Mental Health Is the Next Crisis to Hit the Startup World

Coa co-founder Dr. Emily Anhalt outlines why all founders need to prioritize their “emotional fitness”.

By Olivia Fleming

Design by Perri Tomkiewicz

After years experiencing difficulty finding a therapist, Coa co-founders Alexa Meyer and Dr. Emily Anhalt created a “match” tool that allows patients to be matched with highly-experienced and compassionate therapists from a wide range of backgrounds and specialities. Now, Coa’s online mental health workshops are focusing on the importance of emotional fitness for burnt-out founders.

“The culture of founder-hood is so much about pushing through stress, pushing yourself to the brink,” says Dr. Anhalt. “You’re often commended for sacrificing your self care in pursuit of hard work. That’s really problematic because when something unexpected happens, like COVID-19, it’s not business as usual and suddenly pushing yourself to the brink doesn’t work—there’s a hundred new problems that have popped up. Founders who haven’t been proactive in their mental health are being hit really hard right now.” 

Here, Dr. Anhalt opens up about how mental health can make or break a company, why investors need to take a founder’s mental health seriously, and what founders can do to increase their emotional fitness.

Why is good mental health important for founders to take seriously?

Right now, the way people typically engage with mental health is very reactive. Most people think of therapy as something that you only do when you’re unwell or when there’s a crisis. But to me that’s a little like starting to do cardio for the first time as you get early signs of heart disease. So while it’s never too late to start, most emotional health issues are easier to prevent than they are to fix, and any emotional health struggles a founder has will find its way into the culture of the company. 

A founder is a lot like a parent, in a sense that a parent who has a lot of unprocessed stuff, that stuff gets leaked onto the kids and the kids end up having to figure out how to deal with it. But the parents that really take responsibility for themselves and do hard work—to work through their own stuff—the kids really benefit from that. That’s how I see founders. The more a founder prioritizes their own emotional health and fitness, the better equipped they’re going to be to lead a company. Emotionally fit founders foster and bring in emotionally fit employees, emotionally fit employees create emotionally fit products, and emotionally fit products increase emotional fitness in users. There’s this real trickle down effect that starts with the person who’s leading the company. And during a time like this, when unexpected difficult things are happening, people who already have secure emotional fitness practices in place are able to handle things in a different way, because they’ve already built the tools to face difficult emotions and circumstances. 

How would you describe emotional fitness? 

Emotional fitness is an ongoing proactive practice that increases self-awareness, improves relationships, and helps people become better leaders. It’s about building your resilience muscle. About eight years ago, I wanted to understand what the emotionally fit founder actually looks like, so I did what’s called an interpreted phenomenological analysis. It’s a kind of qualitative research where I interviewed 100 psychologists and entrepreneurs about how they would know if they were sitting across the table from an emotionally healthy founder. What would that look like? What would it feel like? What would that person seem to prioritize in their life? 

I coded all of these interviews for themes, and when I looked at the results, out of this research came these seven traits of an emotionally fit founder: self-awareness, empathy, play, curiosity, resilience, mindfulness, and communication. Emotional fitness is a prioritization of working on these seven things in an ongoing way. 


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What can happen, or what have you seen happen, when a founder has no emotional fitness? 

A founder who doesn’t prioritize emotional fitness is going to have a lot of trouble maintaining trust from their employees, from investors, from their co-founder. There’s going to be much more conflict in the company. It’s going to be difficult for the people they work with to push through tough times because they don’t trust that leadership is able to carry them through those tough times. Founders who don’t prioritize emotional fitness, not only does it negatively affect them personally, but I see directly that it very negatively affects the company that they’re trying to run, and everyone who works there. 

What are some things that you encourage female founders to do for their emotional fitness? 

I’ll give a suggestion for each of Coa’s seven traits to help illustrate this. 

The first trait is self awareness. For this, I suggest getting into therapy. A lot of people think therapy is something you only do when things are going wrong, but actually therapy is helpful for anyone who wants to better understand who they are and how they move through the world. As a founder, especially because you’re responsible for so many other people’s day to day wellbeing, and so many problems coming up, the more support you have, the better. There’s no reason why a founder shouldn’t have the proper support, because they’re supporting a whole company and so many people. And also therapy is a really great proactive practice. If you can get into therapy when things are mostly okay, you’re going to build your resilience muscles and prevent a lot of the emotional health stuff that might eventually lead a person later to needing that support. On top of that, any self awareness practice like journal writing, checking in with your community, getting feedback, things like that are really helpful. 

