The Podcast: Joan Low's HealthTech startup is helping make mental health a priority for everyone every day

January 22, 2024


In this episode, we sit down with Joan Low, Founder and CEO of ThoughtFull, a startup with a unique mental health app that offers end-to-end care through daily bite-sized coaching.

Despite the crowded marketplace, ThoughtFull is gaining traction, especially in the corporate space, recently closing a $4 million funding round led by Temasek.

Joan shares her personal journey and the fragmented and stigmatized mental health care system that inspired her to create ThoughtFull. We also discuss the lack of innovation and capital in mental health compared to other therapeutic areas, Joan’s experience fundraising during challenging economic times, and her passion advocating for female founders to be better represented in the startup and VC space.


Joan Low (00:00)

I think for me, it really hit home when I found out I was pregnant last year. For most women, this is probably one of the most joyful points in your life to realize that you are going to bring a new life into this world. For me, it was actually a very anxiety-inducing one. And the first thing that I thought about was how is this going to affect my fundraise?

Jonathan Nguyen (00:50)

ThoughtFull is a mental health app that offers daily bite-sized coaching anytime, anywhere. It's one of the many players in the mental health app space that depending on which analyst you believe could be worth anywhere between 17 to 30 billion dollars by 2030. Despite that crowded marketplace, ThoughtFull is gaining traction, especially in the corporate space and recently closed the 4 million dollar round led by Temasek. Today, I'm joined remotely by their CEO and founder, Joan Lowe. So, Joan, mental health space, especially for apps, super crowded marketplace, and a lot of people trying to make their mark here. What was kind of your reason for trying to attack this problem?

Joan Low (1:45)

Great question. I think the why has always been very strong. So, building mental health solutions, while I wasn't, I didn't know it would have been a career, was always a calling I would say that's 20 years in the making now. We have been mental health caregivers as a family to a loved one who has been honestly experiencing, I would say, the challenges of mental health. Everything from stigma to the fragmented care to the lack of affordable care that's personalized to what they need. We've been through all of this for the last two decades. Back in the late 90s, early 2000s, mental health was not a hashtag that was trending on any social media for sure. It was something that was honestly quite a black box for us. And so we've gone through this whole firsthand experience of trial and error, trying to find what's right. To be very honest with you, myself, along with millions of other families out there, we're still on this journey. And so looking for mental health solutions was always something that was a part of my life. I'm originally Malaysian. I've spent the last 20 years abroad. Half of it was in North America. The other half was in Hong Kong. I spent a bit of time in France and China in between as well. And throughout this whole time, I was always looking for answers, answers that could potentially solve a very real problem in my own context personally. And I think what really frustrated me after so long was the fact that the innovations were still not there. The capital was in health care, but it was not specifically in mental health. Of all the therapeutic areas, it's probably one of the least developed in the space. And so it was definitely a calling for me to leave the world of finance. I was working in Hong Kong, managing a portfolio of about $1.3 billion. It was a fun time, exhilarating. But I think at some point, a calling to have a greater impact was there, and mental health was a very natural transition for me. And the problem's very real, right? It's not as remote as you might think because the story for our family at least started when this person was a young working professional, just like yourself and myself, really going through the peaks and throws of, I would say, corporate life. And then over time, I think there's always pressure to perform with ever increasing productivity, and there's always life changes as we're going through 20s or 30s and all of that. And I think in an ideal world, the person I loved would have had access to some of this affordable resources in mental health at that time, awareness and education around it, and tools to really help build, I would say, healthier mental models around going through these kind of things in life. And I think it would have even been better and more ideal if, let's say, this person could have done it without fear of consequences of it negatively impacting one's career progression. I think that stigma until today in the corporate world is still very real. Majority of people will not be comfortable sharing with their managers and their up reports that they're burning out or they're going through anxiety and all of that. It's all very real. It's very common, a more common place than we would like. And I think, unfortunately, this ideal world was very far from reality 20 years ago, and it's not that much closer today. And so that's really why ThoughtFull is here. Our vision is really to make mental health a priority for everyone every day. And we are doing that and enabling that really by making mental health care seamless and accessible for them, you know, end to end everything from what they may need preventatively all the way to when they might be going through something and back again. So I think the journey is always a continuum and we're there throughout that journey.

Jonathan Nguyen (6:14)

Why do you think mental health is treated so differently from, you know, something like cancer? When arguably mental health can be equally, if not more debilitating and leading to the same end result, do you have an operating hypothesis of why mental health is traditionally so underfunded?

