Next Question with Katie CouricTalkspace CEO Dr. Jon Cohen opens up about the transformative power of telehealth in mental health care and why it matters more than ever. From the struggles teens face to the often-overlooked needs of older adults, Jon shares his personal journey and how Talkspace’s Medicare expansion aims to bridge critical care gaps and bring hope to those who need it most.
No matter what twenty twenty five holes. A Talkspace therapist can help you get ready for it. Through convenient virtual sessions and messaging therapy. Your therapist will help you build resilience and discover opportunities for growth in the year ahead. Talkspace is in network with major insurers. Most covered members have a copey of fifteen dollars or less, or you can get eighty five dollars off of your first month with promo code Katie when you go to talkspace dot com slash Katiekuric. Hi everyone, I'm Katy Kuric and this is next question. The statistics are pretty staggering when it comes to the mental health of the United States. Forty percent of Americans sixty five and older self identifies lonely, and according to the NIH, approximately seventy percent do not seek mental health treatment. In fact, many older Americans think declining mental health is just a normal part of aging, and of course, for young people, the numbers are even more distressing. Forty percent of high schoolers report feeling persistently sad or hopeless. One in five high school students seriously considered attempting suicide in twenty twenty three, and suicide deaths among ten to twenty four year olds increased by sixty two percent from two thousand and seven to twenty twenty one. Obviously, we're in the midst of a serious mental health crisis. My guest today, doctor John Cohen, is the CEO of Talkspace, the leading online platform making therapy more accessible than ever. He's had quite a professional journey, as you'll hear in our conversation, from winning the science fair in fifth grade, to vascular surgeon, to COVID leader to now health innovator. And here's a big highlight. Talkspace is expanding into medicare, bringing much needed support to seniors. Talkspace is feeling a hugely important need. I've long been interested in mental health and the obstacles many people face when it comes to getting the care they need. But that's a problem John Cohen really wants to solve. Doctor Cohen, may I call you John, absolutely, thank you, Thank you so much for being here. Wow, You've had such an interesting career, and I'm always fascinated by people's origin stories. So I want to start from not the very beginning, but when you realized you wanted to be a doctor.
Sure so thank you and thank you for the opportunity. So I grew up in Queens and in fifth grade I won the science.
Fair yay, and I was do you remember what your project was?
I actually do.
It was actually a dissection of a calf's heart, which I presented in this in this certain fashion.
Well that was very predictive, a.
Little bit of prediction. And I just loved science.
I love to read when I was growing up, and I think it was from that point forward that I said I really want to be a doctor. So I don't that's the one event that I could point to in my life early on.
You ended up becoming a vascular surgeon. That cow's heart was really fascinating to you. Absolutely tell me about what led you to that specialty.
So when you're in training and surgery training, it's a five year surgical training program, which is I did a New York Presbyterian Wild Cornell where I didn't meet my wife. We met as residence and got married our second year.
Who's also a surgeon by the way.
Son in law. Thank you for that. Yes, And I.
Definitely wanted to be a surgeon for a long long time. I don't know when that happened. I was quite honestly, probably influenced by Mash the TV program. Really Alan, There's no question that Hawkeye Peis was a hero of mine.
I think it's so funny.
I think it had some influence on me. And so I trained for five years of surgery, and then trained in VASCA surgery for a post residency up at the Brigham and Women's Hospital at Harvard, then came back to New York and then have been here ever since.
I have a dumb question, and I should know this because I am really interested in medicine and science. I think partly because of my husband's diagnosis of colon cancer, I had to learn very quickly about cancer. And my brother in law was the head of cardiology at the University of Virginia, my alma mater, and so I know a little bit about heart stuff, but I don't actually understand what a vascular surgeon does. Is that embarrassing?
No, No, listen, not at all embarrassing. I'm not surprised because most people don't.
Most people.
So the difference is between cardio surgery and vascal surgery is vascal surgeons operate and all blood vessels except for the heart so it's all the biginst of all blood cells, the carotid arteries that supplied blood to the brain, a orders that supplied blood to the rest of the body, and so all of those blood vessels have certain abnormalities during people's lifespan, and what we did is what we do is vask In surgeons, is fix those abnormalities, whether it could be fixing the blood vessel to the brain, the crotid artery, whether it's fixing blood vessels to your legs so people don't lose their limbs, or whether it's fixing the aorta for something called ordic aneurisms that can burst. So that's the specialty of Vaskal surgery. So that's what I did for almost twenty years.
So you were less interested in the cow's heart and more interested in what made that heart tick.
Oh, more about how you got the blood there and how the blood left there, that's right, and the diseases associated that. So that's in and of itself as its own specialty.
What was your most frequent surgery that you'd perform?
Aerotic aneurisms, which are bubbles which form on very large blood vessels. So the most common surgery it was aortic aneurysm repairs and a lot of famous people including actually Albert Einstein died of a ruptured aortic aneurism. Many people much much early in the forties, fifties and sixties until the techniques were developed to be able to repair them.
So that was my most common surgery.
So do you get a warning that you have that problem or I mean, how do you operate on that?
So the ertic aneurisms are a silent killer. You only would know it if you happen to get an ultrasound or a cat scan and someone discovers it. You can discover it on if they get very large on physical exam, but most of them were discovered with people who do not have symptoms. Now the other things I operate other entities. I operated on corotid arteries, which is people frequently have warning signs of a stroke. People who have leg problems, we knew that they had those problems because see the threatened limb loss or they had pain when they were walking. So the different types of surgery, but for me personally, it was mostly aortic and years of repair.
