Real Change

welcome to Mental Health Evolution, a podcast about what's changing in mental health and why it matters. I'm your host, Rachel Harrison, inviting you into honest conversations with people from all perspectives in the field. Clinicians, tech founders, investors, insurance companies, and all the folks in between. Let's explore what's working, what's not, and what's next. Welcome back to the Mental Health Evolution podcast where we are talking about the landscape and how it is quickly evolving in the mental health industry. Today we are taking a look at an example of a local group effort to begin to address these changes at a community level. For some background, this group is personal to me. This is a small group of local leaders in mental health that I reached out to and we started with a mental health awareness campaign in 2024. This year, when we came together to talk about what to do for mental health awareness in May, it seemed important to talk about the changes happening in our industry and address them in a way that raised awareness and supported the local community. So to give you all the sliver of what we looked at and kind of take you back to where we started our conversation. We looked at some specific articles and I'm just going to highlight those here so that you have a sense of where we were coming from in this conversation and you kind of get a feel of how this moved forward for us. So the first one was called Mental Health Care Startups Shaping the Future of Mental Health Care Insights and Trends. And in this article it really showed how a lot of startups are changing the game and changing the approach of mental health care, especially tech companies. The next article was called University Health Group. University of Minnesota partnered to launch a course on value based care. In this article it really talked about what value based care looks like. If you're not familiar with the term value based care, it is essentially a way that insurance companies are evaluating treatment and treatment providers in order to reduce their costs and hopefully increase the efficacy of care. The next article was Federal judge says class privacy claims may proceed against an online mental health platform. This was an article looking specifically at how Headway shared their mental health information with Google and it highlights some of the risks and different ethics that tech companies have when it comes to mental health and sharing information versus maybe what a local provider would have Next article number four was companies like CVS and United Healthcare are now some of the world's biggest businesses. Is this healthy for the rest of us? So one of the Trends we see is that in the mental health industry there are big companies that are taking on mental health and providing clinics and merging with other big companies and just looking at what is the impact of these things. So looking at the last one was many articles actually from the behavioral health business looking at how companies are acquiring market share in mental health and why they're doing that. We will put all of these in the show notes for you, but I just wanted to give you an overall picture of what we started with reading through these articles and that began a series of conversations for us as a group. I'm gonna let you hear about some of that conversation and some of the things that we've been doing. But there is a lot of news out there and even more since we started this process. So I want you to listen to what we did. We actually to kind of take you through. We met, we talked, we created a video and we had a lovely local group that volunteered to create this video for us called Real Therapy, Real Change. We'll put it in the show notes for you. In this video we tried to be educational toward consumers who would be looking to find mental health services to just give some information about what different services offer. And we asked everyone in our community businesses to roll this out for the month of May, to put this on their websites, to put this on social media. We had a launch party, had an overwhelming local response, but now we've created a group ongoing to continue this message and we call it the Real Change initiative. So I want to introduce you to the group members who are all in the studio with me. We have Melissa Ward from Melissa Ward Counseling. Welcome, Melissa.

Hey Rachel.

And we have Erin Vandermeer from Clearview Communities. Glad to be here. Pleasure to be here. And we have Allison Bomba from Allison Bamba, psychologist, and of course myself from Trauma Specialists of Maryland. So I want to give you a picture of kind of how this group thinks about this process, what we've learned along the way. So I'd love to just throw some questions out and let's just talk how we talk. I'd love to hear from all of you how these changes in the industry resonated with you and why you wanted to become a part of this project.

I think when I started seeing how fast mental healthcare was shifting towards apps and tech driven solutions, I felt that we were losing something really important in the industry. That human connection and trained expertise that make real Therapy so powerful.

And coming into contact in my practice with folks that have sought mental health guidance or care from these apps or platforms and had just what I would consider to be nearly catastrophic outcomes. It became really important that we educate people about the limitations of these kind of ways of going about therapy.

I've also been really uncomfortable with the way that care is being delivered by these big tech companies and AI.

AI.

And I just care so deeply about protecting and preserving what real mental health therapy is, which involves that real connection, that human connection, safety and trust.

Relationship.

Yeah, I think that's the big word that I keep coming back to as part of this whole conversation is relationship. I think that is at the heart and soul of therapy. It's that relationship between us as the licensed practitioner and our clients, those people that we serve. I don't want to lose that with tech. And I think that that is something that I see coming, which makes me really concerned.

