By Bob Conrad and Jeri Davis
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A Reno City Council agenda item for Wednesday’s meeting, which would award to tech telehealth company Talkspace $1.3 million to make available online therapy for all Reno residents, has received a markedly mixed reaction.
First reported last week on This Is Reno, the city’s proposal drew both praise and concern. Residents on one hand, who have used the New York-based Talkspace, rave about it. One This Is Reno reader, citing the cost, said she is looking forward to the option being made available to citizens. She said the service was amazing but that it was cost prohibitive for what she was paying, about $300 a month.
Others complained both about the company and using CARES Act funds for the proposal. Some said they want locally based and in-person mental health services first. And others sounded the alarm about the company’s business practices, which have received noted news coverage. Lastly, based on last week’s news story, some are organizing to encourage the city to include local mental health providers as part of the city’s plan.
Talkspace: What it does
Talkspace is a website portal and mobile app. Users are paired with a therapist with whom they can communicate via audio, video or text. Audio and video sessions require some scheduling, whereas texts can be sent any time of the day or night and are responded to by the therapist during their working hours.
According to the company’s website, there are no constraints on the issues a user can bring up with their therapist, from financial concerns to relationship problems or substance abuse.
The company touts that its text therapy options allow a person to review the conversations they’ve had with their therapist and reflect on their progress and new issues upon which they’d like to work.
Concerns about the company
Talkspace has been criticized by clients, therapists and former employees. Forbes columnist and psychologist Todd Essig has been a Talkspace critic for years.
“I want to be very clear that therapy delivered remotely can sometimes be helpful,” Essig wrote in early 2019. “There is too much good research and too many good stories to even consider saying otherwise.”
But Essig also wrote about the American Psychiatric Association refusing to advertise Talkspace’s services. The APA allegedly refused Talkspace ads after meetings with the company and those concerned with the company’s practices.
“One problem with the APA Monitor on Psychology recruitment ad, the one that invites readers to ‘Join The Future Of Therapy,’ is that it does not represent what Talkspace actually says they do,” Essig wrote. “I am quoting the Talkspace User Agreement. This agreement specifically states it supersedes all other communications from Talkspace. And it directly conflicts with their marketing messages. The document states: ‘This Site Does Not Provide Therapy. It provides Therapeutic conversation with a licensed therapist.’
“I agree. That is what they do. And some people do indeed benefit. Just like people benefit from a gym providing therapeutic conversation with a trainer or a yoga studio providing therapeutic conversation with a yoga teacher, or even a saloon providing therapeutic conversation with a bartender. But none of these activities are what is meant by the professional practice of psychotherapy,” Essig continued.
A therapeutic conversation, he said, “is not a future that serves the interests of people needing psychotherapeutic care. The APA did the right thing and should be commended.”
Other media have reported on the company’s practices, and not all of the reporting has been flattering. The New York Times in August published an exposé that raised questions about the company’s ethical and privacy practices, describing the company as having a “start-up culture.”
The company disputed the reporting in a post on Medium.
“Talkspace is a HIPAA/HITECH and SOC2 approved platform, audited annually by external vendors, and has deployed additional technologies to keep its data safe, exceeding all existing regulatory requirements,” company founders Roni and Oren Frank wrote. “Talkspace analyzes encrypted and de-identified data to look at text so as to both warn therapists of potentially risk-related language usage by a client, and to identify any inappropriate behavior, which has allowed Talkspace to operate for nearly a decade without a malpractice claim in our network.”
But after the Times story was published, a former employee who alleged his personal privacy was violated by Talkspace, posted his own rebuttal to the Franks on Medium. He had sued the company, settled and wrote in defense of the Times’ reporting.
“This is not why the article is negative and the article would have never made it to print if entirely fabricated. The only people Talkspace has to blame for this is themselves,” Ricardo Lori wrote. “They made the choices that got them into this mess. They created the violating environment that’s captured in the [New York Times] article, in my opinion. And let me tell you, I felt and was violated aplenty in hindsight.”
It wasn’t the first time the company faced criticism. The Verge in 2016 published a story, also critical of the company. It raised concerns about low pay and the ability for therapists to contact patients who may be in dangerous situations. As part of that story, Talkspace CEO Oren Frank is quoted as threatening The Verge.
“I will not hesitate to have The Verge answer legally, financially and professionally to any unsubstantiated claim, anonymous quote, or libelous statement that results in damage to our business,” he wrote.
He then countered The Verge’s reporting on Medium, saying he believed in being fair and kind.
“We make sure we make each mistake just once,” Oren Frank wrote. “I’m a strong believer in ethical businesses, and that the way we treat each other, our employees, clients and partners must be fair and kind.”
Reviews mostly positive
Talkspace, Frank maintained, boasts thousands of positive reviews for its services. Indeed, users cite convenience, ease of use, the ability to communicate via text, audio or video, guaranteed response times and available live sessions as positives for the platform.
“It’s an amazing resource for people like me who don’t have access to any form of in-person therapy. I also express myself way better in writing so that’s a plus,” a blogger wrote about Talkspace.
A This Is Reno reader said he would cancel his service with the company in order to take advantage of the city’s proposal.
“That would be a fantastic use of those funds,” he said. “Talkspace has changed my life.”
Another reader simply said, “I use Talkspace and love it. I can’t afford it so I will have to cancel next month.”
One counselor wrote about signing up with a telehealth company — she did not disclose which one — and found the process to sign on with the company exhausting, leading to nearly quitting on the first day.
She stuck with it, however.