So after your career as a vascular surgeon, you transitioned to a lot of other roles. You are a man of many hats. You were leading the large scale COVID nineteen testing efforts at Bioreference Labs during the pandemic. Yes, what was that like?
So I was very fortunate. Yes, I've had a very circuitous path.
Nice way of described haven't even gotten ye right.
Which is a sort of a nice way of saying that I did a lot of things. So Bioreference I was there for. I was the CEO and executive chairman for about a year when COVID hit, which is just an extraordinary event as we all remember or try not to remember at this point. So we were faced by references about the largest laboratory in the country, and we were faced with the trying to figure out how to make the diagnosis of people and how to get COVID testing. So we did end up being the leader in a lot of the customized solutions. So we ended up testing for the NBA Bubble, if you remember, we did the exclusive testing for the National Football League all fall two hundred and fifty six games to Super Bowl. We relaunched the cruise industry with Royal Caribbean and eventually was testing out of ten or eleven ports around the country, and then we were running most of the New York City school testing, testing thousands of children and hundreds of schools every single day. We did the overwelming majority of school testing for New York City and other school districts. So I had a very unusual experience with a great team of people, and as you know, I ended up writing about it about what it's like to be a leader during a crisis, which is a very different crisis. So there are crises that happen and then you have to react. COVID was very different. One of my actually one of my favorite quotes is COVID is where intuition goes to die. Because every time we thought we knew what was going to happen, something different happened, and you're it's a little bit like being in the field in war because you never really know what's going to happen the next day. So every day we will wake up and changes would occur. So it's a very different type of management than an event that occurs and then you actually deal with the crisis. So it was an extraordinary personal experience, an extraordinary experience for the company.
I'm curious how you feel, John about all the Monday morning quarterbacking that's happened after the pandemic ended, And it seems it's become so politicized, and I think it actually fueled a lot of people politically. And you know, there's this lack of trust in science. There's so many, so many things that are a part of this. But what do you make of it?
So I'll stick to diagnostics because that's the industry that I was. I will tell you that the rollout and the COVID vaccine was remarkable in terms of the number of lives that were saved, and I give there's a lot of people that deserve credits for that. I do think Pfizer and the CEO of Pfizer had an extraordinary role in being able to move the COVID vaccine as quick as they did, and the ability to the administration of the Trump administration at the time to actually roll it out. Now, having said that, on the diagnostic side, as I sit here today, if God forbid there's a bird flu outbreak or any other I will tell you unfortunately we're still very very ill prepared for another pandemic. On the diagnostics side, it continues to be an issue relative can we scale and test millions of people a day? And that discussion still really hasn't happened.
But why do you think you know, I've done interviews about pandemic preparedness and this it's been ever thus. You know, before the COVID outbreak, we weren't prepared. A lot of people said, well, we've learned a lot and next time will be better prepared. But it doesn't ever seem to get traction. This idea of gearing up for the possible.
It's like you said, it's probably you know, all political or politicized. At this point. I can't tell you why. I just know that having been through it and seeing you know, what we do or don't have, now, we're not really ready for another pandemic. On the diagnostic side.
A lot of people I think complain about school closings, right, and I always think, well, what if a bunch of kids had died? Right? And that science is an art and that people learn, as you said, where intuition goes to die, people were learning in real time about how this virus behaved.
Well, we were not only learning, but then every time, as I said that, we thought then you had delta, then you had omicron, and then we moved from testing. Remember the lines people sitting in their cars for hours and hours and hours to sit at a drive through the get tested. And then we moved from filling from testing. And at one point we were doing one hundred thousand tests a day in the lab that had not done one single test in March, and so we scaled for several months to get up to that point. But remember we moved from COVID testing, from swabbing you. Then we moved to testing what it's called point of care, where we would go someplace and they test you and you'd wait for thirty minutes. And then we went to home testing, but you had to send your result in. And then we went to testing where people tested theirselves. So the evolution of the technology alone was extraordinary once we got to where people figured out what they needed. But those changes alone only occurred over maybe six or seven or eight months.
Think about that.
You know, we test everybody one way, and then we wake up say oh, no, no, no, now we have to test people another way. Oh and now we need to test them another way. So we were trying to manage that on a day to day basis and people screaming for the results. Anyway, it was a quite It was an extraordinary personal experience. I could tell you that I that, Yeah, it was for three years.
I was going to say, was it traumatizing in some ways?
No, I don't know.
To me, it was a traumatizing. It was its very in some stance of vigor.
It was.
It was exciting that maybe not the right objective to be in the middle of it, but to be part of it and to help figure it out. It was Again, it was an amazing personal experience and for the team of people had around me, they were unbelievable to be able to pull this off.
Quite honestly, we.
Did a lot of experimentation, guessing, making decisions, good decisions, bad decisions, moving forward, and trying to figure out, you know, what was going to work and what was going to work. I mean, we were literally testing hundreds of thousands of people a week in the test that didn't exist in March of tw twenty twenty.
So you go from being a vascular surgeon to overseeing sort of the diagnostic technology, the evolution of the diagnostic technology for COVID right and implementing it in very high risk situations. Right. I can't think of a higher risk situation than a cruise ship right where there was such a huge outbreak early on in the pandemic. How the hell did you become CEO space?
Yeah, it's cool.
Maybe we should explain what talk space is. Can you help us with that?
So Talkspace says we're publicly traded. We've been around thirteen years, when public about three years ago. So Talkspace right now is a mental health virtual provider. So what you do for talk spaces If you need mental health therapy, you go online and we have multiple modalities so you can be treated a lot of people get treated by video, live video. It's a live video visit. We are, by the way, a fully hip a compliant healthcare organization. We have six thousand therapists all fifty states across the country. And what happens you get matched with a therapist and the therapists just like you would go to a therapist to get therapy. Mental health service does that online video We also have which I thought was quite amazing when I got there. Talk sayst died mostly original research that you could provide therapy through texting and.
