CARTER BARNHART: We live in a society where we are disconnected, where there’s increased isolation, loneliness, and the belief that human nature is competitive, aggressive, greedy, and selfish. This is so abnormal compared to the majority of our species’ existence.
We see headlines about suicide rates, and every parent asks, “Whose fault is this?” They want to say that this is because of social media.
To truly heal this generation, we need to focus on how we can make people feel more connected.
We believe that if every single person has access to care when they need it most, it is possible to build a world where suicide does not exist.
BOB SAFIAN: That’s Carter Barnhart, founder and CEO of Charlie Health, which has quickly become a dominant player in virtual mental health care, particularly for young people.
Carter’s story is, in some ways, a classic entrepreneurial journey: She’s crafted an insightful solution to a problem that she, personally, experienced. That said, what she shares may not be easy for everyone to hear. So please take care if an account of sexual assault might be triggering. Still, there’s so much to learn here about business, about society, about our assumptions, and our choices. So let’s get to it. I’m Bob Safian, and this is Rapid Response.
[THEME MUSIC]
SAFIAN: I’m Bob Safian, and I’m here with Carter Barnhart, the founder and CEO of Charlie Health, a fast-growing virtual treatment platform for mental health. Carter, thanks for joining us.
BARNHART: Bob, thank you so much for having me on.
Combating loneliness with connection
SAFIAN: So in just four years, Charlie Health has gone from launch to production. 1,500 full-time employees, 40,000 patients. Your impetus was to focus on youth mental health to prevent suicides, although you’ve expanded to treat adults as well. There’s been a lot of talk about the so-called loneliness epidemic, including from the U.S. surgeon general. It’s like you’ve been a beneficiary of that — though that’s not the right word — but you know, how do you think about it, about the timing and the environment you’re working in?
BARNHART: I think a lot about this study that came out of Massachusetts that looked at 2,000 women over a 10-year period. These were women who were all unhappily married. The ones that didn’t talk about their feelings were four times as likely to die as those that did talk about their feelings. And the only difference was that the women were connected. And that’s really where this all starts. When we talk about loneliness, certainly Charlie Health has believed since the very beginning that a more connected world will help to fight and combat loneliness.
The mental health system was already completely inadequate pre-COVID, but the cracks have just become even more apparent as demand has grown.
And so, yes, Charlie Health has, in some ways, been able to step in as that solution to bridge that gap and provide people access to evidence-based treatment that works. And really, I believe that my role as a connector is also to then just show people that there is hope, and there’s a way to combat this mental health crisis, which sometimes can just feel so hopeless.
SAFIAN: Can you just give me a sentence or two, like, what Charlie Health is?
BARNHART: So, Charlie Health is a virtual mental health care provider that specializes in the high-acuity population. That’s people struggling with depression, anxiety, suicidal ideation, and self-harm. Our clinicians provide intensive support for individuals who need more frequent care than just once-a-week outpatient therapy. Typically, they’re transitioning from an emergency or residential treatment, or maybe you’re in once-a-week therapy and need to step up to something higher.
Inside Charlie Health’s evidence-based treatments
SAFIAN: You mentioned the term evidence-based. Charlie Health calls itself a solution to suicide prevention. So, what is evidence-based treatment, and what makes Charlie Health different than other kinds of treatments?
BARNHART: There’s something called intensive outpatient programming, which has been around for decades and has just been greatly underutilized by the mental health care industry. We figured out a way to deliver intensive treatment virtually. When we first launched Charlie Health, we were using evidence-based curriculums like CBT, DBT, but we didn’t have the evidence to show that if you delivered that virtually, that it would be as effective. And so over the past four and a half years, as we’ve grown, we have been data-obsessed.
Using the data we have to enhance our curriculum, and the patient experience allows us to have better outcomes year over year.
We’ve been able to reduce the number of hospitalizations, which is really what we look at as success. Patients come to us in crisis, and we want to ensure they don’t end up back in crisis again. We follow them after discharge from our program to see if they end up in a higher level of care again, if they end up back at the emergency room. We partner with both our patients and payers so that we can use claims data to really confirm the efficacy of our treatment model.
89 percent of your patients report improvements in self-harm. 95 percent report improvements in their symptoms associated with depression. 92 percent report improvements in their symptoms associated with anxiety. And then you’re able, most importantly, to decrease suicidal ideation.
SAFIAN: I’m wondering if you can clarify for me our expectations about mental health treatment being different from what works. You and I talked earlier, and you mentioned rich kid rehabs versus the power of group therapy. Can you explain what that difference is?
BARNHART: I spent the first 11 years of my career running residential treatment centers. Part of a residential experience is group therapy. That group therapy — I saw how profound it was for individuals. And what I knew was when we created Charlie Health, we needed to create an experience where people could hear “me too.”
