About this episode

My guest this week is Ariela Safira, founder and CEO of Real. Real is a mental health care company, building a new therapy model. Real offers a digital membership for $28 a month, which gives members access to a suite of mental health products and services. In addition to the monthly mental checking, it's a pretty remarkable story so make sure to visit join – real.com.

Ariela shares that she started Real because a close friend attempted suicide. In this episode of course we talk about her journey to founding Real but we also talked a lot about what mental health is, and why is the US so Illiterate when it comes to mental health.

In this episode, you'll hear:

  • She shares how the perserverance and influence of her immigrant parents helped shape her curiosity and work ethic
  • How the suicidal attempt of her friend had a lasting impact on her life and her desire to shape the mental health industry
  • How the impact of COVID forced a shift in her launch plans in order to meet the increased demand for services
  • Why the US is so illeterate when it comes to mental health and how we, as a culture, can make real change
  • She shares her own battles with mental health as a founder
  • What success looks like to her

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Episode transcript

Ariela Safira: Hi, I'm Ariela Safira, the founder and CEO of REAL, and this is MY startup story.

  • Every wildfire began with a spark. Every superhero has an origin story. And every single startup has a moment that they point to as their beginning. And every founder has a purpose that drove them in the midst of all obstacles. THAT is The Startup Story. *

[00:29]

James McKinney: Hello everyone and welcome to another episode of The Startup Story. Can you believe it's the beginning of June? Man, this year has flown by. The past couple of months have been power packed with top notch founder interviews, and in case you're just tapping into The Startup Story for the first time, you should definitely queue up last month's episodes because we featured David Barnett, founder of PopSockets, Matt Meeker founder of BarkBox, and we ended the month featuring Christina Stembel founder of Farmgirl Flowers. Like I said, our episode founder lineup has been incredible and June is going to be no different.

In fact, this month we will be featuring Clay Alexander, the founder of Ember. And to hype up the release of his episode this month, Ember is giving away three sets of the Ember Mug 2. For those that are not aware of Ember, Ember is the very first temperature regulating coffee mug, so your coffee hits the perfect temp and holds that perfect temp until the very last sip. You can enter to receive one of these free mugs at thestartupstory.co/ember. And of course, we're going to include a link in the show notes for easy access. But enter before July 9th because we'll be announcing winners the following week.

One last thing before we jump into this week's episode. I want to thank our episode sponsor, Movo On-Demand. The sponsored the entire month of June and it's because of their partnership we were able to produce such amazing episodes for you. Eric Solis is the founder of Movo and has always been a great supporter of entrepreneurs and startups. As a way of expressing our appreciation to Movo and the Movo Team, please make sure to visit movo.cash/app to download their new app. Again, visit movo.cash/app and of course we're going to include a link in the show notes for easy access. But let's support our sponsor so we can keep delivering high value content just for you. Now let's jump in to this week's episode.

My guest this week is Ariela Safira, founder and CEO of REAL. REAL is a mental healthcare company building a new therapy model. REAL offers a digital membership for $28 a month which gives members access to a suite of mental health products and services in addition to monthly mental check-ins. It's a pretty remarkable startup so make sure to visit join-real.com to learn more. I'm excited to bring you this episode because of its focus on mental health. I'm going to fully honest with you, when it comes to mental health my vocabulary is a bit limited, as is much of the United States. In fact, I would venture to say that there are probably people close to us right now that suffer from depression, anxiety, and suicidal thoughts and we would have no idea because we don't know what to look for. Even more so, because we aren't talking about it. In this episode, of course we talk about her journey to founding REAL, but we also talk a lot about what mental health is, why is the US so illiterate when it comes to mental health, and we even talk about how we as a culture need to change if we want to see real systemic improvement in this area. The reality is that this industry and what Ariela wants to accomplish within it is a huge undertaking. But like every single founder journey, we don't just jump right into starting a company. Well, except with Ariela it's almost like she was predestined for this journey.

03:43

Ariela Safira: In some ways yes, maybe many ways. Talk about taking risks, both my parents were immigrants and from other countries. I think moving to a brand new country in your 20s is certainly a bigger risk than I've ever taken in my life, and both my parents did that. Even more so I think because they are from different countries - my mother is Catholic born and raised in Poland, my father is a Yemeni Jew born and raised in Israel - because they came from different places and raised children in a country that was foreign to them both, they really had to be so much more intentional about every decision made. I think so much of entrepreneurship involves being intentional about decisions and thinking of the why behind problem areas in order to bring creative solutions to life.

When I think of being raised, so many parents sort of defer to what they knew was right based on their upbringing, and then they just mimic that for their children, whereas because my parents didn't have any shared practices and the country they raised children in didn't have shared practices to either of them they had to be so much more conscious and intentional about what after school activities would we do, and what schools would we go to, and what would our home look like, and what holidays would we celebrate. I do think that foundation of intentionality is what drove me to be so much more alert and conscious when I first encountered the mental healthcare system and had curiosities about it, and what has made us so creative at REAL when it comes to building solutions to problems.

05:26

James McKinney: I love the immigrant story. We have had so many founders on this show that were either born elsewhere and immigrated here themselves or they were the first generation born US with immigrant parents. But one of the common themes across all the immigrant story threads that have been part of The Startup Story is the importance of education. The entrepreneur, the current day entrepreneur, as a child it wasn't that they were going to be an entrepreneur they were going to be a doctor or a lawyer because the parental push was this is how you make something of yourself is through education. Was that your parents story for you as well?