For empathy, we have this thing called an emotional fitness survey, which is a way to understand your employees better, and for them to understand you better, so that you can empathize with them. (This comes from the idea that we tend to have an easier time empathizing with things that we understand.) So, you create a survey with questions about who people are and how they do their best work. Some question examples are, “Do you like to be praised in public or in private? How do you like to be cared for or cheered up during a tough time? What are you struggling most with during COVID? Are you working remotely or do you need extra help?” You send out this survey, and everyone gets to see everybody else’s answers, including the founder’s. And now, all of a sudden, you have this place you can refer to when you need to understand how to support the people you work with. It’s also a chance, as a founder, for you to teach people working with you how to do their best work. For example, me as a founder, one of the things I like for people to know about me is that sometimes I get really excited about something, and I’ll sort of interrupt people. And I want people to know that’s not personal, and that they should feel free to slow me down and say, “Actually I wasn’t done yet.” Just by putting that in the survey, people notice this about me and can feel empowered to confront me about it, or to give me a little compassion or forgiveness and not take it personally. Get to know people better, it’ll be easier to empathize with them. 

Which takes a lot of self awareness to know you interrupt people when you’re excited. 

That’s what’s funny about these traits, they’re all intertwined and connected. If you work on any of them, you’re going to end up improving all the others naturally. And over time, what’s nice about the emotional fitness survey is everyone should be able to edit their answers, because as you get to know yourself and each other better, you might want to change what you say. Other questions you could ask include: “Do you prefer feedback that is direct and blunt, or gentle and kind? Do you do your best communication verbally or through writing? What else do you want your teammates to know about you? Do you feel safe and like you belong here at the company?” You can personalize the survey to be right for your team. 

For play, our suggestion is to build play into the daily routine of your company. That can look like starting every meeting with an ice breaker game, or making sure you have a playful attitude and it’s not serious all the time. Play builds community and culture, it increases creativity, it makes people feel more connected to each other, and that’s really important. So think about starting any serious meeting with some kind of icebreaker game. 

Curiosity is about being non-defensive. It’s about being able to ask questions when someone comes to you with difficult feedback or news. My suggestion is, it’s really important to bring in other minds, to talk to people who are outside of your department or in different companies. Talk to your investors, get more people looking at the tough situations, because it’s very hard to see the whole truth as a founder. We’re so invested in the success of our company that sometimes we might not see important things because they’re hard to see. By bringing in other people’s perspectives, we’re going to allow ourselves to have a more accurate view of reality. Something at Coa we do for curiosity is called Feelings Friday, where every Friday my co-founders and I sit down and share a little bit about when we felt supported that week, and when we felt a little dropped. What was the moment that we felt really understood, and seen, really proud of our cofounder? And what was the moment where maybe we felt like we could have done something a little better for each other? This has really helped with preventing small problems from becoming big problems, and it gives us a safe place to process and help each other see our blind spots.

Creating a culture of vulnerability, transparency, and mutual support is going to do wonderful things for the bottom line.

Mindfulness is all about becoming more comfortable being uncomfortable. Think about starting a personal practice like yoga or meditation, which is putting you in an uncomfortable position and then asking you to understand your relationship to that discomfort. Where do you go in your mind when you’re uncomfortable? Do you blame yourself? Do you blame other people? Are you able to extend it or do you try to avoid it? You can learn a little more about what makes you uncomfortable and what you tend to do to avoid that discomfort. As you know more about that, you’re more likely to be able to handle it and make the choice that’s the best choice, instead of the choice that moves you away from discomfort quickly. 

Resilience is about bouncing back during difficult times and requires building your self confidence. Work on accepting compliments, celebrate your wins, make sure you’re pausing. In founder life, every achieved goal is the start of 10 other goals you have to work towards, and if you never pause to celebrate and be proud of yourself, it’s really hard to always keep pushing. It’s important to celebrate wins and build your self confidence. One of my concrete suggestions is to create a team esteem pile. That means whenever good feedback comes in about you, or anyone on your team, or from customers or anything like that, screenshot it and put it into a Slack channel or into a folder so that when people are feeling down, or when the founder’s having trouble feeling confident, you can go through this folder and see all this amazing evidence that what you’re doing is important and that it’s positively affecting people.

Communication is about the importance of good listening, and how you can become a better listener by being really present. Don’t spend the whole time thinking about what to say next, instead ask questions to help people get deeper into what they’re saying. Don’t feel like just because you’re the founder, you have to fix everything right away. Sometimes just giving people empathy and company is what they really need. In the world of remote communication, which is what we’re all doing right now, we came up with this idea called “remojis”, this sort of system of picking emojis that represents feelings that are tough to express in the moment, and agreeing as a company on what these emojis mean. My co-founder and I picked an emoji that means, “I got your back, you’re awesome.” And we have an emoji that means, “I’m feeling a little sensitive today, this isn’t a good time for tough feedback.” And then we even have an emoji that means, “Hey, I saw your message, but I need a little more time on this.” So when we’re communicating remotely, we’re able to communicate some deeper feelings very quickly and easily.

