This story is part of the 2025 TIME100 Next. Read Aileen Lee’s tribute to April Koh here.
April Koh vividly remembers the first time she tried to talk to her mother about her mental health, when she was about nine years old.
“She was doing the laundry, and I kind of snuck up behind her and said to her, ‘I think I’m depressed,’ and she told me, ‘Don’t be ridiculous.’”
Her mother’s response didn’t come from a lack of care but a lack of understanding. “My mother is incredibly loving and the best mother I could have hoped for, but she didn’t have the vocabulary to talk about what I was feeling and what I was going through,” Koh says.
In the following years, it became clear to Koh that the conversation about mental health was challenging for families across the country. Mental health is often not addressed in a deep and meaningful way in our society, stemming from the stigma and discomfort many people feel because they don’t fully understand conditions like anxiety, depression, and other psychiatric disorders. For centuries, such conditions have not even been considered to be health issues in the same way that physical ailments are, and have been dismissed as hysteria or even weakness.
Today—fueled by her own journey—Koh is playing a pivotal part in changing the conversation around mental health. In 2016, she founded Spring Health, a company that works with employers and providers to match people to the care they need using AI. In 2021, Koh became the youngest female founder heading a unicorn—that rare, privately-held company that reaches a value of over $1 billion—and now Spring is valued at over $3.3 billion. As a young founder, Koh says she had a lot to learn about leadership and running a business, but that her core mission in starting Spring has never changed: to eliminate barriers to mental-health care and help patients find tailored services.
Building from experience
Koh immigrated to the U.S. from South Korea with her family when she was four. Her father left a corporate job in energy to start his own company, and Koh says the example he set contributed to her creating Spring decades later.
Entering the mental-health field wasn’t easy, but Koh says now that being new to both business and health was in some ways a blessing. At the time, the field’s most formidable challenges included stigma, access, and the quality of services. People frequently struggled to get the proper diagnoses, and once they began treatment, they would cycle through therapies for months or even years before finding one that worked. The struggles Koh personally experienced mirrored those in the population more broadly. “I felt that stigma pretty heavily through my Korean heritage, through my religious heritage, growing up in an Evangelical church,” she says. “A lot of stigma around mental health was masked as not believing enough or not having enough faith.” In the corporate world, that stigma manifests as the perception that mental-health issues are a sign of “weakness,” says Koh. “You don’t want to give people an excuse to say, ‘Oh, she can’t do it or he can’t do it because they’re struggling with something and can’t be relied on.’”
In addition, mental-health conditions aren’t defined, screened for, and detected as robustly as most physical health conditions are, which contributed to Koh’s struggle to find the right care. “I went through a pretty significant journey of a lot of guessing, a lot of trial and error, just trying to find care,” she says of the years after that initial conversation with her mother. “There were so many points in my journey where I would feel like I lost hope; I would muster up all this courage to start something new, and it wouldn’t work, and I was confronted with this hopelessness and have to rebound from that again and again.”
In 2016, when she was a senior at Yale University, Koh read an academic paper by a doctoral student at Yale named Adam Chekroud that finally gave her some real hope. Chekroud, who trained in neuroscience at the University of Oxford, studied ways to apply computational science and machine learning to better understand mental-health disorders and improve treatments by making them more precise and patient-specific.
“Most people don’t get better [with their first treatment] but do get better eventually once they find the right treatment,” says Chekroud. “I had the idea, ‘What if we personalize those decisions the same way that Netflix personalizes its recommendations?’ There was an opportunity to find the right treatment from the beginning, which not only makes a huge difference for the patient but is a huge economic value proposition. The longer it takes someone to get better, the more it costs.”
For Koh, the paper set off a light bulb. Chekroud’s data-driven approach could be a way to better match people to mental-health care. “This paper described using data and algorithms to cut through the trial-and-error process,” says Koh. She looked up Chekroud in the Yale directory and emailed him to tell him that she found his research groundbreaking.
At the time, mental-health experts were just beginning to explore digital-based strategies for care—mostly through telehealth platforms.
Koh envisioned a more ambitious role for computational psychiatry, one that fully embraced the power and information that data from thousands of patient experiences could provide. Together, she and Chekroud co-founded Spring Health. Dissecting available data and gleaning patterns to identify treatments that helped people with a certain set of symptoms get better, she believed, would lead to more precise pairing of the right patient with the right treatment—something she had struggled to find during her own journey. “People were waiting for technology to disrupt the status quo of mental health care. But for whatever reason, no one was really doing it,” she says.
Which meant that when she and Chekroud first brought Spring Health to employers as a service for their workers, employers didn’t understand the potential power of such an approach. Building on Chekroud’s initial research, Spring leveraged AI to deeply analyze people’s symptoms, treatments, and outcomes to come up with algorithms that could identify which services produced the best outcomes for which people. Employees filled out questionnaires to provide as much information on their symptoms and other relevant factors, which Spring fed into its algorithm to find the most effective mental health treatment for them. “No one was thinking about using AI to match people to the right care for them. We embedded these advanced algorithms in our product from the early days, but when we started pitching AI in mental health care, it didn’t land,” she says.
