Analysis of Start-Up Digital Mental Health Platforms for Enterprise: Opportunities for Enhancing Communication between Managers and Employees

Abstract

The COVID-19 pandemic has resulted in employees being exposed to transformational stressors from within and outside the organization. This has created an opportunity for employee mental health solutions. Indeed, there has been a rapid growth in start-ups offering clinical mental health services via a digital health platform. These platforms servicing enterprise employee mental health needs have not been evaluated with respect to their ability to enhance management communication. Hence, the aims of the present study are to explore communication and service attributes across a sample of five operational leading commercial start-up platforms for mental service delivery to employees. We have observed that all platform models focused on providing on-demand mental health consultation services. Existing platforms fail to adequately support management communication for mental health solutions across 80% of platforms reviewed. We recommend that industry start-ups should understand the need for management engagement with digital mental health platforms. Digital mental health platform solutions in the workplace are ideally supported by valuing leadership communication. A culture around mental health will create sustainability in digital mental health solutions for an organization.

1. Introduction

1.1. Background

In the present study we wish to explore whether commercial start-ups with platform mental health solutions are suited for workplace organizations. We are interested in whether these platforms promote communication engagement with managers and leadership, and whether this provides a feedback loop to improve mental health values across an organization. Employee and organizational awareness of leadership in supporting mental health is important in sustaining mental health interventions. In summary, this paper seeks to understand whether start-up digital platforms that engage enterprise employees also value mental health communication across the organization or whether they are solely client-focused (the employee of the organization).

A refined definition of leadership [1], for the purpose of this paper, defines a leader as one who crafts a shared organizational mental health vision and mobilizes others toward specific organizational goals for a positive mental health work culture. Services are consistent with the shared vision of employee wellbeing. An example would be a leaders’ review of environmental scanning of mental health wellness (via a digital platform solution) that can alert leaders to increased stress within an organization and they can communicate with employees and act to reduce stressors.

Corporate leadership is important for employee communication. Such leadership communication has been defined as the process of exchange of knowledge and internal and external information with individuals or groups directly linked to the corporation [2]. Corporate leadership information exchange with employees can be used to enhance employee wellbeing [3]. Interestingly, corporate communication between managers and employees can also enhance trust [4,5] and can improve employee function across an organization. Employee engagement with management results in several positive employee self-cognitions, such as feeling more valued and motivated [6]. Management having bi-directional communication with employees will permit organizational management listening, monitoring, and solutions to reduce stress within an organization [7]. Important in this process is a clear vision for leadership, which has had multiple definitions and characteristics aligned to function within an organization.

Digital mental health services provided to both community and corporations have expanded during the COVID-19 pandemic [8]. Of interest to our paper are start-ups that have developed a platform for mental health solutions to engage workers within enterprises. We appreciate that many of these platforms will offer digital therapies to the worker client (aligned with blended care models). For corporations, some platforms engage a therapist-led matchmaking approach for employees, combined with employee self-management [9]. It is known that for such mental health services to be successful within organizations, they should also be closely aligned to organizational communication leadership [10]. We have identified that there is no literature on how these digital support services (for employee’s mental health) interact bi-directionally to engage leadership and employees via communication channels.

The practical implication of the absence of mental health management communication engagement with employees is that employees could have an erosion of trust in any system to support their mental health or wellbeing needs [11]. Specifically, a lack of organizational communication may affect any new technology solution. For example, a mental health digital platform after being integrated into a workplace may lack sustainability after it is implemented if there is an absence of organizational value strengthening of the concept of mental health needs. We acknowledge in the literature that there is evidence from the implementation of other mental health programs that leadership communication and engagement beyond the implementation phase is critical for the sustainability of mental health services [12,13].

Additionally, corporate leadership communication during COVID-19 conditions has been recognized as important to sustain employee wellbeing [14]. Prior to COVID-19, it has been known that remote or casual workers have high levels of personal mental health issues, and this has been related to a disconnect in communication with management [15]. There exists a risk when management believes that teams that are primarily interacting through technology require less management communication and psychological investment [16].

