Meet Tess, the Chatbot Helping People Around the World Cope …€¦ · Meet Tess, the Chatbot Helping People Around the World Cope with Stress, Anxiety, and Depression THE CHALLENGE

CUSTOMER STORY • START-UP

Meet Tess, the Chatbot Helping People Around the World Cope with Stress, Anxiety, and Depression

THE CHALLENGE

1 in 4 people copes with mental illness

at some point in life. Therapy can be

expensive, and mental illness carries

a cultural stigma that makes it hard

for individuals and families to seek

treatment. Mental health issues

also account for $30B a year in

lost worker productivity.

THE RESULT

Tess, a text-based psychological AI

chatbot, supports mental health by

responding to people experiencing

stress, depression, addiction, and

thoughts of suicide via customized text

conversations. She is free and available

24/7. Sara, a non-clinical version of Tess,

is now available for employers and

their employees.

COMPANY: X2AI

FOUNDED: 2015

INDUSTRY: Healthcare

RESULTS, OUTCOMES, AND ACHIEVEMENTS

Psychologists using Tess can now treat up to 50 patients a day.

Tess and Karim, an Arabic version, are on display at the Museum of Applied Arts & Sciences in Sydney, Australia.

In a study among 9,000 Saint Elizabeth nurses, 88% reported Tess helped them feel supported.

Field-tested in Lebanon in a Syrian refugee program, Tess has also been deployed in Kenya, Nigeria, Canada, and the Mars space program.

Tess was trained by over 500 mental health professionals who provided scripts and analysis responses for suicide, bipolar, PTSD, depression, and anxiety.

Tess is available as a HIPAA- compliant messaging app on Slack, Facebook Messenger, WhatsApp, and smartphones.

“Tess saves lives. Whether helping

people step back from suicide

with the right level of help at critical

times, preparing them for the lows

of bipolar disease, or fighting

depression to help them begin

truly living, Tess saves lives.”

— Michiel Rauws, CEO of X2AI

The Story of Tess and How She Came To Be

As a teenager, Michiel Rauws faced three different

chronic illnesses. At the suggestion of doctors, he sought

help from a psychologist and learned how to manage his

emotions and effectively deal with his stress and feelings

of depression brought on by his illnesses.

Later in life, after finding he was often called upon to

share his experiences and learnings with friends and

colleagues who were also dealing with stress, he realized

the world needed a scalable mental healthcare coping

system. He also believed that technologies such as

artificial intelligence and natural language response

had evolved sufficiently to be applied to this global need.

Rauws headed to Silicon Valley to continue his AI research and to discover how startups worked. There, Rauws teamed up with his co-founder, Eugene Bann, who had been researching computer science and emotions. Rauws added his knowledge of AI which he’d gained from the IBM Watson team that defined the state of the art for AI. Over the next eight years, Rauws and Bann engaged with psychologists and psychiatrists to gather the latest mental health therapies and content in order to develop the algorithms for the underlying scripts and natural language responses for the AI platform that would later come to be known as Tess.

“Tess saves lives,” explained Rauws. “Whether helping people step back from suicide with the right level of help at critical times, preparing them for the lows of bipolar disease, or fighting depression to help them begin truly living, Tess saves lives.”

Tess works by providing people with mental health education, coping mechanisms, self-care counsel and routines, and emotional well-being tips. Tess “reads” texts and, using natural language algorithms, senses and responds to people’s emotions. Over time, Tess gets to know her patients individually—what they love and why, what scares them, what calms them down, and how to help them cope during a period of depression.

While Tess can be used in voice mode, studies show that people prefer to use text. Texting taps into the journaling that many people do to either prepare for their day or reflect on it. The journaling mechanism already helps people structure and make sense of their thoughts and is the first step in resolving whatever concerns they may have. Texting is also widely available and has become the easiest and most convenient way to communicate in other areas of life, making it the preferred channel of communication for a self-help, mental health application like Tess.

“Emotions are core to helping people, and

these regular exchanges help Tess to form an

emotional bond and personalized experience

with the patient. People like talking with Tess

because she is always there and ready to chat.

There’s no bias or judgement, which helps

people open up about topics, and she is

discreet. She can help create space for self-

reflection or a place to vent without burdening

friends and family. Over time, Tess becomes

a healthy habit.”

— Michiel Rauws

Making the Connections to Bring Tess to the World

In college, Rauws had learned about Silicon Valley-based Singularity University (SU) from his roommate. In 2014, when he was ready to commercialize his AI application, he decided that SU and its global community could help him connect with experts to refine Tess, help her scale, and get her to market faster to begin making a real and positive dif-ference in the world. By chance, Rauws met two people on a train to Stanford University who were working on other projects with SU, and they invited him to drop by and see what they were doing.

