A Mental Health Framework for Founders

From a psychologist turned founder.

Hello 👋

Martin here. Welcome to another edition of Founders’ Hustle.

Today I’m sharing PsycApps CEO and Founder Silja Litvin’s mental health framework for founders. Implementing these best practices will help make sure your startup team is cognitively fighting fit for the long term, whether small or large.

Highlights:

  • How to prevent anxiety, depression, and burnout. 🛡️

  • How to deal with anxiety, depression, and burnout. 🤗

  • How Silja launched a health tech game startup as a non-technical entrepreneur with zero game design experience. 🔥


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Mental health is one of the most overlooked areas of productivity optimization for entrepreneurs.

A lot’s been said about the mechanics of building a startup (MVPs, fundraising, customer acquisition, etc) but the driving force making it all happen, a founder’s brain, gets relatively little attention.

Small investments in this area can have outsized results in terms of energy, problem-solving, ideation, stamina, and communication.

As I recently wrote:

I believe the single most important ingredient for long-term success is how you feel psychologically.

For that reason, I aim to return to the subject regularly.

Today, I’m looping in Silja Litvin, CEO and Founder of PsycApps, who is both a mental health expert and intensely driven entrepreneur with an inspirational story.

What is PsycApps?

A UK-based startup best known for eQuoo.

Similar to Calm and Headspace, it’s a mental health mobile app.

In a crowded market, what’s eQuoo’s unique selling point? It’s a game. 👇

But, don’t let that fool you into thinking it’s frivolous.

It’s fair to say Silja is totally driven by scientifically verifiable mental health solutions.

Whilst working on a Ph.D. in Clinical Psychology, Silja developed a hypothesis for a mental wellness app and began mapping out how to build and test a product that’ll stand up to peer-reviewed scrutiny, and, you know, actually works.

The UK’s National Health Service (NHS) agrees it does.

After a comprehensive randomized control trial with Bosch UK that involved 350-participants, eQuoo has been accepted into the NHS App Library—a non-trivial accomplishment to say the least.

This means a UK doctor can formally refer the game to patients as part of their treatment. Wow.

She previously told TechCrunch:

“While working in an NHS Trust for eating and mood disorders I was dismayed about the fact that many of our young clients had to wait months to see us for a measly six sessions.

Psychologists are not scalable, but apps are, so I decided to make an app.

But, why did Silja choose to study psychology in the first place?

Formerly an international model, she experienced an intense motivating event that completely changed her career path:

“I learned about depression when I was a young teenager: a friend died through suicide, leaving me shocked and determined to fight depression.”

Being the founder of a startup tackling mental health, Silja has an amazing sense of awareness as to the emotional and cognitive struggle that founders go through on a daily basis.

She previously told TechCrunch:

“I think as an entrepreneur you completely identify your job with your company; it’s very closely linked to your self-worth and how you value yourself.

And so, if you fail in a normal job environment it’s just you being human, but if you fail as a startup it feels like you aren’t being the best you could be and I think that really puts a completely different pressure on people.

And then you have the problem — as well as being a startup founder — that you are kind of the “lead horse,” you’re pulling the cart, and you have to have this appearance of strength towards your employees else they or your investors might freak out.

And if you show any weakness, then, you know, it’ll all start to crumble. That’s the difference.”

The figures Silja shared with me reveal this unequivocally.

Entrepreneurs are much more likely to suffer from depression, anxiety, and burnout.👇

Why?

Silja says:

“Psychologists suggest this is due to the nature of a higher workload and an independent attitude (thinking that they can tough it out or fix themselves).

Whilst these can be admirable traits in some circumstances, the bottom line is that it results in more mental illness which is harmful in the long run to individuals and their businesses.

To add further fuel to the fire has been last year’s seemingly unending lockdowns and the threat of illness to oneself and loved ones.

Any disruption to normality can test mental health and 2020 was the big one!”

Plus, building a company from scratch is tough. Ben Horowitz refers to it as “The Struggle” for a reason.

There’s material uncertainty in virtually every aspect of doing it—money, customers, leadership, hiring, etc.

Uncertainty creates sustained stress, which can transform into anxiety, depression, and burnout over sustained periods.

Outside of being plain unpleasant, these are all symptoms that can kill productivity and lead to an escalating feedback loop of trying harder but achieving less.

