Compassion at Scale: How Mental Health Innovations Is Reimagining Crisis Support

0:00:09.8 Kailey Raymond: Welcome to Builders Wanted, the podcast for people shaping what's next in customer engagement. Today's guest is building something truly life changing. I'm joined by Victoria Hornby, CEO of Mental Health Innovations. It's the nonprofit behind SHOUT, the United Kingdom's first 24/7 free confidential mental health tech support service. MHI was founded in 2017 with the support of the Royal foundation of the Prince and Princess of Wales. Since then, they've supported over 3 million conversations, many of them in people's most vulnerable moments. Victoria's work blends empathy and technology, helping users feel seen, supported and safe. Today, we'll talk about how to build trust at scale, why accessibility matters more than ever, and how Mental Health Innovations is proving that digital first doesn't mean less human. Let's dive in.

0:01:02.7 Producer : This podcast is brought to you by Twilio, the customer engagement platform that helps businesses turn real time data into seamless, personalized experiences. Engage customers on their terms across SMS, voice, email, WhatsApp and more. Power every interaction with AI so conversations feel natural, not robotic. Adapt in real time, delivering the right message on the right channel exactly when it matters. That's the power of Twilio. More than 320,000 businesses, from startups to Fortune 500s trust Twilio to transform customer signals into conversations, connections and real revenue. Reimagine the way you engage with your customers. Learn more @Twilio.com.

0:01:51.4 Kailey Raymond: Victoria, welcome to the show. We're very excited to have you here today.

0:01:54.9 Victoria Hornby: Thank you for having me.

0:01:56.6 Kailey Raymond: This should be really fun. You have helped build Mental Health Innovations from a really bold idea into a national lifeline. And just to kind of set the stage for our listeners, would you be able to give us the two minute kind of breakdown of MHI? And if you want to expand, what did you see early on in your journey that made you really believe that this could work at scale?

0:02:21.7 Victoria Hornby: So we ran a campaign, or there was a campaign here in the UK called Heads Together in 2016, 2017, which was really about getting people to talk about mental health a bit more, to start to break down some of the stigma around mental health and to help people to feel comfortable about talking about their mental health. And it was a very successful campaign. I was working at the Royal foundation at the time and we were the instigators of the campaign, but we had a lot of other organizations around us and one of the things that became really clear to us whilst we were running the campaign was that we needed more places for people to talk. Most helplines in the UK were under real pressure with demand and we needed to find more places for people to have those conversations. But I think we also wanted to see how we could use digital to facilitate that, so to facilitate that sort of rapid scale. Because if you can see a need now, then you know that need is going to just get exponentially bigger the longer you take to address it. So during the Heads Together campaign and during 2017, we did quite a lot of research to look at what was happening around the world that was successful, that was showing some of that scale.

0:03:31.0 Victoria Hornby: We could see that there had been significant growth in digitally or tech enabled helpline services and mental health in Australia, in New Zealand and in the US with the Crisis Text line in the US which was just beginning to kind of really kind of gather pace. And we could see that that had happened in a really short. So we reached out to Crisis textline and asked them if we could have a conversation with them to see how they'd done it, to see whether there were ways in which we could learn from their experience. And actually they were at the time just beginning to consider how they would make their technology, the technology that they built for Crisis textline more available internationally. And so we went through lots of iterations with Crisis Text Line around. What were they looking for? What kind of partners were they looking for? And it became clear, I think at that time as well, that you really kind of tech or digital first entity to do that work, bolting it onto another or kind of existing service was going to be challenging. And so over the course of 2017, we came to the conclusion that what would be really helpful would be to create an organization that could deliver what is effectively the crisis Tax line service in the UK, both for ourselves, as it were, as our own organization and entity, but also for other charities that were finding it difficult and other helplines that were finding difficult to operate 24/7 or to kind of transition to a more sort of tech enabled way of operating. And so we established Mental health innovations in November 2017 and kind of began working. I left the Royal foundation at the very end of 2017 and put together a very small team and we got working on establishing what became SHOUT here in the UK.

