Gabe Diop of Rula Health: Inside the Strategy to Fix Inefficiencies and Expand Access to Behavioral Healthcare

The current state of the mental health system is a conversation that echoes in the halls of policy-making, the corners of social advocacy, and within the private struggles of individuals and families. As we continue to witness an unprecedented need for robust mental health support, the shortcomings of the existing system become more glaring. It is within this backdrop that we seek the insight of those who are at the forefront of behavioral health. In this interview series, we are talking to behavioral health leaders, policymakers, mental health practitioners, advocates, and reformers to share their perspectives on healing our broken mental health system. As a part of this interview series, we had the pleasure of interviewing Gabe Diop, co-founder of Rula Health.

Gabe Diop is the co-founder of Rula Health, formerly known as Path Mental Health, a leading behavioral health company focused on improving access to high-quality, personalized, and covered mental healthcare. Gabe oversees clinical and partnerships with payers and health systems. Gabe graduated with a Bachelor of Arts degree in economics from Harvard University before leading partnerships at Spruce Health, a telehealth company that powers the onsite clinic communication for a few Fortune 500 companies, where he worked prior to co-founding Rula.

Thank you so much for joining us in this interview series. Before we start, our readers would love to “get to know you” a bit better. Can you tell us a bit about your background and backstory?

Growing up in a family of doctors, I was always close to the healthcare industry. As I got older and saw people close to me struggle with addiction and mental health issues, I became more interested in the behavioral healthcare space. I had my first introduction to working in healthcare in 2018 when I joined Spruce Health to lead the company’s partnerships team. Then in 2019, Josh Bruno and I co-founded Rula Health, formerly Path Mental Health, with the goal of making mental health care more accessible to those who need it.

Both Josh and I had personal connections to behavioral health, with people close to us who had been failed by the mental health system, experiencing harsh realities and countless barriers preventing them from seeking out and receiving quality care. With Rula, we wanted to make it easier for patients to access care while also taking some of the burden off providers who often are overwhelmed with growing caseloads as more people seek out mental and behavioral health services.

Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?

My favorite life lesson quote is “enjoy the ride.” I’m a hard worker, and quite frankly, I will work too hard sometimes. I didn’t really understand the importance of self-care and boundaries until I burnt myself out working 7 days a week at a previous job. While I still work extremely hard and expect others to as well, you have to prioritize self-care and relationships. I never miss my daily workouts, and I don’t work weekends regardless of how busy I am. I stress that all team members always lead with their personal goals and then get into their work goals.

Let’s now shift to the main part of our discussion. It is often said that “the mental health system in America is broken”. What does that statement mean to you? From your perspective, what is “broken” today?

1. Luckily, it is less broken than people think, and the solution already exists for many people, they just don’t know where to start. Awareness of where to get help is actually the biggest problem. Out of the more than 65 million Americans who seek help for their mental health each year, two out of three of them give up on finding care due to a frustrating, complex system. Frankly, this is unacceptable; everyone who seeks care should be able to access it. To actively pursue care is a huge first step in the mental health journey. Recognizing that you are experiencing challenges with your mental health is sometimes the hardest step to take, second only to having the courage to ask for help. Discouragement resulting from obstacles that inhibit access to quality care can be a huge setback, potentially leading to worsening mental health conditions.
2. Mental health care can also be very expensive. For the 11% of adults with mental illness that do not have health insurance, care may not even be an option. For those who do have insurance, awareness is the biggest problem. Most people don’t know where to go to find the right provider who is covered by their insurance. One in four Americans say they have to choose between receiving mental health treatment and paying for other necessities. However, there are always available providers in every state, but if you don’t know to go to a solution like Rula, you will continue to think you can’t get care in-network because the system is so inefficient.

What about any bright spots? Do you think there are any elements that we get right in today’s world that we wouldn’t want to reverse unintentionally?

In the last 2 decades and especially after COVID, there have been many improvements to the mental and behavioral health care spaces that have brought about hope for a better system. There is generally more awareness and acceptance of mental health issues and a wider variety of care options available than ever before. Technology, such as telehealth, has made it easier to see a therapist or mental health provider, reducing the costs — monetary or otherwise — associated with patients traveling to appointments and providers maintaining an office space.

