Latest / The Mental Health Evolution / Ep 2: Real Change

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Ep 2: Real Change · The Mental Health Evolution

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(Transcribed by TurboScribe. Go Unlimited to remove this message.) This podcast is part of the Frederick Podcast Network.
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Learn more at listenfrederick.com.
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Welcome to Mental Health Evolution, a podcast about what's changing in mental
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health and why it matters.
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I'm your host, Rachel Harrison, inviting you into honest conversations with
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people from all perspectives in the field, clinicians, tech founders,
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investors, insurance companies, and all the folks in between.
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Let's explore what's working, what's not, and what's next.
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Welcome back to the Mental Health Evolution podcast where we are talking
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about the landscape and how it is quickly evolving in the mental
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health industry.
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Today we are taking a look at an example of a local
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group effort to begin to address these changes at a community level.
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For some background, this group is personal to me.
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This is a small group of local leaders in mental health that
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I reached out to and we started with a mental health awareness
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campaign in 2024.
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This year, when we came together to talk about what to do
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for mental health awareness in May, it seemed important to talk about
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the changes happening in our industry and address them in a way
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that raised awareness and supported the local community.
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So to give you all the sliver of what we looked at
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and kind of take you back to where we started our conversation,
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we looked at some specific articles and I'm just going to highlight
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those here so that you have a sense of where we were
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coming from in this conversation and you can kind of get a
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feel of how this moved forward for us.
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So the first one was called Mental Health Care Innovation, Startups Shaping
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the Future of Mental Health Care Insights and Trends.
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And in this article, it really showed how a lot of startups
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are changing the game and changing the approach of mental health care,
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especially tech companies.
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The next article was called University Health Group, University of Minnesota
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partner to launch a course on value-based care.
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In this article, it really talked about what value-based care looks
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like.
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If you're not familiar with the term value-based care, it is
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essentially a way that insurance companies are evaluating treatment and
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treatment providers in order to reduce their costs and hopefully increase the
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efficacy of care.
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The next article was Federal Judge Says Class Privacy Claims May Proceed
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Against an Online Mental Health Platform.
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This was an article looking specifically at how Hedway shared their mental
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health information with Google.
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And it highlights some of the risks and different ethics that tech
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companies have when it comes to mental health and sharing information versus
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maybe what a local provider would have.
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Next article, number four, was companies like CVS and UnitedHealthcare are now
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some of the world's biggest businesses.
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Is this healthy for the rest of us?
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So one of the trends we see is that in the mental
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health industry, there are big companies that are taking on mental health
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and providing clinics and merging with other big companies and just looking
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at what is the impact of these things.
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So looking at the last one was many articles, actually, from the
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behavioral health business, looking at how companies are acquiring market share
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in mental health and why they're doing that.
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We will put all of these in the show notes for you,
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but I just wanted to give you an overall picture of what
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we started with reading through these articles.
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And that began a series of conversations for us as a group.
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I'm going to let you hear about some of that conversation and
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some of the things that we've been doing.
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But there is a lot of news out there and even more
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since we started this process.
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So I want you to listen to what we did.
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We actually to kind of take you through, we met, we talked,
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we created a video actually, and we had a lovely local group
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that volunteered to create this video for us called Real Therapy, Real
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Change.
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We'll put it in the show notes for you.
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In this video, we tried to be educational toward consumers who would
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be looking to find mental health services to just give some information
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about what different services offer.
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And we asked everyone in our community businesses to roll this out
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for the month of May, to put this on their websites, to
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put this on social media.
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We had a launch party.
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We had an overwhelming local response.
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But now we've created a group ongoing to continue this message, and
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we call it the Real Change Initiative.
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So I want to introduce you to the group members who are
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all in the studio with me.
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We have Melissa Ward from Melissa Ward Counseling.
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Welcome, Melissa.
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Hi, Rachel.
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And we have Aaron Vandermeer from Clearview Communities.
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Pleasure to be here.
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And we have Allison Bamba from Allison Bamba Psychologist.
