Therapy apps are the Ubers of mental health — they promise to disrupt a broken system, but instead they shortchange therapists and offer patients mediocre care

After a massive stampede killed 10 people At Travis Scott’s AstroWorld performance last November in Houston, the rapper announced he was partnering with BetterHelp, an app-based mental health company, to offer concertgoers a free month of therapy.

The ad turned on immediate reaction: Scott was accused of profiting from the tragedy through his association with the company (something the company denied), and many people rightly pointed out that a free month of therapy was a drop in the bucket of what was needed for people to heal after the disastrous event.

Although there was no monetary partnership between Scott and BetterHelp, it was part of a public relations strategy employed by BetterHelp and its therapy app competitors like Talkspace to promote their services through partnerships with influential people, Famousand groups as far away as the new york police and a lingerie company.

Therapy apps have proliferated in recent years and promise to democratize mental health care by offering a more convenient and affordable alternative to traditional talk therapy. These promises come at a crucial time. Since the beginning of the pandemic, depression and anxiety rates have skyrocketed Y so has the use of therapy apps – which makes sense given that people have struggled to find a traditional therapist as demand exceeds supply. But the service these apps offer is very different from the traditional concept of therapy: much of the communication between users and therapists is done through text messages or live chats instead of face-to-face meetings. Therapy app companies also don’t hire their own therapists, instead relying on overworked contract therapists.

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Talk therapy is just the latest industry to be disrupted by the Silicon Valley playbook. During years, technology companies have taken advantage of the lack of antitrust regulation in the US and the lack of government support for public infrastructure in order to take over industries and drive down wages in an attempt to make massive (often unsuccessful) profits. From Grubhub to Uber to Amazon, Silicon Valley entrepreneurs have cast themselves as innovators, revamping outdated industries and filling gaps in inefficient systems.

But in reality, these companies rely more on monopolization than on true innovation. These tech companies frequently operate at a loss while putting pressure on enough people in their ecosystem, at which point they can raise prices and reduce costs.

We can see the same thing happening now with therapy apps: BetterHelp, Talkspace, and other therapy apps are not only aiming to take advantage of scarce public health infrastructure to grow their products, but are also seeking to fundamentally change the economics of life. mental health care so that they can siphon money not only from patients, but also from therapists. What these applications innovated was not technology-mediated therapy, but therapy reduced to a basic version of itself, with less quality, less overhead, and less pay for its practitioners.

The Uber model

From the start, Uber, Lyft, and other ride-sharing apps were presented as radical technological advances. But underneath the bright technological veneer lies a much darker reality. Uber and its competitors not only innovated on their way to dominance, they disrupted traditional workforces, circumvented lawsY lobbied lawmakers so that they became almost the only game in town. uber now controls 70% of the ride-sharing marketand ride sharing applications they now account for more than 80% of the taxi market In New York.

On the way to dominance, these apps also wreaked havoc on the workers they depend on. In New York, Taxi driver income fell 44% between 2013 and 2019and many Uber and Lyft drivers They can barely afford housing, food and other basic needs..

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Once Uber destroyed the old labor market and created a new one with lower wages and worse working conditions, it monopolized the market, giving people fewer options for moving around eating into public transport budgets and then force people to pay more for the only options left.

This destroy-to-monopolize system, employed by Uber and many other tech companies, is now standard practice in the tech industry.

The Ubers of Mental Health

BetterHelp, Talkspace, and their competitors are using the same playbook to break down the current mental health system. The applications are presented as technological innovations: never before have people been able to access a therapist so easily! But of course this is not true. As Hannah Zeavin, a professor at the University of California at Berkeley, writes in her book: “The distant cure: a history of teletherapytherapy has been conducted by phone, mail, and other forms of non-face-to-face correspondence since the time of Sigmund Freud. The difference of these therapy apps is that their goal is to make a profit. His priority is not helping people get better, but constantly attracting new clients with a simplified version of therapy.


One psychologist said, “There is simply no replacement for sitting in the same room with someone and having their pain witnessed and validated.”

