Digital Innovation

in Mental Health
CIIE.CO is The Innovation Continuum. This continuum Healthark insights is a boutique strategy consulting
spreads across incubation, acceleration, seed and firm developed by a team of experts from diverse fields
growth funding, and research. Founded at IIM such as consulting, pharma, medicine, medical devices
Ahmedabad in 2002, as an academic centre, CIIE.CO and digital health as well as public health and
has grown and pivoted to include acceleration, management with a common vision to cater to the
incubation, investment, research and publication. healthcare and life sciences industry, along with a
CIIE.CO has aimed at filling the multiple, ever-evolving relentless focus on delivering executable solutions. The
gaps in the Indian innovation-driven entrepreneurship firm solves complex strategic problems through deep
space in many ways. Among various initiatives, it has domain knowledge and technology expertise spanning
conceptualised and hosted India’s first accelerator, through strategy, analytics and digital transformation.
created India’s first and so far the only It has served multiple healthcare clients globally
cleantech-focused fund, accelerated over 1000 including Johnson & Johnson, Roche, Abbott, Pfizer,
entrepreneurs, invested in over 200 startups, inspired Gilead Sciences, Novartis, Boehringer Ingelheim and Eli
over a million with their publications, including Stay Lilly.
Hungry Stay Foolish.
 Chapter Page

i. Preface 01

ii. Foreword 02

1. Disease Burden of Mental Health Disorders 03

(an image will be put here)
2. Mental Health Market 09

3. Digital Mental Health Care Continuum 14

4. Case Studies 18

5. Challenges and Future Opportunities 28

Preface

Mental health in India remains an area seeking significant attention with limited access to mental health services,
shortage of mental health specialists, and lack of awareness and literacy leading to stigmas. In the last few years, India has
witnessed technological innovations addressing the mental health service delivery gaps, policy interventions like The
Mental Healthcare Act, 2017, and emerging business models. On the supply-side, startups are building self-help digital
tools, peer-led support groups and listening circles, while on the demand-side, entrepreneurs are creating and driving
awareness, affordability and providing a digitally safe environment for the users.

CIIE.CO, one of the leading technology business incubators in India, and Healthark Insights, one of the fastest emerging
life science and health consulting firm, have come together for this critical landscape study of the digital mental health
sector in India. With a focus on analysing the gaps and opportunities in the ecosystem, the research combines insights
from secondary data as well as in-depth interviews with multiple industry stakeholders such as mental health
professionals, startups and investors. The report presents startup opportunities through a ‘care continuum model’ which
closely aligns with the typical journey of a mental health patient. Case studies of mental health startups showcase
innovation in products, services or business models.

We believe this report succeeds in creating an active discourse around the digital mental health sector in India, paving the
way for more technological solutions and startup innovation.

Vipul Patel Dr. Purav Gandhi

Partner - Seed Investing Founder and CEO
CIIE.CO Healthark Insights

01
Foreword

The Covid-19 pandemic and its aftermath have led to an increase in recognition, awareness and active discourse around
mental health issues around the world. Conversations about more common health symptoms like depression, anxiety,
attention-deficit / hyperactivity and learning disabilities have finally been stirred. As the burden of mental illnesses rises
in India, there is a strong need to augment awareness about mental health, reduce the stigma associated with mental
illnesses, and build innovative mental health interventions. The future of healthcare is digital, and the future of mental
health is convenience and safety. The ultimate vision would be to democratize mental health in India in a way that the
previously existing solutions have failed to achieve, by driving research-led solutions and creating sustainable business
models. This timely report, by CIIE.CO and Healthark Insights, makes a strong argument towards the significance and
urgent need for injecting tech and data driven solutions into the mental health ecosystem. I hope that it succeeds in
providing necessary insights and motivation to entrepreneurs and innovators seeking to solve the most pressing mental
health issues in India.

Mrs. Neerja Birla

Founder and Chairperson
Mpower

02
Disease Burden
of Mental Health
Disorders

03
Mental Health Disorders represent a significant Disease Burden
globally and in India
1 Billion 20% < 2%
Of the world’s children Global median of
People suffer from a
and adolescents have government health
mental health
a mental health expenditure towards
disorder, globally1
condition2 mental health3

$6 Trillion 5% 11 years
Projected cost to the Of global adult population Average delay between
world economy by 20304 suffer from depression and it onset of symptoms &
is one of the leading cause of treatment (in the US)6
disability worldwide5

56 38 $ 1.03
7.5% 36.6%
Million Million Trillion
Indians suffer India’s economic
India’s share of
from some Indians suffer Indians suffer loss due to mental
suicides,
mental health from depression8 from anxiety9 health conditions,
globally10
disorder7 between 2012-203011

1,4 The Lancet Global Health (Nov 2020), 2,3 Health Topics-Mental Health, WHO, 5 Fact Sheets-Depression, WHO, 6 National Alliance on Mental Illness (NAMI)
7,8,9,10 Swachh India NDTV, 11 Health Topics-Mental Health-India, WHO 04
 Mental Health as a subject has started becoming a larger challenge
and is getting its due recognition in the recent Covid-19 crisis
The COVID-19 pandemic and the resulting economic recession have negatively affected many people’s mental health and created new
barriers for people already suffering from mental illnesses and substance use disorders

