Online Mental Health Tech Companies: What Every Therapist Should Know Before You Sign the Contract
Miranda started coaching other therapists in private practice back when the idea of typing out your progress notes was SHOCKING and many thought unethical. Fast forward 17 years and the landscape is VERY different. From AI to do your notes to online tech companies offering you an endless supply of clients or billing services, a therapist can find all kinds of online technology tools to support them with all aspects of running their business.
This article is meant to support you in navigating this new landscape as more and more companies come online, vying for your attention and your labor. In this article we will cover what you need to know before you sign up for services.
But first…
Whether you are trying to choose your EHR, have a job opportunity at an online mental health company, or you are outsourcing some of your private practice tasks to mental health tech company there are some things that you MUST know.
Therapists: You. Are. Valuable.
Your expertise is valuable. The way you show up for clients is valuable. Your clinical outcomes are valuable. Your business dollars are valuable. It may not feel like it all the time. Especially since mental health degreees are among the United State’s worst paid master’s degrees. But, it is true.
The work you do is priceless. You change people’s lives, their relationships, and their entire family line. What you do in a session impacts generations to come!
But also, you’ve likely been overworked, underpaid, and made to question whether you really bring any value to the workplace. Also, after years of living on student loans and unpaid practicums, you have likely learned to live on very little, and made it paycheck to paycheck. (Or maybe, like many therapists you’ve made it credit card to credit card and have a considerable amount of debt).
Something is better than nothing. You’ve definitely heard that and felt it. So, how does this impact your relationship with online tech companies? When you don’t value yourself, it is much easier to be taken advantage of by mental health tech companies. But we want to help you stop that from happening.
What is a Mental Health Tech Company?
There are several different kinds of mental health tech companies that we want to reference in this article. The idea behind all of them is to improve access to mental health care for people seeking services, such as online counseling directories and access to care online and/or to improve ease of running various functions in private practice for the clinician, such as billing services.
When we were started coaching many years ago, Electronic Health Record systems and billing software were new on the scene, working to earn the trust of therapists to move from paper records to online, encrypted secure records. Many of these were owned or started by therapists who saw a need in our field and who understood the ethics and laws with their implication for practice.
Then, even prior to the pandemic, we started to see more virtual session software development. But then we started seeing two more types of mental health tech companies emerge.
Mental Health Tech Companies that are Founded By Non-clinicians
There are mental health tech companies founded and often led by non-therapists. Business minded individuals and companies started to see the opportunity in working with therapists. They saw our market and the gaps in support being provided and wanted a share in the industry.
The pro means more diversity in options and types of services and tools. The con means, with the primary leadership coming from the business world, leadership has very little knowledge of the clinical impact of the tech services they are offering or the risks involved in the therapeutic relationship or to the customer, whether that be the client or the therapist. So to mitigate this, companies often bring in therapists to their board or other management roles in the hopes to close the gaps of knowledge.
Many of these companies have already been in existence and have pivoted their product or service to expand into our field.
Mental Health Tech Companies that are Backed by Venture Capitalists
Even bigger, and little known to most therapists, there are mental health tech companies funded by venture capitalists (VC) growing rapidly. Most are new on the scene of mental health and have had otehr companies in other spaces.
A group of investors see the ability for high growth potential, so they invest cash in exchange for owning a piece of the business. Accepting money from VC means by default that there are now owners/leaders that are NOT from the mental health space who expect significant profits from their investment. The name of this game is often to show profitability quickly to get further investments down the road or to sale to a larger corporation, meaning a nice cash grab for the investors.
Note* Any company that you are interested in partnering with only takes a simple google search to find out their funding. You are going to find millions of dollars poured into these companies.
But what does VC involvement in our field tell us?
Our labor is powerful. Our spending dollars are powerful. Many of these companies cannot survive without our labor.
But, why care about mental health companies and how they were created?
Doesn’t every mental health company need to make profit?
Absolutely! The truth is, every mental health organization needs to have a balanced budget, even non-profits. People need to be paid, supplies purchased, and we need to put money into savings for lean times, vacation, sick time, training, etc.
The issue is not with profits. The issue is with how those profits are made, what is sacrificed in the name of profits, and who the profits go to.
BetterHelp: An Example Mental Health Company Gone Wrong
Betterhelp is out there trying to make mental health accessible and creating more job opportunities for therapists. They helped to normalize online therapy during a global pandemic. In the second quarter of 2023 alone they invested 29.6 million dollars in podcast advertising making them the #1 podcast advertiser for that time period according to Radio and Internet News. How could any of this go wrong?
More visibility for mental health sounds amazing, right? Maybe not… Let’s take a little excerpt from the Federal Trade Commission (FTC) who fined BetterHelp $7.8 million dollars in 2023. “BetterHelp betrayed consumers’ most personal health information for profit… BetterHelp also misled users and the public in 2020 by falsely denying news reports that it revealed consumers’ personal information, including their health information, with third parties, according to the complaint.” We highly recommend you read up on the full articles and complaint here.
Oof… And you know the worst part? The only reason they could do any of this is because educated, licensed professionals allowed their expertise to be advertised by this organization. An organization that according to the FTC betrayed consumers.