We pair clients together based on their condition, age, the modality of treatment they’ll benefit best from, and their lived experience.
So we can put them into a group where they see people who look and sound like them. In that group, the curriculum we deliver is based on all the data we have from previous clients who are similar to them. We’re able to constantly innovate on what that curriculum is to deliver the best possible group experience.
SAFIAN: So I guess the more your system grows, the better, in theory, this treatment gets because it becomes more personalized, without necessarily costing you more to deliver that personalization.
BARNHART: And that’s what really excites me about Charlie Health. Historically, in behavioral health, as treatment programs have scaled, the quality has gotten worse. For us, because we’re able to leverage technology to really improve care delivery, our treatment gets better.
Carter Barnhart’s impetus to work in mental health treatment
SAFIAN: You were motivated to found Charlie Health in part because of traumatic experiences in your own life. If you’re comfortable with it, can you share that story and say how it led you to work in mental health treatment?
BARNHART: When I was 14, I attended a concert with friends and was sexually assaulted. It was a terrible, life-altering experience. I went from being this carefree, energetic, bold young woman into what felt like really a shell of myself. I started acting out, doing things that harmed myself, and I just really didn’t want to live anymore. It all felt too painful. The next few years were some of the hardest of my life, despite having access to numerous solutions and professionals and growing up in a loving, super supportive family. It took my family two and a half years to find me the right treatment, which, when you’re 14 to 17, feels like a lifetime.
I had to travel across the country to receive the proper treatment. I went to this residential treatment center that was brand new in California. It was there that I formed relationships and a community. I went from feeling lost, alone, hopeless, to connected, inspired, and safe. After treatment, I went back to my high school, finished my senior year, and then reached out to the founder of the treatment center and asked if I could intern for him. He really served as a mentor for me over the next 11 years. I worked for him full-time, growing this small residential treatment center into what’s known today as the gold standard in brick-and-mortar residential treatment.
There were so many days I answered the phone late at night, talking to a hopeless parent on the other line, telling them we didn’t have availability or that the out-of-pocket expense was unaffordable. I wanted to start something rooted in access and deliver that same high-quality treatment experience to so many people who desperately need it.
How Charle Health supports patients after they transition back home
SAFIAN: For some folks who go into treatment like this, when they leave inpatient care and go back to their regular lives, it can often trigger them to slide back. It sounds like part of what Charlie Health also offers is a way to keep that support with you as you re-engage.
BARNHART: The transition back from a residential treatment center or hospitalization is always challenging. You go from a safe environment where you’re with people who understand you, where you’re protected, to home and the realities of life. That is one place where Charlie Health can be extremely helpful. We help with that transition from a residential program back home, providing support virtually so you don’t feel alone. We see so often for our adolescents and young adults, as they transition back into high school and college, they feel like they’re the only ones who have had this transformative experience. That can be even more isolating. Giving them a community of people who understand their journey provides powerful support.
Why blaming social media is misunderstood
SAFIAN: What do you think adults most misunderstand about the mental health of young people?
Modern society has exacerbated this disconnection. To heal this generation, we must focus on making people feel more connected. How can we foster genuine human connections for those who have experienced trauma? How can we help them heal and reconnect with their authentic selves?
I think young people are starting to catch on to that. You’ll see parties where they say, leave the phones at the door. They’re creating ways to prioritize connection because they know they need that. The misunderstood thing is there’s not just one problem. It’s not just social media. I wish it were that easy, Bob. If we could just take away social media and everything would be fixed, that would be great. But it’s not. We have to teach people to connect again. We don’t have to be this competitive society; we can work together.
SAFIAN: Are there ways to use the big digital platforms for meaningful connections, or is that a trap?
BARNHART: I think there’s a way we can leverage technology for meaningful human connection. The goal should never be to replace face-to-face interactions. During COVID, we had people in rural communities who were isolated, and we used technology to bridge the gap. Creating safe spaces, especially for people struggling with mental health, can be powerful. Clinicians can guide and facilitate to show people they’re not alone. Social platforms can be powerful if we use them for good.
SAFIAN: Just going on TikTok and watching videos may not necessarily help me, though. It’s the illusion of connection.
BARNHART: I don’t think it’s going to help you, Bob. I’m sorry.
[AD BREAK]
SAFIAN: Before the break, Charlie Health CEO Carter Barnhart talked about the loneliness epidemic and what it takes to address the suicide crisis. Now we talk about the use of AI in mental health treatment, lessons from Charlie Health’s rapid growth, and more. Let’s jump back in.
Can AI assist with these interactions?
There’s been talk about bonding with a virtual companion and AI, that interactions for mental health could sometimes be better than with a human because empathy is programmed in or something. Do you see AI as a tool in that way?