06:08

Ariela Safira: Part of it, yeah. I think math and science was probably the most important things when it came to academics for us. My older brother is a physicist. I studied math in undergrad. But even more than that my older brother actually said this at his graduation. I think our parents, our mother was very focused and diligent about us knowing math and science, and a lot of math and science. And my father, he was raised in a commune, very fluid and open as it relates to his beliefs in life and his values, and caring about your people more than anything else. I think our mother taught us focus and our father gave us the lightness to know how to change and evolve. I think so often, especially for very intelligent people, panic happens when they're suddenly wrong. It takes a lightness and a nimbleness to be able to pivot in those moments or even have, truly a mental health practice more than it is an intellectual one, being able to in those moments be calm and question what is going wrong, and how can I evolve my thinking. I think whether you're excelling in physics or in building a mental healthcare company you need both that intensity of focus as well as that lightness and nimbleness to evolve and change, and be open to being wrong. You put a Pole and an Israeli kibbutzim together and that's what you get.

07:43

James McKinney: I love it, I love it. So come the end of high school, life has its natural chapters, so coming to the end of high school what did you think you wanted to do? What was the next step for you and what was your plan?

07:55

Ariela Safira: I certainly knew I wanted to go to Stanford. I had gone there for a math competition during my freshman or sophomore year of high school. Like any 15 year old who sees Stanford's campus I was certain that's where I would want to live and be. Outside of that, I don't think I had a consistent idea of what I wanted more than a few years out. I certainly embraced the creative and entrepreneurial culture of Stanford once I got there, but wouldn't have named that I'd be leading a mental healthcare company 10 years later.

08:35

James McKinney: But I mean being surrounded within, just again the culture of Stanford, and I'm assuming you were in probably computer science, computational math, you were probably something to do inside of an engineering discipline. Is that fair to say?

08:52

Ariela Safira: Yeah, I certainly applied check marking that I would study I think math specifically.

08:57

James McKinney: Okay. That's interesting. You say checkmark - what did you end up doing there?

09:02

Ariela Safira: I studied math and CS. So I did academically pursue math intensely and spent a lot of my time working on mental healthcare and creatively researching and ideating on what is the mental healthcare system and how can we improve it.

09:19

James McKinney: Now why was that a focus in college for you? Because again, you're in science and engineering, not exactly where we classify empaths to be. So what happened in college that kind of lead you down that path?

09:37

Ariela Safira: During my freshman year at Stanford a friend of mine had attempted suicide and that was my big eye opener as to what mental healthcare looks like, and I didn't think the system made sense. I obviously wasn't a therapist. I'd like to think I was an empathetic friend, but once I encountered and saw what a rehab looks like, and learned about meds and med distribution as it relates to therapy, I just didn't see logic behind the system. I started exploring it not from the lens of starting a company but rather from a place of curiosity and doubt in the system. I actually got in touch with David Kelley. He's the founder of IDEO, he's also the founder of Stanford's design school. He and I hit it off, and we ended up spending a few years working together while I was at Stanford on how can we redesign the mental healthcare system. I actually left Stanford entirely after my second year. I thought I would drop out to build a mental healthcare company, and after a year David convinced me to come back and would just continue working on mental healthcare until REAL came to be.

10:44

James McKinney: There's a lot of things that happen in our lives where we are curious about or we want to improve, but thoughts and ambitions are one thing, intention and execution is another. Again, I'm going to guess here it was your freshman year so you're probably 18, maybe 19. Mental health obviously being a buzzword of the times when that took place. Well, let's see, you're only 24 or 25 now so six or seven years ago, so it was still very prevalent conversation point. What was it though that drew you to actually take action and want to unpack and understand what went wrong? And maybe more so what went wrong for your friend?

11:37

Ariela Safira: Yeah. I think it was more so certainty that this is wrong than it was a depth in issue itself. One part of the system that I narrow in on is the first time she had ever met the mental healthcare system, the first time she had ever met a mental health clinician, is when she attempted to take her life. It was very clear to me that would never happen in physical care. This idea of imagine if the first time you ever meet a primary care physician is when you had cancer. It wouldn't happen. You would think the system failed you. Similarly, if we saw a child was diagnosed with cancer and told them, "You have a nine month wait list to see a primary care physician," that would be in headlines in the Wall Street Journal, in the New York Times, and yet we have people suffering from clinical depression, from suicidality, and on wait lists to see a clinician for months. I couldn't point to a nice textbook definition for what was the moment. It's not like I picked up a bag of Lay's potato chips and knew this was it, but I do… I think it was just so clear to me and so obvious to me.

Actually what really accelerated the passion was during my sophomore year at Stanford there was a huge uptick in high school suicides in Palo Alto. As you're probably familiar with suicidality is considered contagious, if you will. So it's not so much of a surprise that once one student attempted to take their life or rather took their life, we saw more and more students take their lives. To be honest, I just couldn't believe anyone was continuing to exist and that everyone wasn't stopping what they were doing when they heard 14 year olds were writing obituaries for their friends on a regular basis. At one point we had parents and volunteers not babysitting but watching the train tracks to ensure no student or no child would try to take their life. That to me was like if this isn't a calling for us to stop and change what we're doing, I don't know what is happening. So it really was it almost felt within me this is wrong, something needs to change.

14:02

James McKinney: When you realize it though, you leave Stanford after your sophomore year. What was taking place in your life? Was their traction? What was going on that you said now I'm going to leave and pursue this? You ended up coming back, I get that, but something was circling around in either your brain or there was traction in the startup that you said now I'm going to leave and do XYZ. What was happening in that place and why the draw to leave?

14:29

Ariela Safira: In all fairness, Stanford is obviously a very entrepreneurial school, so I think that I benefited from one having an academic advisor who motivated me to take a leave of absence. I was very encouraged at the university. And two, having multiple friends who did that to start companies. I had friends who were Thiel fellows. During my sophomore year I went to the Thiel Fellowship conference and learned a lot more. Just being in that environment and around so much opportunity, it's hard to not feel that yourself that it's a possibility.

On top of that, I thought it was a waste of time to be at Stanford. I felt there were clear issues that deserved attention and work, and that to be frank I thought most people were wasting their time at Stanford and thinking they were solving problems that they weren't. We were just making up clubs and activities for 19 year olds to do, and I didn't really have the patience for it. I actually first left to bike across America. I think I definitely needed that clear, concise project if you will to call it. Once I was on that, felt the freedom of like I can do this. That was it.

