Technology, Therapy, and the Future of Care

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 everyone to the Mental Health Evolution podcast where we explore changes happening in the mental health industry and discuss topics from multiple perspectives. Although we usually have guests, today's episode is a solo discussion and I wanted to reflect on something that is a pretty big piece that is shaping the industry right now and, and has been for years, honestly. And that is the mental health provider shortage. Talking about how that shortage is increasingly being used to promote technology led mental health tools, tech companies, what all of that means for people seeking care and for the clinicians who provide it. So today I'm gonna kind of use some articles interwoven within our context. I know we kind of talk about those at the beginning a lot of times. I'm gonna reference those as we're and those of course will be in the show notes for you if you want to take a deeper dive into those. We like to make sure that the information that we are putting out has some backing and some research or some articles behind it. So that's what that's all about for us. So I thought it would be helpful to actually define what we mean when we talk about mental health. And here's why we're talking about mental health care. And I think starting from a place of what we are talking about when we talk about mental health is important. The American Psychological association describes mental health as a state of well being in which an individual realizes their abilities, can cope with normal stresses of life, can work productively and is able to contribute to their community. So that's our kind of working definition. At the same time, we know that a lot of people are really struggling with mental health, right? Mental health is not just about reducing symptoms, it's about functioning, relationships, meaning and quality of life. So I want to walk through three kind of connected ideas in this episode and we will weave these together. First, what we know about the provider shortage and how it affects people trying to access care. That's where we're going to start. Second, how technology and AI driven tools often present themselves as solutions to that shortage. Most of the tech companies that I have talked to or people that are creating Innovative solutions often cite this as the problem, the gap, the issue that they are trying to fix. And that is where a lot of these tools come from. Often this is useful, helpful, accessible for people, sometimes in ways that function more as a band aid or for symptoms. Sometimes there's even harm. So we're going to kind of talk through all of those pieces and finally, how hybrid models where technology can support rather than replacing human therapists may be a promising direction going forward. A lot of this information comes from different podcasts that I have hosted over the past year, and so we will also reference those and kind of tell you which ones you might want to jump into if you want to get more information on those. So let's start with piece number one, which is the provider shortage and what's documented out there about the provider shortage. So there is consistent evidence that in many parts of the United States there is a significant shortage of mental health providers. A large share of the US population lives in designated mental health professional shortage areas. And workforce analysis shows that demand for services has grown faster than the clinical workforce can keep up with, particularly since the pandemic. And that is from the Commonwealth Fund and an article from 2023. So a little bit older, a couple years older data, but I think it still reflects what's happening. Professional organizations and workforce researchers point to several contributing factors. Number one is the increased demand for services. We certainly saw that with COVID and I think it has just continued. Second is clinician burnout and attrition. We are seeing lots of clinicians leave the field stating that they can't handle the workload, they can't handle the job. It's emotionally burning them out for understandable reasons. But that is definitely an issue that we are contending with. Next is administrative and billing burden. There's a lot of paperwork of requirements. Depending on the type of payers involved, that paperwork and that administrative burden can be a pretty heavy one. So that is another reason most clinicians don't love administrative work. Kind of tends to be a thing. We tend to be people people. Next is difficulty recruiting and retaining clinicians. So a lot of organizations that are trying to hire clinicians have a hard time finding right fit clinicians. Having clinicians that want to stay and learn and do the work that they do. Also reimbursement and insurance barriers, those are another big issue and I'm going to talk a little bit more about how that kind of plays out, specifically in mental health. All of these conditions lead to longer wait lists, potentially limited availability, and situations where people who want help either wait too long or, or they disengage entirely. That's from the American Counseling Association. So the narrative is real. It's definitely supported by data, and it's reflected in the lived experience of clients and clinicians. It is also very location based. There are areas with much more of a deficit of providers and other areas with an oversaturation of providers. And this is due to population size and as well as attractive places to live. One of my locations as a provider was a resort town in Colorado and there was a very, very high number of clinicians there because it was a nice place to live. That's just an example of one of those pieces. But there's also this nuance that providers are more and more going to private pay models, meaning that they do not take insurance. This is honestly because they can, they have demand. And because many insurance companies reimburse very low fees, this is often touted as the pinnacle of success in private practice circles because coping and dealing with insurance companies is a whole beast in and of itself. So for providers, if they don't have to take insurance, two things happen. They get paid more and they don't have to do all the paperwork. So there's a huge advantage to that and a lot of providers moving to that as they are able. For providers who are willing to take insurance, it's often at a personal cost to them, meaning they have less because they are accepting insurance rates instead of going rates for their services. And a lot of them have student loans. The thing about this industry is it requires at least a master's degree to do the work and then time to get licensed. And all of that is costing. And the reimbursement rates don't necessarily reflect that burden of investment that counselors and social workers in particular invest. This applies to psychologists, marriage, family therapists, art therapists, all of those as well. Um, but recently, as you know, social work and counseling in particular were not deemed professional degrees. And so I'm going to be curious to see what happens to this