Messaging, right, so it's.
Called asynchronous therapy, and the reason it's a really bad move. So asynchronous therapy means that if you send a message to your therapist at three o'clock in the morning, she or he's not getting back to you probably till nine or ten the next day. So it means that it's not happening to be instantaneously.
That's correct.
So well, that's why it's called asynchronous. So it turns out they did the Toxics in most of the original research on that to prove that you can actually deliver therapy adequately through texting messaging and then move to video from there and we talk about it. You know, I got there a little over two years ago. We made a big toxics at a big pivot to being in network. So most people's insurance now cover therapy through talk Space. That's very important. We have one hundred and sixty five million covered lives soon to be two hundred million covered lives, which means when you're looking for therapy now, good chance you don't have to pay for it, or there's a very small copay or at a pocket charge. That's changed the dynamic dramatically for talk Space because the number one. I talk about this all the time. The number one barrier to getting health care is cost. Right, So now instead of.
Going for therapy, mental health care and mentally.
Yeah right, and in general so general health care, the number one is costs. So now in mental health because of a bunch of other issues we could talk about in terms of accessibility and availability, but affordability, cost has been a big issue. So now if people are looking for therapy, basically the insurance is going.
To cover it.
That's fueled a huge growth in talk space in terms of the number of people accessing. So that's that's what talk space says briefly.
Right now, why did this job appeal to you? And no offense, but why are you qualified?
Yeah?
So it's you've asked the same question you've asked is what most of my close friends have asked me.
Also, like what you know? How in the world is this happening? So I so.
First off, total transp answer. Yes, I during medical school. I think I had a week of psychiatry. So I'm not going to tell you that I have any psychiatric background or out or any qualifications from a you know, physician point of view to be a psychiatrist and I have a chief medical officer at the company. Her job is to be that physician and that leader. So I was when I was at Bioreference, and prior to that, I was actually a senior executive at Quest Diagnostics. I have fairly deep background in digital health, so it was always interested when we built a digital health platform and how you get your medical records and how you get results online. And we built a very interesting digital health product when I was at bioreference to be able to go to your home and draw your bloods and get a digital result back. So we built that platform. There was the chairman of the board that Talkspace met me when I was at bioreference and asked me at the time if I would consider coming on the board. So I joined the board of Talkspace first and then post COVID after leaving by a reference, not sure what I was going to do next, they asked me if I would consider coming off the board and taking on the role of CEO of the company. So that's how I ended up there. So I was on the board and then came off to become CEO, and that's a little over two years ago.
So it appealed to your interest and digital health and I guess making health care more accessible and affordable.
Yeah, So there were a couple of reasons. One is which is we should get into is what we like to say is that mental health time has come. If you had this discussion ten years ago, we couldn't have this discussion ten years ago. Now mental health has become front and center. It's become physical health and mental health, and it's become as important, which it should be as physical health. So one is mental all the time has come, So that was very interesting to me. Two is the market, the total addressable market, meaning the ability to have something that has a big influence and has a very big market is very important because you have if you have a solution but nobody wants it, that's it's not really very great, right, but you have and if you have a solution, which I believe Talkspace had in a market where fifty percent of the people coming to talk space every week are new to therapy.
What percentage fifty? Wow?
So you have this incalculable number of people who want it, who need it, and turns out talk Space has a solution that is scalable, affordable, accessible and available. So that was the so for me, it was a very interesting opportunity. And like I said, I'm not certainly not qualified on the psychiatry part of the mental health part. I think that eventually, as a leader, which you see in a lot of different industries, if you learn how to lead, then you can figure it out if you put good people around you. And that's that is the listen, it's whoever's president of United States, whatever.
Corporation to toe you.
Most people walk into a lot of people walk in those positions with not having industry experience, but they have a leadership experience. And there's a big difference between being a successful person and being a leader, very very very different.
The new year is the time to make plans and set goals, but the only thing you can be certain of is change, good, bad, or in between. A Talkspace therapist can help you get ready for what's next, whether you have big ambitions for twenty twenty five or are simply trying to stay the course. Through video sessions and messaging therapy, a licensed talkspace therapist will help you build your resilience and discover opportunities for growth. Talkspace is in network major insurers and most covered members have a copay of fifteen dollars or less, or you can take eighty five dollars off your first month with the promo code Katie. When you go to talkspace dot com slash Katiecuric Match with the Licensed Therapist today at talkspace dot com slash Katiecuric. What do you think makes a good leader? I'm just curious because I feel like there's a real dearth of leaders or I think a lot of people look around and say, where are all the incredible leaders in our society?
So part of that is that, without getting too political, is the reason the reason most people don't run for office as a leader is because of the quote blood sport, that the that the news and the presses nobody wants to put their family and everybody else through what most people have to go through if you're going to run for office.
But it's also the oppa research. Just to defend the press for a second, Yes, a lot of it is coming from whoever is running against you, right right.
There's no question the oppositie your research is the and so that to me is one of the bigges things. So to back the issues of you know, leadership, So I you know I do talk about it during the COVID crisis, and the book is there. There are a bunch of different attributes that make a person effective leader, and there's a lot of people talk about it the son without any particular order.
You know.
First off is to me, it's very important that you listen to your in a voice. I tell people I call it the little man sitting on your shoulder, and as a physician assurgeon, you need to listen to your your gut instincts and what your brain is telling you and not ignore the obvious. Now that may seem like, Okay, well that doesn't sound very important, but a lot of people don't. A lot of people don't listen to their to their in a voice. So that's the one. Second is you need to be able to communicate effectively, both internal communications and external communications. No particular third I bes mentioned you got to surround yourself with great people because you can't do everything. And unless you have great people around you who you really trust, you know incredibly important.
