The failed promise of online mental-health treatment

Remote treatment of mental-health problems surged in the pandemic, as in-person treatment became difficult while pandemic-driven isolation increased anxiety and depression. Digital mental-health companies plunged in, promising to provide millions with access to high-quality care by video, phone, and messaging. Many of the businesses, however, put a premium on growth. Investor-backed, they deployed classic Silicon Valley tactics such as spending heavily on advertising and expansion while often using contractors instead of employees to control costs. A strategy designed for mundane businesses such as food delivery, the formula can be badly suited to the sensitive activity of treating mental-health problems. After Caleb Hill told his parents he was gay, he was kicked out of the house. He had been taught, growing up in a conservative Christian household in Tennessee, that his attraction to men was a grave sin.

Feeling isolated and depressed a few months later, Mr. Hill, then 22, thought therapy might help. He had heard podcast ads for BetterHelp, a company that provides therapy remotely and promises “a personalized therapist match that is tailored to your preferences and needs.” His biggest concern was he missed his family. The therapist he was given, he says, recommended he try to stop being gay so he could go back to them. “He said if I chose to go back to who I was and deny those feelings, he could get me where I needed to be,” Mr. Hill said. Mr. Hill had requested an LGBTQ+ therapist, a screenshot of his intake form shows. BetterHelp gave him one who didn’t specialize in LGBTQ+ issues, according to the provider’s profile on its website, and whose personal website says he practices Christian counseling. “He said either you sacrifice your family or you sacrifice being gay,” said Mr. Hill. “I needed someone to tell me I was gay and that was OK. I got the exact opposite.” BetterHelp declined to comment on Mr. Hill’s experience, citing patient confidentiality. The therapist wouldn’t discuss him either, citing the same reason.