Legislation such as The Mental Health Parity and Addiction Equity Act of 2008, which requires insurance to cover mental health conditions and prevents them from imposing harsh benefit limitations, has also accelerated progress in the mental health space. The reality is payers still under-invested in mental health until after COVID. It’s a top priority for many of them, and they have made changes to help increase access. However, as more people seek out care, we need to create a system that can sustain the growing demand.

In your opinion, what are the 5 most impactful things that could help heal the broken mental health system? These could be on any level including training, workforce, policy, culture, equity etc.

1 . Raising awareness of solutions

While telehealth and other technologies have made it easier to access mental health care regardless of where you live, most people don’t know about these companies that are also covered by insurance. Payers, employers, providers, etc. need to highlight a solution like Rula.

2 . Focusing on holistic care

As many people know, mental health can be impacted by physical health. Chronic pain or long-term physical health conditions can increase the risk of mental health problems, just as one’s mental health can worsen his or her physical health. Yet, our fragmented healthcare system can make it hard to make these connections. For example, despite the maternal mental health crisis continuing to worsen, 20% of care teams that interact with pregnant or recently pregnant people screen for postpartum depression. This is why healthcare workers outside of behavioral health teams should be vigilant and able to recognize the signs of mental health disorders.

3 . Increasing early detection & intervention

Mental health intervention can start at primary care visits. Primary care providers are the doctors patients most often interact with, and they can likely identify mental health concerns early on with routine mental health screenings. Screenings at annual primary care appointments that assess a patient’s anxiety and depression levels as well as potential substance abuse can lead to early intervention, especially among children and young adults who are more likely to experience mental illness.

4 . Improving care quality

Tracking behavioral health progress and outcomes is not as straightforward as taking blood or monitoring one’s heart rate. Mental health outcomes can ebb and flow daily, making it hard to quantify progress on someone’s mental health journey. However, using measurement-informed care models that facilitate the regular collection and comparison of data about a patient’s symptoms can provide objective measures regarding patient progress that can inform clinical decisions down the line, keeping patients and their care at the forefront. These measures can even be a point of discussion for patients and providers to further investigate factors that contribute to improvements and setbacks.

5 . Removing the stigma

There is still a lot of stigma surrounding mental and behavioral health care. Due to cultural or societal norms, certain patient groups may be more hesitant when it comes to seeking out or receiving care. A Priory survey found 40% of men have never spoken to anyone about their mental health, with 20% of those surveyed saying there is a negative stigma that prevents them from speaking about it, leading to worsening mental health issues or even self-medicating with drugs or alcohol. The issue goes beyond not seeking out care, though. Implicit bias or even discrimination on the part of the provider can lead to misdiagnosis or compromised care. Similarly, racial discrimination can also affect mental health treatment. Only one in three Black adults struggling with mental health issues receives proper treatment.

If all of the items on your list were implemented tomorrow what change might we see in the world? What are the signs (big and small) that would show us that the system is being healed?

No matter how we change the mental health system, we will never eliminate or cure all mental health problems. But building a system that encourages action and is sustainable regardless of the demand for care could make a huge impact on the world. Suicide, violence, and generational or cyclical trauma can all be reduced by ensuring everyone has access to quality, affordable mental health care. Ideally, if the mental health system worked the way it should, no one would have to give up on finding care before receiving it or be forced to sacrifice quality care due to financial constraints.

What is a project you or others are working on today that gives you hope? How can our readers learn more about this work?

I find hope in the work of raising awareness that a solution accessing and affording high-quality mental healthcare actually exists. So many people don’t believe they can get the care they need AND have it be covered by insurance. Integrating behavioral health with the rest of the healthcare ecosystem (payers, providers, etc.) is making it easy for people to find the care they need while having it covered by their insurance. You can learn more at our blog here: https://www.rula.com/blog/.

How do you see technology shaping the future of mental health care and its accessibility?

