Latest / The Mental Health Evolution / Ep 11: Building Mental Health Practices Without Burnout with Dan King

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Ep 11: Building Mental Health Practices Without Burnout with Dan King · The Mental Health Evolution

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(Transcribed by TurboScribe. Go Unlimited to remove this message.) This podcast is part of the Frederick Podcast Network.
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Learn more at listenfrederick.com.
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Welcome to Mental Health Evolution, a podcast about what's changing in mental
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health and why it matters.
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I'm your host, Rachel Harrison, inviting you into honest conversations with
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people from all perspectives in the field, clinicians, tech founders,
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investors, insurance companies, and all the folks in between.
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Let's explore what's working, what's not, and what's next.
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Welcome back, everyone, to the Mental Health Evolution podcast, where we are
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talking about how the landscape is quickly changing in the mental health
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industry.
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Today we have a guest with us, Dan King, who is the
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founder and CEO of Fireside Strategic.
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Welcome, Dan.
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Dan leads Fireside...
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Excellent.
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Of course.
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Of course.
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It's good to have you here.
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So Dan leads Fireside Strategic, which is an organization that acquires and
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nurtures outpatient mental health practices with a strong focus on clinician
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satisfaction and workplace culture, with a background in mergers and
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acquisitions law, policy advising, private investing, and executive coaching.
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Dan brings a rare mix of legal, financial, and human-centered insight
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into building mental health businesses sustainably.
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Earlier in his career, he advised Canadian cabinet ministers on
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entrepreneurship programs and even worked on Kevin O'Leary's deal team for
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Shark Tank.
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A lot of us have seen that.
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Giving him a front row seat to how high growth deals are
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made.
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He has since raised institutional capital, built and sold his own coaching
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firm, and taught entrepreneurship at McGill University.
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Outside of work though, Dan is passionate about meditation and tennis, has
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traveled to more than 50 countries, and has even completed extreme road
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rallies like driving a Fiat from London to Mongolia and a rickshaw
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across India.
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Those are some pretty cool experiences, Dan.
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I like it.
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All right.
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So as usual, we are going to start this conversation with a
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little bit of some articles that are going on in the news
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right now, kind of giving you a sense of what's out there
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and the baseline for what we're talking about and why we're talking
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about it on this pod.
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So the first one here is called Mental Health Investment Resurgence.
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And it says, a market ripe for innovation, a look at why
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investors are increasingly focusing on mental health and what innovations are
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gaining traction.
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So in this article from Galen Growth, they highlight some of the
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trends from investors in the mental health industry over the last five
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years.
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So I'm just going to ping these highlights for you today.
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Mental health funding has re-emerged as a bright spot in digital
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health investment, rebounding sharply in 2024.
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The sector attracted $2.7 billion in venture capitalists, a 38%
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increase year on year, making it one of the fastest growing segments
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in health care technology.
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So the bottom line there is there's a lot more funding going
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into mental health.
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Secondly, mergers and acquisitions, also the shorthand for that, M&A, within
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mental health has remained strong, primarily driven by the sale of financially
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distressed startups.
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And 71% of M&A deals in 2024 were venture to
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venture transactions.
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And also large digital health players acquired smaller startups to expand their
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product portfolios.
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So a lot of this is happening on the tech side.
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For investors, the mental health market presents a high growth opportunity, but
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success will depend on backing sustainable and clinically validated solutions,
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which is one of the reasons I'm excited to talk more to
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Dan.
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The shift toward late stage funding indicates a preference for startups with
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proven traction over speculative early stage delays.
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And for startups, regulatory compliance is becoming a significant barrier to
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entry.
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So while funding is available, startups need to prioritize their evidence-based
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outcomes and regulatory approvals remain competitive.
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And lastly, for industry leaders, with insurers and health providers
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increasingly integrating mental health solutions, corporate partnerships are a
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key growth channel.
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However, the slowdown in partnership activities suggest that companies must
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adapt to market dynamics.
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So the long and short of that is there's a lot happening.
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There's a lot changing, but there's a lot of investment still happening
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in the mental health industry, especially on the tech side.
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The next article I want to highlight is called Venture Capital's Priorities
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are Evolving as Behavioral Health Market Matures, Insights on How Funding
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Trends are Changing in Behavioral Health.
