While we take this year’s Pride Month as another chance to reaffirm our fierce support and protection for all types of love, it is also a time to continue to critically examine issues faced by the LGBTQ* community.

Mental Health and Discrimination

Modern sociocultural shifts have allowed for a more expansive understanding of gender and sexuality, as seen in the momentous 2015 landmark decision in which same-sex marriage was ruled legal in all 50 states. More people than ever agree on LGBTQ rights, a trend that appears to hold across political parties and age groups. However, despite increased support, LGBTQ communities are still at a higher risk for depression, anxiety, suicide, substance abuse, and other mental health problems.

LGBTQ individuals are three times more likely to experience a mental health condition than the general population. About 20-30% of LGBT individuals will abuse substances, compared to 9% of the non-LGBT population. 40% of transgender-identifying individuals have attempted suicide in their lifetime, a rate nearly nine times higher than the general attempted suicide rate in the US. In fact, suicide is one of the leading causes of death for LGBTQ youth ranging from 10 to 24 years old. These harrowing statistics point to a need for better understanding the complex barriers the LGBTQ community face with regards to mental health.

Increased Stigma

92% of LGBTQ youth report hearing negative messaging about their identity, predominantly from their school, the Internet, and their peers. Dr. Jeremy W. Luk comments, “We know that LGBQ teens face discrimination because of their sexual orientation. In addition they may experience problems with family acceptance and more frequent bullying from peers.” The combination of self-identity shame and pervasive stigma against mental illness forces LGBTQ folks to fight multiple stigmas simultaneously. In tandem, these stigmas exacerbate isolation and rejection, two factors that greatly influence mental illness.

Fear of Healthcare Systems

Many LGBTQ individuals experience an ongoing sense of distrust, fear of safety, and hesitation of healthcare engagement due to the biases of providers and healthcare systems. A 2015 study reported implicit preferences for heterosexual-identifying patients versus LG-identifying people amongst heterosexual health care providers. About 20% of transgender and gender non-conforming individuals reported facing abusive language by a healthcare professional. Moreover, approximately 8% of LGB, 27% of transgender and gender-nonconforming, and 20% of HIV+ individuals report being denied needed health care outright. These scenarios further the LGBTQ community’s negative sentiments towards healthcare and reduce access for this community. In order to provide effective care, providers and healthcare systems are held responsible for evaluating their possible biases against the LGBTQ community and implementing training programs to combat said biases.

Denial of Civil Rights

Despite improvements in civil and human rights protections for LGBTQ communities, there is still legal vulnerability related to religious exemptions, disrupting LGBTQ safety and wellbeing. Only 19 states explicitly prohibit discrimination based on sexual orientation and gender identity. Meanwhile, in 31 states, it is legal to fire an employee based on their identity as transgender or gay. In 36 states, there are no laws in place to prohibit discrimination against LGBT students. Systems of oppression like these are a key factor contributing to psychological distress and trauma, necessitating a multi-pronged approach to addressing mental health concerns of LGBTQ communities.

Ongoing Effort

Thousands of people fill the streets in the month of June with LGBTQ pride and amongst them are tireless advocates, activists, legislators, and allies. The Trevor Project provides crisis intervention and suicide prevention for LGBTQ+ youth. GLMA, the largest and oldest asociation of LGBTQ healthcare professionals, fights for equality within healthcare settings. Transforming mental health care, The National Queer & Trans Therapists of Color Network advocates for healing justice grounded in social justice and liberation.

Marsha P. Johnson, an activist and drag performer, who battled severe mental illnesses and was one of the vanguards of the Stonewall Riots, once said, “As long as gay people don’t have their rights all across America, there’s no reason for celebration.” Pride has since transformed into not only a moment of rejoicing over LGBTQ identity and resilience, but also a continuation of persevering resistance and commitment to radically improving freedom of access to quality, stigma-free, physical and mental health care for all.

