Combatting the Teen Mental Health Crisis
Marble Health and Affordable, Accessible Online Therapy for Teens
Weekly writing about how technology and people intersect. By day, I’m building Daybreak to partner with early-stage founders. By night, I’m writing Digital Native about market trends and startup opportunities.
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Combatting the Teen Mental Health Crisis
Last year, 1 in 10 teens attempted suicide.
When it comes to teen mental health, you’ll find no shortage of alarming charts and statistics. To start, young people are more concerned than any other age group about their mental health. This chart tracks what percentage of people respond yes to being “very concerned” with their mental health:
And teens have reason to be concerned. A recent report from the Center of Disease Control found that 20% of teens have seriously considered suicide. Among teen girls, that share increases to about a third, while 13% have actually attempted suicide.
In addition to girls, people of color and the LGBTQ+ population are disproportionately affected:
Nearly 1 in 5 teenagers and young adults experienced a major depressive episode in the last year—three-fold the share of people age 26 and up. The chart here shows the clear trend-line up, and this chart data is pre-pandemic; COVID only made things worse.
America’s Surgeon General called the youth mental health crisis the “defining public health crisis of our time,” yet access to care remains limited. The average wait time for outpatient care is 2+ months.
Technology—namely social media—is no doubt part of the problem. We’re still figuring out how to adapt to 24/7 connectivity and comparison. But technology is also part of the solution. Telehealth is the “why now” behind improving access to care. April’s The Telehealth Tipping Point made this argument. The mental health example in that piece was Headway, arguably the most successful startup in the mental health space.
Recently, two of Headway’s co-founders, Jake Sussman and Dan Ross, left to start a new business: Marble Health, a startup focused solely on combatting the teen mental health crisis. At Daybreak, we’re lucky to be working with Jake and Dan on building Marble.
Here’s how it works:
How does Marble work?
I first met Jake last year, when we grabbed coffee in Brooklyn. At the time, he was working as a fifth-grade teacher.
Jake has roots in mental health: he grew up in New York as the son of a therapist and psychologist, then founded Headway in 2017 (last valuation $1B+ in Series C last year). Headway’s core product allows people to find therapists covered by their insurance. At the same time, it removes headaches for the therapist, handling complexities like admin and billing. After building Headway for five years, Jake made a big change: he became a teacher at a charter school in Brooklyn. That’s where he saw the extent of the youth mental health crisis.
Structural features in America’s healthcare and education systems render it nearly impossible for kids to get the help they need. Between acute provider shortages and low insurance participation, kids have no access to timely, effective care. And without treatment, symptoms that were once mild can rapidly devolve into something much worse.
Jake teamed up with Dan, his former Headway co-founder, to build a business specifically built for teens. Their insight was to go through counselors. Selling top-down into schools is notoriously slow and difficult; sales cycles are long and schools are bureaucratic and lethargic. Going bottom-up, through counselors, would allow the company to scale rapidly.
Working at the charter school in Brooklyn, Jake had seen that one school counselor might be responsible for hundreds of students. Families would ask the counselor for help—their kid might be struggling with anxiety, depression, trauma. But the counselor was overwhelmed, unable to direct the teens to care. She might hand families a list of community agencies to try contacting, each with a months-long waitlist.
The system was clearly broken, and everyone—teens, parents, teachers, counselors, therapists—needed a better solution. Enter Marble.
Marble focuses on virtual group therapy. Groups have been shown to be as effective as individual therapy, yet allow Marble to scale capacity, serving multiple kids at once without sacrificing quality of care. As a result, Marble doesn’t have waitlists. School counselors who partner with Marble refer students, knowing that the student will get care within a matter of days.
Research has also shown that kids do better in care when adults in their lives are engaged in that care. That research informs another aspect of the product: Marble provides timely updates to counselors and parents on how things are going. Essentially, think of (1) a marketplace connecting teens to providers, and (2) an all-in-one software solution that ties together the various people engaged in the care journey.
Importantly, Marble accepts all insurances, including Medicaid plans, which makes care affordable and easy to access for all kids and families, regardless of socioeconomic status. Here’s a slide from Jake and Dan’s Seed deck that succinctly captures the business model:
Counselors refer students to Marble, which facilitates virtual care through its network of providers.
Marble bills payers, who reimburse Marble.
Marble pays providers.
The unit economics on group therapy are naturally more compelling than the unit economics on individual therapy, while supply can scale more quickly to meet demand.
Before making the investment in Marble, I talked to 17 therapists and counselors. A few highlights from those conversations:
“We’re seeing a lot more severe mental health challenges post-COVID. A lot of suicidal ideation, school refusal, anxiety and depression.” - Counselor
“I probably refer students out for professional mental health support a few times a month.” - Counselor
“Group therapy can be way more helpful for teens. That’s particularly true with specific issues, like eating disorders, where it really helps the teen to see that they aren’t alone.” - Therapist
“It’s impossible to track whether the kid ever visits the clinic. It’s up to the parent to take them. We don’t know if they ever get care.” - Counselor
“The community center I refer my kids to has about a 6-week wait time right now.” - Counselor
Today, Marble is live in dozens of schools across New York. In May, Marble launched its second set of groups—two middle school groups focused on anxiety. The plan is to add hundreds more schools and thousands more groups in the next year, then to expand nationally.
Marble is hiring across the board, particularly for Product, Engineering, and Operations roles. Check out more specific listings on their Careers page here and get in touch with Jake and Dan at jake@marblehealth.com and dan@marblehealth.com.
Final Thoughts: Tectonic Shifts
Before Daybreak was called Daybreak, it was called “Tectonic.” That’s because the things that interest me are the tectonic shifts—the shifts in both technology and behavior that create openings for innovation. Eventually, a mentor encouraged me to choose a less “private equity”-sounding name (Daybreak is a bit less austere, and connotes more optimism 😊) but the underlying thesis remains the same: we work with companies building along major shifts.
Mental health benefits from a number of tectonic shifts:
Telehealth adoption is a steady, years-long shift that improves access to care.
Insurance is increasingly covering mental healthcare.
Cultural stigmas around mental health are eroding, particularly in the United States and particularly among younger people.
A number of factors—climate change, social media, income inequality—have unfortunately worsened mental health, particularly among younger generations.
The first three shifts are good; the last is clearly very bad. But each powers Marble, and underpins its potential to be a very large and very impactful business. That’s exactly the kind of technology company we want to work with through Daybreak, where our thesis is that the companies that define the next generation will be the companies that make life better for the next generation.
Most Digital Native pieces focus on the macro—the big shifts. Occasionally, we dig into specific companies as case studies of innovation happening on the ground level. That’s Marble. If you’re interested in joining the Marble team, get in touch with them at careers@marblehealth.com; and if you’re building a company powered by other tectonic shifts—both technological and behavioral—I’d love to chat!
Until next week 👋
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