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?
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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.