Speaker 1: From Schwartz Media. I'm Daniel James. This is seven am.
Speaker 1: If you listen to podcasts, and let's be honest, there's
Speaker 1: a fair chance that you do, it's likely that you've
Speaker 1: heard ads for a thing called Better Help. It's an
Speaker 1: app offering flexible, affordable therapy whenever you need it, kind
Speaker 1: of an uber for therapy. Now, the American based Downers
Speaker 1: are expanding the app further into Australia, recruiting Australian psychologists
Speaker 1: to try and capitalize on the failings of a mental
Speaker 1: health system which could be difficult to navigate and one
Speaker 1: which is buckling under the weight of demand. So we
Speaker 1: actually better off with Better Help and apps like it. Today,
Speaker 1: on the show the Ubification of Mental health Care in Australia,
Speaker 1: doctor Ahuna Gouer is a clinical and forensic psychologist specializing
Speaker 1: in complex trauma, and she tells us why a gig
Speaker 1: economy for a psychologist isn't the answer to our flailing
Speaker 1: mental health care system. These are her views only, and
Speaker 1: we're glad she shared them with us. It's Friday, August
Speaker 1: sixth day. Doctor Rahina, when did you first start hearing
Speaker 1: a bit of help?
Speaker 2: I think i'd say I first heard a bit Better
Speaker 2: Help about ten years ago, and that was just when
Speaker 2: I was listening to a range of podcasts back in
Speaker 2: my pre psychology days when I had more time.
Speaker 1: This show was sponsored by Better Help.
Speaker 3: You know, Mitch, I have some self care non negotiables.
Speaker 4: I never skipped leg day and I never skipped therapy day.
Speaker 5: Wow, it's good for you.
Speaker 1: Better Help as an online counseling service, okay.
Speaker 6: It offers licensed professional counselors who specialize.
Speaker 1: In issues like depression, stress, anxiety, relationships, sleeping, anger, family conflict,
Speaker 1: self esteem and more.
Speaker 4: And I didn't have a boyfriend of text anymore, so
Speaker 4: I was like, might as well text a therapist and
Speaker 4: it was really, really a great experience. So we have
Speaker 4: an awesome offer for people who listen to the Daily Detectives.
Speaker 2: So kind of vaguely been aware of them for a
Speaker 2: while and certainly knowing that they've been a very very
Speaker 2: big digital mental health provider in the States because they
Speaker 2: don't have the same healthcare system as we do here.
Speaker 2: But in terms of when I realized I started to
Speaker 2: see them more in the Australian market, look, I'd say
Speaker 2: that was probably about two to three months ago. I
Speaker 2: started to just see ads coming up, both on LinkedIn
Speaker 2: because they were trying to advertise for clinicians, and then
Speaker 2: also on my social media where it looked like they
Speaker 2: were trying to target clients. So I was quite alarmed,
Speaker 2: honestly to see it start to creep into the Australian market.
Speaker 2: I was starting to wonder whether this would be attractive
Speaker 2: to clients who wouldn't really be stopping to maybe think
Speaker 2: through the implications of signing up for a tech entrepreneur
Speaker 2: based app like this.
Speaker 1: So from a patient's perspective, what's the difference between logging
Speaker 1: onto this app and seeking treatment through that app as
Speaker 1: compared to going and seeing someone like yourself.
Speaker 2: So I'm a clinical psychologist and I work in both
Speaker 2: the public and the private mental health spaces, and obviously
Speaker 2: I can't speak for the entire public mental health system,
Speaker 2: but effectively, when you come into either of these services,
Speaker 2: you're typically referred by someone else, usually a GP, sometimes
Speaker 2: another healthcare provider. You come in, you'll do a range
Speaker 2: of assessments where we get a really good history as well.
Speaker 2: So it's quite detailed, it's quite intensive. It's usually assessment
Speaker 2: based initially because it's not that I'm trying to diagnose
Speaker 2: and stop labels onto people, but it's more that that
Speaker 2: helps me provide better treatment once I've identified what a
Speaker 2: person's issues are, so my understanding of better health. What
Speaker 2: you do is you sign up. You fill out a
Speaker 2: question just like you know I've done for my dog's
Speaker 2: pet food delivery, but slightly slightly different.
Speaker 5: Starting your therapy journey has never been easier with betterhelp.
Speaker 5: When you first come to the site, we'll ask you
Speaker 5: some questions about yourself and what you're looking for in therapy.
Speaker 5: We use this information to match you to one of
Speaker 5: our licensed therapists.
