• last year
The gig economy has disrupted everything from transport and hotels to the creative arts. But what happens when it comes for an industry centred on the needs of vulnerable people: mental health?
Transcript
00:00This is a story about people, people who need help.
00:03It's also a story about supply and demand.
00:06Too many people, not enough help.
00:08And it's about what happens when tech companies fill the void.
00:13I was having like five or six panic attacks a day.
00:16I started feeling really overwhelmed by that.
00:21I started trying to call normal therapists.
00:24That wasn't working, I couldn't find anyone, nobody had time.
00:28I was living my dream, but it became such a nightmare that I was dissociating.
00:32And that was when it was like, OK, I need to talk to someone.
00:36Like I need an expert on whatever is happening in my brain.
00:39The mental health crisis meets the gig economy.
00:43Coming up on this edition of Business Beyond.
00:47We just heard from Joe and Diego.
00:49We're not showing their faces or using their real names,
00:52but the stories they're telling are incredibly common.
00:56According to the Global Burden of Disease Study,
00:58there are a billion people living with a mental health disorder right now.
01:03One in eight of us.
01:05Most people don't receive effective care,
01:08even in rich countries with good social safety nets.
01:11Joe's an American living in Berlin.
01:14After getting nowhere in his search for a therapist,
01:16one night his mental health seriously deteriorated.
01:20I was scared about how the night was going to end.
01:25The crisis lines, even though they claim they're 24 hours,
01:28there's one for each individual district in Berlin.
01:32And they're not all manned 24 hours.
01:34And they don't say that anywhere on the website.
01:37So I spent about two hours dialing every single line in Berlin,
01:41just letting it ring for multiple times until I eventually figured out
01:45that it was the Kreuzberg line that was that was manned 24 hours a day
01:50and got through to somebody there.
01:52It was insanely unhelpful.
01:54The day after his experience with the crisis hotline,
01:57Joe went to see his regular doctor, who recognized he was in danger
02:01and fast-tracked him into the mental health care system.
02:04When I finally got in to see her,
02:06she basically just looked at me and was like,
02:12yeah, OK, antidepressants for two years.
02:15I want you to go to a geschlossene Handstein,
02:21so like a closed institution where you can't leave for two weeks.
02:27And that's it.
02:29And I'm like, Jesus, you've talked to me for three minutes.
02:33Like, that's a radical step.
02:36And she's like, yeah, but this is what I recommend.
02:38I'm like, OK, well, I need more information.
02:40What are these drugs?
02:42Why do you want me to go away for two weeks?
02:44And I'll just I won't forget it.
02:47She literally looked at me and said,
02:49my waiting room is completely full right now.
02:51I don't have time to go into detail with you about any of this.
02:56The problem in Germany isn't that there aren't enough therapists.
02:59It's that there are strict controls on how many of them can be licensed
03:03to accept public insurance, which most people have.
03:06Limiting supply keeps costs down for the insurers.
03:10Chronic underfunding is a global problem.
03:13Worldwide, only 2% of health budgets go into mental health care.
03:18And according to the World Health Organization,
03:20around two thirds of that spending goes into an outdated model of care,
03:24psychiatric hospitals.
03:28The medical journal Lancet Psychiatry says major economic trends
03:32like precarious jobs, reduced prospects of home ownership
03:35and unaffordable rent are contributing to youth mental health
03:39entering a dangerous phase.
03:42Other factors are social media use, conflicts and the climate crisis.
03:48Rachel lives in Ireland, which, according to a recent survey,
03:51is the hardest place within the EU to access mental health care.
03:55I had heard anecdotally that, you know,
03:58waiting times were huge, impossible to get appointments and so on.
04:01So I think I would have maybe done a cursory check of that and gone,
04:04oh, God, that seems like the last thing that I have the headspace for
04:08at the moment.
04:09Both Joe and Rachel ended up on an online therapy platform
04:13called BetterHelp.