Joan Low (6:41)

I think at the end of the day, it goes to how it manifests itself. I think with a lot of physical type of conditions, there is a more obvious to the eye kind of manifestation, right? If you've got cancer, you have technology to scan and show you that, hey, there's a growth here. If you have any bone fracture, firstly, the pain will be debilitating and you would externally be showing that you're in pain. And you have physical, I would say, data points for you to actually see that you're going through something. You have the same thing for even your blood work, diabetes, thyroid, all of these things. These are what we call almost chronic illnesses. There are digital and also physical biomarkers for it for you to see it. But I think when it comes to mental health, most of the symptoms are very subtle. They're behavioral. The thoughts that you cannot look into in someone's mind. It is things that may be said that potentially might be only a slight nuanced difference from what they would normally say, but it's changing. All of these kind of things are less obvious in its manifestation. And so as a result, sometimes it is not recognized for what it is sooner rather than later. And I think for that reason, when it comes to investment dollars and to research into development, it's only really in the last five to six decades that work on, you know, just brain science is picking up. And I think it's changing for sure. But there's still a lot more to do for that.

Jonathan Nguyen (8:36)

Yeah, I think you've validated my point of view, so I'm going to agree with you. Good to know we're aligned. OK, so this is this is obviously a hard problem to solve structurally, economically. And, you know, as a as a founder who's just raised funds in this environment, you've got nothing but headwinds so far. And yet I read that in March of this year, you managed to raise a four million round from Temasek. It mustn't have been easy.

Joan Low (9:19)

I would say that everything happens for a reason. You are right in that it's probably one of the worst economic climates that we're in since the 2008 financial crisis, even during the pandemic. And I think it wasn't quite as, I would say, volatile in terms of, you know, the funding environment, the macro environment and just generally sentiment in terms of private investment. Obviously, the challenges were were there. But I think for us, we've always been very steadfast in what we have been building, to be very honest with you since the launch of ThoughtFull Chat, which is our app that provides end-to-end mental health care for individuals. We launched in the height of the pandemic in the middle of 2020. Since then, we've grown from strength to strength. Our vision to build the entire ecosystem for mental health is is still very much in play. We did not have to pivot too much from where we were headed to at the beginning. And I think at the end of the day, regardless of the macro environment, if you know what you're building and the problems you're solving for, then then just continue doing it. And the people who understand what you're doing will essentially come along on that journey. And I think for us, that was, you know, kind of the work we've been doing with Temasek as well, right? It started off with doing a bit of R&D. We are one of the first to actually experiment with, you know, digital wearables to see whether or not we can drive better mental health outcomes by combining objective and subjective data to get a, I guess, fuller picture of an individual. All of these things were things that were basically helping us to solve the big problems in mental health anyway. And so when it came to fundraising, I think for us, it wasn't so much of us, you know, raising to burn more money on trying to get, you know, users and performance marketing and big posters and all of those kind of things. We've always been very, I would say, intentional and thoughtful with how we build, with how we spend. I see what you did there. I know, right? Love it. ThoughtFull branding. But it's always been something that I would say we've been very conscious in building. And so for us, of course, the challenges were there. But I think when you are solving a real problem, you get real traction, you get real revenue. And that's what investors want to fund. It's a company that is building something that can last and that has a very clear road to profitability, yes, that the buzz word right now. Profitability. It's all about profitability at the moment. Yes. This was not the case 10 years ago when quantitative easing was just all over the place. So, yeah, it's a very different environment, though.

Jonathan Nguyen (12:28)

I have a one of the founders I work with very closely. He's been in health for a while. But he said that the reason he's in health is because he's wired for startups. But when you're doing 90 hours a week, whatever it is, to get something off the ground and you look up, you have to have a guiding light that is more than money. But at least when you're doing health, you can look up at 3 a.m. and say that the outcome of what I'm doing is worth something that's more than money.

Joan Low (13:09)

Yeah, absolutely. And one of the most impactful comments that we got, which during one of the toughest times in the environment during the pandemic, really woke us up to the kind of positive impact we were having was when one of our users wrote very simple, just one line, "For the first time, I see myself in the future." That's powerful because that is at least one life changed. And we're really on a mission to do this over and over and over again.

Jonathan Nguyen (13:43)

OK, so we haven't talked a lot about the products. When I say mental health app, there's lots of different directions you can go. Tell us, give us a deep dive on what the app is about and what's unique about the offering.

