Generation Start-up: Tuhoon mental wellness app aims to be culturally relevant in Gulf

Fares Ghandour was inspired to create a mental wellness platform following his own journey with mental health. He spotted a gap in affordable, accessible and high-quality care delivered in the local dialects of the Gulf region.

Mr Ghandour teamed up with entrepreneur and clinical psychologist Dr Naif Almutawa and software engineer and product manager Aymane Sennoussi to set up Tuhoon in June 2021, creating a “tech-enabled care business”.

The Riyadh-based business launched a self-help app in March 2022 for sleep improvement, stress reduction, work-life balance, meditation and self-awareness curated by Khaleeji experts to provide content in Khaleeji dialects.

“Information in Arabic on mental health is scarce and that should not be the case,” Mr Ghandour said.

“It's a question of offering accessibility, quality, affordability and normalisation of mental healthcare that is culturally-relevant and speaks to people in their own language while maintaining credibility.”

While technology helps to improve people's access to mental healthcare, Tuhoon is now venturing into a hybrid model with clinical psychology and counselling clinics that will offer in-person and virtual appointments, the co-founder said.

Plans are under way to open a clinic in Dubai in February and in Riyadh in the second quarter of this year, Mr Ghandour said.

They will start with a size of four rooms before expanding to 10 rooms and eventually 20 rooms.

About 15 per cent of people in the Gulf experience mental health issues, but more than 75 per cent of those who need mental healthcare do not seek it, according to a study by PwC Middle East in June 2022.

While the Covid-19 pandemic has exacerbated the burden of mental health problems regionally and globally, there are only 2.85 psychiatrists per 100,000 population across the six GCC countries, it said.

Untreated mental illness costs an estimated loss of 37.5 million productive days per year, the equivalent to $3.5 billion, according to the survey.

Tuhoon is mainly targeting the Saudi Arabian market with mental health services that are relevant and relatable to the country's demographics, Mr Ghandour said.

In Saudi Arabia, the Arab world's biggest economy, 80 per cent of those with severe mental disorders do not seek treatment, the Saudi National Mental Health Survey said in a 2019 study.

Watch: Here’s why pupils of Abu Dhabi school are wearing their clothes inside out

Additionally, 34 per cent of Saudis meet the criteria for a mental health condition at some point in their life, but only 4 per cent of the Ministry of Health budget is allocated to mental health, it showed.

“That's where the opportunity lies … it's a large, untapped and unaddressed market,” Mr Ghandour said. “Quality mental healthcare supply is the problem, not the demand.”

Tuhoon's target clients are individuals and corporates that provide the services to their employees. Telecom operator Zain, health insurance provider Bupa and Riyad bank are among its customers.

The start-up recently partnered with the National Center for Mental Health and palmHR on a study on workplace wellness, surveying 50 human resource managers and 4,000 full-time employees at private and public organisations across the kingdom.

About four out of five employees experienced at least one mental health challenge in the past 12 months, with the most commonly reported issues including burnout, anxiety and stress, it found.

While 78 per cent of organisations do not measure their employee’s mental well-being, 82 per cent of organisations do not have a dedicated budget for mental health services.

Women are 50 per cent more likely than men to report having poor mental health, as female labour participation doubles in the kingdom, the study found.

This is reflected in Tuhoon's client base, where about 65 per cent of its current users are Saudi females, Mr Ghandour says.

Overall, the start-up has recorded 100,000 sign-ups on its app and about 1,500 active users weekly, he says. The amount of multimedia content consumed per week per user has reached 1.5 hours and is “trending upwards".

Demand for the app's self-help content is “huge”, as indicated by the 30-day user retention rate of 26 per cent, he says.

“Most users love the app but they also want to talk to someone and starting our clinical care venture is in response to users' wants, that's where the demand lies today,” he says.

“Countries like Saudi Arabia are becoming more urbanised, with growing cities and increasing involvement in workplaces, so there are modern-day challenges and balancing that with traditional norms is creating some anxieties,” Mr Ghandour says.

Within the GCC region, post-Covid demand for mental healthcare is continuing to grow amid looming fears of a global economic recession, he says.