burden of student loans in those cases. But a lot of providers also who do take insurance choose the highest paying insurance because in order to make it work, they can't afford to take state insurance like Medicaid, Medicare, or other payers that are traditionally lower payers. Now, this does differ from state to state. There are certainly great clinicians that are able to accept that. I will also add that the paperwork administrative load for Medicaid and Medicare in particular are much higher, as well as the fight for reimbursement so those are just pieces that make providers less willing to take insurance and makes that less accessible then to people who want to use insurance, especially state insurance. So that's a little bit of a dive into that provider shortage. It's real, it's happening, and there are nuances to it. If you want to pay cash for therapy, you're gonna have no problem finding somebody. Also, if you want to do virtual therapy, you're probably gonna have no problem finding somebody. The location and using insurance and depending on what your funding source is, is a lot of what creates the gap there. So that leads us to our next section here. What counts as mental health treatment. I'm excited to dig into this because we use this term of mental health treatment and there are so many different perspectives about what this is. So Mental Health America provides a useful overview of the different types of treatment and support that people may engage with depending on their needs and level of functioning. They describe things like psychotherapy or talk therapy, medication management, case management, hospitalization and intensive services. There are things like iops, intensive outpatient programs, peer support and support groups, complementary or alternative practices, and as well as self help and recovery plans. The framework shows that there is a spectrum of supports, but the pieces generally considered clinical involve the following licensed professionals, individual assessment and treatment planning, evidence based approaches, and ongoing clinical oversight. And that distinction becomes really important when we talk about digital tools, apps or AI companions that are presented as alternatives to therapy. And I want to also talk about this idea of what is psychotherapy? Because there are so many different training programs across the country and different providers are trained differently, they're trained with different approaches and it's not all the same. So what one person says is psychotherapy is not what another person is doing as psychotherapy. And I think it's important to kind of parse that out. We think about things like someone who is trained in a basic counseling program or social work program or psychology program is trained on something called reflective listening. So that is being present, listening and reflecting back what you're hearing. That certainly can be helpful and supportive for people and has been. There are also considered in psychotherapy what I would consider like people that work on coping skills. What are you going to do? How are you going to handle big emotions? How are you dealing with your anxiety? How are you coping with a substance abuse disorder? And talking through strategies to try and things to do to help that also very useful work. But then there is sort of a deeper work kind of process that happens in our field too. That would be more about Getting to the root of the issue and, and that might be a longer term, more permanent treatment focus. Those might be things like psychodynamic therapy or emdr. All of these types of psychotherapy often require evidence based approaches with controlled studies. That would always be my recommendation, like let's look at what the research says, let's look at controlled studies and let's make sure that we have some good, clear research. We also know that the relationship base is a big healing component. Research has shown us that being present with somebody, tuning in, developing a relationship where there is understanding and connection and attachment, that is a lot of what provides a safe enough space for somebody to heal and to get well. So therapy by design is relational. We can learn skills without relationship, of course, but a lot of the other pieces of what is therapy and what is good therapy is really relationship based. So that leads me to point number three, our third section here and talking through tech and AI as solutions to the shortage and that narrative. And like I've said, there's a lot of companies that will put this out there. They are there because they are trying to increase, increase accessibility to care, which is an awesome goal. It's a powerful marketing tool, it's a powerful narrative and it's honestly important that people do have access to care. So I love the idea behind this. Certainly that has led to app based emotional support tools. You've probably seen some of those. Some of them might be like mindfulness practices or maybe they do a little bit of CBT or they're trying to teach you some skills or teach you to take time to check, check in and say, how are you feeling today? All can be supportive and helpful, but definitely not the same as psychotherapy. Then we have the AI driven chat companions. Many of these are marketed as free counseling because they're not being charged for for the most part right now, as we know though, there are some risks there. Could it be great for someone who is lonely to have AI to talk to? Could they even get some interesting perspectives and some dialogue? I think yes. And we know that there's a psychophantic bias where AI tends to tell us what we want to hear and be very, very flattering. So there's some question if that's an actual relationship where there would be more honest feedback or if AI is just telling you what you want to hear. Also we know there have been some safety situations and some legal cases and so there are some caveats and some concerns in that department. There are also platform based therapy marketplaces, so kind of going and finding your provider through these different tech marketplaces. And that certainly can be a way that helps people find someone and get into services. Those are often with actual therapists. Sometimes though not sometimes those are with coaches or different people that might not necessarily be degraded. So it's always good to look at that a little bit deeper and make sure you know what the qualifications are of the person that you are talking with. They're also employer or insurance sponsored Digital Mental health tools and again, those can be great supplements for sure. And many of these tools are framed as scalable, accessible, instant alternatives that can step in and help where human providers are not available. And that's true. Your therapist that you see once a week is not available to talk to you at 2 in the morning. That's definitely not typically part of what therapy in an outpatient model includes. So let's look at an article here. A 2025 peer reviewed digital overview of digital mental health tools called the Evolving Field of Digital Mental Health found this is from PubMed Central, by the