Major contributors to stress during lockdown Mental Health through a gender lens16
(Response analysis of IMPRI Study, 2020)12

29% 38% 30% 39%

Loss of employment
Stress
Fear of virus
Male Female Depression
Money shortage Anxiety

Increased household work 33% 31%

Indian Generalized Anxiety Obsessive

increase in mental illness cases in Disorders Compulsive Disorders
20%13 India, within a week of lockdown
Psychiatrists have
confirmed a surge
Fear of Contracting
in cases of 17 Phobia
Illness
>60%14 of respondents (of IMPRI survey) reported
being anxious or worried during lockdown
Drug Class Y-O-Y Sales(Cr)

non-coronavirus deaths were due to suicides

13% increase in Growth
300 15
(leading cause) between March 19 and May 2,
rise of CNS drug Antidepressants 15% 632
sales in the June
2020 Antipsychotics 13% 270
2021 quarter18

12,13,14,16 Outline India (2020), 15 Economic Times (May 2020), , 17,18 Economic Times (July 2021) 05
Four major Mental Health Disorders in Mental health disorders involve disturbances in thinking,
emotion and/or behavior. The effects of mental illnesses
India and their Disease Burden may be long-lasting or temporary

Mental health disorders are one of the top mortality drivers - ranked 10th in India and 7th globally (2019)

Top 4 mental health disorders in India (Mortality and DALYs)

Anxiety Depression Schizophrenia Idiopathic ID

▪ Feelings of worry, anxiety or ▪ Feeling of severe ▪ People interpret reality ▪ Difficulty in thinking and
fear that interfere one's daily despondency and dejection abnormally understanding
activities ▪ Cause of death accounts ▪ Cause of death accounts for ▪ Cause of death accounts for
▪ Cause of death accounts for 1.8% of total DALYs (as of 0.55% of total DALYs (as of 0.5% of total DALYs (as of
0.84% of total DALYs (as of 2019), changed annually by 2019), changed annually by 2019), changed annually by
2019), changed annually by 0.29% 0.73% 0.64%
0.47%
▪ Female population (2.12% of ▪ Male population (0.62% of ▪ Both female population
▪ Female population (1.02% of total DALYs) where highly total DALYs) where highly (0.51% of total DALYs) and
total DALYs) were highly affected than male (1.51% of affected than female (0.48% male (0.49% of total DALYs)
affected than male (0.68% total DALYs) of total DALYs) are affected equally
of total DALYs)

Note: ID-Intellectual disability, DALYs-Disability Adjusted Life Years 

Source: GBD vizhub Confidential. Internal Use Only. 06
 Anxiety Key Highlights

Anxiety, Depression,
Low
self-esteem
Anhedonia, and Stress
have overlapping
underlying causes

Risk factors Trauma

Financial concerns

associated with Work environment

Other major
illnesses
Mental Health
Disorders are Certain
Smoking
Alcohol High
Depression Lack of sleep consumption Stress
increasing as medications Diet
Life transitions
of caffeinated
beverages
Family history
lifestyle and
societal
Drug abuse
patterns evolve bereavement

Behavioral
addictions

Anhedonia*

*Anhedonia - An inability to experience pleasure

from activities usually found enjoyable
Sources: Web MD, Health line, Mental health 07
Growing prevalence of Sleep Disorders also act as one of the
largest contributing Risk Factors for mental health issues
▪ Chronic sleep problems affect 50% to 80% of patients in a typical psychiatric
practice, compared with 10% to 18% of general US adult population
Sleep and mental health
are closely connected ▪ Sleep problems are particularly common in patients with anxiety, depression,
bipolar disorder, and attention deficit hyperactivity disorder

Major Sleep Disorders – An overview

Insomnia Sleep Apnea Restless Leg Syndrome Narcolepsy

▪ Persistent problems of falling ▪ Potential sleep disorder in ▪ Condition of uncontrollable ▪ Overwhelming daytime
and staying asleep which breathing repeatedly urge to move legs, typically drowsiness and sudden
starts and stops in night-time attacks of sleep.
▪ The rate of insomnia was
26.45% in the COVID-19 ▪ More than 18 million ▪ Only 10% of the individuals ▪ Around 0.1 to 0.2 million
recovered patients (as per a Americans have sleep apnea may experience symptoms individuals have narcolepsy
2020 study) in the US

Sources: India TV, JCSM, Springer, Sleep Foundation, News Medical

08
Mental Health
Market

09
Global Behavioural / Mental Health Market is expected to reach $242
billion in 2027
Global Behavioural Health Market ($ Billion) Key Market Segments ▪ Clinical - EHRs, Clinical
Decision Support, Care Plans,
% E-prescribing, Telehealth
R 5.02
CAG 242 ▪ Administrative - Patient/Client
Scheduling, Document
171.76 Management, Case
Management, Workforce
Management, Business
Intelligence