After seeing the work of other startups underway at SU, Rauws applied for the SU Startup Accelerator and be-gan attending Exponential Medicine, an annual summit devoted to the use of exponential technologies in medicine and healthcare. By attending these events and meeting with SU Impact Scholars and others in the SU ecosystem, he

connected with others from around the world who provid-ed technical expertise as well as perspectives about cultural mores and their potential impact on how Tess would be received. These conversations also often led to new oppor-tunities for Tess.

I believe Singularity University works so well because it has the experts who can educate people about new tech-nologies, and it attracts large companies that may not have participated in exponential technologies before but now want a conservative way to test the exponential waters,” said Rauws. “These large brands are looking for smaller companies like X2AI that are successful and creating value for others. They then slowly adapt our cutting-edge technology into their own businesses where they become part of the core offering and assets.”

The Power of the SU Global Network: Who’s Using Tess

As a result of these SU introductions, Tess has been deployed in a multitude of locations around the world, helping people deal with a variety of stressful situations. Tess is used by insurance providers, hospitals and clinics, universities, government and non-government agencies, and employee assistance programs, and is also offered through communications and social platform companies.

Medical device manufacturers and pharmaceutical companies such as Bayer, BD, and Johnson & Johnson are exploring how to use Tess in conjunction with drug programs, because Tess can help people overcome their fears of new drug therapies, encourage them to take their medication, and provide the latest well-being and coping mechanisms for their particular condition. Rauws and Tess are even impacting how the U.S. Food and Drug Ad-ministration (FDA) approves digital solutions in the future.

“I believe Singularity University works so well

because it has the experts who can educate

people about new technologies.”

— Michiel Rauws

Insurance Companies, Hospitals, and Clinics

At Exponential Medicine, Rauws met representatives from Blue Shield Florida who put him in touch with Nemours Children’s Hospital. Nemours has a 6-state program for children 12-to-15 years of age who are pre-diabetic or morbidly obese. Working with their therapists, the children set their personal health goals, using Tess in between therapy sessions for motivational support, to problem- solve any obstacles, and to track their progress. The doctors receive statistics on how often their patients use Tess and the types of conversations they are having. Because of the success of the Nemours program, Blue Shield of Florida is now providing Tess across its entire population.

At St. Elizabeth’s, the largest home care innovation service in Canada, 9,000 nurses use Tess to support family caregivers, a population that deals with significant stress and burden. As St. Elizabeth’s is also a staffing organization, it uses Tess to support the nurses themselves who work remotely, face irregular work schedules, and often move between locations. A new St. Elizabeth’s program, Caregiver in the Workplace, resells Tess to other companies. Insights from the family caregivers and St. Elizabeth’s nurses are fed back into Tess to ensure her scripts and conversations are updated regularly.

The Hague-based Parnassia Group serves 160,000 patients per year through its mental health clinics in Europe. Tess boosted the productivity of its therapists as well as patient engagement in its online courses. Tess increased the average online engagement time from one hour to more than five hours, and generated over 1,500 patient messages.

Radbound University Medical Center in The Netherlands uses Tess to provide diabetes and cancer patients with access to behavioral health services on-demand, 24/7. By chatting with Tess on their smartphones, patients can work through the uncertainties they face in dealing with medical diagnoses, complying with medication protocols, or coping with the challenges of everyday life. Tess enables Radbound to support the ever-growing demand for mental health care services on ever-limited budgets.

Governments and NGOsIn X2AI’s first field trial, Tess, renamed Karim for Arab populations, was used to provide basic mental health- care services to help Syrian war refugees who had fled to Lebanon from their country, as well as the aid workers, teachers, and medical teams who supported them in the refugee camps. After seeing its effectiveness with the Syrian population, Lebanon’s Ministry of Health is considering making Karim available for its own citizens.

Through SU’s Impact Scholars, Rauws was introduced to JLI Institute and PharmAccess, which now use Tess to support the work of a federal Nigerian psychiatric hospital. Tess may soon become part of Nigeria’s government insur-ance program for its entire population.

Tess is behind the AI that NASA has deployed for the mission to Mars, providing emotion algorithms and combining them within the data and analytics platform to “read” themal healthcare services on ever-limited budgets.

Universities

After Rauws met a Duke University attendee at Exponential Medicine, Tess became part of Duke’s submission to the National Institute of Mental Health for a program grant to support perinatal depression in Kenya.