Tuhoon's business model is centred on individual and corporate users' subscriptions for its app, where it also offers employers workplace assessments of employee mental health, workshops, content recommendations and, in the future, clinical care.

App subscription costs $40 annually per user.

In terms of funding, the start-up is at the seed stage with $2.5 million injected into the business to date from self-funding, angel investment, backing by venture capital firm Wamda and UAE-based Nuwa Capital.

The funds have been used to create content, hire talent and develop the technology behind the app.

Tuhoon targets growing to about 20 clinics within three to five years, with 20 rooms per clinic, mainly in Saudi Arabia, backed by licensed professionals and standardised, regulated mental healthcare, Mr Ghandour says.

The start-up expects to raise more funding in the future, depending on the performance of the initial clinics.

Investments in digital health sector are increasing, with mental health receiving the biggest share, and that is unlikely to slow down over the next decade, Mr Ghandour says.

“It's a serious market in need of disruption and enablement. Technology can play a role in that,” he says.

Q&A with Tuhoon co-founder Fares Ghandour

Who is your role model?

Anyone who suffered in silence but managed to pull through.

Why is setting up a business with social impact important to you personally and professionally?

I believe that entrepreneurship in the Arab world is by design social impact. Investing in and starting businesses in the region has social impact, in that it helps create and spread a culture of innovation and risk taking, and allows societies to emerge and progress on a global scale. It reduces dependence on public sector jobs, which are less competitive, and increases appetite for innovation. I have always felt like the work I do has some form of social impact, be it through my career as a VC investing in tech start-ups in the region for the past nine years, or through the work I do with various non-profit organisations in Jordan and Lebanon. Tuhoon is an extension of that ethos.

What new skills have you learnt since launching your start-up?

People skills. I learnt how to better identify good talent early on, how to incentivise and motivate a team, how to be open and honest with colleagues. I grew a lot more empathetic towards non-founder talent after co-founding Tuhoon. I would mostly deal with founders and senior execs as a VC, now I get to interact with a much deeper team.

How has the Covid-19 pandemic affected your business?

It helped highlight the importance of mental health care. It also expedited the adoption of digital tools in mental health, like teletherapy. Today, over 60 per cent of telehealth consultations in the US are related to mental or behavioural health.

How is your product different from other mental health/wellness resources available in the region and globally?

We're … focused on building an end-to-end suite of products and services in the mental health space in the Arab world. Our inaugural product, the Tuhoon app, is the first app with premium audio content delivered by the leading experts and psychologists from the region, presented in a culturally relevant, relatable and engaging fashion. We want to build a brand that offers various clinical tools and services of high quality and credibility.

What changes in digital mental healthcare should patients expect in the next decade?

With so many co-morbidities and complex mental health conditions, it is inevitable that the industry heads towards more specialised and deeper care. I expect that the space will grow to encompass more offerings and verticals. Single-offering start-ups will have to adapt to that. I suspect a bigger push towards a hybrid care model of behavioural, mental and primary care, that redefines the patient experience in a way that is deeper than self-help or teletherapy on a stand-alone basis.

If you had a chance to do it all over again, what would you do differently?

Of course, I would have focused on clinical care first then expanded into subclinical services, as that today is the highest value service in the industry. I would also start in Riyadh rather than start in Dubai servicing Riyadh. The two markets are very different.

Where do you see the company headed?

In the next year, a much bigger push towards our clinical offering in the UAE and Riyadh. We hope to have three physical and virtual clinics up and running by the end of the year. Bigger engagement with employers as well, I hope we'll secure several more Saudi banks and enterprises as clients. In five years, I would like us to operate 20-25 clinics and have a well integrated digital offering that helps patients manage their journey much more efficiently.

What is your next big dream to make happen?

I would love to work on the research aspect of mental health. Most mental health disorders today do not have a clear pathology that can be examined to produce the most effective treatments. So long as we're unclear as to what really causes a lot of these disorders, it makes it very difficult to work on pharmacological or psychological treatments. Most psychiatric medications or therapy methodologies are fundamentally decades old. We need that “penicillin moment” in mental health, and to do that we really need to understand what causes these disorders in the first place.