In defence of mental health companies

Also: my experience with CBT, and some thoughts on Tesla.

Photo credit: Olu Eletu

I see a fair amount on social media about the morality/ethics of companies in the mental health space. Specifically: profit making entities that make money by operating in the well-being, self-care, and/or mental health space.

There are people both sides of the fence. Given the younger, left-leaning, ‘liberal’ slant to my personal echo-chamber, though, most of the people I see are against it. Or at least undecided.

I’m pro. Below are a few reasons why:

These things cost money

I love that we live in a country with a free at point-of-access healthcare service. I love that I can go to my doctor with my depression, and leave with a range of options to help get me back to myself.

One of the options recently presented to me, was a 6 week CBT course, focusing on self-esteem. Last week I had my final session. On reflection, the whole thing was actually pretty good.

But it wasn’t great.

There’s a lot, actually, that I felt was wrong with it. To take one example, the handouts were clearly the result of someone with 1,000 other, more pressing, things to do. They were poorly designed, hastily put together, and at times almost impossible to follow.

That might seem exceptionally pedantic. But I’ll soon be discharged from that service, and the only things I’ll have to reference will be those slides, and the notes that I took. The website — whilst perfectly adequate as a place to find out what the organisation does — doesn’t have any further resources.

Don’t misunderstand me — I’m not trying to be ungrateful. It is, after all, a ‘free’ service (provided by the council and NHS). And, to be clear, the guy who ran the session clearly knew his stuff and was very amiable. They are doing everything they can to provide a great service.

And that is my problem.

They are doing everything they can — I have no doubt about that. But what they can do is severely hampered by a very limited pot of funding. They have things that they need to spend that money on (you know, petty things like staff salaries, and paying to keep the electricity on). As a result, the service they provide can only do so much. Of course the handouts they provide aren’t great — they are too busy running one-to-one sessions, group sessions, Skype sessions, and courses. Why on earth would they spend an extra 30 mins to an hour, making a slide deck look slightly better, when in that time they could literally save a life?

The sector needs as much good quality help as it can get

Broadly speaking, that’s what my point boils down to. Services like the CBT course I was on are great. But they aren’t going to fix everyone’s mental health.

We need good quality services, and we need more of them. Ones with unrestricted funding streams to tackle the niche that they are focusing on. And the benefit of letting businesses into this space? Whatever the faults of capitalism, when it operates as it should, the things that work stick around. Those that don’t… don’t.

I’m speaking broadly, of course. And I’m not saying that charities and other non-profits don’t have their place. My point is that simply excluding an organisation on the grounds that it makes a profit seems disingenuous to me. Profits allow the company to grow their impact, and to develop into new areas. Being well-funded also means they can pay their staff what they’re worth.

I can’t emphasise that last one enough. Any sector is tough to work in, but healthcare (including mental healthcare) is so ripe for burnout. Earlier this year, Public Health England estimates that staff ill-health costs the NHS £2.4 billion a year. Overload of work and insufficient reward are two of the most recognised causes of burnout. A well funded and resourced entity, that is able to pay its staff adequately, goes a long way to alleviating some of the causes of burnout.

On that point, why shouldn’t people make money doing something they are passionate about?

Call me an entitled millennial, but I don’t see anything wrong with people making a comfortable living out of social good. I don’t believe money is inherently evil. I also don’t believe that the pursuit of a better way of life should be shameful.

If someone has a passion for doing something, and that something is of benefit to the broader community, why shouldn’t they be allowed to work in that space without worrying about their pay? Doing so gives them more time to commit to their cause — because they aren’t also juggling an entirely distinct full-time job. The more time they commit (assuming what they are doing is good — in both senses of the word), the better off everyone is.

There is a lot of uneasy talk around people profiting from the ‘sudden popularity’ of mental health. The idea (and maybe I’m assuming here) being that people who are doing so must be in some way impure.

I have several issues with that as a thought process.