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And this is an article from Behavioral Health Business.
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A few highlights for you.
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It says more than $12.5 billion has been bet on digital
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behavioral health in the last five years, according to Rock Health.
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Funding peaked in 2021, COVID years, with $5.7 billion spent that
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year alone.
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And a quote from Margaret Malone, who's a principal at Flair Capital
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Partners.
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She says, it's our responsibility to help invest in founders who are
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forward thinking and see where the puck is going, but also know
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how hard it is and what the existing infrastructure looks like today.
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This article continues to talk about that at the end of the
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day, venture capitalists raise money from limited partners.
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They have a duty to generate a rate of return on the
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money they invest in these behavioral startups in a limited period of
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time.
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That is why they push growth.
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If the startups can't grow spectacularly or ultimately can't become profitable,
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which is really how you create value, then it's not going to
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work.
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And these companies die away and patients are left suffering.
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So we will dive into that question as well.
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But with that kind of background, knowing there's a lot of investments
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happening, there's a lot of rapid growth pushes.
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There's this business focus in the mental health industry specifically that
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maybe hasn't been there to the same level as it is now.
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I want to dive in with Dan because, as you heard, he's
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got a very extensive background in a lot of these areas.
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And I would love for you all to hear from him more
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how he's thinking about things.
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So Dan, let me just dive in and ask you about venture
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capitalist firms entering the mental health space, backing many different
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companies.
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What is your perspective on why this is happening?
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And what are some of the benefits and the risks to this?
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So thank you again for having me, Rachel.
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And I need to start off by saying I'm not a venture
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capitalist.
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That word has a very specific meaning.
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It speaks to a very specific model of investing.
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So folks on the clinical side may or may not be familiar
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with how to define what a venture capitalist is.
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But for simplicity's sake, a venture capital fund is a fund that
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is seeking very exponential returns.
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Generally, they're investing exclusively in technology companies.
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Technology companies, the risk return profile from an investor's perspective is
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very different than with non-tech businesses.
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We do not invest generally in technology businesses.
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There may be exceptions here or there if there's a synergy with
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the type of business that we typically invest in.
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But I just want to be clear, we are not a venture
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capital fund or a venture capital firm.
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So if I am running a venture capital fund or firm, I
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am looking to deploy a certain amount of capital over X amount
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of time.
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I have to make a certain number of investments.
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And the general expectation is that one or two of those will
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be massive home runs.
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In other words, they're going to generate an exponential return.
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Maybe one of them will do okay, and then the others may
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fail.
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And if they fail, they may fail completely.
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They may go to zero.
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So as we start to think about the financial and human costs
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and benefits, we have to bear in mind that that's one specific
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model of investing is not what we do.
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Lots of investors are not VCs.
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And I so often hear in this conversation, people on the clinical
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side talking about venture capital investing.
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And yes, that is one model of investing, but it isn't the
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only type of investor out there.
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And so as we start to understand the costs and benefits, we
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want to understand the different models of investing, because there's all kinds
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of different incentives at work.
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Does that make sense?
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I love, love, love that clarification, because I hear these terms thrown
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around all the time.
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Venture capitalists, private equity, merger and acquisitions.
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You call yourself, I noticed, an investment company.
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So you kind of don't use any of those terms, really, for
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what you do.
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So I love that you are differentiating that.
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And what would you, what should clinical clinicians, clinical practices know
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about the different types of investment?
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Very, very high level.
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I just explained how VCs work.
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Private equity is a different animal.
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Sometimes we are called private equity.
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Sometimes we're not.
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We actually talk about this internally because the incentives really matter.
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Just a couple of weeks ago, we were talking about it.
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And even within each of these universes, there's all kinds of subcategories.
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And it gets kind of complex, which is why I really enjoy
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having these conversations.
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And I think, you know, it's so important for us to understand
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what everyone's agenda is.
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So I try to be transparent, certainly when I'm dealing with a
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practice that we might invest in.
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But I very much want to be transparent with the broader mental
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health universe to start to educate the market so we can all
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have honest, open conversations about what we all want.
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So in the private equity world, generally speaking, the investments are not
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made in technology companies.
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There are exceptions, but generally speaking, we're talking about more old
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school companies.
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OK, so part of the reason we are sometimes referred to as
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a private equity is we invest in group practices.
