Latest / The Mental Health Evolution / Ep 21: Technology, Therapy, and the Future of Care

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Ep 21: Technology, Therapy, and the Future of Care · 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, everyone, to the Mental Health Evolution podcast, where we
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  explore changes happening in the mental health industry and discuss topics from
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  multiple perspectives.
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  Although we usually have guests, today's episode is a solo discussion, and
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  I want to reflect on something that is a pretty big piece
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  that is shaping the industry right now, and has been for years,
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  honestly, and that is the mental health provider shortage.
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  Talking about how that shortage is increasingly being used to promote
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  technology-led mental health tools, tech companies, what all of that means
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  for people seeking care, and for the clinicians who provide it.
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  So today, I'm going to kind of use some articles interwoven within
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  our context.
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  I know we kind of talk about those at the beginning a
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  lot of times.
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  I'm going to reference those as we're talking, and those, of course,
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  will be in the show notes for you if you want to
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  take a deeper dive into those.
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  We like to make sure that the information that we are putting
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  out has some backing and some research or some articles behind it.
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  So that's what that's all about for us.
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  So I thought it would be helpful to actually define what we
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  mean when we talk about mental health, and here's why.
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  We're talking about mental health care, and I think starting from a
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  place of what we are talking about when we talk about mental
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  health is important.
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  The American Psychological Association describes mental health as a state of
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  well-being in which an individual realizes their abilities, can cope with
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  normal stresses of life, can work productively, and is able to contribute
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  to their community.
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  So that's our kind of working definition.
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  At the same time, we know that a lot of people are
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  really struggling with mental health, right?
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  Mental health is not just about reducing symptoms.
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  It's about functioning, relationships, meaning, and quality of life.
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  So I want to walk through three kind of connected ideas in
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  this episode, and we will weave these together.
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  First, what we know about the provider shortage and how it affects
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  people trying to access care.
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  That's where we're going to start.
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  Second, how technology and AI-driven tools often present themselves as
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  solutions to that shortage.
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  Most of the tech companies that I have talked to or people
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  that are creating innovative solutions often cite this as the problem, the
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  gap, the issue that they are trying to fix.
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  And that is where a lot of these tools come from.
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  Often this is useful, helpful, accessible for people, sometimes in ways that
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  function more as a band-aid for symptoms.
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  Sometimes there's even harm.
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  So we're going to kind of talk through all of those pieces.
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  And finally, how hybrid models where technology can support rather than
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  replacing human therapists may be a promising direction going forward.
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  A lot of this information comes from different podcasts that I have
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  hosted over the past year.
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  And so we will also reference those and kind of tell you
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  which ones you might want to jump into if you want to
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  get more information on those.
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  So let's start with piece number one, which is the provider shortage
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  and what's documented out there about the provider shortage.
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  So there is consistent evidence that in many parts of the United
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  States there is a significant shortage of mental health providers.
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  A large share of the U.S. population lives in designated mental
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  health professional shortage areas and workforce analysis shows that demand for
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  services has grown faster than the clinical workforce can keep up with,
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  particularly since the pandemic.
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  And that is from the Commonwealth Fund and an article from 2023.
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  So a little bit older, a couple of years older data.
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  But I think it still reflects what's happening.
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  Professional organizations and workforce researchers point to several
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  contributing factors.
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  Number one is the increased demand for services.
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  We certainly saw that with COVID and I think it has just
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  continued.
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  Second is clinician burnout and attrition.
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  We are seeing lots of clinicians leave the field stating that they
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  can't handle the workload.
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  They can't handle the job.
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  It's emotionally burning them out for understandable reasons.
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  But that is definitely an issue that we are contending with.
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  Next is administrative and billing burden.
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  There's a lot of paperwork of requirements depending on the type of
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  payers involved.
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  That paperwork and that administrative burden can be a pretty heavy one.
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  So that is another reason most clinicians don't love administrative work.
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  Kind of tends to be a thing.
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  We tend to be people, people.
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  Next is difficulty recruiting and retaining clinicians.
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  So a lot of organizations that are trying to hire clinicians have
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  a hard time finding right fit clinicians, having clinicians that want to
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  stay and learn and do the work that they do.
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  Also reimbursement and insurance barriers.
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  Those are another big issue.
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  And I'm going to talk a little bit more about how that
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  kind of plays out specifically in mental health.
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  All of these conditions lead to longer wait lists, potentially limited
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  availability and situations where people who want help either wait too long
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  or they disengage entirely.
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  That's from the American Counseling Association.
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  So the narrative is real.
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  It's definitely supported by data and it's reflected in the lived experience
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  of clients and clinicians.
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  It is also very location based.
