Two days before our interview is scheduled to happen, an email drops in my inbox from Ken Cahill. For the previous week, we had been discussing themes to discuss in the interview – from the nature of entrepreneurship to the rapid growth and international expansion of SilverCloud Health, the heavily backed Dublin company that Cahill co-founded in 2012.

It seemed an appropriate time for the interview. The importance of mental health has been one of the key issues to emerge over the last year, and SilverCloud has developed more than 30 digital mental health programmes that are designed to help address issues including anxiety, depression and bipolar disorder.

Last year, it raised $16 million from US healthcare funders, bringing its total backing to about $30 million. Even before Covid-19, the company was growing at a rate of knots. When the world went into a remote lockdown and with employers and healthcare providers looking for virtual ways to promote positive mental health, its growth accelerated further.

Much of that growth is coming from the US, where Cahill is now based after relocating to Boston four years ago. It also counts the NHS in the UK as among its largest clients. To date, SilverCloud has delivered its programmes to 646,000 end users, about half of which came in the last year.

In his mail, Cahill said he was happy to talk about his own entrepreneurial journey and the SilverCloud story. But he wanted to address one other issue also: failure. “I am beyond happy to share my mistakes that I have made and hopefully help others,” he said.

When we spoke earlier this week, I put the issue of failure to him. “The most interesting parts have been the bits where I’ve made the mistakes. Where you get pushed outside your comfort zone is kind of where the real learning starts for me,” he told me.

Cahill’s previous venture Candidates Direct ended during the last crisis. A recruitment software business, it had a string of major clients. However, the market evaporated overnight, as did many of its clients such as Anglo Irish Bank. Unlike many entrepreneurs, Cahill is happy to talk about the past.

“I’ve got some serious kicks in the pants all the way along this journey and I’m kind of always happy to share what happened,” he said.

But Cahill is also happy to talk about the future, revealing that SilverCloud is preparing to expand into the German and Australian market, while it 90 strong headcount will rise too.

In a wide ranging interview, we discuss:

• The psychology of entrepreneurship
• An entrepreneur in residence at the NDRC
• Learning from the failure of candidates Direct
• Spinning out SilverCloud
• The importance of mission
• How Covid accelerated growth
• The SilverCloud business model
• Milestones and the SilverCloud growth story
• Expanding in the UK
• Moving to the US
• Raising funds
• A yearlong roadshow to raise funds
• Future expansion and new markets
• Management style

Ian Kehoe (IK): We’ll come to SilverCloud in a moment because in this current climate what you’re doing and the service that you’re providing has never been more important. But I want to start with your own journey because you didn’t start off as an entrepreneur, as a ready-build entrepreneur. You started off working for multinationals.

Ken Cahill (KC): Yeah, I did. But I always had the grá, the sort of the want for business. My dad was a business owner, he set up when he was young. My brother would be the same with that kind of constant want and wish and I don’t know what it was from. I don’t know whether it was the autonomy and the control. I was trying to reflect on this over the past while myself personally, and I’m the sort of guy who likes to go to bed early so I’ll have a really good day the next day. Whilst other people would prefer to maybe stay up late and tomorrow will be what it will be and I know it’s a kind of strange thing to how would you make those analogous. But what I’m trying to say is, in my head and I think a lot of entrepreneurial people’s heads is ‘I would sacrifice the today for a better tomorrow’ and I think that’s kind of backbone of a lot of why we do this interesting journey.

Because what you’re going in for is into battle to bring a product to market, bring people on, create a vision, build, raise money, whatever it might be – it takes a lot of energy you know. I’ve heard other people give this advice which the reason that they have a work/life balance in their 40’s is because they had none in their 30’s. So, that constant kind of backdrop of saying I will sacrifice today for a better tomorrow and you know, go full tilt at it.

Spinning out SilverCloud

IK: Let’s talk about Silvercloud for a moment. It offers 30 online programmes to help people with mental health including depression, stress, anxiety, sleep disorder. It’s phenomenally successful. Now you’ve got 300 clients, you’re all over the world, you’re expanding. As I said, you’ve raised the guts of $30 million from some pretty significant investors. But what was the genesis of the company should I say and how did you get it up and running?