Joan Low (14:00)

ThoughtFull's vision is really to provide end-to-end mental health care seamlessly for everyone. And we do that through our app, ThoughtFull Chat. So this is where employees or individuals can actually download the app very easily without stigma because they can use a pseudonym should they wish and very discreetly access whatever tools that may suit their needs at that specific time in their mental well-being journey. So for some people who may not actually need to talk to a therapist or a coach yet, no problem. There are self-serve tools for them. We have structured lesson packs around all sorts of different well-being topics. How does the food I'm eating affect my mood? How do I communicate better with my boss or my spouse? All these kind of things are factors that can cause or not cause stress. And so these are things that you can embark on and basically explore on your own time at your own pace. They're all structured and they're all done by our clinically-backed team. In terms of progress tracking tools as well, I think it's one thing to consume care, but the other thing is also to track how it's impacting you. So whether it's mood trackers, thought journals, or even clinical assessments for quantifying at that moment in time, where are my stress and anxiety levels at and how can I work better towards a more optimal state? That's also something that we offer. And for anyone who is ready to engage with a coach, a mental health coach, they can. So our algorithms are proprietary and we essentially find you your best fit mental health professional instantly. So I think one of the biggest issues when it comes to well-being is that there's always a long queue. Firstly, if you do find someone that you want to work with, the appointment times can be anywhere from a couple of weeks to a couple of months. I think the other challenge that some people have is not knowing the difference between a life coach, a counselor, a clinical psychologist, a psychiatrist. Who's the right person for me at this point in time? So that's really how our algorithms will help you to figure who's the best fit for you. And for us, I think it's always meeting you where you're at. So it can be text-based, video, in person, all the way to crisis hotlines. We kind of do the whole gamut when it comes to individual care. And I think we're the first ones to actually pioneer text-based mental health coaching as well. So very different. We turned it on its head actually. Instead of your typical one hour therapy sessions, which not everybody needs, we basically broke it down to daily bite-sized coaching. So text anytime, anywhere and your mental health professional will check in daily, usually within a couple of hours or sooner if you want. And they'll be there every day, Monday to Friday. If you want it to be something a bit more to your schedule, you can also kind of schedule it in with your professional. So yeah, that's really how we deliver end-to-end care.

Jonathan Nguyen (17:18)

Wow. So is this something that Jonathan Nguyen can go to the App Store and sign up to? Or is it mainly a B2B business?

Joan Low (17:27)

So if you are a consumer, you can download it on any of the App Stores, even within mainland China. It is available on Huawei. If, let's say, for example, you are a corporate client. So 90 percent of our business is actually in the corporate sector. We actually deliver end-to-end care for individuals through insurers as well as employers. So we are the first in the region to actually partner with an insurer to make mental health part of the coverage. So I don't know if you're aware, but in places like Australia, the U.S. and Europe, mental well-being is normally covered as part of your either public or private insurance policies. In Asia, this is unfortunately not the case yet. And so we actually embarked on this with our very, very first client who signed us on, AIA, back in 2020. And we embarked on trying to see how we could embed this into insurance coverage. And so today, with the likes of FWD and AIA, we basically have a platform available through your insurance policies and employees, as well as direct individuals for policyholders can actually access our services.

Jonathan Nguyen (18:47)

That's great. That's like, how did you how did you did you have to convince them to do that or, you know, were they already receptive and looking for a partner?

Joan Low (18:57)

I think it was a bit of both. So AIA was actually our very first client for their own employees. This was in the height of the pandemic. And I would say they were probably very progressive and very quick to the ball. And so we were covering their employees for for many years already. And there was great reception to it, not just in terms of utilization, where it was 20 times more than what they normally would have seen with their old mental health resources. But I think they were also seeing clinical outcomes. Right. So stress and anxiety, as well as depression, depressive symptoms were actually seen to be improving amongst the population. And so I think when when you are a believer yourself, it was then a very natural conversation to say, hey, this has been working very well for our employees. How do we make this available to all our other clients, corporate as well as consumer alike? And so that conversation started and we got the central bank's approval and all of that. And so now we're in the market.

Jonathan Nguyen (20:05)

Wow. So do you think there is a confluence of events at the moment that make an app like thoughtful, relevant or is there a confluence of events at the moment in the science and in the technology, perhaps, that's giving you a window to take off? What's going on at the moment there?