15:44

James McKinney: You know one of the things that you said as you were talking about perceiving Stanford as a waste of time or people thinking they were solving problems but they weren't, I kept going back to your early days, your early story of just about intention and how your parents just continuing to raise you with intention, to not be on a set path but to always be open for what change might come to be so that you can live life intentionally. It's interesting to know that part of your childhood, to see it take place in your college years and your sophomore year. So you leave Stanford. You are passionate about changing the mental health system. Where do you start? In your mind, what was the problem that you were initially trying to solve?

16:35

Ariela Safira: In the beginning it was I need to understand how the system works. Again, it wasn't an I'm starting a company and talking to investors. It was I'm confused, I'm disappointed. So I LinkedIn messaged everyone who worked in mental healthcare whether you were the head of UCSF's inpatient psychiatry facility or the founder of a nonprofit working on suicidality, or working with LGBTQ+ youth and the Trevor project facing suicidality. I really was just contacting everyone who would talk to me, reaching out to anyone who might talk to me to learn what do you do. At the time, I couldn't articulate as eloquently as I might be able to now that I was learning and really in the research phase, to understand who are the stakeholders here, what kind of power do they have.

Eventually it would sculpt into okay I think rehabs are wrong and inpatient mental health facilities are wrong, so let me reach out to and apply to a bunch of grants to financially support interviewing people who work at these rehabs. That includes clinicians just as much as it includes janitors, just as much as it includes the architects who built those spaces. It was really to understand even decisions like something I really spent a long time thinking about is the most consistent point of feedback I had heard clinicians share in these inpatient mental health facilities was that exercise helps your mental health or promotes your mental health. And yet none of these facilities were offering exercise facilities. So even something I had doubled down on or tripled down on, why is that?

Even learning okay well one every bit of square footage costs more money, two equipment costs not a ton of money to purchase because many people had donated equipment in the past, but rather a lot of money to take care of and to clean, et cetera. So what they did face in the past was people were donating things like stationary bikes and various forms of exercise equipment. Because they didn't really have the nursing staff to take care of that equipment it was rusting and going bad. So the facility kind of just gave up on it. What patients were doing as forms of exercise is very literally jogging in place because the also can't go outside on their own. And just really exploring that phenomena. Imagine being in a mental health facility, being told you need to exercise to promote your mental health, and being stripped of any opportunity to exercise.

19:06

James McKinney: Yeah, yeah. An obvious break in the system for sure. So your year of research, again it is safe to assume that full year away from Stanford was in research? You were just gathering a lot of information and data points.

19:20

Ariela Safira: The first three months was biking America, and then research, and also research with I did a lot of work with the Bay Area school students as well who had attempted suicide, doing a lot of interviews.

19:33

James McKinney: Why did you go back to Stanford?

19:35

Ariela Safira: I had an amazing meeting with David Kelly who shared that if I want to make a dent in mental healthcare, people are going to be skeptical enough that I'm not a medical doctor and if I add to that I also don't have my bachelor's degree I am going to be climbing a very intense mountain. And really as you can imagine many people said I should go back to school. What was so unique about David is he really did meet me where I was at and was able to agree yeah, a lot of this is BS and a lot of this is nonsense. And a lot of these degrees don't really say much other than someone paid Stanford for four years to exist here, and had the ability to get in. He really met me where I was at and understood those things, and empowered me to do what I would otherwise do if I dropped out, to do it at Stanford. I remember saying some of these classes that are allegedly required of me, I don't want to take and I don't see any benefit in. He was like, "Don't take them and see what they say."

20:43

James McKinney: I love it. I love it. What great wisdom from someone inside the system. Everything you were saying, I have very similar opinions when it comes to academia versus the real world and execution. But let's talk about it. So obviously we know the catalyst for where you are with REAL, we know your research period you come back to Stanford. Do you begin actually working on REAL in Stanford or you go through those two remaining years at Stanford, get the degree, get it done, continue with contacts and research and wait until you're done to try start moving forward on REAL? What's the timeline there?

21:22

Ariela Safira: I was very much working on mental healthcare. It wasn't REAL at the time, but working on mental healthcare while I was at Stanford. I probably received five to ten grants from the university to continue while I was a student. Touring rehabs, I took classes on the innovation of mental health. Actually one of my professors would later become our chief medical officer, so I very much continued while I was at school.

21:48

James McKinney: So when do you consider… again, you said it wasn't REAL yet. You were really just trying to wrap your head around the system. So being that you are a person of intention, I'm going to make an assumption. Did you not begin working on REAL until you fully defined where is my starting problem which I'm going to address within the mental health system? The reason I'm asking this question, there has to be a starting point somewhere. There are people listening right now that might be wanting to start fixing some massively large problem but they don't know where to start. You I can tell the way your brain works. So I know, let me rephrase that I don't know, I'm going to assume and you can correct me if I'm wrong, that you were able through all your research get to okay, here are all the many problems that there are but we're going to start here and then from here we can then go to here, and then to here, and then to here. Is that how you mapped it out and how you got started?

22:53

Ariela Safira: I'm going to give you an eye roll worthy response, which is REAL started when I was like 8 years old. I think even now, sure what a headline would call our starting day is the day that investors gave millions of dollars to me, and then we called REAL a C Corp and began hiring. But REAL, and at that moment there were four key problem areas we were solving for, but every single day we add to that. Ideally REAL in 10 years looks larger and more evolved, and really what it's pulling from is so much more than even what happened to me my freshman year at Stanford. It's so much of what I learned before that. For what it's worth I even find it almost not entirely authentic to call my origin story what happened freshman year of Stanford because while I think that was clearly the trigger that got me in the mental healthcare system, I'd been very curious about and passion about people, their motives, and what improves mental health far before then, probably in part because of the kind of person my dad is.