Speaker 2: I don't really know how they actually match and triage,
Speaker 2: but I can say that both in the public and
Speaker 2: the private mental health systems, you're thinking through things like
Speaker 2: the complexity for clients needs, the seniority of a clinician,
Speaker 2: the type of intervention, and whether you're well matched and
Speaker 2: well suited to each other.
Speaker 5: You'll get an email once you've been matched. This usually
Speaker 5: takes less than forty eight hours.
Speaker 2: So you're matched, and then you have a shorter session
Speaker 2: of wait thirty to forty five minutes based on how
Speaker 2: much you're paying their charges. At this point in time
Speaker 2: are Australia ninety dollars or one hundred and twenty and
Speaker 2: if you pay the higher rate, you get the capacity
Speaker 2: to basically text your psychologist. Been quite an unlimited capacity,
Speaker 2: and you're told that they'll log in twice a day
Speaker 2: to respond.
Speaker 5: As soon as you're match to, your therapist will introduce
Speaker 5: themselves and ask you some questions to get to know
Speaker 5: you better. This is your chance to get acquainted with
Speaker 5: your therapist.
Speaker 2: So it's really subscription based, kind of like Netflix for
Speaker 2: mental health net Netflix.
Speaker 1: It's good for mental health, isn't it?
Speaker 2: Well? I suppose it depends on what you're watching, but
Speaker 2: from the perspective of a clinician, it's more like uber
Speaker 2: or psych You know, it's really starting to bring the
Speaker 2: gig economy into what is traditionally not a gig economy
Speaker 2: space at all.
Speaker 5: Yeah.
Speaker 1: Right, It's pretty easy to see why a gig economy
Speaker 1: around mental health has opened up. Affordable and timely access
Speaker 1: to mental health professionals is a pretty appealing proposition, isn't it.
Speaker 2: Look I do agree. I think we have a very
Speaker 2: very tricky mental health landscape across the world. You're in
Speaker 2: a reasonably unique situation here because we do have access
Speaker 2: to Medicare. Look, we certainly know that waitliss a spiral
Speaker 2: and especially for more specialty services. But I do know
Speaker 2: that absolute better help can't actually provide services to people
Speaker 2: who are seeking assessments and things like that in the
Speaker 2: fine printers vary. The KB it that they can't write
Speaker 2: let us for cod they can't do medical legal reports,
Speaker 2: and they obviously can't prescribe medication. Now when you see
Speaker 2: a psychologist here, we also can't prescribe medication. But what
Speaker 2: often happens is we work as a care team, especially
Speaker 2: for more complex mental health issues. You know, if you're
Speaker 2: thinking something like PDSD, serious media depressive disorder, psychosis, bipolar,
Speaker 2: we all work together to effectively coordinate some of our interventions.
Speaker 2: And my understanding is that app based platforms like better
Speaker 2: Help just don't allow access for that because there's no
Speaker 2: contact outside of session with a person's treating team. And indeed,
Speaker 2: I believe that users can remain anonymous, which I think
Speaker 2: is very ethically mablematic because if there's a crisis, you know,
Speaker 2: therapist is left holding that and doesn't know who to contact.
Speaker 1: So there's a series of larm bells related to these
Speaker 1: type of apps, But the mental health system that we
Speaker 1: have isn't perfect either, and people are continually falling through
Speaker 1: the cracks. Shouldn't we embrace the disruption of it all?
Speaker 2: So I'm not saying that app based services don't have
Speaker 2: their place. There's been very little research into the actual
Speaker 2: effectiveness of most app based services, and most that have
Speaker 2: been assessed for effectiveness in terms of reducing symptoms with
Speaker 2: things like text messages have been shown that they don't
Speaker 2: actually work. So there is hope to try new approaches
Speaker 2: and absolutely acknowledging that the mental health state in Australia
Speaker 2: is terrible and I don't feel like there's a lot
Speaker 2: of federal political will at this point in time to
Speaker 2: improve that. But therapy is not one eight hundred for
Speaker 2: a friend, you know. It's really about helping you talk
Speaker 2: through your symptoms when you're there in session, and building
Speaker 2: ways to cope outside of therapy. And I really do
Speaker 2: worry that that kind of constant possible contact leads to
Speaker 2: a level of dependence and people just never exploring or
Speaker 2: actually using the skills. You know, we have to be cautious,
Speaker 2: we have to test, we have to work based on
Speaker 2: the data and not on what sounds like a good
Speaker 2: idea or on what's going to help this app make money?