You need to read.
I know it's a sort of that you need to read, and not just about your industry, but I would tell you an enormous number of ideas that come to us or through me is because I read about something that is totally unrelated to what I'm doing and saying, wow, maybe that applies to what we're doing. So becoming knowledgeable reading I think walking the walks very important. Mean you have to be out there. You can't be an armchair surgeon or an armchair leader. You have to be out there and you know, you know, during COVID, I remember going to visit the cruise line industry. I've never been on a cruise of my life, and I was I'm just not going to I'm very i get very very seasick. But I went and I walked the ship to figure out how are we going to get people tested before they got on the ship. Just to give an example. So you need to walk the walk and really understand what the dynamics are in the field to be able to help lead effectively a bunch of people. I think staying in touch with people's extraordinary important. I will tell you our ability to test different places when we tested for or New York State, when we tested for New York City, when we did the majority of testing for a lot of fifteen in the counties in New Jersey. It was all because of different people that had met during my life that was able to pick up the phone or they picked up the phone to call me and say listen, can you help?
So those are.
I think taking risk is important or feeling comfortable taking risks. Covid is we made a huge amount of decisions during uncertainty. You have to just get comfortable and you got to make a mistake. So those are just some of the things that make an effective leader during a crisis.
Anyway, let's talk about mental health and the stigma that used to surround it. Why is there less of a stigma surrounding mental health today than there was ten years ago? To your point, Well.
First of if you look at either gen Z or millennials, they're so out there talking to people and comfortable discussing their feelings. They grew up in a very different environment than I grew up, and there are still cultural stigma issues. There are definite issues with certain sub segments of the population that just will never talk about it. However, the the the idea that the younger generations feel much more comfortable now, maybe because it's also because of the phones and cell phones, and they used to communicating and they're used to talking to people all the time, but it's very, very different. In addition, people are aware now and they're willing to discuss.
It.
So you know, we may talk about, well, what's happening with seniors, and now talking about seniors and loneliness and isolation. I'll give you a great example when if you remember Deamar Hamlin, he was when I had cardiac arrests during the football team. Remember we're a football game. What was fascinating is, you know, fortunately he did incredibly well and they got him off the field and you know he's back. But the day after that, I will never forget it was I think it was un CNN. One of the player reps, you know, the guys who lead part of the players unions, got up there and said, guys, man up, you need to go talk to people about this. You guys can't just keep your feelings internal. You need to go out there and see somebody talk about it. That never would happen ten years ago that someone would sit on broadcast TV and say to guys like, guys, you got to figure out how to deal.
With your emotions. So that the idea that it's out there is very important. I don't know if you know so.
Our brand ambassador for talk space has been Michael Phelps.
Yes, I know Michael.
So he's been.
Amazed, he still is. He's been amazing. And his journey, his mental journey, actually helped put talkspace on the map when he agreed to talk about his mental journey and he became a big part of talkspace and still is talking about his journey.
It was October of twenty fourteen that I lost all hope. I was one of the world's most successful athletes, eighteen gold medals, all American dream come true.
I was lost.
I hadn't left my room in five days. I questioned whether I wanted to be alive anymore. I realized that I'm the strongest person I know, but at that moment, I was the weakest. I realized I couldn't handle this by myself. That's when I decided to seek help and work with a therapist. That decision saved my life. You don't have to wait for it to get that bad. Please talk to a licensed therapist as soon as you feel you need help, brought to you by talk Space Therapy for all.
So, I think it's people are now willing to talk about it, and actually it's no longer a stigma to get help.
I think you're right, people are talking about it more, and I think there's just a greater understanding, as you said, about the importance of that mental health is as important as physical health.
Right, I mean I.
Would have to talk. I think everybody has should have a primary care phosian. Actually, I believe everybody should have a therapist. I think everybody should have somebody that they could talk to. It would be really helpful.
Let's talk about the accessibility, because I know there aren't enough therapists out there, or at least that's what I've read, especially in rural communities, especially in some underserved communities, and I think there is still perhaps more of a stigma and underserved communities. Can you talk about the challenges of providing mental health services to people in those situations?
Sure?
So the availability or accessibility there links. So availability is okay? Is there a therapist actually available to take care of you? The other part of that is are they accessible to you? Can you get to them? It's no good if you have a therapist but you're three hundred miles away and can't get to them. So the talk Space solution has solved that issue because what happens is by doing virtual you don't have to leave your house, you don't have to travel. We make it incredibly easy for you to schedule it. And by the way, if you want to get a therapist to talkspace, we're going to match you with a therapist within twenty four hours and frequently it's several hours. So you could start communicating your therapist within twenty four hours if you match your therapist through talkspace. So that solution has made it very, very easy for people to get help. So I know we may talk about teen Space, which is the program we're running in New York City, but I'll jump ahead to some of the data. So we have almost two we have almost twenty thousand kids between the age of thirteen and seventeen who are on the Talkspace platform. So we have a contract with New York City it's public to provide Talkspace to four hundred and sixty five thousand eligible teenagers between the age of thirteen and seventeen for free for New York City teenagers. So all you need is your zip code and your data birth to sign up. So if you think about it, We've had twenty thousand teens sign up within the first year. I will tell you no question, ninety nine percent of those kids never would have had therapy before.
Right.
