When Pat Paulson’s son told her he was anxious and depressed in college, Paulson browsed her Blue Cross Blue Shield provider directory and started calling mental health therapists. In Wisconsin, where her son’s college is located, no provider has vacancies. So she bought a monthly subscription to BetterHelp in Mountain View, Calif., which connects people with online therapists.
Her son was uncomfortable with his first BetterHelp therapist. After waiting a few weeks, he saw a second therapist he liked. But she is not available next week.
Despite the conversion and waiting, Paulson is grateful she was able to find her son’s help. “He’s gotten to the point where he’s ready to give up looking for someone,” she said.
many American adults can’t find help Because of a shortage of therapists.Nearly 40% are struggling with mental health or substance abuse problems, according to Centers for Disease Control and Prevention.
As a result, millions of people are turning to online companies like BetterHelp, which have sprung up over the past few years to promote quick access to treatment. Often backed by venture capital firms, these for-profit businesses offer a broad portfolio of services, including one-on-one and group video therapy visits with licensed professionals, supportive text messages, instructional videos, and medication prescriptions.
In their ads, some companies feature testimonials from celebrities such as Olympic athletes Simone Byers and Michael PhelpsBut senior therapists and officials from leading mental health professional associations say there is limited evidence on the effectiveness of the new online provider.
“There are some fundamental questions about what these companies are doing and whether they are reaching people who really need help,” said Dr. John Toros, Director of the Division of Digital Psychiatry at Beth Israel Deaconess Medical Center in Boston and Chair of the American Psychiatric Association’s Committee on Health Information Technology. “They may be doing well, but it’s hard to know when we don’t have that data.”
PhD.Valen ChaudhryOnline companies can help patients who face financial, cultural and accessibility barriers to traditional treatments, said the chief medical officer of online and mobile therapy provider Talkspace. Customers may want the convenience of online care at home, he said.
“By bringing patients together on a remote treatment platform, Talkspace expands the ability to deliver treatment,” he said. The New York-based company says it has served more than 1 million people with 3,000 providers in all 50 states, and it charges $400 or more a month for its four-weekly live classes.
Study shows treatment is offered online can be effective And, spurred by the covid-19 pandemic, many individual therapists are offering sessions with their patients online. But the rapid growth of the online commercial therapy industry has some traditional mental health professionals concerned about aggressive advertising of online services and whether patient care is being compromised by inadequate training and compensation for therapists working at some digital companies worry. In addition, a company was investigated by federal law enforcement after news reports detailed questionable prescription protocols.
“Online companies have flooded the internet with catchy ads that promise treatments for depression and anxiety,” says Marlene MathewClinical Psychologist and Founder Telebehavioural Health Institute, who train practitioners on best online practices and assess services for employers who may wish to offer them as a benefit to workers. “But can you give them to your troubled child?”
word therapy
Study finds face-to-face video psychotherapy visits and other mental health classes just as effective as a face-to-face encounter. But veteran mental health experts are skeptical of the texting practices and services of some online providers that don’t involve live video therapy.Research support for the efficacy of SMS and similar services Scarce. The American Psychological Association has banned an online mental health company from advertising on its own website and publications on the grounds that its services do not meet the APA’s standards for evidence-based treatment.
“We are concerned that patients will leave text messages and the therapist may respond within hours,” said Will Wright, Senior Director of Innovation at the American Psychological Association. “We don’t have peer-reviewed studies to support that this is valid.”
Bradley Boivin, a psychologist who spent three months as an independent contract therapist at BetterHelp last year, said he was so concerned about the heavy use of text messages for therapy that he told clients he wouldn’t.
Boivin, who now works in a private practice in Scottsdale, Arizona, said other BetterHelp therapists told him they felt pressured to respond to client texts at all times of the day. A BetterHelp compensation form obtained by KHN shows that therapists are paid based on the amount of text they read and write.
Aaron Matasfounder and president of BetterHelp, which spends over $7 million In December, it advertised on 556 podcasts defending the use of text messages, saying its company’s therapists don’t immediately respond to client text messages. Each therapist uses professional judgment to decide when is the right time to use messaging and “how best is for each member,” he said.
According to officials from the Association of Mental Health Professionals, many therapists working with online companies are independent contractors and do not have the company’s liability insurance or health insurance.
Online companies often attract inexperienced therapists because salaries are often lower than the typical earnings of therapists in private practice, according to Laura Grosson, Policy and Practice Director of the Clinical Social Work Association. “It’s a way for new clinicians to step in, and that’s what people should know,” she said.
