Ernie Wallerstein, Jr., CEO of Mental Health Technologies



    How can technology be used to treat - and even model and predict - mental health?

    Ernie Wallerstein, CEO of Mental Health Technologies, thinks he has the answer.


    About Ernie
    Ernie has over 30 years of executive management and sales experience in software and cloud computing.

    Prior to founding MHT in 2018, Ernie was the president of Americas for Enghouse Interactive, a publicly traded telecommunications company. He also held management positions in a tech start-up that went public, as well as the SVP of Sales in a $500M+ company that was sold to private equity. Ernie enjoys golfing and spending quality time with his family and friends.  


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    Access the complete transcript of our chat with Ernie below.



    I'm very excited to have with us Ernie Wallerstein Jr., President and CEO of Mental Health Technologies, or MHT. Ernie founded MHT back in 2018 and before that spent his career in big tech startups, few other companies along the way. You can read his full bio in the show notes.

    Mental Health Technologies is a cloud-based platform for testing and screening patients for behavioral health disorders. It aids professionals in addressing the growing challenge in providing services for mental health and substance abuse. By focusing on ease of use for both patients and providers, objective data collection and enhanced billing practices.

    MHT's goal is to horizontally integrate the entire mental health process for healthcare professionals. We'll get into the tech and its applications here a little bit more with Ernie. Thanks for joining us today. 

    Thank you, Kelly. 

    So jump right in. Tell us briefly about what led you to jump from the tech and telecommunications industry to addressing something as challenging as mental health and substance abuse for healthcare. 

    I appreciate that question. I was, at that time I was president of Americas for a publicly traded company in 2018. It was a company that acquired a company I had run before that always in software communications and cloud computing, and was introduced to a psychiatrist who had this idea for simplifying what's called psychometric testing. Basically mental health or substance abuse testing, and providing that information to healthcare providers so they can provide better care for their patients and wellness. And with the growing concern around mental health he had this great idea, but he wasn't a technologist, he wasn't a business person, didn't know how to do it.

    And I just jumped at it.  I'd had a good career up to that point. Thought this was something a lot more meaningful to go do. And there is an opportunity for technology. Technology's not gonna solve the mental health issue, but can help close that chasm a little bit. And it was an opportunity.

    So it was really good. Perfect timing. I met this psychiatrist. He was a great guy. And three weeks later I gave my company notice that, hey, I'm gonna... go find a new president, I'm gonna go do this thing that I think's more important.  If nothing else, Kelly, gets me a little higher on Maslow's hierarchy of needs and a little self-actualization going on.

    Oh, I love that story. It's exciting to have folks, partnering with industry, right? We're rife with people with great ideas, but maybe don't know how to do the tech side or don't know how to, optimize this idea that they have. So good on you for taking that on.

    What about this technology makes it so a clinic or a physician would want to use it? 

    I think, the healthcare industry or the population in general realizes the growing concern around mental health, and I use the term behavioral health and that encapsulates mental health and substance abuse.

    So I'll use the behavioral health term. It's this massively growing concern. And COVID grabbed everyone's attention. But behavioral health is probably a larger healthcare issue and COVID actually exacerbated that problem big time. And healthcare professionals have been wanting to know this information. They're intimidated by it. So, the vast majority of healthcare happens at primary care and primary care physicians can easily be overwhelmed dealing with behavioral health issues. And quite honestly, there's not enough behavioral health professionals to help all the people who need help.

    So, the key for mental health technologies are companies like us. In order to identify people who need help, but also stratify the level of help they need. And technology can do that, right? So you're using these standard screeners and it's not perfect, but it's going to give you a snapshot.

    It's like an SAT test, if you will, for different disorders. And it allows you to have a snapshot of where that person's at. And based on that make proactive decisions of what kind of help they can need. Can they get some self-help? Can they just get some aided tools on the web? Do they need to talk to a therapist?

    Do they need to talk to a psychiatrist? Is this person potentially suicidal? So using this technology, we make that information in real time available to healthcare professionals when a patient has an appointment. 

    Wow. What kind of impact are you seeing already then with this? 

    So the most obvious example would be like suicidal thoughts, suicidal ideation. And that's just a small piece of what we do. So last year we did a little bit over 25,000 depression screens. And in those depression screens, adults, people 18 and older about 9% of the time they had suicidal. So they're admitting that, hey, they think about it, right?

