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Trust & The Power of Company Culture S2E6 Ariela Safira & Dr. Nina Vasan //of// Real TRT: 35:14 Transcript: Paul: Hello friend, I’m Paul Jarvis. Welcome to Call Paul, a show where I get to ring up some of the most interesting minds in small business and have thoughtful conversations about their unconventional approaches to commerce. I’ve run my own small company for the 21 years and I’ve written books on how bigger isn’t always better in business. In this season I’m talking to folks who are prioritizing doing the right thing over just the most profitable. Some are starting something brand new, standing up their businesses in an entirely new environment. Others have been at it a while, working to ensure their continued sustainability through turbulent times. And there’s lots to learn from everyone. Ariela : Investors in 2021 are smart and know what it takes to build a company and retain employees. And I think really experienced investors have gotten very good at naming when ideas and thoughts are not always tied to this clear profit number, this clear churn. I think they know better than that. And certainly the investors on our cap table are fully aware of the magic it takes to change a system. I hate the word disrupt. Sure, disrupt the system. And we put a lot of thought into it. Paul: That’s Ariela Safira, who, along with her cofounder Dr Nina Vasan, run a company called Real which launched in 2020. Real is a mental wellbeing membership, helping folks take proactive care of their mental health through active participation in online trainings, virtual therapist-led events and digital round-tables. Ariela and Dr Vasan believe that their company Real is in a position to not only change how mental healthcare works, but change how companies work too, starting with their own. For example, when our show reached out to them, we got an auto-responder saying the whole company was on a week-long “rest”, which happens every quarter. They also offer grief breaks, autonomy to work remotely and with flex-hours, and large mental health wellness stipends. All of this is to say, they invest heavily in the wellness of their employees because they deeply understand how beneficial it is to have a mentally well workforce. Ariela: Real is a mental health care company, really changing our perception around what does it take to improve mental health and we're starting from within, really evolving what is a workplace that improves your mental health and externally having that manifest in what our products and services across a digital and IRL experience that improves the mental health of the country as a whole. Paul: So for right now, it’s a digital-only experience. Ariela, so then what does it look like when someone goes to your website and signs up? Ariela : So we offer membership to individuals. And what that membership looks like is a $28 per month experience. You join Real you immediately go through an intake process. You're asked the Real 10, which is a built in-house mental health assessment. Really speaking the language of people today more than your universally understood or literature backed clinical assessments might. And from there you pick a pathway. And what a pathway is it's an eight session therapy experience. We have pathways on understanding your body image, pathways on communication relationships, pathways on understanding your depression. And what that looks like is every single week you're pushed a new session. And that's 30 minutes of content from a real therapist learning things like what is the history of body image, for example. When did we start to understand our perception of body image. How that compares to other people. We bring that to today and practicing what is your relationship with body image today? How can we work on that? And we bring that in a very action oriented way to the future of how can you improve your relationship, be it with body image, with depression, with your partner. And what sits outside of the pathway offering is a suite of mental health products. So we have real talks, events, round tables. These are all different kinds of ways you can experience and explore your mental health. And then might be live group sessions with a therapist. They might be on-demand content, much like a Spotify playlist of your mental health questions asked. Things like, how do I get a full night's rest when I have anxiety? Or how do I stop comparing myself on social media? So we're really giving people a suite of offerings to learn very different concepts in mental health. And also to do it in a setting that feels best for them. For some people that's live, showing their face and showing their name in a session with a therapist and a group. For others it's absolutely not live. I need to be anonymous to really explore this. And that's really a problem area that Real solves very well. And this gap in the market, if you will, which is there is this huge moment between I have a concern and I'm ready to say it out loud in front of an individual and a one-on-one appointment. Paul: Are you finding that gap at Real as well? Ariela: We have a pathway around exploring your sexuality. And what we found is the majority of people in that pathway actually go to one-on-one therapy today and have never talked about their sexuality. And what they have shared in these anonymous surveys is they assume they present as straight enough that the therapist has never asked. And they're not yet ready to come out and