Definitely in terms of challenging systems. I can remember a sophomore year of high school class when I started shouting in a lit class, "Who invented the system that we live in and what if the school system itself is what destroys our mental health? Shouldn't we then change the school system?" I don't actually think there's one moment where the pieces came together. I think every day more and more pieces are coming together, and really it's about finding dare I say it product market fit so that it becomes more headline worthy. But it's constantly growing. It's constantly evolving. I couldn't even tell you what it will look like in 10 years.

24:43

James McKinney: We'll definitely get to that question towards the end of the episode. What was your initial problem to solve?


24:51

James McKinney: Okay, hold on. Before Ariela answers that question, I have a question for you. When I say the phrase content marketing what comes to mind? Maybe you hunch your shoulders forward a little bit out of frustration because it feels like a constant chore that never delivers results. Or maybe your internal temperature rises because you've created so much content, but it has never driven the business success that you thought it would. Either way, I am fairly confident that the thought of content marketing is viewed more with disdain than it is excitement. So with that in mind, wouldn't it be helpful to learn proven tactics directly from founders that have executed well in this area? Even more so, would having their tactics delivered to you every quarter be helpful to you as you build your business? That is the exact experience and knowledge sharing that is delivered to you each quarter when you become a Grindology member.

Grindology is an entrepreneurial subscription box that ships every quarter full of resources to help fuel your grind and your hustle. Now you're probably asking what's included in your Grindology shipment. Well first and foremost, every single Grindology shipment will include a copy of the Grindology tactical manual. Every single issue of Grindology will be chock full of real tactics from real business builders, not journalists. Within the pages of the Grindology tactical manual we will be delivering to you tactics and strategies that you can integrate into your business immediately. How great would it be to receive proven tactics on how to leverage existing content that you've created to drive new business and deliver new revenue? Or how about hearing operational tactics used by a founder that saw nearly 400% growth in one year that he directly attributes to his content marketing efforts? Or even better yet, how about hearing tactics from a founder that actually stopped creating curated content and started documenting everything, and saved their business in 2020 because of it? Tell me those founder direct tactics wouldn't be helpful? Well those are the exact types of tactics that will be found in each issue of Grindology. Like I said, real tactics from real business builders.

Our Q2 issue is now available and you can access it at grindology.com. Everything about Grindology is about helping to fuel your grind and your entrepreneurial journey. So visit gridnology.com to learn more. In fact we're going to include a link to grindology.com within our show notes for easy access. Now let's jump back into our episode with Ariela as she was just about to explain the initial problem she was trying to solve when she launched REAL.


27:17

Ariela Safira: When the first round was raised, we were going to build a new mental healthcare system, and we're going to start with a brick and mortar model for 100 reasons. And what we need to ensure in that system is that this is something that is affordable, this is something whose brand results in people engaging with mental healthcare far before rock bottom, and that this is something that is clinically effective. What that manifested in was a brick and mortar studio that would offer a monthly membership as opposed to pay per session, and what that studio would offer is both one on one and group format care that was co-developed by a clinical and experienced design team. That studio was set out to open in April 2020 in Flatiron in New York City. The pandemic hits, it's not able to open, and we've evolved since.

28:15

James McKinney: I assume now your business is… well obviously because of the pandemic purely digital during 2020 for sure, correct?

28:23

Ariela Safira: Yes, purely digital.

28:25

James McKinney: So what is the digital experience? And how did you pivot from the physical in order to prove the demand if you will?

28:33

Ariela Safira: Yeah. So it was late March that we were put in quarantine. We knew the studio was allegedly going to open in two weeks. We were able to predict that's not going to happen. And even more so were able to feel that mental health needs are going to skyrocket during quarantine with people being so isolated, afraid of the pandemic. So we, within eight days, put together what we call REAL To The People and that was a free digital platform that offered therapy in both one on one and group format, all themed according to quarantine and COVID 19. So we had group salons on things like navigating isolation as a single person in quarantine, and juggling parenthood and working from home, and what was unexpected was seeing that everyone preferred group over one on one which was a huge surprise given that a free one on one session is certainly a better deal than a free group session.

On top of that, we saw that most people wanted to join these groups anonymously. When we would follow up with those people to say, "Hey, if you want a more private experience we have one on one available," time and time again people would share, "No I want to be in this group because I want to hear how other people go about this, and I want a therapist to teach me. I want a therapist to teach me what does language use to describe this topic, and what are examples of how other people go about it with the baseline being if you asked me as an individual to walk into a room and talk about my body image for 45 minutes I wouldn't know what to say. I've never been taught how to talk to about my body image, I've really never had role models show me what it means to talk about my body image."

It really inspired this amazing lesson which is we are so behind as compared to our physical health. We are so behind in mental health and we don't have an underlying education to then use that education and understand ourselves. Far before you can be in a one on one setting talking about your body image, you need to know what language can I use to talk about it, what is my relationship with my body, what does it even mean to have a different perception of my stomach versus my thighs, and what is disassociation. All to say the big learning was there's a gap, and there's this gap between I would like to work on myself, understand myself during highs and lows, and I'm ready to do so in front of a stranger in a one on one session. And for many that one on one session will never work. It's never going to be desirable, it's not enticing. It doesn't work for them, doesn't land. And so what we did was built this digital membership powered by various forms to both learn and practice and engage with therapists.

31:21

James McKinney: That is remarkable. I have a quick question though. In your research and in that period where you were collecting a lot of information, was everything US based or did you go from a global perspective?

31:32

Ariela Safira: I also spent some time in Liverpool, England so they have what's considered to the most innovative mental ward in the world. I spent three months there to learn what do they do that's so innovative and how can we bring that with us here. Really their most innovative intervention was being more preventative, and how they did so was or rather is they found that most people who are reaching these in patient mental health facilities were reaching them for… Rather I should say once people reach these inpatient mental health facilities, that was the first time they ever reached a mental health clinician. So similar to what I saw in the US, there was this issue of why is no one reaching any form of clinician until they've attempted to take their own life or attempted to take someone else's life due to mental illness? The solution was we have to meet people earlier. That requires more than waiting for them to reach the hospital, or waiting for them to reach the doctor. We need to come to them.