0:05:20.9 Kailey Raymond: Amazing. And one of the things that you're really touching on you've led policy and nonprofit initiatives at the highest level. But one of these things you're talking about now is the introduction really of technology to be able to scale a lot of your efforts. And oftentimes when I think about technology, I can think about there might be a little bit of some folks that might not want to adopt it. Initially, there might be a little bit of hesitation, if it were. So what does it mean to you in this context to build trust in the space of mental health by leveraging this type of technology?

0:05:53.4 Victoria Hornby: So I think it was very interesting for us that there were, I guess, almost sort of two different sides to it, I think, from our perspective. So there were individuals that we were talking to who had either used helpline services or who had experience of helpline services through family or friends. And for those people, mostly, broadly speaking, tech and text was a bit of a no-brainer. But there was another kind of group, I guess, with more established or traditional mindsets who really felt that text and tech-enabled services, that we weren't necessarily ready for them, that ultimately face-to-face services were best, phone services also, and that text and a kind of tech-enabled text would put people too far away from each other and therefore not be as effective. And so part of our first year really was around testing and understanding how we could use text most effectively, but also how we could test whether or not that connection was still there. Because ultimately, whether you're enabling it through through text or through web chat or phone or face-to-face, it's actually all about that human connection.

0:07:05.4 Victoria Hornby: So could we learn more about how to make that human connection as effective as possible using text and tech in order to be able to do that? So we spent quite a long time testing that out. And actually, we found for a lot of people, it's very instinctive. And so it's really a question of finding the people that had that sort of intuition, but also people that found it not too difficult, I guess, to find their voice in text, which I know always sounds strange, but that is what kind of makes it work best, is that sense of finding your voice and finding that connection.

0:07:43.6 Kailey Raymond: That makes perfect sense. And I like that you've kind of used this term already. It's like this human connection, really, that you're trying to facilitate. That's the outcome. How do you define success for MHI when that is the outcome that you're looking for?

0:08:00.8 Victoria Hornby: I think for us in a couple of different ways. So obviously, it's the number of people we reach. So we've just passed a million people, million individual texters, which is amazing. So that's great. That feels like an incredible milestone. So three million conversations, one million people. So that's one measure, I guess. The percentage of people that find it helpful is really important to us. So we measure that and track that as much as we can. And we try and get as much feedback as we can. So we send almost all of our texters a post-conversation survey, and about 20% of texters fill that in. So that really helps us to understand what people find helpful and useful and what people find less helpful and useful. And then we can feed that back into our training and into the way we train and support and supervise our volunteers. I guess the other way that we try and understand whether it's helpful, which kind of links back to things like analyzing surveys, is really understanding what the data is telling us about who we're reaching. And one of the things that we have found is it's SMS, partly because it's free and it's off-bill.

0:09:09.2 Victoria Hornby: And so it's very, very accessible for people. They don't need to have a smartphone or data, is that we're reaching some of the most disadvantaged communities and groups in the UK. We're also reaching a lot of people who have felt or do feel marginalized or who feel stigmatized by who they are or how they're feeling. So that for us is really important. And that is a constant challenge for us. We've done well, but we still have further to go in terms of reaching communities that we're not yet reaching and those that are most likely to be impacted by their mental health.

0:09:50.1 Kailey Raymond: It's really interesting that you're bringing this up because I was going to ask this question is you've brought up folks that might be marginalized that are using your services. And I do think that in many ways technology can do a couple of different things. Like in some ways, perhaps if it's a very new technology, people might not want to adopt it. But conversely, with SMS, like actually an older technology, something that is free, it does seem like that's building accessibility into your audiences. And so it's playing a role in making sure that mental health is accessible to these communities. What's the cost of not innovating in this type of space?

0:10:30.6 Victoria Hornby: I think that the biggest cost probably is that you leave a generation behind or that you are always one generation behind. We have a lot of younger people that use our service and I think we need to be where they are. And that means thinking about how do we reach them in ways and in means that they find easy and accessible, where there are the fewest barriers to them to reaching out for help. So a lot of people reach out to us in a mental health crisis and that's really important. But a lot of younger people reach out to us because they are feeling confused or anxious or worried about the world around them or the situation they find themselves in. They're not in what you would term sort of clinically as a mental health crisis, but what we think is really important is that habit of reaching out for help is made as early as possible and is made as accessible and easy as possible. So the fewer kind of challenges and barriers you put in the way, particularly of young people in asking for help, the more you're going to be able to get them to come to you at an earlier stage.