▪ Financial - Revenue Cycle

2020 2027 F Management, Managed Care,
General Ledger, Payroll
Drivers of Growth Growth Evidence

▪ Growing interest of NGOs in mental health can be seen with the development of
Increasing awareness and social acceptance niche community-based services including day care centers and residential facilities
▪ Rise of mobile based mental health applications including telehealth, smartphone
Government and non-government monitoring, internet- based group/community, among others have helped this sector
inclination over the issues to bloom
▪ COVID-19 pandemic has severely impacted psychological well being of individuals,
Innovation in software & services and in turn has increased the demand for mental health services
▪ Increasing mental health awareness campaigns through celebrity endorsements,
Lifestyle changes and unhealthy working
government, academic & business programs, and social media have raised its
hours
significance among the population

Sources: Globenewswire, Forbes, Healthinformatics

10
Global Behavioural / Mental Health Software Market is expected to
grow at a CAGR of 14.4% from 2020 to 2027
Global Behavioural Health Market ($ Million) Key Market Segments

3689.5
4%
14.
GR
CA
1469.2

2019 2027

Drivers of Growth Growth Evidence

Growth Evidence

Adoption of management software by

▪ Rise of healthcare software applications with enhanced quality, user-interface &
healthcare providers
security have helped the software sector to bloom
Rising demand for mental health services ▪ Growing investments have paved the way for its market growth. For instance, 900+
amidst the Covid-19 pandemic (predominantly digital) mental health startups have collectively raised approx. $1.5
billion in investments in 2020
Innovation in software & services
▪ COVID-19 pandemic has severely impacted the mental state of individuals, and in
turn has increased the demand for mental health software-based applications
Increased funding and investment (telehealth / telepsychiatry platforms, meditation & daily fitness apps, activity
tracking devices etc. )

Sources: Verified Market Research, Forbes

14 Confidential. Internal Use Only. 11
Mental health startup funding has seen an uptick since 2018 globally
and will continue to grow during and after the Covid-19 pandemic
Digital behavioral health startups secured a record $2.4 billion in venture funding in 2020

Funding and number of deals 2012 – 2020 ($ Million) Start-up Funding, by Category

Key Highlights

▪ Increasing amount of capital into later-stage deals, as opposed to early-stage funding rounds, help mature companies to scale to meet
urgent demands. The average later-stage deal has increased from $23.7 million in 2016 to $64.2 million in 2020
▪ Generalist startups, companies that offer behavioral health and non-behavioral health services, accounted for $1.6 billion in funding in
2020, and specialist startups, those that only treat behavioral health conditions, raised $804.3 million
▪ Relatively low amount of capital is going startups in substance use disorder and developmental disorders in comparison to those in
mental health
▪ Behavioral / Mental health startups are more likely to exit via acquisition rather than an initial public offering

Sources: RockHealth, What If Ventures

Confidential. Internal Use Only. 12
Recent funding in the Indian mental health space has been
encouraging

Indian Mental Health Startup Funding Indian Funding Scenario

Wysa, an AI-enabled mental health app, has

secured an undisclosed amount of investment
from the Google Assistant Fund
$20 M $10.74 M
2016-2020 2021 (till August) Mumbai-based mental health startup
InnerHour has raised $5.2 Million in its Series
A round from venture capital firm Lightbox

Health and fitness startup CureFit has raised

Mental health startup funding in India has grown 5x as $75 Million in a funding round led by existing
of August 2021 when compared to 2020 investor Accel Growth

Deal sizes in India are still very low compared to global Mental Health Startups

Modern Health, a mental Ginger, on demand mental Vida Health, a virtual care Lyra Health, mental healthcare
health platform has raised a health company received platform has raised $110 benefit company, raised $187 M
total of $164.4 Million $100 Million Series E Million Series D from Ally Series E from Addition and 3
funding in total 6 rounds funding from Blackstone Bridge Group and 10 other other investors
investors

Sources: Economic Times, Live Mint, Inc42, VC Circle, Crunchbase

13
Digital Mental
Health Care
Continuum

14
Typical journey of a mental health patient
Clinical events /
Non-clinical events

Risk Assessment Diagnosis Treatment & Disease Management

• Symptoms (depressed mood, • Examination of medical Treatment & Therapy

loss of appetite, loss of history ▪ One-on-one
motivation etc.) • Blood Tests (to rule out Counselling
• Clinical risk factors (family other physical disorders
like thyroid) ▪ Disorder management
history, serious/chronic illness therapies (CBT, ECT, Talk
etc.) • Questionnaire and
Counselling therapy, Light therapy
• Behavioral changes etc.,)
(shopping spree, high caffeine Referral to ▪ Brain stimulation
intake, high screen time etc.) psychiatrist or treatments (TMS, VNS
• Lifestyle (drinking, smoking, psychologist etc.) as the last resort
diet & sleep)
• Diagnosing symptoms Medication
• Socioeconomic factors Life Style
• Behavioral & lifestyle
(financial concerns, personal ▪ Diet (cutting down Antidepressants
questions ▪
matters, work environment caffeine etc.)
• Physical examination ▪ Antihistamines
etc.)
(Vitamins and Hormone ▪ Exercise/Yoga/Meditation ▪ Benzodiazepines
• Self-monitoring (mobile test) ▪ Sleep Beta-blockers
applications, books, gadgets • Standard screening
▪
etc.) ▪ Monitoring change using Antipsychotic medication
questions (PHQ-9, ▪
gadgets and apps
GAD-7, SHAPS, HAM-D, ▪ Use of Supplements,
etc.) ▪ Self-help books and apps Vitamins and Essential Oils

