#10 Brand in Mental Health: The lever for value creation that we've all been ignoring
plus... the text based CBT provider making moves in the UK, the Nigerian expanding mental health access and all the latest mental health news
Hi friends,
When you think of Mental Health, what is the first brand that comes to your mind?
Over the last few weeks, I’ve been asking everyone this question - it’s OK, my barista already thinks I’m weird.
The answers I received validated my hypothesis.
That there are no dominant brands in Mental Health.
From the dozens of people I asked, hardly any of them mentioned the same brand twice.
Today I want to tell you why that is a problem. But also why it’s a massive opportunity for organisations building in this space.
We dive into the role of brand in mental health and why it might just be the most powerful lever for create impact and value, that we’ve all been ignoring.
This week in The Hemingway Report;
- Brand: The lever for value creation that we've all been ignoring
- Company Spotlight on ieso health: the text based CBT provider making moves in the UK
- A pre-seed round for a Nigerian mental health tech business
- Plus all the latest news in mental health innovation
Brand: The lever for value creation that we've all been ignoring
Go to your app store right now and search for “anxiety relief”. You’re going to see something like this.
What do you notice?
Now imagine you are someone struggling with anxiety looking to choose one of these apps to help deal with your symptoms.
How would you do that? Maybe, you’ve heard of Calm before. But what about the rest of them? They all look identical. Which ones can you trust? Which ones do you think will actually work? And which do you think are made by some app farm in the Philippines trying to make a quick buck?
It’s incredibly hard to make that choice. And one of the reasons is that none of these companies have brands.
I mean, I guess you could choose an app, google it, search for its research papers, read them and evaluate the quality of their evidence. You could look up their leadership team and learn about their backgrounds, find out if they have good clinical oversight and a track record of doing right by patients. Then you could repeat this for every single app, making a Google sheet of your findings, a rubric to assess them all, a powerpoint with your findings and finally… you could choose the best app.
Of course, this is not how people make choices.
When you’re shopping for a new pair of running shorts online, there are also hundreds of available companies you could buy from. But some of these shorts are made by companies you recognise and trust.
You know that if you buy a pair of Nike shorts, they’re going to arrive, they’re going to be good quality and they aren’t going to fall apart on your first run.
Why don’t these brands exist in mental health?
Now, If you don’t believe in the importance of brand, come take a walk with me for a second…
Over the years, I’ve worked with plenty of CEOs sceptical of the promise of brand. I think they’re afraid of a flip-flop wearing creative taking millions of their money and throwing it to the wind.
But brand does not mean launching a sexy marketing campaign. It is much, much more than that. And it’s an important strategic lever for organisations, especially in mental health.
After working with these people for years, I’ve learned that what ultimately convinces them to see the importance of brand is to show them how it creates enterprise value for their organisation. And I want to show you the same thing.
How brand creates enterprise value?
I’ve read dozens of books on this topic, but one of the most influential to my thinking has been 7 Powers by Hamilton Hemler - it’s really incredible.
Hamilton has an extremely analytical and scientific approach for showing how brand contributes to enterprise value. And it’s highly relevant to mental health organisations.
When we think of how brand creates enterprise value, we can break it down into two categories, the direct benefits it provides to your organisation and the barriers it creates to new entrants and competitors. With these two things, your business can deliver differentiated returns versus competitors over time, thus increasing your enterprise value.
Now let’s break down those two categories a bit…
The benefits a business gets from having a strong brand is through both uncertainty reduction and affective valence.
Uncertainty reduction
Let’s go back to our app store example. Imagine a world where one of these apps had a brand that you instantly recognised and trusted. The “Nike Shorts” of anxiety apps. Amongst a sea of other products that you have never heard of, you would choose the product from the brand you already know, and more importantly, that you trust.
A brand reduces uncertainty in any choice.
One thing we must consider with choice is that we aren’t just trying to choose the best option, we are also trying to avoid negative experiences.
It’s the reason why we often avoid choosing the oysters on the menu. I mean, they could be great, but if they’re off, that’s a whole world of pain!
A lot of choice is driven by this desire to avoid the tail of negative outcomes. I call this The Zone of Disaster and it’s a huge motivator in any choice. In business, the primary motivator for employees (whether they admit it or not) is simply to not get fired.
Again, brand helps here. When we trust a brand, we trust them to make sure they never give us a severely negative experience. I hate McDonalds. But if I’m stuck in a foreign country and desperately need something to eat late at night, guess where I’m going. One Big Mac and Fries please!
So far, we’ve been looking at choice and brand through the eyes of a mental health patient.
But what about other important stakeholders for your business, like clinicians, or even insurers or government payers.
They are all making decisions regarding your product every day.
Let’s focus on clinicians for a moment. Think how high the barrier is to get a clinician to recommend your product to a patient?