What they also found is that libraries had become completely empty buildings, perfectly located, very beautiful and expensive buildings that were no longer used because that was 2016, because of tech millennial didn't need them anymore, libraries weren't purposed. So they repurposed libraries to be iPad driven, meets cafe, meets free group therapy classes. The goal being let's bring let's bring this to the community rather than waiting for the community to come to therapy, and offer it in this more free form format where people can learn, could walk in while they're grabbing coffee, while they're on their iPad in the library. When I was there they had just put up their first or maybe second so I didn't get to see what the outcomes looked like, but in so many ways I think that inspired what REAL looks like today in terms of how do we make this more accessible and approachable to someone who isn't at rock bottom in the hospital.

33:32

James McKinney: You know the reason I ask the question about global perspective, it has been interesting over the last I'm going to say 20 episodes or so where I've met with some founders that are really trying to change the very large systems, very complex broken problems or broken systems if you will, complex challenges. The US is behind in a lot of ways. Banking alone, again banking and mental health totally different but we are behind on so many levels from where even Africa in how banking is done. In Africa you can send money via text message and we can't do that here in the states. A lot of it is regulatory and things like that which complicate things as well, but I would assume there's a lot of regulatory things that are going to create hurdles in the mental health space as well. The reason that I was drawn to the global perspective was because you had mentioned body image. And again, body image in Russia is so different than body image here in the states. So that's why I was starting to think I wonder what this is like elsewhere from a mental health perspective. I don't know suicide rates in other countries, I don't know any of those data points, but I agree with you we are behind on so many things. It continues to surprise me when I come across brilliant minds like yourself trying to tackle some complex systems, because I have to believe that there's going to be some regulatory obstacles you're going to come against. To this point, have there been any regulatory things that have created challenges for you?

35:12

Ariela Safira: I'll start by saying sadly mental healthcare systems are pretty poor across the world, but what's so different is that other countries build other systems with mental health in mind and we don't. While the clinical mental healthcare setting looks pretty poor across the board, what's so different is other countries value community so much more deeply. The isolation, lack of community in the US is so often what drives depression and isolation and anxiety. In other places they have such, whether it be come from a place of religion, whether it come from a place of even what school systems look like and how competitiveness manifests differently, they don't have a system that calls upon competitiveness quite like the US system does. All these things together just result in a better community or a country that has better mental health than the US. I also think it's what makes REAL so different than other mental healthcare companies is we're not narrow mindedly thinking about the mental healthcare system. Part of the issue with I think solving problems in the US and certainly healthcare is what we end up doing is we focus on the system today and putting band-aids on that system which is not solving the inherent problem, it's solving the system that maybe never worked.

Two, it's thinking too narrow mindedly in terms of what does it take to improve the actual emotional or human need you're trying to improve. When I think of REAL's future, I often think about the future of REAL is rethinking what are all the systems that might be hurting our mental health, from workplaces to family systems, to relationships. How we treat grief and funeral and loss. In some ways we can add an app or a program that helps you work through those systems, and in other ways we have to change this fricking systems. The workplace in the US destroys mental health, and while we certainly can add care and programs around making it better, a much more efficient solution might be working fewer hours. Or it might be having very different relationships and communication streams and transparency in the workplace in the US rather than the very like power driven environment we've become accustom to.

So all to say when it comes to comparing us to other countries, I think what I learned most didn't necessarily come from comparing the United States doctor's office to France's doctor's office. Instead, it came from the United States, an American, to a French person and saying what are the systems that impacted those individuals? If one of them is more mentally well than the other, why is that and what do we have to change about the other to ensure they're just as mentally well? And that's where I think a lot of countries are ahead of the game compared to the US.

38:07

James McKinney: That's interesting. I want to ask this question that just came to mind, and so it's not well polished or thought out so I might have to work it out with you audibly. If one wants to tackle disease there are very lengthy hurdles and regulations you have to go through. If I had a cure for cancer there are many hoops I would have to jump through in order to cure cancer. But I would also only have to go through those hoops to get it adopted within the medical system for implementation. When it comes to mental health, am I wrong in saying that your having to go straight to the end user and not through a system?

38:58

Ariela Safira: We still have a legal system that we have to work with.

39:00

James McKinney: Of course, of course. Yeah, I wasn't saying it's the Wild West.

39:06

Ariela Safira: We currently are not working with or through providers, though certainly have had conversations with insurers, with employers to talk about what it means to work through those systems, and are being very intentional and conscious about what does that require of us and what constraints does that put on us, and do we want to do that. But in terms of who we're reaching, again still need to follow legalities. We employee licensed clinicians and have suicide protocols in place, et cetera, though we are directly working with consumers as opposed to working through a hospital or insurance system

39:51

James McKinney: Do you think that creates an ease of adoption and therefore cultural change? Or do you think it makes it more challenging because now the adoption is more disparate?

40:04

Ariela Safira: I've never worked in any other system so I don't have anything to compare it to first hand. I think it allows us to be far more human. We talk about human centered design, or user centered design. That becomes much more challenging when the person you're talking to isn't actually the human, it's the hospital system or the insurer. So I think it allows us to be more human and actually capture what do people want and how do their behaviors change or not change through a system rather than being accountable to a businesses or a hospitals metrics.

