After a stay at an inpatient mental health facility changed her life as a teenager, Carter Barnhart wanted to make adequate mental health services available to all young people in crisis.
Speak to Carter Barnhart for just five minutes, and you’ll understand how this 29-year-old wunderkind became CEO of Charlie Health, one of the most promising youth mental health platforms in the digital space. Barnhart brims with passion and devotion both for the patients Charlie Health serves and for her career — one that could cause most people to burn out in a matter of months. “I hear that a lot,” says Barnhart, “that the work I’m doing must be so dark and depressing. But I don’t see it that way. Yes, we talk to people on the worst days of their life, but I’ve spent my whole career being the bottom of the ocean that these patients get to bounce off of. When someone comes into our program, they feel their life is at rock bottom, but I know that it’s only going to get better from here.”
Charlie Health is an entirely digital intensive outpatient treatment program. Unlike other digital mental health platforms, which generally serve a clientele of patients who seek therapy to get through a difficult patch, Charlie Health exclusively serves one of the most vulnerable patient populations: high acuity adolescents and young adults. “These are young people who are profoundly struggling,” says Barnhart, “many of whom have been recently discharged from a hospital and need more than once a week outpatient therapy.” Their needs are often significant and unpredictable. Barnhart understands the struggle these high acuity adolescents face firsthand: at one point, she was one of them.
We spoke with Barnhart about what made her want to become a leader in the mental health space, why she’s chosen to work with such a vulnerable population, and how Charlie Health is radically changing the notion that mental services are only for those who can afford them.
KCM: What is it about working with people with severe mental health issues that made you want to commit your entire career to it?
Carter Barnhart: Before I knew that behavioral health was going to be my career, I was a behavioral health services patient. When I was 14 years old, I was sexually assaulted at a concert. I came from an intact family, with loving, supportive parents who did absolutely everything to protect me. After this traumatic event occurred, they sent me to doctors, therapists, psychics, Reiki healers…anything to try to help me. After two years and many failed treatment approaches, they found this brand new residential treatment center marketed toward 14- to 17-year-old girls who had experienced sexual trauma and who had parents that would commit to being in-person for family therapy once a week. So they made the decision to send me across the country from Philadelphia to California to this center called Newport Academy.
I was their second patient ever. When I moved into the house, my roommate was my same age and basically had my same story. A week later, two more girls moved in, and they were similar to me in age and had similar stories too. I was there for 45 days. When you talk to a lot of people who have mental health struggles, they’ll talk about being “in recovery.” I have not had any symptoms of PTSD since my 45 days of treatment, which is very rare. I couldn’t stop thinking, how did I get to be the lucky one? Which is a really wild way to think after you’ve been sexually assaulted.
After being a patient at Newport, you ended up working there. How did that transition happen?
After treatment, I went back home, completed high school, and got into college. I wanted to go to NYU, and my parents told me that I would need to get a job. So I called the owner of the rehab and I said, “Can I come work for you for the summer?” And he said yes. I ended up spending the next 10 years working for him, growing Newport from that small six-bed house to one with 300 beds [the company was recently valued at over a billion dollars].
I had the opportunity to wear just about every hat except for a clinical role, but what I saw every day while working there was that we turned down more patients than we were actually able to help. There are millions of kids who struggle exactly like I did when I was a young teenager, and they either can’t get off a waitlist, or they don’t have great insurance, or their parents can’t afford a flight. These kids go untreated. That’s why the suicide rate is so high in our country.
How did that experience translate to your founding Charlie Health?
I started this nonprofit on the side, where I would help people sign up for Medicaid insurance plans, but then there was no treatment program that accepted Medicaid. So I decided that I wanted to create something that was truly payer agnostic and would bring the same experience that someone has at a Newport residential program to the 96 percent of the world that would never have access to it. That’s what we’re doing with Charlie Health. We built a treatment program that is accessible and affordable, and has incredible treatment outcomes.
A major cornerstone of treatment with Charlie Health is structured group therapy. Why is this so important?
We put patients into groups of six with kids who are going through similar experiences. For example, we received a few different referrals from pediatricians for young girls who had all been using marijuana. During our initial intake, we discovered that all six of these girls, who were referred by six different pediatricians because they were all maladaptively coping with life by smoking weed, had underlying sexual trauma. They also all happened to have colorfully dyed hair — colors like blue and pink and green. So we were able to put these girls into a group together and deliver services to them through telehealth, and immediately they all bonded over their hair! They each thought, “this is a program where people look like me.” The same is true in the LGBTQIA community and the BIPOC community, in a larger way, of course. They have a shared experience, and in that setting, we can deliver the most effective evidence-based care.
