Interview: Simon Miller, Headspace
HBI speaks to Simon Miller, Headspace’s international partner lead, about the company’s long-term vision to create a digital mental health platform offering a personalised service across a wide continuum of care.
Headspace is one of the world’s best known digital mental health brands, but it is no longer just a guided meditation and mindfulness app. In 2021 it merged with a digital coaching and therapy company called Ginger, and now provides coaching and therapy services in combination with the Headspace app to thousands of companies as well as insurers in the US. This year it launched this service in the UK.
Before joining Headspace, Miller worked for insurance companies AXA and Aetna, with a focus on value based digital health, and, in more recent years, on digital mental health. This work involved investing in partners like Headspace, so he was very familiar with – and fond of – the company long before he started working there six months ago.
Simon Miller
He tells HBI: “Part of what attracted me to Headspace was its brand, which would have been compelling enough by itself. But what’s really exciting is the journey it’s on to become much more than just a guided meditation app. It has an incredible vision to transform how mental health care is delivered.”
The mental health sector is in dire need of new treatment options and business models, with one in eight people across the world suffering from a mental health disorder and existing solutions and clinical capacity clearly insufficient to meet this need.
“We believe there is a better way, which is to provide more access to that subclinical level of support and focus on the root cause as well as fixing seriously ill people”, says Miller. “We’ve found that one session of mindfulness with Headspace can reduce general anxiety scores by 30% in 30 days. Also, a lot of people go into the clinical modality when they don’t really need to. In the US we see 80% of people who engage with our coaching service don’t need to go on to further support. This is why there is such a huge demand for what we offer.
“We liken it to brushing your teeth: you brush your teeth every day to avoid going under the drill, not because your teeth are in a bad way. Another helpful analogy is that it’s like using a gym for your mind. Exercising is important not just for people who are struggling but also people who are thriving.
“But the challenge is always funding. Mental health systems have in the past been primarily focused on clinical solutions. But there is a real shortage of resources and major cost implications with these.”
The case for funding preventive mental health solutions should be as clear as it is for physical health. The return on investment in terms of significantly reducing the cost and burden to clinical mental health infrastructure but also the benefits it would have to the wider economy should make it a no-brainer. But health systems and payors are not always as forward looking as they could be.
One possible solution is employer health plans: “Companies are increasingly seeing the multiple benefits of spending money on this, which include lower absenteeism, increased productivity (which provides a direct return on investment), but also improved retention rates. Employees expect more from their employers today than they used to.
“[Consultancy firm] McKinsey did a study where they found that about 1% of the workforce has acute mental care needs, either in the form of psychiatric care or long term therapy. But the study also found that 75% could benefit from some kind of everyday self-guided care, such as that offered by Headspace, and that 24% could benefit from some kind of lower acuity intervention like therapy or coaching, such as that provided by Ginger.”
Headspace merged with Ginger in August 2021 in a deal that gave the combined group a valuation of $3bn. The Ginger coaching service was previously only available in the US but launched in the UK in January.
“The two entities are focused on different ends of mental health care, with Headspace focused on mass wellbeing engagement, and Ginger coming from the therapeutic end. We’re now bringing them into a single proposition: a continuum of care business that can provide support throughout that journey, and provide it in a much more scalable and cost efficient way. The coaching service is now absolutely core to what we do.
“Coaching is not therapy. It uses CBT-type techniques and motivational questioning to help people discover in-the-moment needs (rather than deep causes), and to be able to set goals and tasks to deal with present issues. This could be anything that’s affecting how you’re feeling or working. For example, if you wake up in the middle of night and need to vent after a bad day at work, is that something you’re going to go get therapy for, or go to a GP for? The coaching service allows you to speak to someone potentially through an online chat at any time of the day or night.”
Access to therapy is also provided, although Miller says that engagement with employers’ traditional therapy services is lower, not because they’re not good but because sometimes they’re not fully understood by employees, as well as perhaps some stigma.
Most people who access the Headspace Health coaching service do so through texting, although users can also access video or face-to-face therapy appointments. One obvious question given this is whether the service could be provided by a chatbot rather than a human, especially in light of how advanced language processing algorithms are becoming (as anyone who has tried ChatGPT will know).
“Our belief at this time is that the value is in being able to speak to a human, for the contextuality and cultural aspect, and diverse needs. But there are other chat AI models out there. Interestingly some studies came out recently where somebody had deployed some AI pilots without letting the users know. They found some evidence suggesting that people often didn’t realise they were speaking to a chatbot, but also found that people tended to have quite a negative reaction when it was later revealed to them. This hidden approach is certainly something we wouldn’t be comfortable with in terms of ethics. But the open use of AI Chat in appropriate parts of the customer journey is a development that the market is going to continue. We are seeing it trialed for self-referral triage in the NHS talking therapies framework and we are keeping a close eye on this.”
Currently the coaching service and the Headspace app are offered as separate apps which are linked (similarly to how the Facebook app is linked with the Messenger app), with coaches being able to “prescribe” content on the Headspace app. But the idea is that eventually there will be a single app through which users will be able to gain access to the full continuum of services.
“At the moment bringing them together is a corporate focus, but in the long term we can expect to see them come together on the consumer end in one app, and also plugging in with partners.
“We don’t make specialist referrals as that requires a full clinical diagnosis. But if a more specialist need is required we can guide users to GP services and make them aware of what to expect and the types of onward support they might need to explore. And of course, we always have safe-guarding built into this. If someone is showing signs of self-harm or abuse, we have the ability to escalate and reach out to emergency services, and we signpost to SOS, Samaritans etc. within the app.
“It’s true, there are a lot of digital mental health services out there already but they can be quite fragmented, disconnected and hard to navigate. There are other companies that provide digital therapy and coaching, but to be able to offer it as part of the overall continuum of mental health care, and to do it within a user experience that users can feel is their own experience, rather than their employer’s or health system’s, is what it’s all about. And Headspace has a well known and loved brand that helps us engage in proactive mental wellbeing to support people before they get ill or catch them early if they do.”
Headspace Health currently has over 100m active users, in over 190 countries. It also now has over 4,000 corporate clients, to whom it makes available subscriptions to both the Headspace and the Ginger offering (some of these are on Ginger only, some on Headspace only and some are on both).
“Previously we were only able to offer this to US-headquartered companies, but now we are offering it to UK-headquartered companies as well. But many of our corporate clients are multinationals, so there are many people outside the UK and US who already have access. And we will quite quickly expand into more countries. For example, we’ve got existing clients in the Netherlands who are interested, and as a result that has shot to the top of the list. English speaking markets are naturally a priority but we also have Spanish capabilities within our coaching service, which will shape next steps. What employers are looking for is to provide harmonised benefits and inclusive access across the countries they employ in. We are providing a solution to this demand from multinationals.”
We would welcome your thoughts on this story. Email your views to Martin De Benito Gellner or call 0207 183 3779.