And because this is a new kind of approach to kind of therapy ish, there's also no data around efficacy, and there's no data around risk. So I think that's something that occurred to me when I was, you know, working with people who had been what I consider to be harmed by these platforms.

And when I hear you say that, I'm thinking about how in our field, we do make a concerted effort for looking at and looking at research and figuring out what it is that's working and trying to use those techniques and those pieces. So that data piece is going to be very critical going forward. What do you think is important for people who are looking for mental health care for their family members, friends, for themselves? What are the most important things to know about tech options and about what maybe a typically trained therapist in a community would have to offer?

I think that consumers need to know that not all therapy platforms are created equal. I think they need to ask questions like, who's running this company? Are these real licensed therapists? What's happening to my personal information? Those are really important questions to ask, and I don't know that the general public knows to ask them all the time.

Yeah, I wholeheartedly agree. I don't think all tech options can be helpful tools, but they're not all created equal. So it's important to stay informed. Are we working with a licensed therapist? Is it a chatbot? Is it someone providing therapeutic support? But they're not actually a licensed trained provider. So I think transparency is something that consumers should demand from the companies in

which they're working with, especially because there's been stated incidents where headway, for example, has actually sold private information. That has happened. So the precedent's been set, and none of us really read those kind of documents when we sign, you know, privacy policies. So I think really drilling down on what you're signing to make sure that you're protected well.

And as someone, I'm sure you are the same, like HIPAA has been part of what we have had to really learn to do and protect private health, of personal health information. Phi is what we kind of call it in the field. And all of that training that I've had for years and years and years and years, it's a little bit shocking because I always thought I can just skim that document or not even read it at my doctor's office because it pretty much says what I've already been trained in. And I know and people have to protect that and follow rules. So it does feel shocking from. From our angle to be like, how these companies actually selling either the specific information or putting the data together and selling the data. And both of those things, I think, are pretty prominent in the tech industry.

Yeah. In therapy practices and even like family practitioners are doing those kind of things.

That's right.

I know. Asking to record sessions. And then my. My question is always, what do we do with that recording? What happens to that? Right. And especially in therapy, when we're asking people at some points to really get into some hard moments in their life to share their trauma, their fears, the anxieties, those. Those things that haunt them, those are really difficult things to talk to someone about. And then if there's a recording of that, what happens to that information?

I think all of our platforms that we use for our therapy offices, like Simple Practice and TherapyNotes, now offer a recording feature. And I'll be honest with you guys. I would never ask someone to be recorded, only because I feel like it creates almost like an artificial barrier in the room knowing that this is memorialized, you know, and people frankly, you know, especially people that don't respect Phi, can get sloppy. So I wouldn't want my client to wonder what happens.

It's really appalling that companies like Headway and BetterHelp and, you know, these other big tech companies are violating phi, violating hipaa, yet we see commercials on TV for them all the time, advertising their services, podcasts.

I feel like every podcast I listen to, I hear a commercial for

and

I guess going off what Erin and Melissa were just talking about with sessions being recorded. I know just the other day I had a doctor's appointment at my own doctor's office, and they asked if I would consent to the appointment. Being recorded. And I asked if I would still be able to be seen in the practice if I declined, and they said yes. So I declined because I'm just not quite sure how I feel about it yet. I know a lot of practitioners are moving towards that, and I'm not saying that I won't in the future. I just. I need to know more because I know that my doctor, for example, assured me that the recording would be destroyed. But would an IT professional guarantee that something is ever really destroyed? Right. I just don't know enough about that yet to feel comfortable.

And I feel like being married to a computer nerd. He's told me for like 25 straight years that nothing is ever deleted. Right. There's always some. Whatever that can be found. So it's a new technology that we're all squeamish about.

I think the important thing is making your policies transparent and giving clients an option to opt out so that they can make an informed decision.

