Joe Fuller: Welcome to the Managing the Future of Work podcast from Harvard Business School. I’m Harvard Business School professor and visiting fellow at the American Enterprise Institute, Joe Fuller. This episode is one of the series of special dispatches on the sweeping effects of Covid-19 on our economy, society, and the future of work. In addition to our regular podcast episodes, we will be bringing you interviews with business leaders, policy makers, and leading scholars on the coronavirus.

The Covid-19 pandemic has triggered widespread emotional and mental distress. There are many causes—everything from balancing remote work and family life, the threat of unemployment and business failure, and the specter of a lethal and unpredictable virus. Researchers are having to devise new metrics. A June 2020 report from Harvard University and the University of North Carolina introduced the concept of a pandemic distress index. That index correlates with the probability of clinical anxiety and depression. The report’s authors conclude that at least a quarter of all US adults are presently in a condition of high emotional distress directly attributable to the pandemic. How can businesses and individuals track and support mental health during a global crisis? Total Brain is a San Francisco-based company that offers an online platform combining mental health tools and data analytics. Grounded in integrative neuroscience, its approach screens for conditions like anxiety, depression, and addiction. During the pandemic, Total Brain has tapped its user data to create its own mental health index for US workers. The index shows dramatic spikes in anxiety, stress, and signs of depression, especially among lower-wage workers and women. Before the pandemic, Total Brain touted the bottom-line benefits to companies of attending to the mental health needs of their employees. Now it’s sounding the alarm over the Covid-19 pandemic’s impact on the mental health of workers across the country. Total Brain CEO, Louis Gagnon, joins me today to discuss the crisis and how businesses can help address it. Welcome to the Managing the Future of Work podcast, Louis.

Louis Gagnon: Thank you so much for having me.

Fuller: Louis, Total Brain is a firm that’s based on integrative neuroscience in order to understand trends in mental health. I’m sure that term is familiar superficially to our listeners, but could you talk a little bit about what it means in practice and how Total Brain puts science to work in offering its services?

Gagnon: Yes, absolutely. Let’s go back to the original problem we’re trying to solve. There is a mental health crisis out there, where 20 percent of the population currently has a mental condition like depression, anxiety, PTSD, addiction. Twenty percent! And another 52 percent are at risk. So mental health is a continuum, and people are constantly moving on that continuum. So you can hear that, if we have 20 percent with a condition and 52 are at risk, about 72 percent of the population has varying degrees of impairment. They’re not at their best, and that’s a crisis. Now, of those 72 percent, about 10 percent access care. They will go see a therapist, they will go see a psychiatrist, and they will be cared for, which means that the other 10 percent plus the 52 percent that are at risk have to manage their own mental health. The issue with this is that nobody knows anything about it, nobody knows anything about their brain. It’s very, very difficult to understand when we should consult and when we should not. What is the difference between being sad and being depressed? When do I cross a clinical line? These are some very serious issues that are underlying the mental health crisis. In light of that, we said why don’t we bring neuroscience to the digital world—neuroscience being the science of the brain—and why don’t we help people measure their brain, measure the risk that their brain gets impaired—we call it self-monitoring—so that they can then manage their lives, become more aware of what moves them in the right or the wrong direction, so that they can build capacity, they can build performance for themselves by doing self-care. So you self-monitor and you self-care using tools that have been well established in science, like positive psychology, brain training, breathing, meditation. So we basically bring it all in an easy-to-use digital format, where you can self-monitor brain capacities, mental health risk, and self-care using science-backed, well-known tools that will hopefully change the brain and reduce the health care risk of people. This is what we do.

Fuller: A subscriber would be periodically administered some type of self-diagnostic instrument, and then, from those results, navigate toward steps they could take for treating themselves or flagging that they may need more serious professional help?

Gagnon: Exactly. When we do see a risk, we do make a referral to the health system. We can connect with the health system, providing all of the data that the person decides to share—or not—with the health provider, which in the case of the health provider or in their position is extremely useful, because now what they have is really interesting data about the brain and not just data about symptoms of mental conditions. They can then craft better treatment and understand how their treatment is affecting the person in the long run. Generally speaking, one will self-assess or monitor about once a month for 20 minutes. One can self-care as much as one wants. We usually recommend 15 minutes per day, three days a week.

