Since I have had revenue streams on my mind lately, I thought it would be helpful to share important considerations when partnering/contracting/otherwise working with companies. There are hundreds of mental health startups, all claiming to have the solution for mental health care, but their quality varies, with many openly violating the laws and ethics codes we are required to uphold. Some blatantly mistreat the therapists they hire or grossly underpay us.
What do you need to keep in mind when choosing your partnerships?
Many therapy startups are run by people in the tech field, with little or no input from mental health providers. These individuals are not bound by the ethical codes that a licensed mental health provider must follow and, although I would argue that they have a responsibility to be aware of and follow these codes, they typically choose not to.
Your licensing board will not accept “But it wasn’t me, it was the company” if you cross an ethical or legal line when working for one of these companies. It is up to each provider to ensure that they are working with ethical companies. Your integrity is on the line with every partnership you make.
Not to mention, why would you want to work with an unethical company?
If you are engaging in any kind of clinical work with a company, you must ensure that the company’s product, platform, and policies are all HIPAA compliant. Again, the tech folks creating these platforms might not be bound by our legal and ethical requirements, but we must still uphold them in our work.
Earlier this year, BetterHelp was fined for illegally selling client information to third-party advertisers. BetterHelp has been under scrutiny for years for illegal practices, but therapists continue to accept jobs with them.
If you knowingly work with a company that is violating HIPAA, you are violating HIPAA. Any client receiving a payout from BetterHelp’s recent fines could potentially report their specific therapist for providing services through the platform. You might be able to document that you were not aware at the time (BetterHelp’s fine includes a reprimand for advertising themselves as HIPAA compliant when this was not true), but make sure you have done your diligence on this.
After the BetterHelp judgment went public, I contacted every company I work with. I sent them the article about BetterHelp’s fine and reminded them that I had asked if they were HIPAA compliant before I started working with them. I asked if this was still true, and I asked if they had any policies similar to BetterHelp. They all responded that they have never and will never sell client data, and they will always provide HIPAA-compliant services.
Now, I not only have reassurance, but I have documentation of their claims in writing.
I have heard horror stories from colleagues about telehealth companies requiring absurd time commitments and workloads. Some expect providers to see huge caseloads, and some require responses to any and all client messages within a certain timeframe (sometimes as few as six hours!) regardless of when the message comes through. That means, if a client emailed you at 3am on Christmas day (assume for this hypothetical scenario that you celebrate Christmas), you would be contractually obligated to reply to them by 9am that same day.
What is a reasonable workload for you? What are your boundaries around your work? Say no to companies that will not honor your needs.
I often speak about how therapists are under-paid. Many telehealth companies are awful about paying a living wage, with some offering as little as $35 per session.
(Remember, this is for a job that requires a master’s degree and annual licensure/continuing education that can total in the thousands. Furthermore, $35 per session is not the same as $35 per hour. For every hour spent in session, we have about an hour of treatment planning, marketing, consultation, documentation, emails, phone calls, et cetera.)
You deserve to be compensated appropriately for your work and expertise. Do not settle.
When I first started accepting EAP clients, I actually had very little availability in my practice. I said yes to the contract because the company also offered continuing education to therapists in their network, as well as other mental wellness products to their clients. I wanted those opportunities, and I learned that they chose their teachers and developers from their network of therapists.
So, I made myself available for one hour a week to get my foot in the door. Now, I do therapy, education, and other mental health products with this company.