share they might be doubting their sexuality. And so they're facing their own inner turmoil even though they're showing up every week and paying and time and money to be there, they're not actually working on the issues that are really hurting them most. Whereas what Real's pathways allow for is for you to explore those concerns, those uncertainties, the questions, without anyone knowing you're exploring them. And for you to do them on the time and pace that works best for you. If you go to a one-on-one therapy today or if you try to go to one-on-one therapy today, you might get an appointment on Monday at 2:00 PM. And what I like to say is, "This Monday at 2:00 PM I'm going to be stressing out about my next board meeting. I'm not going to reach any vulnerability. I'm not going to able to tap back into that thing that happened to me at six years old. Whereas catch me Friday at midnight and I have shit to talk about." But no therapist is available Friday at midnight. And not only do I need it to be Friday at midnight, I need it to be Friday at midnight in my bed. That's when I can get to my deepest issues. No one's available then. And so what Real allows for is for you to personalize this experience and decide where and when is best for you to tap into vulnerability. Paul : So then how did Real start? Or what was the spark that led to this becoming a company? Ariela : About seven years ago I was an undergrad at Stanford. That's actually where I met Nina and a friend of mine had attempted suicide and I was not studying psychology. I was not a clinician. I was studying math and CS but it was the first time I'd ever experienced really the mental health care system up close and fairly personal. And I didn't think it made sense, from rehabs to the relationship or lack of relationship between therapy and psychiatry. I didn't think the system was, or rather, I thought the system was failing my friend. So I threw myself at it. I got in touch with David Kelly who's the founder of IDEO and would spend the next two to three years working with him on how can we redesign the mental health care system, actually dropped out of Stanford and thought I would leave entirely to found Real. Came back after a year. And that's where I took Nina's course, which is innovation and mental health care. worked a lot on what does it take to improve the mental health care system. From there joined IDEO, New York. Joined a Google company called Cityblock, working on redesigning care. Biked across a bunch of countries to fundraise for suicide prevention and then ultimately joined Columbia's clinical psych program to train to be a therapist. And it was while I was there that I saw how problematic the system is from the therapist training perspective. So reached out to Nina for the 20th time since graduating to talk about dropping out of Columbia and founding Real. Paul: Dr Vasan, what drew you to Ariela as a business partner? Dr. Nina Vasan : So when I met Ariela I think what immediately stood out was how she understood the nuances of mental health care problems in a completely different way. That's really what I think was so different and fundamental about her ideas of Real is she really was like, "Let's just not make incremental change. Let's completely start from scratch and rethink what mental health can look." So I'm a psychiatrist, a general adult psychiatrist at Stanford, which is where I had the pleasure of meeting Ariela, where I'm a professor and researcher and educator as well. And I think the first thing to start off with is just how broken the healthcare system is. And those of us who are clinicians and doctors we get into treating patients because there is something so really magical. And I think sacred about the experience of treating patients and what you're able to give, especially in mental health where we recognize that what you're sharing in that experience is oftentimes something so vulnerable that people have never shared with anyone before. And you're able to help in such a deep and fundamental way not only with that person, but then recognizing how it passes on. If you're treating a mother, how that then impacts what it's like for her to raise her child and how that translates to the family getting better and the community getting better. But it's a very special experience. But what I've seen as a physician, is that we have wait lists of up to nine months when people are trying to get care. And I grew up in a family of oncologists and I always think about these analogies between a disease like cancer and mental health. And think if there was a kid with cancer who was told, "We know you have this diagnosis but you're going to have to wait nine months to get treatment." That would be on the front page of every newspaper. Yet somehow in our country we're saying it's okay. Or it's not an outrage that someone has to wait nine months to get mental health care. And I think as we've lived through the pandemic, thinking about all the kids who have had all these life changes and haven't been able to get the help that they need, all the adults, everyone period. Just one example of how frustrating it is to be in a system where there are so many smart people, so many great ideas that we know are out there to transform the healthcare system yet it's not happening. And so my own work actually has been specifically on how can we best leverage technology to transform healthcare Pail: So, Ariela, why did you want to specifically partner with Dr. Vasan? Ariela : She the first clinician