Hi friends,
Carmine Di Maro sees more mental health startups than probably anyone. Including me.
He is the Executive Director of the One Mind Accelerator (OMA), and if you don’t know what that is, you should. But don’t worry, we’ll get to that.
Carmine has analysed hundreds of mental health startups and has helped build an accelerator that has produced some of the most impressive organisations in this space.
Organisations like Slingshot, TownHome, Cerula Care, Jimini, Sanmai, AMPA Health and many more. Together, OMA graduates have raised over $650M and served over 860,000 patients. That’s a lot for an accelerator that is only three years old.
I caught up with Carmine to get his perspective on the major trends in mental health innovation. We also chat about OMA, how they’ve evolved, what they are doing for startups and their new VC fund (which I somehow didn’t already know about).
They’ve just opened up applications for their 2026 cohort, and if you are a Seed - Series A startup, you should apply. As valuable as I hope this article is for you, the most valuable use of your time will actually be to apply to OMA.
Anyway, if you’re still here, let’s get into the good stuff.
In this week’s article, I share all the insights from my conversation with Carmine, including:
Startup Category Trends: the categories in early-stage MH that are thriving, saturated or ripe for opportunity
Mental Health Moonshots: Why we don’t see many true “moonshots” in mental health, but why a new generation of founders might just change that
Winning Formulas: The defining traits of the most successful mental health startups in 2025
OMA 2026: The brief history of OMA, their 2026 accelerator and why they’ve started a VC fund
Let’s get into it.
Startup Category Trends
Carmine sees a few interesting opportunities for mental health startups.
The first is in serving the older-adult population. As of 2022, there were 58 million Americans aged 65 and older (NCOA). That’s 1 in every 6 people in the U.S. This segment is expected to reach 82 million people by 2050. They have a high prevalence of mental health disor,dersders and are massively underserved by existing solutions. This is a huge open space for startups.
Along these lines, another area for opportunity is in startups focusing on specific population groups. For example, maternal mental health or people in specific professions. Sharp Performance built a solution for people in “high-risk occupations” - police, paramedics, etc. They’re growing fast and just raised $12M from A16Z. This population-specific focus allows startups to build more tailored solutions (look at how Sharp positions itself) and also makes client acquisition easier. Niches get riches.
Carmine is also very interested in startups with comorbidity-centric offerings (behavioural health for cancer, diabetes, neurodegeneration, etc.). Roughly 60% of U.S. adults with a mental illness also have at least one chronic physical condition (CDC). Conversely, one study found that the prevalence of stress, anxiety, and depression among patients with chronic disease(s) was approximately 68.7%, 51.1%, and 58.8%, respectively.
We know that it is very difficult to treat these illnesses in isolation. Startups that focus on providing a mental health solution for people with specific comorbidities that integrates with the rest of their care have the opportunity to create meaningful outcomes for patients. There is also a significant commercial opportunity. Physical healthcare still accounts for the vast majority of all healthcare spend. If a mental health offering can reduce the physical healthcare costs for a specific patient population, they have a much greater opportunity to capture those savings as revenue.
Furthermore, chronic conditions are a specific area of interest, given the high cost of caring for these patients. Cerula Care is a great example of a company in this space (and a graduate of OMA). They partner with oncology practices to provide behavioural health solutions to their patients. Love that.
Categories like AI chatbots and teletherapy are becoming very saturated. There are hundreds of early-stage startups building solutions like this, and several large, well-capitalised businesses are also pursuing these opportunities. Startups must, therefore, make sure they have a clear and valuable differentiation from others in the space.
Carmine still sees opportunity for more deep-science companies and those focused on truly innovative delivery models. Sanmai and Attune are both doing incredible things in using ultrasound to treat brain disorders. Sanmai recently raised $12M from Reid Hoffman and others. AMPA is another startup taking a truly innovative approach, delivering a full course of TMS treatment in a single day (versus the standard protocol, which is 36 sessions).