0:11:32.9 Victoria Hornby: And really with mental health, as with everything else, early intervention has got to be the way to go. And I think that is really where the innovation over the next few years needs to come. We need to be using innovation, digital and technology to reach young people earlier. In the UK, we have seen a steady increase in the number of young people really feeling challenged and distressed with their mental health. And they tend not to often sort of surface, if you like, until they either feel that they're in some kind of crisis or they have been feeling alone with how they are, with how they're feeling for a long time. And so those feelings and that way of being has become quite embedded. So we want to get earlier and quicker. And that means innovating. It means being in the places that young people are not just in the places where young people go for help, but in the places where young people hang out for good reason, as well as for worrying reasons.

0:12:41.1 Kailey Raymond: That makes a ton of sense. I recently read The Anxious Generation, which I'm sure you're intimately familiar with in your line of work and the rising rates of anxiety and depression amongst young people. But what you're saying is really, really interesting because tech space support is really simple, but it's this really powerful shift because to your point, it's meeting people where they are. It's reducing the friction in the journey that you're creating for them to access care and help and preventative health care. And so what have you learned by engaging people through SMS? 

0:13:18.3 Victoria Hornby: So we've learned, I mean, first of all, we've learned that people find it easy and that's partly because it's silent. It's partly because you're not going to be overheard. It's partly because often people have got a really deep sense of shame about how they're feeling. And it can be really hard to put that into words. So I think that text is really helpful for that. I think we certainly see that people feel calmer often. So you send a text, you receive a text. It's a bit like slowing down your breathing. All of which are just kind of simple tools. But for people that reach out for help from us, they send a text, they get one back. There's that sort of instant connection. And that helps to bring down those levels of anxiety and for them to feel their way into the connection so they can share what they want to share. They don't have to share if they don't want to. And I think we often see people who start out the conversation with us in a very nervous or apprehensive way. And as they get into the conversation, they feel more comfortable. And that's partly because they have time to read what we've sent them and think about it and consider it and then send it back.

0:14:33.0 Victoria Hornby: So it's often quite calming in itself. Just the process is quite calming. But actually, it's up to you what you want to share or not share. And you can compose, recompose your messages, which I think we all do quite a lot anyway in our kind of day to day. And then I think the other interesting thing about a text exchange is that I think often people feel a bit more in control of a text exchange than they might do in terms of a phone call or face-to-face. It doesn't have as much of a kind of leap of faith in many ways as it does to attend a face-to-face meeting or to make that phone call because you can kind of feel your way into the conversation a bit more. And it is anonymous and it is kind of, it's easy to feel that you could walk away if you want to or you can just finish the conversation or just not respond. So it has less of an apprehension in itself, which is really helpful.

0:15:31.4 Kailey Raymond: That makes so much sense to me. You're saying this as somebody who can remember what it's like to text in T9 of like just waiting on somebody. But like what you said, like the calmness of it, like somebody is going to text you back, the rhythm of that actually slows you down and that you have the ability to think and know how you want to respond. That'll stick with me. That's really resonating with me. You've kind of mentioned this already. You get surveys back from some folks. Obviously, you have usage patterns and volumes and those types of things. So all of this data that you're aggregating over time, I imagine, has the ability to provide feedback into improving your services and kind of adapting what you're doing. So walk me through that. Like, what are some of the ways that this data, these surveys or other things that you're collecting and looking into helps you adapt your services to improve them?