to really motivate me to start a company. She would pull me aside every week to say that I should start something. It was very moving to have someone motivate me so much but even more so was moving to have someone who's a clinician motivate me so much. At a school like Stanford, anyone who's studying math or CS is going to be motivated to start some company but it felt like a different degree of validating for a doctor to be doing so and for a doctor to be even commending my understanding of healthcare. So it was very clear that she was not just brilliant, which anyone can see when meeting her, when seeing her resume, but even more than that she was a warm and loving partner. And someone who played that role to me far before a company existed or funding existed. Paul: Do you think she thought that you would ask her to partner when she was prompting you and telling you that ‘hey you should start a business?’ Ariela : I don't think so. As you'll see in talking to her she is so honest and genuine in her approach to people that it always felt like she was speaking almost on behalf of the mental health care community. Like you as human should start something as opposed to partnering up. And that ended up being years prior to when I finally would found Real. Paul: I'm curious from your perspective, how did it go from Ariela as a student to you two are partners in the company that you're starting? Dr. Nina Vasan: I get pitched really every day from a different startup, a different founder on, here's my idea of how I want to change mental healthcare. And lots of great ideas and of that she has still stood out as the single person where I basically have been like, "Yes, I think you are absolutely brilliant and absolutely phenomenal human being and will quit everything to follow you across the country. Wherever you tell me to go I will go." Because it's not only just an amazing vision. I think what's been phenomenal to see from initial ideation stages to now where the company has grown to 40, 50 people and raised millions of dollars is how she is able to inspire so many other people and yet keep a steady vision, build this incredible culture. When I look at the people who are a part of our team today, the same culture that she had when this was a two, three person company is the same culture that there is today and incredibly supportive and dynamic. And I think that's incredibly rare and it's really a huge testament to who she is and how she's able to find and draw in the best people who have those same values. I think that's something that I found to be very unique.When you see leaders and what they do, how in the face of a challenge or this case, the biggest challenge we've had in our lifetime, how they thrive in new ways. And for Ariela I think that was completely being able to realize another version of her vision that was far more universal and able to make even deeper impact than ever before. And I think that just getting to be a part of that journey has been a dream come true, certainly for me. (((( - PIVOT APP )) Paul : So as far as how Real works,[...], can you talk about the philosophy that you brought, one, to run a company in a very specific way? For example, we were looking at the benefits page and there's a section called autonomy, … which is quite a bit different than how a lot of other businesses, specifically startups, typically run? Ariela : I was raised by a dad who was raised in a commune. And I think his way of living and his eagerness for autonomy, his passion for community and people really played a massive role in my upbringing and what I value in life. And I'm very capable of recognizing that what made me understand the mental health care system so well and build such an innovative approach to care was autonomy and my own sense of autonomy and exploring care in a new way. And I want every employee at Real to feel that, I think it's for the betterment of mental health care if everyone could feel that drive to think intentionally. And I think it's for the betterment of their mental health if they feel that sense of ownership over their own time, their own work et cetera. Paul : Yeah. I think that culture is probably one of the hardest things to scale in a company. So I think that that's amazing that that has happened. Even one of the things when one of the producers of the show reached out to you all, we got an email saying that the company is off because this is your week off, this quarter, to not work. And so I guess, can you talk about that specifically a little bit? Why mandate time off? Ariela : I think that in startup culture the concept of unlimited PTO is offered to individuals but never used. And in non-startup culture we limit the number of PTO days and it becomes a private concept. You practice on your own and probably don't return to work to talk about PTO because you don't want to be that guy talking about Hawaii when your friends are working or peers were working. And early on I'd sent a survey to the team really asking questions around what does time away from work look like for them. What does rest look like for them? What has PTO looked like today? And used their answers to ensure this resonates with them to realize that true rest involves not getting Slack messages and not getting emails. And it also involves coming back to a workplace not thinking that you're going to have twice as much work to do because you were off. And so what I found is that to actually feel a sense of rest and break requires everyone feeling