Speaker 1: Should you be worried about your data when using one
Speaker 1: of these apps that's coming up, doctor Ahona, Patient data
Speaker 1: and it's privacy is paramount any sort of healthcare setting. Absolutely,
Speaker 1: when it comes to mental health, particularly, there's differently an
Speaker 1: expectation that what you say is private between you and
Speaker 1: your practitioner. What does the app actually do with the
Speaker 1: information that you give it?
Speaker 2: I don't know. So I know that there's been a
Speaker 2: very very big case brought against Better Help.
Speaker 6: All right, we're keeping an eye on your wallet tonight.
Speaker 6: You may be entitled to a refund if you used
Speaker 6: online therapy through Better Help because they're accused of selling
Speaker 6: information about your mental health.
Speaker 3: The company agreed to a seven point eight million dollars settlement.
Speaker 3: This is what the FTC. The agency says Better Help
Speaker 3: promise to keep users information private, But the FTC says
Speaker 3: your information was given to Facebook, Snapchat, Pinterest for advertising purposes.
Speaker 2: They sold consumers private data. So we're talking things like
Speaker 2: email addresses and responses to the mental health questions that
Speaker 2: people complete as part of the intake. So they sold
Speaker 2: that to third party advertisers so that they could better target.
Speaker 4: Ads better help.
Speaker 3: Says the settlement with the Federal Trade Commission is not
Speaker 3: an admission of wrongdoing and adds that what they did
Speaker 3: is a standard for the industry.
Speaker 2: Data privacy is absolutely paramounted healthcare. Who owns the data,
Speaker 2: things like case notes, who has access to it. These
Speaker 2: old things that when you attend a psychology led service
Speaker 2: are pulled through very very carefully. If you are a
Speaker 2: registered health practitioner here, you're bound by an entire host
Speaker 2: of laws, effectively meaning that you can only shake information
Speaker 2: either with consent for the purposes of providing healthcare or
Speaker 2: in certain key situations where where you're mandated to, like
Speaker 2: if a court asked for access to information. So there's
Speaker 2: so many protections. And when you're giving your data to
Speaker 2: a third party, non clinically led company that operates overseas,
Speaker 2: you have very very few data privacy provisions.
Speaker 1: You mentioned earlier that they're recruiting psychologists in Australia. I'm
Speaker 1: just looking at one of these ads now, the saying
Speaker 1: that you can be quite an independent contractor and are
Speaker 1: in between one hundred and eleven one hundred and thirty
Speaker 1: five grand a year offering flexibility with no overheads. What
Speaker 1: do you make of that as someone who knows the
Speaker 1: inside of the industry. Is it tempting for someone like you?
Speaker 2: Yeah, look, there's absolutely nothing about that that is tempting
Speaker 2: for me in the current Australian landscape. I suppose my
Speaker 2: view just looking at the pay that they offer. They
Speaker 2: have a bit of a tiered model, So it looks
Speaker 2: like it's thirty USD if you do under thirty hours
Speaker 2: a week, and that's not thirty hours of overall work.
Speaker 2: That is thirty hours of clinical work, so clinical engagement
Speaker 2: with a client, and if you're over that, then you
Speaker 2: make the higher rate of forty five USD, which is
Speaker 2: similar to what clinicians and public mental health gat. But
Speaker 2: we also have access to and will leave sickly professional
Speaker 2: development and quite a host of other entitlements, and all
Speaker 2: of our time is not clinical time. So if you're
Speaker 2: working thirty to forty five hours a week in just
Speaker 2: seeing clients back to back for that, as appearsed to
Speaker 2: be the model, you will burn out very very quickly.
Speaker 2: It might be attractive to clinicians who might just be
Speaker 2: starting out, who might be trying to build up a
Speaker 2: bit of air referral base. But honestly, if I was
Speaker 2: going to have to work for that amount of time,
Speaker 2: I'd probably be finding work in a different industry podcast host,
Speaker 2: podcast host, Except that also sounds like very hard work
Speaker 2: where you're talking to people all the time.
Speaker 1: So can I ask about your work? Then? Because you're
Speaker 1: working both the private and public sectors, you would never
Speaker 1: work for a platform like better Help. But do you
Speaker 1: worry about the impact this sort of tech disruption could
Speaker 1: have on clinicians less experience than yourself and the industry overall.
Speaker 2: Look, so I work in quite the point to end
Speaker 2: across both my role. So within my public mental health role,
Speaker 2: we assess and we treat people who have been identified
Speaker 2: as possibly being at high risk offending, you know, the
Speaker 2: types of behaviors that they might be engaging and at
Speaker 2: things like arson, stalking, intimate partner violence, sex offending, general violence,
Speaker 2: and metan threats. And then in my private work, I
Speaker 2: see a lot of trauma and complex trauma as well
Speaker 2: as mood and anxiety disorders. I usually see you know,
Speaker 2: anywhere between five to seven clients a day, and outside
Speaker 2: of that, I do things like obviously making session notes,
Speaker 2: spending some time reflecting on session tracking how we are going.