The truth is, the advertising practices Betterhelp employed are perfectly appropriate outside of the medical and mental health spaces. They may or may not have initially understood the ethical issues they were stepping into… but isn’t that the issue? When you have business people not properly learning about the work that we do, or caring to do so they end up creating businesses that they have no business running.
But It Goes Beyond Mental Health Tech Employers
Can you imagine logging on your electronic health record and getting a notice that everything you or your clients put in their system including audio, video, and written data could be used for marketing purposes? And, that if you didn’t agree to these changes you’d be locked out of the system within 14 days? That is what happened for a group of consumers using an electronic health record recently.
Now, there were caveats within about not using anything identifiable, but when pressed for clarification about what was considered identifiable information, they sent messages that did not align with HIPAA regulations. To see the entire situation, and also watch a free panel discussion with a privacy expert, a mental health ethics attorney, and a private practice expert, click here.
Let us just say, it had thousands of therapists in panic mode trying to understand the changes to the terms of service, trying to get appointments with attorneys to read them ASAP, and trying to navigate what to do if or when they did decide that the organization and their values and ethics no longer aligned with the needs of their private practice.
The terms of service in question were totally normal for a non-mental health tech company. The company was actually developed by a therapist for therapists and had been well respected for over a decade. But, a few years ago, the therapist founder sold to a larger organization. But, as commonly happens within a few years, the founder stepped down and the new guard took over and the trust built up throughout a decade was shattered in less than a year.
Ways Other Mental Health Companies Are Impacting the Profession
Therapists are being turned away when they try to individually credential with insurance companies. They are being sent to mental health tech companies that take an additional cut of reimbursement rates, which in many areas of the country are already unlivable.
Therapists are being given calculators regarding potential earnings that are absolutely not accurate. The calculators also leave out the additional expense of self-employment taxes as many of these positions are 1099. The companies are hiring people that are clearly not companies and that do not meet the qualifications according to the IRS guidelines for contractor vs employee hiring.
Therapists are paneling with mental health tech companies being promised that the collective bargaining allows for higher reimbursement rates. However, they find the reimbursement rates are the same or lower AND then there are expenses to take out of that.
There is little to no focus on clinical outcomes in most if not all of these organizations. Many of the employers expect therapists to see 40+ clients per week every week. They have clearly NEVER done clinical work a day in their life if they think that this leads to good clinical outcomes.
Therapists are signing contracts that are vague and very hard to discern the impact on the clinical work that they will be doing or the impact on their clients, especially when it comes to privacy.
How Do Therapists Know Who to Trust?
When we talk about this with therapists, often it leads to fight, flight, freeze, or faun. Take a moment to check in with yourself. What is your first response? Breath into it. Let’s ensure you are present here and not going into a response based out of fear. Let’s talk about what you should be looking for before engaging with any mental health tech companies whether they are a potential employer, someone you might contract with, or a service/software you might pay for.
Letting individual clients opt-in or opt-out of data sharing
No data sharing at all
Therapist(s) on the leadership team
Pubilc payscales that have a livable wage
Hiring therapists as employees versus contractors (in most cases the therapists are NOT contractors)
Clear language in terms of services that shows what supersedes the terms- as allowed by law
Sharing the minimum amount of data to deliver services
Not taking your intellectual property for profit
Being clear about how they will use the data and with whom
Examples of cool uses: documentation, tracking you and your clinicians' outcomes, billing reporting, etc.
What might you add to this list? We’d love to hear from you. We are having these conversations often over on Instagram here.
Therapists: You Are More Powerful Than You Realize
But, what happens when you notice something that is NOT right?
Express yourself
Let your dollars do the talking
Look for therapist-led services
File a report with the FTC Any publicly traded company is overseen by the FTC. As we saw with Betterhelp, this is one way companies can be held accountable.
What about filing a HIPAA violation with the Health and Human Services agency?
What about filing a labor board violation with your local state?
The reason that these tech companies are viable is because we agree to work with them. Many companies and associations can't even post this kind of material because of their affiliation with online tech companies and the profits they recieve. If we demanded better from them as a collective, they would need to respond, or go find a different profession to work with.
Next Steps for Therapists in Private Practice
It is exciting how technology can help us run our private practices, but no matter what technology we deploy, we still want to be empowered as private practice owners and to make decisions from a place of understanding what is best for us and our clients.
You cannot afford to hand over the keys of your business to a mental health tech company. You are too precious and so is the work that you do. These companies work at scale. The rely on mass quantities of service providers or clients. Your knowledge of how to run the business is key to your success. Once you understand what you need, then you can determine if there is technology to support you. Don’t assume that the technology offered is right for you. You have the ultimate say.
So your next step is to learn the ins and outs of running your private practice.Once you know your processes and how to operate the practice, you can then determine what technology can assist with automation and easing the workload.
Finally, research the technology companies, read the contracts, google and search for any complaints from clients or therapists and make sure you fully understand what you are signing. From our experience, if it sounds too good to be true, it likely is. No amount of technology can absolve you of running your business responsibly.
Need help in becoming the best business owner and leader you can be? Check out our training on How to Build and Grow a Sustainable and Profitable Private Practice
