Tackling MENA's mental health

Whilst researching mental health in the MENA region back in 2021, Fares Ghandour came across a striking statistic.

The search rate for the phrase "how to improve my mental health" in Arabic had grown by 1,100% over the previous five years.

What’s more, interest for the Arabic word for “therapist” reached a 10-year high in the same month.

When it comes to mental health solutions, the problem lies not in the demand…

But in the lack of supply.

When Wamda Capital decided to not raise another fund, Fares decided to make a rather unconventional switch - from investor to operator.

Recognising that a global shift in mental health awareness was taking place in the wake of the pandemic, Fares wanted to ensure that the Arab world was not left on the outside looking in.

So, he co-founded Tuhoon, with Aymane Sennoussi and Naif Al Mutawa.

Tuhoon, which translates to “it gets better” was launched to provide reliable, affordable mental health services tailored to the local cultural context and Khaleeji dialects.

Inspired by the success of apps like Calm and Headspace, Tuhoon launched a self-help app in March 2022, focusing on two specific areas:

1. Sleep

2. Stress

Calm’s success with sleep stories and guided meditations (now the world’s first mental health unicorn) validated that addressing a specific pain point is more successful than trying to tackle multiple areas initially.

Focusing on sleep was an extremely effective way to attract users to mindfulness and wellness platforms, as insomnia is a common issue without the stigma or taboo of depression and anxiety.

Whilst addressing stress has allowed Tuhoon to target organisations looking to improve employee wellbeing and productivity.

Tuhoon now counts telecom operator Zain, health insurance provider Bupa, and Riyad Bank among its customers.

The company has continued to build on its corporate solution, introducing pathways on work-life balance, productivity, and resilience since launching.

The benefits of B2B are numerous; it’s cost-efficient, with lower acquisition costs, higher retention, and better cash flow compared to B2C.

It’s also allowed the company to prove its value proposition and demonstrate early success.

As of January 2023, the start-up had recorded 100,000 sign-ups on its app, and currently uses a freemium model, offering restricted access to pathways on sleep improvement, stress relief, and productivity, curated by Khaleeji experts.

The startup is at the seed stage, with $2.5 million in funding from self-funding, angel investors, Wamda Capital, and UAE-based Nuwa Capital.

In 2023, Fares announced plans for Tuhoon to venture into a hybrid model with clinical psychology and counseling clinics offering in-person and virtual appointments.

Tuhoon will aim to grow to about 20 clinics in Saudi Arabia within three to five years, providing standardised, regulated mental healthcare.

Fares is one of many founders in the MENA region committed to improving the access, availability, and effectiveness of digital mental health solutions for individuals.

🏥 State of play

In the GCC, 15% of people have a mental health disorder, which is higher than the global average.

However, the actual number is likely higher due to stigma and a shortage of mental health professionals.

Telemedicine and digital mental health solutions have helped improve access to mental health services, particularly during the pandemic.

Hanel Baveja (formerly Union Square Ventures, now CREANDUM) has an excellent framework that we can apply to thinking about the evolution of mental health tech in MENA to date.

Mental health 1.0: Traditional, in-person sessions, either one-on-one or in group settings like AA meetings.

Mental health 2.0: Digital versions of traditional care, such as online provider directories and marketplaces.

🧘‍♀️ Headspace and Calm expanded how and when one could practice meditation and mindfulness and built massive businesses, providing confidence that this model generally works + avenue to scale.

In the MENA region, platforms like Tawazon, Tuhoon, and Mindtales have adapted these models to fit local cultures.

🗣️ On-demand therapy platforms like Talkspace and BetterHelp allow people to find and visit therapists virtually.

• Similar services are provided by Labayh, O7 Therapy, Shezlong, Cura, Takalam, Arab Therapy, Esaal, Sukooni, and Hakini in MENA.

On-demand, virtual care means that users across the region are no longer limited by local provider availability.

