— Hey guys! Could you both tell me more about your backgrounds?

El Tayeb Hassen: My name is Tayeb Hassen; I am originally and proudly Sudanese. I am the co-founder of Nafsi. My background is actually in startups as a career, but I studied biomedical sciences. So, somehow, I ended up in business.

To give you a bit of context and follow the right timeline, I grew up in Sharjah, and then I went to the University of Surrey in the UK, where I studied biomedical sciences. I worked in pharma for one year at Sanofi. Then, I made the shift to business, did a master's in entrepreneurship & Innovation management, and have been in startups ever since.

In the UK, I started a health tech company focused on tech for nursing care homes. After that, I returned to the UAE for personal reasons, mainly feeling homesick and wanting to be close to family. I started working for a quasi-VC/consultant/network for entrepreneurs called Endeavor. I did that for just over four years, which really exposed me to the entrepreneurial ecosystem and startup field here. Then, I transitioned to Nafsi.

Sammy Sawaf: I am Syrian, born in America, and have lived in Dubai since 1999. Growing up in a healthcare-oriented family, I naturally gravitated towards the field. My studies at USC in LA focused on business and finance, leading me to a role in deals advisory at PwC. There, the harsh work-life balance and high stress illuminated the critical impact of mental health in the workplace, with a notable 80% dropout rate within two years.

Facing my own mental health challenges during COVID, I struggled with the limitations of online therapy through BetterHelp, hindered by cultural disconnects and time zone issues. This experience underscored the need for culturally relevant mental health services in Dubai. Together with Tayeb, we worked tirelessly to create the first DHA-licensed mental health platform in Dubai. Our service accepts insurance, meets HIPAA standards, and employs locally licensed psychologists, truly embodying affordability, privacy, and flexibility.

Amaan Khullar: I am a Software Engineer with experience in Machine Learning and Arabic Natural Language Processing. I grew up in Dubai, attending both Dubai College and Dubai English Speaking College. I have spent the last decade in the US, 4 years getting my undergraduate degree at Columbia University in NYC, 2 years in San Francisco building a cloud platform at Samsara Networks Inc., and then returned to NYC during COVID where I spent my last 4 years building a cloud developer platform at MongoDB. I have 6 years of experience building scalable platforms with pleasing designs and intuitive user experiences.

— Amaan, what made you leave the US and join Nafsi Health? 

Amaan: Having grown up in Dubai, the region has always and will always continue to be home for me. I knew I was going to return to the UAE at some point, it was just a matter of when. I have had the privilege of working at some amazing companies with incredible colleagues who always made me feel welcome and from whom I have learned an immeasurable amount. My time spent in the US was invaluable for me and catalysed my transformation into a professional.

However, as time passed, the US felt less like home. Having been raised in the Middle East, I felt an unshakeable calling to return home and build something for the region as well as help create a vortex of tech talent here. I made the decision in mid-2023 to leave my comfortable job at the start of 2024 and take a career break to focus on my health and relocation back to the UAE. While on my break, I had a chance encounter with Sammy and Tayeb on a Friday afternoon in the middle of summer. I first met Sammy for the first time a couple of years ago when he was first ideating Nafsi. Meeting him for the second time, he and Tayeb were able to bring the vision to life. We got to talking, and the rest is history.

— Were there any issues with trust from the client side? I mean, some people still have scepticism and don’t believe that a website can select a therapist for them.

Sammy: I can’t say that we noticed it. But, you know, even if users have these concerns, they always have the option to choose different psychologists until they find one that fits them. We are just simplifying this process by connecting patients to the right psychologists based on specific criteria developed by our team. 

Tayeb: We worked closely with our psychiatrists and psychologists, researching global standards for triage and self-assessment to create a system that matches patients with the right therapist for them. However, we still maintain the flexibility for patients to choose the therapist they feel most comfortable with. One of our top psychologists mentioned that choosing a therapist can sometimes be like going on a date.

— That is why you use the word “match”. 

Tayeb: Yes! It is essential for users to feel immediately comfortable opening up. What we can see now: the trust factor is significantly enhanced by licensing. Being a licensed platform by your regional or national regulator, especially in competitive markets, adds a layer of trust for our clients. They know that if the DHA and the government trust us, they can too.

