Mind 24-7

Love Meets Logistics:

Jeff Spight and the Mission of Mind 24-7

Introduction

In late 2022, as the sun dipped below the horizon of the Mesa district of Phoenix, Arizona, Jeff Spight, CEO and founder of Mind 24-7, found himself in a moment of reflection. Spight had just experienced an encounter that deeply impacted him, encapsulating his perspective on the impact and future of the mental health care start-up he had founded. A woman, with tears of gratitude in her eyes, had approached him and said, “You saved my husband’s life.” Her words echoed in Spight’s mind as he drove home. It was more than a thank you; it was a testament to the life-changing work Mind 24-7 was doing. Yet, for Spight, the moment was bittersweet.

As he navigated the evening traffic, Spight’s thoughts wandered to the countless other families across the United States who were still out of Mind 24-7’s reach. Spight felt the emotional weight of this realization heavily. Spight was at the helm of an organization that had already made significant strides in the provision of urgent mental health services in Phoenix, Arizona. Yet he couldn’t shake the sense of urgency and the need to scale the reach of their services more rapidly. The drive home became a crucible moment for Spight, underscoring the core dilemma he faced: how to balance the pressing need to expand Mind 24-7’s life-changing services with the practicalities of running a profitable and already operationally complex business.

Within 24 months of its founding, what had started as an idea on a napkin now encompassed four large physical clinics, with 265 clinicians and 85 head office employees treating over 400 patients per day. Mind 24-7 had rapidly transformed from a small start-up into a major logistical and medical operation. But the process had not been easy. Rapid scaling had led to painful HR issues, costly real estate missteps, and complex and evolving monetization challenges with a vast web of external stakeholders, from local police, hospitals and schools, to the insurance plans that paid for Mind 24-7’s services. Mind 24-7’s financial backers, a health care-focused private equity fund, had invested meaningful seed money in the venture and were exerting pressure on Spight to establish profitability before casting his net wider into new territories.

A Career In Health Care

Spight’s journey to founding Mind 24-7 was not driven by a quest for financial gain, but by a deeply personal mission. “There are times that I think it would be much easier to go take a health plan executive job and I could kinda do it in my sleep. We’d be fine, and my kids would be great, and it’d be a hell of a lot easier. But then I get back to, but there’s that family down the street that I didn’t know needed help? I feel like that’s a responsibility.”

“We’re not just building clinics; we’re creating a movement to change how mental health care is delivered.”

Spight’s career began in health care after his undergraduate degree, working at Deloitte Consulting, advising a range of health care clients including Kaiser Permanente and Catholic Healthcare West. After completing his MBA at Stanford Graduate School of Business, Spight worked in leadership roles in both payer and provider sides of health care insurance. Spight joined McKinsey & Company, which took him to Australia, Singapore, New Zealand and all over Europe. Everywhere he went, no matter what part of health care he worked on, he saw that general health care services were severely hampered by the dysfunctional provision of mental health.

Mental Health: A Broken System

Spight felt that the mental health system in the United States was fundamentally broken and ill-equipped to handle the diverse and complex needs of its patients. Mental health systems were also dragging the local area services (police, hospitals, schools) down with them. 

According to Spight, the provision of U.S. mental health solutions, driven by a profit-over-care philosophy, delivered poor outcomes at exorbitant costs and kept the majority of patients in a repeating cycle of disorder. Individuals in urgent need of psychiatric care often had to wait three to six weeks for an appointment. With nowhere else to go, those in urgent need turned to hospital emergency rooms for immediate attention. Emergency centers were ill-equipped to manage the volume and complexity of these cases. While emergency rooms excelled in handling a wide range of medical emergencies, they were typically ill-equipped to address urgent, but non-life-threatening, mental health situations. The lack of specialized staff and appropriate facilities in these settings meant that individuals with mental health issues did not receive the focused care they required.

