Technology and The Evolution of Mental Health Care

On this episode, Tom talks with Ravi Sharma, board director and founder of OOTify, a mental health hub that leverages artificial intelligence to provide a personalized ecosystem of resources for its clients. Together they discuss how a multifaceted approach to mental health has gained popularity as an alternative to traditional care, how AI can act as an important tool during the process, and why targeting resources to younger adults is so important.

Transcript

Intro 00:01
Welcome to Digital squared, a podcast that explores the implications of living in an increasingly digital world. We're on a mission to inspire our listeners to use technology and data for good. Your host, Tom Andriola is the Vice Chancellor for Information Technology and data and Chief Digital Officer at the University of California at Irvine. Join us as Tom and fellow leaders discuss the technological, cultural and societal trends that are shaping our world.

Tom 00:31
Today on the show, I'm talking to Ravi Sharma. Ravi is the founder and board director of OOTify a mental health hub that leverages artificial intelligence providing access to a personalized ecosystem of resources for its clients. In our talk, we discuss how a multifaceted approach to mental health has gained popularity as an alternative to traditional care, how AI can act as an important tool during the process, and why targeting resources to younger adults is so important. Ravi, thank you for joining us on the podcast.

Ravi 01:03
Thanks for having me.

Tom 01:04
Absolutely. So you've had a long journey into this role as a mental health activist. Tell us a little bit about the journey.

Ravi 01:13
Yeah, sure. Tom, thanks. Thanks for asking. So kind of started as a personal journey. As it does, I think with anyone that's in the mental health space, to be honest with you, I have seen kind of two family members, one on my paternal side and one on my maternal side, through the grapevine, I hear that they had kind of committed suicide. So for me at a young age, kind of hearing, you know, again, through the grapevine that there had been some mental health challenges that kind of piqued my interest very early on, when as a kid, but it was one of those things where it was like, don't talk about Bruno, we don't talk about those family members, you know, Southeast Asian culture. And so was just always in the back of my mind. And then when I got to USC and started my undergraduate studies, I saw other family members struggle with mental health issues, specifically my mother. And, you know, I tried to white knuckle it, and be the therapist myself. But I found really quickly that that's not a good role. For me. What I did find is that using multiple interventions, so therapy, nutrition, sleep, sort of virtual support groups, all these things, were very helpful to get my mom into remission. And the positive spin on this is she's been in full remission. She's been in great shape. And that kind of sparked the interest for me to get into mental health and forever become an activist for mental health and champion other mental health champions as well.

Tom 02:46
Yeah, so I want to get into this concept of the multiple interventions, right, but there's a story behind the name OOTify, right? Please share that with our audience.

Ravi 02:54
Yeah, so the genesis of you know, OOTify, which is the mental health company that I founded, was to live meaning is to lift up. And so my whole thesis is you lift up your mental health by re-upping almost every day, right? You work on all these different facets that impact your mental health, which can be clinical interventions, or subclinical interventions. And then it can be simple things like sports, nutrition, meditation, gratitude, and therapy and coaching if you need it, as well. So that was kind of the genesis of starting the company. And, you know, here we are today.

Tom 03:28
Yeah. So you know, Ravi, the audience doesn't know. But you and I have had a chance to work together, you were one of the key sponsor for a mental health challenge that we had here at UC Irvine. And one of the things is I was coming to understand and interact with you and OOTify is, you know, you use the power of ecosystems to kind of drive this activism in this movement. Can you talk a little bit about what you learned from your investing days and the power of an ecosystem and how it's really shaped how OOTify has evolved and what it's doing?

Ravi 04:02
Yeah, that is the billion dollar question, to be honest with you. What I have found in the mental health space is everyone is operating in a silo, right? You've got so many different participants and so many wonderful interventions that are standalone apps or standalone entities. And what ends up happening is you're not getting the benefit of a true ecosystem to leverage all those different interventions. And that's where technology, if you have the right recommendation engine, and you're able to have an incentive structure that kind of gives you that extrinsic and intrinsic motivation to engage with those interventions and see what works for you, because certain things aren't going to work for certain people. That's where you can really have a lot of impact. So we fell out of the gate having an ecosystem with multiple interventions, doing clinical trials around that, at LMU and USC to really kind of dive in deep on that would be the key to potentially solving the mental health crisis and that's the problem we're trying to solve.

