‘Alarm bells should be going off’ as mental health counselling app expands into Australia, critics say

Consumer advocates are calling on the privacy regulator to investigate the “Uber of therapy” platform BetterHelp as it expands in Australia, after a US ruling that the company shared customers’ sensitive data to third parties.

BetterHelp – known to many because it is the second-largest advertiser on podcasts in Australia – claims to offer affordable and flexible online therapy. But experts have warned the commercialisation of healthcare in Australia could compromise patient data and reduce the quality of care that therapists provide when acting as “gig workers”.

The US Federal Trade Commission in 2023 required BetterHelp to pay US$7.8m to customers to settle charges it had shared customers’ email addresses, IP addresses and answers to personal health questions with platforms including Facebook and Snapchat – despite promising to keep the data private.

In a report published on Tuesday, the consumer advocacy group Choice said Australia lacked the regulations needed to cover online mental health platforms such as BetterHelp. The platform’s growth coincides with increasing demand for mental health services.

Choice found that BetterHelp had increased its advertising on social media and podcasts, including offering Australians a free session if they sign up in June. The platform has also done deals with Australian influencers and posted job ads on LinkedIn to recruit local counsellors, psychologists and social workers.

Choice’s consumer data advocate Kate Bower and the former privacy commissioner Malcolm Crompton said overseas wrongdoing by BetterHelp meant the Australian information commissioner should investigate whether the company had breached local privacy laws.

“Australian consumers deserve to know what BetterHelp has been doing with their data here and we’re urging the privacy commissioner to investigate any potential misuses,” Bower said.

BetterHelp has changed how it tells users about its data-sharing practices after the FTC action. The company acknowledges in its lengthy privacy policy that it shares an encrypted version of a client’s email address with advertising partners.

That means if a BetterHelp customer uses the same email address when setting up a social media account, the latter knows whether the user has accessed the mental health service, Bower said.

This helps BetterHelp target its advertising spend on social media because the social media platforms can advise what other users may have similar characteristics and therefore be more likely to purchase BetterHelp.

Crompton told Choice he believed the data gathered and shared by BetterHelp with Facebook would be classified as “health information” under Australian law and be considered “sensitive information” under the Privacy Act.

Dr Piers Gooding, a La Trobe University researcher on disability and health issues, said BetterHelp’s model was the “Uber of therapy” – it connected patients to therapists on demand.

But, referring to the FTC’s findings, Gooding said: “When a company is seeking to expand its market reach at the cost of deceiving customers as an acceptable cost, then alarm bells should be going off.”

Gooding warned the platform could reduce pay to counsellors and reduce the quality of service over time to maximise profits – much like Uber put downward pressure on driver pay.

BetterHelp charges a monthly upfront fee of A$90 to $120 a week allowing users to access one 30- or 45-minute live session with a therapist per week and messaging with their therapist. There is also a journal feature on the app, webinars on mental health topics and worksheets assigned by their therapist.

Frances Carlton, a clinical counsellor in New South Wales, said she was paid US$145.22 ($219.91) for seven 45-minute sessions with clients on BetterHelp’s platform.

Frances Carlton says that for seeing four clients via BetterHelp, ‘I got paid less than I would have done for seeing one client in my office’

For therapists who work five hours or more in one week, BetterHelp pays US$35 an hour. The rate is US$40 an hour for those who work more than 10 hours, US$45 for over 15 hours and up to US$70 for 40 hours a week.

Carlton said all seven of her sessions ran over 45 minutes but because the platform does not pay therapists overtime and deducts pay if a client logs online late, her weekly total came in under five hours so she was paid a US$30 hourly rate for her week’s work.

Carlton, who in her private practice charges $150 an hour for patients she usually sees on a fortnightly basis, said: “For four clients I got paid less than I would have done for seeing one client in my office.”

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The fee structure Carlton was provided by BetterHelp

Carlton said therapists would need to see 48 clients in a week to work 40 hours. “As a clinician, there’s no way you can give good service and good attention to clients with that volume of work.”

A 2021 survey by the Psychotherapy and Counselling Federation of Australia found most counselling and psychotherapy fees were between $100 and $160 an hour, while the Australian Association of Psychologists’ recommended fee for a psychologist is $315 for a standard 40- to 60-minute consultation.

Carly Dober, a psychologist and director of the association, said the recommended fee reflected the true cost of the psychologist providing the service, while BetterHelp’s fees “puts tremendous pressure on the person to put in long hours to earn a reasonable living”.

“This is what the gig economy looks like,” Dober said.

Carlton claimed that “the only clinicians who would sign up to BetterHelp and stay with them are newly graduated clinicians who can’t get a job but need to get experience with clients”. She argued they weren’t necessarily best suited “because they need to have regular supervision and run ideas past people”.

A spokesperson for BetterHelp said: “We value our therapists and understand the importance of fair compensation.”

The spokesperson said therapists were offered competitive compensation of up to A$137,410 a year based on 52 working weeks – but actual earnings varied due to conversion rates, caseload and client engagement on the platform.

“We are confident in the quality and safety of our offerings.”

BetterHelp also said: “Private information like members’ names or clinical data from therapy sessions that BetterHelp members share with their therapists over text, phone or video call is never shared with a third party and never has been.

“Following the FTC settlement, we have implemented additional measures to enhance data privacy and provide clear information to our users about how their data is used,” the spokesperson said.

Its data-sharing practices complied with Australian legal standards and prioritised consumer privacy with an opt-out function, BetterHelp said.

Dr Elizabeth Deveny, the chief executive of the Consumers Health Forum of Australia, said: “This push by an overseas mental health supplier I think provides us with another example of how the Australian healthcare system is continuing to be commercialised by private organisations.

“We are really concerned by cases of illegal patient data sharing we have seen overseas. Patient data is sacred in Australia and must remain so,” Deveny said.

Guardian Australia has previously run ads from BetterHelp on its podcasts.

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