Well, and I also think about. I know when I was trained, which has been quite a long time ago now, I don't know if it's the same, but a lot of the focus of mental health care in specific was based on the fact that it is confidential. And we go to great lengths, even in our treatment notes, to make sure that we are not exposing something that someone is not ready to have exposed. Because without that privacy, how can you have full transparency and honesty? I mean, we would. We would all edit what we say. We're editing what we say recorded on this podcast, versus if we were sitting in a restaurant, as we often do, and talking through things, like some personal things might come up, we might share those. We're not going to share those on this podcast. I think it's the same kind of idea, you know, if something's being recorded, is that going to be that voice in the back of my head that's like, I can't bring this, this up with my therapist because I have that fear of where it's going to go versus feeling that complete trust. To be like, this might be the hardest thing I've ever shared with somebody, but at least I can get this out here and address it and talk about it.

And even going back to what we were talking about earlier with relationships, tech companies may offer chatbot features, the ability to do text therapy. You don't know who's on the other end of that, that might not be a licensed person, and that's the fear. And for me, I think it also is this void of relationship. Then of you do not have an individual, possibly, if it's a chatbot who has experienced human emotion, who understands what it means to go through life. A computer can analyze everything on the Internet, but does it have that lived experience? And then can it relate to us in the human experience that we're going through?

And there's a lot of evidence that suggests chat box. And those kind of features are recorded to improve them, to improve the tech. So they, you know, if you're talking to a chatbot, they're going to record it. So the chatbot improves its, I guess, way of talking.

I don't know. Now, what about other therapists, other mental health professionals from that lens, what do you think it's important for that group of people to know about these changes?

I think we're doing part of that now. The important work of starting this conversation. I think tech's here to stay. It. It will only increase in the marketplace for. For what's happening in therapy. So tech's here to stay. But I think we can advocate for our role as therapists in shaping how that gets integrated into care. What that looks like, is it involving licensed professionals who are trained in this, or is it just anyone who has empathy and a desire to help? And I think there's a huge difference in that. And so us as therapists, I think, have to understand that tech won't go anywhere but to have these conversations now to talk about the ethical practice and involvement of tech into what we do.

And we have to be knowledgeable, because it's not gonna go away. It's gonna change and shift continuously through the rest of our careers as therapists. So we need to make sure we're informed so that we can also advocate and protect the clients. Most of us do this work because we really care about our clients, we really, really care about people, and we don't want to see anyone harmed, and we don't want to see what we love as a career and what we've poured our hearts and souls into, turn into chatbots.

I think therapists need to be cautious. I think other therapists, all of us, need to make sure that we're not getting too comfortable or disconnected with what's really happening. And I think there's a need to revamp ethical guidelines and standards to protect our licensure and to educate the public and the community continuously.

I was gonna say there's a unification that we're asking for here.

The list.

Yeah, yeah, absolutely.

It is on our list.

And how do we get together and have this conversation as a greater group of practitioners to talk about what are the ethical standards there.

So I'm curious because you all are having conversations with other therapists, other practitioners. How often do you find that people are aware of these things versus how often are you introducing a topic where they're saying, oh, I had no idea

I felt that way when you first reached out, Rachel, of like, hey, have you seen all these articles coming out about what tech is doing in our industry? And I think I was so involved in the work where I wasn't really paying attention to the landscape that we, that we were in currently. And so it really drew my attention to it. And now I can't help but see it everywhere and the changes in our industry, but not just our industry, other industries.

That's right.

So I don't think we're alone in the conversation about how do we involve tech, but ethically, I think everyone's as a part of that.

I have a suspicion because I was kind of in the same boat as Erin, where I was aware of it, but I wasn't aware of how present it was. I have a suspicion that many of our colleagues really don't know because they haven't dealt with clients who've been harmed firsthand or they haven't, you know, their 15 year old kid wasn't on with the chatbot. So I think that's another difficulty is how do we make sure that our community is educated about these things?

It's easy to just put your head down and get, keep working and just to kind of almost trust that these are just new changes in technology. It's making life a little easier, maybe increasing productivity. I've had many conversations with therapists, local therapists who were shocked after watching our video or attending our launch party and learning more.

Yeah. And I do think that therapy can be very emotionally, mentally taxing work. And it can be hard to reach out and take in new information and think critically about these things. And I think that's exactly where some of this could end up just happening without our voices involved, which I think would be a shame because I think because we've been doing this work for so long, I think our voices are a critical piece of making this successful.