Note : Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder-7(GAD-7), Snaith-Hamilton Pleasure Scale(SHAPS), Hamilton
Depression(HAM-D) Electroconvulsive therapy (ECT), Transcranial magnetic stimulation (TMS), Vagus nerve stimulation (VNS), Cognitive
behavioral therapy (CBT)

Source: Healthark Insights 15

The Digital Mental Health Care Continuum
Care
Continuum Identification /
Prevention Diagnosis Treatment Recovery / Support
Risk Assessment
Landscape

Address social stigma, Educating or creating

Educate people on tracking Creating awareness for Educating mental health
motivate people to awareness around various
Patient Awareness understand importance of
mental wellbeing, screening and diagnosing
treatment avenues to
patients on various recovery
identifying symptoms tools and techniques / support solutions
mental health masses

New data-based tools and Training / education

Physician Awareness Decision support systems to Information systems for new
NA techniques for risk platforms for physicians;
/ Support measurement digital diagnosis tools
aid in patient treatment drug, treatment modalities

Physician Access Preliminary telepsychiatry

Detailed telepsychiatry Continuous telepsychiatry Remote recovery / support
session to assess risk based
(Psychologist, NA
on personalized data /
sessions to diagnose the based therapy sessions and interventions,
Psychiatrist) underlying cause prescription of medicines e-prescriptions
situation

Lifestyle Management Productivity improvement Tracking and monitoring Evaluate mood, stress Self improvement programs,
Digital wellness assistant,
tools, mental workout, diet, mental wellness parameters anxiety based on data, tools / plans to fight stress,
& Support fitness plan (HR, BP, Sleep, RR etc.) images etc. anxiety
productivity improvement

Preliminary telepsychiatry Detailed telepsychiatry

session, digital app-based sessions or digital Behavioural change
Counseling / CBT Mental wellness platforms, Continuous telepsychiatry
questionnaires to assess risk app-based solutions to platforms with access to
(Therapist) Mindfulness platforms
based on personalized data / diagnose the underlying
based therapy sessions
therapists
situation cause

Digital Solutions

Source: CIIE.CO Insights and Healthark Insights Analysis 16

Mental health startups operate in several places in the Care Continuum
Care
Continuum Identification / Risk
Prevention Diagnosis Treatment Recovery / Support
Assessment
Landscape

Patient Awareness 5 10 0 11 7

Physician Awareness 0 13 12 22 5

Physician Access 0 11 7 30 8

Lifestyle Management
1 13 6 33 10
& Support

Counseling / CBT 4 2 2 23 6

Note: 76 mental health Increment count in matrix

startups were mapped in
if startup is operating in 0 1-6 7 - 12 13 - 18 19 - 24 25 - 30 31 - 36
the care continuum
the specific space

Source: CIIE.CO Insights and Healthark Insights Analysis 17

Case Studies

18
 Prevention Identification / Risk Assessment Diagnosis Treatment Recovery / Support

1. Pear Therapeutics (1/2) Pear Therapeutics

currently has 3
• Founded in 2013, Pear Therapeutics is a leader in digital therapeutics and has built a pipeline of approved products
potential new therapies across disease areas and expects 3
• Pear Therapeutics develops software-based prescription digital therapeutics for the treatment of additional products to
severe medical conditions and diseases, operating at the intersection of biology & software technology be in pivotal studies by
2023

Headquarters Total capital raised Serviceable

Serviceable Total US
Boston, USA $254 Million market
market in US addressable
potential in US
Key Stats 2 with current 15 with current 250 market
Last funding type Post-money valuation products opportunity
pipeline
Series D ($ Billion) ($ Billion)
$500 M – $1 B ($ Billion)

Script Volume
• Inclusion of digital therapeutics solutions in clinical guidelines 9 Pipeline
and integration into health infrastructure
• Increase in Telemedicine
Total pipeline products : 17
• Ensuing prescriptions for patients who benefit
Launched products : 3
• Reimbursement for clinician dashboards and assessments 4 4 Products in development : 14
Potential Coverage
Drivers of Others include oncology,
• Additional HEOR data along with increased provider demand
Growth gastroenterology etc.
• Potential value-based agreements with major commercial
players
Psychiatry Neurology Others
• Increasing Patient-pay options to increase access
• Federal legislation for medicare coverage of PDTs Commercial Pivotal POC Discovery

Sources: Pear Therapeutics, Crunchbase 19

Confidential. Internal Use Only.
 Prevention Identification / Risk Assessment Diagnosis Treatment Recovery / Support

1. Pear Therapeutics (2/2)

Addressable Market
Launched Products (USD)

