New York, NY – It’s become more and more apparent that the need for comprehensive mental healthcare has exploded. With health insurance lacking coverage options through cost prohibitive, minimal-at-best, or out-of-network mental health coverage, finding and getting the proper care has become overwhelming. Now, for people facing mental health burdens, including common issues like anxiety, depression, and ADHD, making the choice to get care has become the lesser hurdle. Finding care – focused on an individual’s challenges without a heavy expense challenge – has become a new focus and growth opportunity within the healthcare industry. In the past few years, the question has been posed: How do we make mental health care accessible, relevant and affordable? Many new startups and initiatives aim to answer that, but within the spectrum of care, the industry as a whole, needs to evaluate the usefulness and appropriateness for patients in need.
A few of the current players in the online therapy space include AbleTo, BetterHelp, TalkSpace, ReGain, Breakthrough, and MyTherapist. There is regular and continued addition of new players to this field, which highlights the need to thoroughly evaluate and understand these competing organizations.
Here Are a Few Things To Consider:
With new and burgeoning startups dedicated to mental healthcare accessibility, what processes, guardrails, and criteria will be established to connect people to the care that will be most effective to them?
Based on my own perusal of some of these sites, individuals are screened, but most services are offered remotely. In fact, on BetterHelp.com, they highlight job opportunities as a “private practice with no doors and no overhead,” but also note for patients that “…while the service may have similar benefits, it's not capable of substituting for traditional face-to-face therapy in every case.…provider[s] won't be able to make any official diagnosis, to fulfill any court order or prescribe medication.” While almost all of the sites have established remote screening processes, most of the companies do not meet with care providers face-to-face. Due to this, there is a limit to what they can monitor and ensure with regards to quality of care.
Security of personal information is another crucial detail to consider. For example, TalkSpace notes within their privacy policy that while anonymity remains, their app will collect personal and treatment data, including the content of messages, inclusive of images, between you and your provider to share with advertisers and media organizations. Furthermore, they accept no responsibility for data lost, exposed or used due to the nature of the Internet, technical malfunctions, etc. These facts, when highlighted, can make individuals feel unsettled about sharing intimate details about their lives.
Another facet that is not often highlighted is that there is a fundamental difference between counselors, psychologists, and psychiatrists, beyond just training. Counseling tends to focus on learning techniques for coping and avoiding problem areas. That may be a perfectly suitable option for some people; it may be the only available option for some people. However, the delineation between these occupational roles still remains:As opposed to counselors, psychologists and psychiatrists are equipped to help people deal with longer term issues like depression, anxiety, and ADHD, with psychiatrists having the ability to monitor and initiate psychopharmacology. While many of these online or remote therapy providers have both social workers and psychologists, patients must rely on an undefined assessment to pair them with a care provider. In one privacy policy, it stated that the onus of care was on the patient: “You are always advised to exercise a high level of care and caution in the use of [the] Network of Providers as you would making any mental health or medical decision…You have to create the best therapeutic journey that matches your individual needs.” That’s yet another scary thought for anyone overwhelmed and seeking mental health care.
In part, the emergence of some of these companies leaves something to be desired. And as some of these companies get bigger, they are using advertising to recruit patients in an effort to build their revenue streams. Recently, TalkSpace has used Michael Phelps as a celebrity endorser for their advertising campaigns. One must consider their intentions as a company. Instilling more confidence of care is AbleTo, which has initiated patient screenings with clinicians to make sure that their services are appropriate based on the need of the person. Furthermore, if they decide AbleTo is not the right option for the patient, they work towards finding appropriate care via the patient’s insurance network. This patient screening process is not specifically highlighted in detail on their site and it’s unclear if other organizations follow similar methods, if any. Talkspace also mentions patient assessment and provider matching, but it’s unclear what that fully entails. As the landscape continues to evolve, we need to start asking – Are these companies connecting patients in need with the appropriate care? If not, what can be done within the health sector to change this dynamic?
While I, an avid mental healthcare advocate, appreciate the influx of care options aimed to tackle this burden, my questions to many of these organizations are as follows: How will they ensure that the people that come to them get the right care option (not just the available care option) and are truly considered beyond the acquisition and revenue-driving factors? If they are ensuring patient assessment protocols, how can they create more transparency about and confidence in their patient to care provider matching process?