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Just as Uber and Lyft have raised prices while continuing to pay their workers less, therapy apps charge high fees to provide poor service and wages. improvehelp can cost up to $360 a monthwhich may be cheaper than some therapists, but is more expensive than government-covered therapy or private insurance, which may be free on some insurance plans, or partially reimbursed. And despite the fees, the apps pay contract mental health workers less per hour than traditional therapy models. Companies have tried to keep their pay structure as opaque as possible, but therapists told New York magazine that they were earning between $20 and $30 an hour, far below the rates of traditional therapists (the average salary for therapists and psychologists in 2020 was just over $89,000 a year, according to the Bureau of Labor Statistics).

Apps charge too much and pay too little just to offer poor service: Therapists told New York Magazine that the hybrid structure of talk and text that can take place at any time, not during a defined weekly session, does not benefit users. patients and goes against most of their therapeutic training. Other users have reported mediocre support, such as therapists offering one word answers. Research on the effectiveness of app-based therapy is still limitedbut even BetterHelp says on its own Frequently asked questions which might not be a good replacement for traditional therapy. like a psychologist put it“There’s just no replacement for sitting in the same room as someone and having their pain witnessed and validated.”

So what is the purpose of these apps if not to provide better care or easier access? They simply exist to make money, and they will do so by any means necessary. Many therapy applications have been accused of using questionable data sharing practices, which is particularly worrying as the apps handle sensitive mental health information; Y, similar to how Uber and Lyft circumvented some laws to operate, Talkspace has offered to cover the legal expenses of the therapists operating in states in which they are not licensed.

An innovative dead end

Talkspace, BetterHelp, Uber, and other tech companies exist in part because they don’t is a need for disruption in the fields in which they operate.

Uber has been so successful not only because of its business strategy, but because it filled a void in the United States and other countries where public transportation is severely lacking. Many people have no choice but to use Uber in places where metro and bus systems do not exist or have been systematically underfunded for decades.

The mental health system also needs change: it is expensive, bureaucratic, fragmented, confusing and exclusionary. Many people can’t afford therapy, and insurance is often not required to cover it. Waiting lists for psychologists or psychiatrists can last for months.

While Silicon Valley companies aim to fill the gaps in these troubled systems, they are often unsuccessful.

A group of Uber and Lyft drivers waving banners protesting how little the apps pay.

Uber and Lyft drivers protest in Los Angeles on May 8, 2019 over what they say are unfair wages.

Mark Ralston/AFP via Getty Images

In the case of Uber, recent studies suggest that it increases traffic congestion. And workers are beginning to realize that their tenuous job (which legally isn’t a job at all) isn’t worth it and protest Or simply give up. Meanwhile, it is not clear whether ride-sharing companies are profitable, despite their high prices and monopolization of the market. And while Uber tries to fill in where public transportation fails, it remains unaffordable for many.

We can see the same thing happening with therapy apps: Using the teamwork economy approach, these apps take advantage of working therapists trying to earn extra money or help more patients in their spare time by paying them much less than they normally would. What are they. value. Like Uber, it’s a stopgap solution for workers who aren’t paid enough at their day jobs, and the lack of public services like transportation and health care in the US keep them from working time with benefits. And like Uber, it’s not doing well anymore: Talkspace went public last year and its stock is already collapsed to almost a tenth of its original value; now facing a shareholder lawsuit.

If businesses are barely profitable with labor laws tilted in their favor, and while they pay their workers less and provide poor service to customers, it is not clear how they can be sustainable if they are forced to pay fair wages and provide adequate services. to his clients.

This is the darker side of the Silicon Valley model: companies disrupt industries, but often don’t create a sustainable alternative in their place. And even when these companies struggle, they cause massive changes in the industries in which they operate, hurting customers and suppliers in the process.

It’s too early to tell how disruptive apps like BetterHelp and Talkspace will be to the mental health industry, but if the history of other Silicon Valley tech companies is any guide, then a lot of people — workers and patients — could be hurt in the process. road.

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