0:16:26.6 Victoria Hornby: I mean, we're incredibly lucky because it's text and because we have a really good data insights kind of analysis team. So we now have three million conversations worth of data, and that really helps us to look at a whole range of topics so we can look at the things that people find helpful, the things that people don't find helpful. So, for example, we know that if one of our volunteers or one of our team is somehow sounding a little bit robotic or impersonal, that's really not helpful for the texter. So we have adapted our training to make sure that it can be super nerve-wracking as well when you're the volunteer. And so really helping people, I said earlier, that thing about finding your voice and that it is your personal voice that is the most powerful tool in volunteering for us. So, of course, the training is really important, but actually taking that training and making it your own and for it to come out in your own voice, that is what really, really resonates for a lot of people. So things like that have really helped us to kind of be in the loop.

0:17:30.0 Victoria Hornby: I think the other thing that we often use the data and data insights for is to understand either people that we're not reaching or specific groups of people that have started to use our service. And sometimes you'll become an organisation which is signposted to particular groups of young people or particular groups of people. So, for example, we have a lot of people who identify as being neurodiverse who use our service. And so we provide a bit of additional training around helping our volunteers to communicate most effectively with people who tell us that they are neurodiverse in some way. That, again, helps us to kind of build out on the training and build out on how we support our volunteers, but also how we can then feed that information back into whether that's kind of government reviews around mental health of particular groups of the population. We try and share the insights that we have from our texters, which is so important because they are people's own words. They're not our words. They're not our conclusions. They are their own words. And we have really, really poignant insights, I suppose, from different groups of the population who are experiencing different conditions or different circumstances.

0:18:51.5 Victoria Hornby: And being able to feed those in and being able to feed it in that really sort of visceral, personal way is really important.

0:18:58.9 Kailey Raymond: Yeah. I mean, I really love what you're saying about making sure that you're training people to respond in their own voice because this level of personalization, meeting somebody where they're at, really this human connection to the original part of our conversation, I think, is what we're striving for. And my brain in this conversation immediately goes to chatbots and AI and what that looks like in the future. But I want to ask you a slightly different question, which is, is there something that you think that people might often misunderstand about building technology for emotional and mental health support? What would that be?

0:19:36.8 Victoria Hornby: I think that people assume, so when we say ours is a digital service, then people assume that it's not very human. The reality is, is that we are using technology to connect a person who is struggling with another person who has decided and trained to help someone exactly in that moment. And that connection, so there's a connection, there's a technical connection, and then that facilitates a human connection. And that means that we are able to provide that service and that connection at scale and 24 hours a day. We have a team that run the sort of technical oversight of our service from New Zealand overnight. And that's good for our team because working a 24-hour shift pattern is not great for anyone's well-being. So we are incredibly lucky to have an amazing team in New Zealand. They support our nights from their days. That's kind of better for everyone. And the person here in the UK, they may be connecting with someone who is literally the other side of the world. And that doesn't change the value or the nature of that connection. So you can see that that has enormous potential as technology improves. We're always going to need more people to help. And so thinking of technology as the enabler of that connection is really critical.

0:21:03.0 Kailey Raymond: Yeah. Kind of like the original thesis of the internet, the great information flattener, right? It gives everybody access to all information at your fingertips across the world. Same thing with connection. If you can have another human being sitting 5,000 miles from you, you can talk to them in real time. That's still a human connection that you can feel. I'm wondering if there's a moment in this work that you've been doing if you sat down with your team because you really just had to pause or kind of shift course because something didn't go quite as you had intended.

0:21:35.9 Victoria Hornby: It's very interesting that our timeline spans the kind of COVID timeline. So we launched the service publicly. So we operated it as a kind of white label for other charities for a year. And then we launched it publicly in May 2019. And we did a big kind of public launch and it was quite a big bang and that was all very exciting. And actually, within the space of a day of launching, we had 15,000 people volunteer to volunteer for us, which was amazing. And we had lots more people texting in and all that sort of thing. And then less than a year later COVID comes, we all go into lockdowns. And that had an enormous impact on our service. So over the course of 2020, we went from doing between 500 and 700 conversations a day to up to 3,000, 4,000 conversations a day. Particularly in the UK, we had a lot of unexpected announcements around school closures or the kind of rules around meeting up with people. And a lot of those were quite shocking and distressing for people. And so we had this enormous growth. And I think a lot of that growth was really, to some extent, facilitated by the fact that so many of our volunteers who we trained over 2019, early 2020, were now at home and they couldn't go out.

