Little Otter cofounders Rebecca and Helen Egger
Any parent whose child needs mental health services likely knows the pain of months-long waiting lists and high out-of-pocket costs for experts who don’t take insurance.
Today, Little Otter announced the launch of its service to improve access to quality mental health care for kids and families. The company provides therapy, parenting support, education, and medication management if necessary for children with anxiety, ADHD, depression, and emotional or behavioral challenges. Annual or three-month memberships cost $30 per month, though some provider consultations cost more.
Little Otter was founded by Dr. Helen Egger, a renowned child psychiatry expert and former chair of child and adolescent psychiatry at NYU Langone Health, and her daughter, Rebecca Egger, a computer scientist who previously worked on the Chan Zuckerberg Institute infectious disease program. The company’s services are built on proprietary assessments based on Helen Egger’s decades of research.
The company’s origins are personal, too. One of Egger’s sons has a rare autoimmune illness which presents with psychiatric symptoms. Her direct experience as a mother in the healthcare system highlighted how much of a privilege good mental health care is.
“I wanted every child to get that,” she said.
Rebecca Egger also benefited from access to good mental health care, having gone through ups and downs as a child. “I got amazing care because of who my mom was,” she said.
Many kids aren’t so lucky.
Nearly one in five children in the U.S. has a mental health need, but as many as half don’t get the care they need.
Studies show that only 17% of child psychiatrists have available appointments and the average wait time to see a child psychiatrist is 43 days. At least half of psychiatrist’s offices didn’t return calls seeking appointments.
In the U.S., there simply are not enough child psychiatrists to meet the demand. Nearly three-quarters of U.S. counties have no child psychiatrist. Even where there are psychiatrists, only 55% accept insurance.
“Child and adolescent psychiatrists were hard to come by even pre-pandemic,” said Dr. Anjani Amladi, a Board-certified child and adult psychiatrist in Sacramento, California.
Demand has only grown during the pandemic without schools and structured activities to provide at least some support to kids with mental health needs.
Remedying the dearth of child psychiatrists is not an easy fix.
“At the end of a very long and expensive journey through medical school, asking somebody to do another year or two of subspecialty training is difficult, regardless of whether or not they love working with children,” Amladi said. For many doctors with college and medical school debt, a child psychiatry fellowship is not an option.
“You cannot solve this just by creating more providers,” said Helen Egger. “We have to leverage technology and data science and particularly tele-psychiatry and tele-mental health approaches if we are going to even get a dent into this.”
Enter Little Otter.
“We’re providing more care and we’re going to provide more efficient care,” said Helen Egger.
Investors have been betting big on telemedicine and telepsychiatry to increase efficiency and expand capacity to meet rising mental health demands.
“I think we were at just the beginning of a revolution in consumer healthcare,” said Jonathan Keidan, founder and managing partner of Torch Capital, which led $4.2 million in pre-seed and seed investment in Little Otter. “People are so frustrated with healthcare in every way. It's not personalized. There's no follow-up. It's so inefficient. So all of these things are just ripe for new founders to come and help manage and make better experiences for patients.”
Because child mental health care requires different processes and expertise than adult services, most existing mental health companies cannot simply extend their services into pediatrics.
“You really have to start from scratch,” said Keidan. “You’re really treating the family. There’s a lot that goes into that.”
When California-based Ellen Keith Shaw joined the Little Otter pilot, she didn’t realize initially how much focus her family would get. She was just looking for support for her six-year-old son, who’d been intensely vocal about not wanting his little sister since she was born three-and-a-half years ago.
“I’ve had three years of chaos,” Shaw said. “So I’m trying to find a way to get through that and have us operate as a family, [because] she’s not going anywhere.”
Before trying Little Otter, Shaw estimates she had spent at least $10,000 dollars on parenting coaches, meditation programs, and therapists. “You name it, I’ve tried it,” she said.
Like many parents, Shaw wasn’t sure if her son’s behavior was normal. The family consulted a Little Otter psychologist and found he does not have a mental health diagnosis. But they benefit from a Little Otter parenting coach who provides ongoing support, organizes resources, and coordinates access to a couples therapist for Shaw and her partner.
“I would say maybe the biggest change is not so much in him, but in how we’re showing up,” Shaw said.
Frayed by the stress of the pandemic, she feels better equipped to handle challenging parenting situations and plans to continue working with Little Otter now that the pilot has ended.
“It feels like Little Otter’s our village,” she said. “I’m not totally alone in parenting.”
Shaw’s experience demonstrates the precise impact the founders envisioned.
“We’re really focused on understanding each family’s unique story,” said Rebecca Egger. The company’s tools identify and triage families’ needs and connect families to appropriate resources. “We see ourselves as an advocate for childhood mental health and for families, and that doesn’t always have to be directly through providing care.”
For children with mental health disorders, Little Otter hopes to speed up access to care.
Most adult psychiatric disorders start before age 14, according to Helen Egger, which makes early intervention important and long waiting lists to see specialists particularly detrimental.
“What if we invested in our youngest children?” she said. “That’s the way we’re going to create the healthiest adults and the healthiest society.”