    The more alarming number for me was we also tested a really good pool of children, 11 to 17. And the propensity for suicidal ideation there was almost 20%. So that's scary. And statistically, if you look at like the CDC stats 50% of all behavioral health issues go undiagnosed or untreated.

    And then last year there were about 900 million doctor visits in the US. The average US citizen goes to the doctor 2.7 times a year, right? So let's just do the math. So, at about 20% of the time, someone's gonna have a behavioral health disorder. So 900 million visits, 20% of the time, that's 180 million times people went to the doctor who had a behavioral health issue, and statistically 90 million times no one did anything about.
    This is the United States. The problem's worse elsewhere.  I'm talking to a company in the UK, they're way less prepared for this. So as bad as it is here, it's even worse elsewhere in the world. So some of the goal for MHT will start here.

    The nice thing is technology travels well. So, the goal would be to take this  and expand the footprint  and bring this solution in other avenues. So in the US it's a little bit easier because it's reimbursable. So there's a financial aspect to this because we're in a commercial environment for healthcare.

    When you go elsewhere in the world, a lot of it's social medicine. But the big thing there is they need to know how big the problem is. So, you're in London. And you want to know in 2030, how many depressed people, how many people with anxiety, so you start taking this data that we're accumulating and you cross-reference that, and you're starting to be able to now model on a population basis behavioral health needs.

    Because like I said before, Kelly, there's not gonna be enough people to help everybody who needs help. So you have to build platforms, systems. Methodologies, tools, technology, non-technology. Technology is part of the solution. It's also part of the cause. It's quite a dichotomy, right?

    Because technology, especially with kids, is a contributing factor to this problem. 

    That's interesting too. And I've often wondered... you hear in the news that the US has all these mental health problems.

    It's nowhere else. And I wonder sometimes, are we less afraid to talk about it? Is it because we're in a reimbursable payer model with our healthcare system that, while it has its drawbacks,  makes it a little more accessible to us too? I wonder why that is. 

    I'm not clinical enough to answer that.

    But based on having done this for four years and all these touch points and seeing results from hundreds of thousands of tests and having conversations with people outside the US, I think. For lack of a better term, I mean, we're more in tune with this.

    We're way more technologically enabled on average than the rest of the world. If you think about it, so China's this massive economy and yeah, there's 200 million people with tons of technology. There's a billion who don't have technology.  India, all these people, so like on average, there's a lot more access, accessibility to technology, and again, to the prior point, technology is both a cause and also part of the solution, right?

    So the upside, I think, Kelly, is our kids. The kids, the generation behind us.  I have two boys. And they're way better at talking about this. They're way better at talking about social issues than I was. And they're also massively influenced, right?

    I always give this analogy of, when I was a kid if there was a bully, I had two  choices. I fought or I ran, right? Today, bullies are virtual. You could be a 10 year old girl and have 3000 people commenting on your Facebook post or your Insta post.

    And that's insane. So anyway I think what we do at Mental Health Technologies, we try to inform healthcare professionals to have a better snapshot of where their patient is. And I really have a personal hope that it has an impact on the generations behind us to give them a little bit of a better starting spot.

    Cause I don't know that we've given them the best starting spot. 

    No, we haven't. And I think too, even when we had, or maybe we were on a better track, than we have COVID, you mentioned that earlier. We saw several headlines about the increase in mental health, substance abuse problems since the pandemic.

    I mean, I have two kids as well, who figure out how to homeschool and all those things, and then go back and  really, I think my older son is a little better equipped. My younger daughter is kind of struggling with the social aspects of having been stuck at home for a year and a half.

    Sure. Isolation is tough. Yeah. And it really is. It really is. And so, yeah, she spends more time on her device and yet that makes things worse.
    So how has the pandemic changed your product or your strategy?
    Big impact there. 

    The, so the pandemic impacted us twice, right? So, and in the long run, the pandemic itself,  I believe at least in the United States, has shined the light on the behavioral health issue and how important this is. On the back end of Covid, there is, using your daughter as an example, there's this long trail of people that were impacted on it by it, right? So the initial part was our audience, our healthcare providers, right? We're a B2B, we're not a B2C. So we built a technology that is very easy to use in a healthcare environment so they can provide this testing and screening, if you will, to their patient population.

    So COVID hits and that slows the entire market down because healthcare industry had to learn how to do tele. So the average doctor, nurse, physician's assistant isn't a techie, right? They're clinical. And so they had to learn technology. They had to learn how to do video conferencing, right?