The reason is is we've made it one affordable, it's free. It's incredibly successful because they're ninety percent or greater of the kids are accessing it through their phone. So now it happens if you look at we've done the zip code analysis, so where we're reaching, we're reaching into communities of color, underserved, communities that never would have access before because we're meeting kids where they are, which is on their phone. So we've solved the issue. So, whether you live in a rural community, as long as you have internet access, you can get therapy through talk space.
Are you finding it difficult to have enough therapists to treat the need?
So we do not.
We have therapist we have we're continually adding to the platform. Part of the reason is because well, the majority of our therapists are what's called ten ninety nine's a part time. A lot of them are actually stay at home moms or they have a small practice on the side. So let's put aside the video for a second, because video you have to schedule, you know, we like people to do an hour of the first intake and then subsequently maybe shorter periods of time. But at least almost fifty percent of the talk space sessions are still done through texting and messaging. The reason that's important is you have an incredible ability to scale when you're testing and messaging all during the day or in the evening or weekends. So our therapy network flexes to a significant degree. So a lot of therapists may take extra hours a night, they may take extra hours during the weekends. They may say, oh, you know what, a week from now, I'm going to take a bunch of more sessions because I have time availability. So because of the scheduling system is so effective, and because they can make themselves available, we have a lot of ability to flex because they're not they're not just saying okay, I have I could see eight hours of patients. Say I could see eight people or I could see sixteen for half hour. We have therapists who could be texting messaging thirty or forty people at a different time. Because it's so easy in terms of how you message people back and forth and have conversations.
Back and forth.
Now, of course that raises a red flag for me, thinking, Gee, if I were a traditional therapist or I was somebody who wanted therapy, how effective is that? And I know you all have done reams of research on it, but you know talk therapy requires talk or does it?
So it does, but not the butt.
The research is very clear that it's highly highly effective. So we have outcomes measures, we measure quality. May have a huge number of quality metrics is in terms of we measure relative to therapists their ability to deliver therapy inadequately, but we have we have measure in some instances every three weeks how effective the therapy is in terms of how what the outcomes look like.
So we know it works.
It wouldn't and to the credit of the insurance companies, they figured out it works also, which is why they've put us in network because it's become a very it's an important solution for them to be able to provide mental health support as opposed to the standard way that people usually provided.
There was a time where people were too ashamed to put to contact their insurance companies and say, I mean, I've been working for a long time and I think ten years ago people would be worried that their employers would look as scance at them, or they wouldn't have enough privacy, and they would be afraid to actually reach out to their insurance company to cover therapy.
So if you ask any HR executive today or tomorrow, what's their number one issue, it's mental health support for their employees. So they have recognized to a very significant degree how important it is for their employees. And we again have data, so I will tell you it's another extraordinary statistic. The average number of days lost to mental health is twenty eight. Twenty eight days of a year lost to mental health support for employee. So employers know if they support, if they have mental health support, which we do talk space with the large with a significant number of employers. Is it improved, First of all, decreases people are absent, It increases productivity, and it makes the workforce happier. So the impact, it is hard to measure, but it's enormous.
So those days are over when you wouldn't tell your boss or would be afraid.
So we have In addition to I talked about the cover network, we still have a consumer is meeting people who still directly come to us to pay for therapy out of installa of using their insurance. And the reason is is there's still some people who say, I'm not sure who I want to know. I'd rather pay for it out of pocket.
I'd rather just not have people though, So I don't think that's.
Ever going to go away completely. But it's much less than it was years ago, much much less.
So you bring up affordability, how much does it cost or does it depend and how much does insurance cover? And what about people who don't have insurance.
So the average out of pocket cost if you're covered by insurer right now is about fifteen dollars. The majority of people have no out of pocket because we're covered. We're a covering service.
Now you're expanding the Medicare coverage, right, so we.
Just went we were by the well it's December. By the end of this year, we will be in just about every all fifty states. It turns out you have to go state by state for Medicare, even though it's national. So we've made a big effort to cover Medicare, you know, elderly adults, and that will launch really January first of twenty twenty five. The reason being, of course, is twenty five percent of people over the age of sixty five have a diagnosable mental health condition, which is usually loneliness and slash depression. Almost forty percent of people feel socially isolated, So we know that it is a very significant issue relative to the older population. So we've launched into medicare. There people have standard medicare as you may know, where you get eighty percent covered and then you have other insurance, or people are in Medicare advantage programs where there's no out of pocket.
Is that a fast growing population for you all? Because again, those are people. I mean, I'm going to be sixty eight in January, good lord, and I think that's still a population that might feel less comfortable with therapy or talking about their problems. Right. So the I'm not by the way, so I.
Wouldn't say the jury's out. The jury hasn't even been seen. Meaning we're just getting into medicare. We believe that it's we know it's an enormous need. So we have a whole plan to roll this out in terms of how do we tell people about it, how do we get them comfortable with it? So there's been some questions raised about, well, you know, our seniors going to use it. So my view is, like the teens, is we need to spend a lot of time educating people and telling them about what they can do. We also have to spend time with their caregivers, which frequently is their children who are taking care of their parents and getting them come. Frequently it's the children of the seniors that actually want the support more than the seniors want the support because they're dealing, you know, they're in between, they're dealing with their kids and then they're dealing with their parents. So we're about to launch. We'll see how we believe it will be successful. We know that the need is very high. There's been some question about well we'll seniors use the technology. My view we talked about earlier. If you're a grandparent, ask any grandparent, they know how to get on to their phones, they know how to talk to their grandchildren, and they know how to FaceTime them. So I think the technology piece is not of much concern to us. We do have the data on people use the technology from if you're sixty five to seventy eight at seventy eighty, so there is a fall off after eighty years old in terms of certain abilities. But we do encourage people when they sign up and use it to find somebody to help them.