it.And what I've seen in practice is, it's not just that people feel more restful upon return, it's also they feel a greater sense of community with one another because we have this shared ritual of a quarterly week off. I think something I learned in one of these surveys. A question I asked is, how would you compare summers off as a child, summers off from school, to PTO today? And one person shared that a big difference was that summers off from school was a shared ritual. And that is what's so missing from the workplace. So really when I think of our quarterly week off it's in part a more restful break from work, and we've seen that in practice. And also it enhances community within and makes us celebrate one another's time off and time on. Paul: What was the initial vision for Real? I believe it changed because the pandemic happened. And then can you talk about what that led to in terms of how you had to pivot to deal with what was happening in the world? Ariela : I think Real's mission has remained the same, which is to make mental wellness an essential part of everyone's life. And the first round of funding was raised on this idea that we will build a brick and mortar studio that offers a suite of in-person mental health care offerings. That brick and mortar studio was set to open in April of 2020 in Flatiron in New York City because of the pandemic that couldn't happen. And essentially come late March within eight days we realized we need to bring Real to the people. Mental health concerns are only going to sky rocket with this isolation. So we built a digital offering called Real to the People, which was a one month offering, a free digital therapy in both one-on-one and group format. And it was really meant to be a one month altruistic offering of care during this crisis. And we learned a lot, namely that everyone prefers group over one-on-one care and that people want to join anonymously. And this was a surprise given that a free one-on-one session is certainly a better deal than a free group. And yet time and time again people are choosing group salons and events over one-on-one appointments. And with that asking to join anonymously, their videos off, with their names removed, because they needed that anonymity in order to comfortably join. For the majority of people who joined in April and for myself included, if you asked me to go to a one-on-one appointment and talk about my body image for 45 minutes I wouldn't have much to say. But really what I need is I first need to learn, what is language used to discuss these concerns, these topics? What are examples of how it manifests in other people? And to use that to empower me to figure out how this manifests within me. So I'll just say this inspired a totally new idea, which is our digital membership today. And within that same month we fundraised a second round of funding and started developing a membership that would open in August of 2020. Paul : My background is building software and building something in eight days. It blows my mind how amazing and commendable that is. Ariela : Yeah. I think what allowed us to be so nimble is actually and authentically caring about our mission. And I don't mean to rag on other companies but so often founders step out of business school and really their goal is to make money off of this product. After thinking of that they attach an emotional mission to that. But that is incomparable to earnestly and authentically feeling an emotional connection with this mission. And that's what drives you to think innovatively and to be able to think quickly when you actually do care about this. Paul : And I guess that's resonating with investors as you've raised a few rounds. I'm actually surprised by that, maybe I shouldn't be. That the way that you approach business doesn't always line up with the way that venture capital wants to see a business run Ariela : I think that often we assume passion comes with naive belief. Whereas certainly in the case of Real and for both Nina and I, that passion has always been coupled with very strategic, methodical planning. And so I think that there's so much heart and love in Real. And there's an equal amount of thoughtfulness and strategy behind it and investors feel both. I also will add that investors in 2021 are smart and know what it takes to build a company and retain employees and fully aware of the magic it takes to change a system. I hate the word disrupt. Sure, disrupt the system. So they get it. And we put a lot of thought into it. Paul: What are some of the issues that existed that you're trying to solve for? I guess, both in terms of the patient or the person getting the care and in terms of the practitioner who's helping provide that care? Dr. Nina Vasan : The first is that the sense of when are you receiving care. When do you actually need help? When you're most struggling, it's probably midnight on Friday. And if you call your doctor at midnight on Friday they're probably not going to pick up and probably will be a little bit annoyed about that. And so what we realized is that this asynchronous model. People should be able to get help when they need it at any time of the day. Because when you're feeling pain, when you're anxious, that's exactly the moment that you want to be able to get that help. And that's what's very completely flawed about the existing system. Number two, I think is consistency. If you go to five different doctors, you shouldn't have five completely separate experiences. There should be