40:45

James McKinney: One of the things that I find fascinating about American culture is our limited vocabulary, our limited experiences. First and foremost, we're a young country. We are an experiment to some degree. But when you go to other countries that have been around for centuries they have a better and a more thorough understanding of a lot of things. For us in the US, I'm going to over generalize that when we think of mental health we think of suicide, depression, anxiety, the rare but extreme like bipolar, schizophrenia, the things that we have probably heard of throughout our life. Unfortunately it's probably been the butt of jokes within sitcoms and movies of our culture, and therefore we've minimized the significance and importance of these things. But I also think there's probably a lot of people that would have never in a million years put body image in that category as well as you have done earlier within our episode already.

So I guess I'd like to ask you to help reframe and broaden our perspective on mental health as well as what are the things that we are just inundated with as a culture that we may not even be aware is impacting our mental health but truly is? Can you please enlighten us and pull back the veil on this category? Because I think there are a lot of people that again minimize. I'm going to put it out there. We are a culture of entertain media. I think entertainment media has minimized and trivialized so much of this discussion, so I think we need to call a spade a spade and just say here's how broad this is, and here's how saturated and pickled we are by the brine of our culture as to what the problem is with mental health.

42:31

Ariela Safira: When we take ten steps back and ask how does someone work on their mental health, what that means taking ten steps back, step one is having the language to talk about your mental health. That is foundational to work on or understanding any part of us. Something that is lost in today's solutions for mental healthcare is that people have no language for their mental health. Where do we learn language? We learn language in our school systems at a young age. We learn language from our family members, from our peers. Most Americans don't say the word depression until they're at least 16 if not 46. If you ask most people today to define anxiety or define trauma, they wouldn't know how. When you stop and think how does this compare to our physical care, why is it that I'm able to explain what is a broken leg versus a sore leg, it's because starting at a very young age I went to annual physicals so I was introduced to who is a doctor far before I ever got sick. Starting at a very young age, my mother taught me the difference between if my stomach hurts here it means I have a stomachache, if it hurts a little lower it means I need to poop, right, whereas I was never taught the difference between a headache versus anxiety versus depression.

Similarly, throughout our lives we had multiple milestones where we got to learn more about our bodies. We were welcomed to experiment with learning about our bodies. At a young age when I ran and I thought I broke my ankle and I went to the hospital, and they said it's not broken it's just sprained, no one mocked me for that. Today, you have a 13 year old tell you they want to go to the hospital because their mental health is so in pain, they're mocked and they're not in that hospital until they attempt suicide. I got years and years of development and really education in physical health that helped me to get to a place today at 26 years old where I know the difference between a stomach ache and needing to poop. I know the difference between a broken arm and a sprained ankle, whereas most people don't even hear language let alone learn it and digest it and apply it, but most people don't even hear language around depression or anxiety or body image concerns until they've gotten there. What's even more problematic with that is because they've never heard it before, once they reach those very traumatic experiences they assume they're the only ones who have ever gotten there, because no one else has ever said this. They never had role models who shared "I too have faced this."

Far before we're putting bandages on what is depression, what is anxiety, and what is PTSD or bipolar disorder, far before we get there we need to start teaching people what these things are. And not just teach them what they are, but let them learn for themselves how it manifests within them. Today, if two different people share they have depression but they manifest in different ways, I would bet 99% of their peers would think one of them don't have depression. Or maybe both of them don't have depression. We have this very narrow minded perspective on oh well if you're not sleeping in this much and gaining X amount of weight and losing this much hair, you must not be having depression. Whereas from a very young age my family welcomed that when I got fevers my eyes burned. My brothers, when he got fevers his eyes didn't burn. That didn't mean one of us was lying about it or making it up, and it didn't mean one of us didn't have a fever, we welcomed and embraced that illness or concerns in our physical health manifest differently for different people.

But we don't carry that same amount of empathy or really if you ask me intelligence when it comes to mental health. We assume there are very narrow definitions of every illness, and we also don't teach those definitions until someone has reached their absolute rock bottom. Once we get there, we pretty much shame them for it. We look down upon it. We think they failed. It's not that the system failed or that they naturally… they as humans failed, something went wrong that they face depression. And so when it comes to forming a solution, we really need to start with teaching that language and engraining that language in people, and then embracing the fact that those individuals will teach us how that language, those words, those terms manifest differently across people.

46:56

James McKinney: I love it. When it comes to making change, there's the young, let's say high school kids now. High school kids might be more open to having these conversations more openly. They might be more open to leveraging technology or these teledocs and all the things that are out there. Whereas an older generation like myself might be more apprehensive towards it. But nonetheless, I want to be sensitive to my teen and I want to meet them where their needs are. So how do we change the system? Does it start with the younger generation? Or how can us old folk come in and start making changes now? What are some tactics that we can give the listening audience for how to have a higher IQ when it comes to mental health?

47:46

Ariela Safira: I think part of it is starting to learn before anyone has reached rock bottom and putting in the time to understand what are these concepts, and the way you understand that, I'm not saying go on Google and search "what is anxiety." To be clear, a lot of mental health are positive feelings as well. The way to understand that is go and have conversations with your people. The vast majority of Americans, if you ask me, have very shallow conversations 99.999% of the time.

48:15

James McKinney: Yes, yes.

48:16

Ariela Safira: And dinner time conversations amongst most families don't reach a greater depth than "How was work? Fine." And most couples stop having any depth in their relationship after date four if they even had it through date four. We don't know one another, and we don't know ourselves. Really when I say get to know these concepts, it doesn't start on Google, it starts within you.

48:40

James McKinney: I love it.

48:41

Ariela Safira: And take the time yourself to explore who you are as a person, and what makes you tick and why is it that you keep repeating that one experience that happened to you at 14, and why are you so fragile or delicate when someone mentions a certain topic. Similarly, what brings you joy and what makes you happy. When I think of so much of American culture I think of superficiality and a lack of joy, true joy. Not like hell yeah I got likes on my Instagram, but I feel fulfilled and I feel whole, and I'm grounded and a feeling or presence. I think so many Americans are afraid to even be alone. They don't know what presence is. They need friends to go with them to run errands because it's so panic inducing to be alone, and how do we get people to not fear that but to embrace that, and to embrace the bad and the good in hopes that we reach more good in the future, and hopes that we can take on bad experiences in the future better than we did in the past.