KC: Yeah, certainly. So, if we cast our mind back to, probably about 2010. I got involved in the NDRC, the National Digital Research Centre based in Dublin, where I was working in there as an entrepreneur in residence. So, I’d a number of entrepreneurial endeavours up to that. As the American’s would say learnings, as I think I’d be more traditionally used to using the term failures. But post that, I’d almost say post that and sort of post licking my wounds from those battles, I went into the NDRC and I was working on a number of later stage research projects – working with those projects to help commercialise them and they were across different areas.

There’s about five in my kind of portfolio that I would help to commercialise. But it was just something about this particular one, Silvercloud, which had recently been rebranded from Technology Enhanced Therapy. It was something in terms of what was there, but I think more so there was something in terms of the team you know, that were there, James and Karen and John and Gavin were phenomenal. My exposure to James, who’s our CTO and co-founder and Karen, who’s our Chief Product Officer and co-founder as well, who I sort of spent most of my time with during that period of time. What they had built, what they had tested, what they had delivered out and some of the initial results and user feedback, coupled with such a huge, what I felt a huge economic and social need for mental health delivery.

When the opportunity came about to say hey, you know, let’s kind of go do this as a group. That came on the back of a number of very frustrating meetings where the company was, we were selling the IP to a UK public company and it was clear that that UK public company was taking the proverbial insofar as what they were trying to do with negotiations and everything else like that. Post a very frustrating meeting, I walked out and said to the other guys hey, why don’t we go and do this ourselves? And we did. So, we spun the company out in, I think it was about March 2012 to form who we are. We brought on our first kind of customer or two over that summer as well as securing some funding from Enterprise Ireland and indeed NDRC and the rest as they say is history. I think we were four people then and today we’d be 90 people.

IK: And I’ll come to that scaling piece and the nuances and the intricacies of that in a moment. But people talk an awful lot about mission, mission behind companies. But there seems to be a real mission behind this particular company.

KC: Yeah, so our mission is effective mental health care for all. And the great thing about digital delivery, digital delivery of anything kind of can get into anyone’s homes. Be you stable house or housing instability, be you in every far flung part of the world almost at this point. If you’ve access to a digital device you can get access to what we deliver out and I think that for me is a phenomenal thing. When I kind of grew up you would see from television and other shows the portrayal of mental health delivery was not an overly positive one. And it was sort of using that very traditional backdrop versus mental health today is now being seen as, in my opinion, the key to unlocking so much of life.

It’s how you frame, it’s how you state, it’s how you view the world, your workplace and how you cognitively process. So, how you take information in and act upon it is all down to mental health. In the work place it’s productivity, absenteeism, presenteeism in the… from an insurer’s perspective it’s healthcare utilisation or over utilisation. But then from a humanistic perspective it’s helping one person with their mental health has such a ripple effect out in terms of you help that one person, you help the family, you help the community and the workplace that perhaps they work in as well. It’s a phenomenal, like a privilege to be part of this journey and to do what we have done so far. It’s been great. We’ve 646,000 end users, clients, patients, whatever your term is. We kind of prefer the word end-user of client and that we’ve delivered the platform too since 2012, with about half of those in the past year.

IK: That is massive growth. Obviously, Covid must be really playing into that expansion, is it?

KC: Covid was certainly and you can see on our stats, – March/April/May of last year, the huge switch I suppose and uptake around mental health and SilverCloud’s utilisation there. But even coming into it, the January before Covid, essentially every quarter that we had was our best quarter in terms of user numbers. Even the December and January before lockdown, they were both our best months that we’ve ever had in terms of onboarding or bringing users on. But Covid certainly has accelerated you know, looking over the summer months in the NHS, SilverCloud was responsible for nearly 30%/40% of all mental health delivery for them which was a huge, proud testament to what we wanted SilverCloud to be. We didn’t want to just to be something small and niche. We wanted it to be a mainstream part of mental health delivery, a mainstream part of health actually rather than mental health delivery and that’s down to that mission which is effective mental healthcare for all.