As they sought the right external programs to which to refer patients, hospital workers were confronted by a labyrinth of providers that were set up to serve hyper-specific demographic and diagnosis groups. As a matter of last resort, patients in need of minor but urgent care frequently ended up in costly inpatient care programs, receiving care at a level of intensity and for a duration that far exceeded their needs. The cost of delivering such inappropriate levels of care resulted in extraordinary costs that were passed through to insurance payers.

Spight became more and more fascinated by the promise of solving mental health. “I really just became enthralled with the idea of fixing mental health care, I felt it was one of our two generational challenges.” Recognizing the shortcomings of the system, the inception of Mind 24-7 was driven by a critical question: How could a new and effective “front door” for mental health care be created?

A New Model of Mental Health Care

Spight knew that he had a significant challenge ahead of him. To succeed, Spight needed to build an alternative model of mental health care that was fundamentally better for all stakeholders—particularly patients. The solution needed to be highly responsive, and cater to a large volume of demand that was fragmented in its mix of diagnoses, urgency and demographics. The offering would need to be sufficiently attractive to patients to ensure that they showed up, to community stakeholders that they would bring patients to their clinics, and to the insurance payers to ensure that the business was economically viable.

Taking everyone

Spight decided that Mind 24-7 would accept all patients, regardless of their background, profile, diagnosis or—critically—their ability to pay. By taking everyone, Spight hoped to ensure that anyone in need always had an available option. He also wanted to reduce the burden on emergency room nurses, law enforcement officers, and school counselors who typically lacked the time, resources, or training to know where to send patients in need. Spight wanted Mind 24-7 to become the immediate choice where all individuals would be readily accepted and assisted. Not only would this create the highly inclusive care offering that the industry lacked, but it would be critical for Mind 24-7 to capture the volume their operation would need.

Within months, Mind 24-7 became the “monopoly owner” of kids’ mental health care in the Phoenix area. And the same adults who had previously faced a wait in the emergency room for 8 to 10 hours followed suit. By January 2024, each Mind 24-7 clinic saw ~100 patients per day. Spight saw this as evidence that Mind 24-7s offering was attractive to its market, and provided the volume necessary to negotiate effectively with insurance payers. “That is a market leverage position that enables us to negotiate better economic relationships with insurance payers; you need that market share,” Spight explained.

24/7 available & immediate care

To be the go-to solution for all of Phoenix’s mental health needs, Spight knew that he needed to go further than just accepting everyone. Given the urgent and unpredictable nature of typical mental health crises, Spight decided that all Mind 24-7 services be open, available, and fully staffed 24 hours a day, seven days per week. 

Spight recognised an opportunity to radically redefine expectations around how quickly a new patient would receive attention. Aiming to slash the patient waiting times that had traditionally plagued the industry, Mind 24-7 set out to see all new patients within 25 minutes of their arrival, the majority of which would be processed through their facilities and sent back home within two hours.

Spight explained how these simple operational designs directly addressed the core challenges in mental health. “I can keep people out of the emergency room because they’re going to be able to come into a Mind 24-7 clinic anytime during the week. And they’re going to wait no longer than 20 to 25 minutes to see the psychiatric provider, versus the typical three to six weeks elsewhere. They’re not going to go to a hospital emergency room because they know they’d be waiting there for hours. Plus, emergency rooms are just notoriously bad places: you can easily end up in another, much worse place, just because you’re there,” he said.

Not only were waiting times at Mind 24-7 distinctively low, but clinic operations focused on maximizing the efficiency of each patient visit. In a significant departure from typical operational practices, new patients to Mind 24-7 were assessed by Spight’s most senior and experienced medical professionals first. “Instead of conducting five different assessments at all different levels of staff, we’re just gonna get you the most advanced clinician in the building first to figure out what you need. The first clinician is immediately figuring out: does this patient need the gold package, the silver package, the platinum package? This has a huge impact on both the patient and subsequent flow of operations,Spight explained.