49:45

James McKinney: Oh my goodness, you just took us to church, that was so good, so good. Pass the offering plate, ching ching, that was so good. Man, so let me get real with you for a second here because again this is The Startup Story and I preach all the time it's about bringing authenticity and transparency back to entrepreneurship and getting outside these personas that headlines have created of what it means to be an entrepreneur. You are trying to tackle something immense and as a human I have to believe you reached moments in your journey where it was just… you were so overwhelmed with the feat that was ahead of you. So let me ask this question was there ever, has there been a moment in your journey thus far where you just thought to yourself I don't know if I can do this?

50:39

Ariela Safira: Yeah, I think I've really never doubted if I could do it. I've doubted if I want to, and to be frank that has… Exploring all of these problems and being so emotionally attached to how painful these problems are, I have certainly reached my own form of depression, and this feeling of overwhelm, if how awful the system is and how insane it is that not everyone is dropping what they're doing to work on that is. I think my close friends would certainly attest to how frustrated I can get with others who choose to work in systems that aren't helping people, and I get really upset when it comes to that. And I've certainly had times in the past where I've just been so disappointed by where our system has brought us and with how few people are conscious enough to even notice how problematic it is, that I've reached my own form of rock bottom.

It is an isolating, lonely feeling and I think I very much empathize with founders who have faced that sense of isolation it can be. Even if you are motivated or rather even if you are encouraged by others, I've been fortunate to have people who've believed in me in many ways. It's still a little startling to be so alone in these thoughts, especially when you feel so adamantly and certainly that these thoughts are true. All to say yes, absolutely, I've been lost in my own overwhelm, disappointment, and sadness, depression, certainly I faced suicidality, got the works.

52:26

James McKinney: I just love how honest you are about it. So for those that don't have the vocabulary you do, they don't understand the toolbox to navigate some of this, what are some things that have helped you navigate those seasons, and to keep your mental health strong through the challenges you're trying to navigate? And I ask this question because to your point that you've mentioned depression has manifest a certain way with you. That was enlightening to me that depression can look differently across many people. Within my founders, they may not know that they're dealing with something, but there's this constant burden on their shoulders that they don't know how to manage or navigate. For you, if we can just learn from your process and your personal tactics, and your personal exercises what is it you do to keep your mental health strong?

53:22

Ariela Safira: I leave my everyday life. I think that physical distance from the world we've created, and in my case in Brooklyn, is so important. And leaving to be in nature on my own is certainly for I think we call them empaths, it's very hard to not take on the feelings of others and to be guilt tripped into supporting others. For me, that means multiple times a year doing my own getaway in nature. Whether it's a multi day bike trip or backpacking, needing the physical space to really regain perspective and feel grounded in myself. Outside of that, I've now said this in two interviews which I never said before this year, but an activity that is probably my best form of mental health care that is certainly not clinical advice or any form of advice, is I do these death exercises.

What that means is once a month, maybe twice a month I kind of get in… really get in my own thought and truly envision one of my loved ones dying, and I fully imagine the car accident, the hospital trip, being told they've died. Sometimes I'm like saying their funeral speech and as you can imagine I'm very worked up, I'm crying, I'm like living in that feeling. It's something like a 45 to 60 minute activity, sometimes it can be 10 minutes, and I come out at the end… I in that imagine what does is my every day without that person, what's life like without my brother, and truly feel sadness and emptiness, and loss, and I get to end that activity realizing they are still alive.

And so often my loved ones will receive a phone call or a text message from me after that sharing how freaking excited I am that they are here, alive, and that I have them whole. I don't know when those started. I guess I've always been pretty fascinated by death. But they've really been like my driving factor to really reground myself in what matters and to feel so much gratitude for what I do have, regardless of all else happening. So that's a great mental health practice for me. I don't know if it is for everyone.

55:50

James McKinney: That is fascinating. How frequently, so you mentioned the getting to nature a couple times a year. How frequently are you going through those exercises?

55:58

Ariela Safira: Like once or twice a month.

55:59

James McKinney: Okay.

56:00

Ariela Safira: Best friends, yeah.

56:04

James McKinney: I love it. This is probably one of the deepest episodes that we've ever had. It has been so rich, and as our time begins to come to an end, a couple questions I want to ask you before we get to my final three that I ask every founder. But one of the questions I do want to ask you is for you particularly, how do you measure success when it comes to REAL? What is the metric that you look at and say okay, we are doing exactly what we were supposed to be doing and we are doing it well? What does that look like?

56:34

Ariela Safira: Letters from members. So one of the experiences we offer is called Pathways, and they're these 8 session therapy journeys. Even week you're pushed a new session. They come with reflections and challenges, and at the end of a pathway we ask members to write a letter to someone who is starting their pathway. The richness and depth and self awareness that those letters carry mean, wow, so much more to me than any of our numbers. I'm obviously very proud of the team for having thousands of members, supporting thousands of members, working so thoughtfully and creatively. And we're seeing, we push clinical assessments every 30 days, we're seeing improvements in mental health.

But I connect with nothing as much as I connect to those words, those letters shared. On top of that, the words that my employees share in hearing what REAL has done for them both in terms of their mental health and being a part of a workplace that speaks so openly and with so much depth about where they're at, and also just what it means for them to feel more empowered, more autonomous. At this point with the people I'm serving are my employees more than it is every day members. I'm putting trust in them to then empower and build all of our members.

58:05

James McKinney: Oh my goodness, I love that. What has been your greatest challenge in the last few years when it comes to building REAL the solution, building REAL the community, building REAL the team? In any category, what has been your greatest challenge?