04:14Now, if your algorithmic gods are anything like mine,
04:17you've probably seen their ads in your social media feeds.
04:20They're kind of everywhere.
04:22I have been in therapy since I was six years old.
04:25My parents said we want her to be emotionally intelligent.
04:27And that I am. I never stopped going to therapy.
04:29Platforms like BetterHelp make getting started so easy.
04:31And you can change therapists as many times as you want,
04:33literally by just clicking a few buttons.
04:35So here's the reminder.
04:36This time, choose yourself.
04:42BetterHelp is just one of a host of online therapy brands
04:46that have popped up over the past few years.
04:49Many of them grew rapidly during the pandemic,
04:52when telehealth took off.
04:54BetterHelp was founded in 2013,
04:56and it's now owned by Teladoc Health, a publicly traded company.
05:00It's a subscription model with users billed between
05:03$260 and $400 monthly.
05:07They can chat with their therapists on video calls or via text.
05:11BetterHelp's active user numbers fluctuate,
05:14but since its founding,
05:16close to 5 million people have used the service.
05:19The company employs around 35,000 therapists,
05:23mainly in the US and UK,
05:25but has also recently been recruiting in Australia.
05:28Last year, it made over a billion dollars in revenue.
05:32I feel like I maybe would have first heard about it
05:34through like podcast and YouTube advertising.
05:38You know, they sponsor an awful lot of videos
05:40and a lot of podcasts and stuff like that.
05:42They sure do.
05:43According to Miguel and AI,
05:44in July of this year,
05:45BetterHelp spent more than any other brand
05:48on podcast sponsorships,
05:50hitting well over $7 million in July alone.
05:53Their monthly YouTube ad spend is in the millions too.
05:57When you sign up,
05:58you have to fill out a health questionnaire,
06:00and we're gonna talk more about that later.
06:03Now, after being masked with a therapist,
06:05Rachel wrote to her describing her issues.
06:08Three days later,
06:09she received a pretty impersonal and stock-sounding response.
06:13Something along the lines of the stereotypical sort of,
06:16oh, interesting, how does that make you feel?
06:18It just sort of immediately gave me a bit of a bad feel,
06:20and I just thought this person isn't actually really engaging
06:23with any of what I talked about.
06:26She eventually switched therapist
06:27and tried to arrange a video call,
06:29but the therapist didn't show up.
06:32After that, Rachel left the platform.
06:34It felt like there was nobody in BetterHelp that cared
06:38because it was just matching me up with these randomers.
06:40There was no central person or team.
06:42Nobody reached out to me after the failed voice calls
06:46or anything like that.
06:48The internet is full of stories
06:50about people who've had bad experiences with BetterHelp,
06:53from a young woman with an eating disorder
06:55whose therapist dangerously missed the mark.
06:58What she said to me there was,
07:00oh, good for you, congratulations on all that weight loss.
07:04Deleted the chat, deleted the app,
07:05and never advocated for myself again.
07:08To a guy whose therapist seemed, well, distracted.
07:12She would go off of camera sometimes and do other stuff.
07:16So I do another one, same thing.
07:17She's going off of camera.
07:19This time she's in Austria on vacation.
07:21We know clients are far more likely
07:23to share bad experiences than good,
07:25and we will actually hear
07:27a positive BetterHelp experience later.
07:30But first we need to figure out
07:31what's happening on the other side.
07:33Becky, not her real name,
07:35worked at BetterHelp for five years.
07:37I call BetterHelp the Uber of mental health
07:41because people have this expectation
07:44that they're gonna sign up
07:45and then automatically be able to see a therapist,
07:48but that's not how it works.
07:50BetterHelp is a classic gig economy model.
07:53Therapists can work flexibly online
07:56as much or as little as they want.
08:00It was a lot during COVID, which is to be expected.
08:04So I was doing that plus working full time.