The first responsibility of everyone in healthcare is “do no harm”. So in every clinician’s head, they are asking themselves “how do I know this new product won’t harm my patient?”.
If their levels of awareness and trust in your brand are low, they are not going to feel comfortable recommending your product.
It’s important to recognise, this is different from just having a clinically validated product. Yes, you must have the research and evidence base to support your product’s safety. That’s table stakes. But it takes much more than that for clinicians to actually adopt it. They have to really trust you. What are you doing to build that trust?
Now think of a payer like a large employer or even an insurer. They are making decisions on choosing a company to work with where they inevitably don’t have 100% of the information. This creates uncertainty, So how do they choose? Brand helps massively in uncertain decision making environments. You’ve heard the saying “no-one gets fired for buying IBM”. Who is the IBM of mental healthcare? I would argue one doesn’t exist and that this is a huge opportunity. Is this something you could become?
Affective valence
Because we all work in the field of mental health and psychology, we know just how odd our brain can be sometimes. I was chatting to a Doctor recently about the results of some drug trials in Mental Health. He told me that the placebo affect in these trials was incredibly strong. Patients who were on the control drug, reported significant improvements in their mental health symptoms. Of course, placebo effects are nothing new, but let’s reflect on what that actually means. Patients got better just because they believed they were taking something that would make them better.
The placebo effect is evidence that with all products, it is not just the inherent qualities of the product that give value to the user. There is an additional set of emotional and psychological associations to a product that also deliver value.
Let’s do this thought experiment. Give me two cola drinks - one is a generic brand of cola in a plastic glass. The second is a glass bottle of Coca Cola, beads of condensation dripping down the side. Even if the liquid in both is identical, and they taste identical, I’m going to enjoy the Coca Cola in the glass bottle more. This is because of the emotional associations I have developed with this branded product over many years. It reminds me of holidays, of times with friends, it sends signals of enjoyment and relaxation to my brain.
The engineer in tells me this is bullshit, that we should ignore these benefits as they are not “real”. But that is ludicrous. Of course they are real.
Rory Sutherland talks a lot about this, explaining how brand is not just responsible for making people aware of your products, but that they can actually improve the value that consumers derive from the product itself. I’d recommend listening to him.
This happens in mental health too.
Here’s a perfect example. I used to be an avid Headspace user, meditating for hundreds of days in a row in the app. It was the voice of their founder, Andy Puddicombe that I mediated to each day. And over the years, I built a connection with that voice. That voice brought me peace and gave a sense of security. One day, Andy stopped recording new podcasts and I had to listen to someone else’s voice instead. It wasn’t the same. The meditations themselves were identical, the new voices equally calming and sweet. But the positive valence that had developed between me, Andy and Headspace was now gone. And as a result, I enjoyed the experience a lot less. After a few weeks, I lost my streak…
Brand allows you to add value to your product without actually having to make the product itself better. Consumer goods companies understand this deeply. In that industry, purchasing decisions are driven primarily by affective valence.
Consumers choose products that align with or help to define and communicate their identity. People will pay a lot of money for brands that help them define their identity.
Hemler has a great case study on the diamond industry to prove the power of affective valence in value creation.
He explains how two different companies (a generic jeweller and Tiffany) sell identical diamond rings for massive differences in price. And the crazy thing? When you tell people this, the fact that they can buy the exact same quality diamond for a fraction of the price, they still choose Tiffany. There is value in the fact that the diamond is from Tiffany, even if its the exact same diamond you could get for less than half the price down the street. Over time, this has allowed Tiffany to consistently deliver higher profit margins than other generic diamond jewellers like Blue Nile, which of course, contributes massively to enterprise value.
Brands that build affective valence tend to have higher margins, more loyal customers, and more enduring value as an organisation over time.
I hear some of you screaming “this is healthcare, not diamond retailing!”. But tell me why the theories of uncertainty reduction and affective valence don’t apply to mental healthcare. We should be learning how other industries create value for their customers and adopting it into our strategies - not ignoring them because “that’s not how we do things here“. Creating a commercially successful mental health organisation that delivers real impact to users is a bloody tough challenge - we need all the help we can get!
Brand as a barrier:
There has been an explosion of mental health startups in the last decade. This is a great thing. But it has led to a bunch of competition. If you want your organisation to have enduring value over time, you need to create barriers to competitors coming into your market, stealing your customers or eroding your margin. Brand is very powerful way to do this. Why? Precisely because of how hard it is to create. By definition, any new entrant does not have a brand when they start out. And as we’ll discuss later, it takes a long time to build this brand, so if you have the dominant brand in the industry, it will take years before they are able to even think about competing with you.