58:21

Ariela Safira: Pivoting an entire company from brick and mortar to digital was a challenge. If I'm going to be completely frank, then as someone who cares as deeply about people as I think I do, it's been so… having to let people go is the worst thing ever. I really do form deep connections with everyone at the company, and have so much love for them as individuals. And also understand that as a startup we're strapped on cash and we have to achieve certain metrics by certain dates. It means having to make decisions that sometimes can land pretty harshly to others. I do the best I can to be transparent and communicate as early as possible when those decisions are made, but still freaking sucks and if anything it empowers me to be super intentional and forceful about hiring, and knowing I guess a success metrics for me maybe should be never having to do that, and ensuring we're hiring right and training, and motivating people internally correctly.

59:31

James McKinney: I love it, absolutely love it. I want to honor your time, I want to honor our listeners time, and as we bring this episode to a close our final three questions. That first one is about perspective of entrepreneurship. There is this narrative out there that anyone can be an entrepreneur. But then those who are doing it may say otherwise. What are your thoughts? Can anyone truly be an entrepreneur? Is there a genetic makeup to it? What are your thoughts?

59:54

Ariela Safira: I want to say anyone can do anything. I don't think anyone wants to do this. I think it takes a lot of intentionality and lightness, nimbleness to listen and to change your mind, to change product and deliverables based on what people want. And I don't know if that's an amount of focus, nimbleness, or patience people want to practice every day. On top of that, I think to be a good entrepreneur, to be a good founder you need to really care about your people, or be privileged enough to get loads of money without being a good boss. I don't know if many people want to do that. I think there are a lot of people who don't. So sure if you want to do it, I'm sure it's possible. I don't know if you'll do it well and I don't know if you'll enjoy it.

60:47

James McKinney: I love it, love it. Great answer. The second question has to do with breaking down the narrative about entrepreneurs as this isolating journey, and it's all about sitting on your friend's couch and pounding way code, and that's where the success stories come from because the media loves those stories, they love those narratives. But that's not… that is one way to do it, absolutely. That is one pathway to it. But I find that entrepreneurship is while it can be lonely, it shouldn't be done alone. So when you think to your entrepreneurial journey who are the people that you point to with such immense gratitude for their contribution to where you are today?

61:27

Ariela Safira: First person to come to mind is my childhood best friend, Dani Freid. She really has been my person since the start of REAL. She does not work at REAL, she does not have equity in this company, and is fully devoted to my wellness and sanity. It's been so beyond generous of her to give me the time, patience, care, feedback that she has. And that's both feedback on me as a human as well as giving feedback to every possible product REAL has created, far before REAL had a name. She's been a participant in every survey and getting thanked for everything. I'd say she's been a really big part of that.

Second is probably my partner Zack who would be my cofounder if he'd allow us to work together. Deeply emotionally intelligent and thoughtful as it relates to understanding my goals with REAL and how sometimes it goes against what does it mean to found a venture backed company, and marrying really understanding who I want to be as a person and what I want to build with the realities of today, and offering advice to ensure I get there.

62:52

James McKinney: I love it. I love that question. Really if I had to bring the episode to 20 minutes that question would never get trimmed. I love it. It almost feels like an Oscar speech sometimes but it's one of those things that I think people again have this false idea of what entrepreneurship is and when they hear people like Ben Chestnut who founded Mailchimp with no investment capital, $7 billion valuation, or Randi Zuckerberg. When I hear people like them go through this laundry list of people that are part of their story and they're so grateful for, I think it just chisels away at that narrative that it has to be isolating when it really shouldn't.

As our time does come to an end the final question is if you were to imagine yourself having coffee with one of my listeners. Maybe that listener is the frustrated entrepreneur because COVID either destroyed or nearly destroyed everything they had built and they're not quite sure how to recover. Maybe they've placed their own self worth on the challenges of their business. Whatever persona you would like, it is an entrepreneur and you're having coffee with that person. What would you say to one of my listeners as we wrap up your episode of The Startup Story?

63:58

Ariela Safira: Build the company you want to work at, no matter how radical or different it might be. It's your one shot to make a new thing. Make it something you would want to be a part of.

64:11

James McKinney: Once you've had a few moments to process all the value Ariela Safira brought us in this week's episode, please hit me up on LinkedIn, Facebook, or Instagram and share with me your thoughts on this episode. If you've been around The Startup Story for any length of time then you know how much emphasis I put on the idea that entrepreneurs support other entrepreneurs. For that reason, I hope every single one of you will visit join-real.com to see all that REAL has to offer. In addition to visiting join- real.com, if there is anything you've gained from this episode I hope it is that we need to engage with those around us. Have some honest discussions with those close to you. Check in on them. And at the same time, share with them what is going on with you. Like you heard Ariela share herself, entrepreneurship is incredibly hard and can absolutely impact our mental health. Don't journey this path alone. Reach out to someone or visit join- real.com if you want to talk with someone outside of your network and somewhat remain anonymous. We are all on the same journey as entrepreneurs, but our paths all look very different. Let's be intentional with checking in on one another. And now for my personal ask.

The Startup Story community has been so incredible about sharing our podcast with others, but we have more stories to tell and more people to reach. We too are a startup and word of mouth is everything, so please follow us on Facebook and Instagram @TheStartupStory or on Twitter @StartupStory_. If you're on LinkedIn, please search for The Startup Story and follow our company page. LinkedIn is a really powerful way to raise awareness of the show. But the most impactful way you can help us grow our audience is to leave a review on Apple Podcast. Or if you listen to the show via Spotify, then please simply share the podcast directly from your Spotify app or wherever you listen to the show.

These simple actions can make a huge impact in getting these amazing founder stories out to the masses. And please make sure to tag or mention The Startup Story when you do share so that we can connect with you and say thank you directly. I'm so incredibly appreciative of the fact that you listen to the show each and every week, and I look forward to sharing these amazing stories with you every Tuesday with hopes of encouraging and inspiring you to start your story.

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June 01 2021
Ariela Safira, founder and CEO of REAL

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