08:07They do have an incentive program
08:09where like the more clients you see,
08:10the higher your pay rate will be,
08:11which to me is super unethical.
08:13They have like a messaging system.
08:15So they did expect you to constantly message people,
08:17which is very annoying and stressful.
08:19And you got paid for a certain amount of word count.
08:22Carly Dober is the director
08:23of the Australian Association of Psychologists.
08:26She's got serious misgivings
08:28about BetterHelp's recent expansion into Australia.
08:32The work of the staff is not accurately valued.
08:36And also their privacy and confidentiality concerns
08:39about patient data and information
08:42is very, very concerning.
08:46Remember that health questionnaire
08:48Rachel and Joe filled out when they signed up?
08:50It includes questions about your sexuality,
08:53relationship status, religion,
08:55physical health, and financial status.
08:59Last year, the Federal Trade Commission
09:00accused BetterHelp of sharing those health questionnaires
09:03along with clients' email and IP addresses
09:06with companies including Facebook and Snapchat.
09:09The company was fined $7.8 million.
09:14Competitor Cerebral got a similar fine this year.
09:19As well as privacy concerns,
09:20there's also the question of liability.
09:23Both Rachel and Joe live in Europe,
09:25but were initially matched with therapists in the US.
09:28In Germany, for example, if this were offline,
09:30those providers wouldn't be able to practice
09:32outside of their country
09:34without going through a lengthy process
09:35of having their qualifications recognized.
09:39BetterHelp says it only hires
09:41registered or licensed counsellors,
09:43psychologists, social workers, and therapists.
09:47But depending on what jurisdiction you're in,
09:49take Australia, for example,
09:51what those terms mean can vary.
09:55Therapist is absolutely not a protected title.
09:57Anyone can call themselves a therapist or a counsellor,
10:01irrespective if they're actually engaging
10:03in any kind of formal education or training about that.
10:06So if there are so many pitfalls,
10:08how come the business model hasn't collapsed?
10:11Well, the thing is, sometimes it does work out for people.
10:14Here's Joe talking about the second
10:16BetterHelp therapist he was matched with.
10:18I made sure that that was the main thing he was doing.
10:20It wasn't like he was a waiter on the side.
10:21Like that was his main focus.
10:23And I really saw a massive change in quality based on that
10:28because he was like absolutely great.
10:30He was exactly what I wish I would have gotten
10:33two years previously.
10:34I reached out to BetterHelp for clarification
10:36on a number of issues raised in this video,
10:39from working hours to data sharing and license checking,
10:43but I received no response.
10:46Joe and Rachel both paid out of pocket
10:48for their online therapy,
10:49but actually the trend is moving away from that.
10:53Steve Duke works as an advisor to mental health companies.
10:56He says online therapy platforms are seeking out new payers.
11:00More and more, especially the bigger ones,
11:02it's not the consumer who's actually paying.
11:04It's very often either insurers or employers or schools.
11:10This applies to Diego.
11:11Remember, we heard from him right at the beginning.
11:14In 2023, he was going through
11:16a crazily stressful period professionally.
11:19It was like going to work every day.
11:20Like if it was a video game,
11:22it was like a very third person feeling.
11:23And that moment was when there was like,
11:26okay, I think I'm losing my mind.
11:27Like at this point, I think I'm going nuts, like completely.
11:31One of the perks of Diego's company
11:33was access to a platform called OpenUp.
11:36Through it, he started seeing a professional.
11:38All of a sudden I was like,
11:39hey, it's okay to feel bad for a while.
11:41Right, okay, I have these anxieties coming
11:43because whatever is happening tomorrow at work,
11:47but now I know what it is
11:49and I can just sit and think through it.
11:52As rates of mental health issues increase,
11:55employers are increasingly offering workers
11:57access to online therapy platforms.
11:59If you go onto any of these companies' sites,
12:02you go to their like for business section,
12:04all of this data around how they reduce
12:08absenteeism from employees,
12:09how they increase worker productivity
12:11by providing mental health.