Worryingly, this often happens over a long stretch of time so it can be hard to perceptibly notice and deal with.

I asked Silja to share some advice on how founders can optimize their mental state.

Her response was a little more in-depth than I was anticipating.

An ebook!👇

This resource goes beyond founders and discusses optimizing mental wellbeing for an entire startup team.

In an era of heavy remote working, this is particularly relevant.

It’s easy to feel disconnected and harder to build comradery with peers—an important mechanism for mental wellness in the face of sustained adversity (like entrepreneurship).

Also, many founders and leaders report finding it difficult to assess the psychological state of their colleagues and team.

Are they stressed about something? Are they truly motivated?

With fewer real-world interactions and idiosyncratic conversations that occur in passing around an office or co-working space, answering those questions is less intuitive than it used to be.

Let’s walk through Silja’s framework that tackles this subject next. 👇


Mental Wellness Framework

Silja’s framework is based on three intervention phases:

Phase 1: Organization-Wide Prevention

This first phase seeks to raise awareness of mental wellness amongst all team members.

The idea is to foster an environment in which mental wellness can be spoken about openly, even if everyone ‘seems fine’.

Basic steps should be taken to demonstrate it’s not a stigmatized subject and that the necessary channels are in place should a problem arise.

Why?

“Prevention is always better than cure. Not only for individuals but their effect on your business as a whole. Infact, investing in mental health can offset future costs, not to mention take care of your workforce!

Current statistics show a positive case for investment in mental health by employers, Deloitte found an average return of £5 for every £1 spent.”

Strategies for implementing this include:

  • Ongoing startup-wide dialogue discussing mental wellness.

  • Scheduled mental wellness one-to-ones (virtual or in real life where possible).

  • Recommended usage of digital aids like eQuoo, Superbetter, Calm, and Headspace.

“The most important thing you can do when taking responsibility for your colleague’s well-being is listening. Take the time to check in with each team member and simply ask them how they’re doing and what is the biggest challenge they are facing at the moment—whether personal or not.”

Phase 2: Proactive Prevention

Recognizing early symptoms of psychological distress and taking steps to mitigate them before they escalate is a key tool in the mission for sustainable positive mental wellbeing.

Educating your entire team about them will help spot problematic symptoms faster since many pairs of eyes are better than one.

Plus, it acts as a support network for you since being consciously self-aware of these symptoms can easily be missed.

The most widespread issues in the start-up community are anxiety, burnout, and depression.

Below are the main symptoms. 👇

If you notice these symptoms in a team member, it’s important to have a plan ready to deal with it.

For example:

  • One-to-one coaching with a dedicated team member (virtual or in real life where possible).

  • Seminars and workshops (depending on startup size).

  • Discovery and resolution of startup-related issues.

  • Escalation to the next phase if necessary (worsening of symptoms to the point they are debilitating and impacting quality of life).

Phase 3: Reactive Support

The previous prevention phases are there to minimize this phase being reached at all.

It’s the most serious and costly in terms of both productivity losses and the resources needed to resolve it.

But, it will happen eventually. Particulalry as a startup grows and onboards ever more team members. It’s kind of inevitable.

There is really only one resolution:

  • Therapy with a licensed health practitioner.

To learn more about setting this framework up, you can access the ebook in its entirety through this link. It has a ton of external links to even more incredible resources that Silja has personally vetted.


Building PsycApps

Silja is a huge inspiration to aspiring entrepreneurs.

Particularly those who are starting out on their own and maybe lack the technical and product expertise to build an MVP.

Whilst she certainly had solid domain expertise on the mental health side of things, Silja was not a programmer and had no experience designing games.

But, that didn’t stop her from founding a company that designs and programs games. I love that tenacity and drive.

Better still, Silja’s approach has achieved real-world results.

This includes:

  • Building an MVP.

  • Conducting successful clinical trials.

  • Securing financing from angels.

  • Crowd-funding through Indiegogo.

  • Taking a scientifically proven product to market.

  • Signing one of the largest global corporations as a B2B client.

  • Materially improving the mental wellness of thousands.

Now, PsycApps is working on a sequel game: eQuoo: The Next Generation: Lodestar.

Given her skill set gaps, how did Silja piece all this together and make this happen?

In the below Q&A session with me, Silja shares key insights into how she built PsycApps and made her vision a reality.👇


Q&A

Did you raise money before building a product or MVP?