    Nobody benefited more than Zoom, right? So that slowed down. Like they knew they needed to do this, but, hey, hold on a second. I have to show a doctor how to do a video conference. And I have to teach my admin staff how to tee up that video conference call on behalf of the doctor.

    So all that happened, so it slowed us down a little bit. But again, it shined a big light on behavioral health. The bigger issue, Kelly, was on the back end of COVID, there was a massive impact on the US workforce. People didn't go back to work. So we built this tool, right?

    So I come from a cloud computing background, my CTO comes from a cloud computing background, and we really focus on UI, user experience, UX, how do we make this as easy as possible to administrate. Back into COVID, there was no one to train on how to use the tool because the administrative layer in healthcare is entirely transient.

    Unbelievably vicious cycle of turnover, right? I have a customer who had 120% turnover of their admin staff, so they  turned everybody over, trained people and still lost another 20%, right? So on the back end, we spent the vast majority of last year, Kelly, automating the entire process.

    So no one has to touch MHT. So we integrate with the back office application and healthcare, which is called an EHR, electronic health record. We get triggers based on appointments. We algorithmically figure out if the patient should be tested and what test they get based on the rules of that healthcare clinic.

    They tell us what the rules are. We built the tool, the wizard, we send an email or text message to the patient. They take it and then we write those results to the EHR. So we actually spent the entire year of 2022 making it so that our customers actually don't touch MHT. Everything resides in their EHR, which is their single source of truth.

    So for all intent and purposes,  MHT becomes a system of action. And the EHR is a system of record. An analogy to that would be in financial services, right? Everything sits in their financial app, their Jack Henry or their Fiserv application.

    But there's all these tools hanging off it, but nobody touches those tools. Everything resides in their single source of truth. So in healthcare, that's the EHR. 

    I know my brain is spinning now. Here at Qualio we're in software as well, and we're always talking about the data and where it resides and whether or not we have to protect it.

    And of course in the life sciences industry, you have things like complaint files, but complaint files can contain PHI. How do you architect all of that to then protect the data and all. That's quite a complex problem.

    We actually thought of that in advance. Because when we built MHT, and again, both unluckily and luckily I wasn't a 25 year old starting a tech company, right? So the unlucky part is I'm not a 25 year old person starting a tech company. That's the horrible part.

    The upside is you already knew some of the things we needed to do as table stakes, if you will. So we actually built MHT on a cloud platform that's easily portable. And we normalized and built out the data dictionary in a way that we knew it's already fully encrypted. It sits on an encrypted instance, and we can take that and replicate it in another country.

    So we actually built this with the idea of very quickly going to the UK and going to Canada. Even though the product is multilingual, right? So especially in the US it's English and Spanish, right? So we know from the EHR if the person is Hispanic, and then we would send the test in Spanish.

    It's important to me.  I'm actually, I'm a Cuban background, my family are immigrants from Cuba. So that was an important piece of it. 

    That is important. Absolutely. No and making it friendly and accessible to people where there's this, I don't know, segment of the population, right?

    That they don't trust technology anyway and yet they're probably more in need of some of these kinds of services. And so it's like you gotta overcome this idea that you're not gonna just be talking to a person. 

    It is a great point. That's actually something we're still trying to crack the code on because there, there is a massive part of the United States population that is, underserved, for lack of a better term, in healthcare.

    And that underserved community, by and large, does not trust the federal government and does not trust institutionalized solutions.  So we have to figure out other ways. So we're in a community mental health center and when they walk in, there'll be a kiosk there and they can take their tests.

    They can do it anonymously so we're making it as easy as possible to get this data so that the healthcare provider knows if there's something that needs to be addressed beyond the primary complaint. The analogy Kelly, would be, I go in cause I can't sleep. Am I depressed cause I can't sleep or am I not sleeping cause I'm depressed?

    That's an important part of  finding out the root cause, right? 

    Absolutely. Pivot a little bit. We have a lot of founders who tune into the show and our founders have lost at least a few hours of sleep along the way on their go-to-market strategy. Walk us through your go-to market strategy at MHT. 

    Sure. So we made a conscious decision to go B2B versus B2C. So our customers are healthcare clinics, our healthcare providers, right?  So from a GTM, we're not spending a lot of time on consumer based marketing. And that's on purpose. Like, at least from my experience, that's a different thing.

