Mental Health Basest

This is an ad on Instagram from Basis, a putative mental health startup. I do not like it.

According to the company’s website, Basis provides on-demand mental health support from “specialists… who have completed a comprehensive training program.” Users can book 45 minute phone or video sessions to talk to someone about stresses, fears, anxieties, etc. You know, like therapy.

Here’s the rub. These “specialists” aren’t mental health professionals. They’re just people who have completed Basis’s training program and then been deemed qualified by the company. From The Verge:

Basis does not offer traditional video or chat therapy. Unlike apps like TalkSpace, Basis doesn’t connect you to licensed therapists, who are governed by professional boards and have at least a masters’ degree in social work. The service connects you to Basis specialists that complete about 15 hours of online training and, according to its website, don’t need a healthcare background or formal training in psychology. A GED, emotional intelligence, and a desire to help might be enough. (For context, training for the volunteer suicide hotline Samaritans involves eight three-hour modules and observing a mentor for up to six months.)

Basis claims that this makes mental healthcare more accessible by making it cheaper and easier to navigate with a low-intensity solution suitable for most people. Not everyone needs some expensive doctor with a fancy medical degree after all, right?

The solution to our mental health crisis is not sham telemedicine. Licensure in healthcare is not a formality. It’s how we set and enforce standards for training and clinical practice.

You cannot simultaneously argue that mental health is important/should be valued and also that any old schmo can do it. You wouldn’t go to your buddy to figure out a heart condition or cancer if s/he weren’t a physician. Your mental health is no less important or delicate.

Basis CEO Andrew Chapin is right in arguing that there’s deep problems of stigma against treatment and lack of affordable options. And he’s also correct that not everyone qualified to provide mental health treatment has to be an MD or PhD. Social workers, counselors, and certain nurse practitioners are all trained and licensed to provide mental health treatment. It’s an insult to their expertise and dangerous to patients to pass off Basis’s fly by night counseling as real care.

Licensure is important because some outside body is enforcing a standard (however arbitrary it may be). Otherwise we’re left to self policing. So the standards may not be good enough but they exist for a reason. If Basis (or anyone else using unlicensed practitioners) is being sketchy there’s zero accountability or redress.

Mental heath care is too expensive. The need to improve access/affordability is tremendous. But this ain’t it. I think the most effective lever would be to improve insurance coverage and bring more practitioners in-network. There’s so much waste in healthcare. Eliminating waste is another way to improve CoGS and therefore improve access. Finally there’s tons of underemployed social workers and counselors who would love to pick up extra work they can do from home. That’s an available labor pool of qualified professionals for exactly what Basis claims to be building.

All of these are much harder than on-demand randos but hard things are hard.

Now I’m sure Basis’s lawyers have vetted their marketing communications enough that nothing the company is saying is illegal but that doesn’t mean it’s ok. Maybe the licensing standards are bad. Maybe they’re overly restrictive. Maybe anyone really can provide quality mental healthcare (NB: the research says they can’t). Maybe someone needs does need to challenge the status quo. Even if all that is true, one has to wonder the costs and risks of just plowing ahead.

One the most common questions we get at Tusk is whether it’s better to ask for forgiveness or permission. Should startups work to navigate the system or should fight to break it? Time and time again the answer is “it depends.” It depends on context and laws and necessity. Most of all it depends on the consequences of getting it wrong.

At Tusk we are, basically as a rule, investing in companies and founders pushing the limits. Sometimes that even means operating in flagrant opposition to them. But the key is always to understand whether or not companies are operating in good faith. Do they understand the importance of what they’re doing and are they committed to acting as faithful stewards of their customers/users’ (in this case, patients’) trust?

I am down for pushing boundaries in critical areas only when I really really trust the founder and his/her intentions. But I don’t see Basis as a good faith effort. It feels crass and cynical. They’re just waving their hands and saying “research.” It’s some ex-Uber guy who saying “sometimes people yelled at me at Uber and I wanted to vent” so he literally invented Uber for emotional labor.

This is not how we’re gonna solve mental healthcare. But I’m sure as hell excited about all the serious people doing good work to try.