Our goal is to provide licensed therapists while giving clients the flexibility to choose someone they are comfortable with. All our clinical psychologists and psychiatrists are fully licensed, unlike some platforms that accept unverified life coaches.

— And in the Middle East, going to therapists is still uncommon, right?

Tayeb: First, I would like to highlight some statistics: one out of three people in the Middle East reportedly suffer from mental health issues at some point in their life (1 in 4 require professional mental health support). A similar number find it difficult to seek help due to privacy concerns and cultural taboos. Unlike the West, the Middle East still associates negative stigmas with seeking mental health support, often assuming those who seek help are "outcasts." This leads many to ignore or suppress their issues, exacerbating their conditions.

We have seen this firsthand. One of our friend's brothers, a conservative Muslim from the UAE, has struggled with alcohol addiction for nearly 20 years. Divorced and isolated, he is in his late 40s, confined to his home, and drowning in alcohol daily. His family, friends, and ex-wife haven't heard from him in months, and he can't even admit to drinking, let alone his full-blown alcoholism. He represents the type of patient we are here to help — someone who needs support but can't admit it publicly. Our services allow people like him to seek help from the comfort of their homes.

People have issues but they are rarely discussed due to the stigma surrounding mental health. We aim to address these concerns head-on, providing much-needed support and breaking the silence around these critical issues.

Sammy: We want to normalise mental health support. For instance, in New York City, employees usually have weekly therapy sessions on their calendars, treated as routinely as gym visits or spa appointments. CEOs, C-suite executives, and business people openly talk about their therapy sessions, often bragging about them as a form of self-care. In Western societies, discussing therapy has become a status symbol rather than a taboo. This is the direction we aspire to take in mental health support in our region, making it a normalised and even celebrated aspect of overall well-being.

— I tried out your website and noticed some details. When you ask those 12 questions, there is a list of issues like OCD. Why did you choose those particular issues? Are they the most common in the Middle East?

Sammy: Absolutely. We conducted two types of research. The first was made with the help of our partner’s clinical psychiatry and psychology department. Their data provided valuable insights into the top 15 complaints people seek help for, revealing key trends in mental health issues.

We also conducted our own research across the MENA region. While our initial focus is on the UAE, our platform is designed to scale and serve the entire MENA market. Our findings from both research sources overlapped, highlighting the most common mental health complaints and conditions in the region.

Tayeb: Depression and anxiety are the most prevalent issues we encounter, more so than OCD and ADHD. Also we noticed an interesting point: while OCD and ADHD are often seen as conditions affecting young people in Europe and the US — such as children, high school, and university students — they manifest differently in the Middle East, particularly in the UAE. Here, OCD and ADHD complaints are more common in adults over 40. These conditions likely started in childhood but were suppressed due to the stigma around mental health issues, which were seen as signs of weakness or excuses. As a result, many individuals suppressed their symptoms until they reached adulthood or faced a particular trauma, causing the issues to resurface more prominently.

These findings highlight the importance of addressing mental health issues across all age groups and breaking down the stigmas that prevent early diagnosis and treatment.

— How many therapists are you working with now?

Sammy: In total, we have onboarded over 25 therapists, with more being added to the website as we speak. We launched a job listing a few weeks ago and received over 100 applications.

Despite the rapid onboarding, we are committed to maintaining a high quality of therapists on Nafsi. We prioritise thorough vetting to ensure our therapists meet stringent standards. This approach ensures that our clients receive the best possible care from highly qualified professionals.

— How do you select them? What are the rules for therapists?

Tayeb: We currently focus on licensing as a black-and-white criterion. Our primary requirement is a DHA (Dubai Health Authority) license, which ensures our therapists are qualified for clinical psychology. While we also acknowledge CDA (Community Development Authority) licensed professionals, they primarily offer counselling rather than clinical therapy, so we prioritise DHA-licensed practitioners. There are other licenses like DOH (Department of Health) & Ministry of Health (MOH), but DHA remains our main focus.