0:22:54.7 Victoria Hornby: And so we had a volunteer capacity to meet the need. And that was extraordinary. And people people who were either not working or working from home had a much greater capacity to be there later into the evening or on a Saturday night or on a Sunday night, all the times of the week when otherwise might find it difficult. And so for us actually, and that went on through 2021, and we had expected after COVID for the numbers to drop, but they didn't really. But what we did find was that not surprisingly, a lot of our volunteers wanted to go back to life. They wanted to go back to their lives. And so we had to really kind of radically rethink our volunteering and the way we recruited and managed and supported volunteers in order to maintain that, in order to maintain the numbers that we had. And that was quite a that was quite a challenge and it required quite a kind of shift for us. And it's funny, we'd at some points during the pandemic, we had more volunteers than we had Texas on some days.

0:24:00.0 Victoria Hornby: And so we had to really adapt to that and we had to find new ways of recruiting volunteers and also find new ways of making sure that we had the capacity we needed, particularly middle of the night, early hours of the morning, where people do volunteer for us at those times, which is absolutely amazing. But it's quite a life-changing time of the day to volunteer. So yeah, that's been something that we have had to really sort of adapt to is the first two, three years have been very different from the next two, three years.

0:24:34.9 Kailey Raymond: That's really interesting. It's also so interesting that you had this kind of like surplus of folks. Awesome, you had the surplus of folks looking to volunteer and then the shift of COVID completely changed the demand spectrum for what you needed and then kind of like met in the middle. That scale also must have been just like unbelievable to watch in a very short amount of time. And as a support service, I'm wondering, what's the trade-off between speed and stability that you need in a way when you're scaling? How did you make calls between speed and stability?

0:25:09.4 Victoria Hornby: We had this massive period of scale and we have very much tried to kind of consolidate since then. So I think one of the reflections for us over the last sort of year, 18 months certainly, is that we have large numbers of people using our service because they're feeling alone and they're feeling unconnected. And so one of the things we did last year was merge with another digital mental health charity called The Mix, which provides more of a kind of online community for young people. So a very strong peer community and a very strong set of resources and opportunities for young people to connect with each other, whether that's with a peer, whether that's with a near to peer, a slightly older, and then huge banks of resources and lots of other learning and opportunities for young people to learn more about their mental health. And we felt that was really important because we could have set ourselves up to continually grow the SHOUT service from 1,500 to 2,000 conversations a day to many more. But I think it's been our view that whilst we absolutely need to provide the crisis services that we're providing, we also want to provide something a bit longer term and a bit less kind of crisis dependent, if you like.

0:26:30.5 Victoria Hornby: So that if people come into the SHOUT service because they are feeling overwhelmed by something going on in their life, that we can provide that support in the moment, but we can then also pass them on to something which is equally has all the same features as our service. So it's silent and it's private and it's confidential and it's about human connection, but in a different way and in a way that is designed to support people over a long period of time. So it's not our ambition, which sometimes seems odd particularly when you're a kind of tech type organisation, not to sort of grow and grow and grow what we're doing from a crisis perspective, but to spend a bit more time thinking about, particularly for young people, so about 65% of our texters are young people under the age of 25. How can we help those young people once they have got past that moment of crisis, how can we help them to find a strong kind of community online that can help them, where they can find other young people who they identify with and who they can build connection with? Because one of the one of the things that came across to us most obviously with the young people that were using our service was that they were feeling very alone and like they were the only ones experiencing this, which is normal.

0:27:51.5 Victoria Hornby: We all kind of look at other people in our daily lives and think, oh, their lives seem great and my life isn't so great. And social media does a lot to amplify that. So yeah, that for us has been very much about responding to what we're seeing, but responding to it in a way that enables us to help to provide that missing piece for young people. And for some people, it will be a conversation with us will be enough. And for others, a kind of longer term engagement with their peers will be the additional support that will help them through whatever period they're in.

