Today, we talk with Alice Zhang and Nisha Desai, co-founders of Anise Health. Anise is a culturally responsive digital mental health and well-being platform dedicated to meeting the unique needs of communities of color. For now, it’s focused on Asian American folks.
This is our first episode of the 2022 season of the John E. Martin Mental Healthcare Podcast. But more than that, it’s a homecoming of sorts. We first met Alice and Nisha in 2021 when they were business school students competing in the John E. Martin Mental Healthcare Challenge case competition. Today, we find them working on one of the greatest challenges of our day. I hope you’re excited to join us in learning more about their success and what motivated them to embark on this journey.
On grounding philosophies
[4:28] Anise is really centered on this one concept: that culture matters a lot in mental healthcare. And we’re incorporating culture and intersectionality into evidence-based treatment. Anise is actually the first digital mental health platform that’s dedicated to meeting the needs of the Asian American community.
To start, we offer culturally adapted therapy, coaching, and a self-service tool, which research has shown to be five times more effective than existing one-size-fits-all model. One reason behind that is because modern therapy ignores cultures, despite it playing a critical role in shaping how we experience the world, how we express our emotion, and hence what strategies can effectively resolve our psychological blockers and barriers.
On initial personal experiences with mental health services
[11:11] It didn’t work for me because, no matter how long I spent explaining my upbringing and things that I thought were causing me trouble, I don’t think it really got through to my therapist, Or, the strategies that he was recommending didn’t necessarily work for me. And it wasn’t until I found a therapist who approached therapy with culture in mind that I started to understand myself better from the lens of someone who grew up in this culture.
I cycled through several therapists until I found one that worked for me. And I think for a lot of people, when they’re just starting out, they have no benchmark comparison. So, we’re trying to take that work away from someone who’s already in a place of distress to have to go through multiple trials until they can find someone that can understand them.
On why Anise works
[13:09] Unfamiliarity with verbalizing and expressing feelings is something that is often a barrier for many Asian clients to even start therapy. It’s also often a reason for why they drop out of therapy prematurely. They aren’t able to see the progress, in the early days, that they’re probably hoping for, and it results in mistrust with their provider.
They feel like, ‘if I’m not making progress, like why am I wasting time doing this?’ For the Asian community, where not only is this verbalization that’s an issue, but also: people really want to achieve and they wanna get things done, they wanna be action-oriented. The behavioral coaching integration built into our care model really helps achieve progress quickly.
On dealing with racism
[16:12] There’s some things that are institutionalized, some forms of– whether it’s racism or oppression– that might have deeper structural roots, that aren’t going to change anytime soon.
So perhaps the right approach is accepting a certain situation and learning how to be okay with it in order to move forward.
(Transcripts may contain a few typographical errors due to audio quality during the podcast recording.)
[00:05] Britt: Welcome to the John E. Martin Mental Healthcare Podcast, created in partnership with Google and U.C. Berkeley Haas School of Business. I’m Britt Jensen.
[00:12] Michael: And I’m Michael Martin.
[00:14] Britt: And we are your hosts for today.
[00:16] Michael: I’m thrilled today to be welcoming Alice Zhang and Nisha Desai, co-founders of Anise Health, a culturally responsive digital mental health and wellbeing platform dedicated to meeting the unique needs of communities of color, starting with a focus on Asian-American folk.
Britt, what can I say? I’m excited. Yes, this is our first episode of the 2022 season of the John E. Martin Mental Healthcare Podcast. But more than that, it’s a homecoming of sorts. We are welcoming back Alice and Nisha, whom we first met in 2021 when they were business school students competing in the John E. Martin Mental Healthcare Challenge case competition. Today, we find them working on one of the greatest challenges of our day. I’m excited to learn more about their success today and what motivated them to embark on this journey. So, without further ado, Alice, Nisha, welcome.
[01:04] Nisha: Thank you.