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These are not fancy technology companies, right?
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This is a old school business, which some people will view as
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less sexy, right?
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A lot of people who go to antsy MBA programs want to
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work for either venture capital or VC funded startups.
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And it's sexy in the sense that the potential for growth is
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very high, but the risk is also higher.
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So we, as investors, are not taking quite the same risk that
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VC people are taking.
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And PE people don't expect the same level of growth.
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But what's also interesting is that within the PE category, there's a
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lot of innovation nowadays and a lot of people are exploring different
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ways to do things.
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How can we not just include social impact, but make that as
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important as profitability?
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In my opinion, in mental health, if we leave the venture world
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behind, if we get more into the PE world, what I would
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argue is that profitability and human fuel each other.
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We will actually obtain, in the long term, the most profitable returns
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for our investors if we really, really care about the human side
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of the equation.
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I think my personal view is it's harder to make that case
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in venture, and we can get into why that's the case.
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But for simplicity's sake, let's just say that there's venture that are
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shooting for super high risk return profiles.
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There's PE that are taking less risk, but also have less of
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a need for profitability.
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And I think there's more potential for innovation to include other factors
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in our decision-making.
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Yeah.
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So, that leads me into a question about your story.
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How did you personally decide to start this company?
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How did you decide that this was what you wanted to invest
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in and spend your life's work doing?
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It's a long story.
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I don't know how much time we have, but the simple version
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is, in a lot of ways, it found me.
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I think that when people...
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There's this beautiful book that influenced me years ago called Range by
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David Epstein.
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I don't know if anyone knows that book, but it basically says
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when you're planning your career, there's two broad mindsets to come from,
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the specialist or the generalist.
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And the book contrasts Tiger Woods with Roger Federer.
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Tiger Woods, from a very young age, just played golf, and his
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dad forced him to play golf all the time and to do
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nothing else.
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And he made a lot of progress very quickly, but he ran
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into some issues later on in life.
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Whereas Roger Federer, before he came to tennis, he played a whole
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bunch of sports.
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He played cricket, he skied.
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I can't remember all the sports he played, but he played a
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lot of sports.
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And it took him a little longer to find his footing.
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And so, I very much identify with Roger Federer more than Tiger
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Woods, not just because I like tennis, but because I'm a generalist
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by orientation.
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I explored a lot of different worlds.
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And in retrospect, all these worlds, you know, I think these things
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tend to happen for good reason.
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And so, each of these experiences gave me knowledge and gave me
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a sense of the world that I was able to bring together.
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And so, to me, the most interesting companies, the kinds of companies
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I invest in, are often run by generalists, but with supportive specialists,
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because we work best when we work together.
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So, the short version is, starting in law, I knew that there
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were aspects of it that I enjoyed, but I didn't love the
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environment.
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It felt very militaristic and hierarchical to me.
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And when I went to the Shark Tank, when I went to
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work on Shark Tank for one of the investors there, I really
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loved the entrepreneurial angle of things.
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And I started to notice that there were culture issues with a
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lot of companies that investors backed.
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And that sparked my interest in culture.
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And I left law for a time, went back to school to
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study organizational psychology, because I wanted to understand how we as
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investors could have done a better job with culture.
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And ultimately, built a few companies in that space.
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And building companies from scratch, I realized was, you know, I had
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some failures and some successes doing that.
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And I thought, oh, can't I combine the culture with my M
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&A roots?
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Why don't I go back to what I learned originally and fuse
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those together?
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And I need to do it in a space where I feel
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a sense of mission.
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And the brain was always at the dinner table for me growing
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up.
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Dad is a brain doctor.
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Mom has some background in psych and all kinds of formative experiences
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in college with friends with mental health issues.
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Always made that interesting.
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I was always reading about, you know, mental behavioral health in my
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own time.
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And so I had a hypothesis, maybe, maybe there's a positive impact
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I could have there.
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And over time, I tested the hypothesis, slowly but surely, the world
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gave me the feedback that, yeah, you're on to something, and you
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better do this, because we're going to stop you from doing anything
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else.
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I like that.
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I like how it found you.
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And it's, and that's interesting, that sense of mission of bringing your
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worlds together and having something that you truly believe in.
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I think that's interesting for people to hear.