*LGBTQ is used in variations depending on what specific groups of people were included in the research statistics

Six things we’ve learned in Woebot’s 1st year

Our little Woebot is one year old today! On June 6th 2017, we launched with a simple idea: radically accessible mental health. Now we are used by hundreds of thousands of people from 16 to 90 years old, in more than 130 countries. We have ignited significant discussion around human-robot interaction and breaking down barriers to mental health with over 600 pieces of press coverage across the globe. Here’s some things we’ve learned along the way.

1. Everybody has mental health.
Woebot is one small step towards frank discussion around mental health. We all have mental health and we all need to take care of it. We are proud that Woebot has had much broader appeal than we anticipated— currently, Woebot is being used equally across genders and has a surprising appeal across all age groups.

2. Chatbots are not going to replace therapy, but they will exist side-by-side.
The problem with introducing a new service is that people seek to anchor the concept to what they believe is the closest approximation. This is why descriptions like “We’re Uber for X” abound among startups. Woebot is often described as “AI therapy” but this comparison misses the point entirely: the structure of Woebot is completely different—part online learning exercise, part game, and part self-help book— unlike therapy, there is actually very little open ended conversation, and unlike therapy, you can reach out to Woebot for some perspective whenever you like.

3. Woebot is not therapy, but good mental health practice.
Woebot can be there for you around the clock, and in a way that is integrated into your everyday life. In this way he helps you practice good thinking hygiene in the very moments you are likely to need to most. Why is this important? Because even in traditionally delivered CBT, practice between sessions strongly predicts positive outcomes. Woebot is the proverbial tennis ball machine, shooting tennis balls at you to help you practice your swing, but it’s never going to replace the experience of playing the game. Woebot exists alongside more traditional services as part of a broader health ecosystem. At the end of the day, more evidence-based tools is good news for people, as lives become more complex, time becomes more scarce, and access becomes more challenging.

4. Chatbots can reduce the burden of mental illness on a global scale.
Woebot spoke to more people on his first day of launch than a mental health professional could see in a lifetime. In just a few weeks after launch, Woebot was being used by people in more than 130 countries around the world. In just 7 days past launch, Weobot’s iOS app was being used by people in 116 countries. Scale alone doesn’t have impact, but scale combined with demonstrable symptom reduction is a genuine contribution to lowering the burden of illness. It is well understood that we’re going to need to leverage tech in order to meet the increasing demand for services. Even small effect sizes at scale can have significant impact at scale.

Figure 1: Woebot’s Global Reach 7 days after iOS app launch

5. Chatbots are not about AI, they’re about a more human interface.
People know how to converse, and that’s why a well designed chatbot feels very simple to use. In a noisy world, conversation can feel like a personal and simple refuge from the bells and whistles that vie for our attention. Most of Woebot’s conversation is scripted, it is designed to ask you the right questions so you can figure out the answers on your own. The “intelligence” that Woebot has is baked into the conversational scripts that are written by our expert clinicians together with a few well-placed algorithms that work to appropriately classify what people are saying. When the interface is just a conversation, there is nothing about this tech to learn. My mother who is 86-years old has never used a mouse, but she can comfortably text on her phone. This is why this technology works: it is about simplification. Turns out that when we’re upset, we talk about our problems, we don’t swipe or click through them.

6. Companies can and should be built with compassion as their engine, not growth.
We launched Woebot on Facebook at the start of what became the most turbulent time in Facebook’s history. We launched there because our users liked it, and it’s in concert with our values, it is important to meet people where they’re at. We believe in informed consent and transparency, we have published our values and beliefs since the first day Woebot was launched and we think communicating these is more important than ever. In a world where our data can be used to sell us more stuff and our emotions are being weaponized to win elections and polarize our communities, we believe people deserve better, and should demand better. We want Woebot to be better every day.

In the Office & Off the Clock, Mental Health Matters

Everyone Has Mental Health

It would be rare to meet someone who believes that people don’t have medical needs. Or that investing in one’s own physical wellness isn’t a worthy endeavor. Medical and physical needs are obvious priorities. But what about mental health needs?