Finally, I’d say each founder has to figure out what their emotional fitness routine looks like. Which of these seven traits do they need support with? Which are they already doing a really great job at? Think about it like going to the gym: sometimes you do you work on cardio, sometimes you work with weights. The idea is that we should always be proactively thinking about how to strengthen ourselves emotionally, because founder life is full of the inevitable tough times; especially right now.

Coa's Emotionally Fit Leadership Series is an interactive 8-week practice for founders to proactively train in each of these seven traits. 

Is mental health a crisis the startup world needs to face?

Founders often don’t have the internal resources to push through tough times. It’s almost like you’re encouraged as a founder to drive your car on empty all the time, and only stop for gas right before you totally run out. With COVID, it’s almost like the gas station you thought you could stop at is closed, and you have to go a lot farther than you thought. Founders who haven’t been proactively replenishing their emotional fitness are suddenly unable to do what they need to do, and it has resulted in the downfall of a whole bunch of people who weren’t supported in building more self care into their routine.

We often see this kind of pressure coming from investors—where an investor is asking a founder to run on empty. This became a talking point in a number of recent “female-founder takedowns,” where emotional resilience was not prioritized. How can founders advocate for themselves and express their need for support to investors who want to see constant growth and returns? 

The fear that investors only care about numbers and want you to push yourself past your brink leads to a lot of founders feeling like they have to hide where they’re at from their investors. I see it all the time. People say, “Oh, I’m really struggling, but I can’t tell my investors that, because they’ll lose faith in me.” What ends up happening is the problem gets worse and worse, and the investor doesn’t even realize there’s a problem. Then it blows up into some issue and the investor expresses frustration and it makes the founder feel even more like they should have somehow not shared it. 

In my experience, founders can be more proactive and transparent with their investors along the way—especially if they can summon the courage to say, “Hey, I actually am really struggling right now.” A lot of investors will actually rise to that challenge and will try to help the founder with whatever the need, whether it’s mental health resources, or a game plan, or helping them hire so that they’re not doing so much themselves. Ultimately the investor wants success, and I think that investors are also waking up to how important founder mental health is for success. Investors have a new openness to supporting this, and founders feel that they can enlist them before everything blows up, rather than waiting until they have no choice, if that makes sense. 

Seeking out mental health services is often synonymous with weakness. Do female founders lack the confidence to be honest—whether it’s with their employees or their investors—because they’re scared they’re going to be seen as weak or as incompetent? 

Yeah, even though we’ve come a long way, there’s still a lot of stigma about mental health. Women especially feel like they have to come across as twice as competent; that they have everything together. Because yes, women founders are still funded at a much lower rate than males founders. So I can totally understand the hesitance, and I know that it’s a problem we still have a lot of work to do around. But I think the tides are turning a little bit. And again, it makes a big difference for someone to be able to say, “Hey, I see a problem coming around the corner and I want your help making sure we don’t get there,” versus feeling like they have to figure it out on their own, and then when things really falling apart, trying to get help. So again, I really want to push this narrative of proactive mental health. Think about it more like going to the gym instead of waiting until you have to go to the doctor. 

This is a really hard time to be a founder. It’s not business as usual. And for founders who are upset with themselves because they’re not performing at a hundred percent, they have to have a little bit of self compassion. If they give themselves self compassion, it also gives permission for employees to give themselves a little self compassion.

In terms of mental health for employees, do you see a future where that is a benefit all companies offer? 

That’s the future I hold in my mind every moment, and one I’m pushing towards. My belief is that when mental health is supported early, a lot of issues will get prevented. It’s very much in every company’s best interest to support the mental health of their employees. Creating a culture of vulnerability, transparency, and mutual support is going to do wonderful things for the bottom line. It will directly positively affect the business to pay attention to these things. 

Have you ever seen the television show Billions? This reminds me of Wendy, the character who keeps all the employees “sane” with her in-house mental health services. 

I’m so grateful for Wendy because she validated the work that I do. She was the first sort of media figure to represent this idea that it’s very smart to pay attention to emotions in the workplace—that who we are “anywhere” is who we are “everywhere”, and if we don’t pay attention and get support with our emotions in the workplace, it will cause problems. It’s worth paying attention to.

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