Consumer advocates are calling on the privacy regulator to investigate the “Uber of Therapy” platform BetterHelp, which is expanding in Australia, following a US ruling that the company shared sensitive customer data with third parties.
BetterHelp – known by many for being the the second largest podcast advertiser in Australia – claims to offer affordable and flexible online therapy. But experts have warned that the commercialization of healthcare in Australia could put patient data at risk and reduce the quality of care therapists provide when acting as ‘gig workers’.
The US Federal Trade Commission (FTC) in 2023 required BetterHelp to pay $7.8 million ($11.8 million) to customers to cover charges it shared email addresses, IP addresses and answers to customers’ personal health questions with platforms like Facebook and Snapchat — despite promising to keep the data private.
In a report published on Tuesday, Consumer advocacy group Choice said Australia does not have the regulations needed for online mental health platforms such as BetterHelp. The growth of the platform coincides with the increasing demand for mental health care.
Choice found BetterHelp had expanded its advertising across social media and podcasts, including offering Australians a free session if they sign up in June. The platform has also signed deals with Australian influencers and posted job openings on LinkedIn to recruit local counselors, psychologists and social workers.
Consumer data advocate Kate Bower and former privacy commissioner Malcolm Crompton said misconduct overseas by BetterHelp meant Australia’s information commissioner should investigate whether the company had broken local privacy laws.
“Australian consumers deserve to know what BetterHelp has done with their data here and we urge the Privacy Commissioner to investigate possible abuse,” Bower said.
BetterHelp has changed the way it informs users about its data-sharing practices following the FTC action. The company acknowledges in its extensive privacy policy that it shares an encrypted version of a customer’s email address at advertising partners.
That means if a BetterHelp customer uses the same email address when setting up a social media account, the latter will know whether the user has accessed mental health care, Bower said.
This helps BetterHelp focus its ad spend on social media because the social media platforms can advise which other users have similar characteristics and are therefore more likely to purchase BetterHelp.
Crompton told Choice he believed the data collected and shared by BetterHelp with Facebook would be classified as “health information” under Australian law and considered “sensitive information” under the Privacy Act.
Dr. Piers Gooding, a disability and health issues researcher at La Trobe University, said BetterHelp’s model was the “Uber of therapy” – connecting patients with therapists on demand.
However, referring to the FTC’s findings, Gooding said, “When a company wants to expand its market reach at the expense of misleading customers as an acceptable cost, alarm bells should go off.”
Gooding warned that the platform could reduce pay for advisors and reduce the quality of service over time to maximize profits – just as Uber put downward pressure on driver pay.
BetterHelp charges a monthly upfront fee of A$90-120 per week, allowing users to access one 30- or 45-minute live session with a therapist per week and message with their therapist. There is also a diary feature on the app, webinars on mental health topics, and worksheets assigned by their therapist.
Frances Carlton, a clinical consultant in New South Wales, said she was paid $145.22 ($219.91) for seven 45-minute sessions with clients on the BetterHelp platform.
For therapists who work five hours or more in a week, BetterHelp pays $35 per hour. The rate is $40 per hour for those working more than 10 hours, $45 for more than 15 hours, and a maximum of $70 for 40 hours per week.
Carlton said all seven sessions lasted more than 45 minutes, but because the platform does not pay therapists’ overtime and withholds rewards if a client logs in online late, her weekly total came in under five hours, so she was paid an hourly rate of $30 for her week. work.
Carlton, who charges $150 an hour in her private practice for patients she usually sees biweekly, said, “For four clients, I was paid less than I would have been for seeing one client in my office.”
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Carlton said therapists would have to see 48 clients a week to work 40 hours. “As a doctor, with so much work, it is impossible to provide good service and attention to clients.”
A 2021 research by the Psychotherapy and Counseling Federation of Australia found that most costs for counseling and psychotherapy were between $100 and $160 per hour, while the Australian Association of Psychologists recommended compensation for a psychologist is $315 for a standard consultation of 40 to 60 minutes.
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 “put enormous pressure on the person to work long hours to get a earn a reasonable income.”
“This is what the gig economy looks like,” Dober said.
Carlton claimed that “the only doctors who would sign up with BetterHelp and stay with them are newly qualified doctors who cannot get a job but need to gain experience with clients.” She argued that they were not necessarily the best suited “because they have to have regular supervision and communicate ideas to 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 per year based on 52 working weeks – but actual earnings varied due to conversion rates, caseload and customer engagement on the platform.
“We are confident in the quality and safety of our offering.”
BetterHelp also said: “Private information such as member names or clinical data from therapy sessions that BetterHelp members share with their therapists via text, phone or video call is not and has never been shared with a third party.”
“Following the FTC settlement, we have implemented additional measures to improve data privacy and provide our users with clear information about how their data is used,” the spokesperson said.
The data sharing practices complied with Australian regulatory standards and prioritized consumer privacy with an opt-out feature, BetterHelp said.
Dr. Elizabeth Deveny, CEO of the Consumers Health Forum of Australia, said: “This push from an overseas mental health provider I think gives us yet another example of how Australia’s healthcare system continues to be commercialized by private organisations.
“We are very concerned about cases of illegal sharing of patient data that we have seen abroad. Patient data is sacred in Australia and it must remain that way,” Deveny said.
Guardian Australia has previously run BetterHelp ads on its podcasts.