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And of course, myself from Trauma Specialists of Maryland.
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So I want to give you a picture of kind of how
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this group thinks about this process, what we've learned along the way.
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So I'd love to just throw some questions out and let's just
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talk how we talk.
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I'd love to hear from all of you how these changes in
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the industry resonated with you and why you wanted to become a
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part of this project.
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I think when I started seeing how fast mental health care was
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shifting towards apps and tech driven solutions, I felt that we were
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losing something really important in the industry, that human connection and
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trained expertise that make real therapy so powerful.
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And coming into contact in my practice with folks that have sought
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mental health guidance or care from these apps or platforms and had
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just what I would consider to be nearly catastrophic outcomes, it became
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really important that we educate people about the limitations of these kind
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of ways of going about therapy.
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I've also been really uncomfortable with the way that care is being
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delivered by these big tech companies and AI.
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And I just care so deeply about protecting and preserving what real
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mental health therapy is, which involves that real connection, that human
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connection, safety and trust relationship.
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Yeah, I think that's the big word that I keep coming back
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to as part of this whole conversation is relationship.
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I think that is at the heart and soul of therapy.
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It's that it's that relationship between us as the licensed practitioner and
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our clients, those people that we serve.
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I don't want to lose that with tech.
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And I think that that is something that I see coming, which
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makes me really concerned.
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And because this is a new kind of approach to kind of
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therapy-ish, there's also no data around efficacy and there's no data
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around risk.
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So I think that's something that occurred to me when I was
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working with people who had been what I consider to be harmed
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by these platforms.
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And when I hear you say that, I'm thinking about how in
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our field we do make a concerted effort for looking at data
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and looking at research and figuring out what it is that's working
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and trying to use those techniques and those pieces.
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So that data piece is going to be very critical going forward.
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What do you think is important for people who are looking for
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mental health care for their family members, friends, for themselves?
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What are the most important things to know about tech options and
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about what maybe a typically trained therapist in a community would have
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to offer?
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I think that consumers need to know that not all therapy platforms
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are created equal.
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I think they need to ask questions like, who's running this company?
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Are these real licensed therapists?
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What's happening to my personal information?
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Those are really important questions to ask.
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And I don't know that the general public knows to ask them
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all the time.
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Yeah, I wholeheartedly agree.
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I don't think all tech options can be helpful tools, but they're
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not all created equal.
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So it's important to stay informed.
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Are we working with a licensed therapist?
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Is it a chatbot?
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Is it someone providing therapeutic support, but they're not actually a
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licensed trained provider?
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So I think transparency is something that consumers should demand from the
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companies in which they're working with.
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Especially because there's been stated incidents where Hedway, for example, has
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actually sold private information.
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That has happened.
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So the precedent's been set.
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And none of us really read those kind of documents when we
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sign, you know, privacy policies.
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So I think really drilling down on what you're signing to make
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sure that you're protected.
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And as someone, I'm sure you are the same, like HIPAA has
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been part of what we have had to really learn to do
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and protect private health of personal health information.
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PHI is what we kind of call it in the field.
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And all of that training that I've had for years and years
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and years and years, it's a little bit shocking because I always
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thought I can just skim that document or not even read it
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at my doctor's office because it pretty much says what I've already
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been trained in and I know and people have to protect that
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and follow rules.
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So it does feel shocking from from our angle to be like
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how these companies actually selling either the specific information or putting
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the data together and selling the data.
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And both of those things, I think, are pretty prominent in the
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tech industry.
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Yeah.
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In therapy practices and even like family practitioners are doing those kind
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of things.
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I know asking to record sessions and then my question is always
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what do we do with that recording?
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What happens to that?
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Right.
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And especially in therapy, when we're asking people at some points to
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really get into some hard moments in their life, to share their
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trauma, their fears, anxieties, those those things that haunt them is a
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really difficult things to talk to someone about.
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And then if there's a recording of that, what happens to that
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information?
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I think all of our platforms that we use for our therapy
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offices, like simple practice and therapy notes now offer a recording feature.