Speaker 2: So all of this is outside of session work that
Speaker 2: you know usually happens after hours, So the mental health
Speaker 2: profession isn't flux. I think I'm certainly POSTCOVID noticing a
Speaker 2: lot of almost a moral injury, a lot of burnout,
Speaker 2: a lot more people trying to find passive income and
Speaker 2: ways of trying to move into other spaces. And I
Speaker 2: think I am concerned about things that I'm seeing even
Speaker 2: outside better help, things like using AI. Would you're starting
Speaker 2: to rely more on machines. There's a couple of patient
Speaker 2: note taking software things which actually listen in to your
Speaker 2: sessions and then just transcribe a note for you, and
Speaker 2: I know of a few people in private practice starting
Speaker 2: to use that. But just all kinds of implications from
Speaker 2: a privacy perspective. But I also think fundamentally, as you know, psychologists,
Speaker 2: we have to have a good grasp of why a
Speaker 2: person behaves the way that they do, and if we're
Speaker 2: relying on machines to give us those answers, we're going
Speaker 2: to lose some really essential case conceptualization skills.
Speaker 1: So I've finally given what we do know and what
Speaker 1: we don't know. What advice would you be giving anyone
Speaker 1: that's considering signing up for one of those apps?
Speaker 2: I would say, bier, beware, know what you're signing up for.
Speaker 2: I would ascertain whether your mental health conditions are mild
Speaker 2: to moderate. So if you're not hugely distressed, if there's
Speaker 2: maybe the one issue that you want to talk through
Speaker 2: and it is an overly severe then that might be okay.
Speaker 2: But I'd be looking through carefully the fine print, and
Speaker 2: I'd also be asking questions about the person you're seeing
Speaker 2: and what the what their qualifications are like. So approaching
Speaker 2: with a lot of caution if you do choose to approach,
Speaker 2: would probably be my suggestion. And then if you do
Speaker 2: have maybe slightly more severe difficulties, or if there's a
Speaker 2: lot of distress or more more complex issues, say you
Speaker 2: have PDSD, understanding that what better help offer our only
Speaker 2: thirty or forty five minute sessions? You know the capacity
Speaker 2: to do things like cognitive processing therapy for four PDSD
Speaker 2: or maybe EMDR. You can't do any of that and
Speaker 2: thirty or forty five minute session, so you're better off,
Speaker 2: I would say trying to establish whether you can see
Speaker 2: a practitioner, even if it's viatally health with a more
Speaker 2: traditional therapeutic setting where you are offered I guess the
Speaker 2: longer sessions which are usually fifty to sixty minutes, and
Speaker 2: also continuity of care and maybe more wrap around care.
Speaker 1: Doctor Aherna, thank you very much for.
Speaker 2: Your time, pleasure, thanks for having me.
Speaker 1: Also in the news in Parliament, the last sitting day
Speaker 1: of the week has been consumed by headed debate over
Speaker 1: visas to Palestinians fleeing Gaza. Opposition leader Peter Dutton suspended
Speaker 1: standing orders to debate his argument that there should be
Speaker 1: a blanket ban was Independent MP Zali Stegel calling on
Speaker 1: the opposition leader to quote stop being racist before withdrawing
Speaker 1: the comment. And there's calls for the new South Whalest
Speaker 1: Liberal state director to resign this week after the party
Speaker 1: failed to meet the deadline to enroll candidates in the
Speaker 1: upcoming councilor elections. They failed to nominate one hundred and
Speaker 1: thirty six candidates across seven A councils, meaning currently no
Speaker 1: Liberals will stand in the areas like Camden, Northern Beaches
Speaker 1: and Woollongong. In the mid September elections. Seven Am is
Speaker 1: a daily show from Schwartz Media and The Saturday Paper.
Speaker 1: It is produced by Shane Anderson, Zultan Fecho and Zaia Antangral.
Speaker 1: Our senior producer is Christine Gate. Our technical producer is
Speaker 1: Adigus Bastow. Sarah mcveie is our head of audio. Eric
Speaker 1: Jensen is our editor in chief. Mixing by Travis Evans,
Speaker 1: Adigus Bastow and Zultanfecho. Our theme music is by Net
Speaker 1: Beckley and Josh Hogan of Envelope Audio. I'm Daniel James.
Speaker 1: This is seven Am. See you next week.