Fuller: One of the ways that Total Brain came to my attention is that you’ve been publishing a mental health index, and that, during this period of the Covid pandemic, when so many people’s routines have been disrupted, you’ve been showing a marked increase in different forms of behavioral health issues, whether it’s stress or depression. Could you talk a little bit about the index and what you’ve been seeing over the course of the pandemic?

Gagnon: Yes. Total Brain serves dozens of large self-insured employers in the US. We have almost a million lives covered. So as the employees of those firms come and assess themselves on a regular basis, we have a view—an aggregate respecting anonymity and confidentiality—we have a view on trends. What we do is we take a sample of those users on a weekly basis and we control for cohort effects. And then what we do is we go check—how are the capacities and how is the mental health risk evolving over time?—so that we can start understanding the impact of life on our mental health. Obviously, our life has been enriched by some serious dramas in very recent months, and what we have seen is that, when we compare the mental health risk pre-Covid—that is, February and before into 2019 versus March, April, May—the mental health risk of things like depression, anxiety, and addiction and PTSD has more than doubled. It has tapered off in May as the Covid situation got better on the coast, but it is still almost double at the end of May of what it was at the beginning of the pandemic. And it affects women more than it affects males, in general. I think there’s a lot of interesting interpretation for that data. It also affects the elderly differently from the youth. And the people who are in the middle—the working middle-aged people—are also seeing increased risk compared to the other two. So that is the key highlights, if you like.

Fuller: So when you point out that it’s tapering off, do you feel that’s because the situation has just become more familiar and it’s not as alien to people anymore, who have had so many of the normal routines of their day-to-day lives disrupted? Or is it because people are more hopeful that perhaps we’ll have a return to normality?

Gagnon: I will say the latter, people are more hopeful. The sun came out, the beaches opened, and generally speaking, when summer starts, our mental health is generally getting better. So that, together with the fact that the pandemic seemed to get under control, has certainly contributed to the tapering off, if you like.

Fuller: One of the things you discuss in some of your literature are experiments that talk about human beings having an anticipatory threat response, like in a horror movie; that their anxiety goes up anticipating that some nasty thing is going to happen on the screen. Then, of course, when it does unfold, those anxieties go up. As you interpret this data, is your finding that people are actually experiencing anxiety because of what’s happened to them, or is it more a function of they’re uncertain what’s going to happen, but they’re anticipating something bad might happen and, therefore, having that type of reflexive anticipatory response?

Gagnon: Yes. It’s a little bit of both. On the one hand, our brain is the best threat-detection system ever invented. So our brain has detected that there is something major happening with Covid, and that puts a lot of us in fight-or-flight mode—that is, we become hyperfocused. We become contracted as opposed to expansive. And we don’t think, and we’re losing a little bit of our normal collaborative attributes—we become much more closed, if you like—due to the fact that our brain has detected danger, and this is now the state we’re in in the moment. Then with that moment, some people have more or less propension to be anxious and anticipate. And that is getting worsened by the fact that times are very uncertain. So 1) there’s the threat that’s very real. We’ve lost our jobs, our health, and a bunch of things. And 2) we don’t know what’s the end and what is going to happen after this very moment. And we all know that it’s going to last for a while. The vaccine in most people’s mind is the key milestone. But until we get there, we don’t know. So both those things definitely contribute to put us in a state of high alert and high anxiety, and there is not much we can do about reducing the uncertainty. However, we can do a lot about reducing our state—that is, this fight-or-flight state. We can shut it off. We can short-circuit it by using tools that relate to our physiology, such as breathing.

Fuller: The data suggested a pretty markedly higher level of anxiety among lower-income workers. Has that held true across the time you’ve been doing the index? And is that primarily an expression of the asymmetry of the impact of Covid-19 on people with lower-wage work?

Gagnon: Without a doubt, in my opinion. We are also seeing the same thing with people who are younger, in terms of certain attributes specifically to do with negativity and anxiety. We’re seeing a higher risk of mental depression and anxiety for women, also. So lower income, youth, and women have some correlations with the fact that those populations or those groups are often in the front line. They are often the most insecure economically, given the uncertainty that we are coming into as an economic era. And also the sheer pressure of having to deal with families and kids at home is also a major factor.

