Digital mental health companies check-in and raise concerns

When Pat Paulson’s son told him he was feeling anxious and depressed in college, Paulson went through his Blue Cross Blue Shield provider directory and started calling mental health therapists. In the city of Wisconsin where his son’s university is located, no provider was open. So he bought BetterHelp, a monthly subscription to Mountain View, California, which links people to online therapists.

Her son felt uncomfortable with his first BetterHelp therapist. After waiting a few weeks, he saw a second therapist, whom he liked. But he was not found the following week.

Despite the switch and the wait, Paulson is grateful that he was able to find help for his son. “He reached a stage where he was ready to give up trying to find someone,” he said.

Many U.S. adults are unable to find help due to a lack of therapists. According to the Center for Disease Control and Prevention, about 40% are struggling with mental health or substance abuse problems.

That’s why millions of people are turning to online companies like BetterHelp, which have grown over the years, advertising faster access to therapy. Often backed by venture capital firms, these for-profit businesses offer a wide range of services, including one-on-one and group video therapy visits with licensed professionals, helpful texting, coaching videos and drug prescriptions.

In their ads, some companies show testimonials from celebrities such as Olympic athletes Simon Byles and Michael Phelps. But officials from the Association of Experienced Therapists and Leading Mental Health Professionals say there is limited evidence of the effectiveness of new online providers.

“There are fundamental questions about what these companies are doing and whether they are reaching out to such people,” said Dr. John Torres, director of the digital psychiatry department at Beth Israel Decones Medical Center in Boston and chairman of the American Psychiatric Association. Health Information Technology Committee. “They can do wonderful things, but it’s hard to know when we don’t have that data.”

Dr Varun Chowdhury, chief medical officer at Talkspace, an online and mobile-based therapy provider, said online companies could help patients who face financial, cultural and accessibility barriers to traditional therapy. He said clients can seek the benefit of taking care online from home.

“By bringing patients together on a teletherapy platform, TalkSpace expands its ability to provide treatment,” he said. The New York-based company says it serves more than one million people with 3,000 providers in all 50 states and charges $ 400 or more per month for four weekly live sessions.

Research suggests that online therapy may be effective, and inspired by the Covid-19 epidemic, many independent therapists are offering online sessions with their patients. But the rapid expansion of the online commercial therapy industry worries some traditional mental health professionals who have expressed concern about aggressive advertising for online services and whether patient care is compromised due to inadequate training and funding for therapists working in some digital companies. Also, the news report contains detailed suspicious prescription protocols, after which a federal law enforcement company has launched an investigation.

“Online companies flood the Internet with attractive advertisements that promise treatments for depression and anxiety,” said Marlene Maheu, a clinical psychologist and founder of the Telebehavioral Health Institute Offer. “But can you trust them to have that problem with your baby?”

Therapy through text

Studies have shown that face-to-face video psychotherapy visits and other mental health sessions are just as effective as face-to-face encounters. But experienced mental health professionals are skeptical about the texting practices and services of some online providers that are not involved with real-time video therapy. Research support for the effectiveness of texting and similar services is scarce. On its own sites and publications, the American Psychological Association has banned the advertising of an online mental health company because its services do not meet the APA’s criteria for evidence-based therapy.

“Our concern is that a patient may leave a text and it may be a few hours before the therapist responds,” said Vail Wright, senior director of innovation at the American Psychological Association. “We do not have peer-reviewed research to support whether this is effective.”

Psychologist Bradley Boivin, who worked as an independent contract therapist with BetterHelp for three months last year, said he was so concerned about the widespread use of texting for therapy that he told his clients he would not do it.

Boivin, who now works for a private practice in Scottsdale, Arizona, said other BetterHelp therapists told him they felt pressured to answer client lessons all hours of the day. A BetterHelp compensation sheet obtained by KHN shows that therapists are paid by reading and writing as many text words as possible.

Elon Matas, founder and president of BetterHelp, which spent more than $ 7 million advertising 556 podcasts in December, defended the use of texting, saying his company’s therapists could not be expected to respond immediately to clients’ texts. Each therapist uses professional judgment to determine the exact time when to use messaging and “how it is most appropriate for each member.”

According to officials at the Association of Mental Health Professionals, many therapists working for online companies are independent contractors, with no liability insurance or health insurance from the company.