Because many of the sub-sectors in mental health still have no dominant brand (which is to some degree a function of the fact that many of these companies have just not been around that long) it is very easy for new entrants to come in and compete. If you can build the dominant brand in your sector, you will create barriers between you and these new entrants, not just this year, but for years to come.
Who’s doing brand well?
Honestly, not many. I’m quite critical of the effort of most mental health businesses to build meaningful brands. It seems very few organisations have taken it as a strategic priority and there’s been a dearth of creativity.
One business who did do a great job of this are actually Headspace. Headspace understood the importance of brand, have invested accordingly and are seeing the benefits as a result.
They invested in partnerships with real stars like John Legend, Raheem Sterling and the La Lakers. They built entire campaigns around these ambassadors that yes, built the awareness of Headspace, but also cemented it as the meditation app of choice for many people (uncertainty reduction) and built affective valence. If Lebron uses this app to prepare for games, you can be damn sure I’m going to feel good about using it as well!
Heasdpace have now pivoted to being primarily a B2B EAP (an industry that is particularly awful at branding) yet still see benefits from their consumer brand efforts. They report having 5-10 times higher engagement than traditional EAPs. Why? Because employees know and like the Headspace brand and are therefore more likely to engage with the service, certainly more than they would with generic EAP they have no emotional connection with.
So how should you be thinking about brand?
I will write a separate post on brand strategy for mental health companies. But when you think about your own organisation’s brand, here’s what needs to be top of mind for you;
- Brand is a lever for enterprise value. This should be clear by now but you must think of brand as a way to create value for your organisation. Whether you like it or not, your company has a brand, it’s up to you how you use it.
- Brand is built through repeatable actions over a very long time period. Think of the strongest brands in the world, most have been around for decades. Like personal reputation, it comes from repeatedly doing what you said you were going to do. Hemler uses this graph to show the benefits of brand over time. The takeaway? This thing takes time and it may be a while until you start to see the results. But when you do, they can be extremely significant. Brand is so much more than a campaign run by your marketing campaign, it is created by literally everything you do. It comes from repeated action that is aligned with your core values, especially during hard times. And brands are built as a function of time. To butcher a quote… The best time to start building your brand was five years ago, the second best time is today.
- You can destroy your brand in minutes. There is a time asymmetry in brand. Although it takes years to build, it can be destroyed in minutes. As Buffet says :"It takes 20 years to build a reputation and five minutes to ruin it”. Just look at what’s happened to Cerebral recently. This is a notice Cerebral had to send to their customers recently. It’s now been shared across social media. Just think about what that has done to the trust people have in that organisation.
But let’s not end on that note.
Brand is an opportunity for everyone in mental health. Brand can help patients with choice though uncertainty reduction. And brands can increase the value patients get from their products due to the affective valence afforded to them.
For organisations, it’s a strategic lever to create long term enterprise value - something that is much needed in this era of mental health innovation.
P.S. as you may have guessed by now, I’m kind of obsessed with brand strategy in mental health. If you’ve got questions, just hit me up.
Company Spotlight: ieso health
- What they do: Online cognitive behavioural therapy (CBT) provider delivering one-on-one therapy sessions through a secure digital platform
- Headquarters: Cambridge, United Kingdom
- Founders: Dr. Andy Blackwell and Dan Clark
ieso provides text-based cognitive behavioural therapy (CBT) through a secure digital platform. Their platform uses natural language processing and AI to enhance the therapeutic process, providing therapists with real-time feedback and support to improve treatment outcomes.
One super interesting this about ieso is their ability to use data to refine their treatment for patients. They’ve been able to collect over 650,000 hours of de-identified therapy data, analyse it and then use those insights to refine and personalise their treatment plans.
Currently, ieso is in the pilot phase of developing a digital therapeutic product. The Digital Programme is app-based and provides support for worry and anxiety management. It blends CBT approaches that have been selected through their dataset of 700,000 hours of delivered therapy. This Digital Programme would be delivered by an AI chatbot.
Their services are available through various healthcare providers and insurance plans, primarily in the UK.
Mental Health News:
- Blueroomcare raises a pre-seed round to improve mental health access in Nigeria (Techpoint.Africa)
- New study shows promise for extended-release ketamine tablets in treatment of treatment-resistant depression. Unfortunately, there was also a suicide of a 65-year-old man in the treatment group. The principal investigator considered this death due to his illness rather than the treatment, however it reminds us of the importance of ensuring safety during trials of this nature. (Nature)
- Spring Health launches a new program focused on addressing patients’ social determinants of health. The new program aims to improve the social conditions that impact a patient’s mental health, including their ability to access food, housing, childcare and other factors. I’m fascinated to see how this goes. (BH Business)
Make it this far? Fair play! Reply to this email and let me know what you thought.
That’s all for this week.
Keep fighting the good fight!
Steve
Founder of The Hemingway Group
P.S. feel free to connect with me on LinkedIn