When you enroll with Charlie Health, you’re committing to 11 hours a week of therapy with us. That’s nine hours of group therapy, three days per week, three hours at a time plus one hour of individual therapy and one of family therapy. If you think about it, even in a big city like New York it would be hard to find six people who are around the same age, who have the same primary diagnosis, and who are all available for therapy at the same time. So what ends up happening is, you could have a 13-year-old girl with sexual trauma sitting in a group next to a 17-year-old male heroin addict. That could potentially be re-traumatizing for that girl. Since we can connect adolescents from across the country, we can get hyper-specific with how we group patients. We don’t just have an LGBTQIA group, we have a nonbinary group, and a group for male to female trans patients, and female to male trans patients, and those considering transitioning, just to name a few.
What happens in these group sessions?
They’re three hours long, and at any given hour of the day, we have about 25 different groups running. The first hour is evidence-based therapy — something skills-based. So if we’re offering traditional dialectical behavior therapy, the therapist is teaching a concrete, established skill, like the “ride the wave” technique, which is the practice of understanding how to surf your own powerful negative emotions without fighting them.
Next, there’s some form of movement-based therapy that helps the patients get in touch with their bodies. So we do yoga, art therapy, music therapy, movement therapy…and they’re sticking with that same group of six kids that they were within the first hour. Then the third hour is really a process group, where kids talk concretely about what’s going on in their lives, and how to apply the skills they’ve just learned to whatever it is that’s going on in their world. Then during individual therapy, we will address each patient’s deeper trauma. In the family session, the patient shares what they have addressed that week with their parents, or partner, or chosen family, and allows them to react.
Who is a typical Charlie Health patient?
Right now, we’re focused on patients who are stepping out of hospitals, inpatient programs, or ERs, or are struggling in school. So big red flag patients. We hope over time that we can also be preventative so that when there is a yellow flag, that patient can come to us before being hospitalized. As we continue to educate pediatricians, psychiatrists, therapists, and communities about the work that we do, we will continue to build that trust.
Our patients are between the ages of 12 and 28, and 45 percent of our population identifies as LGBTQIA. Ninety-eight percent of our female patients and about 50 percent of our male patients have some sort of history of trauma.
Generalized anxiety disorder and major depressive disorder are the two most common diagnoses that we see upon admission, and since most of our patients are referred to us by a hospital or ER, many of them have recently had some sort of crisis.
We know you put groups of patients together who share things in common. How do you pair patients with therapists?
We hired industry veterans who know this patient population really well. We thought the hardest part in building this company would be recruiting, but we’ve been really lucky. We have all these clinicians that live in remote areas, who were driving an hour to go to the nearest clinic to work every day, and now they’re able to make these incredible connections with patients from home.
In terms of matching patients and clinicians, we have a lot of parents who request therapists that look like their kids. That’s something that we prioritize — being able to do proper matching based on skin color, faith, orientation, geography, or whatever is important to the patient or parent.
What do you say to parents or patients who feel virtual therapy can’t be as effective as in-person?
When high acuity kids are driven to in-person treatment, they may refuse to get out of the car. Being in a physical space for some patients can feel scary. When patients feel protected by a screen, they might be more likely to be vulnerable and process their experiences openly. They also don’t need to worry about what they’re wearing or exposing their physical body to others, particularly if they struggle with body image issues. We also deeply believe in the value of healing in the home environment.
Are there any patients whose stories have had an especially profound impact on you?
I tell everyone on my team, the longer you work here, the more thank you letters you’ll get. I save each and every one of them. I get these letters, a year later, five years later, ten years later, from people saying, “you helped me when I was 16, and I’m here now because of you.” That is what keeps me going. I hear horrific stories all day long, but I also get to see such greatness as people go on to college and go on to live happy lives, and I can know that I played some small role in their success.
Our first patient ever, who came into our program a year ago, lived in Big Sky, Montana. She had been hospitalized seven times within the past year, all for suicide attempts. Unfortunately, in her area, the only option for her was to go to the local ER, where they would send her to an inpatient unit for 10 days and then send her home and just hope she would get better. So she was stuck in this cycle. Since she was our first client, she basically had one-on-one group therapy. She has never been hospitalized since her time with us. That really made me realize that we had an opportunity here to help so many young adults. Because finally, this girl is happy and free.
Then just recently, we were doing patient discharge surveys. We call our patients 30 days after treatment, 60 days after treatment, and 90 days after treatment to see how they’re doing. Every single person on our team is required to participate in this collection process. So I recently reached out to a mom who lives in Idaho, whose daughter had been hospitalized three times prior to coming to Charlie Health and had completed our program 90 days ago. I asked her how her daughter was doing, and she just broke down into tears. She said, “We are the only family of color that lives in our community, and my daughter has never been able to speak to a therapist who she could relate to, so she would just shut down. When you paired her with a Black therapist, she finally felt like she could open up. We have never gone this long without a crisis, and I know without a doubt it’s because my daughter finally felt seen.”