    That's a different animal. It's actually not my background. So that had something to do with it. But that's not the lead. Cause there was just, there's other companies like MHT out there, they're more focused on the consumer and doing some type of self-help tools. And then we took the stance of let's get this information in the people that are providing the care, right?

    So the real key for us is primary care and then automating a referral to behavioral health. So we do that. So you go to primary care and if you indicate, we'll ask you if you wanna talk to a behavioral health professional, we'll automate that referral. So we take the people out of making that decision and make that much more efficient.

    In terms of our go-to-market strategy, we focus on healthcare providers. We're mainly focused on large, private, and our entire strategy, Kelly, is around a hub. So basically we get a large behavioral health provider that has a couple different attributes. The biggest one is they have capacity, they have the ability to take on more patients, right?

    And we work with them, they start using MHT but then we actually partner with them and go after primary care providers in their geo to automate the referral process.  So that's really our go-to-market. Our go-to-market is a hub and spoke approach and it is around B2B. Does that make sense? And it took a while to get that going. 

    So it took a while and now it's taking off because I think things have calmed down from Covid and they realize that they have to go address this.

    Yeah. And they're just way more open to it. And, using MHT whilst providing massive clinical value, there's a financial benefit to it, which is critical in healthcare. 

    And anytime we can simplify that too, then you start to see a little bit of that whole economy of scale thing.

    Instead of referring these things out, or do I need to refer these things out? That kind of thing. The doctors actually have the brain space to engage. 

    Sure. And they have data points, so doctors are doctors, nurses, and PAs, physicians, assistants, right? They're flying around. They're seeing 2, 3, 4 people an hour, and it's hard for them to engage the conversation, but we're giving them a heads up and saying, Hey, here's a snapshot. Here's this Polaroid of where they're at. Start the conversation two minutes in. And that's critical to them, right? From a time efficiency standpoint.


    Well, we love seeing tech like this that's very patient-centered as well. How do you see this tech and its applications evolving over the next decade? 

    Think the future for MHT is we are going to really focus like when you talked about  go to market, we're now more focused on business development partnering with people than we are marketing itself.

    Like we do a ton of marketing. We're really good at social media, but our big thing is we look at behavioral health and our technology. As sort of a highway, right? So you are screening people for behavioral health issues. Now they're on a road. You need a bunch of exit ramps, right? Because some people can do self-help, some people can go to website, get help.

    Some people need to see a therapist, and the last thing you want them to do is go to the emergency room, right? The behavioral health issue in the United States is overwhelming emergency rooms in the US. Yeah, right? It is a significant percent. So the evolution is we will continue to work with complimentary solutions in behavioral health that become part of this continuum of behavioral health services and the screening. 

    The other aspects of this, the biggest thing I see, Kelly, is we're going to take all this data we're going to cross reference and correlate it, from a business intelligence standpoint with treatments.

    So we could do efficacy of treatment, but also do that based on ethnicity, sexual orientation, demographics and actually start building a model that starts predicting behavioral health issues on a population basis. So, I actually always thought from the beginning, that is the biggest thing we'll do.

    The biggest thing we'll do is allow a population to understand both the cause and the propensity for behavioral health issues so they can build programs to be ready for that. Because right now, we are 100% reactive to behavioral health issues. Now we're not in the proactive world. And where I see MHT going is getting into the proactive, like algorithmically using AI, start figuring out that based on these social determinants of health, based on that ethnicity, based on that economic status, we need to go test that person proactively every three months and see how they're doing. Whereas we don't, or we need to somebody who's affluent, but they're in this area, maybe we need to test them for stress every few months. That gets proactive and then hopefully we start cracking the code a little bit and we actually get ahead of this a little bit, cuz right now we're totally behind it.

    Yeah. The proactive idea is pretty impressive. And it's interesting. That's been a common thread and a lot of the folks I've talked to on this podcast, we talk a lot about, we would like to amass this data and then really start to leverage it.

    Or maybe they already have a lot of data and how do we start to look at. Now that we have so much more power in analytics and the AI predictor models, all that kind of stuff. At the same time, it feels a little intrusive. Maybe to those of us who aren't quite so used to having my whole life be on a computer.

    Yeah, there's an Orwellian aspect to it, right? So that's the other key to this thing, right? So the other key to the way we did MHT is  we send someone a link from their trusted advisor, which is their doctor, and say, Hey, we're asking you to take these.