The SilverCloud business model

IK:  On the business model, because you mentioned the NHS is a customer and you have large corporates as customers as well and insurance companies and healthcare providers. You’re not a business to consumer business but rather you supply your expertise and your products to companies, to insurers and people like the NHS, that’s the model.

KC: We enable these organisations to deliver to their population. We’ve always kind of taken an attitude that us delivering directly to those populations could be misconstrued as us competing with them which is not what we want to be. We want to be really good at what we’re really good at. So, be they healthcare assistants, healthcare providers, insurers or even you know, large corporate organisations as you say. We want to enable them to deliver care, effective care and results versus us kind of you know, insert your credit card here. It’s just a very different ethos, it’s a very different attitude. It’s a very different approach to business and a very different business model. Now we do support and help you know, large organisations who would themselves be direct to consumer. So, we kind of do that sort of business-to-business and then to consumer if you will. So, some large pharmacy chain organisations here in North America who would offer SilverVloud out through less sort of traditional healthcare paradigm than what you’d traditionally think of.

Milestones and the SilverCloud growth story

IK: So, you start off, you come out of a meeting, it hasn’t gone well, you look at your colleagues or your potential colleagues and you say let’s get this business, let’s do it ourselves. We go to NDRC, you go to Enterprise Ireland, you raise the funds. But how do you get to a place within, I think this is what an awful lot of businesses will want to know, how do you get to a place within seven/eight years where you’ve 90 people, you’re expanding internationally, you’ve moved to Boston. Can you just talk me through some maybe big milestones along that journey Ken?

IK: Certainly, you just need a really good team and one of the great lessons I learned from my previous kind of big entrepreneurial endeavour, a company called Candidates Direct, which was a recruitment and candidate management system that I’d built. And you know, my badge on honour is that I’m not a very good coder or developer, yet I had built this web system that was five and a half copies of War and Peace was how many lines of code I’d written in kind of 18 months to build what was there. The challenge or the problem with it was that what I had built and I still have and I have it here in my home office here in Boston, a folder which is the code base from it and it’s kind of always there as a reminder in the back of my head going you can have the best technology in the world, you can have the best code in the world, you can have the prettiest whatever it is, but if you don’t have tractions, logos, customers, people willing to pay for and appreciate and a customer value perception of what you’re delivering is good; the rest is kind of, let me kind of describe it I suppose as being academic. James, who’s our CTO and co-founder – I remember shaking his hand at the very start of the journey and said, ‘I’m never allowed near the servers, I’m never allow near the code-base’, and he just said, ‘Fine’, and I never have been. Because the lesson I’d learned was get out, get it sold, get it delivered, get people using it, get traction. That’s what I need to do, rather than building this.

Because for me, it was much easier for me to keep coding and perfecting and I mean perfecting the code and the system and the functions rather than going out and getting customers on board. I mean you know, a friend of mine, Stephen Noonan joined me during that journey and we had some really good traction with some you know, McDonald’s Restaurants Ireland recruiting through it and some interesting names of organisations like Anglo Irish Bank for example. But unfortunately, it was too little too late, November 2008 came and wiped us out, we were done, we were toast. And that was the end of that and that was probably two-, two- and a-bit years of essentially my life gone into it for both of us. And a hard learned lesson.

It was a whirlwind. It was literally a whirlwind. We got the visa on I think a Monday, the container came on the Tuesday and we were gone on the Thursday.

But then from a SilverCloud perspective, we looked at you know, you look at a map of the globe and you kind of go where do we go to from here? And you will essentially, you will scatter gun everywhere, I’m not sure my investors would love to have heard this but you will at the start, you will scatter gun and you will try and cherry pick and you will try and test different markets that you could go into and different areas that you could be applicable, you know. An easy one is the UK because the geography that’s there, it’s English speaking as well and if you cast your mind back to 2011/2012/2013, Ireland was a hard place to be in relatively speaking. The radio channels were all doom and gloom, the country wasn’t essentially open for business, as I perceived it anyway. So, me flying into London or into Manchester, coming off the tube or some other method of transport and you’d walk out of the building and the sky was higher, the sky was bigger, it was bluer, they were open for business and that was phenomenal versus where we had. So, we had to, out of necessity, Ireland was small anyway but there just wasn’t a perception of a need for what we had. NHS then was the logical next step. Some great colleagues along the way who were part of sort of that starting journey.