No, I built an MVP, we did a clinical trial and then I raised my friends and family round. 

🔎 Silja’s MVP was not a game but a simple psychological app, developed and tested with 1,000 participants under Ludwig Maximilian University after pitching the idea to her Professor, Markus Maier.

The MVP ‘worked’ in that it significantly lowered participant depression levels, but user retention was pretty bad. As in, unworkable commercially.

Since games are widely known to be sticky, this discovery led to the idea a mental wellness app could be designed as a game to encourage long-term usage.

But, Silja had no data to back this up.

Fortunately, the MVP medical results alone were enough for Silja to raise capital and start building a team around the mental wellness game concept.

This is an important takeaway in that MVPs do not have to function like the grand product vision in order to progress a startup to the next step.

Building your founding team. Did anyone from your network join the company?

Yes, but through my wider network: my investor introduced me to my co-founder [and COO], Vanessa Hirsch-Angus for example. 

How did you meet your CTO, before he joined? This is something a lot of startups with non-technical founders struggle with.

I met him [Med Bukey] at a startup event.

He tried to help me first to find a technical cofounder, because he was not a developer but ended up joining after a few months. 

🔎 Med introduced Silja to a game development company, Collision Studios, which built a prototype mental health game from the ‘friends and family’ round. This would later become eQuoo.

The beta generated over 4,000 downloads in the app store, with users spending 10 minutes per session playing it on average.

What key skill sets did you prioritize for early-on and why?

Since we’re a mental health startup, the clinical side was very important to me: I had to make sure we’re clinically solid.

That and making the game fun. Because of that I wasn't able to work full time on the business model, so that became a focus when my co-founder [and COO] Vanessa joined.

Your background is in Clinical Psychology, not games. Did someone with gaming expertise help design eQuoo?

Absolutely: I wouldn’t have been able to design such a great game without originally, Bitbox, an LA-based game design studio, and now Mitale, an awesome game development company based in Finland. 

Fundraising from angels and VCs, what’s a key piece of advice you can give to other founders?

Tenacity: just keep going and iterating according to feedback: the 50th person might be the dream investor. 

What didn't work?

Early-stage VCs have no issue with stringing you along for months with a vague promise of financing. It’s better to push for rejection than hope — a ‘maybe’ is mostly not a ‘yes’. 

What was your experience like fundraising through Indiegogo?

Worst. Month. Of. My. Life.

Indigogo as a platform is fine and user-friendly, but fundraising via crowdfunding is not for the faint of heart - which I apparently am.

You have to be at it 24/7. It’s a 4-week marathon at high speed. 

Why is crowdfunding "not for the faint of heart"?  

You have to relentlessly badger everyone you know, their grandmother and their dog to raise the money over the usual 4 weeks.

Every day you send out 40 - 50 emails and messages, and you have 'events' every week to keep the interest alive and have news to share to those who may support you.

It's like marketing on steroids and costs a lot of money and time. 

How did you test your product with early adopters?

We did typical A/B testing of messages and pictures to make sure we’re addressing the topics the users are interested in. 

What KPIs do you optimize for?

  1. Conversions  = download to level by level.

  2. Impact = as significant increase in mental wellbeing based on clinically validated questionnaires.

What customer acquisition channels have been important?

The App Stores is where we get most of our B2C players: the conversion rate went up by 160% since the first COVID lockdown.

Then it’s the NHS Apps Library and Mental Health America.

With ‘eQuoo: The Next Generation: Lodestar’ it's mostly corporate downloads. Our biggest client is currently Unilever. 

How are you thinking about scalable customer acquisition?

B2B all the way. You can often reach 20 - 60 000 players at one time that way. But we’ll stay on the app stores for anyone to use!

What has been an effective strategy for you acquiring those B2B clients?

Hiring a commercial director - you can't do it all!

🔎 eQuoo was initially a B2C-only app. After clinical success, numerous awards, and approvals from credible institutions like the National Health Service and Mental Health America, Silja was able to use this momentum to hire a commercial director and launch a B2B model.

What do you wish you knew before you started PsycApps? 

How to find the right team members, I guess. The team makes or breaks the startup. 


Thanks, Silja!

If you’d like to check out eQuoo, here are links to the iPhone and Android versions.

Until next time…

Martin 👋


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