consistency on both angles. But from the patient, you want to actually know that what is going into that experience has been really thought through and is consistent. The third is evidence-based. So at the end of the day, as a doctor, I think of myself first as a scientist, wherein all of the stuff that I've been learning is the collection of a lot of scientific studies and trials. And so when we actually have so much evidence around what we're doing that needs to actually go into what the member is learning. The reality though is that while in training we all learn what the evidence is, the number of clinicians who actually then use that in their daily practice is actually quite low. And that's why then there is such inconsistency when you're doing one-on-one. And the reality is that there are metrics that we can follow. What percent of mental health clinicians do you think use these metrics in everyday practice? Paul: Even just given my own experience with therapy probably 25%. Dr. Nina Vasan: 10%. Paul : 10%. Wow! Dr. Nina Vasan: So of course insurance companies are skeptical and of course the world is skeptical if it's 10%. At Real 100%. Were saying 100% of people... Every member should have that experience because, Paul, one, metrics are so important because it's you as the user understanding yourself better Paul: I like that a lot. When you're starting a business, one of the things you think about is the market that you're going to serve. The question has to be two parts. One, why does it feel like mental health is devalued as a priority in society? It feels like a big question. And then two, how do you help show people the benefits of caring for their own mental health? Dr. Nina Vasan: So there's a Lancet study that looked at the return on investment for mental health care. And what they saw is that from a top down perspective it's about a five to six X return when you invest in mental health care. And this is so important for employers to think about but also societaly. Okay? And when we break that down there are two big components there. One is when we look at healthcare costs period, because it's not only just investing in mental health needs, prevention, treatment that mental health gets better, it's because other diseases get better as well. When you invest in mental health care, you don't get heart disease, you don't get diabetes. Or they get addressed early on. And so you don't see the late stage consequences or sequella of those disease. Or when you're getting treatment for depression, you're not ignoring your diabetes treatment or not taking your other medications and things like that. And then what the consequences of what that looks like for their family or society could be so much worse. Ariela: We haven't built a preventative mental health care system. The reason why I know to go to the doctor when my head hurts is because starting at five years old I was taught what is a fever versus what is a headache. Whereas when it comes to mental health care, the system itself is really only set up to meet people at crisis. We haven't built the annual mental checkup. We haven't introduced mental health education in school systems like we have introduced physical education. I think part of what triggered my building Real is when my friend attempted suicide and realized the first time she had seen any mental health condition was when she attempted to take her life. She hadn't been going to therapy for years. She'd never met a mental health clinician. And that's because that starts so much younger. Our understanding of when do I reach care and when is a system appropriate for me. We're not doing that for children when it comes to their mental health. Workplaces are not doing that for employees when it comes to their mental health. School systems are not doing that for people. Paul: My wife is a first responder, so I know that working in a field where there is trauma can be hard. I don't know how it couldn't be as human beings. So has that been part of the conversation when you're thinking about how we structure the business, how we can best take care of the people who work in the company so they can provide the best work to the people who are members as well? Ariela : More than anything what we've done is taken 10 steps back and asked, what does it take to live a mentally well life? And instead of throwing bandages on a workplace to solve for the mental health concerns the workplace brings you, how can we change the workplace itself such that it causes fewer mental health issues? I think we intentionally separate things like rest and vacation. And we intentionally separate autonomy and healthcare. And those are different concepts and they take very different amounts of time and a different kind of org structure even. What does it mean for you to feel autonomous or restful at work? It means you're not a one man team and that we hired another person to work on your team. Even though we can't calculate 80 hours of work on the week we do know that you're constantly thinking and you're constantly on the only way you're going to take that PTO is that there exists another human on your team so that you can actually take PTO. It is a very beautiful thing in startups that people feel so connected to their work and so actually responsible and needed in this workplace. But of course the backlash of that is being so responsible for work getting done and responsible for the company means you're never going to stop working. And so what we need to do to change