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Because sometimes in our field, on the clinical side, I think money
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can almost be seen as the enemy or the antithesis.
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Like if you're pursuing money or profitability, that is the opposite of
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helping people.
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So I'm curious if you can speak at all to how you
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sort of merge those two things.
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Yeah.
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I was flying yesterday and I listened to this wonderful podcast by
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a guy named Michael Neal.
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The podcast is called Caffeine for the Soul.
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And the episode is called Rethinking Business.
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And he makes a point that you can essentially come from two
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places when you start a business.
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You can feel deeply insecure.
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You can be trying to solve your own pain through business, which
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is not the healthiest place to come from.
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Or you can feel already secure, largely.
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You can feel like you're free and you're coming from a place
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of pure possibility where a solution mindset to a big problem that
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you feel able to solve is there for you to solve.
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I think the same is the case on the clinical side, by
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the way.
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You can come from a place of deep insecurity.
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You can come from a place of having very, very deep money
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wounds.
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Or you can come from a place of largely feeling already secure,
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right?
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About money, about work.
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And I know which kind of clinician I would want to work
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with.
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And I know which kind of investor I would want.
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Yeah.
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Yeah.
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I really like that.
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Yeah.
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I think there's a lot there.
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But what do you feel like you want clinicians to know in
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terms of or practice owners to know if you are if you
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are meeting with a company for the first time and talking about
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maybe opportunities?
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What is your lens?
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What are you thinking about?
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What's what's good for people to know?
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What's good for clinicians to know when they meet with an investor?
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Or practice owners, which are often one in the same in my
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field, right?
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So if I'm a clinician and thinking about meeting with an investor
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or a practice owner, I want to get so, so clear on
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what my goals are.
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What do I really want?
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What's an alignment for me?
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And you want to assess that as quickly as you can, whether
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the person that you're considering working with, the organization you're
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considering working with is in alignment with your mission, looking to make
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a big, big potential partnership.
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Whether you're a clinician joining a group practice or I'm a practice
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owner considering working with an investor, be honest with yourself.
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Are you aligned?
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Right.
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And ask questions to understand how, you know, this person and this
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organization sees their mission, but then also read between the lines.
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So listen to the words, but then also listen to the energy
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behind the words.
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And as clinicians, you're often uniquely gifted to be able to do
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that.
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Absolutely.
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I like your focus on transparency.
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I'm wondering, do you ever hear negative feedback about what it is
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that you're doing or challenges to that?
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And I'm curious how you respond to those things.
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A hundred percent.
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I don't want to quite say every day, but very often.
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And every piece of negative feedback is different.
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There's the substance of what's being said, and then there's the energy
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behind what's being said.
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So I try to listen to both.
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And there's a lot of complexity in what we do.
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And I try to do my best to appreciate the complexity that
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someone else is coming from while articulating what we have to deal
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with.
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And I can't share everything all of the time.
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That's not realistic or fair to everyone, because there's so many different
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stakeholders involved in what we do.
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But I try to understand, again, what is an alignment for everyone?
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And what I can always be transparent about is what our high
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level mission is.
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And if that doesn't feel aligned, then we should go our separate
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ways.
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And sometimes people come to us and they don't really know exactly
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what they want, or they change their mind two or three months
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later.
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And so part of my coaching background has trained me to sit
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with people who are in that moment of possibility and help them
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figure it out, because they often don't know.
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Right.
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And I think, you know, having clinician-led practices, which is largely
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what has kind of grown up in this field, is such a
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different perspective than maybe a business-owned, you know, coming to start
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it from the business side.
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Somebody who went and got an MBA and did like that whole
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track of things.
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It's such a different mindset.
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And I think it's interesting when you talk about alignment, I feel
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that even within my practice and thinking of staff, we're always, how
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aligned are they with what we're doing as a company?
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And if they're not, they could be an amazing talent, all kinds
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of things, right?
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But if they don't have that, then it's just not going to
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work out.
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It's so interesting to hear group practice owners talk about how they
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interview.
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And some of the wise ones are trying to suss out not
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just what is the clinical ability of this person, they were, did
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they actually want to start their own practice?
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And so there's a classic assumption that you don't want to hire
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them if they want to start their own practice.
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But that could still be an alignment, because you could have an
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open, honest conversation, right, about that.