And that's going to change as population ages, because people are becoming more proficient on their phone and that's not going to change right as they get older. You're now focused on the military population as well. Why and how.
So Military there's ten million military and dependents. We just got into network with the coverage of the military, which is you know, it's called tricaren Try West, So that's also just being launched. The suicide rate, as you as you mentioned earlier, is high in the military. The amount of you know, PTSD is obviously very high. It's a little bit different for active military versus independence. We are very early on, but we know that there's a significant interest in the military spouses and children of active military that are looking for mental support. So that's a that's also a work in progress, just launched.
If you want to get smarter every morning with a breakdown of the news and fascinating takes on health and wellness and pop culture, sign up for our daily newsletter, Wake Up Call by going to Katiecuric dot com. Let's talk about the youth mental health crisis. It's something that I've been very interested in and it's super concerning, as you well know. I mean, you look at some of the statistics. Teen mental health had already begun worsening prior to the pandemic. By twenty twenty one, more than forty percent of high schoolers reported feeling persistently sad or hopeless, and experts expect the trend to continue. What is eating the nation's children.
It is a crisis, an unparallel crisis. And you probably see the Surgeon General report about social media.
Fiction and also Jonathan Height's book The Anxious Generation. And yes, you know, it's so funny. When I was at CBS in the early two thousands, I wanted to do something on phone addiction, and they all thought I was crazy, But you know, I thought it was tearing apart families, that people weren't spending time together, that it was taking over people's lives. Anyway, that's me patting myself on the back for being prescient. But yes, it feels like we have reached a tipping point finally in understanding the negative impact of phone addiction.
So you mentioned some of the data we know that twenty to twenty five percent of teenagers on intake have had suicidal ideation. It's which blows me away. I remember seeing the data for the first time. It's just unbelievable to me to think that that's what's happening. So I don't, so why is why is the crisis? You know here at the phone issue is unquestionably, you know, propelling a lot of this, the social media addiction. So I don't know if you've you know, I've talked about, but the average number of hours a teenager is on their phone is eight eight hours a day right on their phone. And of course it's not just the it's not just the social media that they're looking at. It's the dangers, right, So you talk about suicide right being aware, it's of course the inappropriate content, it's the cyper bullying, it's the issues about being recruited to do something really bad.
And then just old fashioned self esteem issues right where you see people living their best life on social media and it makes you feel bad about yourself, or with girls and eating disorders, and.
Then there's so the social media adiction is obviously a huge issue. So it's real, so't I don't predict that you're going to be able to get kids off their phone. I will tell you that having seen this, read about it, see what's going on. I think I told you I have a seven and a half and a four and a half year old grandchildren. Terror it's terrifying to me about you know, what are you know what's my daughter?
And it's a looging to do about, you know, phones with these kids.
Well, I think people who have kids that age are starting to realize how dangerous they are. And you know, by the way, so I have a grandson too, who just turned eight months, and I was thinking, when Ellie is with him, if she's on her phone, she's modeling a certain behavior. So it's not just not giving kids phones until they're fifteen or sixteen. It's not having them as such an ubiquitous force in their lives, right.
And it's just so it is difficult. We're not going to totally solve that. So so it talks to us. We've leaned in on teens, as I said, So we have the We talked about New York City, We just announced Seattle another fifty five thousand students. We have Baltimore, and then we have a bunch of other private schools in other districts. So the one of the so what's become very important of us is because we're actually using their phone to some benefit, which is texting the messaging therapy.
You know. We found that it's you know.
Very very important and attractive for the student to be able to access it, and so most of them are accessing it actually after school just you know, after four pm. Turns out after four pm on Thursdays is the most popular time. But what's also important is we in twenty nineteen talks based reported on a large language model AI slash ability to actually predict suicide based on a conversation.
That's so fascinating to me. How can you in simple terms, how that works.
So what it is is we looked at all of the millions of conversations and was able to identify with kids at risk certain words and phrases in the context of the conversation that will alert the therapist of possible self harm for the for that person and now teenager because we've revalidated in teens. So it's so let me it's let me describe it this way because his way is debscribed to me, because I you know I knew nothing about this, certainly several you know, several months ago.
Is some of the things we do is what's.
Called bag of words. So here here's the context. If I say to you, look at these four words, and I'm going to say a crib, a rattle, a doll, and you know, uh, another toy. That's obvious and those words all belong together, right. But if I said to you a rattle, a crib, a diaper, and a knife, say well, like okay, something's wrong. That's a simplistic way of what's called bag of words. So what the what the engine does It looks at the conversation and it is able to actually pick out words and phrases. Is that are key to determining whether or not a person is thinking about self harm. It's unbelievably fascinating. Now it doesn't mean, it doesn't mean yeah. So it's eighty six percent accurate, and we've actually dialed it to be more false positive because what you want to do is is have more false positives. Obviously, so we reported this back in twenty nineteen. Since we report So what happens when you're on a texting messaging platform on talkspace the engine is running in the background, and what it does is it sends an alert to the therapist and then the therapist decides whether it's real or not real.
That's scary and big responsibility, isn't it.
Well, it's like other healthcare alerts.
It's it's like having telling your primary care physician, Oh, you know, Katie just had her blood's drawn. Her potassium is six. We want to make sure that you've seen that because that's really dangerous. So there are a lot of alerts that go on in medicine. So what this is and there may be a reason for it. So the therapis then has a discretion Okay, this is real or it's not real, and then has to decide how to has it, deal with it, or refer the patient to a higher level of care. So since twenty nineteen, we've had it's over thirty two thousand alerts on the.
Platform that people are risk of self harm.
Right.
