Open Letter to Therapists

Dear therapists,

You’re falling for a scam. Truly, you are. The mental health system has been so broken, for so long, that things look like solutions when they aren’t. Big tech is taking over mental health, and you’re letting it happen. Some of you are unwittingly participating. Don’t worry, I have, too. When I wanted to get back into direct client care to support my teaching and supervising, I could not have an on-ground, in-person practice. I live in two states. How could that even work? Enter large, flexible tech company (this was pre-Covid, when tele-health was the exception and not widely a thing). I worked for them for a while, but my ethical heebie jeebies set in. That, along with the abysmal pay, led me to go out on my own, where I control the ethical decision making, and I make the money.

Photo: Unsplash Alexander Debiève

Turns out, I was right. BetterHelp was recently fined $7.8 million by the FTC for sharing personal health information of clients, to none other than information gathering giant Facebook (and others)! Cerebral shared the data of more than 3 million users with the likes of TikTok, Google, and Meta. This breach included actual mental health details from assessments, as well as names and other private information. Headlines continue to refer to these companies as “mental health” companies, but can we all agree that they’re actually tech companies looking to capitalize on broken systems to line the pockets of their investors? Clinicians, who are incentivized to ramble on and carry huge client loads in order to make a decent living, are rarely compensated fairly for the work they’re doing. Trust me, I know.

Photo: Unsplash Gorgio Trovato

Ok, so you might say, “Well there are companies like Headway and Alma that will do the insurance billing for you and increase access to services, some of them even for free. That’s got to be good right?” If you ask me, nope. First, even the “free” ones are not free. They’re taking a cut of the insurance payment they negotiated, and you’re not seeing it. Many of the people I know who work with these companies don’t even know what percentage that is, or they think the service is truly free. Hmm. But ok, the mission of these places. It sounds good right? Bring mental health care to the masses and ease the burden of insurance billing for providers who just want to fight the good fight. But if that’s really the case, why aren’t these places non-profits? Also, has anyone critically considered what happens when the bargaining power in negotiating with insurance companies lies with a small handful of HUGE entities? Think independent, smaller practices run by actual therapists are going to be getting the best reimbursement rates? I doubt it.

These companies are basically GIANT group practices, and that comes with caveats you might not even expect, like no out-of-network benefits for clients who come to see you under your private practice NPI, not through the billing provider you’re using. These, too, are tech companies. Are any of the above types of organizations run by therapists? Not usually. Do they have investors who want return on the money they put in? You bet! Are they endorsed by popular therapist podcasts? Disgustingly, yes. We have to fight the Amazon-ification of mental health services.

So, what do we do? We need accessible mental health services. Clinicians need to be able to charge reasonable rates and make a living seeing a sustainable number of clients (hint: that’s not 30 per week for most people). Finally, no one, and I mean no one, wants to deal with insurance companies. That’s hours of unpaid labor. It’s fair to say that these large companies exist because of a real need within a very poorly functioning system. The answer is certainly not, “If you can’t beat ‘em, join ‘em.”

While I don’t know all the answers, I will share that I have recently gotten involved with a group of people who I think might change this trend in mental health service provision. To be very clear, the opinions above are mine alone and not theirs. However, I think they’re onto something that might address my concerns. They are creating what’s called a decentralized autonomous organization, or DAO. In some ways, it’s techy beyond my wildest imagination, in others it’s just a group of mental health folks coming together to say, “No thanks, we’ll do this ourselves. We want people to have access to services; we want to have a truly anti-racist and equity-minded organization; we want therapists to be paid what they’re worth to do more than just one-on-one therapy; and we want therapists to be in charge of and making decisions together within this community.” What I admire about this group of people is that they’re taking the power back, not for themselves, but for the sake of community and a sustainable model that is healthy for everyone. Even better, they’re doing it, not by rejecting the model of techy mental health service provision, but by adapting it to suit the people who provide the services and the people who need the services. And, I even enjoy meetings; they're full of real connection and collaboration, as well as challenges for us all to be and do better. You all, after working in so many toxic situations that I left to do my own thing, I have hope again for a functional, collaborative system whose members actually do the things they say they will. We don’t have to accept the status quo of the tech giants running our profession. At the risk of sounding sales-y, if you’re a therapist and are interested in learning more, let’s chat.