[01:05] Michael: Alice and Nisha, before we dig into your compelling stories and Anise Health, I’d like to pause and ask you to share one thing you’re grateful for today, or perhaps, a few things that you’re grateful for today.
[01:19] Nisha: The first couple of things that come to my mind is, one, my dog. I just got a new puppy this summer. But specifically, what I’m really grateful for is that he’s brought a balance to my life that I’ve really appreciated over the past couple of months, forcing me to take time away from work and to appreciate and be present. In the moments that I’m not working, with him, as well as with my husband, I think that balance has made me also way more productive during the workday and has helped me feel an overall sense of satisfaction with my work-life balance, my overall life. That is definitely an area of gratitude for me.
[02:01] Michael: Excellent. And what is the name of this furry friend?
[02:05] Nisha: His name is Guda.
[02:07] Michael: Alice, what about you?
[02:08] Alice: Hi, Michael. Hi, Britt. Thank you so much for having us on. We’re really excited to be back speaking to you and the team. I do try to make it a habit to practice gratitude. And there are a lot of things I’m grateful for in my life, one of which being just being able to work on Anise Health, day in, day out, as my life work. And I’m really, really grateful for my support system that enabled me to do this hard work, which includes Nisha, my amazing co-founder, my partner who is so supportive of what I do, and the great team that we have at Anise. I think I get a lot of energy from having these good people in my life. And it really propels me to keep going.
[02:55] Michael: That’s fantastic. Thank you for sharing that. One of the things that I want to go and do is find out more about Anise’s mission. Before doing that, I’m really interested in the name itself. Help us understand where that came from.
[03:12] Nisha: Yeah, of course. We actually get this question a lot, and I love explaining the story behind it. So, great question. The name, Anise, is a few different things. First, it’s interestingly a mix of mine and Alice’s names. So, that’s a little interesting treasure hunt. But beyond that, the spice, anise, is actually something that originates from Asia. And its original purpose was for healing and medicinal reasons. So, we felt that it really resonated well with our mission to serve ethnic minorities our mental health platform. And then the last little interesting tidbit that we heard from a mentor was actually that having a company name that’s at the beginning of the alphabet is really helpful for SEO and when you’re at a conference, being at the beginning of the alphabet will get you some additional looks. So, just a little clever trick. But I’d say number two is the main reason, the medicinal healing purposes that originate from Asia.
[04:15] Michael: I like it. Well, I’ll go with the Holy Trinity on that one because each and every one of those was lovely to go into here. In terms of going back to the mission, tell us more about that.
[04:28] Alice: Yeah, Anise really is centered on this one concept or one notion that culture matters a lot in mental healthcare. And we’re incorporating culture and intersectionality into evidence-based treatment. So, Anise is actually the first digital mental health platform that’s dedicated to meeting the needs of the Asian-American community. To start, we offer culturally adapted therapy, coaching, and self-service tool, which research has shown to be five times more effective than existing one-size-fits-all model. And one reason behind that is because modern therapy ignores cultures, despite it being a critical role in shaping how we experience the world, how we express our emotion. And hence, what strategies can effectively resolve our psychological blockers and barriers?
[05:24] Michael: It’s really interesting that you share that. And one of the things I want to go and ask, and I recognize and acknowledge that this is going to go and come off as a bit personal, and I believe that’s part of the intention here, is, what were your lived experiences that ultimately caused you to go and say, “This is a need that’s being underserved?”
[05:44] Nisha: I think we both can share our stories related to that. We have our firsthand experience that really helped us realize how important and how pronounced this need is in communities of color. For me, specifically, I grew up in a traditional South Asian household. What that meant, growing up, was that I was always told… I’m a generally sensitive and emotional person, but whenever I went to my parents with some sort of problem, the go-to response was “just get over it” or “tough it out.” It was generally deemed to be better if you were emotionally tough and didn’t verbalize your feelings.