We all have those too. The National Alliance on Mental Health reports that approximately 1 in 5 (that’s 20%!) of adults in the United States experiences a mental health condition.

People everywhere struggle with untreated or undertreated mental health conditions, and the unfortunate truth is that many employers – across industries – overlook or underestimate the extent of the mental health needs of their employees. When employees feel forced to sideline their mental wellness in the name of workplace productivity, they may be perpetuating the situation.

Being There vs. Your Wellness

Often times, individuals find themselves choosing between their mental wellness and a feeling of obligation to their workplace responsibilities. The United States Department of Health and Human Services notes that approximately 81% percent of lost productivity related to mental health is specifically attributable to presenteeism––aka being there but not really there. Even with “mental health days” becoming more openly discussed and accepted, many employees find themselves grinding through a day at work when they might be better off taking a personal day to rest and recuperate.

Looking to the diagnostic criteria for depressive disorder – difficulty concentrating, difficulty making decisions, persistent fatigue, and anhedonia (loss of interest or pleasure in doing activities one typically enjoys) – offers more insight into how an employer, or employees themselves, could conflate serious mental health symptoms with an “off day” at the office. Each of these symptoms proves a barrier to engaged, efficient, and enthusiastic worker productivity, but more importantly, is a sign of a larger issue that deserves to be addressed. It’s time that all of us start prioritizing mental wellness.

Mental Health: Educate, Encourage, Repeat

Studies have shown that we are better workers when we’re happy. As an employer, offering at minimum, introductory levels of mental health care, such as self-care promotion and wellness programming, are an easy and accessible way to create a pro-mental-health workplace environment. A number of companies have already implemented such programming and resilience support for their employees.

Stanford University offers wellness programming, aptly named WellMD, to their hospital physicians. Unilever took it a step further and launched Wellbeing Zones within their corporate offices. These Zones promote rest, recovery and sleep for employees, and includes spaces dedicated to interpersonal connectivity among colleagues (the Connection Bridge), physical movement like yoga (the Movement Zone), and meditation and sleep (the Quiet Zone). SAS provides weekly farmers markets while Happster leverages the power of peer encouragement via their open channels for positive peer recognition.

Many companies have even more targeted mental wellness programs, working closely with teams to provide education and advice around mental health and the workplace. For example, BetterHelp, and EaseCentral offer telemental health options to their employees, while other companies offer comprehensive employee assistance programs. The HR Company educates employees at the managerial level about how to spot and support employees who may express mental health concerns.

Mental Health Care for a Healthy Career

We need to acknowledge and implement mental health wellness programming whenever and wherever possible, including within the office. Including additional education on understanding and recognizing mental health concerns, as well as acknowledgements of mental health related movements such as Suicide Awareness Month and World Mental Health Day, can also be helpful in showing employees that mental health issues are pervasive, and that if they are struggling, they are not alone, and should feel supported.

While not a cure-all combination, promoting adequate self-care, offering wellness programming, and prioritizing employee resilience can help scaffold employees toward mental health awareness and action, as well as help poise them for workplace productivity. Employers have been doing a better job at encouraging employees and supporting their mental health in recent years, but this is just the beginning. When proactive steps are taken to support mental health, employees have an opportunity to thrive––and employers and organizations may even benefit in turn.

Mental Health Awareness: Past, Present, & Future

Grow the Conversation

In 1949, Mental Health America (MHA) championed the beginning of what has become a nationwide movement towards bettering mental health culture. Throughout the years, MHA has covered a range of topics, 2018’s being Fitness #4Mind4Body, which emphasizes looking at a person holistically, rather than separating physical from mental health. In previous years, MHA had more strategy-based topics like 2008’s Pathways to Wellness, focusing on concrete approaches to bettering wellness.