0:28:28.7 Kailey Raymond: I love that you're working with this sense of community because I mean, we're recording this, it's during Pride Month as a gay woman, like the community that I lean into every single day is extremely important to my sense of self, to not feeling lonely in this experience. You've mentioned a couple of these kind of anecdotes throughout our conversation, but I'm wondering if you have a story, could be big, could be small, that might capture what Mental Health Innovations is really about and why this work matters.

0:29:03.3 Victoria Hornby: We have a couple of internal stories, which I love. We have a couple of people who started with us as texters. So their first experience with us was texting in. And then a little while later, some people actually, we've had people who've been amazing at they use our service and then maybe they'll do something for they might do a run or a walk or a cycle or something like that to raise money. But actually a lot of people then volunteer for us and they go through the training and they sort of it's that sense of will it work for me? And now I would like to give some of that back. And I think we certainly feel that people that have been through that experience, and if you like, kind of come out the other side, are amazing volunteers. But we now have a couple of those that have transitioned from volunteers to staff members. So they've changed, they've got their professional training and they've staffed and in fact are one of our very first cohort of volunteers. So he trained with us before we went live in 2018.

0:30:04.0 Victoria Hornby: He'd had very much his own experience with mental health. He still volunteers for us today, but he has recently, or not even that recently, actually, a couple of years ago, qualified as a counsellor and is now a counsellor in schools. And for us, that ability to bring people into this world, into the mental health world in a really positive way, there's often few positive stories around mental health. We talk a lot about that spiral down and not very often about the climb back up and the kind of successful kind of emergence from what is a pretty common occurrence. But we don't talk about it like that. But I think for most people, if you think about the course of your life from your early days at school to the kind of friendships and the challenges, often of friendships at school and the challenges you might have at home and exams and breakups and having children and all of those sorts of things. I mean, most of us need help and support at some point in our lives. And so I think we need to get away from it being the exception and that it is the norm to seek help and support.

0:31:18.5 Victoria Hornby: And some people are incredibly lucky and have that kind of support around them, but some people don't have that support around them. But that doesn't mean that it's a permanent downward spiral. There is the upward piece at the end. And I think we're seeing more and more of that now, having done this many conversations with this many people. We're increasingly seeing people who have used our service and are now either contributing to other people who were in a similar situation or contributing in other ways. But it's been really amazing to see some of that sort of progression and those journeys.

0:31:56.4 Kailey Raymond: Talk about a sense of community. I mean, that really shows what you're building. It's such a valuable part of folks' lives once they can understand that they aren't alone in this and that people are generally very willing to lend a helping hand if you ask.

0:32:15.9 Victoria Hornby: I mean, I think the other thing that we're increasingly also finding out about is people that they volunteered for us, they got their skills. We get constant, really great feedback on the way people use their skills in their everyday lives. So, yes they use their skills when they volunteer for us, but outside of volunteering for us, it makes them better parents, better friends, better colleagues. And in fact, we have someone in our team who was a SHOUT volunteer, had the training, did his kind of shifts on the platform, and then was, I think, on his way to work one day and saw someone who clearly was thinking about ending their life. And he said it was amazing to have those skills and the confidence to be the person to be able to approach them and say, can I help?

0:33:06.9 Kailey Raymond: That's amazing. I literally just got chills.

0:33:09.8 Victoria Hornby: Well, it's it's one of those things, isn't it? We don't think about it as skills that we use in our everyday life, but just the ability to have a good conversation what we call the art of a good conversation is something we should all learn.

0:33:23.6 Kailey Raymond: Yeah, it makes you feel more connected. It makes you feel more human. It makes you feel like you're a part of something to be able to connect with somebody one-on-one like that. And as much as technology enabling that, like you're also teaching the skill of going back to the human connection of how to really engage with somebody, which is really beautiful.

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0:34:37.4 Kailey Raymond: I'm wondering if there was something that you did behind the scenes, some sort of experiment that made a really big difference in what you do with either your users or your volunteers.