First PDT to receive FDA authorization, and treats addiction to alcohol, cannabis, cocaine and $5B+
stimulants

Only FDA-authorized software product to help make patients with opioid use disorder stay in
$1B+
outpatient treatment longer

First and only FDA-authorized and guideline recommended treatment for chronic insomnia $5B+

reSET & reSET-O have outperformed in real world setting

Substitution Reduction
Clinical Trials

Improved
> 2X 100% Abstinent at
62% ~$2,150
Real World
abstinence upto for clinician
time
88% 12 weeks
in inpatient
stays - 62% - 20% - 90%
for reSET
+ + Post-
Cost
Patients
Of patients 12 Of upto
85% retained in 20%
Reduction in
emergency
Inpatient
Stays
Emergency
visits
Observatio
savings /
patient
82% retained in
therapy for
continuous
months use therapy at visits at 6
n

12 weeks months
reSET-O

● Pioneers in the digital therapeutics space, Pear therapeutics has proven the utility of digital therapeutics in the treatment of severe
medical conditions and diseases and, it is set to be a leader in the space powered by a rich pipeline of products.
● In spite of PDT’s proven clinical utility and need in the Indian market, there is no company developing PDTs for mental health in India

Sources: Pear Therapeutics, Crunchbase 20

 Prevention Identification / Risk Assessment Diagnosis Treatment Recovery / Support

2. Happify Health (1/2) Partnerships

• Founded in 2012, Happify Health is a behavioral change technology company that drives personal, Multiple
business, and healthcare outcomes through improved emotional health. Sclerosis
• Happify Health features science-based activities and games that tackle topics such as resilience and
mindfulness, as well as conditions ranging from depression and anxiety to chronic pain and insomnia Psoriasis

Headquarters Last funding type Total capital raised Post-money valuation

Key Stats New York, USA Series D $118.7 Million $100 - $500 Milion

Digital Therapeutics Care Delivery Activation Wellness Coaching

Happify offers a range Happify currently offers Happify’s Activate Happify’s Wellness is Happify’s Anna is a
of products, offering a 2 products; Connect helps deliver effective, a B2C platform that digital well-being coach
variety of solutions (Aims at simplifying custom campaigns helps individuals that helps deliver
from helping improve how individuals access that generate build skills for mental health
mental health to an organization’s health awareness, achieve emotional wellbeing interventions and help
helping individuals resources) and Kopa (A mass adoption, and solve behavioral health
Products realize their full patient-centered maintain engagement conditions by
potential engagement platform) for an organization identifying appropriate
Happify activities

Sources: Happify Health, Happify - Crunchbase Company Profile & Funding 21

 Prevention Identification / Risk Assessment Diagnosis Treatment Recovery / Support

2. Happify Health (1/2)

For Employers and, Payers & Providers For Pharma
External Happify Partners

Activate Tested & proven

DTx
Tested & proven Activate activation services
activation services
Happify offers a variety of solutions

Catalog of digital
therapeutics covering DTx
across different domains

mental & chronic illness Screen & refer

needs Connect Screen & refer
individuals to right
Catalog of digital therapeutics Kopa individuals to right
covering mental & chronic illness level of care
level of care
Happify needs
Coaching Access to any
Clinical Trials drug or digital
Live clinical & AI-assisted 3rd party Referral to therapy trial
coaching support Coaching coaching solution PDT

Kopa FDA-approved prescription

digital therapeutics to treat Telemedicine
Referral to mental & physical conditions
Personalized disease in-network digital
Happify

specific care delivery and Therapy Direct access to

or in-person telemedicine Ecosystem
community offering providers services Partners

Rx Referral to in-network
Kopa is an offering for digital or in-person
“Payers & Providers” and Referral to
Ecosystem Drive personalized providers
is not a part of the in-network digital
Partners or in-person awareness to your Rx
“Employer” ecosystem treatment options
providers

Happify Health identified emotional health as a key pain point for personal, business & healthcare outcomes and, thus created a wholesome
solution to drive improved emotional health for improved outcomes for Employers, Payers & Providers and Pharma

Source: Happify Health

22
 Prevention Identification / Risk Assessment Diagnosis Treatment Recovery / Support

3. Wysa (1/2)
• Founded in 2015, Wysa is an AI-enabled life coach for mental and emotional wellness, Wysa is developed by Touchkin e-services Pvt. Ltd

Marquee Investors

Headquarters Total Capital Raised Kavita Boradia, Kae 100M Conversations

People
Bengaluru, India $10.4 Million
Key Capital, Pi Ventures, Lives helped in
Google, W Health 10M 3M +
Stats Company Status Valuation covered 60+
Private $30.4 Million Ventures, countries
91% Happy users

Services
Collaborations & Features Users
AI Chatbot
Collaborations
AI Chatbot- includes clinically safe mental health tools Key Features
along with professional chat-based therapy supports.
& Partnerships
It uses AI to ‘listen’ to users and understand user input
Rated 93% by ORCHA
Premium Self-Care Library
100% Clinical
Premium Self-Care Library contains over 150 tools to Assurance
help the customer to deal with issues ranging from
body image to breakups It has over 100
different AI models
Professional Therapists
Recognize Over 70
Different Emotions
Professional Therapists- Therapists are qualified and
experienced global mental health professionals who
Anonymous,
supports via in app text-based chat sessions
Evidence Based