Tom 05:01
And so if I then act as kind of a front end understanding the individual and then the personalization into directions for the right type of services that will help me in my condition at this point in time is that kind of what happens behind the sauce?

Ravi 05:16
Yeah, 100% I think you hit it on the nail, you know, we take a few psychological assessments, so like the GAD seven, which is for anxiety, that PHQ nine, which is for depression, we do a little Personality Inventory, which is the Neo IP, these are all open source psychological assessments, but they serve as the input. And then based on those inputs and the level of severity and your symptoms, we're matching you to certain interventions that we put into the, into the platform or into the ecosystem.

Tom 05:45
You know, I know we work with you because you have a huge focus on young people in terms of helping them with their challenges with mental health anxiety, but your platform is with people of all ages and backgrounds. How do you take into account different age groups and the different types of things that people struggle with different cultural differences? How does that get handled in a platform like yours?

Ravi 06:09
Yeah, you know, actually, that's probably one of our pitfalls, if I had to be 100% honest with you. And you know, when you're in a startup, and you're trying to solve a big problem, you're making mistakes. And I think we tried to do too much too fast. And the reality is, you’ve got to be focused when you're a startup, there's this thing, there's a death by 1000 swords. Yeah, what we found is we really want to focus on the college market. You know, it may not make us a billion dollar company one day, but there's this, there's an interesting statistic out of NAMI, which is the National Alliance on Mental Illness, and he said, almost 80% of mental illnesses are diagnosed before the age of 24. Wow. So you kind of want to get ahead of it early, and have students and our youth have the sort of framework to manage their mental health early on, even if it's small interventions that they're doing. Because you know, what can happen is you can prevent mental illness before it onsets, if you're if you're thoughtful about it early on. So that's why I'm really passionate about it. I feel like it would have helped a lot of my family members and even friends that I've seen battle mental health issues on a daily basis.

Tom 07:20
Well, I need to think about what we've all been through over the last few years with the pandemic, right, and how that's exacerbated some of these issues that people grapple with, it even accentuated the challenge even more what I saw from the work that that we did with with you, with our mental health challenge on campus, the way that such a large percentage of our students identify with the issue, and overcoming the stigma of being willing to kind of talk about it and engage around it was really, it was just transforming for me. And then of course, I have children in the age bracket that you're talking about. And so it's also a very personal topic, because this is a topic that they're not afraid to talk about with their parents. And so it's really, really interesting. And I think you've hit on it, which is, it's a great place to start. Because, you know, we know that the issue is there, it's in there in large percentages, and we can get ahead of the bigger issues just like, you know, being an active person, you know, when you're younger, yours helps you with things like diabetes and cardiovascular disease when you're older. So it's a great fit, it makes perfect sense. So you know, the title of this podcast is Digital Squared, your life in an increasingly digital world, so I spend my, you know, my days and my weeks trying to understand how technology is now coming into an ever increasing number of spaces and into our lives, how it accelerates things, and how it impacts it both positively and negatively. So if we take the topic of mental health in terms of your work, what you're doing, the startups that are coming into your ecosystem, what does the future look like for us in terms of mental health services, through more technology and more data and more intelligence through the data?

Ravi 09:19
Yeah, no, that's a great question. So, you know, I kind of look at mental health as a spectrum, right? We all have mental health, it's either languishing or it's flourishing. And the reality is, the more input data that you have, the smarter the better algorithm that you have, the more customized and personalized your suite of interventions is going to be. Now what does that mean improved? It means improved health outcomes. At the end of the day, if you get a personalized treatment plan, and you have a combination of interventions that speak to you, you're going to have better mental health. And so what does that really mean? Right, so what are those inputs? What are those inputs that are going to improve your mental health. So in our platform and beautify, we look at the psychological assessment data, which is symptomology. Right? What how acute is your are your symptoms? That's number one. Number two, your personality, right? What is your personality? Are you extroverted or introverted, in a very in a very simplistic sort of way to kind of put things but if you're extroverted, you're probably going to be open to social events, group yoga, and other sort of mental health interventions. If you're introverted, maybe you just want to do therapy, and you want to work through things just with your therapist. But going beyond that, what is really exciting with AI is you can start looking at how many, so what is the utilization rate of different subclinical interventions on campus? Right? You're looking at a population that at the end of the day is going to be very similar. They're going to want to do a lot of similar types of things. And what is the high frequency? What is the utilization of those with those inputs and creating a feedback loop to effectively recommend the best possible interventions and getting that data back from the students saying, hey, this worked for me, or this didn't work for me. And that's where the AI is going to get smarter, it's going to get more intelligence, gonna get more thoughtful and more, more personal.