Patient outcome-centered design

Beyond offering all patients low wait times and rapid assessment, Spight was adamant that Mind 24-7 would provide a level of care that was appropriately calibrated to suit the needs of each patient. Spight not only aimed to minimize cost by avoiding unnecessary procedures, but felt that doing so would optimize the quality of each patient’s experience and the outcomes achieved. 

Mind 24-7 achieved patient-centric care by cutting out unnecessary or inappropriate interventions. Spight shared: “Generally, health care functions with the mentality that ‘the more I do, the more I make.’ From day one, I told the team that I don’t want Mind 24-7 to be about that, I want it to be about the more impact we can make, the more value and then the more money we’ll make.” Throughout Spight’s career in health care, he noticed how strongly “fee-for-service” incentive structures influenced otherwise commonsense health care decisions. “It’s not unusual to see medical institutions giving every 58-year-old female patient a pregnancy test. I’m not saying there are no 58-year-old women who may need a pregnancy test—sure there are some—but probably not everyone. But a lot of places do it, because they get a chance to make an extra $30.” 

A significant portion of the cost incurred in traditional mental health services stemmed from the minority of patients whose failed interventions caused them to cycle back repeatedly through the system. For Spight, building a system that broke this cycle, while fundamentally improving the outcomes for these patients, would be central to creating a model that maximized the best patient outcomes and was financially sustainable. To manage the large volume and complexity of incoming patient cases, Spight and his team designed three service streams: Crisis Care Service, Mental Health Progressions, and Urgent Care Express.

Crisis Care Service

Crisis Care Service at Mind 24-7 was their version of a psychiatric emergency room, built to provide immediate and reactive resolution to the most troubled individuals, many of whom posed an immediate threat to others or themselves. Mind 24-7 designed a set of protocols to keep these patients onsite at the clinic for up to 24 hours. During this time, patients were assessed, carefully treated, prescribed necessary medications and treatment plans, and then usually sent home. In Spight’s experience, an impressive 80 percent of these urgent cases were successfully de-escalated and sent home safely. 

Beyond the personal benefit to the individual, the economic value created in these cases was significant, forming the central argument in Mind 24-7’s revenue model. Every time an urgent patient crisis was swiftly resolved and the individual was sent home, the health system avoided the alternative of a two-to-three week stay in an inpatient mental hospital. Spight explained, “80 to 85 percent of the time we can avoid that typically-completely-unnecessary-but-extraordinarily-expensive $20K to $30K stay. When you start adding up $30,000 across all the patients we treat this way, you start to create a pretty big economic impact.”

For the 15 to 20 percent of patients whose condition was beyond the scope of Mind 24-7’s immediate capabilities and not treatable on-site, nurse practitioners selected external programs that were suited to the specifics of the patient’s situation and profile. Spight decided that the Mind 24-7 clinics would not offer their own long-stay inpatient care facilities. Offering these long-stay services would not only distract his staff from a focus on offering highly efficient and fast turnaround care, but would introduce a conflict of interest with the goals of his staff. Spight trains his clinicians to keep patients out of beds whenever possible. “I can’t tell my team to do everything they can to keep a patient out of a bed, only then to put them in our own beds. It also muddies up my conversation with those who are paying, because otherwise they’d think I’m just the fox in the hen house.” Instead, Mind 24-7 connected these individuals back into the rest of the health system by employing a deep knowledge of the patchwork of various institutions and programs available. Mind 24-7 did not enjoy any further economic benefit from these external referrals, a situation that Spight claims was key to the comfortable relationship he enjoyed with insurance payers. 

But that was not the end of the story for the patients referred externally. Demand for external programs was often intense and facilities were frequently full, with waitlists that could span three weeks or longer. To ensure that the patient did not relapse in the intervening period, Mind 24-7 developed a bridging program called Mental Health Progressions.