Fuller: How do you get individuals to actually engage in a service like this? Certainly, Americans are widely reputed to be people who are loath to engage in self-efficacy programs—that there’s multiple instances of services that enjoyed some initial success, but then user adherence drops off rapidly. What have you learned about how you can get someone both to engage in this type of self-discipline and self-care and also stick with it?

Gagnon: We have a huge advantage over anything that has existed in the past, and that is that we have the largest neuroscientific database in the world, which allows us to give anyone a personalized score for their four key brain functions over 12 capacities, which in and of itself in terms of content is extremely attractive for people. People want to know how smart they are. They want to know how emotionally good they are. They want to know their cognition, or if they have good memory. Are they good decision makers? This idea of being able to benchmark themselves against people their age, their education, their gender is super powerful. And that is our entry into engaging. We say to people, “Just come and understand your brain capacity, understand your brain in the process.” And then as part of this, we mention the risk, if and when there is one. So our focus is not at all on the mental health issue as in mental conditions, but it is on the real mental health of people, which is about performance and brain performance. And so people are super-engaged. That’s why we’re able to see engagement rates are getting close to 50 percent on one of the largest employers that we have in our customer list. In terms of maintaining engagement, like any other behavior change app, we are seeing serious drops after a few months, but we believe that the key here—and we are a brain company—the key here is to really adapt the user experience to the brain. And we are in the process of really understanding that there are two personas out there. There are people who don’t want to assess anything—they just want a fix, and they want to fix in this moment. And there are people who are much more full of ... much more intentful, trying to really do things in a systematic, objective manners in the long run. And so we’re trying to gather to both those groups by giving people quick fixes—short-cut, dopamine-generating little experiences, where they’re going to see the results of what they do immediately, and it’s not very demanding. And then we compliment that with other more long-term tasks that are certainly more demanding. And, in general, doing this we’re able to maintain above-average engagement. We are able to reengage 35 percent of our population, in general, which by any standard is fairly high in that field.

Fuller: Yes, it is. Can you tell us a little bit about the origins of the database you mentioned?

Gagnon: Yes. It’s a 20-year endeavor, where Dr. Evian Gordon, who’s an integrative neuroscientist, decided to build a database that would be standardized with an assessment of the total brain, which would basically put together all of the tools to measure the key brain functions, the most valid, best tools. He brought it all together in a digital format, built the database, and then opened it up for the academic world and for the pharma world to use. And so there was more than 200 studies where people contributed their own data to the database and used obviously the data of others to build their own knowledge. So 200 studies, 300 publications, 26 clinical trials, plus then going to employers and getting about a million people registered to the app really is what built the database over time.

Fuller: You have a very interesting background for someone who’s now running a neurosciences company. You were involved in marketing and user experience at places like Monster.com. You’ve worked at Amazon. You’ve been in private equity. How did you find your way to Total Brain, and how do you see it evolving?

Gagnon: Yeah. Like any good entrepreneur, I tried to solve a problem, a problem that I had, a problem that I suffered from, a problem that I saw. And that problem is that mental health has not really moved since the 1960s. I don’t feel good. I go to see a doctor for an hour. He’s going to give me pills. I’m going to try that. And then I’m on a six-week cycle of trial and error with those pills, where I’m changing the chemistry of my brain. And then I may have talk therapy once a week, and I don’t understand what’s going on. I don’t understand how this all works, how it’s impacting me. Is this treatment working for me or not? I personally was affected by PTSD. I got caught in the Rwandan genocide when I was 26.

Fuller: Oh my.