According to Laura Groshong, director of policy and practice at the Clinical Social Work Association, online companies often attract less experienced therapists because salaries are usually lower than what therapists earn in private practices. “It’s a way for new doctors to keep their feet on the door, and it’s something people should know,” he said.

The BetterHelp compensation sheet shows that the company pays therapists on a sliding scale based on how many hours they work per week – $ 30 per hour for the first five hours, $ 35 for the next five, etc., $ 70 per hour for more than 35 hours. This is less than the typical $ 100 to $ 200 per session that private-practice therapists across the country charge clients.

Mattas said the sheet does not reflect that the therapists’ base hourly compensation by his company could be supplemented with monthly stipends, payments for group sessions, bonuses and caseload incentives. BetterHelp has more than 25,000 therapists in its network, and Matas says it effectively pays up to 60% more than the average compensation for licensed therapists in every metropolitan area where there are therapists.

A virtual pharmacy

There are also concerns about online companies whose physicians prescribe psychiatric medications – either controlled substances that are potentially addictive such as adrenaline, or antidepressants such as zoloft that are not addictive but have potentially dangerous side effects.

Federal law requires doctors to see a patient in person before prescribing controlled drugs, which are strictly regulated by the government because they can be abused. The federal government has waived that provision under the Public Health Emergency Rules issued early in the Kovid epidemic. Officials are considering whether to extend the waiver whenever the public health emergency ends.

That review has been confused by recent law enforcement action since the news report in March. The Department of Justice and the Drug Enforcement Administration are investigating Cerebral, a San Francisco-based online-determining agency, for possible violations of controlled substance law for adrenaline. The agency told news agencies it had not been charged with violating the law and would take a break from prescribing Adderall and other controlled medications for attention-deficit / hyperactivity disorder. A statement issued to KHN last month said, “The Cerebral Justice Department is fully cooperating in the investigation.”

The DEA declined to comment on the investigation, and the judiciary did not respond to KHN.

In a letter to the editor in response to a Bloomberg News article on the cerebral cortex describing cerebral practices that included patient brief appointments, aggressive advertising and pressure on suppliers to prescribe medications, Cerebral founder and CEO, Kyle Robertson said, To prescribe medicine to doctors. Cerebral “follows clinical guidelines based on the latest research,” he writes.

The company’s directors fired him in May.

Cerebral complaints are “a wake-up call for everyone in the industry,” said Thomas Ferrante, an attorney for Foley & Lardner, who represents some online companies. “It’s a reminder that healthcare is a highly regulated space.”

“Companies like Cerebral are ruining telemedicine for everyone,” said Piper Boersmeyer, a psychiatric nurse practitioner who owns the majority of Med Rx Partners, an online and personal service that evaluates patients and prescribes medications in Vancouver, Washington. “They’re losing confidence.” He said he was concerned that some companies did not properly assess patients’ mental health problems before prescribing drugs.

Other companies also advertise directly to consumers to help them get the drug. For example, Hims & Horses, another San Francisco telehealth firm, has run ads to provide “anxiety and depression medications in less than 24 hours” after clients fill out a short form and connect online with the Hims & Horses provider. A spokesman for the company, Sam Moore, said suppliers prescribe drugs only after following “evidence-based clinical protocols.”

The president of Lyra Clinical Associates in Burlingame, California, Dr. Bob Kochhar says the best medical pair with medicine when needed is talking. It usually works better than medication alone, he said. But he worries that some online therapy providers may not perform adequate clinical assessments before and after prescribing patients, rely too heavily on patients’ self-diagnosis, and may not offer adequate talk therapy.

“It’s not always clear that it’s frustrating,” says Kochhar, a practicing intern. Prescribing medications without adequate diagnostic work or continued talk therapy, he added, “would be worrisome, because antidepressants are not without their own serious risks, including suicide.”

Based on some online company reviews for employers and the experience of training therapists in online settings, Maheu is concerned that companies may not provide training on how to provide their therapists with safe, effective and ethical therapy online. As an instructor of online providers herself, she teaches therapists how to minimize suicides or other crisis situations on video screens. Meanwhile, there are very few government or professional rules to protect consumers, he added. “What’s happening is the corporate takeover of behavioral healthcare by digital entrepreneurs,” Maheu warned. “This industry is waiting for a catastrophe to happen.”

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