Joan Low  (20:35)

You're right. I think it's a lightning in a bottle situation right now. And I'll tell you why by sharing with you how we've seen it evolve over time. So ThoughtFull has actually been working with corporate since before the pandemic. And so it was actually onslaught of the pandemic in 2020 that really accelerated a launch of ThoughtFull Chat as well as our business in the corporate space. I think since the pandemic, what you've seen is a change in mindset where mental health is no longer a luxury for for employees and top talent. It is no longer a luxury for populations in a nation. It is truly a necessity. If you want healthier populations, you have to look at mental health. If you want high performing employees, you have to look at mental health. And you're seeing this, I would say this change manifest in many different areas, right, from a top down approach as well as a bottom up approach. From the top down, you're seeing governments change their stance on mental health in terms of including it into their policies. For example, believe it or not, Philippines was actually one of the first ones to come up with the Mental Health Care Act. They are the ones who actually make it compulsory for all employees to to have access to resources. Even in Singapore, what you're seeing is a move towards, I would say, more preventive care. And this is really where initiatives like Healthier SG, which was just announced, is coming into play. And mental health is really part and parcel of preventive care when it comes to things like that. And I think, you know, apart from government, you're seeing the private sector also acknowledging it and putting real investment dollars into the mental health infrastructure. There's a great push, I would say, away from the more ad hoc type of activities around mental health to really putting long term infrastructure in for their employees. And I think from the bottom up, you're also seeing a change in sentiment, right? I think people are, number one, more aware about how their mental well-being affects their physical well-being, emotional well-being and productivity in their personal and professional lives. I think people are a bit more open about it, as I mentioned. Back then, when I first heard about mental health, you know, 20 years ago, it was not a trending hashtag. It is certainly a trending hashtag now. So I think the tides are changing, and it's really creating a top-down and bottom-up kind of change in sentiment. And I think this is really also coupled and, I would say, accelerated by what you're seeing in the digital and technological innovation. Because back then, I would say it would have been more of a telemedicine type company that's really, you know, HealthTech 101, right? V1 of HealthTech was telemedicine, solving a logistical problem of access by using technology to connect one to the service. I think now what you're seeing in, you know, the next generation of health care innovation is more personalized care, more predictive care. And, you know, I'm not even going to start going into the whole topic of AI and generative AI, because that's a whole podcast on its own. But these things are all coming together at the same time. And it's truly, truly exciting to be in this, because, I mean, we were really at the forefront of these, I would say, changes. And I cannot say with certainty where the next 20 years will be, but I can say it will be very different from where we are now.

Jonathan Nguyen (24:23)

Yes, we're historically very bad on predicting that far ahead for most things, especially with technology. Absolutely. So, you know, how do you think it's a crowded marketplace? You've given your investors enough confidence to throw in more money. What are your high walls, deep moats? What is your innovation solution position that makes you unique and different and have a defendable market?

Joan Low (24:58)

Well, if I was to tell you what's proprietary and what our moats are, then I probably won't be doing our investors justice, neither would our business. That's the secret sauce I'll keep behind the wall. You could tell me that you'd have to kill me. Yes. I'm not going to use that word, but yes. But no, I think at the end of the day, we always go back to the problem that we're trying to solve. And that's truly a health care problem. We're not trying to build a tech company that so happens to be in mental health because it is a rising tide right now. For us, we were very, very aware of the problem before it was a trend back in 2018. when we first started this. It continues to be what we're chipping away at in terms of building solutions to close all the gaps. And so for us, this is why I would say that we have not deviated too much from our original thesis and our vision to really build a better and more improved mental health ecosystem, whereby the payers, the providers, as well as the users can actually have a seamless experience. And to do that, there's a lot of infrastructure building to be done. That in itself, I would say, is a moat because it's a lot of hard work. It is not as easy as throwing millions at performance marketing to drive users and so-called downloads. It is truly covering potholes on a road. And to do that, there's a lot of pieces to pull together. And that's why for us, again, the grand vision is really to make mental health a priority for everyone every day. And we can only do that if we make it seamless for people to access end-to-end care. Because at the end of the day, our journeys are always going to be fluctuating. Our start points, our end points are always going to be different at different points in our lives. And we need that partner to be around with us to essentially be there for our well-being. And that's what we're doing. And we'll continue to do that until it's done.

Jonathan Nguyen (27:07)

So you're standing here now in a relatively privileged position of getting to a point where you have some serious backers now. But did you ever have a moment where you thought, you know what, I don't know if I can pull this off.

