So far this year, Kristen Engleman has cycled through three therapists in six months.
Engleman, 41, signed up for Talkspace in February, after breaking up with her partner, contracting COVID-19 and facing an unexpected pregnancy the year before. She had heard about the teletherapy provider through friends and decided to give it a try. Because the fine-dining restaurant where Engleman works does not offer insurance, she paid $275 per month for access to a Talkspace therapist.
The first therapist she messaged through the platform never responded. The second had a couple of sessions with Engleman before announcing she was leaving the platform. Engleman stayed with the third one for about three months, when she decided she needed to see a specialist in person. Although she had paid for phone, text and video visits, she said she only used texting with her providers, out of convenience.
"I guess with therapy, you get what you pay for, which is unfortunate because it's so expensive," Engleman said. "I don't have insurance, but even if I did, I think it would be kind of a hassle because it's always a nightmare to find a provider. This is cutting out the middleman on that."
While Engleman's experience with Talkspace may be unique, her decision to try digital therapy was not. In 2020, consumers rushed to digital treatments to soothe their anxiety over COVID-19, and investors watching the shift from in-person care opened their wallets. By the end of the year, investment in mental health startups reached a record of $1.5 billion, with no sign of a slowdown.
Teletherapy platform Ginger joined the unicorn club in March, after raising a $100 million Series E round that brought its valuation to $1.1 billion. LifeStance Health Group went public in early June, with an outsized IPO valuing the in-person clinic and digital therapy provider at $8 billion. Talkspace entered the public markets through a special-purpose acquisition company on June 23 in an IPO that valued its therapy services at $1.4 billion.
While teletherapy apps have traditionally been a cash-pay industry, employers, insurers and even government agencies are now partnering with these services to provide members access at scale. In April, Cigna announced it would offer Ginger as an in-network service for its 14 million members. LifeStance boasts contracts with more than 200 payers. City Council members in Reno, Nev., decided to spend the city's $1.3 million in CARES Act funding on a contract with Talkspace, offering the service free to any Reno resident over age 13.
"I think many people believe that this is the future of all kinds of care," said Hannah Zeavin, author of the forthcoming book The Distance Cure: A History of Teletherapy.
But as interest in these apps grows, companies are scrambling to prove their products actually work. Startups are partnering with research institutions to publish studies, but the companies' involvement in producing these reports raises some questions about their influence on the results, Zeavin said.
Without independent research on these tools' efficacy, she said most payers are relying merely on companies' marketing, and price, as a way to differentiate among the more than 20,000 apps available today. As more mental health and digital therapy startups enter the market, Zeavin said payers must demand that businesses compete to be in their networks based on verifiable patient outcomes.
"One of the problems with these proprietary platforms is that, because they're about scale and because they're about profit, it's much harder to adjudicate what's working or not working on the grounds of the unit that actually needs to be thought about, which is the patient," she said.