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Why Investors Should Care About The Mental Health Of Startup Founders It's paramount to address the startup's business needs, as well as the work culture and personal well-being of the founders.

By Marcel Muenster

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In recent years, the clinical diagnosis of attention deficit hyperactivity disorder (ADHD) has grown exponentially. But did you know that ADHD is prevalent among startup entrepreneurs?

Based on my experience working with startup founders, an ADHD diagnosis is not just commonplace, but often considered a "status diagnosis." There are two reasons for this. First off, some of the most creative and successful people have the condition, including Sir Richard Branson, David Neeleman, founder of JetBlue, Ingvar Kamprad, founder of Ikea, and John T. Chambers, founder of CISCO. That's pretty rarified company to keep. Secondly, in the realm of entrepreneurship, there are tangible benefits of having ADHD- it has almost become a credential, akin to what a Harvard MBA was two decades ago. In fact, many high achievers falsely selfdiagnose themselves with ADHD, when often they suffer from another condition.

"About 30% of my highly successful patients who come into treatment incorrectly diagnose themselves as having ADHD," says Dr. Paul Hokemeyer, an internationally renowned clinical and consulting psychotherapist. "These people typically suffer from generalized anxiety, a depressive disorder, or a substance abuse issue. All of these conditions can carry symptoms of physical agitation, trouble concentrating, and disturbed sleep patterns, the same conditions that patients who suffer from ADHD report." Here's what you need to know about ADHD. According to Dr. Hokemeyer: "The people who suffer from ADHD have challenges focusing and very short attention spans. They are restless, and suffer from poor impulse control."

Over the last two years, he has noticed more patients coming through the door diagnosing themselves. Yet, before an ADHD diagnosis can be given, an adult patient must manifest at least five of the following symptoms consistently over a six-month period:
• Carelessness around details.
• Difficulty holding attention on a single matter.
• Difficulty listening when others are speaking.
• Difficulty organizing tasks.
• Prefers ticking off tasks that are completed quickly rather than investing in those that require a longer duration.
• Easily distracted.
• Frequently loses objects like keys, mobile phones.
• Tends to be forgetful.

Dr. Paul Hokemeyer, an internationally renowned clinical and consulting psychotherapist. Source: Dr. Hokemeyer

According to the National Institute of Mental Health (NIMH), ADHD affects 8.1% of the adult population, and 29% of the entrepreneurial population. And, in my experience as a serial entrepreneur, it seems like many entrepreneurs I know suffer from some sort of mental health issue. I recently read that 72% of entrepreneurs have a self-reported mental health condition. "Historically, the patients who I end up treating for ADHD come into my care through a more acute condition like depression, anxiety, bipolar disorder, a relationship issue, or a drug and alcohol problem," explains Dr. Hokemeyer. "In the process of working on that issue, I discover the patient meets the diagnostic criteria of ADHD." With a proper diagnosis, a bespoke treatment plan can increase your probability of channeling the condition to success. "My work with my patients involves exploring on a cognitive level the pluses and minuses of ADHD, and deciding how to tweak their neurophysiology and physiology to accomplish their intentions," says Dr. Hokemeyer. "My first line interventions have nothing to do with medication. It's amazing what benefits can be gained from even the most subtle changes in one's diet and exercise routines."

Related: Nothing Ventured, Nothing Gained: Handling The Burden Of Business Success

My discussions with Dr. Hokemeyer got me thinking about my own struggles and successes. I've always had trouble staying focused. I'm easily distracted, and the rise of smartphones and other digital devices has made my life even harder. I'm also naturally impatient. In my world, things should happen yesterday. At the same time, I'm quite efficient and try to be as productive as possible. But I always need a certain environment and mood to get things done or even excel at tasks. That's definitely a challenge.

In entrepreneurship, I think my impatience is a blessing and a curse. And, my restlessness and natural curiosity are a key driver of my progress in life. "To be a successful entrepreneur," says Dr. Hokemeyer, "a person must live in a state of constant restlessness and dissatisfaction. They must be driven, and shallow in their self-reflection. As to the shallow self-reflections bit, entrepreneurs are constantly managing an unrelenting stream of pernicious and hypercritical judgments from others."

This resonates with me and my own entrepreneurial path. When faced with the decision to move out from the traditional medical doctor career path, and become an entrepreneur seven years ago, it was a natural fit. Let me explain further. I think every job or career attracts matching personalities.

Entrepreneurship as a career path was the most attractive to me. For as long as I can remember, I've always been someone searching for a greater purpose in life by challenging the status quo. I thrive in uncertain and constantly changing environments. I also feel my best work is being produced with the right amount of pressure. A number of articles has addressed the mental health crisis in startups, including everything from substance abuse, bipolar disorder, depression, ADHD, and more. I asked Dr. Hokemeyer what the investment community can do about this mental health crisis, particularly among startup founders. "I'd look at it first through the lens of due diligence," he says. "The data shows happiness and mental health increase financial performance exponentially. Therefore, responsible fiscal management requires funds to be allocated where these factors are being maximized. The second lens is through a fiduciary responsibility to have a highly developed ecosystem that contains resources to identify and treat the myriad of mental health issues that have empirically been found to exist in the entrepreneurial population. If we know there are problems lurking with, say, substance abuse and anxiety, then we have a duty to flesh them out and treat them." Lastly, when it comes to ADHD, consider checklists, and writing out a strategic plan. It's also critically important to become aware of your optimal environment, says Dr. Hokemeyer.

Related: You're Not Alone: Entrepreneurs Need To Talk About Their Mental Health Battles

Did you know that 90% of companies fail within the first year? And that out of that 90%, 65% fail because of founder burnouts? In my experience, most investment funds, small or large, focus on the obvious benefits of money, knowledge, and network. But I have never seen one that focused on the mental and physical well-being of their founders. In addition, happier founders are 20% more productive. Therefore, investors need to consider the economic benefits of healthier work cultures. For example, a healthy work environment leads to higher retention of employees, lower recruitment cost, and cheaper office space. And, happy employees care more about the people than perks. For these reasons, the Gritti Fund was founded with both mental and physical wellbeing in mind. For example, our team has the world's leading expert, Alexander Kjerulf, on happiness at work. And, once we decide to invest in a company, it's paramount to address the startup's business needs, as well as the work culture and personal well-being of the founders. I know first-hand that the pressures an early stage entrepreneur faces. Our job is to help founders automate their workflow, and provide professional and emotional support, so that they can feel understood and safe.

Related: Your Tough Experiences As An Entrepreneur Can Help Your Peers Succeed With Their Endeavors

Marcel Muenster

Founder of The Gritti Fund

Marcel Muenster is a serial entrepreneur, a Johns Hopkins-trained medical doctor, public health professional, and management consultant. He is the founder and CEO of Doctor in Your Pocket, an industry leading global digital medical concierge service, giving international travelers access to trusted local, virtual, and house call doctors around the clock anywhere in the world. In 2015, Marcel was a finalist for Ernst & Young’s Entrepreneur of the Year Award. His work has been featured on Forbes, TechCrunch, The New York Times, and other industry-leading publications. Besides his CEO role, Marcel also mentors companies as part of his Entrepreneurship Unplugged World Tour and engagement with Techstars. In his latest endeavor, Marcel founded The Gritti Fund, the world’s first purpose-drive and happiness-focused investment fund. 
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