Sources: Wysa - Everyday Mental Health, Exclusive: Google Backs Mental Health Startup Wysa In
Confidential. Series A Round
Internal (inc42.com)
Use Only. 23
 Prevention Identification / Risk Assessment Diagnosis Treatment Recovery / Support

3. Wysa (2/2)
Real World Impact Real World Impact Future Plans

▪ In 2020, the government of • Wysa aims to expand from 3 M users to 10

Singapore licensed Wysa, and M users
provided the service for free to help Wysa plans to expand its Indian footprint
40%
•
cope with the emotional fallout of and offer services in various vernacular
the coronavirus pandemic languages to help aid in the expansion
Lower impact for
low/non users ▪ U.K.’s National Health Service (NHS), • Wysa team is working with Apple’s
High users Low/ non Wysa is compliant with the NHS’ SiriKit, to “transform” Wysa into a
n=108 users n=21 DCB0129 standard for clinical safety, voice-based platform
the first AI-based mental health app • Plans to launch services for healthcare &
• Frequent users showed a 40% to earn the distinction insurers to increases mental health
improvement in self-reported awareness
symptoms of depression ▪ In the U.S., the Wysa app, fits the
• Frequent users had a significantly FDA’s definition of a general
higher average mood improvement wellness app or a “low risk device”
• 67.7% of user-provided feedback because during the pandemic, the
responses found the app experience FDA has created a guidance to
helpful accelerate distribution of these apps

Wysa’s 3 tier assessment & care system coupled with it’s easy to use interface has led to it’s wide adoption that has led to Wysa being among
the leaders in AI-assisted mental & emotional wellness support systems .
Even though Wysa is an Indian company, majority of its user base is in US & Europe that could be due to Wysa’s focus on international
markets or existing challenges in the Indian market e.g., language barrier , social stigma etc.

Sources: Wysa - Everyday Mental Health, Exclusive: Google Backs Mental Health Startup Wysa In Series A Round (inc42.com)
24
 Prevention Identification / Risk Assessment Diagnosis Treatment Recovery / Support

4. Manah Wellness (1/2)

Founded in 2020, Manah Wellness is building a comprehensive and preventive emotional well-being platform for employers
that focuses on three important pillars i.e. Emotional Wellbeing, Personal Growth and Professional Effectiveness.

Key Milestones
Aug 2020 - Launch
Headquarters
Pune, India
18 50+ Sep 2020 - First paid client
Key Facts Languages Corporate clients
Jan 2021 - First international client
Company Status supported by served
Private Lets Talk India
Apr 2021 - Partnership with top 5 insurance brokers in
India - Access to 700 clients

Manah Digital Mental Health Tools and Activities Library Manah USPs

Relaxation exercises Affect Labeling Meditation Platform designed with preventive approach

Coping
Techniques Wellness for everyone – regular evaluation / risk
mitigation
Breathing Exercises Mindfulness Activities
Personalized plan – New skill building / Personal
growth
Creating a worry
Create a journal Stress Ball
Box Chat with Therapist / Manah BOT
Self care activities
Playing music of Mental health First
A letter to self Live Corporate dashboard
one’s choice Aid etc

Sources: Primary Research, Manah Wellness, Outlook India 25

 Prevention Identification / Risk Assessment Diagnosis Treatment Recovery / Support

4. Manah Wellness (2/2)

Digital-first 5 Step Process

Onboarding Assessment Engaging Institutionalising Resilience Building

• Manah Wellness • During this phase • Manah provides the • During this phase, • By this time, Manah
conducts awareness Manah conducts emotional wellbeing Manah provides an Wellness has a
sessions/ webinar proactive digital report card to the emotional wellbeing wellbeing ambassador
talks with the HR, assessment for employees which also report to the Corporate established within the
Employees, CXO to employees to identify has recommendations. (Corporate emotional company with a full year
get everyone on the risk, coping skills across • The recommendations wellness index). calendar filled with
same platform. 9 parameters through will be in the form of self • It includes events and programs.
• They also ask them an online confidential care activities / skill recommendations in
to participate in the self assessment which is building which are terms of programs to be
selfcare bootcamp or powered by Manah’s available on the Manah carried out within the
other Manah proprietary process. platform. company with calendar.
activities which are • It is followed by a • Therapists may also • The programs include
regularly conducted comprehensive advise counseling which specialized workshops
by the Manah team. emotional check-in can be scheduled as per and mental wellbeing
interview with their employee convenience. first aid training.
expert psychologist.

