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I grew up in a small town that was a mental health desert. My mom was a career educator who spent her life teaching kids with autism, and through her I watched what happens to families who need help and can't reach it — not because they didn't try, but because the right support wasn't there. The waitlist was two years long, and the one provider was in another county. What I saw wasn't only suffering that went unrelieved. It was potential that went unrealized.
This month I'm stepping into the CEO role at Brave Health, after six years of learning this company from the inside — first in marketing and partnerships, then in operations, and now leading it. I'm taking the role at a moment when behavioral health, as an industry, still hasn't solved the problem it set out to solve a decade ago: not enough people can get real care, fast enough, from someone who understands their life.
For most of that decade, access was the metric that mattered. Apps downloaded, users onboarded, waitlists technically shortened. But access on its own was never going to close the gap for the patients who need care most. Only about 36% of psychiatrists accept new Medicaid patients, (KFF), and demand for behavioral health services is projected to outpace provider supply by more than four to one over the next decade (HRSA). In large parts of the country, particularly rural counties, that shortage isn't a statistic. It's the entire behavioral health system.
You can't download your way around a workforce that doesn't exist.
That's the bet I'm making as CEO, and it has three parts: build the capacity, reach people at the moment they're ready, and deliver the right care once you have them. Technology doesn't replace any of that. It's what makes all three possible at scale.
You have to build the clinicians, not wait for them. Building large, trained workforces is the problem I spent nine years on at General Assembly, where we taught people skills no classroom near them was offering, and where students who'd been told they'd never code without a computer science degree proved that wrong thousands of times over. It's the same problem here, with higher stakes.
That's why we built a clinical training program at Brave rather than waiting for an industry-wide shortage to solve itself. It helps new clinicians get licensed, and our centers of excellence let them train on the job treating new populations and certify in new modalities. Our W2 labor model means that when we join a health plan's network, we're bringing net-new clinicians onto that roster and into that state — not reshuffling the same scarce supply between companies.
Patients also deserve clinicians who understand their lives. Today the majority of our workforce is female, the company is majority-minority overall, and our clinicians speak eleven languages. That isn't a diversity statistic. In a field where the shortage is worst for the populations with the fewest options, it's the difference between care that exists on paper and care someone will actually accept.
Timing is everything with behavior change. The biggest opening for connecting someone to the right services is the moment the need surfaces — after a hospitalization, during a primary care visit, or when someone says, "I think I could use help with that." Miss that window and the chance they follow through drops steeply.
Healthcare has always been reactive: someone hits a crisis, then we respond. What I'm most excited about is getting ahead of that. Increasingly we can see who needs outreach, which message they'll respond to, and when they're most likely to say yes — so we're reaching people before the crisis, not after. That matters most for exactly the patients who are hardest to reach in the first place.
Not everyone needs the same treatment. Some people need medication before therapy can work. Others need EMDR, DBT, psychiatry, or case management. And it isn't only which care and in what order — it's how much. Match the right intensity to the real need and you stop over-treating people who need less and under-treating people who need more. Patients shouldn't have to figure any of that out themselves.
The technology underneath
High-quality clinical care is the product at Brave. Technology is the infrastructure that lets us deliver it consistently, personally, and at scale. I'm not interested in technology because it's convenient. I'm interested in it because it enables care that's more consistent, more personal, and higher quality than a patient could get in the room. Quality, not just access, should be equitable.
In practice that's less glamorous than it sounds. Healthcare improves through operational excellence, and that's a grind: transitions after hospitalization, medication adherence, follow-up after discharge, closing HEDIS gaps. My career has been built in human-capital-intensive businesses, where people deliver the product — and that taught me to keep the tools simple, to obsess over what people will actually use, and to know exactly what our clinicians need before we build it. None of it is flashy. But small improvements, repeated thousands of times a day, are what become better outcomes and better stewardship of public dollars — which matters enormously when you primarily serve Medicaid and Medicare.
Mental healthcare isn't something you reach for in weakness. It's how you build strength. I'm an eternal optimist, and I believe it does more than help people heal, stabilize, and feel whole. I believe it helps people build a life they choose.
We serve parents who get to keep their children. Kids in foster care who move between counties and, because of how we're built, keep the same clinician through all of it. Teenagers who need creative approaches to keep showing up to a DBT program. The patient who was in and out of the emergency room dozens of times a year, and now goes just two or three. We meet people in some of the darkest moments of their lives, and we get to help them find their way out.
The industry spent a decade proving people would download something. I've spent my career betting that wasn't the real test. That's what I'm building toward: a workforce built for the people we serve, and a way of reaching them that makes access mean something — for patients who don't have many other options.
Sarah Tilton is CEO of Brave Health, a virtual behavioral health company delivering therapy, psychiatry, and specialized care programs to Medicaid and Medicare populations across 14 states. She previously served as Brave's President & Chief Operating Officer. Before Brave, she was employee #1 at General Assembly, where she spent nine years scaling its consumer education business ahead of its 2017 acquisition by The Adecco Group.
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