Joan Low (27:28)

The most recent story that comes to mind would be the fundraise last year. And this is truly where I would say it has given me a renewed purpose beyond just advocating for mental health. I'm also a very strong advocate for women founders and the underrepresentation that there is on both the founder side as well as the funder side. Just to give you a bit of context setting, in Southeast Asia, startups that were founded solely by women accounted for only 0.6% of capital invested in the region in 2021, at the height of when money was flowing everywhere. In the US, where you have even more venture capital dollars, only 2.4% of this capital were invested into female founded companies. And this is not surprising because if you look at the VC and the investor landscape of all the general partners or the GPs that you have, only 12% of them are women in this region. So when you have the odds stacked against you, I think it is a situation where the underrepresentation will manifest itself in very subtle ways and sometimes subtle and not so subtle ways. And I think for me, it really hit home when I found out I was pregnant last year. For most women, this is probably one of the most joyful points in your life to realize that you are going to bring a new life into this world. For me, it was actually a very anxiety-inducing one. And the first thing that I thought about was how is this going to affect my fundraise? And it's not without reason, right? I have other female founders who have had term sheets given to them, and then when they found out that they were expecting, ghosted them completely, these are stories that you hear in varying forms over and over again. And so I think for me, it was a situation where I realized how much more work we need to do, both on the funder side and the founder side, to normalize the situation, to really advocate and be a voice, a lending voice for all the other women out there who might be going through this very lonely journey as well. I think for me, finding out that I was pregnant, fundraising in a time where no one was looking to fund anything because interest rates were increasing, capital was drying up, taps were getting tighter and tighter around liquidity. I think that was really a situation where I was like, "Oh crap, is this really the best time to be pregnant?" I think the fact that women founders have to go through this, I think, is something that we shouldn't. Things need to change and it can change with time. And I think it's one of those things where I really had to be very careful with who I shared information with, who I approached, and truly find allies in the space. And thankfully, one of the biggest investors in Singapore is a strong ally of the ecosystem in an unbiased way. And I think that is definitely a very good signal for the entire nation in Singapore and hopefully the region as well. And so, it was not without anxiety, it was not without fear, but thankfully there were some allies who continue to support us and me personally on this journey.

Jonathan Nguyen (31:33)

Yeah, it's a very strange thing, isn't it? Because we're recognizing at the moment already that parental leave needs to be longer, it needs to be paid. We recognize it in a corporate setting, but in the startup space, it's still slow to move.

Joan Low (31:51)

Very much so. I think the reality is that in the startup and VC space, there's no regulation, so to speak, right? You're not a big MNC where regulators are there to tell you, "This is how your policies need to be. This is how you're supposed to run things." I think it's a little bit more fluid and as a result, I think there needs to be a bit more momentum in terms of understanding how equal representation can be, how it can be structurally introduced as well as implemented in our very fluid startup VC ecosystem.

Jonathan Nguyen (32:34)

Okay, I've got one last question for you and this is my favorite question. It's often the hardest question to answer because it's so open-ended. So, we've just looked back at where you've come from and now if you turn and look forward at all the money going into the space, all the innovators coming into the space, a diverse range of innovators like yourself. What does the future hold?

Joan Low (33:06)

I think it will be very powerful to see how generative AI can actually, I would say, not replace but enhance the innovations that are already happening in the health care ecosystem. And I think that for me is just another tool in the toolbox. But when it comes to the change that I want to see in the future for mental health, when it comes to well-being or diversity or inclusion, if you think about all these kind of things, it's a state of being. It's not just a categorical topic that we should be talking about. It is an embodiment of how things are and what we do and what we embody. And I think that over time, we really hope to be the pioneers in co-creating what we call #AThoughtFullWorld, right? That's why our URL is ThoughtFullWorld. Our hashtag is #AThoughtFullWorld because we want to create this world where employers, employees, governments, all the parts of the ecosystem, we don't have to specifically talk about it all the time because it should be embodied in how we live. For example, you don't see special topics at work about brushing our teeth, having a shower, doing all these what is now mundane things because it is completely ingrained into our daily habits that we don't even think about it anymore. And in the future, as behavioral, I would say that the behavior of consumers change as the approach to what mental and physical health is, I think at some point, all of these things will be ingrained into our lives that we don't have to advocate for it so ferociously anymore because everybody will be embodying mental well-being. And for us, that's what #AThoughtFullWorld is about.

Jonathan Nguyen (35:10)

Well, definitely from me. I've got all my fingers crossed that you achieved that vision. And it was wonderful to hear the story today, your story, and I hope that we get more female founders and funders talking more broadly about what they're doing and the journey they've been on. So thank you very much for sharing today.

Joan Low (35:39)

Thank you, Jonathan. It's been a pleasure being here.


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