Gagnon: Took me about 20 years to work through this trauma. I also have a lot of mental-health issues in my family, including, parents, siblings, children. And so I was a very close witness to the utter lack of knowledge and accountability on the system side. And I decided that my experience in tech and big data could be helpful here to bring structure and to bring insights and to surface a certain level of accountability that does not exist. And that is really what brought me here. Now where is this all going to go? My hope is that we become a tool that people use frequently to become self-aware. You know, self-awareness is usually understood as a quasi-spiritual concept. But what we are trying to bring here is the fact that the brain that we have is our operating system. And understanding its strengths and weaknesses in its key dimensions—emotional conditions of controlled feelings—understanding that is understanding ourselves. And if we can take a measure of that—like we take a measure of our steps on our Fitbit or our Apple Watch every other day, as we take measures of all sorts of things—if we were to now measure how our brain is doing, we have insights into how life affects us and how we affect ourselves by making choices—life choices, practice choices. And it’s having a tool where I can A/B split test myself. Or I can do something one month, see if it has an impact. If it’s negative, I can change. And now I have a tool to really self-improve based on data. So self-awareness is one thing, independently from our self-care. If someone decides that the data that we give is correlated to the fact that this person has been playing tennis three times a week, and that person continues to play tennis for that reason, this is what we want to do. And then our self-care is there to help—for whoever wants to use these very much, century-old wisdoms of breathing and meditation, where the body’s integrated, and we’ve really helped people leverage the breath, the lungs, the heart, pulled the brain together and the body with exercise and nutrition—if we’re helping people do that more, we’ll be very, very happy on both sides. Self-awareness, and then caring for themselves a little more. My dream is that we have as many people as possible do that. And if in this process we help resolve the mental health crisis, then that will be time well spent.

Fuller: We’ve spent time talking to employers about their workforces, the importance of mental health in a workforce. And you also get to talk to them about how individuals can make use of Total Brain’s tools to enhance the quality of their personal lives. Do you have any advice to give to employers or even individuals at this point based on all your research and based on what the company sees in its creation of these indices?

Gagnon: Yeah. So the first thing for me coming out of this—and this is a fairly recent insight—so we’ve had a theory all along, and that theory is not neuroscientific, specifically. It’s also very much aligned with Eastern philosophies and yogis and meditation theories. But we’ve had that theory for a while that life that is unfolding in front of us affects us mentally. And we don’t control what’s happening in front of us. But if we’re going to be affected by it, it means that our mental health is a lot more volatile than our physical health. So the volatility of mental health is something unique that we need to consider. When we do the index, we can measure it. And for me to see that the risk of mental health in our workplaces has just doubled in a month and a half, that is a staggering fact. Having 7 percent of people at risk of depression in February, going to 22 percent from the risk point of view, has a tremendous impact on the output of a company, on the relationships of people within that company, on the productivity of the whole company. And so multiply that by the number of conditions, and what you have here is a very, very serious issue. So it’s volatile, it’s very serious. And we have no way to know. And individuals don’t know. So giving people self-monitoring tools of all kinds—not just ours, but there’s a lot out there that can bring people to self-assess and realize how they’re doing—is key. Prevention is costing four times less than care. And so by simply making monitoring tools available and having good, fun, interesting monitoring tools is key here. We’re going to reduce the problem very significantly down the road. It’s also very, very useful to use the same data to understand health outcomes, to understand what works, what doesn’t work, to understand the impact that the company might have on its workplace. I have companies asking me all the time, “Give me a breakdown of the brains by offices.” You can see, for example, that the Seattle office’s stress has gone up 50 percent, while the rest of the country is down. What’s happening in Seattle?

Fuller: Interesting.

Gagnon: And so we provide this workforce analytics in the back end—that it’s opening up a whole new way to affect workplace and workforce management. So in short, mental health is super-volatile. We need to monitor it better. We need to prevent and stop caring and getting people in emergency rooms at 15 times the cost. And we need to use the data smartly, is what I would think is the most pressing needs for businesses and individuals alike right now.

Fuller: Well, certainly our research here at the Future of Work Project at Harvard Business School has indicated that employers that take a more deliberate and structured approach to helping their employees deal with all the various attributes of care in their personal lives—whether it’s caring for children, caring for parents, caring for themselves—do reap a benefit in terms of higher levels of loyalty and lower levels of turnover associated also with higher levels of productivity that you mentioned earlier. Well, Louis, we thank you so much for joining us on this Covid-19 dispatch podcast from the Managing the Future of Work Project at Harvard Business School.

Gagnon: Joseph, it’s been a great pleasure. Thank you so much for having me.

Fuller: Thank you for listening to this special episode of the Managing the Future of Work podcast. To find out more about our project on the Future of Work and for more information on the coronavirus’s impact, visit our website at hbs.edu/managing-the-future-of-work and sign up for our newsletter.