We're running it, of course with the teens, and you know, we've had alerts that we've been able to intervene on. It's a proprietary algorithm. We don't think anybody else has it. We are also looking at alerts right now for harm, both homicidal tendencies. We're also looking at eating disorders. We're also looking at abuse. So what we're doing is using the engine.
Abuse someone who is being abused being abused.
Yes, yes, there is more than you want to.
Know about domestic violence.
It means basic violence referrals we've had to make to child's protective services. Yeah, it's more than.
You want to know.
What we're doing is we're trying to we're finding it right. So the power What you want to do is give the therapists the ability to make decisions. What we don't do, which I'm a huge believer in, is is I'm not going to tell a therapist how.
To give care.
What I'm going to do is give them the alerts and let them decide. And we don't just you know, we don't do AI bots or anything like that. We will not do AI therapy.
So this is a.
Support MESA are some people doing, yes, yeah, there are some.
There are some some people out there who are doing AI supporting.
Like chap GPT stuff.
Yes, yes, so that's what we're doing on the teen side.
The UH and so you said you've had thirty two.
Thousand alerts since twenty nineteen.
Is there any way to quantify how many suicides you've intervened in or potential suicides?
So that's an amaz amazing question and the answer is no, because we don't really know. We're again HIPPOC compliant. People could leave therapy. We don't know where that we can. We can't follow up and say, hey, what happened to this person, So we don't know the answer. We've tried, actually we've tried to use some surrogate analysis, but we've been unable to, you know, to determine whether or not how many people have gone on.
What about the effectiveness of working with these teens in the New York City public schools? You say you're going to do another program in Seattle, right, is there any way of knowing the efficacy of talks based therapy for these kids? How do you measure if it's working and what kind of feedback have you gotten?
So the program for New York City is for all teenagers who live in New York. It's not just public schools. So whether it's parochial schools or yeshivas or charter schools, any kid thirteen to seventeen has access. And that was the decision. That's the mayor decided that when he did the program was that's how he wanted it. He wanted to make it available to everybody.
So we do have one year into the New York City program. We have one year data.
We've had almost seventy percent improvement in terms of clinical outcome. I think I talked about we're reaching kids where they are, which is in all you know, all sorts of communities. What's interesting is the top diagnoses or problem is actually being a better self. Second is relationships, and then it drops off to anxiety slash depression, bullying relatively low, which was a surprise to us. But the relationship thing and being a better self is really important. And we had done a bunch of focus groups before we launched, and it was very clear the kids, I say, they want access, they wanted immediately, and they wanted you know, almost whenever.
They could get it. So we've basically solved that issue.
When you say relationship.
My relationships with family or relationship with friends, they'll say, I have an issue with a friend, I have an issue with my parents, I have an issue with so help me talk me, you know, the therapist, help me get through that. Do I how do I deal with those kind of familial problems or other problems that they have. The the being a better self just means they want to be better at who they are, they want to be more self aware.
It's really a full fascinating it is area, and I think you're right as a physician. If you see a need and you have the capacity to fill it, that must be incredibly gratifying.
No, it's it's a I'll tell yes, love of everything else, we're doing good, that we're doing a lot of good, which makes you know, all of us feel really good about what we're doing every day.
How do you increase awareness that this is out there? And like, let's say I'm like, oh, I really enjoyed talking to doctor Cohen. I want to be a part of talk space. I want I don't have a therapist. Actually I don't have a therapist, and you know, I want to find a therapist. Do I go to an app? To what do I do?
So there's multiple ways that essentially you go on to talkspace dot com. For the teens, it's actually it's New York City teen Space.
What about other teens across the nation? Is it available to them? Or not yet, so.
It is if it is to their to their parents' insurance. So the difference is.
You have to go be hard because sometimes you don't want to go on and tell their parents.
Well, that's another interesting issues parental consent. We do get parental consent through the process. It's all part of the digital intake. We send an email to the parents, they mail us back their consent. There are exceptions that you cannot have to get parents consent. There is certain kids who are, you know, by the court, deemed independent. There are kids that are married, they're kids that have children, and then they are just kids that will come on and say I don't want to tell my parents, and then what happens. They have a conversation with the therapist and then the therapists will make the ultimate decision with the child about whether or not they're at risk and whether.
They should tell their parents.
So we have an entire consenting mechanism that's built in, so that's an important part of it. But most teens, if you get it through one of the programs. The reason it's so important that there's a program that pays for it is because you don't want to have a teenager to say, okay, well what's your parents insurance? Go get their insurance card, fill out the information. As we said earlier, the number one barrier we know is cost or having to identify costs. So sure every teenager across the country has access, but those other teenagers have to go through their insurance, which is a barrier.
It's always a barrier.
And I can't believe you don't have a shortage of therapists. I mean, I know you talk about the flex schedule and everything, but I mean I've heard for a long time that it's just there aren't enough there therapists for all the patients out there.
Yeah.
We then they're unfortunately referred to as ghost networks. So you've probably heard the term. No, okay, so there's a term. It's called ghost networks for the payers, which means if you try and get a therapist frequently, if you find somebody and you check the not taking new patients, or it's a three month wait to get it right.
Yes, so how do you combat that?
Right now?
For us, it's not potission and we do know that quod Hotly, the therapists mostly like being on the talkspace platform. We made it very easy for them. They don't, they just have to come on in New therapy, we do all the billing and collection and our step and we educate them and we provide a network for them. We provide you know, other people for them to talk for us. So it's not it's not just that they're coming on talkspace, but they're they're becoming part of a very large community that helps them, you know, be better at what they do.
Also, I always tell young people to go into therapy. Talk about a growth industry, right, don't go into media. Become a therapist.
