For a new generation of patients, could the laptop — or even cellphone — replace the stereotypical shrink’s couch? A crop of new startups wants to take psychotherapy into the 21st century.
About one in five Americans will experience a mental health challenge during their lifetime, according to the Substance Abuse and Mental Health Association. But experts say that 60 percent of them will never seek help. The lack of available care, inconvenience and cost are all barriers to access, but so is the fear of prejudice and discrimination from friends, family and even employers.
“Stigma and shame is a huge factor – maybe the most important one,” said Oren Frank, founder of mental health startup Talktala. “People who have been to regular therapy are less ashamed of it, but people who are newcomers are paralyzed by fear.”
Online options enable people to receive therapy on their own turf and terms, without needing to update others on their whereabouts – and they offer the benefit of anonymity.
For example, a study released last month from Case Western Reserve found that while many new moms suffering from postpartum depression wouldn’t seek help because of the stigma or lack of time, they would go online for support if providers were available and they could communicate anonymously.
It’s still a new and relatively small field — therapists may worry about liability issues or misdiagnoses, patients may harbor concerns about privacy and security online and getting insurance to cover it is a challenge — but it’s gaining support among patients and providers.
Here are four startups leading the way:
Launched last month, TalkSession’s goal isn’t just to provide online therapy; it has big plans to bust the stigmas surrounding it. “There are actually two stigmas — first the stigma against mental illness and then the stigma within the community against technology,” said founder and CEO Melissa Thompson.
Through regular livestreamed online conversations with top experts in the field, policymakers and other medical and mental health leaders, the startup plans to start by tackling sensitive issues in mental health. And it intends to launch a digital magazine to give leading mental health providers a place to share best practices and build an online presence.
Once it has established a strong network of providers, Thompson said, TalkSession plans to launch an OpenTable-like service to help patients find and book online therapy appointments. Already, the site has recruited 100 therapists and patients can complete a quiz that will help match them with their ideal therapist, but receiving the online therapy is still a little ways off.
People readily tell friends (and even strangers) about relationship troubles or problems at work, but once you start dropping clinical terms, they’re often likely to clam up, said Talktala founder Oren Frank. That’s why his site is trying to build online therapy options that meet people where they are, in the language in which they want to speak.
Instead of offering services tagged with terms from the DSM (the Diagnostic and Statistical Manual of Mental Disorders), Talktala invites users to join online chats and forums with friendlier titles like “Relationships are complicated – some advice” and “How to communicate better with your partner?”
In the forums, patients can speak freely and anonymously with others experiencing similar challenges, but a therapist hosts the discussion. During the chat, he can guide conversation in productive directions and if he observes anything significant, he can follow-up with patients individually.
Patients can view any number of online forums and ask a limited number of questions for free, but if they want additional support — from asking unlimited online questions to participating in private and group chats or privately texting with therapists — they can pay up to $30 a month in subscription fees.
Frank said the site isn’t trying to be a solution for people with serious mental health issues and it doesn’t provide services that are reimbursable by insurance. But the service appears to be attracting positive attention — he said it currently has 250 vetted therapists on the site and recently partnered with the Huffington Post’s GPS for the Soul initiative.
iCouch launched as a service for U.S. patients and therapists but in the three years since its launch, co-founder and CEO Brian Dear said it’s actually attracted a strong international following. Not only has it recruited 165 therapists worldwide (from countries including the U.K., China and Australia), 30 to 40 percent of its clients are based outside the U.S.
Through the site, people can search for therapists according to specialty and gender, scan each therapist’s bio and price and then book online appointments. Via computer or iPhone, they can they videoconference with vetted therapists through the site’s HIPAA-compliant system.
The site helps people who want to receive therapy sessions in the privacy of their own homes but, Dear said, it can also be an advantage for people who live in areas where the culture may not be receptive to their particular issue. For example, the service has several clients from the Middle East who speak with their therapists about gender identity issues or homosexuality — topics that may be taboo in their cultures, he said.
“It breaks down the geographic barriers — it allows people to go into another culture that may be more accommodating to their concerns,” he said. It also enables expats to receive care that might be more difficult to receive in their new home countries, Dear added.
(While most therapists are only licensed to practice in a given state, Dear said that it’s not illegal for therapists to conduct inter-state or international sessions.)
One of the earliest startups to bring mental health services online, Breakthrough is only available to residents of California for now, but it plans to expand to Texas and other states soon. Through its site, patients can connect with a network of certified mental health professionals and conduct appointments via chat, email, phone or a custom HIPAA-compliant video system.
But while other services may not prioritize working with the insurance system, Breakthrough — which is backed by angel investors such as former Square COO Keith Rabois, PayPal director and former eHealth exec Avery Kadison, Charles River Ventures and others – aims to make online mental health services more mainstream by working with health insurers. Magellan, one of California’s largest health insurers, for example, last year agreed to extend coverage to Breakthrough.
In addition to showing real-time available appointment slots for therapists (ZocDoc-style), the company shows which doctors are online now and plans to enable on-demand, off-hour services.
Image by bloomua via Shutterstock.