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  There are areas with much more of a deficit of providers and
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  other areas with an oversaturation of providers.
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  And this is due to population size as well as attractive places
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  to live.
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  One of my locations as a provider was a resort town in
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  Colorado and there was a very, very high number of clinicians there
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  because it was a nice place to live.
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  That's just an example of one of those pieces.
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  But there's also this nuance that providers are more and more going
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  to private pay models, meaning that they do not take insurance.
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  This is honestly because they can.
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  They have demand and because many insurance companies reimburse very low fees.
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  This is often touted as the pinnacle of success in private practice
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  circles because coping and dealing with insurance companies is a whole beast
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  in and of itself.
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  So for providers, if they don't have to take insurance, two things
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  happen.
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  They get paid more and they don't have to do all the
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  paperwork.
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  So there's a huge advantage to that and a lot of providers
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  moving to that as they are able.
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  For providers who are willing to take insurance, it's often at a
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  personal cost to them, meaning they have less because they are accepting
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  insurance rates instead of going rates for their services.
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  And a lot of them have student loans.
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  The thing about this industry is it requires at least a master's
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  degree to do the work and then time to get licensed.
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  And all of that is costing and the reimbursement rates don't necessarily
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  reflect that burden of investment that counselors and social workers in
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  particular invest.
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  This applies to psychologists, marriage family therapists, art therapists, all
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  of those as well.
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  But recently, as you know, social work and counseling in particular were
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  not deemed professional degrees.
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  And so I'm going to be curious to see what happens to
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  this burden of student loans in those cases.
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  But a lot of providers also who do take insurance choose the
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  highest paying insurance because in order to make it work, they can't
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  afford to take state insurance like Medicaid, Medicare or other payers that
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  are traditionally lower payers.
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  Now, this does differ from state to state.
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  There are certainly great clinicians that are able to accept that.
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  I will also add that the paperwork administrative load for Medicaid and
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  Medicare in particular are much higher as well as the fight for
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  reimbursement.
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  So those are just pieces that make providers less willing to take
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  insurance, makes that less accessible then to people who want to use
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  insurance, especially state insurance.
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  So that's a little bit of a dive into that provider shortage.
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  It's real.
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  It's happening.
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  And there are nuances to it.
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  If you want to pay cash for therapy, you're going to have
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  no problem finding somebody.
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  Also, if you want to do virtual therapy, you're probably going to
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  have no problem finding somebody.
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  The location and using insurance and depending on what your funding source
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  is, is a lot of what creates the gap there.
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  So that leads us to our next section here.
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  What counts as mental health treatment?
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  I'm excited to dig into this because we use this term of
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  mental health treatment and there are so many different perspectives about what
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  this is.
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  So Mental Health America provides a useful overview of the different types
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  of treatment and support that people may engage with depending on their
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  needs and level of functioning.
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  They describe things like psychotherapy or talk therapy, medication management,
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  case management, hospitalization and intensive services.
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  There are things like IOPs, intensive outpatient programs, peer support and
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  support groups, complementary or alternative practices, as well as self-help
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  and recovery plans.
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  The framework shows that there is a spectrum of supports, but the
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  pieces generally considered clinical involve the following.
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  Licensed professionals, individual assessment and treatment planning, evidence
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  -based approaches and ongoing clinical oversight.
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  And that distinction becomes really important when we talk about digital tools,
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  apps or AI companions that are presented as alternatives to therapy.
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  And I want to also talk about this idea of what is
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  psychotherapy because there are so many different training programs across the
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  country and different providers are trained differently.
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  They're trained with different approaches and it's not all the same.
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  So what one person says is psychotherapy is not what another person
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  is doing as psychotherapy.
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  And I think it's important to kind of parse that out.
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  We think about things like someone who is trained in a basic
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  counseling program or social work program or psychology program is trained on
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  something called reflective listening.
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  So that is being present, listening and reflecting back what you're hearing.
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  That certainly can be helpful and supportive for people and has been.
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  There are also considered in psychotherapy what I would consider like people
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  that work on coping skills.
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  What are you going to do?
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  How are you going to handle big emotions?
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  How are you dealing with your anxiety?
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  How are you coping with a substance abuse disorder and talking through
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  strategies to try and things to do to help that also very
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  useful work.
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  But then there is sort of a deeper work kind of process
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  that happens in our field too that would be more about getting
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  to the root of the issue.
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  And that might be a longer term, more permanent treatment focus.
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  Those might be things like psychodynamic therapy or EMDR. All of these
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  types of psychotherapy often require evidence based approaches with controlled
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  studies.
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  That would always be my recommendation.
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  Like let's look at what the research says.
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  Let's look at controlled studies and let's make sure that we have
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  some good clear research.