12:12So like, that's the pitch.
12:14But is outsourcing your mental health
12:15to your employer really the answer?
12:18At the beginning of this video,
12:19we looked at some of the economic factors
12:21that are contributing to poor mental health.
12:23And we looked at why young people are struggling
12:26to attain the stability their parents had.
12:29People are working.
12:30Workers' rights have been decimated
12:33in many countries and many fields.
12:36For many people,
12:38going to university is either inaccessible
12:41or it doesn't really mean the same
12:43or lead to the same opportunities
12:44that they might have 10 or 20 years ago.
12:47In a world of mass layoffs
12:49and increasingly precarious working conditions,
12:51relying on your employer for mental health support
12:54can seem a little off.
12:56I put that to Steve Duke.
12:58I think like, first of all,
13:00we can probably separate those two things, right?
13:02So it's like,
13:06of course, something like laying off people
13:08is like a risk factor for somebody's mental health.
13:11But at the same time,
13:12does that mean that they shouldn't also provide
13:15mental health services to their employees?
13:16Like, of course not, right?
13:17Like both of those things can be true.
13:20It can be true that it's bad to lay people off
13:21and it can also be true that it's good
13:22to offer them mental health services.
13:25But even a good job with benefits
13:27is no longer a guarantee of economic stability.
13:30In Ireland, where Rachel lives,
13:32the housing crisis means young people
13:34are spending years of their life
13:35in uncertain living arrangements.
13:38I think there is a kind of a trauma in our generation
13:41to do with the fact that we have that instability.
13:44I think particularly in Ireland,
13:46there's a borderline obsession with property.
13:48You haven't made it in life like until you own a house.
13:51That's very much the mentality
13:52that a lot of our generation are in,
13:54is that it's kind of hopeless.
13:56I do think that contributes an awful lot
13:58to mental health problems.
14:00Another issue affecting younger generations
14:03more than their parents,
14:04the ubiquity of smartphones.
14:06Diego was literally holding his phone up like this
14:09when he spoke the next few words.
14:11I think that eventually this will be banned,
14:13at least for minors.
14:15I think this is cancer, this is horrible.
14:16This is like we are giving cigarettes to everyone.
14:20That's my feeling about it.
14:21It's like, I hate it.
14:22I'm a technologist, I'm a computer scientist.
14:24I hate this.
14:25There are reasons to be cynical
14:27about the idea of tech companies involved in mental health.
14:30But given the scale of the problem,
14:32some say we can't afford to ignore them.
14:35I think private companies where we've seen
14:37in mental health, in healthcare,
14:39in almost every other industry,
14:41they're exceptional at innovation
14:43and they're much better than public health systems.
14:45If you take a step back and look at mental health,
14:47we need significant innovation.
14:49So how can online therapy platforms
14:51like BetterHelp improve?
14:53They need to sort out their compensation
14:54and their incentives.
14:56I think there's like some really basic stuff
14:57that they can do.
14:59Like a lot of the therapists aren't offered any equity
15:03or any of the share option schemes
15:06in some of these companies.
15:06I really don't understand like why that is.
15:09Because then when these companies come out
15:11and they get billion dollar valuations,
15:13therapists would be a lot happier if they had equity.
15:16So definitely screening people,
15:19having probably a better platform to use
15:22and less about messaging
15:24and more about actually providing good care,
15:27not stealing people's cookies,
15:30you know, or private information.
15:32Reporting this story has opened my eyes
15:35to just how inaccessible mental health care can be.
15:38But it's also made me realize
15:40that without addressing our economic system
15:42as a risk factor, demand for services will only grow.
15:48I'd love to hear your thoughts on this.
15:49What's mental health care like where you are?
15:52And do you agree that economic factors
15:54are making the problem worse?
15:56Let us know.
15:57Thanks so much for watching and see you again soon.

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