This appeared last week:
The failed promise of online mental-health treatment
Remote treatment of mental-health problems surged in the pandemic, as in-person treatment became difficult while pandemic-driven isolation increased anxiety and depression.
Digital mental-health companies plunged in, promising to provide millions with access to high-quality care by video, phone, and messaging.
Many of the businesses, however, put a premium on growth. Investor-backed, they deployed classic Silicon Valley tactics such as spending heavily on advertising and expansion while often using contractors instead of employees to control costs. A strategy designed for mundane businesses such as food delivery, the formula can be badly suited to the sensitive activity of treating mental-health problems.
After Caleb Hill told his parents he was gay, he was kicked out of the house. He had been taught, growing up in a conservative Christian household in Tennessee, that his attraction to men was a grave sin.
Feeling isolated and depressed a few months later, Mr. Hill, then 22, thought therapy might help. He had heard podcast ads for BetterHelp, a company that provides therapy remotely and promises “a personalised therapist match that is tailored to your preferences and needs.” His biggest concern was he missed his family. The therapist he was given, he says, recommended he try to stop being gay so he could go back to them. “He said if I chose to go back to who I was and deny those feelings, he could get me where I needed to be,” Mr. Hill said.
Mr. Hill had requested an LGBTQ+ therapist, a screenshot of his intake form shows. BetterHelp gave him one who didn’t specialise in LGBTQ+ issues, according to the provider’s profile on its website, and whose personal website says he practices Christian counselling.
“He said either you sacrifice your family or you sacrifice being gay,” said Mr. Hill. “I needed someone to tell me I was gay and that was OK. I got the exact opposite.” BetterHelp declined to comment on Mr. Hill’s experience, citing patient confidentiality. The therapist wouldn’t discuss him either, citing the same reason.
“Given the scale of the service, unfortunate and negative experiences are not completely unavoidable,” BetterHelp, a unit of Teladoc Health Inc., said in a written statement. “This is true in all therapy settings, whether traditional or online.” A number of other clients of digital mental health companies described to The Wall Street Journal how they felt they were badly matched or encountered unprofessional therapists. Some, like Mr. Hill, also told of being gay and being assigned to therapists who were unsympathetic.
Other clients of digital mental health companies described to The Wall Street Journal how they were badly matched or encountered unprofessional therapists. Some, like Mr. Hill, also told of being gay and being assigned to therapists who were unsympathetic.
Telehealth technology was used for 36% of outpatient visits for mental-health and substance-abuse treatment in the March-through-August stretch of 2021, a jump from essentially zero before the pandemic, according to research from Kaiser Family Foundation.
Sensing opportunity, investors last year poured $4.8 billion into startups offering digital mental-health services, according to Rock Health, a research and investment firm. Some of the companies provide therapy, some prescribe psychiatric drugs and some do both.
The companies say that their advertising helps to break the stigma associated with seeking mental-health treatment. And those that lean on nurse practitioners instead of physicians to prescribe medication can lower the price of care and expand the number of available providers. Many patients say the care they have received from the companies is good and also is unavailable elsewhere.
Cerebral Inc. was a star in the field. It raised hundreds of millions of dollars, signed Olympic gymnast Simone Biles as a spokeswoman and by two years after its launch was valued at close to $5 billion.
Its heavy social-media advertising and brief appointments with clinical contractors sparked trouble when the company began prescribing drugs that are prone to abuse. The Wall Street Journal reported how Cerebral executives pitched its investors on the superior profitability of prescribing stimulants such as Adderall, which can benefit people with attention deficit hyperactivity disorder but are sought by others for the buzz they provide. The reporting showed how some Cerebral clinicians felt pressured to prescribe the drugs.
Cerebral now faces two federal investigations, has been told by Walmart Inc. and CVS Health Corp. that they will no longer fill its prescriptions for controlled substances and has been dropped from insurance networks Optum and Aetna. It has laid off hundreds, fired its CEO and stopped prescribing stimulants.
Another digital mental-health provider, Done Global Inc., faces a Justice Department investigation after the Journal reported that some of its clinicians, too, felt pressured to prescribe stimulants to treat ADHD.
Done, run by a former Facebook product manager with no medical training, also advertises heavily on social media. Done’s clinicians continue to prescribe stimulants, sometimes after appointments as short as 10 minutes, the Journal has reported. Walmart and CVS have said they won’t fill its prescriptions for the drugs.
Cerebral and Done have said that they don’t pressure clinicians and that they provide an essential service. Cerebral has said it is cooperating with the investigations and hasn’t been accused of breaking any laws. Neither company answered questions for this article.
Workit Health Inc. was a hot startup treating opioid addiction via telehealth, ranking among the leaders in capital raised. Its clinicians prescribe Suboxone, an aid to controlling cravings. Workit’ssocial-media ads show boxes of the medication.
Addiction experts say that while Suboxone can be crucial for opiate addicts to help hold addiction at bay, so is counselling that helps them develop new habits and gives them other tools to beat the addiction.
Workit advertises support to help with recovery. In some states it has hundreds or thousands of clients but just a handful of counsellors, according to people familiar with the figures. In Florida, it recently had a few thousand clients and no counsellors licensed there, the people said, as its last one departed in September.
Vastly more here:
What I can away from all this was that the treatment probably worked but that the surrounding business models and profit seeking left a fair bit to be desired and lacked clinical focus etc.
I would take the headline with a ‘grain of salt’ and suggest that OZ and the US may have very different experiences of value delivery!
David.
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