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  We also know that the relationship base is a big healing component.
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  Research has shown us that being present with somebody, tuning in, developing
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  a relationship where there is understanding and connection and attachment, that
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  is a lot of what provides a safe enough space for somebody
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  to heal and to get well.
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  So therapy by design is relational.
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  We can learn skills without relationship, of course.
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  But a lot of the other pieces of what is therapy and
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  what is good therapy is really relationship based.
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  So that leads me to point number three, our third section here
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  and talking through tech and AI as solutions to the shortage and
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  that narrative.
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  And like I've said, there's a lot of companies that will put
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  this out there.
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  They are there because they are trying to increase accessibility to care,
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  which is an awesome goal.
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  It's a powerful marketing tool.
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  It's a powerful narrative.
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  And it's honestly important that people do have access to care.
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  So I love the idea behind this.
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  Certainly that has led to app based emotional support tools.
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  You've probably seen some of those.
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  Some of them might be like mindfulness practices or maybe they do
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  a little bit of CBT or they're trying to teach you some
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  skills or teach you to take time to check in and say
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  how are you feeling today?
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  All can be supportive and helpful, but definitely not the same as
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  psychotherapy.
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  Then we have the AI driven chat companions.
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  Many of these are marketed as free counseling because they're not being
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  charged for for the most part right now.
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  As we know, though, there are some risks there.
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  Could it be great for someone who is lonely to have AI
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  to talk to?
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  Could they even get some interesting perspectives and some dialogue?
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  I think yes.
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  And we know that there's a psychophantic bias where AI tends to
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  tell us what we want to hear and be very, very flattering.
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  So there's some question if that's an actual relationship where there would
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  be more honest feedback or if AI is just telling you what
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  you want to hear.
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  Also, we know there have been some safety situations and some legal
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  cases.
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  And so there are some caveats and some concerns in that department.
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  There are also platform based therapy marketplaces.
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  So kind of going and finding your provider through these different tech
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  marketplaces.
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  And that certainly can be a way that helps people find someone
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  and get into services.
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  Those are often with actual therapists, sometimes though not.
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  Sometimes those are with coaches or different people that might not necessarily
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  be degreed.
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  So it's always good to look at that a little bit deeper
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  and make sure you know what the qualifications are of the person
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  that you are talking with.
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  There are also employer or insurance sponsored digital mental health tools.
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  And again, those can be great supplements for sure.
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  And many of these tools are framed as scalable, accessible, instant
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  alternatives that can step in and help where human providers are not
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  available.
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  That's true.
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  Your therapist that you see once a week is not available to
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  talk to you at two in the morning.
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  That's definitely not.
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  Typically part of what therapy in an outpatient model includes.
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  So let's look at an article here.
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  A 2025 peer reviewed digital overview of digital mental health tools called
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  the evolving field of digital mental health found.
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  This is from PubMed Central, by the way, that these tools can
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  be helpful for things like symptom tracking, skill practice, stress, mild
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  anxiety and may increase engagement, especially when used alongside clinician
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  involvement.
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  So all positive things.
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  But that same review also found that outcomes are more limited when
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  tools are used without human guidance.
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  So when people are just logging onto an app by themselves and
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  not talking to somebody about that process, engagement often drops over time,
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  might start strong, then it's forgotten.
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  And integration into real world clinical care remains challenging.
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  So these tools are most effective, it seems, so far when they
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  supplement therapy, not when they stand in for it.
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  And the APA, the American Psychological Association, has also echoed this
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  caution in its statement on AI and wellness apps.
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  The APA warned that generative AI chatbots and wellness apps lack sufficient
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  evidence and regulatory safeguards to function as standalone therapy and should
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  not replace clinician-led care, particularly for people with significant
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  symptoms or complex needs.
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  So I think the distinction between symptom relief and deeper healing work
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  becomes important here.
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  AI and chatbot tools are appealing because they are immediately available.
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  They are low cost or free.
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  They are less intimidating maybe than sitting and talking to a person
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  and also framed as on-demand support.
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  And for some people, I do think those can be helpful options,
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  but they really function more as a band-aid or a tool
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  that tries to help but might not have the deeper relationship, relational,
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  developmental, contextual issues that people seek therapy for.
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  The Society for Psychotherapy has written about this difference in the context
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  of human clinical judgment versus algorithmic systems, noting that
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  psychotherapy is grounded in empathy, trust, context, and complex relational
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  understanding.
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  Qualities that AI systems cannot authentically replicate even when they appear
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  conversational.
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  So that is an article that was interesting to me on this
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  topic as well.
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  When AI and app-based tools can be helpful, it's really to
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  support symptom work and not so much deeper healing work.