While TownHome Health may not be pushing the boundaries of science, they are pushing the boundaries of care delivery. A lot of people don’t want to mess with brick and mortar, Medicaid or other, less sexy parts of the mental health system. But that’s exactly where we need attention, and it’s why, if you get it right, there are rewards.
Despite the companies I just referenced, Carmine and I agree that the biggest opportunity for startups is in taking bigger, bolder swings in mental health. And that if they did, the whole ecosystem would be better for it.
In short, we need more moonshots.
Mental Health Moonshots
We need more organisations pursuing moonshots. That is, doing stuff that has the potential to make a massive impact on population mental health if it works, even if the odds of success are low.
Headspace and Calm were moonshots. A decade ago, the idea of making mindfulness and meditation a mainstream activity seemed incredibly unlikely. Today, they have hundreds of millions of users. They took a massive swing, and while their stories are not yet finished, they have helped a huge number of people in ways we never would have thought possible.
Pear and Akili were also moonshots. They did not end so well. But that’s the thing with moonshots. Most will fail.
So why do Carmine and I think we need more? Because from all the startups we see, only a small few are doing something truly novel. It’s rare we see a company where we say, “Wow, that’s different, I don’t know if this will work or not, but if it does, that would be incredible”.
A company like Slingshot is an exception to this. They are a moonshot. Limbic is also a moonshot. Carmine mentioned a company he knows that is “trying to become the Kaiser Permanente of Behavioural Health”. Now that’s interesting. Hard to say if it will work, but boy, if it does!
Other startup categories, like climate tech, fintech and consumer tech, have plenty of moonshots. So don’t we have as many in mental health?
First, the nature of the supply-demand challenge has meant there’s been a lot of opportunity in simply pursuing less innovative approaches, e.g., teletherapy businesses. Those opportunities sat nicely on the risk curve (they will probably work and will be a decent business), so founders started those businesses and investors funded them. In 2020, an ambitious mental health founder could start a teletherapy business and probably do quite well. So why take a moonshot?
Another reason is that moonshots in mental health often demand investors and founders to assume scientific risk. That’s a hard risk to bet on. Much harder than betting on market risk, or even technology risk.
Take something like Uber, for example. That was a moonshot. The risks were big but straightforward. There was really just market risk (will people get in a randomer’s car, and will people drive their own car for Uber) and a bit of regulatory risk. There was hardly any technology risk (can they build an app?) and no scientific risk (cars already existed, duh).
That is not the case in mental health. The most innovative approaches, like Slingshot, for example, hold scientific risk. Will a foundational LLM trained on psychotherapy data be able to heal human beings? I mean, maybe? Because so many of the underlying mechanisms of mental illness and treatment are unknown, investors and founders have to take bets on unknown science. That’s hard. And it therefore reduces the number of moonshots being pursued.
One thing that can break this cycle is founders with huge credibility. People who have built successful businesses deeply understand the industry and already have a network. These people have the credibility to attract the capital and talent needed to pursue a moonshot. It’s one of the reasons Slingshot have been able to raise over $90M – their Co-Founder, Neil, previously built Casper. While not a mental health business, it was a massive consumer brand that created its own category. That gave investors confidence he knew how to pursue a moonshot.
The first generation of mental health startups is now graduating. With that, a cohort of seasoned operators and executives is re-entering the fray. Fortunately, these experienced operators are not (overly) jaded and are now founding or joining a second generation of mental health startups.
For example, Headway founders Jake Sussman and Dan Ross founded Marble Health, which was funded by Khosla. Employees from Woebot and Talkspace are now working at Slingshot. There are many more examples. Hopefully, this means that more of this second generation of mental health startups will have the freedom and capability to take real moonshots.
That would make Carmine and me happy!
Learn about a THR Pro Membership
As a THR Pro member, you’ll get access to exclusive content, access to our vetted community and invite-only events (like the one I’m hosting in SF tonight).