• Remember, the GCC only has 2.5 psychiatrists per 100,000 residents, significantly lower than the global average of 7 and the OECD average of 10+.

The MENA region hasn't yet seen a true Mental health 3.0 platform emerge.

Tuhoon’s touted hybrid model and Mindtales' combined wellness and counselling services are steps in the right direction.

But there are still significant challenges and hurdles that need to be overcome in the region before a 3.0 player emerges…

⛔️ The roadblocks and how startups are overcoming them

1. Perception and stigma

One of the main barriers to mental health care in the region is poor understanding and stigma, which prevent people from seeking help.

However, things are improving.

Governments are focusing more on mental health policies and enhancing the workforce.

Stigma is decreasing, especially for conditions like depression and anxiety.

The COVID-19 pandemic has accelerated these positive changes.

The growth and visibility of digital mental health platforms in the region will further support this progress.

For example, the Saudi platform Labayh had over 1.2 million users by the end of 2022, demonstrating that remote accessibility from home is significant in overcoming the reluctance to seek help.

2. Shortage of qualified mental health professionals

The shortage of qualified mental health professionals across the GCC is helped by a lack of relevant university-level degree programs in clinical psychology and psychiatry.

In fact, there is almost no access to master’s or doctorate-level programs.

Several regional startups, such as Labayh, O7 Therapy, Shezlong, Cura, Takalam, Arab Therapy, Esaal, and Sukooni, are helping to remotely connect patients with the practitioners that are there.

As well as this, Arab Therapy, is working to improve the skills of their therapists through detailed training programs conducted by Arab doctors in Germany. These programs cover various therapeutic techniques and cultural sensitivity, aligned with Germany's high standards of care.

While startups are making strides in improving access, comprehensive solutions to the professional shortage will ultimately need to come from educational and policy reforms.

3. Lack of support in the workplace

In MENA, untreated mental illness costs an estimated loss of 37.5 million productive days per year, the equivalent to $3.5 billion.

Despite this, only 33% of employees feel that they receive support in managing their wellbeing in the Middle East, and in Saudi Arabia, over 80% of workplaces lack a mental health budget.

Nearly every startup in the mental health tech space in the region has established a B2B offering, emphasising the financial and productivity gains of adopting digital mental health solutions.

For example, Mindtales’ B2B landing page features an interactive slider that allows businesses to see how many employees are struggling with mental health issues, the number of days lost annually to work-related mental health problems, and the estimated annual cost based on the number of employees inputted.

4. Cultural nuance and language

Mental health advice must consider the specific cultural context of each country to be effective. High-quality US or European apps might do more harm than good if they ignore these nuances.

Suna Zoabi-Othman recognised this gap in the Middle East. In 2019, she founded Tawazon, a Palestine-based meditation app, to address the lack of Arabic-language meditation apps - there were about 1,000 meditation apps worldwide, but none in Arabic.

Tawazon aims to spread the practice of meditation tailored to the cultural needs of Arabic speakers.

Similarly, Tuhoon, curated by Khaleeji experts for Khaleeji dialects, ensures that mental health services are culturally relevant and accessible to the local population

5. Not leaving the vulnerable behind

Lower-income migrant workers make up a significant portion of the population in many GCC countries, but mental health policies often overlook them.

In the context of the ongoing conflict in Gaza, a Palestinian mental health startup called Hakini has provided over 3,500 people on the ground with mental health support, via interactive and professional workshops, counselling sessions, and guidance offered via phone calls.

To help fund their efforts, please visit here.

⛰️ What’s next?

The increase in the number of startups addressing mental health-related challenges is encouraging and is already playing a significant role in tackling stigma.

Currently, there is a clear distinction between platforms offering digital therapy services and more holistic approaches centered around mindfulness and wellness.

Although no startup has surpassed the Seed stage yet, focusing solely on metrics would overlook the meaningful progress being made in this space.

Progress may be slower than desired, but in the realm of mental health, a cautious and deliberate is far more preferable in my book, than moving fast and breaking things.

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