Mental Health Progressions

Mind 24-7’s Mental Health Progressions program offered transitional treatment and support to patients for up to 90 days. The program catered to patients that were “between institutions,” ensuring they remained cared for before a vacancy at their next treatment center opened and their new program started. Mind 24-7 continued to provide these patients individual and group therapy, medication management, and peer support, elements of which were provided remotely through telehealth technologies. Mind 24-7 also worked with patients to solve contributing external factors, such as housing instability, food insecurity, unemployment, and exposure to abuse.

Urgent Care Express

The Urgent Care Express line was designed for patients seeking prompt attention and care, but whose immediate situation was less urgent. Mind 24-7’s Urgent Care Express services catered to those seeking immediate consultation with a licensed professional, offering comprehensive mental health care, including physical and psychiatric evaluations, medication reviews and refills, and care planning. The majority of patients completed their visit in under two hours, allowing them to quickly resume their daily activities.

Mind 24-7’s role in the community

Mind 24-7’s services sat at the intersection of law enforcement, health care, and schooling. To create value for the community, Spight saw an opportunity to reduce the burden that a failing mental health sector had placed on these core services. Spight knew that establishing strong community relationships would be critical to Mind 24-7’s success.

By January 2024, Spight had been heartened by the impact that Mind 24-7 had made on the local services and their staff. Law enforcement officers frequently traveled from over two hours away to bring troubled individuals to his facilities. Spight explained: “The police know they’re not gonna be chasing their tails and going to six places and waiting a couple hours at each place. And they know we’re going to say yes. They ring the doorbell, they don’t even have to tell us they’re coming. We’re there in two minutes. We ask them their badge number, their name, a little context, and they can be on their way.” Mind 24-7 clinics were designed to make the law enforcement feel particularly welcome. Each facility offered dedicated lounges with drinks, snacks, and air conditioning for officers, designed to acknowledge their needs and the challenging nature of their work. 

Police chiefs approached Spight expressing admiration for Mind 24-7’s services and requested a discreet way for officers and their own families to receive their own care from Mind 24-7. Spight noted, “The police chiefs around town came to us and said: Hey, we love what you do, but it’s been a rough few years for our officers and their families. We’re struggling, and we don’t know where to go to get help. We go to other places, but we’re not comfortable there. We like the way you guys look and the way you care for people. If you could help us figure out a way to get care without having to come through the lobbies of the patients we’ve just brought, we’d love to figure something out.” Spight was delighted to accommodate this request, as he saw it as ultimate proof that Mind 24-7 was a trusted resource to this critical audience. The facility was updated to allow for separate entrances, providing law enforcement and their families dedicated attention and privacy from other users of the space. “It’s the most amazing compliment when you see an officer bring their 10-year-old kid into your clinic because they think this is the best place to bring them. We have to acknowledge and understand that’s the role we play in the community,” Spight said. 

In response to the increasing patient demand and to deepen community links further, Mind 24-7 extended these complementary care services to health care workers, teachers, and their families, in recognition of the widespread challenges faced in recent years. This care was offered as part of Mind 24-7’s commitment to the community, without charge. These community-focused programs made a significant impact. “We’ve had hospital administrators tell us they couldn’t imagine going back to a time before Mind 24-7 existed,” Spight shared.

A Complex Operation

But by Spight’s own admission, starting, growing, and managing such an intensive operation had been a monumental challenge. “I won’t kid you, this whole process is hard as hell,” Spight remarked.

Chief amongst these challenges was the sheer scale of operations. To uphold the promise of accepting all patients, clinic sites required significant scale. Each facility was substantial, spanning 20,000 to 30,000 square feet with sufficient treatment rooms and waiting areas capable of handling up to 130 patients daily when operating at full capacity. And to cater to a diverse set of groups, the facilities were designed with separate lobbies for children and adults and had distinct drop-off doors for first responders and law enforcement, further segmented for kids and adults, ensuring tailored and efficient service for each group.