If you want to know more about the benefits of a THR Pro membership, I just published a new page on our website with lots of details. Our memberships are growing every single month, so if you are interested, feel free to check it out.
Winning Formulas
Carmine sees hundreds of startups every year, so I wanted to know what separates the best from the rest. We’ve already discussed the importance of pursuing bold and novel ideas and the categories where we see opportunities, but what else?
Really, it’s all about the fundamentals. The best startups right now have a few common traits:
Unit-Economics: The table stakes are to know your unit-economics inside and out. The best companies are using pricing, innovative delivery models or new client acquisition to actually deliver unit economics that are strong today and will improve with scale.
Capital efficiency: Capital markets are tighter, and mega-rounds are more scarce. Investors want to know their capital will be used efficiently. High burn rates are no longer acceptable. This goes hand-in-hand with strong unit economics, but also simply demands greater operating discipline. Despite being a brick-and-mortar business, TownHome are an example of a super capital-efficient business - I explore how they do that in our article on them here.
Clear and valuable differentiation: There is a lot of sameness in the mental health market. If you have read my writing for a while, you’ll know how strongly I feel about this and how important it is for businesses to find differentiation. But as Carmine reminded me, differentiation has to be something that is actually valuable to your users, payers or providers. Sharp Performance is a good example of clear and valuable differentiation. Too many companies differentiate on things no one really cares about. That’s not helpful.
Distribution: Client acquisition remains a challenge for almost all mental health startups. The best mental health startups have found scalable and cost-efficient ways to acquire clients.
OMA 2026
Helping companies develop winning formulas like this is something the OneMind Accelerator (OMA) is acutely focused on. I wanted to learn more from Carmine about OMA, how they’re supporting mental health startups and how they see their role in this ecosystem.
The history is interesting. The One Mind organisation has been around for three decades, doing great work to fund mental health science and drive advocacy. But they realised that they also needed other solutions. While funding science is important, the timeline to impact is long. And we need solutions today.
That’s one of the reasons they launched their accelerator in 2022. By supporting founders directly, they hoped to pull innovation forward, getting it out of the lab and into care delivery.
The approach was to use OneMind’s deep network of investors, entrepreneurs, academics, and those in the health system to support early-stage mental health startups. While that approach remains the same, over the last three years, they’ve done a lot to both deepen and expand the support they provide startups.
I was at the OMA 2025 accelerator opening week last February, and I was blown away by the quality of support. They had leaders from health insurers, lived experience councils, employer benefits leaders, hospital execs, top investors and more. And they were all openly sharing their advice.
One of their new additions for the 2026 cohort is a growth and business development council, with leading Heads of Growth, to support their cohort with patient acquisition. They are doing so much cool stuff, so just go check it all out here if you are interested.
OMA seems to be compounding in the way the best accelerators do. Their alumni network is high-quality and growing. So is their network of experts. This means that the next cohort of founders entering OMA will benefit even more than last year’s, and subsequently, they’ll enhance the value of OMA itself. Oh, don’t you love a good network effect!
OMA is now also launching its own VC fund, something not many people - including myself - seem to know. The fund will be used to invest exclusively in companies graduating from the accelerator, making sure that they not only have the expertise and connections needed to succeed, but also the capital. With their access to top startups as well as the support they can provide them, I’ll be super interested to see how this fund performs!
Talking to folks like Carmine and hearing about the work OneMind is doing makes me feel hopeful. And I think we could all do with a bit of that right now.
If you’re interested and want to learn more about the OneMind Accelerator, register for their info session here, and if you’re ready to apply, you can do so on their website.
That’s all for this week. It’s time for me to go enjoy San Francisco and meet all the wonderful folks working on mental health here. If you’ve got any SF foodie recommendations, let me know!
Keep fighting the good fight!
Steve
Founder of The Hemingway Group