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And I'll be honest with you guys, I would never ask someone
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to be recorded only because I feel like it creates like almost
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like an artificial barrier in the room knowing that this is, you
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know, memorialized, you know, and people frankly, you know, especially people
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that don't respect PHI can get sloppy.
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So I wouldn't want my client to wonder what happens.
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It's really appalling that companies like Headway and BetterHelp and, you know,
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these other big tech companies are violating PHI, violating HIPAA, yet we
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see commercials on TV for them all the time, advertising their services.
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Podcasts.
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I feel like every podcast I listen to, I hear a commercial
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for them.
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And I guess going off what Erin and Melissa were just talking
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about with sessions being recorded, I know just the other day I
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had a doctor's appointment at my own doctor's office and they asked
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if I would consent to the appointment being recorded.
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And I asked if I would still be able to be seen
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in the practice if I declined.
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And they said yes.
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So I declined because I'm just not quite sure how I feel
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about it yet.
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I know a lot of practitioners are moving towards that.
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And I'm not saying that I won't in the future.
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I just I need to know more because I know that my
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doctor, for example, assured me that the recording would be destroyed.
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But would an IT professional guarantee that something is ever really destroyed?
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Right.
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I just don't know enough about that yet to feel comfortable.
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And I feel like being married to a computer nerd, he's told
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me for like 25 straight years that nothing is ever deleted.
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There's always some whatever that can be found.
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So it's a new technology that we're all squeamish about.
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I think the important thing is making your policies transparent and giving
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clients an option to opt out so that they can make an
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informed decision.
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Well, and I also think about I know when I was trained,
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which has been quite a long time ago now, I don't know
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if it's the same, but a lot of the focus of mental
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health care in specific was based on the fact that it is
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confidential.
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And we go to great lengths, even in our treatment notes, to
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make sure that we are not exposing something that someone is not
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ready to have exposed.
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Because without that privacy, how can you have full transparency and honesty?
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I mean, we would we would all edit what we say.
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We're editing what we say recorded on this podcast versus if we
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were sitting in a restaurant, as we often do, and talking through
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things like some personal things might come up, we might share those.
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We're not going to share those on this podcast.
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I think it's the same kind of idea.
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You know, if something's being recorded, is that going to be that
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voice in the back of my head that's like, I can't bring
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this up with my therapist because I have that fear of where
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it's going to go versus feeling that complete trust to be like,
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this might be the hardest thing I've ever shared with somebody, but
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at least I can get this out here and address it and
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talk about it.
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And even going back to what we were talking about earlier with
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relationships, tech companies may offer chatbot features, the ability to do
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text therapy.
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You don't know who's on the other end of that.
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That might not be a licensed person.
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And that's the fear.
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And for me, I think it also is this void of relationship
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then of you do not have an individual, possibly if it's a
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chatbot who has experienced human emotion, who understands what it means to
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go through life.
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A computer can analyze everything on the Internet.
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It doesn't have that lived experience.
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And then can it relate to us in the human experience that
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we're going through?
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And there's a lot of evidence that suggests chatbots and those kind
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of features are recorded to improve them, to improve the tech.
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So they, you know, if you're talking to a chatbot, they're going
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to record it.
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So the chatbot improves its, I guess, way of talking.
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Now, what about other therapists, other mental health professionals from that
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lens?
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What do you think it's important for that group of people to
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know about these changes?
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I think we're doing part of that now.
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The important work of starting this conversation.
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I think tech's here to stay.
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It will only increase in the marketplace for what's happening in therapy.
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So tech's here to stay.
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But I think we can advocate for our role as therapists in
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shaping how that gets integrated into care.
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What that looks like.
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Is it involving licensed professionals who are trained in this?
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Or is it just anyone who has empathy and a desire to
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help?
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And I think there's a huge difference in that.
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And so us as therapists, I think, have to understand that tech
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won't go anywhere.
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But we have to have these conversations now to talk about the
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ethical practice and involvement of tech into what we do.