Beyond the scale of the premises, Spight and his team operated a staff of over 100 employees at each location. All essential staff had to be present in the building simultaneously, including psychiatric providers, nurses, lab technicians, therapists, and social workers. “I can’t run a setup where my psychiatric providers are just here for an hour to a day and they leave because they don’t know when people are coming,” Spight explained. Maintaining a full complement of staff was necessary due to the unpredictable nature of patient arrivals and the diverse and urgent needs they presented. Coordinating such a comprehensive team was a daunting task, but one that was fundamental to the facility’s functioning and to the central value proposition Mind 24-7 offered to the community.

In pulling off such a feat, Spight acknowledged the role played by the culture of his team and the physical design of the clinics.

Team Culture

The culture of the team at Mind 24-7 centered around a simple commitment to helping people. The patients that Mind 24-7 received were vulnerable and often arrived at the clinics during some of the most challenging times of their lives. Spight encouraged his staff to view each patient not as a source of additional work, but as an opportunity to make a positive human impact. Mind 24-7’s culture rested on the central principles of service, teamwork, and fun. 

In a typical, modern health care setting, Spight observed that up to ~80 percent of a clinician’s time can be spent on the computer, completing forms and paperwork. “But we forget that there’s a real person on the other end,” Spight explained. “Because we’re here to help everybody, our staff get really jazzed up about it, they’re excited about it.”

Spight recognized that the work he asked of his clinicians was extremely demanding. The act of caring for those in urgent and desperate need of psychiatric assistance could take a toll on any individual, especially those not sufficiently supported. Spight emphasized a supportive work environment, especially important given the clinic’s high-stress work. Mind 24-7’s often-repeated mantra of “You’re never alone” was a cornerstone of the company’s culture, ensuring staff felt supported and safe. This focus on team culture was essential to maintain the high level of care and commitment that Mind 24-7 aimed to provide.

Wherever possible, Spight and his team sought opportunities to inject fun into the team’s working day. Spight reminded all his staff that creating an atmosphere of fun and laughter was a shared responsibility. Whether through trips to baseball games, holiday parties, or tamale bake-offs, Spight understood that fun and relaxation were critical to maintaining a working environment that was sustainable for his staff. “What we do is hard. It’s a really tough job,” Spight admitted.

Design of clinics

When Spight analyzed the existing options for mental health care, he noticed that the physical spaces of his competition were often run-down and unappealing. Many of the mental health institutions located in hospitals or separate clinics were run by charities or nonprofit organizations with little resources to invest in physical infrastructure and furnishings. Moreover, historic stigma around the issue of mental health had driven clinic locations off street corners or down side streets. Spight wanted Mind 24-7 to change this. Spight’s ambition for the design of Mind 24-7’s clinics was one that delighted visitors and maximized operational efficiency.

Mind 24-7’s spaces aimed to emulate a retail-like, Starbucks-inspired atmosphere, focusing on creating a bright, clean, and modern environment. The intention was to evoke the feeling of a spa rather than a traditional run-down mental health facility. This was achieved through beautifully designed lobbies that were well-lit and aesthetically pleasing.

Beyond an attractive aesthetic design, clinics were arranged to maximize functionality, emphasizing the efficient movement of patients through the facilities. Clinic facilities were tailored to the needs of the patients, featuring easily cleanable, practical furniture and a layout that swiftly moved patients from the lobby to intake rooms and then to the provider.

Safety First

Operational protocols at Mind 24-7 were developed with safety in mind. All new patients into the Crisis Care Service were changed into scrubs, so staff knew there were no hidden weapons or other objects in patient clothing. Staff were trained to de-escalate agitated or violent situations without placing their hands on the patient. Oftentimes, law enforcement who had brought a patient to the clinic would offer to stay, especially if the patient was in a particularly high-stress state. The offer was typically refused. “We say no, it’s better if you go. The notion of having somebody with a gun just escalates the anxiety,” Spight shared. Mind 24-7 went one, unusual, step further in reducing the perceived level of anxiety, by opting not to employ security guards at any Mind 24-7 facilities. “We don’t even have security guards at our facilities because it just raises the anxiety level.”