“Six months after sending my first message to my first client, I am very thankful that I joined the site I selected. I have been able to engage with clients again and have made a fair amount of money working at my own pace and time,” said Melanie Person, writing for the American Counseling Association’s Counseling Today publication. “I would recommend this avenue for counselors looking to take on new clients and who have the freedom and flexibility to work with these contracting companies.
“Although the pay is poor and the process new, the experience has been more than I had hoped for,” she added.
Reason for Talkspace proposal
Mental health resources in Nevada are notably lacking. But telehealth is seen as a viable option that is more convenient, and more affordable, than typical office-visit therapy. A 2016 legislative fact sheet about providing telehealth services in Nevada noted resources were scarce.
“Telehealth technology often requires significant investments of both time and money,” the report by Megan Comlossy of the Legislative Counsel Bureau noted. The report also indicated benefits of telehealth include reduced costs for patients and increased availability.
“Studies show that telehealth can increase the availability of and access to quality medical care, improve population health, and lower the cost of health care,” Comlossy wrote. Challenges remain, particularly for rural area residents who may not have access to high-speed internet services.
“Greater reliance on technology for health care also raises security and privacy concerns over improperly exposing patient information,” Comlossy noted.
The ability to get mental health treatment, remotely, however, especially during a global pandemic, makes it an attractive option — especially when purchasing this benefit for an entire mid-sized city. Many therapists, locally and statewide, offer telehealth as a treatment option.
Talkspace, on its website, says “the therapist you work with will be licensed in your U.S. state of residence.” In the Medium post, referenced above, the company said it has more than 3,000 therapists, nurse practitioners and psychiatrists available.
When asked about available resources to treat Reno citizens, Mark Hirschhorn, Talkspace’s president and COO, said yes but did not disclose a specific number of available mental health professionals on its roster.
“Talkspace is ready and prepared to begin supporting the City of Reno to ensure therapy is available to all residents who seek it,” he said. “We have dozens of licensed counselors across the state who are prepared to provide teletherapy services and we are continuing to actively recruit. Now more than ever, mental health is critical to overall health and we look forward to the opportunity to support the health of Reno residents in the difficult year ahead.”
The pandemic has raised the profile of apps like Talkspace. Nearly half of all Americans reported suffering as a result of the pandemic, and CNBC reported in May mental health apps had record downloads this year. That is ultimately the reason Reno is proposing to use CARES Act funds for Talkspace.
“The trouble we have run in to with mental health spending is that Nevada simply does not have sufficient access to mental health care,” said Reno City Council member Devon Reese. “We would implement a more local program in a heartbeat, but we couldn’t find any infrastructure to accommodate or deploy immediately.”
Complicating the City of Reno’s proposal for Talkspace is the CARES Act, which encourages telehealth options by providers but is also restricted by spending requirements. Reese said, in so many words, time is of the essence due to CARES Act spending requirements.
“Keep in mind that any proposal must be ‘stood-up’ and paid for before the END of December,” he posted on Facebook. “We have been searching for a way to assist folks with known mental health issues that have been exacerbated by the COVID pandemic. The trouble we have run in to with mental health spending is that Nevada simply does not have sufficient access to mental health care; and admittedly, this program would be an experiment.”
Reese went on to say that, provided more time, local solutions would be ideal.
“This would take time and money along with the difficult task of eligible insurances,” he explained. “We are fortunate to have amazing providers locally but many can’t offer services at this reduced rate. I always believe local is best but people are struggling NOW.”
Talkspace, he said, is an experiment worth trying.
Local therapists to make an alternative proposal
Kat Geiger is a local therapist who specializes in eating disorders and maternal mental health. She’s one among many local therapists who decried the city’s proposal to sink CARES Act dollars into Talkspace.
She wrote a lengthy Facebook post directed at Reno Mayor Hillary Schieve and city council members urging them to consider investing all or a portion of the funds in local resources. Nearly 30 people have signed a proposal requesting the city consider local options for mental health treatment.
This Is Reno spoke with Geiger to learn more about how she would propose using the funds locally.
“A lot of us in the community that have agencies or are affiliated with training the new therapists in town, we all got together via Zoom…and started putting together a proposal—and I’m actually drafting it—to give to the city council and Hillary this evening,” Geiger said. “So, it should be ready to go for them [Monday] morning.”
The proposal seeks to create a single point of entry for the funding, “almost treating it like victims of crime funding but more like victims of COVID funding—and having one of our agencies essentially managing it like a fund and giving people vouchers and getting them signed up through the Crisis Call Center,” she said, “if they’re willing to partner with us—so shoring up that service because the infrastructure is already there.”
Geiger said that under the proposal, part of the funding would be offered to the Crisis Call Center to allow them to pay for crisis counselors and create an intake position for a person who would get Reno citizens vouchers for therapy and help match them with a therapist based on a list of local mental health professionals who are willing to participate.
“And then they would all have telehealth available, messaging available—and then, after hours, we would be shoring up the Crisis Call Center with additional people,” Geiger said.
She and other therapists intend to attend the Dec. 2 city council meeting to make their presence and willingness to address the therapy needs of locals known.
“‘Please, don’t complain to us that Reno doesn’t have enough mental health resources and then go out and invest in a New York-based company.’ That doesn’t make any sense whatsoever. What we could do locally to change the landscape with that money is unbelievable, I think, long-term,” Geiger said of the proposal
Geiger believes that with help to get locals signed up for therapy there are enough therapists to serve the community.
She said should it be found that this is not the case, then the city might consider giving half of the proposed funding to Talkspace.
“At least give us the opportunity to do everything that we possibly can do, locally,” she said.
The Reno City Council is scheduled to vote on the proposal at its Wednesday meeting.
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