Trusted by Progressive Organisations

Manah Wellness partners with progressive organizations to help them take care of their employees‘ emotional well-being by leveraging an AI driven
emotional health platform complemented with a human touch

Sources: Primary Research, Manah Wellness 26

A series of Startups have emerged in the last few years across the Care
Continuum
Identification /
Prevention Diagnosis Treatment Recovery / Support
Risk Assessment
Global
India

Sources: CrunchBase, Medium, Inc42

27
Challenges
and Future
Opportunities

28
Challenges and Opportunities in the Indian Digital Mental Health Market

Challenges Opportunities

Lack of awareness and social

Disruptive technology
stigma

Supply deficit and access Low-cost solutions

challenges

Diagnosis Awareness and access

Cost, monetization and

Re-positioning
funding

29
 Challenges
Challenges

Mental health in India is plagued by Lack of Awareness and Social

Stigma, which has been reinforced by Supply Deficit and Poor Access
Limited awareness and seriousness about mental health problems in India
o Rural vs Urban - Lack of awareness in Tier II, Tier III cities and beyond
o Intergenerational gap - Awareness gap exists between younger and older population. Younger population is more prone
to mental health issues
High stigma prevents people from opting for treatments / solutions
Lack of
o Like awareness, stigma is more prevalent among older population and there is intergenerational gap
awareness &
o Indian society is largely dominated by the “What others will think” notion, which prevents people who are suffering from
social stigma
mental health issues from seeking professional help

There is not only higher awareness and lower stigma but also health conscious people in Tier I cities. Also, mental
health awareness got a boost from a lot of factors such as Covid-19 and endorsements by many prominent public
figures

Limited certified colleges and high variations in educational programs India has
• There is a lack of quality psychologists (RCI registered) in Tier II & Tier III cities 1 Psychiatrist
• Approximately 650 seats in RCI approved colleges (Majority of RCI trained Psychologists per 300,000
enter into academics) people vs the US
which has 16 per
• Various diploma courses with no clear description of coursework enable people to practice
100,000 people.
Supply deficit clinical psychology and this has led to a compromise in quality due to lack of standardization
and less access • Lack of quality psychologists and lack of awareness has led to poor access for patients in Tier II 1 Psychologist for
& Tier III cities and the current solutions / companies rarely target population in Tier III and every 15,000
beyond people vs the US
• Traditional solutions also have a “matching problem” i.e., inability to match the patient with the which has 33.6 per
right kind of therapist which can also eat away limited supply side resources 100,000.

Despite the large burden of mental illnesses, only 10% of Indians with mental health
problems receive evidence-based treatments 30
 Challenges

Accurate Diagnosis is difficult and majority of Indians are unable

to afford the current treatment options
Broad spectrum of symptoms and behaviors for the same mental health condition
• Digital-only solutions such as AI Chatbots, self-help apps aren’t sufficient for diagnosing
• Inability of patients to express symptoms due to language barrier is a hurdle. Patients are unaware of what exactly to tell
the doctor and there are no specific words in many languages for mental health conditions

Limited diagnostic options

Diagnosis
• Most of the currently available sensor based devices and imaging techniques are indicative in nature and not diagnostic
In order to diagnose mental health conditions, it is important to understand the functioning of the brain and its state
needs to be captured continuously – FMRI, SPECT, CT, PET etc.

Out-of-pocket burden
● On an average a seasoned psychologist / psychiatrist charges 1000-1500 rupees per session. At a rate of 3 – 4 sessions /
week it amounts to approximately 5000 rupees a month (~20 % of the average income of a person in India)
● Diagnostic costs is a major hurdle for patients seeking treatment - Brain Mapping tests, Neurofeedback session cost
Cost of ~30K+ rupees in India
● Insurance does not cover therapy / counselling, neurofeedback sessions. It only covers in-patient services
treatment
Lack of willingness to pay - Even if people can afford, there is a lack of willingness to pay for mental health services

Monetization for B2C mental health offerings has been proven difficult in the past
Monetization ● MoodCafe shut down operations primarily because in their freemium model people were using free services and
conversion rate to paid services was abysmally low to sustain the business

Funding - Even though funding has picked up, it is miniscule compared to other sectors. Moreover, securing funding for
Funding moonshot projects is difficult.

31
“
Challenges

Industry Perspectives

“It is difficult to express depression “While seeking Mental Health support, it is indeed true
in one’s own native language. In that affordability is a major issue, particularly where
fact, people don’t know what the it is needed the most. Innovative models which help
right word is” increase access, increase affordability and increase
adoption are much needed”
Dr. Ambrish Dharmadhikari, Head
Dr. Ashwin Naik, Founder, Manah Wellness

”
Psychiatrist, Mpower

“In pay per session models, there is no “Mental health startups historically have faced
transparency as to what a professional will challenges owing to social stigma and unproven
charge. The pricing is all over the place and is business models. However, with the current tailwinds
opaque. It may range from Rs. 300 to Rs. 7000 and rising awareness, the future for mental health
& above per session” space in India is interesting.”