Information technology solutions have been previously suggested and are more important during COVID-19,during which the workforce is displaced [14]. An additional resource to corporations is the emergence of digital mental health platforms for employee engagement. Ideally, such platforms are bi-directional, supporting both the employee and leadership to sustain a culture of mental health prevention and support within an organization. The idea of a communication component for a platform to foster leadership to engage employee mental health is explored in this paper. It has long been known that management engagement in wellness programs will foster employee participation [17]. Specifically, we wished to explore whether available public domain content is aligned with management and leadership around an organizational mental health culture. We are particularly interested in emerging start-up solutions to foster corporate employee engagement for mental health and their targeting of information.

1.2. Literature Review

During the ongoing COVID-19pandemic, there has been increasing interest in delivering corporate employee programs that assist with providing services for employee mental health and wellbeing in the workplace [18,19]. It is thus not surprising that there are a growing number of commercial providers offering subscription-based digital mental health services for employees [9]. Many of these platforms and apps are being scaled by start-up companies looking to resolve mental health issues in the workplace [20]. An exploration of the literature makes it known that there are published theoretical frameworks for digital health ecosystems, which include a focus on the client, digital infrastructure, and digital health literacy [21]. However, there is a gap to consider management communication for the implementation and sustainability of a mental health solution for an organization. As start-ups have emerged offering mental health engagement via digital platforms for employees, their interest in organizational leadership has not been assessed.

Both employee stress and burnout during the COVID-19pandemic has escalated across businesses [22,23]. Chronic stress and burnout are often the result of an imbalance between job demands and an employee’s mental and wellbeing resilience [24,25]. Organizational workload thresholds being exceeded, and a lack of managerial communication and support are associated with increased risk for employee stress, depression, and anxiety [24,26]. Often, employees are found socially isolated due to the nature of COVID-19 working conditions, which can exacerbate mental health problems [27]. Importantly for management, they should be able to track employee outcomes and modify outcomes appropriately. It is also well understood that a management communication strategy is important to allow for a reactive process to reduce aggregated employee stress (particularly if this is detected).

Online mental health platforms generally engage the employee to self-assess their mental health and provide interventions. Traditionally, online platform programs or mobile applications (apps) have engaged employees with relaxation or mindfulness techniques [24,28]. In other instances, a counsellor may assist with one-on-one sessions (via direct linkage to the platform or by digitally encouraging the affected employee to seek external services and review) [29].

For some companies, these mental health platforms have focused more on physical fitness and team collaboration [30]. Team collaborations involving fitness aim to increase social activities and are presumed to be motivated via team incentives, rewards, digital badges, or a combination thereof [31,32]. However, it is also understood that such activities will not address pre-existing or new acute mental health disorders in a COVID-19 environment [33]. Digital mental health platforms for enterprises are not all the same [8]. They have variable component interventions that may be passive or interactive. There may be guided therapy or a service provider supplying virtual therapy to the employee [29].

Several systematic reviews exist on corporate digital mental health solutions for the workplace (aimed at diagnosing or improving the mental wellbeing of employees, often app-based, or platform-based). One systematic review [34] suggests that the use of smartphone-based apps is usually a vehicle for assessment or guidance for sub-component mental health disorders (anxiety and depression). It is important to the employee to identify and ensure treatment pathways are present, that there are active preventive mental health interventions available (that are scientifically evidence-based), and that the organization is supportive. From an organizational perspective, having responsive leadership communication systems will facilitate positive inclusive mental wellbeing and strengthen organizational employee values. Such bi-directional communication between leadership and employees is believed to be an essential component to build sustainability for mental health provision and employee trust in such systems.

