Courtesy of Nema Health

An online program launched by a clinical faculty member at the Yale School of Medicine hopes to break down barriers to evidence-based therapy for survivors of trauma. 

In 2021, Sofia Noori, an instructor at the School of Medicine’s Department of Psychiatry and a graduate of Yale’s psychiatry residency program, founded the platform Nema Health. The program uses intensive therapy, delivered virtually, to treat post-traumatic stress disorder, or PTSD.

Noori said she hopes that the virtual model, coupled with intensive, standard-of-care therapy options that few mental health providers offer, could make headway in making trauma care more accessible.

“By doing it remotely, we’re trying to take away one more barrier for a patient to come and do trauma therapy,” Noori said. 

Post-traumatic stress disorder, or PTSD, is a debilitating psychiatric illness that millions of Americans suffer from each year, including veterans and survivors of sexual violence. The condition often goes undiagnosed and untreated, even though many patients experience psychological distress, nightmares and intense flashbacks, according to the U.S. Department of Veterans Affairs.

Individuals experiencing PTSD might try to avoid reminders of their trauma which also makes it difficult for them to seek out help, said Noori.

As a daughter of refugees who survived the Vietnam War, and as a survivor of sexual assault in college, Noori knows firsthand how trauma can impact health. Based on her own experiences, she acknowledged how difficult seeking treatment can be for survivors. 

During her psychiatry residency at Yale, Noori looked for ways to combine healthcare innovation with evidence-based trauma treatment. However, while there were effective treatments for PTSD, it was nearly impossible to find providers who offered them, she said.

Then, as the pandemic forced mental health care to shift online, Noori realized a virtual model could be an answer to delivering accessible, effective care to community members. As the first chief resident of digital psychiatry at Yale, she helped found the Center for Digital Psychiatry at the Connecticut Mental Health Center, which focuses on integrating digital health into treatment for patients with serious mental illness. 

Shortly after she graduated from residency, she started Nema Health. 

Noori said that Nema Health’s clients experience relief from PTSD symptoms in as little as two weeks. By program completion, she pointed out that nearly 80 percent of patients no longer meet the criteria for a PTSD diagnosis.

But these impressive results, Noori pointed out, are not unique to Nema’s program: PTSD is a highly treatable condition with long-term results.

“Treatments for PTSD are actually super effective,” Noori said. “They generally take 10 to 12 sessions to complete. And they lead to generally permanent recovery.”

Nema Health uses what Noori refers to as one of the “gold standard” PTSD treatments: a method called Cognitive Processing Therapy, or CPT, in which therapists guide patients to challenge and reframe harmful thought processes linked to their trauma. But according to Noori, many providers don’t offer CPT, creating a scarcity of therapy options for patients. 

As an evidenced-based treatment, Noori said, CPT has been shown to be highly effective when delivered virtually — just as Nema Health intends to do. 

The program uses an “intensive model:” instead of meeting once a week, the program advertises that Nema clients are matched to a dedicated therapist with whom they meet for three to five sessions per week over three to four weeks. 

After the initial course of treatment, Nema continues to provide regular check-ins, medication management and peer mentorship, said Noori.

“If you actually look at the research, Nema’s outcomes are consistent with what people see,” she added.

Right now, Nema Health operates in three states: New York, Connecticut and New Jersey, though Noori’s goal is to expand its teletherapy coverage to all 50 states.

The cost of Nema’s virtual therapy can be prohibitive, admitted Mariam Malik, co-founder and COO of Nema. Without insurance coverage, the program costs $400 for an initial evaluation and $250 for each individual session according to Nema’s website, though Malik clarified in an email to the News that these services are offered on a sliding fee scale for those who cannot afford to pay full price.

Nema’s treatment is currently covered by a few health plans in the Trisdate area, including United Healthcare, Optum, ConnectiCare and Oxford. According to Malik, the company is working to expand coverage to other insurance providers, including Medicaid, though negotiating pricing with insurance providers has proved time-consuming.

“A lot of people who need our care wouldn’t be able to afford it out of pocket,” said Malik. “Our care needs to be accessible, especially with people who struggle from complex trauma. Being covered by their health benefits is part of Nema’s mission.” 

Noori acknowledged that virtual therapy can’t fix every gap in mental health access, and it might not be the appropriate approach for every patient facing mental health challenges. 

For Walter “Stan” Mathis, a former colleague of Noori’s and a clinical psychiatrist who directs the Connecticut Mental Health Center’s Assertive Community Treatment team, telehealth options are incompatible with the needs of clients he treats each day.

Mathis works primarily with clients who have psychotic disorders — visiting them in their homes or out in their communities. For people who are experiencing psychosis and have trouble differentiating what is reality, he said, virtual care is seldom a good option. 

“There’s a real fantasy of treating mental illness homogeneously,” Mathis said. “But person to person is different, and there are big picture diagnostic differences.” 

Beyond differing treatment needs, there are also technical and structural barriers that make accessing virtual care difficult. At the Center for Digital Psychiatry in 2019, Noori and Mathis helped develop an initiative to teach clients to use their smartphones for telehealth. 

But instead, the program ended up teaching clients basic technology literacy skills.

“Our training sessions were like, how to charge your phone, and that’s what they wanted to talk about,” Mathis said. 

Still, Mathis said he believes that programs like Nema Health are a great way to increase the availability of mental health care. 

“I think we’ll end up using telehealth as a way to make the spectrum of care have more options,” he said. 

The Connecticut Mental Health Center was founded in 1966. 

Update, Feb. 12: This article has been updated to reflect the correct definition for avoidance in PTSD, offer more information about Nema Health’s sliding payment system and clarify that Nema Health offers virtual therapy — not psychiatry.

Hannah Mark covers science and society and occasionally writes for the WKND. Originally from Montana, she is a junior majoring in History of Science, Medicine, and Public Health.