that is to do things like hire more individuals such that you can take time off. Or things like mandate everyone to take that week off. And that's a pretty foreign concept. We even have employees who have shared that this is weird. What if this doesn't work as opposed to naming, what if completely reinventing mental health care starts internally and say you need to not work 52 weeks a year. And if employers really did feel so adamantly that employees should take 20 days off a year, maybe they would actually mandate it. And say the entire company is off. And so by taking that seriously, those quarterly weeks off, those are what we call rest. That is you actually feeling away from work. And separate to that is unlimited PTO where you can take vacation. And that exists by, one, naming it and putting it at benefits one pager. And also, two, practicing it ourselves. I take PTO. And I sleep, I'm not very good at but I don't work every weekend. And I think it's so challenging because there's so many pressures from investors, from movies that tell you to work all the time and celebrate working all the time. It's very hard to practice otherwise But really applying the same design thinking and product innovation we do to products and technical products in Silicon valley, applying that to the workplace to figure out what are the pain points of employees. Why are they unwell? And then it is my job... It's our job to creatively innovate and say what is a solution for that, even if no one else is doing it, how can we do it? Paul : Yeah. And as somebody who's been part of startup culture for 20 years, I understand. I don't think I know a single person who hasn't burnt out at some point because the pace that work is supposed to be is unhuman a lot of the time. So I think it's commendable that you all are thinking about that. Dr. Nina Vasan : One of the things that Ariela has said is, "I want to make sure that when people are working at Real that they are actually healthier as a result of that." How many workplaces can say that? I think that that's incredibly different. And some of the things that we've done, even in a very small level, like now all of our meetings, our Zoom meetings, start five minutes after the hour. We have a one hour pause on Tuesdays that you're not allowed to schedule any meetings, everyone is like... Literally on the calendar it won't let you schedule. You have to be out doing something else. And I think that's incredibly powerful, even just those five minutes. Being able to use the restroom or they take a... Do meditation or mindfulness or something like that. It's so powerful for that to be a company-wide policy. And to hear, "Yes, you can take care of yourself. We care about you." And really say, in this case, "Less is more." when these things are put in place people are just as, if not more productive, right? And stress levels go down. And so for the most part, when you have hardworking employees who are mission driven and want to do good stuff they're going to do that. I do think that employers have the potential to really transform what the future of mental health looks like perhaps more than any other entity does today. Even more so than... I'm a physician, speaking on behalf of the health care system, maybe even more so than policy makers, I think employers can make the biggest impact right now. Paul: I don’t know how else to put this, other than to lean on an overused phrase, Dr Vasan and Ariela “practice what they preach”. They are in a unique position to understand what it takes to run a rapidly growing startup, but also what it takes (and this is equally important), to make a positive mental impact for their growing group of employees. As entrepreneurs, a lot of what is taught to us is that we need to go-go-go and hustle at all costs, in order to succeed. We’re sold this bill of goods that we need to sacrifice both mentally and sometimes physically to get ahead. But the problem with this “hustle porn” mentality is that it doesn’t work. Or at least, it might for a bit, but then comes crashing down when we inevitably burn out. But there is another way for business owners. It’s actually profitable to take care of ourselves and our employees, and it’s got a great return on investment too. What’s different about Real is that they are a Venture-backed, fast growing tech startup, but one that knows the critical long term value of self care, for themselves and their clients. And in doing so they’re not just disrupting the mental healthcare model, they’re disrupting startup culture. And maybe even the very fabric of society. (music) Next Friday l’ll be chatting with with a fellow who makes physical products for people who work digitally. And he does it in a way that sometimes breaks Kickstarter from incredible interest. Jeff Sheldon: I call myself a designer by trade and an entrepreneur or businessman by accident. My love for design and making things better is where Ugmonk was born from, I hope you’ll join us. In the mean time you can listen to the small business spotlight, sharing with you a behind the scenes peek at the day to day of running a company. These stories are from folks who are doing amazing things, I think you'll really enjoy them. They’re also in the Call Paul feed. Call Paul is wonderfully produced by Ruth Eddy and is a Mailchimp Original Podcast. Subscribe now on your favourite podcast player, so you can check out all our other episodes and seasons. And if you want more awesome content, go to mailchimp dot com slash presents.