There has been a significant venture capital investment in the start-up space around mental health digital solutions and digital platforms [35]. The pace of this innovation in mental health in the past has not always been aligned to: (i) obtaining regulatory approval from national device regulators for mental health apps, (ii) meeting medical-legal standards, and (iii) secure patient (client) data protection and privacy laws [35]. A start-up solution which could navigate risk and offer organizations a solution is to adapt to offer a platform solution that allows for customization and counselling support that can meet privacy laws for both the employee and clinician communities.

From an organization perspective, start-up technology offers a potentially sustainable solution as a “plug and play” approach for organizations. Furthermore, engaging employees with mental health services may reduce the perceived burden on leadership for mental health provision. However, from a sustainability perspective, organizations will ideally wish to understand whether start-up (scalable) digital mental health platforms are providing services that allow for both the employee and employer engagement. Indeed, it has been established that leadership engagement is crucial for the sustainability of mental health programs. For example, the National Evidence-Based Practices Project is often cited [36]. The case study illustrates that leadership has a role in employee mental health stability and recovery. Leadership can be a reactive process to reduce stress across an organization based on feedback. A manager’s leadership involves positively influencing a culture of mental health programs, such as to facilitate learning, and encouraging employee engagement to talk about mental health. Leaders need to articulate vision, values, and commitment to employees by ensuring ongoing strategy such that organizational structures can support feedback from the mental health programs in place [37]. Currently, there is no research with respect to reviewing the services offered by start-up platforms for employee mental health engagement and how this intersects with management.

Our aims highlight the gaps in start-ups with respect to the perceived importance of engagement with leadership (see Figure 1).

The broad aims are to explore communication and service attributes across a sample of relevant large scale start-up platforms for mental service delivery to enterprise employees.

Aim 1:

To assess individual platform services provided to the employee and any scientific evaluation of these services.

Aim 2:

To assess whether the platforms facilitate mental health leadership coaching and engagement.

Aim 3:

To assess whether the platforms provide an inclusive culture that values mental health engagement and communication of employees.

Hypothesis 1.

Start-ups that have developed mental health platform content are focused on therapy for the individual employee and are evidence-based.

Hypothesis 2.

Digital mental health platforms do not have built-in communication channels to support leadership to foster mental health engagement with employees and the organization.

2. Materials and Methods

Inclusion of digital mental health platforms for analysis: We searched Google for early-stage high valuation digital online mental health companies on 5 January 2022. Key combinational word search terms included “digital mental health”; “covid”; “mental health platform”; “enterprise”; “start-up”; and “funding”. A platform had to meet the following conditions: (i) had a considerable population employee end users, (ii) the platform targeted enterprise mental health, (iii) had considered mental wellbeing communication in the delivery of mental e-health wellness, and (iv) had a venture capital-backed investment valuation of greater than USD 2 million (hence was a growing start-up). Platforms were randomly assessed until saturation with five platforms identified for analysis.

For each platform, the following sequence of narrative analysis was conducted [38]: (i) each software platform website was reviewed to determine descriptive biomarkers for mental health interventions and to determine whom the targets of these interventions were (Hypothesis 1); (ii) the level of service provision and other wellness products (Hypothesis 1); and (iii) assessment of evaluation of management interactions with the start-up or the platform (Hypothesis 2). We compared each of the 5 mental health platforms with respect to the types of management communication that are either included on the platform or externally via the commercial start-up provider.

3. Results

The results support the descriptive analysis of the platforms examined below when exploring the content of each platform and the level of service provision and to whom (Hypothesis 1); any published literature to support claims for evidence-based service provision is also provided (Hypothesis 1). Additionally, narrative content is explored, examining whether information is built into the platform or coaching is provided to engage management (Hypothesis 2).

Descriptive analysis of the key elements contained within each of the five platforms is provided below.