Tom 11:15
Yeah. So one of the interesting things I'd love to ask you about is, you're in this increasingly digital world, you and I are having this conversation over a technology called Zoom. In that there's now a digital signal, that is the images that we're looking at each other, you know that that video file, there's going to be a transcript of every word that we've spoken to each other. And there's also a WAV file of the tonality associated, right. So to me, being the data guy, these are all data signals that are now computable against. So while I might, in the past, just sit in front of a mental health professional, and they're picking up the signals with their eyes and their ears, we now have data to compete against. Are you seeing startups getting into this case? It's like, here's some new data that somehow will be usable. To help diagnose my condition, I like to say, you're going to study all these three files and find out that while I may sound very energetic, but by looking at the MCQ, the 42 muscles in my face, and how they change and listen to tonality, my voice that I'm actually deeply depressed person, right, that's what the algorithm may tell you someday. So the question is, are you seeing startups starting to use some of these new data signals? And try to figure out how to bring them towards your ecosystem?

Ravi 12:35
Yeah, you know, there are quite a few startups where, you know, you simply answer a prompt of questions. And based on how you're typing, you know, kind of 200 words, 300 words, they can predict with a high level of, of certainty, whether or not you're anxious or depressed. There was this startup and, you know, this is why it's such a hard problem to crack, but there was a startup called Mind Strong Help that I invested in as an investor, they just went under last month, unfortunately, after reaching a, I think it was a one to $2 billion valuation backed by Jeff Bezos, their technology was phenomenal. So based on what you're doing on your phone, how quickly you're typing on your phone, based on what websites you're visiting, they can determine with like a 90% probability whether or not you're going to have a manic episode, or if you're schizophrenic at that moment, they can literally predict the acuity of your mental illness and the onset of an episode. That technology has now been sold to other startups. So my investment still has a fighting chance, because they can leverage that technology and build something off of it. But that's where AI can get really, really interesting and fascinating. However, there are some, you know, and I think we talked, we've talked about this before, Tom, there is some danger to that too, right? There's privacy concerns, there's, how far do you want to use those data inputs? Right? Do you want the AI to prescribe you medication? Do you want the AI to diagnose you? Do you want the AI to tell you to leave your husband or your wife or your boyfriend or your girlfriend? We've seen edge cases like that happening today, where the AI is telling you to do that with very incomplete data. And to give you perspective, I look at companies that are trillion dollar, almost trillion dollar companies like the Googles of the world, they have Bard and if you go on board today, and you type in who founded OOTify, it'll mention two people that I've never heard of both Indian one's a doctor and one's a business guy, but it's not me. So there's a lot of complications that can happen because the reality is, is parsing so much data. And you know, that interpretation of that data is, and kind of use of that data, and you know, for certain use cases, especially in mental health, when it's your health care can be dangerous. So, you know, there's there's definitely some positive potential implications, but to our earlier discussions, negative implications,

Tom 15:11
yeah, yeah, it's gonna get us, you know, back to this, we're seeing this in some of our healthcare examples here at the University of, you know, open data is can be very dangerous, right, as the impact of decisions have, you know, are higher. Do we have more curated data, right? I mean, you know, the reason why you can give that data to a mental health professional is they've been trained, right, and they have all of these hours that they've logged as part of their training and their practicum, that put them in a position to use that data in the right way on behalf of the patient. With a large language model from the internet, you don't get that same level of confidence, for sure. So then how did you, how's it as an investor, right? So here, you are looking at the powerful potential of a technology that the startup is bringing, saying, hey, please invest into us? And then bringing these issues around privacy and ethics? How do you bring that? How do you bring those topics into the conversation when you're evaluating a potential investment?