And so, mental health was not something we ever talked about in my household. And it wasn’t really something we talked about in my community. So, it really wasn’t until I got to college that I really started to notice other people around me experiencing similar things as me. People were actually sharing their feelings, and it was suddenly okay to not always be okay. And though I was never formally diagnosed with depression or anxiety because I was fearful of seeking out care, I did struggle with things, like imposter syndrome when I got to college, self-doubt, some relationship issues that I just had no one to talk through these things with.
And, unfortunately, part of my lived experience was by college, at my undergrad, we had a really broken mental healthcare support system. The counseling services on campus were always overbooked. They were really underfunded. So, the providers that I had access to, just to be frank, weren’t doing a good job. And a lot of my classmates like me were unable to get the help that they needed. And that led to a tragic loss of lives on my campus. There were 14 suicides during my time at my undergrad, and I noticed that almost all of them were people of color. And, more specifically, many of them were Asian-American. So, as you could imagine, this left a really big impact on me. And I’ve, since then, really been dedicating my career to raising the voice around the importance of mental health and, also, de-stigmatizing seeking treatment in our community. It’s something that is so pronounced, not only in the South Asian community and the Asian community, but in all communities of color, where people have gone through similar lived experiences as myself. So, experiencing all of this, and then, also, in a professional setting, seeing some of the formal research and data around how underserved these communities are made me really excited and passionate about working on Anise Health full-time.
[08:37] Michael: Alice, what about yourself?
[08:38] Alice: So, when Nisha and I met as classmates at Harvard Business School, what drew us to each other was our shared passion for mental healthcare. And for Nisha, that’s been from her experience in undergrad. For me, I was first exposed to mental illness in high school through an encounter with a close friend who was suffering from a fairly severe form of mental illness. But due to the stigma that was in his Asian family household, it wasn’t really talked about. And that led him to try to stop treatment whenever he started to feel a little bit better, which causes condition to deteriorate. And there were many ups and downs. And I really saw the devastating impact of untreated mental illness, including potential for loss of life. And at that time, mental health wasn’t even something that was in my 16, 15-year-old vocabulary because it wasn’t talked about in my household. It wasn’t something I was taught in school. And I really learned through firsthand experience that this is a biological clinical condition that has a treatment that you can get better from if you’d seek out the proper care.
So, I actually went into studying neuroscience in undergrad to understand it better. But even for myself, I didn’t actually seek therapy for myself until well in my adulthood. Actually, the first time I sought therapy was when I just started at Harvard Business School. And, all my adult life, like Nisha talked about, I think in our communities, the common push is just they’re taught, don’t show your weakness and just stay the course and push as hard as you can. I think that’s the immigrant mentality as well. But when I got back to school, it was a lot of adjustments—adjustment from work, transiting from work life to being back at school. And I also moved from Japan to the U.S. And at that time, there was a lot going on. So, I’m glad that there was access to mental health services on campus.
But when I started seeing a therapist, my first therapist was a white male. And it was my first time in therapy. So, I didn’t know how to even evaluate if it was working or not. In hindsight, it didn’t work for me because, no matter how long I spent explaining my upbringing and things that I thought were causing me trouble, I don’t think it really got through to my therapist, or the strategies that he was recommending didn’t necessarily work for me. And it wasn’t until I found a therapist who approached therapy with culture in mind that I started to understand myself better from the lens of someone who grew up in this culture.
So, also, from my personal experience, I’ve cycled through several therapists until I found one that worked for me. And I think, for a lot of people, when they’re just starting out, they have no benchmark comparison. So, we’re trying to take that work away from someone who’s already in a place of distress to have to go through multiple trials until they can find someone that can understand them.
[12:20] Britt: What do you guys focus on in your work as elements that make it more specific to that lived experience?