Worked together to bring on our first NHS customer and then our second and then we partnered with one of the big NHSs in the UK called Berkshire. One of my great lessons was you know; partnership should be just that. It should be win, win, win and somebody at the end gets the benefit. Both parties in between get a benefit from partnering together. And that was, we were able to co-build additional programmes for our library, utilise the NHS brand logo, cache and the network effect that was there. So, you bring one NHS service on, you bring a neighbouring one and so on. And then…

Going stateside

IK: No, and you scale it and you scale it up that way so that’s almost like your template for how you do it.

KC: So, I’m forgetting the really key crucial points. The team had built something that works. So, it was, for me I always kept repeating and have done for maybe ten years, this isn’t you know, a solution problem or a market problem; this is a commercial problem. We need to commercialise this is the big challenge and I always put it back on because I think all to often having come from a sales background, a lot of sales folks can often kind of go well, if I had it in green, I could sell this all day long, you know. Or if I had it in blue I could… there’s always a different shade of colour it could be for you to be able to sell it or deliver it in and I always kind of advocated that responsibility and said no, what we have here works; we have the data, we have the proof, we have the evidence-base, we have the research, people like it and they’re getting huge benefit out of it. Okay, responsibility is now on my shoulders to make sure we get people signing on the dotted line.

And we sort of rolled out and brought the UK on and you know, seven years ago had 1% of all NHS services, today we have 84% of all NHS services using our platform delivered care. And then the next bastion is the US right, it’s a 340 plus, 350 plus million people, a huge country, huge cost disparity of healthcare and the challenge was I was flying back and forth all the time, I was selling by vacation as I learned it to be called. And the challenge with that is you don’t actually really get embedded in in society, in the understanding of what goes on here and the difference, and it is different. You don’t build up that customer trust versus where are you based? I live in Boston with my wife and two kids, oh, oh okay. Versus, well we’re European’s and we travel back and forth but we’re really serious about the US and they’ll go, we’ve seen it a dozen times before. A company comes in and then they just disappear or withdraw because we knew the US has been the graveyard for many, many Irish companies and European companies and likewise in reverse. So, spent a couple of years trying the selling by vacation, my long-suffering wife came with me. We lived with my brother-in-law in Portland, Oregon on the west coast. I worked out of there for eight or nine weeks. We tried living in downtown Boston on a temporary basis for six or eight weeks, both of those were failures as I would have charted them.

The first one was eight-hour time zone different from Dublin and the UK, the UK was our biggest market. Managing the UK team and leaving the team there. All I was doing was essentially getting up at two o’clock in the morning or one in the morning sometimes and working through a weird hour day. So, I just managed them remotely which was you know, not what the point was. Travel kicked up a notch, I was probably travelling 75/80/85 per cent of the time. Our first child first probably would have been a year and bit old at that point, and we were almost due our second guy.

And you know, I remember my wife kind of saying to me, you’re travelling 75/80% of the time to the US, why don’t we base ourselves in the US and then you’ll only need to travel back 20/25%. I mean sheer clarity of thought. So, I said okay, let’s go do it. East coast was preferable, Boston particularly, used to travel to and from, Aer Lingus have got two flights a night, you know, to Dublin and another probably three of four to Cork and Shannon and other parts and then United and Delta. So, I needed somewhere that I could travel back and forth to quickly. Time zone, five hours was the max and the fact that Boston also is a semi-main hub airport. It meant I could travel across the US in one hop. So, loads of these things I learned along the way of challenges.

I’ll profess to not understand the US health system. Most American’s themselves will also profess not to understand it.

IK: It must have been a big thing though to uproot and say we’re really going after the US market, I’m moving myself, my wife, my children. We’re going.