Ravi 16:12
Yeah, it starts with your thesis, right? What is your at the end of the day, what is your conviction? And what is your thesis? And my conviction is that the technology is there, it can be used for good. And my thesis is it should never be used for diagnosis or for prescribing medication. Right. So that's one side of the spectrum, where I think it fits nicely. And maybe I'm a little biased, because we would advise using it in this way is, we don't want the data. We don't want to hold the data. We don't want to warehouse the data. But we do want to create a recommendation engine, right. So we do want to make sure that we have the ability to continuously provide personalized care plans. But once that's done, you know, we don't we don't want to necessarily house that data. That does put us in a position where we're not going to have the kind of large datasets to continuously learn. But at the end of the day, we feel like we have enough data in real time to kind of provide the right recommendation engine, so at no point is OOTify ever gonna recommend or sorry, prescribe or medicate you, right? It's just, hey, here's interventions that are working for the population right now that we've seen from our dataset work for students. We appreciate any feedback on that. And then that's used to kind of enhance the recommendation engine.

Tom 17:26
And as you think about OOTify and being the orchestrator of an ecosystem, right, on behalf of your users who then can get to different types of services. How do you think about these privacy and ethical issues with respect to who you allow to play in the ecosystem on behalf of your users? That's got to be pretty complex, at least when I try to think about it, it seems very complex.

Ravi 17:50
Absolutely, like HIPAA compliance, obviously, is very important. Deidentifying the data is very important. Disclosures to the students and to the participants about how the data is being used as very important in natural, clear language. And, you know, just being very thoughtful about you know, and I think Apple done a really good job of this, is just really getting permission, instead of forgiveness. At the end of the day with data. You know, I will say when I'm in my Tesla, and I get in the car, and it's my time to play tennis, and it's like, it's already loaded in my, by the time I get into my GPS, and knows what time I play tennis, it's loaded. I like that. Right. So there are some benefits to the AI. And so just using it more as a co-pilot, as opposed to the, you know, the orchestrate, not the orchestrator, because I think that's actually a good use case. But as the end all be all, I think that's the way, that's a good use case for AI and technology.

Tom 18:58
So one of my kind of passion areas. So, you know, I've spent a good part of my career involved in the healthcare industry. As I progressed, I'm much more interested in keeping people well, or bringing people back to wellness, extending health span, right versus lifespan, right? So how do we keep people well in the first place, so they don't, no one ever aspired to become a patient? So we talk a lot in activities I'm involved in about a holistic understanding and a holistic treatment of the individual. And more and more what's coming into that conversation is understanding the you know, the mental component of this and how that's impacted by not just disease but also circumstances and environments and those types of things. Is OOTify playing into that part of the holistic understanding and wellness of the individual, or is that something that hey, they are not there yet. But that's something we're pleased. We're gonna go.

Ravi 20:04
Yeah, no, that's a great, great sort of question. So unequivocally there is a bi-directional relationship between physical illness and mental illness, right? You've got McKinsey, BCG, Bain, all the top management consulting firms that advise insurance companies. You know, the commercial payers like Aetna, Cigna, like, hey, you got to solve the behavioral health problem because the reality is your cost to insure your book is very high. Because when people are mentally ill or sick, their knees hurt more, their chronic illness goes up, eating habits are bad, right? There's so many, there's such an impact there. So although we are not necessarily completely in the physical space, we do believe that subclinical interventions like movement are important. One day we aspire to be able to, you know, be on par with Aura ring and Whoop. Because I think what they've done and I'm sure you're familiar with those, those platforms, they're looking at your heart rate variability, they're looking at your steps, they're looking at your REM sleep, they're looking at your, you know, basically everything that you're doing, right, they're looking at your heart rate, EKG, so all these things are going to impact kind of the potential predisposition or not even the predisposition, but the potential for heart disease and diabetes and all the things that you and I have talked about before, it's very much correlated. So we think that we are looking at things from a holistic perspective. And if you do have quality mental health care that has multiple interventions, it will undoubtedly improve your physical health and reduce the cost of care. Absolutely.

Tom 21:57
Yeah. Totally, totally with you on that. As we're having this conversation. Today. The world around us is all abuzz of chat GPT and generative AI…What is your medium to long term prediction about how this is going to play a positive role to help people manage their mental wellness?

