Without access to mental health care, the Egger family might look very different today.
As a child, Rebecca Egger routinely struggled with anxiety. This manifested as ADHD, a disorder that is severely under-diagnosed in girls because of the different ways it can present between the genders. Because Egger’s mother, Helen Egger, ran the child psychiatry department at Duke University Hospital (and later NYU’s Child Study Center), Egger’s issues were identified early and she received help as soon as possible.
This set her on a different trajectory than the millions of kids suffering with mental health issues who do not have a child psychiatry department director as their mom. Today, UNC grad Egger has grown into an adult who can run a startup—Durham-based Little Otter Health—while managing depression and ADHD, which is something she credits to her early childhood intervention.
Similarly, when Egger’s brother began displaying psychosis symptoms at age 13, it was because of the easy access the Egger family had to mental health services that made it so he was properly diagnosed with autoimmune encephalitis, a rare brain disease that can mimic a mental health disorder.
Without having a doctor parent who could advocate on his behalf, though, Egger’s brother very well could have fallen between the cracks.
This is the reason Egger and her mom founded Little Otter Health two years ago. It’s not fair that every child doesn’t have access to the resources and expertise that her family did, Egger said. And even worse, the current healthcare system does not trust families, and they tend not to look at the entire family unit holistically, Egger added.
Each child’s mental health issue has an impact on everyone else within the family, and this is something Little Otter Health, as a digital mental health platform for children, seeks to address.
“This is not about just sending your problem child over to a therapist,” Egger said. “You come together. We actually provide—once you come into the platform—a 360-degree view of a family.”
Egger, who worked in product design at Palantir Technologies and then the Chan Zuckerberg Initiative in San Francisco after graduating from UNC with a degree in computer science, saw an opportunity to help these other families by teaming up with her mom. The two co-founders officially launched Little Otter Health in 2021.
They want to shift the paradigm so that mental health check-ins for kids are as routine as a motor skills test for infants and toddlers. By working with Little Otter, families have a whole host of mental health tools at their disposal. Sometimes they need just one therapist provider, but other services could include a couples therapist or a parenting specialist.
By offering a whole suite of services, Little Otter Health can connect families to wide-ranging resources and track outcomes over time. And every therapist on Little Otter is hired directly by the platform, making sure families have access to the highest care possible. (Only 3 percent of therapist applicants are hired at Little Otter.)
While families currently have to pay with cash for Little Otter, Egger said the startup is working to get in-network with several insurance companies by the end of this year. This would greatly increase accessibility for families, who traditionally have to pay $90 for an initial call and $200 for each session.
Back home to the Triangle
Once headquartered in San Francisco, the Eggers decided to bring Little Otter home to Durham, where Egger grew up and attended the North Carolina School of Science and Math.
Egger said she missed home and wanted to invest back into the community. And if the pandemic revealed anything, it’s that tech companies do not have to operate in Silicon Valley to be successful.
“It felt like as our company continued to grow, there was an opportunity for me to bring a company here and really live and build and be part of building up that community that I deeply care about,” Egger said. “With a pandemic, it really showed us that we can work from anywhere and anyone can build a company from anywhere.”
Little Otter Health hopes to hire additional staff in engineering, marketing and therapist roles from the Triangle, in part to create little hubs of communities even as an entirely remote company. In the near future, Little Otter will also host its first “Ottercon” in Durham, bringing every employee and their families together to celebrate the startup and the Triangle tech ecosystem it is now a part of.
The pandemic also brought some unexpected positives for Little Otter Health. In particular, it spurred the rapid adoption of telemedicine, which is essential to Little Otter’s growth.
“It really changed the perception of digital health and telemedicine and gave us an opportunity to prove that telemedicine does work,” Egger said, “and we can change the landscape of mental health care.”
Little Otter is currently live in seven states and has around 50 employees. Part of this fast-tracked growth comes from a Series A funding round led by San Francisco’s Charles River Ventures that provided $22 million to hire well and hire quickly, Egger said. In all, Little Otter has raised $26 million.
“We really couldn’t be able to grow as quickly without that funding and also the amazing investors who believed in us and supported us,” Egger said. “It really just opened up a larger network of resources, which I’m incredibly grateful for.”
Lessons From The Journey So Far
Throughout Little Otter’s story so far, Egger has learned a few things. One: the importance of making decisions quickly.
“Following your gut and instinct has almost 100 percent led me in the right direction,” Egger said. “When I fight against that, it usually led me down the wrong path.”
As a startup founder, so much is out of your control, Egger said, but you have to find a way to create something great regardless. That means embracing life’s curveballs and turning them into strengths, like Little Otter did with the pandemic-influenced shift toward telemedicine, which Little Otter always knew had to be a key component of their services.
After all, 70 percent of counties in the United States have zero child psychiatrists. The only place families in these areas would be able to find care is at academic institutions, where they might face long drives and even longer wait lists.
“We are not going to solve this problem by getting all the psychiatrists to move to all of those counties,” Egger said. “We must leverage telemedicine. We must leverage efficiency. So we always knew that that needed to be a core part of our strategy.”
Instead of seeing telemedicine as a lower quality alternative to traditional care, Egger sees it via Little Otter Health as something entirely better. In this way, all parents can be involved, kids can get help in the comfort of their own homes, and more kids have access than ever.
“We’re not creating something that’s as good as in person,” Egger said. “We are creating something better because we can do more with our technology.”
Little Otter Health intends to be fully national by the end of 2023 and will continue to add wraparound services that will help families in between sessions, Egger said.
“I want every child and family to be able to get quality mental health care when they need it,” Egger said. “We’re not just about access. We’re really about creating a new standard of mental health care for families that says this is what you can expect and what you deserve.”
The implications of such a mission can be far-reaching, and Egger sees a potential impact across an entire generation of children.
“What if we had a generation that had this mental health journey, what would our world look like?” Egger said.