Virtual care startup Charlie Health expands to 25 states to tackle escalating youth mental health crisis

The U.S. is facing a growing youth mental health crisis. In 2019, 13% of adolescents reported having a major depressive episode, up 60% from 2007, according to federal data. Suicide rates among youth aged 10 to 19 jumped 40% from 2001 to 2019, while emergency room visits for self-harm rose by 88%, Centers for Disease Control and Prevention data shows.

Suicides have been increasing since 2007, passing homicide as the second-leading cause of death for those ages 10 to 24.

But the medical system struggles to keep up with the crisis, experts say, with limited options for inpatient treatment.

Charlie Health launched in 2020 to help fill these gaps and provide virtual high-acuity mental healthcare for teens and young adults. The startup aims to make intensive outpatient treatment accessible to young adults and the program combines supported groups, individual therapy, and family therapy into evidence-based, comprehensive, and personalized treatment plans.

Dr. Caroline Fenkel and Carter Barnhart of Charlie Health
Caroline Fenkel, Ph.D., chief clinical officer (left) and Carter Barnhart, CEO of Charlie Health (Charlie Heatlh)

"We deliver that program virtually, specifically for this high-acuity patient population—so for people who have experienced suicidal ideation, perhaps a suicide attempt, or self-harm. Over the last three years, we've helped tens of thousands of patients throughout the country," said Carter Barnhart, co-founder and CEO of Charlie Health, in an interview with Fierce Healthcare.

Charlie Health launched in Montana and is now available in 25 states with its recent expansion into Maryland and Wisconsin, a milestone the startup shared with Fierce Healthcare exclusively this week.

With this growth, Charlie Health is now able to serve half of U.S. states and over 245 million clients and their families through its virtual intensive outpatient program (IOP), Barnhart said.

Barnhart said she was inspired to launch Charlie Health based on her own personal experiences struggling with mental health challenges. Following a sexual assault as a young teenager, she struggled with depression, anxiety and post-traumatic stress disorder, she said in an interview.

"My parents searched for two and a half years to find me appropriate treatment and ultimately found a residential treatment center that saved my life. Fast forward, I then started working at that residential treatment center two years later, and worked there for 11 years helping to expand their locations from one little small facility in Southern California into really what's known today as the gold standard in high acuity, residential treatment," she said.

During her 11 years working at Newport Healthcare, the residential mental health treatment program, Barnhart rose through the leadership ranks, serving as chief experience officer, but she also noted the ongoing access problem for youth mental health services.

"No matter how fast we grew, we were always capacity constrained by the number of beds that we had and also constrained by the types of insurance that we could take. And there was always a waitlist," she noted. "It wasn't easy for people in crisis to receive care. I wanted to launch something that would really make crisis care accessible to everyone, when they need it most. And they didn't have to fly somewhere to it. They didn't have to even have a parent that could drive them there. Instead, they could really own their own treatment process, and participate in care from anywhere."

Charlie Health's evidence-based virtual IOP is specifically designed to bridge the care gaps faced by high-acuity mental health patients. The company offers a level of care in between traditional once-weekly therapy and inpatient treatment.

According to Barnhart, intensive outpatient programming is underutilized in the behavioral health continuum of care. "With Charlie Health now in 25 states, millions and millions of people now have access to our care and can receive care from home," she said.

Since people of younger generations are constantly on electronic devices as it is, there is an even greater opportunity to leverage telehealth to engage them in mental health services, Barnhart explained.

"It's three hours, three days per week—that's a nine-hour time commitment for group therapy. People asked, 'How are you going to do this?' My response is always, well, they are already on their phones and computers that much, we just have to make it interesting for them so that they want to get their mental health support live from licensed clinicians versus people on TikTok telling them what their diagnosis is," Barnhart said.

Charlie Health developed compelling content to keep individuals engaged in care and every patient is paired with a personalized therapist who is trained to address their specific needs. Patients also are placed into curated groups with peers coming from similar backgrounds and life experiences, executives said.

"They want to be with people who are similar to them, who are the same age, have the same primary diagnosis, same secondary diagnosis and same lived experience and that makes them show up. That's really the secret sauce of Charlie Health," Barnhart noted.

Charlie Health matches clinicians with patients based on strict licensure qualifications, which are set out by individual state licensing bodies. "We actively pursue multi-state licensure for our full-time, independently licensed, therapists with the goal of increasing our capacity to deliver telehealth services and ensure greater flexibility of treatment across the United States," Barnhart said.

While the use of virtual healthcare services has grown in the past few years, the outdated licensure system in the United States poses a significant obstacle to fully embracing telehealth's potential, according to Barnhart.

"During the COVID-19 pandemic, several states temporarily waived licensure requirements, allowing people to receive necessary care from providers across the country without negative consequences. However, reinstating these barriers prevents teletherapy from fully addressing the nation's mental health crisis and limits accessibility based on location or identity. It is time for cross-state licensure reform to ensure broader access to mental health services for all Americans," she said.

The startup currently has 900 employees and also works with independent contracted therapists, according to the company.

Charlie Health's services are growing as there has been a significant surge in adolescents and teens seeking mental health services, resulting in a notable strain on existing mental health resources, according to reports.

In Maryland and Wisconsin specifically, local hospitals have reported a concerning uptick in emergency department (ED) visits by teens and young adults for mental health crises, putting further pressure on an already burdened healthcare system. 

Hospitals report a surge in young adult visits to emergency rooms for behavioral health issues. A JAMA study revealed that visits to the ED related to suicide among children and adults in the U.S. increased 5x from 2011 to 2020. 

Research demonstrates the effectiveness of Charlie Health's virtual intensive outpatient treatment program for high-acuity youth. Published data from a study in partnership with the University of Pennsylvania found that Charlie Heath’s intensive outpatient program leads to a 71% reduction in suicidal ideation and a 60% decrease in symptoms associated with depression. The study also found a 58% decrease in self-harm among patients.

Virtual care has the potential to play a significant role in addressing the youth mental health crisis, Barnhart contends. The same study found that teens and young adults who received treatment via Charlie Health’s virtual program attended 91% of scheduled sessions, compared to a 65% industry average.

The company is focused on providing evidence-based care that is continuously evaluated and backed up with research data. To this end, Charlie Health has built up a robust research and outcomes team, Barnhart noted.

Charlie Health works with major commercial and Medicaid insurance plans. In Maryland, the startup is in-network with Aetna, Optum and Cigna, with more to come. In Wisconsin, its in-network with the Blues and Aetna, Optum and Cigna.