0:34:48.1 Victoria Hornby: When we started out, we used the, and we kind of inherited the Crisis Text Line training, and it's fantastic training. But it was built around, not surprisingly, and quite rightly, it was built for a kind of US culture and way of doing things. And we had adapted it, but we hadn't really kind of rethought it at any stage. And so we went through quite a long process in 2022, 2023, where we went through a whole process with our teams to kind of quite radically overhaul the training and deliver it in quite a different way. And that was quite it was quite a big gamble. I mean, at one point, you have to stop the training that you were doing and start new training. So there was a kind of gap in between, which is always a bit of a risk because you're not training new volunteers. And I think it's important to say that we don't expect people to volunteer for us forever. A lot of people will volunteer for us at a point in their life where they have capacity and space. And then if they move on and they no longer have capacity and space, that's fine.

0:35:49.5 Victoria Hornby: We do need to keep training people. So there was quite a risk to having that break. And we used a new platform and all of that kind of stuff. So that felt like quite a risk. And I guess for us as an organization that had started very much learning, amazingly, all the lessons that we'd learned from Crisis Tech Sign in the US, to kind of, in a sense, take it not a step away, but just to do things in a different way that kind of made sense for us here. And I think also mental health in the UK operates in a slightly different way. And there were lots of reasons why it seemed like the right thing to do. But yeah, it felt like quite a change. And it felt, I mean, it was obviously a big thing for our team to take on. But I think we feel and we we constantly iterate on the training. But I think we've definitely felt that having that kind of bespoke training, which has been delivered with, based on the experience of our volunteers and our clinical team, and our data team, that that has been really amazing.

0:36:51.1 Victoria Hornby: But yeah, it did feel quite a risk at the time.

0:36:53.5 Kailey Raymond: Totally. Yeah, and it goes back to the idea of personalization. Like the thing that worked in one place isn't necessarily going to be the perfect thing for another. So being able to take that feedback loop and make sure that you're building it in a way that makes sense for you and your culture and in your health system, which is quite different than ours.

0:37:14.2 Victoria Hornby: Yeah, absolutely.

0:37:15.7 Kailey Raymond: I just have a couple additional questions for you. This has been so lovely to get to know you. But I'm wondering, you've been in this space for quite a while. So looking towards the future, is there a shift in mental health or nonprofit tech that you're watching closely?

0:37:32.7 Victoria Hornby: So I think, I mean, it's very interesting how much busier the mental health space is than it was five, ten years ago. So we're seeing lots of online and we're seeing lots of kind of AI-enabled apps and tools, which I think is great. I think we I mean, obviously they need to be carefully managed and all those sorts of things and they need to be safe. But I do think that we need to be careful not to be behind the curve. And I think it's very easy to be behind the curve. So we are very aware of the challenges of using AI. And I think those are kind of well-documented where people might have used an AI chatbot and it's kind of hallucinated and gone off in its own direction. And that's a real challenge. And of course, it is a challenge. But I think we need to be clear that people are using AI to talk about their mental health. I can't remember which paper it was, but we saw a paper recently. It is now the number one use of kind of GPT type chatbots, which is to talk about mental health.

0:38:41.7 Victoria Hornby: And we certainly saw it ourselves when Snapchat turned on its MyAI. Our numbers of young people using our service went up by 25% overnight, literally overnight. So I think we have to all think carefully about how are we going to respond to that. And I think that there are challenges. Of course, there are. I think there are also real opportunities. So from our perspective, about 20% of our texters, first time they text us, don't engage. So they've texted and then when someone says, Hi, my name is Casey. Thank you for texting in. They don't engage. So they either text stop or they just don't respond. And part of that for us that we need to we want to understand is that they just don't feel ready to talk to a human. And are there ways that we can use AI to bridge that gap? So can we begin that conversation on a chatbot, which is supervised and safe in the same way that our service is, but to give people just that entry point so that we can reach that additional 20%, which for us, that would be amazing. And I think we feel that we need to be exploring those things. We've built a generative AI chatbot trained on our data, which we use to train our volunteers.

0:40:07.0 Kailey Raymond: Cool.