Spight explained Mind 24-7’s unconventional but successful approach to staff and patient safety through the visit of a hypothetical teenager in crisis. “So we may have a 16-year-old boy who comes in, he’s pretty violent. But if he’s surrounded by four or five staff and there’s no real place to go, and they’re all four or five feet away and we’re just talking. The boy will quickly realize the futility of trying to fight their way out. It’s just not gonna work. And oftentimes what we’re just trying to say is, hey, we’re with you. We’re on the same side as you are. We’re not judging you. We’re going to help you out,” he explained.

And oftentimes what we're just trying to say is, hey, we're with you. We're on the same side as you are. We're not judging you. We're going to help you out.”

A Busy Start

By January 2024, Spight was proud of the progress he had made in building Mind 24-7. Since its inception in 2021, Mind 24-7’s clinic network had grown to four fully functional sites and had treated over 45,000 individuals. But Spight admitted that the road to this point had been difficult. He conceded, “I think you have to be certifiably nuts to want to do this, because when you try to change the world, the world fights back.”

A major challenge for Spight and his team had been the incredibly rapid pace of change. Mind 24-7 had transformed from an idea on paper in July 2021, to seeing its first patient in September 2021. Within 24 months, Mind 24-7 saw thousands of patients per week, growing from $6 million to $40 million in annual revenue. This rapid growth required the near-constant evolution of Spight’s team and operations. “We’ve had to totally reinvent our team four times in two and a half years,” Spight admitted. Team evolution this fast confronted Spight with numerous difficult decisions about long-standing team members—some of whom were close friends of Spight’s—who were deemed unable to adapt to the company’s quickly evolving needs. Spight admitted to struggling to let go of team members who couldn’t make the next step. “It really weighed on me, but the right call was to let them go,” he explained.

One particularly challenging episode revolved around the hiring—and subsequent firing—of a talented chief operating officer and a chief medical officer, both of whom were Spight’s colleagues from previous companies. Six months into their appointments, and despite their impressive backgrounds and individual competencies, it was clear to Spight that they were incapable of working together effectively. Spight’s decision to let them both go—while necessary for the long-term success of the clinic—resulted in delays to a number of critical processes and an increased workload for Spight. “We have to have specialists in different functions,” Spight shared. “Letting go of two C-suite leaders simultaneously was painful but necessary, and put a ton of pressure on me during the leadership gap.”

Rapid rental and build out of real estate and facilities added further strain to Mind 24-7’s growing operations. The urgent need to alleviate overcrowding in one clinic led to the rushed and inefficient renovation of a former large LA Fitness Gym. The decision—while providing a small degree of immediate relief—ultimately resulted in far higher costs and a much longer overall completion time. “The other locations were bursting at the seams taking care of kids, and we needed to get some immediate relief. We rushed the opening of this new prototype clinic and ended up wasting ~$3M of investor money that I would much rather have spent elsewhere,” Spight admitted.

For Spight, these challenges were an expected part of taking on such a daunting task. While he was conscious of the significant challenges he’d faced so far and the toll this had taken on him personally, he remained focused on the overall goal. “There’s already 45,000 lives that are much better off because we were here. Now we’re going to go and figure out how we get the next 45,000.”

An Innovative Economic Model

The Mind 24-7 economic model was centered around the value created for all stakeholders involved in mental health care and the local community. “Generally, I’m of the belief that as long as we’re creating economic value, then the challenge is just how do I negotiate to go get my piece of that?” Spight explained.

Mind 24-7’s primary revenue stream stemmed from reimbursements from insurance payers. The business relied on a fee-for-service structure, traditional in U.S. health care, where compensation was tied to the volume and type of services provided. About 35 to 40 percent of Mind 24-7’s revenue came from insurance payments, predominantly from Medicaid plans that insured the low-income demographic they served. According to Spight, the first contracts he was able to secure with payers were “good enough,” but after the first year and demonstration of success at managing a high volume of patients, Mind 24-7 was able to negotiate rate increases. Spight saw these fee-for-service contracts as a robust starting place for Mind 24-7, but he had bigger ambitions.