[12:26] Nisha: I’m happy to share a couple of the things that we have learned, and then Alice can add on to anything that I have missed. As you can probably imagine, it’s not a finite list. There is an infinite list of things that each individual goes through and experiences at varying levels. So, what we’re trying to do at Anise is do our clinical research, try to validate some of the experiences that are the most common, and share strategies and tips, guidance, that the therapists can then titrate and iterate based on the individual’s experience.
So, we’re not intending, by any means, to stereotype or pathologize, but just to explain a couple of the things that we’ve seen, what Alice just described of this unfamiliarity of verbalizing and expressing feelings is something that is often a barrier for many Asian clients to even start therapy, or is also often a reason for why they drop out of therapy prematurely. They aren’t able to get or see the progress in the early days that they’re probably hoping for. And as a result, it results in mistrust with their provider. And they feel like, if I’m not making progress, why am I wasting time doing this? So, for the Asian community, where not only is this verbalization an issue, but also, people really want to achieve. And they want to get things done. They want to be action-oriented. This behavioral coaching integration built into our care model really helps achieve progress quickly. And the behavioral code serves as that really direct and action-oriented support system, on top of the therapist, to help that patient start to feel more comfortable in their own skin and to start feeling like they can talk about their emotions and they can make progress. So, that’s one example.
And then, one other thing that I wanted to bring up that we’ve observed in our client base is this topic or this notion that we like to call bicultural tension. And what this really is, is the norms and values between the Eastern culture and the Western majority culture are often at odds with one another. There are vast differences in the way the two cultures view day-to-day life. There’s collectivist society in the East, individualistic society in the West. And oftentimes, clients who are born in the U.S. who are very acculturated to this dominant majority Western culture are left feeling very stressed due to the constant day-to-day competing value sets. And they’re feeling as if their Eastern upbringing is actually detrimental to their progress in a majority Western society.
And so, one thing we really try to focus on in the treatments goal at Anise is, rather than pathologizing the eastern culture or certain behaviors and beliefs that might be stemming from the individual’s minoritized identity, we really try to validate our clients’ backgrounds and help them develop strategies that feel authentic to them, whether that’s blend of both cultures gravitating towards one or the other. And the way we do that is by actually introducing alternate pathways for improving mental health that is not just, okay, change the way you do this because it doesn’t fit into the dominant culture approach. In some cases, change might be the right path, but we also suggest two other pathways, which are accept. There’s some things that are institutionalized, some forms of whether it’s racism or oppression, that might have deeper structural roots that aren’t going to change anytime soon. So, perhaps, the right approach is accepting a certain situation and learning how to be okay with it in order to move forward.
And the third pathway is what we like to call advocate, which in certain instances, we really want to lift up our clients to advocate for themselves and their rights to change the system within which we live to really believe in the virtue of the value behind the minoritized identity that they belong to.
[17:00] Britt: I’m curious if you guys have thought more about, when you’re thinking about equity beyond just financial equity and accessibility and being covered by insurance companies, things like that, are there other equity considerations within the Asian-American community that you’re trying to serve that you’re thinking about?
[17:16] Nisha: One thing we are trying to normalize is we get this question a lot about, even within the Asian culture, there are a lot of wants across all the subcultures that exist. There’s South Asian. There’s East Asian. There’s Southeast Asian. There are differences, even in those subcultures, that we need to acknowledge. So, one thing that we are hyper-cognizant about is not stereotyping, and instead individualizing the chair that we offer on our platform. So, rather than spelling out a protocol that says, if someone comes in with complaints of stress due to family dynamics, like, this is what you should do. Because in Asian culture, obviously, someone is dealing with tiger parenting. We never want to do that.
