The Long Road In: Why Selling Mental Health Tools to Schools and Health Systems Takes So Long

In 2026, 73% of startups applying to the Headstream Accelerator named customer acquisition as one of their biggest challenges. A year earlier, that number was 60%.

For eight years, SecondMuse’s Headstream program has worked with founders, schools, health systems, investors and young people to scale access to effective digital youth mental health interventions. The Headstream Accelerator supports early-stage edtech, social tech and digital health founders building these tools. In each of the last three years, roughly 180 to 250 of them have answered our application questions about what prevents them from reaching more young people and the caring adults in their lives. The institutions they sell to are stretched. In schools, federal pandemic relief has ended and federal school mental health grants funded by a $1 billion appropriation were canceled, ruled unlawful and targeted for termination again. In healthcare, Medicaid, which supports more than $7.5 billion in school-based health services each year, faces an estimated $911 billion in federal cuts over the next decade. One analysis found 446 hospitals at high risk of closing or cutting services as a result. That uncertainty slows purchasing: in 2024, vendors reported K-12 sales cycles running about 30% longer than the year before, and nearly half of health plans, employers and health systems now tie what they pay vendors to outcomes.

We asked applicants about the biggest challenges their companies face in entering their target markets. Very few named competitors or problems in their products. Most described the challenges in the system itself, including how institutions make decisions, who pays, and how long the process takes. What these founders describe is a system in which promising products stall long before they reach the young people they were built for. Many of the barriers are structural and funders are well positioned to help close the gap.

The Sale Moves at the Institution’s Pace

Most of these founders are selling to institutions, not individuals. Among 2026 Headstream Accelerator applicants, 87% either sell into schools or plan to. Headstream alumni surveys show us that more than two-thirds of alumni sell business-to-business (B2B) or business-to-business-to-consumer (B2B2C), most often to community healthcare facilities, outpatient clinics, private schools, private practices, and hospitals.

Selling into these institutions is rarely a simple process. LeVincia Porch, Founder & CEO of Sprouts, shared, “One of the biggest challenges in entering the K-12 market is navigating the complex and often slow-moving decision-making processes within schools and districts. Education budgets are tight, and administrators must prioritize tools that demonstrate clear ROI.”

Different departments are responsible for privacy reviews, security audits, and legal sign-offs, and often no one owns the request from start to finish. We heard this from multiple founders. Srishti Srivastava of Infiheal shared, “Selling into schools and universities is slow by design.” Eric Tao, CEO of MegaMinds, added, “One of the biggest challenges MegaMinds faces in expanding within the education market is the slow adoption cycle of new technology in schools. Decision-making processes are lengthy, often requiring months of approvals, pilots, and budget allocations before full implementation.”

Many of these safeguards exist for good reason. Tools built for young people should face careful scrutiny on privacy and safety. The challenge isn’t the review itself, but that founders need the runway and funding for the time these safeguards take.

The road gets even longer with new product categories. Sixty-one percent of applicants also named building awareness of their product as a top challenge in partnering with schools and health systems. “We’re creating a category while selling into it,” said Deanna Oliver of Psyflo. Ellie Francois of Unicover shared: “Every conversation starts with education before I can pitch.”

Alumni companies share this experience too, even years into their journey. Amen Rahh, CEO of Knowlej, shares, “The biggest challenges in scaling sales are long school procurement cycles, limited discretionary budgets, and the need to demonstrate clear impact quickly. As a growing company, building awareness and expanding district-level partnerships while navigating these procurement processes remains a key focus.”

The Value Has to Land Twice

The people who use these tools are rarely the people who pay for them. For 62% of 2026 applicants, users and customers are distinct groups: teens and their parents, student-athletes and their coaches, patients and therapists. “The person who sees the need… is rarely the person who controls the budget,” said Julian Singleton of Clear30. Gregory Akinbiyi of Èrò described the stakes: “Coaches are the buyers. Student-athletes are the users. Both must find value, or neither will stay.” For independent therapists paying out of pocket, the math is just as unforgiving. “They cannot justify the cost of a tool if their patients abandon it,” said Sah of MoodRoom.

Many buyers also arrive skeptical. Fifty-nine percent of applicants named building trust with decision makers as a top challenge in partnering with schools and health systems. “These leaders have been burned by EdTech tools that promised transformation and delivered a login page nobody used,” said the founder of Reflect. That skepticism can be especially strong in communities that have historically been underserved by education and healthcare systems.

The CEO of Koala For Work shared, “BIPOC and Latino students have valid reasons to be skeptical of new tech solutions, especially around mental health.”

