Growing up, Gabriela Forter Miranda watched her family struggle with mental health crises. But it wasn’t only the illnesses themselves that posed a challenge; it was also the difficulties in finding appropriate care. Having lost her brother Josh, an Iraq War veteran, to a drug overdose and seeing her parents’ difficulties in finding consistent therapy for themselves, a core issue became clear: Where could families turn when weekly therapy wasn’t enough but hospitalization was too much? Especially for low-income communities, “the continuum of care has a hole right in the middle,” she says. “That’s where so many families, including mine, get lost.”
With the support of a Stanford Impact Founder Fellowship from Stanford GSB, Forter Miranda is building Joshua Tree Health, a network of clinics that will serve both commercially insured and Medicaid patients with individual therapy, group therapy, and family support. Keenly aware that half of all mental illnesses begin by age 14 and having learned of the shortage of care providers in low-income and rural communities, she is focusing on teens in those communities.
Forter Miranda acknowledges that, in the long term, policy shifts and public service investments will be critical in creating a more comprehensive mental health care system. However, in the meantime, she believes her on-the-ground approach can make an immediate impact. “I’m building what’s needed most: the middle of the system, where families need help but can’t find it.”
Structure, Accessibility, and Community Connection
In the course of her research, Forter Miranda discovered that intensive outpatient programs (IOPs) and partial hospitalization programs (PHPs) — which offer structured, monitored treatment several days a week but allow patients to return home at night — could provide preventive care while closing the gap between outpatient therapy and residential care. Yet because investors tend to seek rapid profitability, IOP and PHP providers are primarily located in areas where patients can afford premium insurance or high out-of-pocket fees.
As a result, many of those facing mental health challenges seek help only once they are in crisis, rather than when anxiety and depression first emerge. “Care is needed before it becomes more serious,” Forter Miranda says — especially for teens, who already face higher suicide and hospitalization rates and often lack access to prevention or recovery services.
Forter Miranda believes the solution is to design mental health care for teens that bridges outpatient and residential treatment and is proactive rather than reactive. While she recognizes technology’s ability to create solutions at scale and to enable back-office efficiencies, when it comes to supporting teen mental health, she does not see technology as the answer.
“That means small, relational, in-person clinics,” she explains. “We need to build social communication and trust through human connections, and that comes through structured in-person group therapy, creative and family work, and trauma-informed, harm-reduction approaches.”
In the Joshua Tree model, each clinic will provide step-up and step-down care, helping teens move from hospitalization back into the community while offering more structured support if weekly therapy is insufficient. The idea is to create a continuum of care connecting every level of treatment.
Services will offer a combination of individual and group therapy with a range of approaches, such as cognitive and dialectical behavioral therapy. Other approaches include arts therapy, which provides opportunities for self-expression; somatic therapy, which uses breathing and body movements; and family sessions, which strengthen communication and rebuild trust.
Clinics will be led by licensed clinical directors and a multidisciplinary team of therapists, psychiatrists, and creative art and music facilitators. Rooted in the community, Joshua Tree’s programs will accommodate referrals from schools, hospitals, and pediatricians.
“At Joshua Tree Health, treatment is designed as a repeated rhythm rather than an appointment,” Forter Miranda says. “Only in a structured program like this can we integrate so many dimensions of healing.”
A Strategy for the Long Term
Having identified the demographic she wanted to serve and refined her model for a seamless continuum of mental health care, Forter Miranda needed to find a business strategy that would sustain increased consistency and quality of care while widening access to that care for vulnerable communities.
This meant asking more questions, which she was able to do while studying for both her MBA at Stanford Graduate School of Business and her MPA at Harvard Kennedy School. While at Stanford GSB, Forter Miranda took classes at Stanford’s medical school, spoke to every founder of a mental health care services provider she could find, and launched a mental health entrepreneurship club that brought together students from disciplines such as psychiatry, health policy, and business.
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“We need to build social communication and trust through human connections, and that comes through structured in-person group therapy, creative and family work, and trauma-informed, harm-reduction approaches.”
Her business school classes also fortified her entrepreneurship skills. “Courses like Formation of New Ventures with Scott Brady, Entrepreneurship Through Acquisition with David Dodson and Gerald Risk, Managing Growing Enterprises with Graham Weaver, and Financial Management for Entrepreneurs with Rob Siegel taught me to build for endurance, not speed,” she says.
The courses helped her create an innovative model with the potential for long-term financial stability. Forter Miranda plans to balance the payer mix so that resources from commercially insured patients help support care for Medicaid or uninsured patients. Meanwhile, learning about different forms of entrepreneurship led her to decide to grow the business organically, clinic by clinic. This, she argues, will allow her to expand and meet demand in communities lacking sufficient providers. “At some point, I want to be opening one clinic per year,” she says.
During a summer internship as chief of staff at a behavioral health clinic serving Hispanic young people in Miami, she gained valuable operational experience by recruiting therapists, collaborating with the clinical team on programming and measuring outcomes, and talking to payers and parents.
“I was doing everything,” Forter Miranda recalls. “It made me realize that the design and infrastructure of care — how people enter, move through, and stay connected — is as important as the therapy itself.”
Meanwhile, a series of fellowships has helped her deepen her understanding of the broader mental health landscape. For example, the Center for Social Innovation’s Impact Design Immersion Fellowship provided her with funding, programming, and peer support, enabling her to explore the impact of IOPs and PHPs on underserved communities. And now, the Stanford Impact Founder Fellowship is making it possible for her to work full time on developing the business she has spent the past three years planning.
Driven by Personal Passion
Today, Forter Miranda is working to find the right community and location in North Carolina to operate her first clinic. She chose North Carolina partly because her husband’s work had brought them to the state, but also in light of her discussions as a Harvard student with former North Carolina Governor Roy Cooper, who was teaching health policy and leadership at the time. From him, she learned of the state’s Medicaid expansion and renewed emphasis on behavioral health but also its lack of sufficient numbers of dedicated youth programs, despite a severe adolescent health crisis.
By engaging with established providers and mental health experts, she knows she can meet the need for care in the most efficient and effective way possible. “The Stanford fellowship gave me time to test ideas responsibly — to study how operations, policy, and community partnerships intersect before I scale.”
She is also excited by the prospect of collaborating with clinical teams to explore new forms of treatment. “The field of mental health is very multifaceted,” she says. “I’m looking forward to working closely with experts to deliver what works.”
Forter Miranda continues to bring her personal experience to her business approach. Even the name of her company reflects the challenges she faced with her family: It was in Joshua Tree National Park that her brother was able to find moments of peace and strength in the midst of his decade-long mental health struggles.
Indeed, the Joshua tree has become a metaphor for the work ahead. “The Joshua tree grows in the desert — a place of scarcity — yet it survives and thrives because of its adaptability,” Forter Miranda says. “That resilience is what we’re trying to cultivate: a place for hope and healing even in systems with limited resources.”