Continuing our conversation about the NYT’s investigation into the practices at Talkspace, the remote mental health therapy app.
The problem stems from running a healthcare service like this as a business. Worse, a startup. Having spent the vast majority of my professional life at startups, I am all too familiar with the incentives to scale, to perform according to metrics, to employ ‘growth hacks’. When a healthcare startup employs these, the effects are much worse than a game or a social media app.
[the company] has questionable marketing practices and regards treatment transcripts as another data resource to be mined. Their accounts suggest that the needs of a venture capital-backed start-up to grow quickly can sometimes be in conflict with the core values of professional therapy, including strict confidentiality and patient welfare.
In 2015 and 2016, according to four former employees, the company sought to improve its ratings: It asked workers to write positive reviews. One employee said that Talkspace’s head of marketing at the time asked him to compile 100 fake reviews in a Google spreadsheet, so that employees could submit them to app stores.
When convenient, the company spins itself as a healthcare provider: “users can’t delete their transcripts, for example, because they are considered medical records.”, but those transcripts are used by the company for customer engagement and retention:
[A therapist on the platform] said that after she provided a client with links to therapy resources outside of Talkspace, a company representative contacted her, saying she should seek to keep her clients inside the app… “I was like, ‘How do you know I did that?’” Ms. Brennan said. “They said it was private, but it wasn’t.”
Finally, the disconnect between offering a private healthcare service and the exigencies of operating a startup is clear in the company’s public statements:
On Nov. 9, 2016, the morning after the election of Donald Trump, Mr. Frank wrote on Twitter: “Long night in NYC. Woke up this morning to record sales.” The Trump election tweets are examples of the sometimes unfiltered social media presence of Mr. Frank and Talkspace — an irreverence familiar among start-ups but unusual among organizations devoted to mental health care.
In 2016, a man named Ross complained on Twitter that the company’s subway ads “were designed to trigger you into needing their services.” Talkspace’s official Twitter account responded, “Ads for food make people hungry, right?” and added, “I get what you’re saying, Ross, but medical professionals need people to buy things.”
The problems of misincentives of private healthcare are well known and well debated, though nowhere close to being resolved. And startups get a lot more attention than a more traditional healthcare provider would. And Talkspace may have begun with noble ambitions. Regardless, what it has built isn’t anywhere what I think mental health care tech should look like.
How it approaches conflict between what is good for itself versus what is good for its customers – patients – diminishes trust. When it come to data privacy, to marketing, to its incentives for therapists, its responses indicate that it will choose its financial health over people’s mental health. Unfortunately, it’s likely similarly funded venture-backed tech companies in healthcare have similar conflicts and pressure.
(Part 3 – How I’d approached a simple mental-health chat service)