0:40:08.1 Victoria Hornby: So it can be a texter and it's very accurate in terms of what you'll expect. So our volunteers, if they want to, can practice multiple times and they can choose what the subject would be. So a lot of our volunteers, when they finish their training, don't feel quite ready to take that conversation with the first human. So the more we can provide opportunities to practice that where you can just keep going. So we have that technology. I think the question is finding safe ways of testing or deploying it because I think what we don't know is if you have really safe and for us that means supervised and in real time in the same way that our conversations are could you provide an additional service for people that would not otherwise use our service and that is really interesting. So at the very least, I think we would like to understand whether that would be helpful. We have a couple of academic partnerships that we think with Imperial College and University College London, which both of which might be really helpful in helping us to test that. And then the other bit I think is just is giving people skills.

0:41:18.0 Victoria Hornby: We found through our training that we can give people skills digitally and we would like to give the people that use our service a lot of that skills and knowledge digitally as well. So we've just tried our first, it's kind of testing at the moment, it's a self-paced learning tool about anxiety. It's one of the most common reasons that people contact us and we feel that a lot of people don't know very much about it and don't feel equipped to understand it and manage it and to understand how and where to get help. So I think I think that there are so many opportunities with technology, with AI, with others to get there. There are clearly opportunities for it to go wrong but I think we feel that we should see if we could get it right.

0:42:09.9 Kailey Raymond: We'll be on team hopeful today. I mean, I'm thinking about like personalized bots in everybody's pocket to be able to speak to anyone, a bot, 24/7 that knows you, that can help you. Like that is an unbelievable resource in healthcare, in mental health, in preventative health and that I think is something to look forward to. My last question for you today, Victoria, you've been very generous with your time, which is what's the best advice that you would give somebody that's looking to build a mission-driven organization that scales?

0:42:44.6 Victoria Hornby: Oh, well, I would definitely say do it. Love it. And sometimes you do just have to do it. I remember the week before we switched the platform on thinking, are we really going to do this? But I think as long as you have fully understood who it is you're trying to support and that you have spent quite a lot of time with people who are the people that you would most like to support and kind of understand what would be helpful for them, then I think you have the ingredients you need to kind of make a really good start of it. I think the biggest the biggest challenge for us hasn't been the numbers of all the things that we thought would be really difficult when we started are not the things that are difficult. What's difficult is it's always difficult financially to sustain a charitable entity. I think that's just difficult. And so planning for that, I think, and thinking about in the same way that you would as a business, and I think this is something that we don't do very much in our sector.

0:43:52.7 Victoria Hornby: If you're setting up a business, you probably have a really clear idea of where you need to get that business to over a period of time in order to be able either to sell it or to finance it sustainably. And I think that is the challenge for, if you like, kind of digital technology-based organizations is that you don't have as much time to build in that runway. So we became a national service in two years. Previously, that would have... Particularly when you're talking about bricks and mortar charities that would have taken 15, 20 years. And so you've got time to build that organization alongside you. That is the challenge. And I think it's a challenge for us in our sector as the people delivering. But it's also a challenge, I think, for the philanthropic sector on the other side. And in our case, certainly the sort of statutory sector, which is we really want people, certainly as a stated aim here in the UK, we really want people to be innovating, to be bringing tech and digital and innovation into health and social care and the kind of well-being and education or all of the areas that we really want to see grow.

0:45:11.9 Victoria Hornby: If that's going to happen, then you need to work out how you're going to finance that growth because it's financed commercially, but we're not commercial businesses. And if we were commercial businesses, we wouldn't be aiming our service so specifically at the groups of people that use it. We'd be pointing in a different direction. So I think there's a bit of working out. If we want innovation, we need to think about how we sustain it.

0:45:40.0 Kailey Raymond: Absolutely. And sometimes it boils down to like the really unsexy stuff of financing. Like that is the thing that you have to think about to be able to provide these services. I mean, mission-driven organizations, it's in the back of everybody's mind. That makes perfect sense. Well, Victoria, thank you so much for being here and thank you for the work that you're doing. You're impacting people's lives every single day. You've told some really inspiring stories today. I really appreciate your time.

0:46:06.3 Victoria Hornby: My pleasure.