The business of teletherapy platforms

An increased demand for private practice therapists has caused many people to turn to telehealth platforms, but increased reliance on these virtual therapy companies creates uncertainty for the future.

Mental health platforms such as BetterHelp and Talkspace are very different from a private practice therapist, benefiting from billions of dollars in investments and marketing. According to financial data firm PitchBook, investments in mental health startups and apps topped $1 billion in 2020 and are set to grow. 

Dependence on these virtual services is becoming the norm, and advertising and data sharing are surefire moneymakers for these large companies. As monetary gain meets mental health, users may be negatively affected. 

“At the end of the day, these therapy companies are companies first and they happen to host therapeutic activity second,” said Hannah Zeavin, author of the 2021 book “The Distance Cure: A History of Teletherapy.”

Mental health platforms have widespread marketing campaigns across social media platforms like Twitter and Instagram. These apps are easy to promote — a mere download link to an app store is much faster than finding and calling a private practice. According to advertising intelligence website MediaRadar, BetterHelp spent $100 million in digital, print and national television advertising in the past year. 

BetterHelp, the leading telehealth platform on the Apple App Store, is known to partner with social media personalities, such as YouTuber Shane Dawson, for discounts and affiliate links which reportedly generate profit every time a fan subscribes to the service. 

BetterHelp competitor Talkspace recently partnered with Olympic athlete Michael Phelps for a series of television commercials. According to David Luxton, co-author of the 2016 book “A Practitioner’s Guide to Telemental Health,” this marketing allows therapists to benefit from the publicity and name recognition of well-known services. 

“They’re positive for the clinicians because they have some infrastructure around their practice by joining these organizations and providing services, you know, they can take advantage of the marketing that comes with it,” said Luxton, who is also an associate professor at the University of Washington School of Medicine in Seattle.

While platforms using large-scale advertising to promote therapy is an effective business strategy, some users find that it depersonalizes their mental wellness experience. 

“Obviously, therapists need to make money, but BetterHelp as a platform sometimes advertises in a way where it’s like, ‘Oh, like that feels kind of rude,’” Prifti said.

After the Nov. 8 Astroworld tragedy in Houston, a music festival where 10 people were killed and hundreds were injured, rapper Travis Scott pledged to provide Astroworld attendees one month of free membership through BetterHelp. This was advertised in a press release on both Scott’s and BetterHelp’s social media accounts. 

“With over 20,000 therapists nationwide, we are uniquely qualified to meet the needs of large numbers of people when tragedies like this occur,” BetterHelp said in a statement on their FAQ webpage.  

Backlash to this partnership was rampant online, as users questioned whether Scott or BetterHelp were making money off of this collaboration (BetterHelp responded on their FAQ page with a mere “No.”). Zeavin noted that as telehealth platforms are growing in popularity, she is seeing more of their users create discourse around them. 

“This kind of criticism arose of using tragedy as a way of doing marketing. I think that there’s been much more attention on teletherapy, so there is more pushback. I think people are more at their limit and more aware of the kind of insidious ways that these companies operate,” Zeavin said.

Brown said that she considered terminating her membership as a response to the Astroworld marketing, as well as the allegations that BetterHelp does not properly compensate their therapists. 

“I was like, ‘Well, I don’t want to be using something that kind of has those effects,’” Brown said.

Another concern of telehealth platform users is data sharing — a 2021 Consumer Report showed that mental health apps do not always fall under the Health Insurance Portability and Accountability Act, or HIPAA, a federal law that protects data collected by healthcare providers. The report also showed that mental health apps such as BetterHelp, Talkspace and Wysa admitted to selling “limited information” about their users to Facebook for targeted advertising.

Luxton, who teaches about data security at the University of Washington, said that while many mental health platforms are cognizant of what constitutes private information, users should remain vigilant about what they choose to share as these platforms become more widely used.

“My concern about using mobile apps is to make sure that your information is not being sold to some other company,” Luxton said. “With anything that you’re putting information on the internet and filling out any forms, you want to read the small print, to make sure your information is really secure, whether or not they’re following federal laws, such as HIPAA.”

When asked about user security via email, a representative from BetterHelp referred to its privacy policy, which states that it does not collect or store information from therapy sessions without user consent.

“Due to the use of cookies and web beacons, information regarding your activity on our websites, excluding activity when you are logged in and have started therapy, may be disclosed to our advertising partners to optimize marketing,” the privacy policy reads. 

While concerns about marketing and data security are raised, mental health platforms are continuing to gain prominence. The value of the mental health app market is poised to grow rapidly by 2027, which will undoubtedly attract more users and therapists to log on. Looking forward, the future of mental health may be the smartphone in your pocket.

“Apps like Talkspace and BetterHelp were built as alternatives because they were teletherapy,” Zeavin said. “But right now, all therapy is teletherapy. All teletherapy is understood to be kind of the basic form, it is no longer in the shadow.”