https://www.nytimes.com/2022/09/20/opinion/us-mental-health-...
> "That the status quo is once again benefiting the usual suspects is all too obvious in the booming market of venture-capital-backed mental health tech start-ups that promise to solve the crisis through a gig economy model for psychiatric care — a model that has been criticized for selling psychiatric medication irresponsibly, with little accountability..."
> "And yet when the plan addresses suicide, it focuses on crisis intervention — as if suicide were a kind of unfortunate natural occurrence, like lightning strikes, rather than an expression of the fact that growing numbers of people are becoming convinced that the current state of affairs gives them no reason to hope for a life they’d want to live..."
P.S. Another good read:
https://en.wikipedia.org/wiki/Political_abuse_of_psychiatry_...
Historical societal failures in the Soviet Union have many interesting similarities to current societal failures in the United States.
Because yeah, that's dystopian as hell, not to mention dehumanising.
And I speak from experience after going to therapy for my anxiety. I guess it sort of helped, but also I could very easily imagine a world where the whole problem wouldn't have existed in the first place - it's just not the world that we live in.
We try to profesionalize big parts of heathy communities and families so we don't have to deal with its downsides.
So no, therapy is not part of the problem. Just because in your hypothetical scenario therapy has now been spread across multiple roles instead of a dedicated one, doesn't mean it ceases to exist - you are now expecting your family, friends, mentors, etc. to act as your therapist at will.
Unless you assume people are in therapy just because they get annoyed at how their lover eats breakfast, or whatever superficial aspect that could easily be solved with some chat. I don't know many people paying the cost of therapy for superficial problems like that but hey maybe in your community they do!
You are still giving them pretty private information. If they actually provide a benefit, that might be worth it. But I am not convinced they are actually helpful.
My guess is that exercise, especially outdoor exercise or getting together with friends has far more mental health benefit than these apps and also much less privacy downsides.
Neither meeting friends or using an app are binary events. The more you spend time on one, the less you spend time doing anything else — in the limit including the other. There's considerable evidence to suggest app and/or media usage encroaching on in-person time. It seems plausible that people who can band-aid their feelings in an app may be less inclined to take the leap and talk about personal matters with friends.
But these are complex things - there would need to be a study to know for sure.
People are not actively making a choice, they are passively making the choice to sit on their phones.
Perhaps something that uses CBT, gratitude, and postive reinforcement to help people build good exercise and diet habits?
Is there a way for a company to implement sufficient privacy protocols that would appease the most privacy-concious users?
The trivial way is to just not send data back to the internet. Nothing you listed here is impossible to do client side.
It is the sad state of insurance and mental health coverage in the US that is driving users to these apps that have no/little proven benefit. Then the high cost of education has made it practically impossible to provide low/no cost mental health services.
My wife's internship was at a place where she had 8+ sessions per day, they had a dozen or so unpaid interns still in school (usually second year of masters program) providing mental health services for low-income medicaid patients. And that leads to very quick burn out, and doesn't compensate fairly (or at all, actually) while accruing massive amounts of student debt.
There are federal programs that if you make it 10 years in community mental health paying your student loans at a lower rate, your loans are discharged, but it takes a very special person to survive 40+ hours per week of sessions, taking in and holding other people's mental health, and then add another 10+ hours of notes/insurance/treatment plans.
They are on SSI and Medic[are|aid] (not sure which).
The nice thing about their insurance, is that it covers 100% of their mental health care needs.
I am not aware of any private insurance that even comes close. The most I've seen, is a limited run of social worker appointments. No inpatient, heavy co-pays, etc.
Mental health is not a priority, in the US. We spend a lot more effort and money, ensuring that mentally ill people have access to weapons, than to care.
The mnemonic I heard from Planet Money was "grey hair? Medicare. Underpaid? Medicaid." Although Medicare will also apply to people under 65 with some conditions.
It's the mentality that making as much money as possible is the sole reason we exist. Paying interns nothing because "they're in school, learning" is no different than saying you don't want to pay college athletes because "they're supposed to be in school". Nah, you just want free work from people who you've led to believe that the way to grow in their life is to give you that free work.
Pay your workers, whether they're students or not. Stop working for free.