Spight’s goal was to transition to a revenue model based on capturing a larger portion of the economic value that his clinics created, and the substantial savings that the health plans enjoyed as a result. By Spight’s own estimate, each Mind 24-7 clinic saved health insurance plans around $200 million per year in costs that would otherwise have been spent on unnecessary treatments. Mind 24-7 saw roughly 10 percent of that value as revenue. “We’d like to establish arrangements where we’re getting paid more based upon a percent of what we are saving the plans. We’re working through those dynamics with them right now,” Spight explained.

VALUE BASED CARE MODEL

1

Agrees to care for a health plan’s 200 highest cost patients

2

Calculates a competitive rate and establishes metrics

3

Signs contract with the health plan

4

Provides patient-centered care

5

Hits quality metrics and gains bonuses

To supplement income from insurance reimbursements, a base of grant funding accounted for a further 30 percent of Mind 24-7 revenues. Along with supporting the overall funding of a location, these grants helped to cover the roughly 10 percent of uninsured patients who sought care, viewed internally more as a “marketing expense” than a financial liability. By absorbing the cost of underinsured patients, Mind 24-7 built a reputation in the community and maximized the volume of those patients who were insured. “I think of that unallocated or unpaid care like a marketing expense, since I’m taking everybody, and I know that only one out of ten won’t be able to pay. I’m not worried about the one you’re going to send me that can’t pay, I’m more interested in your sending me the other nine,” Spight shared.

For every clinic, Spight targeted a revenue figure of $20 million. Between insurance plans, local grants, and city-supplied funds, Spight’s task with each new clinic was to patch together the various funding sources to hit that goal. He noted, “We have a lot of options about how to get there. Every time we go to another market, it’s a puzzle to solve: How do I get to that $20 million number?” 

Some local city councils were offering Spight large grant checks up front to bring a Mind 24-7 clinic to their area. “We’re having some places come to us and say, can we just pay for your clinic to be open? Some large cities are telling us they want to give us $20 million to see a hundred people a day and to deliver our care. Other cities are considering giving us $5M or $10M. In these situations, the gap that I’ve got to go and get from the rest of the system has decreased,” Spight explained.

Spight believed that close, symbiotic relationships with local law enforcement brought in patients and supported Mind 24-7 in conversations with local governments—and felt that outweighed any direct financial gain. “The notion that we would charge the police doesn’t really make sense to me. However, as you get into budget conversations, if the police are lobbying for you to make sure your funding is not cut, that’s a super helpful ally to have in those conversations.” Mind 24-7’s impact on the local police force was significant. Instead of a two-hour wait, the process of dropping off a patient at Mind 24-7 was streamlined to just two minutes, allowing officers to quickly return to their duties. This efficiency meant that for every 20 police drop-offs, the equivalent of a full-time officer was added back into community service. With hundreds of police drop-offs occurring weekly, the clinics significantly enhanced community policing capacity without additional financial investment from local authorities. 

Mind 24-7’s financial relationship with local hospitals, however, was more lucrative. Spight established agreements with some local hospitals to place Mind 24-7 personnel in their emergency rooms. Hospitals paid Mind 24-7 to engage with psychiatric patients and their families, and patients were encouraged to visit the Mind 24-7 clinics. This arrangement not only generated direct income for Mind 24-7 but also provided a steady stream of referred patients, effectively turning the emergency room into a marketing platform for the Mind 24-7 services.

Balancing Scale and Profitability

As Spight looked to the future, he weighed the personal urgency he felt to scale the reach of his services against the imperative to demonstrate profitability and financial sustainability.