Yeah. And one of the things with tech that I'm still trying to figure out too is I really want people to have access to good therapy. Right. And I would call good therapy a relationship with a licensed practitioner. And I want people to have access to that. And tech can afford us some of those options. I don't know exactly how I think that's why I want to be part of the conversation, because I want to make sure that people do have access and even affordable access, as that changes in the landscape too. And I don't have all those answers right now. Naive enough to. To believe that I will have all those answers. But I think we need to bring up those questions.

I think that's such a good point because all of us kind of the pandemic, we were all virtual all the time. And I was not super psyched about it. I don't think most folks were. But I did see the ability to open up my services to different types of folk who maybe live further away, who maybe struggled with mobility. So we did see a first iteration where tech can be awesome for our work. You know, we just need to see what the next awesome thing is.

And also with some of the mental health disciplines forming compacts. Right. So psychologists have the psypact now, which allows psychologists who are a part of that compact to seek clients via telehealth across many state lines. And I think social workers and professional counselors are moving in that direction and pushing for that as well. Really does open up and increase access to care. So technology is not all bad. You know, there are definitely some things that have really helped our profession.

Counselors had the first wave of openness happen where it's a weird role, but only the client or the therapist has to be in the state of Maryland. So that. And that's a huge shift. Right. So I. I'm not sure why they set it up that way, but we'll see if there is some kind of movement toward a compact in the LCPC community.

So as we've talked about these things, I know for the Real Change Initiative, our initial push was to educate people looking for mental health care. So we' conversations about this. But I'd love to hear maybe your thoughts on what's next for the Real Change Initiative.

Big question.

Oh, we got together earlier this week and we talked about what. And you guys let jump in because I may not be remembering this well, but we talked about the idea of three buckets of what this initiative could be. One was education, which we're rolling with. The other one was advocacy, meaning how do we reach out to not just our community, but maybe legislators or even know people in power that can make changes. And the other was unity, which is bringing our, you know, therapeutic community and all its factions together to kind of have a. Be bigger stakeholders and have a more powerful voice.

I like the idea of just continuing to do our own research and synthesize the information and the data that we're learning and then sharing it with the community. And then I think there's power in collective advocacy, and I think it's just going to need to happen.

Right.

I think the mental health industry is becoming increasingly corporatized. Does that work? And so. But it's also bringing up this opportunity for us to kind of spearhead change in creating new ethical standards or guidelines to protect our profession and to protect clients.

Yeah, I approach it that way, too. Alison is from a protection of clients standpoint, if we think that this will impact the ethical way in which we serve people, I think we have a duty and to have this conversation. I don't know exactly what the change looks like yet or what we need to do to advocate for changes in tech or corporate buyouts of organizations. I don't. Not even saying that I want to be involved in any of those things, but I want to have the conversation with people about what that looks like as a duty to protect those people that we serve. I think we're mandated towards that.

I think I agree with that for sure. And I love what you said about research. I feel like we're kind of at the tip of the iceberg here where we really need to kind of figure out not only like, what other people are doing, but what has been done. Because in certain states, there is legislation around these platforms. So for us, as an initiative, it's beholden. It's necessary that we kind of make sure we know what's current, and that research is going to be a very critical component moving forward. Therapists love research.

It's just. It is innate within us, that's for sure. We are getting close to wrapping up here, but I wonder if each of you could say if there is one critical piece of information that you want people to know, kind of synthesizing just a little sound bite of information to take away from this conversation. What would that be?

I think for me, it's that real therapy is about connection, human connection. And it's not just a service. It really is about the relationship, the client therapist relationship. And there is no app or chatbot that can replace that.

Allison stole what I was going to say. I feel like there is no. No comparison to being in relationship with a therapist. It's just the thing that creates authentic change. You know, if you want authentic change, the art of the relationship is what will get you there.

I want to make sure the focus stays on people and not products. And I believe that people deserve real relationships and especially real relationships with licensed therapists who are going to help them to create real change in their lives.

I think for me, it's also the educated choice. Like consumers are smart, people are smart. Give them the data, they can make their choices and figure out what's best for them.

And we teach that in our practices.

Yeah.

Yeah, that's right. All right.

Well, we're going to wrap that conversation here. I want to thank you all for being here, for joining us and for sharing what you've learned and where we are in this grassroots effort to support consumers in finding the right fit for care. Join us next time on the Mental Health Evolution podcast and we will be talking from another view on changes in the mental health industry. Thanks everybody. Bye for now.

Thanks for having us.

Thank you.