At the request of the United Nations, professors from Yale University wrote a book entitled “How to Provide Psychological Support to Refugees,” based in large part on the work X2AI has done in Lebanon among Syrian refugees.

Companies and Employee Assistance Programs

X2AI expects one of the biggest developments in healthcare will be the expanded use of AI technologies like Tess into more employer Employee Assistance Programs (EAPs). Healthcare is one of the most expensive components of employee benefits, and among the highest healthcare costs are those involving behavioral services. In addition to the negative impacts of depression, anxiety, and stress on a person’s overall health and well-being, these conditions can also significantly impact employee absenteeism, lower productivity and morale, and cause high employee turn-over. Consider the following example from Telefonica, the Spanish telecommunications company.

After meeting representatives of Telefonica at Exponential Medicine, X2AI went to Barcelona to brief them on Tess for a program Telefonica was launching to help employees manage bipolar disorder. X2AI developed specific content, scripts, and responses for the condition’s high (euphoric) and low (depressive) phases. Tess is now programmed to recognize the likely onset of the depressive stage and begin to prepare users with ways of coping, reminders about the effectiveness of medication routines, encouragements to connect with family and friends, and more.

Evolving Tess to be Culturally Effective

“One unfortunate reality the world over that we are striving to solve is the stigma that is still associated with mental illness,” noted Rauws. “We believe Tess helps overcome this stigma because it provides a very acces-sible, low-barrier-of-entry channel to patients that is discreet and free to use. People can just start chatting about their issues and get an immedi-ate response that can help them talk through their problems.”

One of the big lessons X2AI learned from its initial deployment of Tess in Lebanon was the importance of being on the ground when the chatbot was first being introduced. By meeting with leaders of the local community, X2AI was able to explain how the technology would work and what it could do, and in the process assuage any cultural concerns. In Lebanon, the male name X2AI had originally chosen in Arabic, Aziz, caused concern among people because it sounded too similar to ISIS or ISIL. So Karim was born.

SU’s development partners that helped X2AI get in touch with UNICEF and the Red Cross were influential, as well. Initially, those in-country believed Karim or Tess, in deference to how local conversations be-tween humans took place, should start each chat session with general questions about a person’s day or family, and then work gradually to ask more personal questions about any potential mental health concerns. In reality, the exact opposite was true. It turned out that people around the world are so comfortable with the anonymity of texting and the one-on-one nature of human-to-machine chats that they wanted to start con-versations immediately with more direct pleas for help and statements about how they were feeling.

Tess engages by helping people communicate using the tools they are already familiar with and fosters conversations people would have if they were conversing directly with a coach or a psychologist in a therapy session. Tess automatically adjusts her communication style to the user. Younger people respond quickly and with less detail, while older people type more slowly and consider the question and their response more completely. Some use Tess on the fly when they’re on the move during their day. Others engage with Tess at the beginning of the day to pre-pare, or at the end of the day to reflect.

“We believe Tess helps overcome

this stigma because it provides a

very accessible, low-barrier-of-entry

channel to patients that is discreet

and free to use. People can just start

chatting about their issues and get

an immediate response that can help

them talk through their problems.”

— Michiel Rauws

Michiel Rauws explains how AI is the Engine Behind Tess’ Highly Effective Emotional, Personalized Response

Mental health professionals are often limited in their capacity to provide treatment, and there are other barriers like wait times, cost, and social stigmas that can prevent people from getting the support they need. In some areas of the world, mental health services are practically nonexistent. Tess bridges these gaps and provides people quick access to high-quality mental health services and support. Because Tess is powered by AI, it can support many patients at the same time with customized care.

AI encompasses many different methods and technologies that essentially make a system behave in a smart way—everything from predicting to analyzing to correcting. Tess uses AI in a patient- centered application that applies these self-learning elements to healthcare in order to customize the response and experience for each individual and chat session. Since over 500 professional psychologists and psychiatrists provided counsel on stress, anxiety, depression, PTSD, suicide prevention, and bipolar disorder therapies, Tess has algorithms that monitor emotional signals from text copy and can determine which practices will be the most effective to apply.

One feature that makes Tess unique from other AI systems is that everything Tess can say is checked by a licensed psychologist, which ensures the ongoing safety and quality of the system. In severe crisis situations, the system will automatically alert a psychologist in the Doctor on Demand psychologists network who can take over the conversation.

X2AI is a nice intersection of exponential technology with direct global impact. X2AI is as exponential as it gets.

“X2AI is a nice intersection of

exponential technology with di-

rect global impact. X2AI is

as exponential as it gets.”

– Michiel Rauws, CEO of X2AI

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