• Oliva Health is an online platform designed to provide employees with optional access to mental healthcare services [39]. For example, employees can confidentially review their mental health and be matched with an appropriate mental health therapist. The platform matching is typically integrated into Google or Slack. The platform is flexible in the number of mental health professionals it can continue to add to the platform as the client base grows. The platform also allows for different treatments targeting specific mental illness needs. It is suggested that the initial matchmaking with a relevant therapist is a key component to the platforms use [39]. There are also courses and dedicated training for managers (to build resilience, knowledge, and effectiveness of teams over time). They also suggest that communication for managers is enhanced by creating an inclusive culture around mental health.
• Modern Health is a mental health and wellness platform. The platform has continued to gain traction throughout the COVID-19 pandemic. Modern Health provides app-based solutions and applications for mental health. Employees complete a survey related to their mental health and then the algorithm provides a selection of digital programs that address their needs [40]. These offerings address issues such as stress, financial wellbeing, work performance, and relationship guidance, and can be augmented with remote coaching or with live group or one-on-one therapy. Evaluation includes use of the WHO well-being assessment, self-service wellness kits, a global network of certified coaches, and licensed therapists available in 35 languages. The company suggests that employers who adopt their technology are by default embracing mental health via increasing accessibility of mental health services for their employees.
• Unmind is a business-to-business service that incorporates mental health tools, training, and assessments for company employees. The company defines their technology as a workplace mental health digital platform. The digital platform is delivered through a mobile app. The wellbeing intervention exercises are kept intentionally short in terms of time span. Similarly, the platform allows for personalized assessments, and customized programs for improving areas such as stress, focus, depression, anxiety, and insomnia [41,42]. The app provides to employers anonymized data, and the company suggests employers can respond to their employees’ needs once the data are available to them, but does not say if the employers are trained to provide solutions or if there is a communication strategy. Unmind in mid-2021 disclosed that its app was available to 2 million employees in 110 countries, and the uptake of the app ranged from 15% to 60% of an organization’s workforce [42]. This implies that management would need to also communicate and encourage the workforce to engage in the use of the app. There is emphasis on scientific evidence for the app and ongoing research, and the published data on the website so far pertain to systematic reviews to guide usage of digital technologies and tools. However, evaluation of their own product in a real-world environment is ongoing and no published studies to date have been identified.
• Lyra Health is an Employee Assistance Program (EAP) company that partners with employers to provide mental health services. Lyra Health’s initial engagement with an enterprise is with management and employers, where they provide knowledge and plans to communicate to employees about the Lyra Health platform services. Lyra Health has a network of circa 2500 therapists (the majority of whom will provide cognitive behavioral coaching) and uses a matching algorithm to connect enterprise employees (including spouses and children) to service providers [43]. For the provision of extended family services to employees, Lyra Health uses Lyra Concierge, which provides personalized support for children, adolescents, and adults who need help accessing specialized mental health support. Lyra introduces services to provide personalized support for people who need care through intensive outpatient and rehabilitation facilities. Services are online but external, one-on-one, in person sessions are also available, and psychotherapy is promoted via the platform. Therapists are contracted to the platform through Lyra, and these include psychologists, psychiatrists (this allows for medical prescribing), social workers, licensed professional counselors, and nurse practitioners [44,45]. Lyra Health, from its website, has suggested it has delivered mental health services to more than 2.5 million global employees and dependents. Lyra’s online resources suggest that the benefit to employers is the ability to offer management reliable access to providers who practice evidence-based mental health care for their employees. The platform provides additional resources such as worksheets, reading material, quizzes, and access to the third-party app Calm, which promotes mindfulness and mediation. Lyra’s platform takes users through a brief triage process, during which members are asked about their presenting problems, from clinical symptoms to the severity of issues. From there, “intelligent matching technology” connects members with a provider who has the availability and is best suited to serve their specific needs. This process takes less than 10 min, with appointments available within 24 h. Interestingly, the Lyra health app service has been evaluated in a real world setting and was demonstrated to reduce stress and improve wellbeing, and to also reduce anxiety and depression [46] based on video coaching.
• Ginger is an MIT University spin-out start-up, with a focus on app-based technology for clinical mental health research. App-based technology has permitted end user engagement to monitor changes in behavior. Adverse behavior detection informs both the employee using the technology and their health care provider. Over time, this platform has been a tool for providers to offer digital mental health services for behavioral tracking and care-provider engagement [47]. However, friction across the supply chain for clinical service provision was not time efficient and could become problematic. This created friction across the supply chain and the business model was adjusted. For this reason, the company had pivoted to focus on both medical insurance rebates (for those with pre-existing cover) and employers purchasing Ginger.io services. The new business model is thus a corporate benefit for employees and members. Ginger.io uses advanced algorithms to provide fast mental health care and predict future events via changes in behavior monitored by the app. This is facilitated by individual end user sensor data collected through a patient’s phone and self-reported information to track patient activities. The app can identify when help is required and provide behavioral coaching [48]. By continuously monitoring the user, Ginger.io may be more effective at targeting care to when the patient is perceived to need it through biomarkers and self-reports. Ginger.io functions as a licensed medical provider to directly deliver holistic mental healthcare to employees [49]. The platform also engages coaches and provides digitized self-management tools and treatment interventions such as online cognitive behavioral therapy and mindfulness activities [47]. From a communications perspective, Ginger.io has developed communication tools for video conferencing and secure messaging to facilitate relationship-building between Ginger.io coaches and patients. However, these tools do not appear to place emphasis on employer and employee engagement. In essence, the platform’s purpose is to provide a mental health solution and wellbeing solution to enterprises. There is evidence that the platform and the engagement tools have been tested and are shown to reduce anxiety and stress in real world settings [50].

