KRYSTIAN FIKERT

Ireland,

In Ireland, adequate mental health care is out of reach for many who need it because public offerings are too slow and the private market is too costly. Krystian Fikert has created a new social business model of community-based mental health services, which has unleashed a movement for accessible, preventative mental health care. Krystian’s model reaches out beyond Ireland to other areas in Europe to create the structures for expansion from the very start.

This profile below was prepared when Krystian Fikert was elected to the Ashoka Fellowship in 2011.

INTRODUCTION

In Ireland, adequate mental health care is out of reach for many who need it because public offerings are too slow and the private market is too costly. Krystian Fikert has created a new social business model of community-based mental health services, which has unleashed a movement for accessible, preventative mental health care. Krystian’s model reaches out beyond Ireland to other areas in Europe to create the structures for expansion from the very start.




THE NEW IDEA

Through his MyMind program, Krystian has created a movement for community-based mental health services, driven by a revenue-generating combination of paid and pro bono therapists and practitioners to make mental health care available and affordable without stigma. He uses both in-person and web-based support services to build his system for multi-layered support.

Krystian has removed the slow referral process and offers visits in a matter of days with three levels of fees, free for the unemployed and unable to pay, and fees for paying clients still well below market. He uses web counseling and question answering as a portal to bring people in who may be too afraid or unaccustomed to therapy, and offers a multidisciplinary team, from psychotherapists to life coaches, which limits the all-too-common dependency on drug-based solutions in the sector. Krystian’s online intervention tool serves as a gateway for tentative users and provides a shared learning platform for practitioners, making mental health care affordable without stigma, and maximizing efficiency through technology and allowing for international outreach.

Krystian has two centers in Dublin and is expanding into Limerick and Cork. His flexible, inexpensive system allows for full focus on early intervention and prevention, making mental health care available to those who need it most.




THE PROBLEM

Krystian has identified the main elements of weakness in Irish mental health delivery. A system that is accessible, flexible, and inexpensive allows for early intervention, yet the current system exacerbates existing problems. Because the Irish Health Service Executive (HSE) is designed inefficiently and is jealously guarded by civil servants, HSE psychologists typically see four to five patients over three to four days, an amount drastically below capacity. In addition, there is a significant spare-time capacity among professionals in the public and private system, and many who are willing to work for those most in need, and able to be mobilized to provide free and accessible care.

In order to receive mental health care, a patient must go to their general practitioner and get a referral. In Ireland, government referral for mental health care can take eighteen months or more, and a single session through a private provider can cost upwards of €100 (US$130). As a result, many wait until situations are desperate before seeking help. In addition to this length of time being untenable, it also precludes any early intervention, allowing problems to blossom. Aside from the long wait times, when mental health care is secured through government channels it is inevitably medicalized—hosted in hospital settings and resorting to the drug-based psychiatry covered by insurance rather than talk-based solutions.

Ireland has significant underserved populations for mental health. Mental health care is considered a luxury, and prices reflect that sentiment. The market rate for mental health care in Ireland is between €80 and €100 (US$104 and $130) per session, which is out of reach of many who need it, especially immigrants and those at the bottom of the socioeconomic spectrum. Other social organizations, such as Samaritans, are private charities based on grants that offer only intermittent reduced fees. Mental health is an unregulated market throughout much of Europe.

Mental health issues have a tremendous stigma in Ireland. Though mental health issues are widespread, it is a significant obstacle to get people to admit to problems and seek treatment, and few channels to find support in a discreet way.




THE STRATEGY

Krystian is crafting a highly scalable social franchise model that offers affordable and easily accessible mental health care with service for all. Initially begun for Polish immigrants, he quickly saw a much larger need for his work and expanded his efforts to include immigrants of all types as well as lower-income citizens and anyone else in need. Krystian’s MyMind program offers both face-to-face and online programs to make mental health care available, and break down the barriers to accessing it.