Notably, celebrities, public figures, and national associations, such as Demi Lovato, Stephen Curry, and the National Basketball Association, have recognized the importance of this mental health messaging. They have joined efforts to destigmatize mental health through their own posts, fundraisers, and outreach. Moreover, during his term, President Barack Obama formally proclaimed May to be National Mental Health Awareness Month, pushing the important conversations surrounding mental health out of doctor’s offices and into the public. Since then, Mental Health Awareness Month continues to raise awareness about all things mental health, consistently pointing to staggering statistics that highlight mental health as a human, rather than just healthcare issue.

From Conversation to Action

Efforts such as Mental Health Awareness Month are instrumental in destigmatizing mental illnesses. However, the conversation surrounding mental health should not and does not stop as May comes to a close. As more and more people become comfortable talking about mental illness, we can begin to shift towards accomplishing concrete goals to bettering mental health care.

For example, what would it look like if companies incorporated employee well-being into definitions of productivity? Could schools redefine student wellness and resilience in order to better support students’ ability to pursue higher education? What if children had role models demonstrating that mental health is not an individual burden, promoting the idea that we should all be looking out for one other?

A few grassroot organizations have started conversations and taken action. Community United Against Violence bolsters and empowers LGBTQ+ communities, replacing cycles of trauma with safety, wellness, and freedom through advocacy based counseling, leadership development, and coalitions against policies that directly harm this demographic. Also on the policy side, Young Minds Advocacy works to improve mental health care systems by directly engaging with communities who are affected by mental health reform while also increasing and improving youth mental health care services in California. They take an intersectional approach, looking at how different identities and experiences can affect mental health, and honing in on the foster care and juvenile justice systems.

The Icarus Project, an organization run by and for those “who experience the world in ways that are often diagnosed as mental illness,” centers their work around how mental health is a social justice issue, hosting workshops and trainings with an anti-oppressive framework at clinics and schools, as well as for health care providers. Emphasizing disability justice and a peer-support model, Project LETS builds peer-led communities of education and advocacy on college campuses, implementing numerous initiatives including a university-based and nationwide Peer Mental Health Advocacy program which offers free, one-on-one, long term mental health support.

Mental Health: Everyday Awareness

When speaking about mental health, it’s important to be aware of the full wellbeing spectrum that ranges from the wide array of mental illnesses that span beyond depression and anxiety to the many wellness practices we can incorporate into our day to day. As we collectively continue to reform how we humans engage with this mental health and wellness culture, we can also be cognizant of the ways in which daily interactions within our communities play a role. Each one of us has the ability to promote mental health practices, and that begins with encouraging ourselves and those around us to prioritize mental health. Whether it’s doing something we love, finishing that last task on a to-do list, or having confiding sessions with people we trust, there is no “right way” to care for ourselves and each other, as long as we are doing it.

Why we need mental health chatbots

Mental healthcare is in crisis. Depression is the leading cause of disability globally, and the cost of mental illness to society has doubled in the last 10 years in every region of the world. Yet, the global median spending on mental health is just 2.8% of government health spending. In the US, 9 million adults report having serious thoughts of suicide in the previous year. Staggeringly, more than 8% of young people in the US report having made a serious suicide attempt in the previous year (Mental Health America, 2015). There are simply not enough mental health professionals to meet this demand.

The truth about good therapy

The popular idea about therapy is that it holds a kind of special magic that can only be delivered by individuals who are highly trained in this mysterious art form. The truth is that modern approaches to mental health revolve around practical information gathering and problem solving.

The best example of this is cognitive behavior therapy (CBT). CBT is probably the most effective approach to depression and anxiety developed to date. Decades of scientific study show its effectiveness for lots of problems ranging from depression and anxiety to sleep. It is also effective across the lifespan being used by children through older adults. CBT is highly structured and practical, and involves a lot of learning, so it lends itself well to being delivered over the internet. Internet-delivered CBT has been shown to be as effective as therapist delivered CBT for both anxiety and depression. Why is this important? Because if something this useful can be delivered using the internet, then it has the capacity to reach the millions of people all over the world who struggle with their mental health.