Sounds right, It sounds about right. So, but yes, we are always recruiting.
Do you do group therapy?
No, we do peer to peer, which is it's not really group, but it's peer to peer support. We also have launched and we don't do we don't really do coaching, right, So would.
You ever get into group therapy which is very effective.
We we've talked about it, and like I like to talk about I like to stay in our lane. What I mean by that is there's so much need for what we have right now. I want to continue to focus the company on what we do best, which is what we're doing right now.
Do you have anyone who specializes, say in cognitive behavioral therapy.
Yeah, no, no, all the basically every therapist does. Yeah, because that's how they're their license. Remember all our all of our therapists are licensed. You know, they're fully licensed to deliver therapy in the state that they're in and each state has different rules and ranks.
Have you tried talk space?
I have, yes, So.
I think that's kind of a personal question. You don't have to necessarily answer that. What I mean, I would think, as the CEO, you would want to test your product.
Yeah, so what I've done it actually twice to test the product and see what the therapists do and to try the intake. But yes, I've tried. I've taken it to a certain point. But beyond that, it would be difficult for me to have one of my own therapists obviously take.
Care of me.
And by the way, I mean talk about a need the medical community, I mean we saw during COVID the amount of burnout among medical professionals, nurses and doctors and people who work in hospitals was so high, so many people left the profession. Is that a population you're kind of reaching out to?
So, right, at the beginning when I first got there, talks I said, had done actually not only delivering therapy to healthcare workers. Did a study he was six hundred plus healthcare workers, thirty five percent of them were new to therapy, described an enormous need, you know, watching what.
Was going on.
By the way, can I just interject one thing, John, I thought during COVID that hospitals could have done a much better job of providing mental health support. I mean, I know, everybody's hair was on fire. And I'm not being critical. I just think that was a huge vacuum at the time.
So we did, we were providing it. We saw fifty I think it was fifty percent improvement within four weeks.
Wow.
And there were a lot of healthcare workers who were texting and messaging the therapist and getting online to be able to you know, help them through. It was an enormously, as you said, difficult time for healthcare providers. I mean we were, because I'm here, you know, we were at almost ground zero for COVID in the Northeast at the beginning.
I remember, yeah, me too.
Is there anything you'd say to people who are still reticent about getting mental health care or the word therapy kind of still freaks them out a bit.
I think it's the message is to try it. It's very easy, it's very affordable. Is to try it and see if it makes a difference in your life. I would say to parents to encourage their kids if there's an issue and there's still a stigma in certain populations for parents who don't want to talk about this with their kids, and I would encourage parents to also have their kids sign up.
That's one interesting thing that I've learned recently that I think a lot of parents, with the number of kids who have suicidal ideation, I think for so long parents felt like they shouldn't talk about it or bring it up. But my understanding is that it's okay to say to a child, do you feel like harming yourself? Do you think about hurting yourself? That that's okay. We don't have to necessarily talk about this because you're not a therapist. But I'm just curious what you're understanding is.
I certainly would encourage it one hundred percent. I mean, I think any conversation is good. Yeah, there's yes, there's a kids it's just never talking to their parents.
Also, you're afraid you're going to put the idea in their head.
Yeah, well, let me tell you if you don't, they have plenty of access where that's going to go in their head. I mean the amount of unfortunately on the social media stuff, whether whatever platform you're on, not criticizing any particular platform, there's all of these things out there relative to putting thoughts in the kids' heads that you don't want them. And that's again why the whole issue right now is about how you regulate social media, how you know what's appropriate, how do you prevent it, how do you alert kids.
It's an enormous problem.
You know, it's the General said, it's the greatest sorts of children lives is social media.
It's greater than cigarettes smoking right now.
And I'm happy to hear so many schools are starting to say no phones during school hours. I'm taking them away, Tally.
I couldn't agree with you more. We've had the discussion. They say, well, you're providing therapy on your phone. You have an issues, said absolutely not take the phones away, you know during school hours, one hundred percent. You know they could get therapy after hours. They don't need to have their phone, you know during school it's a huge issue.
Doctor John Cohen aka John, Yes, I can call you that. Thank you so much for being on Next Question.
My pleasure.
Thank you for the privilege actually, and it really is a privilege and honor to sit here and talk to you about this and to get the word out.
So thank you for doing this.
Actually, yeah, thanks for listening everyone. If you have a question for me, a subject you want us to cover, or you want to share your thoughts about how you navigate this crazy world, reach out send me a DM on Instagram. I would love to hear from you. Next Question is a production of iHeartMedia and Katie Couric Media. The executive producers are Me, Katie Kuric, and Courtney Ltz. Our supervising producer is Ryan Martz, and our producers are Adriana Fazzio and Meredith Barnes. Julian Weller composed our theme music. For more information about today's episode, or to sign up for my newsletter, wake Up Call, go to the description in the podcast app or visit us at Katiecuric dot com. You can also find me on Instagram and all my social media channels. For more podcasts from iHeartRadio, visit the iHeartRadio, app, Apple podcasts, or wherever you listen to your favorite shows. The new year is the time to make plans and set goals, but the only thing you can be certain of is change, good, bad, or in between. A talkspace therapist can help you get ready for what's next. Whether you have big ambitions for twenty twenty five or are simply trying to stay the course. Through video sessions and messaging therapy, a licensed talkspace therapist will help you build your resilience and discover opportunities for growth. Talkspace is in network major insurers, and most covered members have a copay of fifteen dollars or less, or you can take eighty five dollars off your first month with the promo code Katie when you go to talkspace dot com slash Katiecuric. Match with the licensed therapist today at talkspace dot com slash Katiecuric