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  So it seems that the last part I want to talk about,
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  we are kind of evolving to a place and several of the
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  guests that I talked to were advocating for this, which is more
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  of a hybrid care where tech may be most useful.
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  So maybe it's about technology being used effectively when it supports highly
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  trained human clinicians rather than standing in for them.
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  Cases where technology has the greatest potential are not necessarily replacing
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  therapy, but in reducing parts of the work that make the profession
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  harder.
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  Things like documentation and paperwork, scheduling and billing, administrative
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  functions, insurance and authorization processes, and workflow burden.
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  Most therapists find great benefit, honestly, from using AI for these kinds
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  of things.
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  It does have the potential to reduce the administrative load, streamline
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  processes, support continuity of care in between sessions, and help clinicians
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  spend most of their time doing the actual therapeutic work they're trained
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  for.
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  So if we combine tools here with the human expertise in the
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  relationship, then maybe that's a great outcome.
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  I will share that a personal opinion here is that one of
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  my greatest concerns remains that with any kind of AI recording a
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  session, in order to produce the notes and also sometimes provide feedback,
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  observations about patterns in the sessions, my biggest concern is the security
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  of the data.
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  I mean, this is how we're trained.
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  Protect privacy, protect privacy, protect privacy.
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  So where does this recording go?
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  Do we know that that's where it goes?
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  What is mined from it and who really owns it?
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  I have talked with several companies about this.
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  I have not yet gotten an answer that makes me comfortable enough
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  to use it personally.
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  Though I do think when we're training clinicians, often recording a session
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  is part of the training process.
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  So we do use this in our field.
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  And typically when that's done, it is used on like a personal
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  device and it is deleted immediately afterwards.
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  No data mining, no nothing.
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  So that might be a safer way for us to allow AI
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  to record.
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  But then what does that AI system do with that recording?
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  I think there are lots of different thoughts on how safe this
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  is or how not safe this is.
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  And each person needs to choose for themselves what they're comfortable with.
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  I also believe that if a clinician is not writing a note,
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  I think they're losing part of the clinical process because in writing
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  the note, you are required to synthesize the session.
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  You are required to draw out highlights, important pieces, things that you
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  are working on, things that you want to bring back in the
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  next session.
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  And I don't know if AI writes the note and the clinician
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  just edits it.
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  Do we get that same mental benefit of conceptualizing our client and
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  what their needs are?
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  It's a question that remains to be seen for me.
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  But some of my favorite conversations on this podcast over the past
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  year have come from leaders who think about technology in exactly the
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  way of this hybrid approach, something that can support human therapists and
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  practice systems rather than compete with them.
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  If you want to go back and listen to those, they are
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  the recordings, the podcasts from Ajeta Robinson, Jordan Harris, Dylan Ross,
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  Uriah Guilford and Jeremy Zugg.
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  They all had really thoughtful perspectives about hybrid, about tech-assisted
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  models that still center on the clinician and about ways to use
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  AI in supporting workflow.
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  So we'll definitely link those episodes to the show notes so that
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  you can jump in to that at any time you want to.
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  Now, sum up, thanks for listening today to this episode.
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  I really wanted to spend time looking at the provider shortage, what
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  AI and tech companies are doing to bridge that gap, as well
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  as what we can do to maximize the greatest benefit, a therapeutic
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  benefit for people seeking services.
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  People who want to do that deep healing work, how do they
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  get that?
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  People who are just looking to learn a few new skills, what's
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  their best approach?
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  And I think some of this is going to come down to
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  educating people on what different services look like, what to expect from
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  different services and what a psychotherapy practitioner actually does.
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  So I'm hoping as a field, we can educate people more about
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  that.
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  We can help people find what they're looking for.
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  And maybe we can even triage people to be able to say,
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  you know what, that skill building app would be perfect for you
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  or you need hospitalization all the way on the opposite side of
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  care so that we're getting people to the right places and hopefully
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  continuing to train excellent clinicians to provide these services.
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  So thank you for listening.
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  If this conversation resonates with you, whether you're a clinician, a group
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  practice business owner or someone who has tried to navigate these options
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  as a client, I'd love to hear your thoughts.
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  We'll be back in the next episode to explore more issues with
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  more guests, shaping the mental health care landscape.
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  There continues to be so much happening so quickly.
• 25:06
  We want to help keep you informed.
• 25:07
  Thanks for listening.
• 25:08
  Bye for now.
• 25:10
  Thanks for listening to the Mental Health Evolution podcast.
• 25:14
  Join the conversation.
• 25:15
  Find us on socials, send us your thoughts and tell us what
• 25:18
  you are seeing in your corner of the mental health world.
• 25:21
  Until next time, stay curious and keep evolving.
• 25:27
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• 25:32
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