1. The initial adoption of telehealth in the behavioral health space was a huge milestone. Especially in rural or remote areas where it might be hard for patients to find a provider that meets their mental health needs, telehealth can bring services to people who otherwise would lack access. Telehealth also allows for greater flexibility and makes mental healthcare more manageable for both the provider and the patient.
2. Technology like AI is also helping with patient engagement and treatment effectiveness. Using patient data and preferences, mental health providers can tailor care to each person, leading to better outcomes and higher patient satisfaction. There is still so much more untapped potential in the mental and behavioral health space that can be capitalized on using next-generation technology — we’re really just getting started. However, it’s important to remember that technology can’t solve everything. System design with payers and providers is just as important.

In your view, how do social factors like poverty, education, and culture affect mental health care and its effectiveness?

Like other areas of healthcare, mental health is impacted and can vary based on many social factors. For example, people of color disproportionately face more barriers in accessing mental health care. For those living in poverty or without insurance, it may be impossible to afford care. Depending on one’s education level or awareness of treatment options, people might not even know to seek out care when it is needed. Stigma from one’s own community can also impact whether an individual is likely to ask for help. Even when they do, implicit bias and discrimination within the mental health system can impact the quality of care patients receive.

This is why it is so important that patients are matched with a provider that best fits their needs and understands the unique challenges they are experiencing. Mental health providers that specialize in treating members of the LGBTQ+ community or people of color — or are even members of these communities themselves — may help a patient feel more safe and comfortable during therapy sessions and might facilitate unique progress tied to socioeconomic factors that impact mental health. However, due to geographic barriers, some patients may have a limited pool of providers to choose from and those providers may not meet their specific needs. This is where telehealth can be helpful in widening the pool and matching patients with the best-fit provider regardless of distance.

In light of the growing mental health crisis among young people, what innovative approaches or interventions have proven most successful for children and adolescents?

1. The youth mental health crisis continues to worsen at an alarming rate. In addition to poverty, peer pressure, isolation, abuse, bullying, and stigma, adolescents today have so many more added stressors to combat and face. In the midst of the COVID-19 pandemic, the growing number of school shootings and the increased use of social media, young people are still developing mentally and cannot yet fully navigate the many pressures they are facing, leading many to suffer from anxiety, depression, or even thoughts of suicide.
2. 9% of high school students have attempted suicide and 20% have seriously considered it. This is insane. Young people don’t have to wait for a crisis to seek out mental health care. Intervening early with counseling even before teenage years, focusing on the unique ways a youth’s developmental stage affects their mental health, can prove quite powerful in helping them thrive into adulthood. Using counseling as a preventative measure can stop emotional or behavioral challenges from escalating.

We are very blessed that some very prominent names in Business, VC funding, Sports, and Entertainment read this column. Is there a person in the world, or in the US with whom you would love to have a private breakfast or lunch, and why?

LeBron. I’m a huge sports fan and even growing up in Boston, I still love LeBron. The amount of pressure that was on him from a young age is something that would break most people. Not only has he crushed it on the court, but what he’s done off the court is maybe even more impressive. Not only is he a great businessman, but he gives back to the community. I know he takes self-care seriously, including taking care of his mind and behavioral health. Knowing the importance of physical activity and health equity with behavioral health, I think LeBron could have a massive impact on behavioral health across our country.

How can our readers further follow your work online?

You can connect with me on LinkedIn or visit rula.com to learn more about Rula Health.

Thank you for your time and thoughtful answers. I know many people will gain so much from hearing this.

About The Interviewer: Stephanie Greer, PhD is the Co-founder and CEO of Akin Mental Health — a company dedicated to guiding families on their journey supporting a loved one with mental health challenges like bipolar disorder, schizophrenia and severe depression. Stephanie is passionate about this topic from her own personal experience growing up with a mother who struggled with bipolar 1 disorder and found a path forward to overcome the obstacles and live well. Stephanie’s professional experience includes a doctorate in neuroscience as well as design research roles at Hopelab and Apple. Stephanie brings this personal passion together with her world-class science and technology background to support families across the US in their personal journeys supporting loved ones with mental illness. To learn more about Akin Mental Health and join our community, visit us at akinmh.com.