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And we have to be knowledgeable because it's not going to go
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away.
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It's going to change and shift continuously through the rest of our
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careers as therapists.
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So we need to make sure we're informed so that we can
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also advocate and protect the clients.
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Most of us do this work because we really care about our
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clients.
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We really, really care about people.
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And we don't want to see anyone harmed.
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And we don't want to see what we love as a career
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and what we've poured our hearts and souls into turn into chatbots.
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I think therapists need to be cautious.
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I think other therapists, all of us need to make sure that
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we're not getting too comfortable or disconnected with what's really happening.
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And I think there's a need to revamp ethical guidelines and standards
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to protect our licensure and to educate the public and the community
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continuously.
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I was gonna say, there's a unification that we're asking for here.
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Yeah, it's on the list.
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Yeah, yeah, absolutely.
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It is on our list.
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And how do we get together and have this conversation as a
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greater group of practitioners to talk about what are the ethical standards
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there?
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So I'm curious, because you all are having conversations with other therapists,
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other practitioners.
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How often do you find that people are aware of these things
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versus how often are you introducing a topic where they're saying, oh,
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I had no idea?
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I felt that way when you first reached out, Rachel, of like,
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hey, have you seen all these articles coming out about what tech
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is doing in our industry?
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And I think I was so involved in the work where I
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wasn't really paying attention to the landscape that we are in currently.
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And so it really drew my attention to it.
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And now I can't help but see it everywhere and the changes
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in our industry, but not just our industry, other industries.
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That's right.
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So I don't think we're alone in the conversation about how do
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we involve tech, but ethically, I think everyone's as a part of
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that.
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I have a suspicion because I was kind of in the same
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boat as Erin where I was aware of it, but I wasn't
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aware of how present it was.
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I have a suspicion that many of our colleagues really don't know
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because they haven't dealt with clients who've been harmed firsthand or they
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haven't, you know, their 15 year old kid wasn't on with the
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chatbot.
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So I think that's another difficulty is how do we make sure
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that our community is educated about these things?
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It's easy to just put your head down and keep working.
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And just to kind of almost trust that these are just new
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changes in technology.
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It's making life a little easier, maybe increasing productivity.
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I've had many conversations with therapists, local therapists who were shocked
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after watching our video or attending our launch party and learning more.
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Yeah.
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And I do think that therapy can be very emotionally, mentally taxing
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work, and it can be hard to reach out and take in
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new information and think critically about these things.
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And I think that's exactly where some of this could end up
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just happening without our voices involved, which I think would be a
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shame because I think because we've been doing this work for so
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long, I think our voices are a critical piece of making this
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successful.
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Yeah.
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And one of the things with tech that I'm still trying to
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figure out too, is I really want people to have access to
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good therapy, right?
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And I would call good therapy a relationship with a licensed practitioner.
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And I want people to have access to that.
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And tech can afford us some of those options.
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I don't know exactly how.
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I think that's why I want to be part of the conversation
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because I want to make sure that people do have access and
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even affordable access as that changes in the landscape too.
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And I don't have all those answers right now, not naive enough
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to believe that I will have all those answers, but I think
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we need to bring up those questions.
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I think that's such a good point because all of us kind
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of, the pandemic, we were all virtual all the time and I
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was not super psyched about it.
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I don't think most folks were, but I did see the ability
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to open up my services to different types of folk who maybe
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live further away, who maybe struggled with mobility.
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So we did see a first iteration where tech can be awesome
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for our work.
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You know, we just need to see what the next awesome thing
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is.
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And also with some of the mental health disciplines forming compacts, right?
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So psychologists have the PSYPACT now, which allows psychologists who are a
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part of that compact to see clients via telehealth across many state
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lines.
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And I think social workers and professional counselors are moving in that
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direction and pushing for that as well, really does open up and
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increase access to care.
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So technology is not all bad.
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There are definitely some things that have really helped our profession.
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Counselors had the first wave of openness happen where, it's a weird
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rule, but only the client or the therapist has to be in
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the state of Maryland.