KC: Yeah, it was a whirlwind. It was literally a whirlwind. We got the visa on I think a Monday, the container came on the Tuesday and we were gone on the Thursday. It was literally that much. I asked the board for permission to do it the previous week, to sign off on me doing this. I kind of said this is kind of now or never, you know. Yeah, it’s essentially now or never. The kids are of the “right age”, right age insofar as hard work but much more transportable and mobile versus as they get that little bit older it’s a little bit harder. So, yeah, you know, I was only talking to my wife Caroline over the past while over this and we kind of were taking a little bit of a breath and it was kind of, when you picture back the changes that we went through four years ago, it’s kind of like wow, did we do that.

And I think it’s part of this entrepreneurial journey, you know. You wouldn’t actually do this journey if you knew what was ahead of you. I don’t think any person would. But you’ve got to kind of embrace the naivety that comes with that because you will find solutions, you will find ways around roadblocks as they come up versus sitting at the starting line kind of going, ah no I can see all the way this journey you know; I would never do it. So, yeah, it was a big challenge, it was a big change. It was well supported by the team to do it. They were all behind me. And I moved over three years ago, brought on our first team member.

IK: Has it worked? Has it worked Ken? Has the US expansion been successful?

KC: Yeah, we’ve 35 people now based here in the US. We have a really good brand name, a really good I suppose reputation throughout the US health systems, the healthcare organisations. And indeed, we were focussed on raising our series B investment raise. We were focussed on raising that through key strategic organisations. So, those would be organisations who would deliver healthcare or would be part of the healthcare system. So, if you think about, there’s different styles and types of investors. The strategic ones are the ones you want to bring on for yes, absolutely investment in the business of course, but the smarts that come with and the contacts and the access to.

I mean I’ll profess to not understand the US health system. Most American’s themselves will also profess not to understand it. I know an awful lot more than I did three years ago, don’t get me wrong. But bringing on these people who knew the markets, knew the characters and the players and everyone else that was around the table, that was key for us. It has been a phenomenal success thankfully. But it’s been not without its challenges over that. I mean I know maybe 18 months into that journey, maybe even two years into it I was asked you know, when are you throttling back and coming home with a declaration of ‘ah, it didn’t go well did it’. And I kind of said no, this is now the time we throttle up harder and we’d go for it and thankfully we did. So, over the last 18 months we’ve brought on a huge number of organisations. I would say probably the nine months prior to Covid lockdown were transformational for us. We had built the trust; we’d built the name and the reputation wide enough and far enough that we were able to trade through Covid-19 as well. So, yeah, timing.

A yearlong roadshow to raise funds

IK: You referred to your series B what you raised, I think it was $14.5 million from healthcare funders. Was it tough to get it over the line?

KC: I think every investment round is always tough to get it over the line and it’s never one person, it’s always a team. Kevin, our CFO, Leon, our Head of Corporate Development, we went on a roadshow for a year. It was a full year that we were all away from our families for days and weekends and weeks and whatever else like that, going meeting these investors. And you know, I’m not childish but you know, a lot of these investors wouldn’t have given us the time of day three years ago are banging down our door today. Missed calls, voicemails from them, it’s just an interesting, it’s an interesting dynamic as you know, I’ve always been impressed with the investors who gave us the time then, gave us a bit of advice, a bit of feedback. They gave us a half hour and I would give that back to them in spades today versus the ones who you knew weren’t interested, didn’t want to be there or just completely blanked you.

Now, I’m ready to go back again and that’s the beauty of what we do here. So, to say I love it is an understatement.

But I think it’s like any industry right, it’s always the way. And they get inundated with thousands of people asking them for stuff, so I understand that as well. But yeah, it was tough, it always is a big challenge to raise investment. You’re saying to people give me X amount of money and I will make it bigger and give me the trust, insofar, as I will bring us on this vison or this path. I think it changes based on, I think you’re seed round is more speculative, your A is more getting it embedded and you’re a is probably more about hope. Hope that this will move to kind of more mainstream and your B is more about okay, now we’re delivering operational efficiencies, now we’re bringing in profit, now we’re really scaling the organisation to go for it essentially. And we couldn’t do it without the team that we have, the 90 folks that we have split across the UK, Ireland and the US have been phenomenal, they genuinely have and mission driven, mission led. Just really, really good people.

