Shelby Challis

One of the greatest societal issues facing the world today is the delivery of affordable and accessible mental health services to the majority of the world’s population. Oren Frank, the CEO and CO-Founder of Talkspace, an online platform that connects users to licensed therapists from around the world, has been leading the fight to bring those services to the most under-served in our community.

I sat down with Frank at this year’s Web Summit in Dublin to discuss the current crisis  of mental health service delivery, how previous online therapy attempts have failed, what sets Talkspace apart, and what can we as policy-makers learn from this new platform.

Talkspace came about as a response to three main barriers in the delivery of mental health services: cost, stigma, and access. Therapy exists within a knowledge-based industry, and yet its service delivery has not significantly changed over the past 150 years. To get a sense of the current salience of the problem, according to the Canadian Mental Health Association (CMHA), 1 in 5 Canadians will experience a mental health or addiction problem in their lifetime. As such, there is a serious demand for democratizing access to mental health services.

The first barrier has been the cost of receiving treatment. Frank stated that, in the United States, the private cost of treatment is anywhere between $5,000-15,000(US) per year. As such, he argues that, in America, mental health services have become a product for the 1 per cent. What makes the cost factor even more salient is the correlation that exists between lower income and the need for more healthcare services.

The second barrier relates to the stigmatization, shame, and intimidation that still dominates peoples’ perceptions of therapy and mental health treatment. For individuals seeking treatment, not only are they concerned about how their community perceives of them upon discovery that they are receiving treatment, but they themselves may find the entire process shameful. Many individuals who seek treatment hold the belief that their therapist, rather than alleviating their crisis, is casting judgement upon their character.

Lastly, there is the accessibility barrier. Frank stated that the mean amount of time it takes an individual to secure a one-on-one session with their therapist is three weeks. However, an individual in crisis cannot afford to wait three weeks to access treatment, whereby the crisis could either dissipate or become unmanageable.

Online therapy is not a new phenomenon, and it has a history of failed attempts. Frank discussed these failed attempts and argued that the self-service platforms that have been created, though built with evidence-based methodologies and efficiency, fail because they neglect the fundamental element that successful therapy is predicated upon: the quality of the relationship between the individual seeking treatment and his/her therapist. Frank went on to state that the whole industry exists on a continuum, with software on the left side, and people on the right, with the proper solutions falling somewhere in-between the two.

This “in-between solution” is where Talkspace comes in. By moving therapy onto an online messaging platform Frank and his team have removed the notion of the dreaded “session”, and have created a daily product that fits into our modern lifestyles. As Frank argues, “every person under 40 has been conditioned to retain control over communicating on their own terms.” The medium of choice for communication now is through text and online messaging, and by providing this messaging service allows for the barriers to treatment to be struck down. This form of service delivery is cheaper ($25 per month), protects the privacy of the individual, and is highly accessible.

There are a number of takeaways from a public policy perspective that can be extracted from this innovative service delivery method for mental health services. For one, this digital platform has a built-in evaluation tool. Every interaction is recorded and stored within the platform, and as such, ensuring that optimal outcome measures and evidence-based therapy are delivered. Furthermore, this data capture is also used to ensure that the product and the therapists are achieving their optimal levels of delivery. The therapists are measured in terms of their engagement, supervision, and clinical efficacy outcomes. Also, the users themselves are also able to rate the therapists, which is predominantly how their engagement score gets calculated. From a public policy perspective this platform demonstrates a means through which evidence-based, high-quality mental health care services can be delivered in such way that eliminates not only cost barriers, but barriers as debilitative as stigmatization.

I asked Frank what he envisions for his company moving forward, and he left me with this parting thought:

We did not reinvent therapy, I have personally nothing against the face-to-face but, to say I won’t go to therapy unless it’s done in the traditional way is a little like saying: I’m in Dublin and I need to get to New York City, but I’m giving myself only two options: I’m either going to take a private plane, or I’m going to swim. Most of the population will never even be able to think about getting on that private plane.

While traditional face-to-face therapy might still be predominantly a product for the 1 per cent, alternative treatment for mental health doesn’t have to be. There is the option of getting on that commercial airliner, which could very well be the difference between drowning or making it home.

 

Shelby Challis is a 2016 Master of Public Policy candidate at the University of Toronto’s School of Public Policy and Governance. She previously completed an Honours Bachelor of Arts degree in Political Science at the University of Toronto, and has since worked for the Ministry of Health and Long-term Care. Her policy areas of interest include healthcare finance, labour relations and security management.