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And maybe they'll tell you, you know, I want to work for
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you for two years and then go off on my own.
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And that might work for you.
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It might not.
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But the more you can get to that place of openness about
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alignment, the more you you'll know relatively quickly whether this is the
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right choice for now or not.
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What would you consider a successful investment from your side of things?
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How do you how do you see maybe that that process go
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forward?
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And what does it look like from at the beginning versus the
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end?
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So we are always measuring the human and the financial, try to
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integrate them.
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So as part of due diligence, we want to understand how satisfied
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clinicians are.
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And of the 70 or 80 practices that I've spoken with, I
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would say a vast majority do not survey their clinicians in any
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kind and even informal way.
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And so for us, due diligence always includes a culture survey.
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And we want to understand what do clinicians actually think.
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The data is always imperfect, but we can get a pretty good
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sense of that.
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So success looks like an increase in clinician satisfaction.
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Success looks like improvements in clinician retention as well as
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profitability.
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All of those are things we measure.
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And in general, not always, you know, the incentives are sometimes at
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cross purposes.
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But in the long term, I believe the two fuel each other.
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We're going to get the best outcomes in both if we have
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a long term mindset.
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We're in this for many, many years to come.
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If I was more short term minded, the incentives would be more
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likely to be at cross purposes.
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Right.
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That's not the kind of business that's in alignment for me.
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So if I even tried to build that, it wouldn't work.
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So I want to measure all of those factors.
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Yeah, that's really interesting.
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I'm finding it curious because some of my thinking as a group
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practice owner is that and what I tell my staff all the
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time is we're going to aim to make decisions that are good
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business decisions, but are also good clinically and good for the people
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here.
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Like those two things both have to be what we're looking at.
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And they can often seem to be at odds.
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And so sometimes it does take talking a lot as a leadership
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team and figuring out how do we make a choice here that's
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in alignment with both of those things.
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I think in the short term, it's more often that you'll find
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that the incentives are at cross purposes.
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It's more common in the long term in a group practice.
23:10
I'm completely convinced that they're not.
23:12
So if you look at where your practice is now and you
23:15
look at where it could be, if you're more profitable, you can
23:19
pay your clinicians more.
23:20
Not only can you pay them more, you can provide benefits.
23:23
You can introduce them to other types of specialties.
23:25
You can broaden their minds as to what's possible and not just
23:28
mental health, but wellness, health overall, that the range of possibilities
23:33
available to you is unbelievable.
23:35
That doesn't all happen in five minutes.
23:37
Oh, of course not.
23:38
Of course not.
23:39
Yeah.
23:40
Yeah.
23:40
And that's interesting because you talked about your entrepreneur journey.
23:44
And from what I'm looking at from a business perspective, you are
23:48
choosing at this point to come in and take a practice that
23:52
has already done that startup part.
23:56
Really, you're coming in and you are taking it to the next
23:59
level.
24:00
So I'm curious, what's the inspiration for that for you?
24:06
So, you know, we all in searching for our purpose, we have
24:10
to be very honest about what we're good at and not so
24:12
great at.
24:15
And I'm just not the best at cleaning up messiness.
24:18
You know, you should look around here.
24:21
I just got back from traveling.
24:22
It was pretty messy here.
24:23
And it took me quite a lot of time to figure it
24:26
out.
24:26
Yeah.
24:27
So something that is already in good shape.
24:30
Right.
24:30
I am wired to take it from good to great.
24:33
Our team, we have the right team to take it from good
24:35
to great.
24:36
I'm not saying messy to good can't be done.
24:39
Right.
24:39
Of course it can be done.
24:40
It's just you have to be honest about why you're here and
24:43
what you're good at.
24:44
Right.
24:45
Fantastic.
24:45
Yeah.
24:46
So I would love to also get your perspective on kind of
24:51
zooming out to the wider, like what's happening in mental health overall.
24:56
There is a lot of tech, which you made it clear that's
24:59
not your side of the investment piece.
25:02
But there's a lot of that happening.
25:04
There's a lot of venture capitalist things happening as we read an
25:07
article.
25:08
What do you kind of see as trends in this industry?
25:13
And what are you paying attention to in that paying attention to
25:17
in that trajectory?
25:19
What am I paying attention to in the realm of tech and
25:21
mental health?