Future expansion and new markets

IK: What does the future hold for the company? So, obviously the US expansion is going well, you’ve done really well in Britain, are you looking at new markets, new funding or where is the growth or the future expansion? Or are you comfortable in the markets that you’re in?

KC: No, I think it’s you know, you’re always going for future expansion. I think you kind of have to be in any tech business. We see another announcement over the weekend, over the last couple of days with some other Irish phenomenal success stories and you kind of have to keep pushing forward. If you don’t keep pushing forward, you’re going to call behind. So, that kind of relentless pursuit of that is always there. We’ll be entering the Australian market in the next quarter. We’ve been doing a lot of work there. Germany as well, we’ll be entering that in the next quarter as well, we’ve done a lot of work in terms of regulatory there. And just we’ll expand the team by a further, I think it’s 55 people over the next two quarters. So, bringing us up to North of 135 people on the team. And keep delivering on that mission of effective mental healthcare for all. And the big goal that we have is to be the global leader in digital mental health, delivering the best in terms of outcomes inside and outside of the current healthcare paradigm. And it’s a big ambition, it’s a big goal. I’ve no doubt in my mind that the team can do it and do it every day. So, it’s an honour to work with them.

Management style and fulfilment

IK: You mentioned at the start, you were talking about the driven nature of the entrepreneurial personality in your you know, forsaking today for tomorrow, working hard in your 30’s to get to that point. How do you marry that with your own management style because that’s fine for you and the boss but you’ve 90 people, a lot of them are probably in different places in their lives and maybe not looking for that sort of entrepreneurial venture or adventure? So, how do you manage your own style of management for want of a better phrase?

KC: I think that’s part of it. I think you have to understand where people are and what their goal and ambitions are. Some people in the team would want to be very much part of the entrepreneurial piece and want to be at the cold face and want to be the longer hours and the longer days certainly. And then some folks are more focussed on you know, absolute mission driven, don’t get me wrong, but also need to have the balance for a whole host of reasons. And know pros and cons on either side of the equation but just different people for different, you know, different strokes for different folks and that’s absolutely fine. I am who I am, I am driven the way I am driven. And I would see kind of creating the vision and purpose and setting it off far enough away and helping people to sort of lean towards that charge is really I think the key. The key for it all. And it’s also helping them in terms of high-visibility of high-performance. So, where they have high-visibility of what they’re working on, how that makes a difference of what they do, how that contributes to their team and how their team contributes to Silvercloud’s mission, goal, ambition, delivery, clinical results, revenue, whatever it might be. Is probably the strongest part of my management style if you will. I have…

IK: And do you still, are you enjoying yourself still?

KC: Absolutely. It is probably the most phenomenal learning I’ve ever had. So, I’ve you know, ten years have compressed countless MBAs I’d would say into it. It’s an amazing learning. But you know, I’ve worked in banking software, I worked in telecoms. There’s not an awful lot to get excited about what you’re doing there versus when you work with SilverCloud. The team are phenomenal, the investors are fantastic and the board are amazing. But the actual core stakeholders within all this is that end user or client and we would get feedback from them. They would rate how they find it. So, 94 per cent is the lowest rating that we have of user satisfaction with our product. And that’s for somebody who is challenged with depression, anxiety, stress, sleep, whatever it might be. That’s phenomenal. But then you see the person giving feedback of they saved my marriage, this pulled me back from the edge, you have undoubtedly saved my life.

That’s different and remember that we were recruiting for a reasonably senior enough decision back, it must have been seven/eight years ago and we’d offered the role to somebody who’d come out, they’d agreed to come and join us and we had a meal out and some drinks and that was fantastic. And then the next day you know, rescinded or sort of said listen, I can’t, I’ve got to stay in my previous role because they’ve offered me X, Y and Z and we couldn’t convince otherwise. And I was a little bit down in the dumps for a minute or two and I think it was, I can’t remember it was James or Karen forwarded me on six or seven user quotes and it was that kind of feedback, it was that kind of…and I was like okay, cool.

Now, I’m ready to go back again and that’s the beauty of what we do here. So, to say I love it is an understatement.

This interview has been edited and condensed for clarity.

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