Even before the pandemic, apps like Talkspace and Betterhelp were becoming an increasingly popular alternative to traditional mental health services. The explosive growth of these companies has attracted major investment, and with it, new questions about access and equity in mental health.

Talkspace recently became the first tele-mental health app to become a publicly-traded company, outperforming expectations. Ariana Grande announced a $1 million donation in free therapy from BetterHelp. At first glance, companies like Talkspace and BetterHelp, appear to be a brilliant solution to meet a growing need for mental health services. Over 40% of Americans in the United State have faced issues related to mental health or substance use. With the pandemic, a record number of Americans struggled with mental health issues related to the impact of COVID-19.

On the surface, it would seem positive that more people are able to access the help they need. However, we must also take a critical look to examine the gaps in healthcare that drove the need for these apps in the first place. Talkspace and BetterHelp exist because the U.S. healthcare system is not affordable for many Americans. However, despite their popularity, apps like Talkspace and BetterHelp are not a replacement for the quality, accessible mental health services we need.

Questions remain about the viability of therapy apps as a bridge over the gaps in our mental healthcare system––not to mention the effectiveness of the therapy itself.

Talkspace’s IPO follows a trend of commercialization that reinforces healthcare as a privilege, not a right. The core purpose of publicly traded companies —to provide investors with a return on their investment — is often incongruous with healthcare providers’ mandate to put patients first.

When healthcare is run solely based on meeting business-related goals — profit is often prioritized before access — providers and patients suffer. Doctors and nurses face high rates of burnout as they often are pressured to generate revenue.

The mental healthcare field is no different. We’re already seeing the negative effects of commercializing mental health services, with telehealth therapists reporting feeling overworked and underpaid after working for tele-mental health apps.

As the business and healthcare sectors seem to be merging at a rapid pace, we must take proactive steps to increase access and ensure equitable access and care. The cost of tele-mental health services ranges from approximately $280 a month to $400. Though some insurers began covering tele-mental health apps amid the pandemic, Talkspace and BetterHelp services are still out of reach for many.

There are steps these companies could take to address these issues. With a new influx of capital from the IPO, Talkspace could consider offering services on a sliding scale based on clients’ incomes. They could also make their pricing model easily accessible without signing up for the service––in order to know how much Talkspace costs, a potential client has to sign up.

At the same time, we cannot rely solely on corporate goodwill to address a systemic challenge. Amid a changing national conversation around health and race, many companies have taken steps to demonstrate their commitment to health and racial equity––without addressing fundamentally inequitable business models.

Talkspace’s plan to provide a $100,000 in-kind therapy donation for members of the Black community is laudable but negligible in comparison to the billions in funding needed to meaningfully increase access to mental health services for Black Americans. In line with the push to collect and share more data about the diversity of the health workforce, Talkspace and BetterHelp should also share the diversity of their provider base.

The U.S. should consider passing legislation that increases corporate social responsibility and accountability, especially as it relates to private health companies.

I want to be clear: This is not an indictment of telehealth as a practice. In fact, tele-mental health services can dramatically expand access to mental health services, provided the right infrastructure is in place.

In response to the COVID-19 pandemic, many states have instituted waivers that allow traditional therapists and clients to engage in therapy online. Many of these waivers will be expiring 90 days after the state ends the “state of emergency.”

We must pass comprehensive legislation that will allow access to quality behavioral health services via telehealth for Medicare, Medicaid, and privately insured patients, permanently.

Ultimately, to ensure that patients can access mental healthcare services, we need to invest in a health care system that prioritizes individuals, regardless of ability to pay. The COVID-19 global health pandemic has exacerbated gaps in coverage and access to healthcare.

Many people lost jobs with employer-sponsored health insurance due to the pandemic, demonstrating the precariousness of tying insurance to employment. These challenges dramatically reduced access to mental healthcare services during a time when they were needed most, particularly for low-income and minoritized communities.

Every person should have a right to a healthy life. As we confront the impact of the pandemic, we have an opportunity to make meaningful changes to our social systems that will support the health and well-being of all Americans, especially our most marginalized.

The more we rely on private companies to sell the care and support we should be offering communities as a basic human right, the higher the risk of people falling through cracks that are growing wider every year.

We need to increase healthcare companies’ accountability to their patients and workforce, while also investing in public mental health infrastructure to ensure equitable access to all.

Randl Dent, Ph.D., is an Equity Scholar and Research Scientist with the Fitzhugh Mullan Institute for Health Workforce Equity at George Washington University and program evaluator with the Atlantic Fellows for Health Equity. She is a recent graduate of the health psychology Ph.D. program at Virginia Commonwealth University.

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