Eventually, Koh pivoted her presentation to de-emphasize the AI-based strategy, while not abandoning it, to focus on more behavioral, outcomes-based benefits of addressing mental health that appealed to employers. Studies show that people struggling with mental-health issues tend to miss more work, and even when they show up, they may perform at suboptimal levels. “When you address the underlying mental-health issues, you get a thriving, more productive workforce since people call in sick less,” says Koh.
From the start, Koh and Chekroud realized that documenting the benefits of their service, in the form of studies tracking both financial savings and improved employee health, was crucial to changing the corporate mindset. Spring conducted two major studies that showed doubtful employers that Spring’s service worked—and could save them money. Still, Spring’s AI-based solution took a while to catch on. If health was among the last fields to embrace the digital revolution, mental health was even further behind in exploring ways that digital platforms could improve access and quality of care for patients. Employers weren’t convinced that technology was the answer and initially were reluctant to sign up. “I did so many sales pitches where people were on their phones or falling asleep,” she says.
There was reason for skepticism. “We were naïve to the complexities of how health care works,” Koh says. But the co-founders’ lack of deep expertise—as well as their willingness to learn—also helped them to think more creatively and beyond incremental improvements to the status quo, which in turn proved to be a powerful catalyst. “I think that ignorance helped us in some ways,” Koh says. “It helped us to have a blank slate and go back to first principles and ask, ‘How should things be?’”
Early adopters
In recent years, employers have started to appreciate the importance of providing mental-health services to their workers, and studies increasingly support the trend. A 2021 analysis highlighted best practices for employers to provide mental-health support, including strong mental-health benefits, workplace policies that recognize and support the need to prioritize wellbeing, and measuring the effect that interventions have on productivity and other workplace measures.
To strengthen her case, Koh focused on documenting the benefits of Spring’s service by providing as much hard data on the resulting improvements in productivity as possible, filling a gap in research and giving investors proof of impact. Clients are now reaching out to Koh and her team to add services to their offerings, and Koh is currently exploring more specialty packages to focus on connecting people with specific types of mental health services, from in person or digital therapists to apps and group sessions—around, say, eating disorders or anxiety.
Ultimately, Koh’s initial insight from Chekroud’s paper about the power of computational strategies in mental health proved correct. As interest in AI started to explode following the public release of ChatGPT in 2022, “suddenly people wanted to talk about AI and our technology,” she says. “And that technology is ultimately what makes our mental health care services the best in the industry.” Now, Spring has a number of competitors, including Lyra Health, which developed its own AI-based matching service for employers, and companies like Headspace Health and Calm for Business, which focus on chat-based and digital coaching strategies.
Lessons learned
Along the way, Koh admits she’s made mistakes and learned some hard lessons. In 2024, the company was fined $1 million by the California Department of Managed Health Care for providing services in the state without a license, an issue Koh says the company has addressed. “We’re absolutely compliant with state licensure and regulations,” she says.
Since Spring’s founding, Koh says she’s also grown as a leader. “One of the main challenges I faced as a young entrepreneur in the field was being underestimated all the time,” she says. “I’ve been told that I’m ‘green’ countless times, and I think ‘green’ is a code word for young and naïve.”
In response, Koh pushed for robust products on tight deadlines to prove her detractors wrong, especially during Spring’s early years. That led to a culture in which some employees said they felt overworked and undervalued by management—ironically, the kind of burnout issue that Spring’s services are supposed to help their clients to address. “Mental health and hypergrowth can actually live in harmony, but you have to be incredibly deliberate about it,,” she says. “And I think we weren’t as deliberate as we should have been in the early days.”
In the years that followed, Koh instituted a series of changes designed to improve Spring’s workplace culture, including fewer meetings during designated “focus weeks”when employees could spend more time on longer term projects or coming up with new ideas, and a new employee coaching program.
In an effort to lead by example, Koh was also more vocal about her own strategies for managing stress and navigating challenging tasks, which include using a Spring coach and therapists, as well as the company’s meditation and mindfulness apps. “I had to actually put on my oxygen mask first and take care of my own mental health in order to lead effectively,” she says.
The changes have paid off: Earlier this year, Spring earned the Great Place to Work certification, which recognizes positive workplace culture. “One of the things I’m really trying to work on is really trying to remind people of the mission,” Koh says, “and to connect everyone’s work to the ultimate mission and vision we have for the world.”
Spring is now available to people in 200 countries, through employers and providers, and covers the mental health needs of more than 23 million people. Recognizing that these challenges aren’t limited to the workplace, Spring is also reaching out to those who might benefit from its services following an unexpected crisis.The company launched its Natural Disaster Mental Health Support Program in January to address the mental health needs of those affected by the Los Angeles wildfires, and in July, Spring provided $500,000 in free services to those affected by floods in Texas, North Carolina, and New Mexico.
For Koh, Spring’s mission to better meet patients’ mental-health needs was made all the more real after her daughter was born in 2023. “I’m trying to fix the system because I had gone through it myself, but when I looked at my daughter for the first time, I thought, ‘One day, I really hope that you will receive excellent mental health care, and I really hope that I’m a part of building that world.’”
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