Teletherapy apps promise increased access. Could they actually deepen care disparities?
A key piece of teletherapy companies’ value proposition is their ability to increase access. But some experts wonder if these startups will eventually make it harder for individuals to see mental health providers in person.
“It would be ironic, right, that these technologies that have the potential to bring equity to mental health could actually do the opposite,” said Dr. John Torous, director of the digital psychiatry division at Beth Israel Deaconess Medical Center in Boston.
Torous, who also chairs the American Psychiatric Association’s committee on mental health IT, noted that the teletherapy boom has created class divisions in how therapeutic services are accessed. He believes that middle-class, white collar workers generally prefer video visits—which several studies have indicated result in the same, or near equivalent, outcomes as in-person care—since they do not require people to travel and can feel more private. Meanwhile, traditional, in-person therapy could become a service for those with higher-acuity cases, a luxury for those with money or a necessary component for lower-income patients who lack easy access to the internet.
As the field matures, Torous said insurers and their partner companies should ensure that a therapeutic safety net exists for those without access to technology—teletherapy should not be their only option for accessing the care they need, and requiring a visit with a digital provider before approving an in-person visit could increase care costs and lead to more gate-keeping in an industry already known for its barriers.
“Part of the advantage of having software and digital treatments is they can be scalable and accessible, right?” Torous said. “But if they’re going to have very high price points, it kind of begins to question the whole potential of it.”
By connecting individuals with remote clinicians, startups can help bridge gaps for individuals located in areas without nearby providers and have the potential to improve pricing, since the care is delivered without many of the costs associated with a traditional retail footprint, said Adam Block, a health economist and assistant professor at New York Medical College. As different insurers’ initiatives unfold, Block said the market will likely divide based on the demographics of patients served, with those having lower-acuity needs being relegated to telehealth services, and more critical cases being referred to in-person providers.
“Prior to this, you could only go to your local psychiatrists or psychologists,” Block said. “Now you have a choice. If you want somebody who specializes in substance abuse, insomnia issues, you can get that sort of level of specialty.”
The popularity of the service has changed how therapists work, with startups relying on therapists to always be available to respond via text, said Hannah Zeavin, author of the forthcoming book The Distance Cure: A History of Teletherapy. However, she contends that the scaling of these services could end up reducing the effectiveness of care, with the ease of telehealth used as an excuse to increase providers’ caseloads to unsustainable levels and the increasing use of AI eliminating the necessary relationship between client and clinician.
Zeavin believes startups’ “techno-cures” often oversimplify the issue of access, and said that fixing the modern therapy industry would require radically rethinking how mental health professionals are paid and trained, among other things.
“Teletherapy has often been escorted by these democratizing comments, right? That we will all have care and it’s just a question of what kind,” she said. “What we’ve seen instead is that, whoever does or doesn’t have care, those populations often stay exactly the same. Especially if you don’t change anything about access in terms of money and economics, or in terms of numbers of trained professionals. By and large, these apps host all of the problems of contemporary therapy and remediate them at scale.”