The BetterHelp pay scale shows that the company pays therapists proportionally based on the number of hours they work per week — $30 an hour for the first five hours, $35 for the next five hours, and so on. Any therapist The maximum wage is $70 per hour. more than 35 hours.less than Typical cost per session is $100 to $200 Private practice therapists across the country charge clients a fee.
Matas said the table doesn’t reflect that therapists’ base hourly pay may be supplemented by monthly stipends, group meeting payments, bonuses and caseload incentives. BetterHelp has more than 25,000 therapists in its network, and Matas says it actually pays 60 percent more than the median salary of licensed therapists in every metropolitan area where it has therapists.
virtual pharmacy
There are also concerns that clinicians at online companies will prescribe psychiatric drugs—either potentially addictive controlled substances, such as Adderall, or antidepressants, such as Zoloft, which is not addictive but has potentially dangerous side effects.
Federal law requires doctors to see patients in person before prescribing controlled drugs, which are heavily regulated by the government because of their potential for misuse.The federal government waived the provision under Public Health Emergency Rules Posted early in the covid pandemic. Officials are considering Whether to extend the waiver at the end of the public health emergency.
Recent enforcement actions have disrupted that review After news reports in March. Department of Justice and Drug Enforcement Administration brain under investigation, a San Francisco online prescription company for prescribing Adderall that may violate the Controlled Substances Act.The company told news organizations it was not charged with breaking the law and it would Suspend Prescribing Adderall and other medications to control attention deficit/hyperactivity disorder. In a statement to KHN last month, it said, “Cerebral is fully cooperating with the Department of Justice’s investigation.”
The DEA declined to comment on the investigation, and the Justice Department did not respond to KHN.
in a letter to editor Cerebral’s founder and CEO, Kyle Robertson, described Cerebral’s practices in response to a Bloomberg News article, which included short-term patient appointments, aggressive advertising and pressure on providers to prescribe medication , he said his company has no quotas or targets for clinicians to prescribe. Cerebral “follows clinical prescribing guidelines based on the latest research,” he wrote.
company director deleted him from his position in May.
Brain allegations are ‘a wake-up call to everyone in the industry’, he says Thomas Ferrante, attorney for Foley & Lardner representing several online companies. “It’s a reminder that healthcare is a highly regulated field.”
“Companies like Cerebral are disrupting telehealth for everyone,” said psychiatric nurse practitioner Piper Buersmeyer, principal owner of Med Rx Partners, an online and in-person service in Vancouver, Washington Assess the patient and prescribe medication. “They’re undermining trust.” She said she worries that some companies don’t adequately assess patients’ mental health issues before prescribing drugs.
Other companies have also advertised directly to consumers about help with getting their medicines. For example, Hims & Hers, another San Francisco telemedicine company, ran an ad for “Medications for Anxiety and Depression in Less Than 24 Hours” after customers filled out a short form and contacted a Hims & Hers provider online. The company’s spokesman, Sam Moore, said providers would only prescribe drugs after following an “evidence-based clinical protocol.”
Dr. Bob Kocher, president of Lyra Clinical Associates in Burlingame, Calif., said the best treatment is to combine treatment with medication when needed. This often works better than the drug alone, he said. But he worries that some online therapy providers may not be able to adequately assess patients before and after prescribing medications, may be too reliant on patients’ self-diagnosis, and may not be able to provide adequate talk therapy.
“It’s not always obvious that it’s depression,” says Koch, a practicing internist. He added that prescribing the drug without adequate diagnostic work or continued talk therapy would be “concerning because antidepressants are not without their own serious risks, including suicide.”
Based on her experience reviewing some online companies for employers and training therapists in online environments, Maheu worries that companies may not train their therapists on how to provide safe, effective and ethical therapy online. As a trainer for online providers, she teaches therapists how to use video screens to reduce escalation in suicide or other crisis situations. At the same time, she added, there are few government or professional regulations to protect consumers. “What’s happening is a corporate acquisition of behavioral healthcare by digital entrepreneurs,” warns Maheu. “The industry is a disaster waiting to happen.”
KHN (Kaiser Health News) is a national newsroom that provides in-depth news coverage on health issues.Along with policy analysis and polling, KHN is one of the top three operating programs in the U.S. KFC (Kaiser Family Foundation). KFF is a donating non-profit organization that provides information on health issues to the state.
Image credit: Olga Strelnikova, Getty Images