25:22
Just the industry overall, like as you're watching all of the players
25:27
and considering where you are in that, I'm just curious some of
25:31
your overall thoughts, but also what that means for your company and
25:35
for you.
25:36
Yeah.
25:37
One of the things I am watching and also just am personally
25:41
very invested in is what I'll call the shift towards comprehensive behavioral
25:47
health.
25:48
So the front line of mental health, you know, the mental health
25:54
crisis in America are outpatient group practices, which are primarily therapy
25:58
practices.
25:59
Right.
25:59
And therapy is a beautiful tool, so useful in the right context.
26:04
And because the plurality of mental health workers are therapists, we sometimes
26:09
use it as a hammer.
26:10
So we try to hit every kind of nail with that hammer.
26:14
And it just isn't the right tool for everything.
26:16
And it's also a more effective tool when complemented with other approaches.
26:21
And if we want to talk purely what's often called behavioral health,
26:25
that means psychiatry.
26:27
It means the psychedelic revolution.
26:30
Yeah.
26:30
It means it means neuropsychological and psychological testing.
26:35
So beyond culture are the sort of second plank of our mission
26:40
is to create practices where usually we're looking to add services depending
26:46
on what clients will be served by best.
26:49
And, you know, what will also boost profitability because that's going to
26:53
in turn boost clinician retention.
26:56
So I think that there's we live in a complex world and
26:59
trying to use one tool as great as it is, as proven
27:02
as it is, to solve every kind of problem is a mistake.
27:06
And ultimately, look, there's so much we don't know about the brain.
27:10
There's so much we don't know.
27:13
And science is now and science and spirituality are to me crystal
27:17
clear that the brain and the body are deeply integrated, deeply integrated.
27:21
And so we can talk about mental and behavioral health.
27:24
And if we totally exclude physical health from the conversation, that's a
27:28
mistake, too.
27:29
Right.
27:29
And so we're very blessed that our lead operating partner, head clinician
27:34
and then named Dr. Michael Goldberg, took the lead in integrating behavioral
27:39
health into primary care where he started his original practice in
27:43
Massachusetts.
27:44
We would love to see more of that.
27:46
And so there are you know, I'm very much watching to see
27:49
how we're able to think in a systems way across the industry,
27:55
which sometimes runs across purposes with an entrepreneur's desire to see a
28:00
specific problem and come up with the simplest solution as quickly as
28:03
possible.
28:04
And I can get into more of where that balance is if
28:07
you want.
28:08
But I am if there's one trend that I'm most interested in,
28:11
it's it's that it's the collaboration of different health care providers
28:15
working together.
28:16
Yes.
28:17
Or or even training different individual health care providers to think a
28:22
bit more broadly.
28:23
Mm hmm.
28:24
Yeah.
28:25
And that's interesting.
28:26
My this is a rebrand for this podcast.
28:29
And last year we did the mental health entrepreneur and it was
28:32
all about bringing in people that were doing creative and a bit
28:37
of things in mental wellness.
28:38
I kind of like to think of it more broadly as mental
28:41
wellness than just mental health, because I do think there's a lot
28:45
of room for creativity in that.
28:48
And it sounds like that's a bit of where you and your
28:51
team are inspired as well.
28:53
Yes.
28:54
Very, very much so.
28:55
Very much so.
28:56
It's where the future is going.
28:58
We're not going to be able in the practices we invest in
29:00
to provide the best results for clinicians or for excuse me, patients
29:04
as well as clinicians.
29:04
Ultimately, if we don't have that mindset, it's crucial.
29:08
Well, we are about out of time for this recording, but I
29:12
just wanted to offer up one more opportunity for you to just
29:17
if there were something that you could share with our audience, what
29:21
would that be?
29:22
So I just had a wonderful conversation with Dr. Arpan Parikh, who's
29:27
the chief medical officer over at at Sol Mental Health.
29:30
And the conversation was about nonclinical and clinical partnerships.
29:34
One of the most important things in general that I want to
29:39
see, and certainly we're a stand for it, but I would love
29:42
to see it across the industry, is are those sorts of partnerships.
29:46
So clinicians know so much that nonclinicians like us don't know, but
29:51
also vice versa.
29:52
We're trying to solve a complex problem, building businesses that serve
29:56
patients who are dealing with some of the hardest.