BARNHART: I don’t think there is a replacement for human interactions. We need human interactions. AI can assist with those interactions. For example, we’re using AI for queuing our clinicians. We take all previous session notes and patient history, and during sessions, we’re able to prompt our clinicians: maybe ask Bob about his kids or something that came up in a group therapy session or a year ago. These prompts are helpful. It’s helpful for clinicians handling complex cases, ensuring the patients feel more connected as their history is remembered. But we still need that human touch.
Who is Charlie Health’s competition?
]SAFIAN: You’ve grown so fast. How has the rest of the mental health space responded? You said to me at one point, you keep waiting for competition.
BARNHART: When we founded Charlie Health, I used to say our biggest competition was the emergency room. I would like someone else to compete with other than the emergency room. But the reason we say the ER is because that’s where young people in crisis were going. That still continues to be the number one place people in crisis show up. ERs were designed for physical emergencies, not mental health emergencies. There’s not another virtual provider at scale focusing on this high-acuity population.
SAFIAN: Apps like BetterHelp for emotional or mental health virtually are not for high-acuity patients the same way?
BARNHART: We would categorize BetterHelp as a low-acuity provider, similar to Talkspace. We partner with low-acuity providers like Talkiatry; they provide access to psychiatry. Mantra, Lyra, all these companies we partner with are helping with aftercare for our patients. They identify those who need to step up into care like Charlie Health.
We partner with organizations like BetterHelp to deliver care successfully, and we’re grateful for those partners.
The healthcare system is similar: you don’t know where to go, from one specialist to the next. There’s no overall guidance. That’s where care navigation is important. It’s a critical part of what we do at Charlie Health — making patients feel taken care of through our case management function so they can transition smoothly from one level of care to the next.
SAFIAN: I’m curious, with so much angst over the political environment and presidential elections, has that fueled trends in anxiety and mental health challenges? Is it too soon to see that?
BARNHART: Anytime there’s a debate or political event, you’re having a trauma response; people are reaching out more. Certainly, in this tough political climate, we see more anxiety, depression, and hopelessness.
What’s at stake for the mental health of Americans?
SAFIAN: What’s at stake for the mental health of Americans?
BARNHART: I like to talk about hope. Instead of what’s at stake, we know we’re in a mental health crisis. The hope is, for the first time, we have solutions. We don’t just have to accept what’s happening. That takes partnerships between payers, government, individuals, schools, hospital systems. It takes collaboration, but there is hope. Treatment has been proven to work. That’s a message everyone needs to hear. As a hopeless teenager, I wish someone had told me this would get better. With the right form of treatment, you’ll feel better.
It’s our job to build this world. At Charlie Health, we’re building a world without suicide. We believe if every person has access to care when they need it most, we can build a world where suicide doesn’t exist.
Lessons from scaling Charlie Health
SAFIAN: For business leaders listening, your business has grown fast. Are there key lessons you’ve learned in scaling quickly?
BARNHART: So many lessons. For me, personally, I’ve learned I don’t have to be for everyone, and that is liberating. Since founding Charlie Health, I’ve learned not every decision will resonate with everyone, and that’s okay. We went from zero to 1,500 full-time employees in four years. Early on, I tried to accommodate every perspective, every person, thinking if I didn’t, I wasn’t leading effectively. But as we’ve scaled, I’ve realized trying to please everyone is counterproductive and unsustainable. Leadership is about staying aligned with your mission and values, even if decisions won’t be popular. This has allowed me to lead with clarity and purpose, strengthening our organization.
I get asked all the time, how do you balance the heaviness of Charlie Health? What we do is emotionally draining.
How do you recover? How do you show up? For me, having a purpose is most important. I’m happiest solving a big or small problem, but a concrete one. That’s when I experience joy. I have to stay true to myself there.
SAFIAN: So you’ve had this great growth. Where does Charlie Health go from here?
BARNHART: We’re live in 37 states today. I would like to be in all states. Five years out, I hope Charlie Health is known as the standard for measurement-based care in mental health, with a tangible reduction in suicide rates across the country as proof of our impact. I hope when we enter communities, they can say, because of Charlie Health, the suicide rate has decreased.
SAFIAN: Well, Carter, this has been great. Thank you so much for doing it.
Listening to Carter, I’m struck by the ripple effects of our choices as individuals and as a society. We choose to tolerate dysfunction rather than commit to support one another. We can and should do better. At the same time, I’m not against competition, and it can be tricky. Competition is a powerful motivator, sometimes for selfish purposes but also for finding solutions to intractable problems. I can’t pretend to understand mental health fully, but I can appreciate when a resource like Charlie Health gains traction. Like Carter, I choose to focus on hope — that the benefits of human progress will outpace the limitations. I’m Bob Safian. Thanks for listening.
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