MyMind has a large team of mental health professionals available for face-to-face services, accessed through self-referral. Krystian has built a team of over forty-five contracted and volunteer staff, unique in their multidisciplinary backgrounds, from psychotherapists to life coaches to a psychiatrist, and fluent in nine languages. His team focuses mainly on widespread issues of depression, anxiety, relationships, and addiction, with an overall strategic focus on early intervention and prevention.

Designed to avoid the referral processes and lack of accessibility that snarl care, MyMind offers appointments between one and three days. Krystian is adamant that his work does not appear “medical,” hosting sessions far from hospitals in a welcoming and discreet setting.

Krystian’s MyMind program has three levels of fees: Free for the unemployed or unable to pay, reduced for those with medical cards, and a full fee of €50 (US$65) per session, which is nearly half of the market rate. Contracted staff are paid €30 (US$39) of the full fee, with MyMind receiving €20 (US$26), and the volunteer staff supplementing the free and reduced fee patients. He estimates 160 clients per week are necessary to break even, and is limited currently by staff capacity. Over the past five years they have served over 4,000 patients in direct service, currently generate 80 percent of their income, and expect to break even in 2015.

In addition to his face-to-face offerings, Krystian has designed an online platform, e-MyMind, as a channel for referrals, a resource for mental health information, and a tool to combat the stigma that keeps many away from mental health care. The e-MyMind program optimizes the latest in free Google technology to serve thousands (4,000) of clients through online question answering, serviced by fifteen volunteers. The e-MyMind program acts as a gateway to those who may be inexperienced, tentative, or unused to mental health care. The site is a resource for those who need support but are not ready for face-to-face care, and is a valuable channel for self-referral in bringing in clients in person. It is also used widely in other countries.

The online portal also offers a community of shared learning for practitioners, with a confidential case log and arena to discuss cases, progress, and approaches. Krystian has designed a system of quality control measures and a team environment to hone practitioner skills around a hub. In conjunction, he is creating a set of online diagnostic tools with follow-up.

Krystian has a lot of new developments in the works for MyMind—he is creating a strategy to collect text fees, building a core curriculum for online diagnostic tools, and setting up infrastructure for Skype sessions. He is laying the infrastructure to guide a movement for a different form of mental health service, and leveraging the offline and online components to expand quickly. After his initial grant from the Polish government, Krystian expanded his work to other populations, and is expanding quickly. He is dealing with lots of international interest from around Europe.




THE PERSON

Krystian has always been an entrepreneur. As a child growing up in Poland, he sold his old toys to friends and their parents in order that he might buy new ones. As a high school student he supported himself through various entrepreneurial ventures and entertained himself by creating his own extracurricular projects. He attended a mathematics secondary school and was something of a wunderkind in mathematics and technology, with IT as his first passion.

As a direct result of that experience, he became driven to explore mental health issues. Krystian began reading heavily on human nature and changed his high school exit exam from mathematics to biology, with an eye for continuing focus on these issues. In college, he studied psychology and volunteered with social workers focusing on addicted patients. Offered a spot in a Ph.D. program, Krystian did not have the funds to attend. He decided to move to Ireland from Poland in search of alternate opportunities, and to pursue a high school dream of working with Google. Krystian began working with the search quality division of Google, handling the Polish market and then all of Eastern Europe, with a focus on fighting spam.

Google offers a perk to employees in “20 percent time,” where staff can devote that percentage to projects of their own making. Called by his other passion, Krystian began to design online free mental health offerings, using Google apps and technological tools, and applying the open principles to MyMind. He also offered free mental health consultations to the Polish community on Saturdays, working out of a back room of a Dominican’s Priory. Quickly, he became overwhelmed by demand, moving to two days, then three, rapidly outgrowing two new locations. Within weeks of beginning, three mental health professionals joined him. Eventually he secured a grant, and took the considerable leap from a comfortable Google salary to open his organization’s first office. Since his initial opening, Krystian has worked tirelessly to grow his hard skills in business and strategy through INSEAD training and mentorship to maximize impact. He is designing his efforts, infrastructures, and communities of learning to be the basis of a global movement for mental health.




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