It’s been more than five years since the arrival of Covid-19, which has led to the deaths of 1.2 million in the US and 7+ million around the world, according to the WHO.
Readers may also remember another crisis that emerged alongside the pandemic: pediatric mental health.
From March to October 2020, emergency department mental health visits rose about 24% among children ages 5–11 and around 31% among ages 12–17 from the year prior, according to the CDC. Suicide attempts also rose nearly 51% among teenage girls in 2021 compared to 2019, the CDC also reported.
At that time, there weren’t enough providers to meet the increased need, an issue the industry has reckoned with for years leading up to the pandemic. As a result, many young patients ended up waiting hours in the ER to be admitted to inpatient care.
To help address this need for care, several new behavioral health startups popped up during the pandemic. While not all of them made it—like Pear Therapeutics, Mindstrong, and Ahead—others, like InStride Health and Brightline, are still going strong.
“It was very clear that what was in existence at the time was not sufficient to meet the needs of kids and families,” InStride Health co-founder and Chief Medical Officer Mona Potter told Healthcare Brew.
Building the supply
Christine Crawford, associate medical director at the National Alliance on Mental Illness, told us there was a youth mental health crisis before 2020, but the pandemic made it worse.
“The system was already quite fragile—and fragmented—prior to the pandemic,” she said. But due to social distancing practices and a loss of social activities, there was a “worsening of mental health symptoms.”
Naomi Allen co-founded California-based Brightline, which provides in-person and online appointments, in 2019. She already had 10 years of experience in executive leadership for new digital health companies, including Castlight Health and Livongo, helping adults with care navigation and chronic disease management.
But Allen pivoted to pediatric mental health when one of her children was in need.
“We just really struggled as a family to navigate the healthcare system,” she said. “We paid cash for everything. Most of our clinicians were out of network…and we sat on a waitlist for nine months.”
The idea was to establish physical clinics for in-person appointments with therapists and psychiatrists, supplemented with a digital platform for caregivers to help them do everything from scheduling appointments to following along to see how the child was progressing.
Brightline was getting ready to open its first clinic in Q1 2020 when the pandemic hit, so it shifted to online only.
Across the country, another startup—InStride Health—emerged in 2021 for similar reasons. It was built out of McLean Hospital, a psychiatric facility in Massachusetts associated with Mass General Brigham.
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Potter originally thought she would only work in academic medicine for her whole career, where she was developing “cutting-edge” treatments, like the McLean Anxiety Mastery Program (MAMP). This specialized treatment program launched in 2014 to treat kids with severe anxiety and obsessive-compulsive disorder using cognitive behavior therapy and group meetings.
Yet lingering were inquiries from families who needed help for their children but faced a four- to six-month wait list “at all times” due to limited participant capacities in academic medicine.
So Potter took MAMP out of academia and built the fully virtual InStride Health, which allowed her team to negotiate directly with insurance companies and design a technology platform.
Need for speed
That shift to telehealth was one of the pandemic’s long-standing impacts on healthcare. It forced providers to move from in-person to virtual care “in one day,” Potter said, creating a “natural experiment” for her team to collect data and evaluate its effectiveness.
From March to June 2019, only 0.3% of all medical treatments for working-age individuals were conducted via telehealth, but in the first three months of the pandemic in 2020, that portion shot up to 23.6%—a 766% increase, according to a 2022 Kaiser Permanente study.
In October 2020, Brightline also launched a Covid-19 behavioral health indicator, a 30-question survey, to help parents understand the impact of the pandemic on their child’s mental health, Allen said.
“We felt this immense need for moving with speed because we knew we were out in front and that families had a tremendous amount of need,” she said.
Forward thinking
Brightline now has 550 employer customers across six states. It also launched in-person care, with one clinic in Brooklyn and two more under development in Manhattan and Long Island. By next year, Allen said she expects to have eight to 10 additional sites, but did not specify where.
InStride is fully active in 10 states, and Potter said the goal is to expand it to all 50. In 2025, the company enrolled 2,500 new patients.
Both companies also addressed out-of-pocket payment challenges patients previously faced, making sure their services are covered under some commercial plans.
Speaking of challenges, upcoming Trump administration cuts to Medicaid and the national suicide prevention hotline for LGBTQ+ youth are presenting additional hurdles to care, Allen said, as the availability of clinicians has not caught up to the need.
Still, Allen said greater awareness in schools and among the public has made a difference. In 2022, KFF reported that 90% of US residents think there is a mental health crisis in the country.
“If there is any silver lining coming out of Covid, it’s that the child and youth mental health crisis that existed already is certainly much more the national dialogue,” she said.
This is one of the stories of our Quarter Century Project, which highlights the various ways industry has changed over the last 25 years. Check back each month for new pieces in this series and explore our timeline featuring the ongoing series.