Our onboarding process is stringent. We interview and assess each therapist as if we were running a physical clinic. Our process includes three stages.

First, candidates fill out a form to verify their knowledge and experience as stated on their CV. Next, a cultural fit interview is conducted by either Sammy or myself. This interview assesses their suitability for online care and their alignment with our team's cultural and societal values. The final stage is a medical assessment conducted by our medical director, who leads the psychiatry department, to ensure the candidate's clinical competence.

The cultural fit interview is crucial. We emphasise empathy towards the religious, cultural, and societal nuances unique to our region. Unlike the Western approach of leaving personal background at the door, we integrate cultural, religious, and spiritual contexts into therapy, guided by scientific principles. This ensures our therapy is relatable and respectful of our clients' backgrounds. I think this culturally sensitive approach differentiates us from other platforms.

— Based on your research and experience with Nafsi specifically, can you say there is a particular age group that suffers the most from any issues?

Tayeb: So far, we haven't identified a dominant age group using our platform. We initially hypothesised that due to the digital nature of our platform and the stronger stigma around mental health among older generations, our primary users would be younger, between 18 to 30 years old. We expected the 25 to 30 age group to be particularly active as they are beginning their careers, building their lives, and often seeking convenient solutions for their busy schedules.

Our data shows that approximately 60% of our users fall within the 20 to 30 age range. Since we currently serve adults 18 and above, with plans to introduce children and parenting therapy in the future, this age group remains our largest demographic. However, the 35-plus age group has also shown a healthy presence. Our user base is almost evenly split, with around 40% between 20 to 30 years old and another 40% between 30 to 45 years old. The remaining users are either younger than 20 or older than 45.

Interestingly, we have observed that our Arabic-speaking audience tends to be older, usually 35 and above. These users often include individuals who have experienced significant life changes, such as divorce, personal struggles, or new mothers dealing with postpartum depression. In contrast, our English-speaking users, who may also be Arabs but prefer to conduct their therapy in English, are generally younger.

This insight has been one of our most significant learnings so far, indicating that our platform is reaching a diverse age range and catering to different linguistic and cultural preferences effectively.

— And gender-wise, who are suffering more, men or women?

Tayeb: We initially expected a 70/30 split between female and male users, assuming women are generally more likely to seek self-improvement and be open to therapy. However, our actual user base is more balanced, with a 60/40 split — 60% female and 40% male. This healthy distribution suggests that men are also engaging with our platform in significant numbers, which is a positive sign for breaking the stigma around mental health among men.

Again, based on your experience, is it true that women often choose women as therapists or not?

Tayeb: Yes, particularly in this region, cultural norms and expectations significantly influence preferences for therapy. Married women, for instance, often prefer speaking to female therapists due to societal norms about interacting with men. Consequently, women feel more comfortable with female therapists. 

On the other hand, men tend to be less particular about the gender of their therapist, focusing more on the therapist's ability to solve their problems effectively. This approach, while pragmatic, may overlook the importance of building a therapeutic relationship based on chemistry and mutual understanding. That is why our matching algorithm is so crucial. It helps clients find a therapist who is not only skilled but also a good fit on a personal level.

52% of Nafsi users prefer the therapist to be female, 27% don’t have a preference and 21% prefer them to be male.

— Again, regarding the list of issues on your website, I noticed that "feeling alone" is included.

Tayeb: The difference between being alone and feeling alone is significant. You can be in a full house and still feel completely isolated because of judgment, pressure, and lack of understanding from your family. This type of loneliness can be more harmful than physical solitude. 

When you are physically alone, it is more straightforward: your loneliness matches your environment. But when you are with others and still feel alone, it can create a profound sense of disconnection. This scenario often involves feeling misunderstood, judged, or pressured, which can lead to thoughts of being a burden or believing that others might be better off without you.

We worked with one psychologist who specialised in crisis management to develop our approach to assessing these feelings. Her insights highlight that feeling alone can be a more critical indicator of mental distress than even anxiety or depression.

— And again, maybe you have some data. Are the mental issues that people face in countries with hot climates different from those in countries with cold climates?