The types of service and the communication style are summarized in

Table 1. A comparison of digital mental health platforms that engage management.

Company Platform	Platform Courses for Employers to Gain New Communication and Resilience Skills	Engage Managers to Develop an Inclusive Culture around Mental Health beyond Purchase of the App.	Focuses on Employee Matchmaking to Clinical Services
Oliva Health	Yes	Yes	Yes
Modern Health	No	No	Yes
Lyra Health	No	No	Yes
Ginger	No	No	Yes
Unmind	No	Yes	Yes

.

4. Discussion and Conclusions

Our content analysis of platforms demonstrated that service delivery predominately focused on the employee. This service was based on one-to-one service matching with professional counsellors, psychologists, psychiatrists, and pharmacological treatments. Platforms also provided referral pathways in some instances for more serious mental health issues.

To add value to the culture of an organization, there is an appreciation that wellness should be applied across multi domains to provide workers with sustainable mental health outcomes. Examples include mindfulness, fitness, and nutrition programs [48]. Interestingly, in our analysis, wellness approaches (if included on the platform) tended to focus on mindfulness. We observed in one case a mindfulness mobile application offered via a platform that was in partnership with an alternate provider.

Interestingly, our results also demonstrated that start-up engagement with organizational mangers and leadership is primarily aimed towards increasing initial workplace employee conversations to increase user engagement (with a platform). These conversations are aimed at promoting uptake of the technology platform solution by individual employees and generating a contract for the services from the start-up. This suggests that, from a start-up perspective, engagement with managers and leadership provides surrogate champions to initially increase employee engagement with the platform services. There is a paucity of evidence from our review of platforms to suggest that there are systems in place for sustainable communication support from employees.

An important consideration from our findings is the need for managers to have a clear mental health communication strategy. The risk for leadership and managers to only offer a third-party service is that they can become disengaged from the collective employees’ mental health. Thus, an absence of an in-platform solution for employers to engage strategies to improve mental wellbeing across the organization may lead to a perceived mental health communication disconnect and reduced psychological wellbeing for employees [49].