The challenges of internet delivered CBT

The internet can increase access, in a way that in-person therapy simply cannot. With this kind of global scale, even modest symptom reduction has the potential to be hugely impactful in lowering the overall burden of disease.

So shouldn’t this solve our supply and demand problem? Alas, there are two catches. The first is that internet-delivered CBT is best when there is a trained guide/coach to check in over the phone. While lesser trained health coaches are in more supply than fully trained, doctoral-level therapists, including any human in the loop will always limit its scalability. The second problem is about engagement. Internet-based CBT approaches suffer from poor adherence; said differently, they feel like homework, and are simply not engaging enough to hold people’s interest. This ultimately undermines their efficacy for those who don’t stick the course.

How Woebot overcomes these challenges

Within the larger goal of achieving true scalability, Woebot aims to address both of these problems. As an automated coach, Woebot helps you practice good thinking hygiene, but he’s also just fun to talk to. People find Woebot easier to engage with than other apps because it’s just a conversation. This is not surprising when you consider that humans have been conversing for about 160,000 years, but we’ve only been designing apps for 10. There’s nothing magic about Woebot, he just asks how you’re doing (mood tracking) and teaches you core CBT concepts in these short conversations (online learning).

Woebot knows his place (…as part of a comprehensive mental healthcare ecosystem)

Woebot will never replace therapy or therapists, and it is not trying to. There is no replacement for human connection — but that is not the point here. The point is that there are millions of people around the world that will never see a therapist, despite the fact that doing so could help them immensely. As a system, we need to get smarter with how we deliver service, and offer lower-intensity options to those who can make use of them. We should be helping people avoid the clinician’s office if we can to free up those precious human resources for those dealing with things that need human intervention.

On an individual level, however, there are so many reasons why people find it hard to reach out. We often say that when you are feeling low, “you should talk to someone”. But insisting that this is the only way to get help leaves behind all of those for whom that is not an option. What if it’s 3am? He won’t do the job of a therapist, but in our experience, that’s not what people want or expect from him either.

It’s nowhere near perfect, but it’s a start.

Woebot Labs’ GDPR Compliance Plan

What is GDPR?

The European Union (EU) issued the General Data Protection Regulation (GDPR) in order to improve upon data privacy laws and influence the ways organizations manage data privacy. GDPR policy must be in place by May 25, 2018.

GDPR impacts all organizations located geographically within the EU, as well as those that are located outside of the EU if they collect, store, and/or manage data of EU subjects.

How will Woebot Labs manage GDPR?

Woebot Labs will be compliant with GDPR by May 25, 2018. We will readily communicate our process of readiness to ensure current updates are easily accessible to you.

1) Remaining committed to ensuring and reviewing a reliable data infrastructure.

As a cloud-based company, we have the benefit of many great tools to assist us in protecting your data and running a reliable service. We constantly monitor our infrastructure to ensure it’s quality. We also work hard to stay up to date with the latest best-practices to keep our services running smoothly and securely. We pride ourselves on meeting the higher standards required by laws such as GDPR by applying them to all of our users, worldwide.

2) Ongoing transparency regarding Woebot Labs’ data policies and procedures.

Since the company’s inception, Woebot Labs has been committed to safeguarding user data and their privacy. Woebot Labs will continue to monitor GDPR regulations and will adjust and update compliance planning accordingly and as needed. Updates will be made available on our website.
Encryption: All message data sent to and from Woebot Labs is encrypted. The conversation data in our iOS and Android platforms are also stored encrypted.
Anonymized data: Since the company launched in June 2017, all user data is limited to the minimum amount required for the Service to function. Data is not linked to users in an identifiable way.
Security Infrastructure: We continue to invest in a robust security team which oversees and maintains:
a) the integrity of the data infrastructure
b) clear and compliant privacy policy and consent forms
c) security incident procedures and notifications that meet GDPR requirements
Data Portability: Users are able to request and delete their data. Procedures for requesting data and/or deletion are in place.

More about GDPR.

EU GDPR Compliance Website