    It's entirely up to them if they take it or not. No one's putting a piece of paper in front of them. They could take it at their leisure, they could take it on their computer, they could take it on their email. Like the one good data point I'll give you, somebody asked me like, all, what do you do in an older generation, right?

    So Medicare people are a big part of our population that go see the doctor. We had ran stats, so over the last year 45% of everyone 65 and older we sent these to completed 'em the first time. We sent them a link. Another 15% did it on the reminder. So 60% of people with over 10,000 data points were completing these assessments on their computer or their cell phone might take 'em a little longer, but they do it at their pace.

    They make the font the size they want, and they're doing it and they're comfortable doing it. That's part of this, right? It's gotta be on your terms when you're talking about yourself. 

    Definitely. I love that. Well, pivoting a little bit again. So if you could go back to the start of your career what would you tell yourself based on what you know now? 

    Less sugars. I think  I would've focused more on automation day one. So people talk about AI and, look I'm a bit older and was writing code a very long time ago, and what people call AI, a lot of times I think people use the term a little loosely sometimes it's really BI instead of AI.

    But leveraging data, to your point, just a second ago and algorithmically. Deducing figuring some stuff out and proactively going to your customer and saying, Hey, here's a model that might work for you based on these million data points. I think I would've gotten into that a lot earlier. I think in most technology companies, we think about data aggregation and business intelligence as a result of what we're doing versus as the driver for what we're going to do.

    And I think if I went back, the 30 plus years I've been doing, I would've told myself, Hey, really think of the data as potentially one of your three key deliverables. And the end point not the result, but actually a goal. Yeah. Because, and what we do here, I don't mean to over-romanticize it.

    The only way to get in front of this behavioral health issue is for us to start proactively figuring out who's gonna need the help before they figure out they need help.  So, I think that was a curious answer to your question, but I think going backwards to make it more succinct, I would tell myself, Hey, really think of the data and what that value is, and architect the product around that being one of the key results.

    I can see that, definitely. I've been in the industry a long time. The same thing, different industry, of course, life sciences, but yeah, feels like we're chasing the data instead of letting the data inform. 

    So inform and also drive some of the technology decisions. I think by and large data is an outcome of our products, and we didn't necessarily architect our products with an intent of resulting data.  That's probably a deeper line than I'm giving it credit for, but when you think of a product, you architect it, you start manifesting it, you start doing all your storyboards.

    If one of your key deliverables is okay, how does this data going to change the narrative? It will have an impact on how you design your product. 

    Another fun question I'd love to ask, please. If I walked into Barnes and Noble, where would I find you? What section? 

    That's a good question.

    It wouldn't be in life sciences. This is actually a technology solution. I defer the clinicals. This isn't the clinical stuff I defer to other people for this is a technology thing. So where would you find me? In the Barnes and Nobles nonfiction and somewhere where you talk about like, humbling success.

    I come from a immigrant family. My parents immigrated here, they came from Cuba. They had to leave the country in two days with three kids and my mother pregnant. We were a very tight family. We didn't grow up with much. And I have very successful brothers and sisters as well, and I'm proud of that.

    I'm proud of my family and I think that where you'd find me now hopefully isn't where you find me in the end because I think, I've done tech for a while and all the tech was business stuff. I'm really hoping that MHT has more of a human impact than some of the other stuff I've done before.

    Sounds like you're well on that path.

    I certainly hope so. I love this, it is a pure techy thing that we're doing. There's encryption, PHI, delivering this stuff results of this. Did a text go? Did a text not go? What do you do with that preference for communication?

    How do you present this information in a very easy, non-intrusive way to healthcare professionals? That's all the tech stuff, right? , but impacting people's lives and maybe helping some people not commit suicide. That's huge. It's cool. That's huge. And I thoroughly enjoy the team I work with and that we're doing that.

    That's exciting. Well, where can folks go to connect with you and follow along with company's progress? 

 and all our LinkedIn profiles are there. I am not basically on social whatsoever other than LinkedIn. I am happy to talk to anybody who's interested either in the beginning of their journey, last thing I'll close with, I've been very fortunate to have some great mentors in my career and I owe that back to some people. 

    So, people want to just talk about how to do this or what they're doing or their ideas. I'm happy to talk to your audience. 

    Excellent. Well, thank you so much for your time today, Ernie. Really appreciate it. What a great story. 

    Thank you so much. Appreciate your time.