Headlines about coping strategies and self-care have proliferated as millions of people experience anxiety, sleep problems and depression related to health fears, financial setbacks and social isolation during the pandemic. In addition, the Centers for Disease Control reported a dramatic increase in serious mental health problems this year.
Yet Stephen Smith ’17, founder and CEO of NOCD, a telehealth company that provides face-to-face online sessions with licensed therapists to patients with obsessive-compulsive disorder, sees promise for behavioral health treatment.
“Mental illness has been talked about much more frequently during this pandemic, which has caused it to become more destigmatized,” says Smith, who was recently named to the 2021 Forbes 30 Under 30 list for the healthcare sector. “I think the more we talk about mental illness and the challenges that people with mental illness face, the less stigmatized it becomes.”
And the less stigma, the more likely people are to seek treatment.
A Growing Company
The startup Smith founded while still a student at Pomona College is growing rapidly, recently raising $12 million to expand its online OCD therapy services to all 50 states. Just a year ago, NOCD—pronounced “No-CD”—was operating in only three states. Now NOCD therapists treat thousands of patients a month, and hundreds of thousands of other people in the U.S. and abroad use the support tools and online peer community available through NOCD’s platform at no cost.
“During the pandemic, growth has spiked twofold,” Smith says.
Besides normalizing openness about mental health, the pandemic has brought telehealth into the mainstream. Almost everyone from kindergartners to grandparents has been on a Zoom call at this point, so the routine has become familiar. Physicians now use video calls for consultations that don’t require lab work or physical exams.
For mental health therapy, an online session can be even better than an in-person session. Evening and weekend appointments are more readily available to accommodate work or school schedules. And no longer must someone seeking help worry about being seen entering a psychiatrist’s or therapist’s office—or worse, sit in a waiting room with an acquaintance in awkward silence.
“We've seen that people with OCD are more likely to seek treatment online and open up faster,” Smith says. “It just feels easier for them to talk about their more taboo, troubling symptoms.”
Based in Chicago, NOCD now has 55 full-time employees—among them Pomona alumni Don Swan ’15, director of people operations, and Andrew Kim ’20, a network strategy manager. In addition to a growing network of providers, NOCD has partnerships with insurance giants United Healthcare and Cigna, among others.
Shaped by Pomona
The company was born out of Smith’s own struggle to be properly diagnosed and receive effective treatment for OCD. After getting better, he transferred to Pomona to complete his degree and college football career.
“I love Pomona,” he says. “Pomona was the catalyst for starting NOCD. When I arrived in 2015, the company was just an idea; it wasn't an actual business. But, by the time I was a senior in 2017, I was flying back and forth to Chicago, raising our first round of venture capital funding. The professors were incredibly encouraging and supportive during the process, and that's what allowed NOCD to get started. They were like, ‘Look, you're trying to start a business to help people. We're going to be completely supportive.’”
An economics major who minored in Asian studies with a focus on China, Smith didn’t have an obvious background for becoming a tech entrepreneur in the health care sector.
“It was a little different. I wasn't a computer science major,” he says, but adds that studying economics was invaluable.
“Here’s why: Our health care system has many problems and unnecessary inefficiencies today, especially within behavioral health. Graduating from Pomona as an economics major gave me the tools needed to not only identify many of these problems and inefficiencies, but also to solve them by thinking outside the box and on the margin. We were taught to consistently ‘ask ourselves why,’ a way of thinking that became invaluable professionally.
“For instance, we realized that OCD is very prevalent and severe, affecting 1 of 40 people and ranked by the World Health Organization as a top 10 reason for disability, yet it’s extremely mistreated since people with the condition are frequently misdiagnosed by providers. As a result, providers send health insurance companies inaccurate data about the condition, preventing them from seeing the condition’s true prevalence.
“When payers don't see the true prevalence of OCD, they then misattribute costs that are caused by OCD to other conditions and prioritize the treatment of those other conditions instead of OCD. And when they prioritize the treatment of the other conditions, they don't develop specialty programs to diagnose and treat OCD, ultimately pushing their providers to misdiagnosis and mistreat it further. It’s a vicious cycle.”
“We designed NOCD to break the cycle. We diagnose people with OCD correctly and then manage them in a clinically effective and economically efficient way, using a hybrid of tech and touch. By doing that, we also fix data attribution issues that cause health insurers to misunderstand the condition. I think our ability to identify the problem and to solve it actually relates back to some of the learnings I had personally from Pomona professors like Michael Kuehlwein, Bowman Cutter and Gary Smith in the Economics Department.”
NOCD therapists specialize in Exposure and Response Prevention (ERP), the form of cognitive behavioral therapy most often recommended for treatment of OCD. ERP works by intentionally exposing people to situations that provoke their obsessions and distress while preventing the compulsive responses. Yet the model Smith has created has potential for many types of behavioral health issues, and NOCD could expand to treat other conditions that respond well to types of exposure therapy, such as post-traumatic stress disorder (PTSD).
“We’ve learned that using technology to treat people with mental illness is actually very effective,” he says. “Going forward, as we step out of the pandemic, we're actually going to be able to use more technology to get people better. And that will allow us to break down barriers that would typically prevent people from accessing effective help.”