What we do want to do is train our clinicians to understand the types of questions to ask to dig deeper into understanding someone’s upbringing, to understand someone’s cultural values, their norms. So, we equip them with the right sets of questions. We also equip them with an understanding of what some of the common norms, common values, etc., are, so that in the solutions that they provide to their clients, they can tailor them once they better understand their client to actually meet their specific needs. So, it is not as simple as just saying, “These are the obvious things that Asians would go through. And this is how you treat them.” It’s much more nuanced than that. And part of our training program involves peer consultations for all of our therapists, so they get a chance to discuss, obviously, on an anonymized basis, any cases that come up that are nuanced. So, if a certain therapist who, say, a Vietnamese client and a specific issue that that client comes to not with is very, very nuanced to their upbringing as a Vietnamese individual, they can rely on the help of other therapists and peer consultation sessions to provide input based on pieces they’ve seen or even the therapist’s personal experiences.
This enables us to treat a wide range of individuals who have differences, while also maintaining a scalable provider organization. So, we don’t only have to match our clients to their direct ethnic match from a therapist standpoint. And that’s actually what we’ve seen in literature to work better, rather than ethnic matching, which actually has a pretty low correlation with outcomes. It actually comes down to the cultural adaptation of the interventions themselves and the training of providers to be culturally sensible.
[20:06] Britt: If people are in California, if they’re interested, or elsewhere, where your services are offered, just briefly tell us what services you offer, where they’re offered, in case people are interested in signing up and getting involved.
[20:17] Nisha: Yeah, of course. We just recently, a couple months ago, launched in beta in the California market. And we are currently servicing Asian-identifying adults, as well as their partners or family members who might benefit from understanding how to live with someone who is Asian-American. We only are currently servicing ages 18 and up, but we do have plans in the near future to expand to other markets outside of California. That includes states like New York and Massachusetts. They’re in the work, as well as several other states.
So, for anyone who is interested, we have a couple of recommendations. If you live in California and you meet the eligibility requirements that I outlined earlier, all you have to do to get started is navigate to our website, which is www.anisehealth.co, and you’ll see a button that says “Get started.” Essentially, all you have to do is fill out this super short intake form. And within two business days, we’ll have you matched to a few culturally sensitive providers from our network.
But if you don’t live in California or fit the eligibility requirements that I mentioned earlier, no worries, we are coming for you next. And so, what we really encourage you to do is go to our website and sign up for our distribution list, our email list, in other words. All of our updates will be sent to you, so that you can be the first to know when we are launching in new communities of color or in new markets or expanding the scope of our services to include things beyond therapy, coaching, and self-service tools.
The last thing I’ll say is the way our program works currently is that it’s a subscription program. We have all of our clients pay around $250 a month. And through that subscription, they get access to four sessions and access to all of our digital library content. And we’re really excited about the fact that, despite the lack of insurance coverage right now, the $250 price point comes out to actually in line with most insurance co-pays and is about one-fourth the cost of private practice rates in California. So, we’re doing our best to make sure our services are accessible and they are actually also eligible for HSA and FSA benefits.
So, for anyone who has questions about accessibility, we encourage you to reach out to us at firstname.lastname@example.org. And we’re generally pretty open and flexible to making sure you can get the care you need.
[23:02] Britt: Any career advice for, either, students or just curious professionals who are interested in making an impact on the space?
[23:10] Alice: Come speak to us. If you’re passionate about culturally responsive mental healthcare, we’re always happy to chat. And our team is growing. So, reach out. For me, I work in finance and consulting before business school. So, it was very, very formed to the startup world where I knew most of the innovation was happening. And what I found was the best way to learn more is through doing. So, I would encourage students, if they have a chance, to take an internship somewhere or do an independent… any project during their semester, and get their hands dirty and learn about everything that’s going on, and see for yourself what role fits best for you.
[23:59] Britt: It’s been so inspiring to talk to you guys today. You’re on an incredible journey and, I think, doing really amazing work.
[24:06] Alice: Thank you, Britt.
[24:08] Britt: Thank you so much for joining us today, as we learned about how to improve the access to and quality of mental healthcare. We would like to send a special thanks to our partners, Google and the U.C. Berkeley Haas School of Business. And we would, of course, like to thank Ventures FM for making this podcast come to life. Until next time, take care of yourselves and each other.