AI adds another layer. Nearly a quarter of applicants named distrust of AI as a barrier to partnering with schools and healthcare systems. “Many of the decision makers we are targeting have real questions about whether AI should be involved in conversations with kids around sensitive topics at all,” said startup founder Maurice Darbyshire. To help districts work through those questions, Headstream and The Jed Foundation developed guidance on AI in K-12 mental health tech for the K-12 Mental Health Tech Navigator.

Founders who break through tend to earn trust the slow way. “We earn trust slowly, through word of mouth and lived proof, not marketing,” said Kathy Long of Nixit AI. For many, that proof starts with youth co-creation. Headstream brings together innovative entrepreneurs and youth leaders to co-design digital products and tools that address today’s most pressing youth mental health challenges. Healium shared that designing with youth “Made us realize that our products needed a person to administer them and that they didn't want their teachers or caregivers to see their scores.” Nearly 80% of Headstream alumni have continued engaging with youth co-creators after the program.

Who Can Afford to Wait

Each of these barriers costs time. Many founders lack the funding to survive the long path to revenue. Often, the schools and communities with the greatest need for mental health support have the least room to take on something new. “Title I districts… have the fewest mental health resources, but… the tightest budgets and the most vendor fatigue,” said the founder of Reflect. Another founder put it plainly: “This creates a risk where only wealthy districts can access our tool.”

The work of adoption often lands on the people with the least time to give. Teachers, counselors, and clinicians have to learn and use these tools on top of full workloads, and 26% of applicants named finding time for onboarding and training as a challenge. Innovators shared the challenges of working with and onboarding clinicians, many of whom had never trained on digital tools at all. Correy O’Neal from MindMode AI said: “... clinicians didn’t go to school being taught these technologies that are in the market today. It wasn’t part of the workflows that were in their curriculum. So one of the biggest challenges is having the clinical trust that this technology will not disrupt their workflow, that it will not interfere with their clinical outcomes.” Justin Henderson of BeeEnrolled sees districts responding with caution, hesitant to adopt “unless it clearly reduces workload rather than adding another system to manage.”

The capital side is uneven too. One founder described, “As an immigrant, woman-of-color solo founder, securing the catalytic capital needed for deep technical leaps requires working twice as hard in a VC landscape built for ‘pattern-matched’ insiders.” For funders, this is a pipeline concern. The startups that close during the wait aren’t necessarily the ones with the weakest products. Many are building for the communities with the most at stake, and they have the least runway to hold on until the sale closes.

How Can We Help These Founders Succeed?

“The question isn’t whether young people need these tools,” shares David Ball, Head of Well-being, SecondMuse. “It’s whether the most impactful startups can find their next customer. A strong product isn’t enough on its own. Founders need capital that matches the pace of the sale and buyers who know how to evaluate what they’re procuring. We’re starting to see that path widen as state governments' understanding, acceptance, and infrastructure develop to scale digital mental health interventions.”

Funders can support individual startups and make system-level investments, which can ease some of these barriers.

1. Access to the right capital. Funding needs to match the pace of the sale: bridge funding, recoverable grants, and paid pilots timed to procurement cycles, with priority for the districts, clinics, and community organizations that carry the heaviest burden. Timing can decide whether a company survives.
2. Access to customers. Beyond capital, founders need help landing their next customer. Founders need introductions, market data, and hands-on support with customer discovery. Seventy-eight percent of alumni say introductions to potential healthcare customers would make the network most valuable.
3. Market curation and demand creation. Federal and state policy can create new markets by allocating resources to support youth mental health. Buyers also need help evaluating a crowded field, and a category has to exist before a budget can fund it. Products built with young people are better positioned to earn the trust of the people who use them and the people who pay.

These three work best together, and few funders can do all three alone. In each sector and place we work in, SecondMuse supports entrepreneurs, advises the organizations that shape markets, and invests where capital is needed most. In youth mental health, through Headstream, that means working with founders, schools, health systems, and young people together.

SecondMuse works both sides of the market, building trust with the community as we go. In Southwest Florida, for example, we worked hands-on with a school district, using our K-12 Mental Health Tech Navigator to help it review and adopt a student mental health solution. It’s a choreography between innovation, capital, and demand-side customers, underpinned by youth co-creation. That view shows us where founders get stuck and what moves them forward. You can read more about Headstream’s approach in When the Whole Economy Shows Up: Eight Years of Building for Youth Mental Health.

The road into schools and health systems will never be short. But when a promising product stalls in procurement, the founder isn’t the only one waiting. So is the student who needed support this semester, and the clinic with a waitlist it can’t shorten. The barriers in this piece are structural, which means they can be changed. Funders who back the time, the customer connections, and the market support that founders need can help these tools reach young people sooner.

If you are interested in collaborating or learning more, reach out to our team.