way, that these tools can be helpful for things like symptom tracking, skill practice, stress, mild anxiety and may increase engagement, especially when used alongside clinician involvement. So all positive things. But that same review also found that outcomes are more limited when tools are used without human guidance. So when people are just logging onto an app by themselves and not talking to somebody about that process, engagement often drops over time, might start strong, then it's forgotten and integration into real world clinical care remains challenging. So these tools are most effective it seems so far, when they supplement therapy, not when they stand in for it. And the apa, the American Psychological association, has also echoed this caution in its statement on AI and wellness apps. The APA warned that generative AI, chatbots and wellness apps lack sufficient evidence and regulatory safeguards to function as standalone therapy and should not replace clinician LED care, particularly for people with significant symptoms or complex needs. So I think the distinction between symptom relief and deeper healing work becomes important here. AI and chatbot tools are appealing because they are immediately available, they are low cost or free. They are less intimidating maybe than sitting and talking to a person and also framed as on demand to support. And for some people I do think those can be helpful options, but they really function more as a band aid or a tool that tries to help but might not have the deeper relationship relational developmental contextual issues that people seek therapy for. The Society for Psychotherapy has written about this difference in the context of human clinical judgment versus algorithmic systems, noting that psychotherapy is grounded in empathy, trust, context and complex relational understanding. Qualities that AI systems cannot authentically replicate even when they appear conversational. So that is an article that was interesting to me on this topic as well. When AI and app based tools can be helpful, it's really to support symptom work and not so much deeper healing work. So it seems that the last part I want to talk about, we are kind of evolving to a place and several of the guests that I talked to were advocating for this, which is more of a hybrid care where tech may be most useful. So maybe it's about technology being used effectively when it supports highly trained human clinicians rather than standing in for them. Cases where technology has the greatest potential are not necessarily replacing therapy, but in reducing parts of the work that make the profession harder. Things like documentation and paperwork, scheduling and billing, administrative functions, insurance and authorization processes and workflow burden. Most therapists find great benefit honestly from using AI for these kinds of things. It does have the potential to reduce the administrative load, streamline processes, support continuity of care in between sessions, and help clinicians spend most of their time doing the actual therapeutic work they're trained for. So if we combine tools here with the human expertise in the relationship, then maybe that's a great outcome. I will share that. A personal opinion here is that one of my greatest concerns remains that with any kind of AI recording a session in order to produce the notes and also sometimes provide feedback, observations about patterns in the sessions. My biggest concern is the security of the data. I mean, this is how we're trained. Protect privacy. Protect privacy. Protect privacy. So where does this recording go? Do we know that that's where it goes, what is mined from it and who really owns it? I have talked with several companies about this. I have not yet gotten an answer that makes me comfortable enough to use it personally, though I do think when we're training clinicians, often recording a session is part of the training process. So we do use this in our field and typically when that's done, it is used on like a personal device and it is deleted immediately afterwards. No data mining, no nothing. So that might be a safer way for us to allow AI to record. But then what does that AI system do with that recording? I think there are lots of different thoughts on how safe this is or how not safe this is. And each person needs to choose for themselves what they're comfortable with. I also believe that if a clinician is not writing a note, I think they're losing part of the clinical process because in writing the note you are required to synthesize the session. You are required to draw out highlights, important pieces, things that you're working on, things that you want to bring back in the next session. And I don't know if AI writes the note and the clinician just edits it, do we get that same mental benefit of conceptualizing our client and what their needs are? It's a question that remains to be seen for me, but some of my favorite conversations on this podcast over the past year have come from leaders who think about technology in exactly the way of this hybrid approach, something that can support human therapists and practice systems rather than compete with them. If you want to go back and listen to those, they are the recordings, the podcasts from a Jetta Robinson, Jordan Harris, Dylan Ross, Uriah Gulford, and Jeremy Zug. They all had really thoughtful perspectives about hybrid about tech assisted models that still center on the clinician, and about ways to use AI in supporting workflow. So we'll definitely link those episodes to the show notes so that you can jump in to that at any time you want to now sum up thanks for listening today to this episode. I really wanted to spend time looking at the provider shortage, what AI and tech companies are doing to bridge that gap, as well as what we can do to maximize the greatest benefit. A therapeutic benefit for people seeking services, people who want to do that deep healing work. How do they get that? People who are just looking to learn a few new skills, what's their best approach? And I think some of this is going to come down to educating people on what different services look like, what to expect from different services, and what a psychotherapy practitioner actually does. So I'm hoping as a field we can educate people more about that. We can help people find what they're looking for, and maybe we can even triage people to be able to say, you know what, that skill building app would be perfect for you. Or you need hospitalization all the way on the opposite side of care so that we're getting people to the right places and hopefully continuing to train excellent clinicians to provide these services. So thank you for listening if this conversation resonates with you, whether you're a clinician, a group practice business owner, or someone who has tried to navigate these options as a client. I'd love to hear your thoughts. We'll be back in the next episode to explore more issues with more guests shaping the mental health care landscape. There continues to be so much happening so quickly. We want to help keep you informed. Thanks for listening. Bye for now thanks for listening to