A fika with... April Koh, Co-founder and CEO of Spring Health

It sounds like this entrepreneurial pursuit became part of your purpose, which eventually led you down the mental healthcare route. How did you meet your co-founder, Adam Chekroud? And what got you guys thinking about Spring Health?

I was back on campus to finish school after briefly working in product management, and I knew I was passionate about mental health. I had a habit of reading papers coming out of Yale Psychiatry — I knew it was world-renowned as a department, and I knew there was a lot of innovation there. (Ketamine was actually discovered at Yale as a treatment for depression.) I came across Adam’s paper, which described the first machine learning model proven to outperform the average psychiatrist in matching people to the right treatment. The paper very much resonated with me. I felt like it represented both the future of mental healthcare and the approach that I wanted to take. It introduced a data-driven framework for delivering care, so you could obtain world-class outcomes without the guessing game that is all too common in mental healthcare. 

So I reached out to Adam and asked him for coffee. He literally responded to my email asking why I wanted to meet with him (ha!) I guess I convinced him with my vision because we met up in a coffee shop. We went for a very long walk, where I shared my story and why mental health was so personal to me, as well as what I had done entrepreneurially. We were all technical; we all knew how to build products. So I pitched this idea to Adam to let us use his algorithm, put it online, and start building an MVP around it. We proved our chops by quickly creating a prototype, which wowed him and pulled him in. He started to get excited about his academic research making an impact in the real world, which is, unfortunately, a rare thing in the world of academia… That’s how we got together! 

You mentioned Adam’s paper was in line with your vision. Can you tell us more about what that vision was at the time? What was the problem that you wanted to fix?

There is so much random guessing around mental healthcare today. As a result, there’s a tremendous amount of waste in the system, both in terms of costs and suffering. What if we could slash those costs and suffering, and eliminate the guessing through data and machine learning, which Adam had demonstrated we could do through his paper? We could pinpoint exactly what would work for someone — much more precisely than an average psychiatrist or clinician — so that they wouldn’t have to go through cycles of different things before they found what worked. The original pitch has actually stayed remarkably consistent through our journey.

We started by selling a software solution to large health systems. It was like a clinical decision support tool that would enable PCPs — primary care providers, who prescribe ~80% of antidepressants in the US today — to make better decisions for their patients regarding behavioural health conditions. We had some success there, and I would say there was a sliver of product market fit. But one day, we were pitching a large health system and they were so checked out — they were on their phones, not really paying attention. At the end of the pitch, they said, “You should talk to our HR department, because our physicians and nurses are really burned out and they could use something like your solution.” 

We were surprised, but at that point, we were really hungry for product market fit and we knew that we hadn’t quite gotten there. So we took that meeting with the health systems HR team, and it was the first pitch where people’s eyes lit up, they were leaning in, they were paying attention. That’s the magic that every entrepreneur should look for, when they’re selling to someone. I felt we were onto something so I asked all my investors to put us in front of as many HR leaders as possible. I remember the early pitches, where we knew nothing about HR and nothing about benefits. Employers were so hungry for something better around mental health for their employees that they bought this MVP solution. We moved very quickly from there.

Let’s talk more about the explosive growth you’ve seen. When did you know you’d really plugged into something? And what would you say contributed most to taking off the way you did? 

It really has been explosive. From our first year entering the market, we were 4x, and then we were 6x. We’re going to 6x again this year, at least. So that’s super exciting. It’s also funny, because every year we expect our growth rate to slow down and every year, we grow even faster. 

When we started out, people would always talk about this mythical product-market-fit flywheel that gets to a point where it’s unstoppable and growth just happens aggressively. We put in so much hard work upfront, in the early days, I feel like we willed our product-market-fit into existence. Once the flywheel took off, I felt that click and everything people had said about this mythical flywheel just felt true. I think it’s a combination of amazing timing, all our hard work, and some of the good decisions we made along the way. 

I’m doing the math in my head, 4x6x6, that’s 144x. To experience that in just three years is unreal. How did you manage culture and purpose in your employee base and leadership team?

In the early days, we had a very strong survival mindset. That, coupled with our collective experience as co-founders and managers, contributed to us making a lot of mistakes. When we shifted from a survival mindset to a thriving mindset, we stopped focusing exclusively on having strong top and bottom lines and started prioritising the creation of a fulfilling workplace with a burgeoning culture. I’m proud to say that the culture we have today at Spring Health is really special. 

Hyper growth startups are often really bad environments for mental health. They’re chaotic, they’re incredibly fast-paced, and people often burn out. We’ve been very aware of that, and see it as an opportunity to go against the hyper growth narrative and genuinely live by our mission of delivering mentally healthy workplaces. We’ve been incredibly intentional about making sure people are not overworked, that they’re not burning out. We’ve leaned into more vacation days; we try to be very explicit about where the company is going to minimise confusion and anxiety; we’ve trained our team to give candid feedback with care because one of our values is “candour with care.” Sometimes mental health and hyper growth can feel at odds with each other, but we try our best to keep them — and our employees — in harmony.

The bigger Spring Health gets, the better it is for humanity — it’s not possible to say that about all tech startups, and it’s one of the reasons you guys are so special. Let’s talk about leadership. We’re firm believers that the best leaders are constantly iterating on their styles. How would you describe your leadership style? And what have you learned from your journey, being a young founder out of college? 

Being a young founder is a double-edged sword. I started a company when I was 24, with virtually no management experience. On one hand, it’s positive because you approach everything from a first principles perspective: you question everything, you don’t bring a biased framework or a chip on your shoulder, you’re ready to just build from scratch. On the other hand, you make a lot of mistakes, you stumble along the way. 

I came at it from a naturally humble place; I was hungry for information, for expertise, and I surrounded myself with mentors. Instead of trying to compensate for my age or trying to hide it, instead of letting imposter syndrome get the better of me, I’ve leaned into being as authentic as possible. I’m always upfront with my team, whether that’s investors, my board, or my employees, even when I sometimes don’t have the answer. I share my emotions openly — I’m very effusive about my gratitude and my excitement when something goes really well and I’m candid when it doesn’t. I think that really resonates and builds better connections. 

It certainly does, and I know we’ve always appreciated your straightforwardness when working with you. Thank you so much for your time, April. We look forward to seeing you 4x and 6x for years to come!