Ravi 22:18
You know, I'm probably, I'm going to be a little controversial. When I say this is an I don't know, I feel like a lot of folks have views on what it's going to do. And I feel like it's just so early. And we don't know, I do think Sam Altman, and you know, the founders of chat GPT are being thoughtful, I personally am on the side, I'm leaning towards the side of regulation. And having a governing governing body that's similar to kind of the denuclearization protocol that was followed, which basically, is, Hey, you want to make sure that you have a review process, you want to have licensure, you want to have a board that kind of governs this, you know, this body of, because it can be deployed as a, you know, in a negative way. So I think regulation is really important. If without regulation, I'm very scared of what could happen, I think the outcome, you know, is could be very scary, and can can be used for a lot of harm, but with the right regulation with the right, constituents, working together, universities, students, the whole ecosystem really working together, including regulatory bodies, man, I think, you know, having a co pilot to help you critically think, solve really difficult problems, like the mental health crisis. I mean, this is the most difficult problem of our generation, the mental problem that billions of dollars have been put into this space. Billions of dollars have been lost in this space. It's because it's a hard problem. Now if we have the benefit of AI to critically think and solve and use data points, maybe that we neglected before to impact the quality of care and holistic care. Definitely optimistic but again, I think there needs to be a regulatory framework that helps all constituents work in a sandbox that is going to be a creative for all parties. And slower is better here. I think it's really fascinating to me, being from the tech industry and finance, you've got finance right now really pushing like let's go fast. Let's see use cases, Google do it. Let's launch Bard, let's get it into, let's commercialize it. And then you've got tech, like the VC folks saying like the tomato, the tomato, Paula Tapia from social capital, you've got Sam Walton like Guys, let's look like we're gonna release it, let's slow down and put together a way to kind of moderate this because, you know, it could be pretty scary if we don't.

Tom 24:57
Yeah, interesting perspective. You know, There's an old saying, Ravi, in our tech world, the biggest challenge is taking innovation to scale. You know, this is exactly why we started working together, why having you as part of the Innovation Challenge was so important, right? Is, we enacted a movement on our campus, because we know the students care about this, we know their lead. And we also know that they're fiercely supportive of each other. And you and I saw that, you know, at all of the presentations and the pitch competitions, etc, what we need to do is continue to work as partners, to say, we've got great innovations here, we need to make sure that every student has access to those innovations in an informed way. And then empower them to find the tools that OOTify has within the ecosystem that are going to help them best manage their situation. I think that's the goal we both would have.

Ravi 25:55
Yeah, and I just wanted, the one thing that I've been trying to push is like UCI is no different than Stanford, no different than USC, no different than UCLA, or Berkeley or any of these schools like that, you have to take a little you have to have a little courage and take a little bit of calculated risk to solve big problems. And I want UCI students to feel that they can, they can do that. And UCI is the right ecosystem, to kind of promote that type of thinking.

Tom 26:27
It fits so well, you're exactly right. And it fits so well with how we see ourselves and how we want to position ourselves, right. So it's not just about having a mental health competition. It's like we have, you know, an institution wide initiative around community wellness. And it's really about caring for the individuals who are part of our community in a holistic way, and everyone's everything from their mental wellness, to the environment that they walk through every day that it's clean and fresh air and aesthetically engaging so that you can breathe deeply and sigh and relax, which we know is an impact your mental health, right? So that's why I think we're gonna buy in. And if they're part of the process, they buy into the mental health hackathon. And they're working on the project. And they're giving us the idea that we can implement tomorrow. Absolutely. Like it's been such a synergistic conversation with you and OOTify, that we've really appreciated it. And, again, we want to say thank you for the conversation. Thank you for kind of leaning in with us. And Ravi, thank you for being here on the podcast with me today to talk more about this

Ravi 27:36
Of course, absolutely. Well, I just want to say, Tom and team, initiatives like this that you're doing, these types of podcasts are so important, not only for the UCI ecosystem, for the Orange County ecosystem, for Southern California's ecosystem, because we’ve got to beat Northern California, right? We have some, we have so many entrepreneurs here. We have amazing investors here, we have a great ecosystem. But it's things like this that you're doing. I mean this very sincerely, that really changed the narrative, what you're doing, what Ryan's doing, what the Antrepreneur center is doing, these mental health hackathons, it just creates energy, it creates confidence. And who knows, maybe one of those students will solve the mental health crisis with AI just because of this pod. And that hackathon, and the butterfly effect that you're creating with this type of content. So I just want to say thank you, because, you know, I'm a mental health activist, and without these types of resources and content being created, the reality is, we're not going to inspire that student to go and solve a mental health crisis. So thank you very much.