By some sort of fortunate occurrence, I started talking to them about 3 weeks before the COVID lockdowns. I don't know how I would have survived if not for him.
Sadly, due to how Kaiser treats their mental health staff, they decided to move on (and leave practicing therapy). Since he was moving on, Kaiser booted me out of their services since I wasn't a case that necessitated emergency treatment (they are right, but I still needed to _talk to someone_).
It's led me down a rabbit hole of trying to find various therapists. Most in this area are at capacity (naturally, everyone needs a therapist right now) or won't accept the third party service Kaiser partners through.
I ended up doing Betterhelp for a bit and that was such a mixed experience. Therapists that are overbooked and just grinding (one told me they have 70 clients a week! Uh, what?!) and the support was just so sub-par.
Specifically due to privacy concerns (and I think it's only a matter of time before these services have some sort of data breach), I registered with a throw away email, truncated my name, and generally just tried to provide very little identifying info.
(I guess they have my credit card details. Oh, well)
2. There is no country as far as I'm aware that can meet the demand for mental health services, from the most socialized to the most open market. None. Therapists are always full, most people don't want to be therapists, and the demand for them is super high.
I have no idea how to solve this. A lot of therapists also tend to stop being therapists pretty early in their career or radically reduce how many patients they see. Basically it just sucks to be a therapist no matter how much we pay and we can't make it better.
There’s a rash of “non-health” mental health apps and that’s just scary.
But even under hipaa providers, I expect they are deidentifying under safe harbor and reselling as much as possible. Imagine the training possibilities on all transcripts “scrubbed of pii.”
There are way too many fast and loose players in the mental health space, they do not care to actually have security. They do not have separate roles for security and engineering.
These startups only have to pretend to have security to appease their VCs. In Series B they MAY get a small security audit, but they already lie on their SOC2 or ISO27000... so whats some more lies?
The idea of having a rigorous process that ensures security is completely unacceptable if it adds any time to market.
This is why we see numerous hacks in the health tech space.
You've hit the nail on the head. A key excerpt from Jane.app's privacy policy highlights the potential risks:
"Suppliers and Service Providers. In order to operate our business and provide the Services to our Subscribers and their users, we may need to share a limited amount of personal information, including Patient Data, with our third-party suppliers and service providers." [1]
Currently, I'm attempting to remove my clinical data from Jane.app's servers, but I don't have high hopes for success. Many if not most of these smaller psychology and therapy groups rely on these platforms to store patient data. It is infuriating to me that the moment we disclose the most intimate details of our lives, they become permanent record.
"Removing Data from Jane. Practitioners offering health and medical services are under legal obligation to retain health or medical information that was collected during the course of treatment. It is their responsibility, in collaboration with the Jane Subscriber (clinic owner), to maintain these records, and in many cases, they are simply not allowed, under law, to delete certain records that they created, and they must retain records for a number of years, sometimes 10 years or more." [2]
Your secrets are not safe.
[1] https://jane.app/legal/privacy-policy [2] https://jane.app/guide/privacy-and-security/protecting-patie...
As someone with a chronic medical condition, my experience is that software approved by the FDA are often prohibitively expensive (they are considered medical devices) and not covered by insurance.
Note that not all software only applications in the medical domain are immediately considered medical devices, the line is a pretty fine one. If you plan on putting out an app that has medical implications you should research this properly to avoid running afoul of the regulators (which isn't a very good way to start your relationship).
I always wonder how things like this interact with sponsorship - I hear a lot of podcasts that have Betterhelp ads in them. I wonder whether, if they knew about such issues, that would affect their decision to take the sponsorship and promote them. Even if not in a binary "that's a non-starter" way, does it make people less inclined to take them on, and more open to other sponsors? Or do people not pay attention to their sponsors at all?
TWIT network does appear to try to vet their ads, even criticizing former sponsors for lax security once things come to light. Yet even they still promote Molecule and other pseudo-sci junk.
On the whole I think the best are listener supported shows. But I'm biased as I now work for a company that helps podcasters sell ad-free and premium access.
Disclaimer: I used to work here.
WHO's guide for "unhooking from difficult thoughts and feelings" which is not an app, is free, and has downloadable audio exercise guidance.
https://www.who.int/publications/i/item/9789240003927
It's one of the best things of its type I've seen.