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So that, and that's a huge shift, right?
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So I'm not sure why they set it up that way, but
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we'll see if there is some kind of movement toward a compact
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in the LCPC community.
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So as we've talked about these things, I know for the Real
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Change Initiative, our initial push was to educate people looking for mental
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health care.
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So we've had conversations about this, but I'd love to hear maybe
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your thoughts on what's next for the Real Change Initiative.
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Big question.
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We got together earlier this week and we talked about what, and
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you guys would jump in because I may not be remembering this
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well, but we talked about the idea of three buckets of what
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this initiative could be.
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One was education, which we're rolling with.
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The other one was advocacy, meaning how do we reach out to
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not just our community, but maybe legislators or people in power that
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can make changes.
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And the other was unity, which is bringing our therapeutic community and
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all its factions together to kind of be bigger stakeholders and have
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a more powerful voice.
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I like the idea of just continuing to do our own research
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and synthesize the information and the data that we're learning and then
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sharing it with the community.
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And then I think there's power in collective advocacy.
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And I think it's just going to need to happen, right?
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I think the mental health industry is becoming increasingly corporatized, is
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that a word?
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But it's also bringing up this opportunity for us to kind of
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spearhead change and creating new ethical standards or guidelines to protect
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our profession and to protect clients.
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I approach it that way too, Alison, is from a protection of
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clients standpoint, if we think that this will impact the ethical way
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in which we serve people, I think we have a duty to
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have this conversation.
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I don't know exactly what the change looks like yet or what
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we need to do to advocate for changes in tech or corporate
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buyouts of organizations.
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I'm not even saying that I want to be involved in any
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of those things, but I want to have the conversation with people
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about what that looks like as a duty to protect those people
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that we serve.
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I think we're mandated towards that.
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I think I agree with that for sure.
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And I love what you said about research.
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I feel like we're kind of at the tip of the iceberg
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here, where we really need to kind of figure out not only
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like what other people are doing, but what has been done, because
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in certain states, there is legislation around these platforms.
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So for us as an initiative, it's building.
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It's necessary that we kind of make sure we know what's current
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and that research is going to be a very critical component moving
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forward.
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Therapists love research.
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It is innate within us, that's for sure.
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We are getting close to wrapping up here, but I wonder if
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each of you could say if there is one critical piece of
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information that you want people to know, kind of synthesizing just a
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little soundbite of information to take away from this conversation, what would
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that be?
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I think for me, it's that real therapy is about connection, human
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connection, and it's not just a service.
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It really is about the relationship, the client-therapist relationship, and
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there is no app or chatbot that can replace that.
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Alison stole what I was going to say.
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I feel like there is no, no comparison to being in relationship
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with a therapist.
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It's just the thing that creates authentic change.
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You know, if you want authentic change, the art of the relationship
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is what will get you there.
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I want to make sure the focus stays on people and not
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products.
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And I believe that people deserve real relationships, and especially real
23:41
relationships with licensed therapists who are going to help them to create
23:43
real change in their lives.
23:45
I think for me, it's also the educated choice.
23:48
Like consumers are smart, people are smart.
23:51
Give them the data.
23:52
They can make their choices and figure out what's best for them.
23:55
And we teach that in our practices.
23:57
Yeah, that's right.
23:58
All right, well, we're going to wrap that conversation here.
24:01
I want to thank you all for being here, for joining us
24:04
and for sharing what you've learned and where we are in this
24:07
grassroots effort to support consumers in finding the right fit for care.
24:12
Join us next time on the Mental Health Evolution podcast, and we
24:17
will be talking from another view on changes in the mental health
24:20
industry.
24:21
Thanks, everybody.
24:22
Bye for now.
24:23
Thanks for having us.
24:23
Thank you.
24:24
Thanks for listening to the Mental Health Evolution podcast.
24:28
Join the conversation.
24:30
Find us on social, send us your thoughts, and tell us what
24:33
you're seeing in your corner of the mental health world.
24:35
Until next time, stay curious and keep evolving.