At the clinic level, Mind 24-7 was contribution-positive, and Spight was aware that incremental margin improvements were still available. Staffing levels at the outset were intentionally high to mitigate operational and safety risks, and with two years of experience, the team had started to shift its focus to adjusting human resources to more efficient levels. Spight was also confident of squeezing additional revenue from payers, grantors, and local community stakeholders. 

However, the overall enterprise remained loss-making. Significant up-front capital investment and the maintenance of a sizable corporate structure kept Mind 24-7 from breaking even. To achieve profitability, Spight was convinced that expansion to at least five or six clinics would be necessary.

In five years, Spight hoped to have established 50 clinics across 8 to 10 markets. With 50 clinics each making $20 million in revenue, Spight wanted Mind 24-7 to be a $1 billion revenue business. A large part of Spight’s confidence and urgency stemmed from the seemingly never-ending demand for Mind 24-7’s services. He noted, “It’s very clear that there’s not a market that doesn’t have a need for us. Virtually every major town in the country is excited about it when we go talk to others around nationally, they’re telling us: please come, please come.” At this scale, Spight Mind 24-7 aimed to continue seeing an average of 35,000 people per year in each clinic, resulting in around 1 million people a year across the entire network.

Fundraising

In late 2020, when approaching his initial fundraising exercise, Spight sought $2 million to $3 million in funding from friends and family. But after connecting in February 2021 with Regal Healthcare, a health-care focused private equity firm that offered to make a $20 million investment, Spight spotted the opportunity to increase the speed at which Mind 24-7 could start seeing significant numbers of patients. Closing the Series A round in May 2021 allowed Mind 24-7 to expedite its clinic roll-out timeline, opening an initial prototype site in September 2021, focused on supporting the Phoenix Children’s Hospital. 

Given the capital-intensive nature of establishing brick-and-mortar clinics, Spight returned to investors in March 2022 to raise an additional $16 million bridge financing for additional locations. Over the summer of 2022, Mind 24-7 raised a further $60 million in a Series B round from existing investors. This coincided with an additional strategic investment from Kaiser Permanente Ventures, who invested $10 million. In total, Mind 24-7 had raised $110 million by January 2024. “This funding was the only way we could have gone as fast as we did; we’d only have one or maybe two clinics if we’d only taken friends and family money,” Spight explained. 

However, the partnership with private equity investors was a source of friction for Spight. Mind 24-7’s private equity backers brought a focus to immediate profitability that added an unwanted burden and pressure that contradicted with Spight’s focus on scale of impact.

Looking ahead, Spight expected to increasingly turn to strategic investors rather than pure financiers. Partners like hospital networks and insurance payers would provide Mind 24-7 access to patient pipelines and support regulatory challenges inherent in entering new regions. There was potential for Kaiser alone to propel Mind 24-7’s footprint to 30 clinics within California.

Spight dreamt of scaling Mind 24-7’s impact across the nation and fundamentally improving the outcome expectation of all mental health patients. An exit to a strategic buyer with significant patient service and profile overlap seemed to be the most likely outcome.

Driving Forward

As Jeff Spight sat in his car, the hum of the engine providing a gentle backdrop to his thoughts, he found himself revisiting the poignant encounter with the woman who had thanked him for saving her husband’s life. That moment had inspired intense gratitude and underscored the weight of responsibility he felt at the helm of Mind 24-7. 

Mind 24-7 had grown into a reliable source of hope for many in the communities it served. Each clinic and each patient story was a testament to the impact they had already made. But for Spight, this was just the beginning. Spight mused, “We’ve come far, but there’s so much more to do.”

Michael Rothkopf and Professor Hayagreeva Rao prepared this case solely as the basis for class discussion. James Davidson, Jazmine Diaz-Esteves and Pablo Woythaler (Teaching and Learning Hub) created the multimedia. Stanford GSB cases are not intended to serve as endorsements, sources of primary data, or illustrations of either effective or ineffective handling of an administrative situation. Funding for this case was provided by the Stanford Graduate School of Business. This case was reviewed and approved before publication by a company designate.

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