Tayeb: At the moment, 90% of our clients are from the UAE, providing us with data predominantly from hot climates. Interestingly, we observe a trend of seasonal depression, but it manifests differently compared to the Western world. In the West, seasonal depression typically occurs in winter, while summer is positive. Here, it is the opposite—our clients often feel more depressed during the summer.

This trend is especially noticeable among those who cannot travel during the hotter months. The intense heat keeps people indoors, relying heavily on air conditioning, which limits their exposure to natural sunlight. Studies suggest that lack of sunlight can reduce serotonin and dopamine levels, contributing to feelings of depression.

This pattern highlights a significant difference in how seasonal depression manifests in hot-weather countries compared to cooler climates. The need to stay indoors to escape the heat, avoid direct sunlight plays a role in mental health issues during the summer months.

— Also, I was wondering: can a person be predisposed to depression? Could this be something innate? Or are mental health problems such as depression or ADHD rather acquired?

Tayeb: That is indeed the magical question: how much do genes versus environment contribute to mental health conditions? While I am not an expert in scientific terminology, it is clear that both factors play significant roles.

We know that mental health issues can have a genetic component. For instance, a family history of alcoholism increases the likelihood that a child will develop a similar addiction compared to those from families without such a history. This suggests a genetic predisposition to certain mental health conditions like addiction, OCD, and ADHD.

Conversely, conditions such as anxiety, depression, and feelings of isolation are often more influenced by environmental factors and past traumas. 

If we had to generalise, it seems to be a 50/50 split between genetic predisposition and environmental influences. Identifying and managing these predispositions early, ideally between the ages of 17 and 23, can be crucial. Developing tools to manage or treat these conditions, sometimes even independently of therapy, can have long-term benefits.

Dr. Hanan Hussein, one of our most in-demand psychiatrists, emphasises the importance of early intervention. As a child psychiatrist, she advises parents to equip their children with coping tools early on without labelling them with conditions like OCD. This proactive approach can help children develop self-management skills by the time they reach adulthood, reducing the likelihood of these conditions being triggered by stress or other factors.

Despite our individual predispositions to certain conditions, environmental factors can push us towards mental health issues. For example, excessive screen time and exposure to flashing videos can induce OCD or ADHD symptoms even in those not genetically predisposed.

Your question about the balance between genes and environment is indeed a valuable one for future discussions and panels. It encourages further exploration and understanding of how best to support mental health across different contexts.

— And a few questions for Amaan: Is there any guarantee regarding users' privacy?

Amaan: The guarantee is that Nafsi Health adheres to all local and global standards of cyber-security, data protection and confidentiality. We have made a valiant effort to cover all our bases, culminating in the Dubai Health Authority licensing our platform. 

— How do you plan to develop the platform from a technical perspective?

Amaan: Throughout my career, I have had the privilege of working at companies that always put the customer first. It was a core tenet of their leadership principles that guided every part of the product development lifecycle. Naturally, this is the biggest thing that has been ingrained in me and will continue to guide my decision-making when it comes to platform development. Constant feedback loops with patients, doctors, admin staff, and health officials are crucial to the success of the platform and will guide our development.

Outside of user feedback, our main focus will be building a scalable platform that can handle a large user base but also do so whilst prioritising performance and security. User experience is tantamount to our success and will be of the utmost importance moving forward.

— How many people have already used your platform?

Amaan: 450 in the first two months of the launch. 

— Is it possible to chat with a therapist if needed? 

Amaan: Not at the moment, live-chatting is a technically demanding feature on any platform — unless it is a highly requested user feature we have no current development plans to support real-time messaging. However, users can see their therapists' notes and we augment direct communications in between via email.

— While using your platform, I noticed that I usually receive only one therapist recommendation. Are you planning to offer more choices in the future?

Amaan: Yes, the next version of our matching flow will offer 3 recommendations depending on clients' answers and preferences. We always prioritize the user in platform development and constantly solicit feedback from our users to improve our platform.

Interesting data from Nafsi user base so far (from Nafsi’s first 200 users): 

— 71.6% of Nafsi users have never had therapy before 

— As expected: Depression, Anxiety & Stress Management are the biggest requests - accommodating for 46% of asks.