Interesting analytics are built into many platforms and are available to report trends in mental health and stress across an organization. In our analysis, platforms have relied on analytics to adjust platform engagement with third party providers for better service provision. Thus, in many cases, the primary use of platform analytics appears to be for automated adjustment of the platform for the primary user, e.g., the employee. On the other hand, a perfect model would be where summary analytics can be shared with management, such that managers can adjust work balance to improve wellbeing and reduce employee stress. McKinsey & Company have identified the leading employer communication actions to reduce team employee stress during COVID-19 conditions. These included: (i) introducing taking a holiday break to boost morale; (ii) increasing frequency of one-on-one meetings for team member to check in or communicate a reduction in non-essential group meetings; (iii) increasing awareness and access to employee assistance programs for mental health; and (iv) establishing team norms to take regular breaks [50]. From an employee perspective, employees have identified management needing to improve communication and culture for organizational mental health awareness (and without stigma) [51]. Ideally, elements of communication (encompassed into a digital mental health platform) could assist employers to have predictive or real time analytics to demonstrate the effects of increasing employee stress.

Our findings create a practical opportunity for the development of a conceptual framework model. For example, bi-directional management communication with employees (around mental health) fits into a digital platform strategy to strengthen workplace mental health values and employee trust. That is a digital solution that engages both employee and management (see Figure 2).

Figure 2 is a conceptual model showing platform elements of engagement on the employee and management side and the need for these to be connected. At this step, a start-up commercial platform engagement solution has been applied for employees to seek mental health help with online counselling. Help may consist of external mental health coaching and counselling services linked to the platform. Importantly, the addition of a management review and solution section to engage the platform (middle section) is required (but largely absent from our review). Management can review the mental health of the organization. The platform is in real time and can alert management of increasing mental stress across the organization. Management can be prompted by the platform to offer top level organizational solutions to reduce mental health stress for employees and provide top-down communication back to employees. Such a response should be rapid to reduce stress across the organization. Stress reduction can facilitate management communication for stress reduction or back to employees to increase trust, improve mental wellbeing, and increase a positive culture for mental health across the organization.

5. Limitations and Future Studies

We have focused on communication strategies around current large scale start-up technologies aimed at providing on demand mental health services for employees. We have used an informatics approach to assess content and the provision of services provided by these platforms to both employees, and management and leadership. We have shown that there is an absence of planning and systems in place to support bi-directional communication to benefit and value mental health culture across the organization. There is a lack of mechanisms to share data back to management to track the wellbeing and mental health of the organization. We have recommended that such platforms should ideally be sharing data with managers to adjust the mental health wellness of an organization. On the other hand, we are also aware that this would require careful planning and consideration of data privacy provisions and employee consent [52]. We have provided a theoretical framework model of the gaps; there now needs to be testing of these platforms to prove that if digital platforms (in the same manner as non-digital mental services) experience an absence of leadership communication, the sustainability of the service cannot be continued over a period. The focus was on the platforms, obvious leadership styles, and communication preferences across the organization, which may also influence the value of mental health support offered to the employee. We recommend that future research addresses the need to better understand the dual effects of leadership style and organizational feedback when designing platforms to provide improvements to organizational mental health. Real-world testing of mental health platforms for employee–management communication engagement under COVID-19 workforce conditions is also required.

In conclusion, mental health platforms for employee engagement are not designed to support management communication for optimizing mental health solutions. This has several implications that can affect sustainability across several aspects of the enterprise. Firstly, the sustainability of the digital mental health platform solution is questioned, as we know that divorce of communication between the platform employee user and management can erode wellness and trust for the employee. This can impact engagement with the platform mental health services (from what is known from the literature). The other practical implication is that the mental health of the employee may be worsened, and this could affect work participation, hence impacting organizational sustainability for the employee. We recommend that the industry should explore opportunities to innovate management communication strategies—if management communication is absent from a pre-existing platform solution. We also recommend to the start-up industry that they do not ignore communication solutions for mental health wellness. That is, there needs to be a dual focus on positive and reactive management and leadership mental health communication. There is real world evidence that app-based platforms do improve mental health and wellbeing at the employee level for common mental disorders, such as depression or anxiety. On the other hand, a lack of communication will affect trust in the system and in organizational values for mental wellbeing. Although we have alluded to the practical outcomes of a lack of trust, trust has not been measured across any of the platforms that we have reviewed.