this year, including the growth of our team, development of mobile app features, user base and revenue growth,” says Low. With 15 staff across Singapore, Malaysia and Vietnam, Low says the start-up is also preparing for their seed round fundraising, which is “starting soon”.
She adds: “The Covid-19 pandemic is a black swan event that has not only presented but also accelerated certain opportunities in the healthtech space. It’s a momentum that we want to continue because it’s a service that is much needed. Our vision is to make mental health as aspirational as physical health. Just like how we try to exercise or move regularly to maintain our physical health, the same should be done for our minds.”