Mental health is getting a makeover.

A wave of digital behavioral health startups, collectively dubbed “Uber for therapy,” promise to revolutionize a broken industry.

Yet across the globe, anxiety and depression numbers continue to climb — this year, to an all-time high.

Is digital therapy hurting more than helping? Let’s take a look.

Barriers to Health

Patients seeking help must first navigate the labyrinth of American healthcare.

Shrink shortage. There’s a critical shortage of therapists and psychiatrists in the US, with just 30 psychologists per 100,000 people. A staggering 55% of US counties have no psychiatrists at all, and a psychiatric study warns of worsening deficits through 2025.

Matchmaking. Finding an available therapist is just the start. No easy feat, a good fit involves trust and understanding from both parties. For some, it can take several tries to find the right person. Others, who might prefer someone with similar cultural experiences or specialized expertise, must wade through a pool of limited options.

Insurance issues. Cost of care is the largest obstacle of all. An individual receiving treatment for major depression accrues, on average, an annual bill of $10,836. Those who don’t have insurance or who can’t afford the steep out-of-pocket costs simply forgo therapy altogether.

In January 2021, 41% of US adults reported symptoms of anxiety and/or a depressive disorder, but nearly 60% of those did not get treatment.

And in a healthcare Catch-22, the people who need mental health treatment most often can’t afford it. Lower-income individuals, people of color, and younger adults are disproportionately affected by mental health issues yet more likely to lack comprehensive health insurance.

The pandemic further exacerbated such disparities. Beyond the individual impact, experts project that untreated mental illnesses could cost the global economy an estimated $16T by 2030.

Ther-app-y for All

As mental health providers struggle to expand access and meet demand, digital startups hope to bridge the gap:

• Last year, businesses in the digital behavioral health space raised a record $2.4B in funding, up from $915M in 2019.
• Text therapy provider Talkspace went public this June in a $1.4B SPAC deal and recently partnered with the city of Reno to offer residents free mental healthcare.
• Blended care therapy provider Lyra Health is now valued at $4.6B after its latest funding round.

Early-stage upstarts are leveraging tech to cut costs, scale psychiatric expertise, and lure patients away from the archetypal therapist couch.

Text therapy. A low-stakes way for newer patients to test out the waters, text therapy offers tiered access to licensed therapists. Subscription-based platforms like Talkspace and BetterHelp allow patients to send texts, leave voice memos, or schedule video sessions with licensed therapists for an extra fee.

AI thera-bots. Dystopian as it may sound, proponents emphasize that AI is meant to bolster, not replace, human connection. Bot therapists, programmed with psychology fundamentals, provide 24/7 support. The automation certainly helps with pricing — Woebot is free, while a Youper subscription is $7.50/month.

Blended therapy. Perhaps the most promising development in digital mental health, blended therapy combines traditional therapy with text support, self-paced video lessons, and group support sessions. Investors are paying particular attention to the likes of Lyra Health, Two Chairs, and Real.

The Turing Test

General “wellness” products, another category of mental health apps, include mood trackers like MoodKit, stress relief platforms like Sanvello, and guided meditation giants Headspace and Calm.

Here, the line between professional mental health services and woo-woo wellness offerings starts to blur — especially when the apps sit side by side on your home screen.

But psychologists are increasingly wary of digital offerings that claim to address mental issues yet don’t come close to providing the professional treatment mental health patients need.

Hannah Zeavin, author of The Distance Cure: A History of Teletherapy, thinks automated therapy is a “fantasy” that emphasizes accessibility and fun instead of actually helping patients get better.

For some, even video calls or text therapy with licensed psychologists don’t cut it. Linda Michaels, therapist and co-chair of the Psychotherapy Action Network, believes such methods to be impersonal and counterproductive:

“These apps really shortchange the essential ingredient that — mounds of evidence show — is what helps in therapy, which is the therapeutic relationship.”

From slight nuances in speech to subtle changes in body language, nonverbal cues speak volumes that a therapist simply can’t detect over video — much less over a text message.

As a result, many therapists dismiss digital apps altogether, asserting that human-to-human connection is essential to treating the complex, ever-evolving puzzle of an individual’s mental health.

Pseudo-psychiatry

Across time, the mentally ill have endured treatments, from the inhumane to the ineffectual, substantiated by nothing more than pseudoscience.

Before the 18th century, mental health disorders were attributed to demonic possession or divine punishment, and those afflicted were tortured or sent to insane asylums.

In the years following, treatment improved, albeit marginally. Doctors performed lobotomies, bloodletting, and purges to “cleanse” the body of its evils. Others sold miracle “cures” — largely useless tonics and pills pushed by predatory salesmen.

Today, many are drawing worrying parallels between these past treatments and the new therapy remedies on your phone. Studies have shown that the majority of companies in the space are making outsized—and even harmful—claims, without the research to back them up.

Worse, the actions of several text therapy providers have raised concerns that tech founders are prioritizing growth and profits over patient/therapist well-being:

• Therapists on platforms like AbleTo and BetterHelp have called meager compensation structures and heavy client loads “abusive.”
• In an open letter to the American Psychological Association (APA), therapists expressed concern about Talkspace’s unethical business practices, questionable marketing claims, and low-quality services.
• On the consumer side, an overwhelming number of patients report poor experiences — like therapists sending impersonal responses or “ghosting” them all together.

Takeaway: The digital mental health industry is still in its infancy,  and even experts aren’t sure if new entrants are doing more harm than good.

What’s certain — the mental health crisis is worse than ever, and the systems in place to address it are deeply broken. Psychedelic treatments hold promise, but it’ll be a while before anything meaningful materializes on that front.

For now, tech companies taking up the mental health torch must be held accountable for the well-being of their users. Even so, can a patchwork of text, AI, and blended care therapy really step in for a human therapist?

Many remain skeptical. But others, like Hillary Schieve, mayor of Reno and arbiter of the city’s Talkspace initiative, take a better-than-nothing approach:

“If we stop one person from committing suicide because we did this initiative, it was well worth it.”