Harjas S. Gulati, Founder, Untangle.Space Chintan Antani, AVP - Seed Investments & Portfolio,
CIIE.CO

32
 Opportunities

Disruptive Tech, Low-cost Models can help in tackling existing

hurdles and enable startups to gain better acceptance in the
Indian Market

• Disruptive tech models using AI & Machine learning are picking up speed in developed markets and have a huge
market potential in India because they reduce chances of misdiagnosis thereby improving treatment outcomes
o Companies like Sparcolife(prototype only), Tytocare & Neuphony have developed device + digital solutions to
aid in improving diagnostic outcomes and partnered with healthcare institutions to deploy their product

• Digital Therapeutics have been picking up speed globally and is expected to show a CAGR in high twenties over the
next decade
o Post-Covid at-home solutions are picking up pace, which presents a huge opportunity for digital
therapeutics
Disruptive
technology • AR & VR, both present a step-change in how individual can improve their mental health. Some companies are
developing AR-VR (Augmented Reality – Virtual Reality) solutions to create life-like experiences to enable healthcare
providers to provide life-like experiences to patients thus improving treatment outcomes (Limbix is developing a VR
system for healthcare institutions that treats fears, addiction, depression, and teaches mindfulness and
meditation)

• Low-cost subscription models can help decrease the cost burden on patients and could drive adoption. Such
models can also help reduce the rural-urban gap because current solutions aren’t affordable for the rural population

• Peer-to-peer Support : A general acceptance and increased uptake of peer-to-peer support solutions have been
Low-cost seen but majority of them are being offered free of cost. An innovative way to monetize such solutions could result
solutions in greater chances of success in the Indian market

33
 Challenges
Opportunities

Huge potential lies in less explored areas such as Awareness /

Access and in Repositioning businesses to target high spending
groups
• Partnering with Empowered Individuals/ Organizations : Influencer community and personalities can help raise
awareness about mental health in Tier III cities and beyond
• B2B models can solve awareness and access challenges in the Indian mental health market

• Developing solutions in vernacular language can aid in tapping the non-english speaking Indians

• Huge opportunity lies in training and developing seasoned psychologists and potentially partnering with RCI can
Awareness / open additional avenues
Access
• Self-help : Self diagnosis or risk identification presents a huge opportunity and can help tackle major challenges such as
awareness, access, supply deficit, cost of treatment etc.
o Self-help tools can also help overcome social stigma and aid in outcomes of the patient at home in one's own
comfort zone
o Monetizing such guidance tools which suggests best path forward could be a part of a larger solution

• Companies are positioning themselves as B2B2C platforms where employers pay for the mental well-being of their
employees for improved productivity

• Targeting niche markets where willingness to pay is high can unlock great financial opportunity for mental health
Repositioning startups (Sparcolife has targeted the reproductive health market)

34
 Disruptive Factors will continue to drive the Future of Mental Health

Increasing number of awareness campaigns by the Govt.

B2B services-led business models are all set to become
as well as non-Govt. organizations will lessen the social
mainstream in the future since employee mental health is
stigma associated with the mental health conditions. The
becoming a bigger part of the conversation in today’s
pandemic has already pushed mental health
workplaces
conversations forward in a way never seen before
Innovative
Surge in
business
awareness
models

Introducing insurance coverage for mental

The concept of Mindfulness has gained
illnesses will make treatment more affordable
prominence during the pandemic. Research Increased Flourishing
and accessible for the general population.
has shown that apart from reducing stress, focus on Insurtech Max Bupa Health Insurance, ICICI Lombard,
scientifically designed mindfulness solutions
mindfulness ecosystem Aditya Birla Health Insurance Company, HDFC
can also improve relationships, increase
Ergo General Insurance and Digit General
working capability and also help to introspect
Insurance are have recently introduced products
and acknowledge one’s emotions
for mental illnesses

Rise of virtual Emerging novel

technologies technologies

Novel technologies such as Neurofeedback and

Growing use of virtual care applications and emerging digital Prescription Digital Therapeutics will completely
tools will augment the mental health care delivery. Also, self-help revolutionize the way complex mental health
digital diagnostic tools are set to place the mental health analysis disorders like ADHD, PTSD, ASD, depression, sleep
right at the hands of the people besides helping the providers related disorders etc. are treated
accurately diagnose a mental health condition
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This report has been co-authored by CIIE.CO and Healthark Insights

Authors:

Shivang Bhagat Nipen Dutta Soniya Sadhnani

Consultant, Healthark Insights Specialist-Insights, CIIE.CO Associate-Seed Investing, CIIE.CO

Contributors: Acknowledgements:
Snehil Basoya, AVP - Insights, CIIE.CO Dr. Ashwin Naik, Founder, Manah Wellness
Dr. Ambrish Dharmadhikari, Head Psychiatrist, Mpower Minds
Marketing & Design Harjas S. Gulati, Founder, Untangle.Space
Niraj Mulani, Sr. Manager - Marketing, CIIE.CO Chintan Antani, AVP - Seed Investments & Portfolio, CIIE.CO
Varunika Lalchandani, Associate - Marketing, CIIE.CO Ria Rustagi, Co-Founder & COO, Neuphony
Saman Arora Makela, Designer Vijaygopal R, Founder, Sparcolife Technologies

(Images from Shutterstock)

CIIE.CO, IIMA New Campus, Ahmedabad-15 821, Sun Avenue One, Nr. Shreyas Tekra,
Bhudarpura, Ayojan Nagar, Ahmedabad - 15
[email protected]
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