Firstly, it presupposes that these people are just in the game to make a quick buck. I promise you, if making a quick buck was the goal, there are literally hundreds of more lucrative — and far, far, easier — ways to make money.

Beyond that though, I actually disagree with the fundamental premise. We all benefit from mental health, and the discussion around it, becoming more common place. I’d argue, though, that if this is something that is going to work, if this is something that is going to become mainstream, we need more eyeballs.

Thought-detour time

Electric vehicles are great. They’ve also been around for ages (trusty Wikipedia says 1884 saw the first production electric car). Yet, it arguably took Elon Musk and Tesla to them to a point where they are actually a viable replacement for our regular cars.

Tesla Model S, Wikimedia Commons

Tesla is not a charity. For Musk (and his investors), it’s a cash making business. But it’s a cash-making business that, from Musk’s point of view, needs to exist if we want to keep living our best life.

If we’re all in a ship together and there’s some holes in the ship, and we’re bailing water out, and we have a great design for a bucket, even if we’re bailing out way better than everybody else, we should probably share the bucket design.
— Elon Musk

No amount of advocating, protesting, or opinion pieces (however well informed) were ever going to make a large enough group of people sit up and genuinely reconsider something as ingrained in their lives as the car they drive. To get there, we needed a car that could compete — on style and substance. And to get there, we needed a lot of cash.

The parallel isn’t exact, of course. But my point is that there needed to be competition in the market. Imagine a new company comes out tomorrow that produces a better, more efficient, more appealing car than Tesla. If Tesla loses out on market share, one of two things could happen:

  1. If they lose enough market share, they’ll go out of business. If that’s the case, good. They weren’t the best people for the job, and people are still buying electric cars.
  2. Tesla steps up their game, and produce an even better, more efficient, even better-looking car. Everyone wins. Except for the other company. But they have the same choice: bow out, or come back with an even better product. And then Tesla will have to come back again…

And suddenly (relatively speaking), you have a market. More people will enter, things will get more competitive. Before you know it, we haven’t hit the UK’s 2040 deadline because of some government legislation. It’s 2030 and kids are growing up having never seen a petrol car, because it doesn’t make sense to own anything other than electric.

Back to MH

What has my little thought-detour got to do with mental health?
Wouldn’t it be great if, as someone suffering from a mental health issue, I could chose between a whole suite of the best treatment options, rather than having to take a two hour round trip bus ride to an hour long session run by a guy who, every 4th sentence, laments the fact that he didn’t get a chance to add something to the session that really would have helped us?

In fact, wouldn’t it be great if that were a thing I could do even before I got to the point where I had to see a GP? How much would it reduce the NHS’s burden if I didn’t have to take up 20 mins of a GP’s time, to get referred to a session, while there are clearly people who would benefit far more than I would? Both the time in the surgery, and from the session itself. Wouldn’t it be great if I could leave a CBT session and focus on what I’ve been taught, rather than wonder who’s missed out on a limited space because of me, and how much more valuable they might have found it?

What I’m trying to say, is that we need far more choice and availability of services. And because of that, I don’t see new businesses in the space as jumping on the mental health bandwagon. I see it as capitalism finally catching up with the rest of us. It’s become financially viable for startups to enter the space, and that is so exciting!

If we really want mental health to become mainstream, what else are we supposed to wish for?


Postscript

Now, that would be a lovely sentiment to end this post on. And I very nearly did so. I have, however, made a few generalisations, and ignored some blatant questions. Being too broad doesn’t help anyone, so I wanted to add a couple of significant caveats:

  1. I’ve made some very sweeping assumptions about the success of capitalism. To clarify, when I talk about companies ‘working’, and thus sticking around, I mean that people are paying for the services. Just because that happens, though, it doesn’t make that product/service good. We have gone some way to tackling that in other sectors though — forms of Quality Assurance, like the Social Enterprise Mark, or BCorps, exist in the social business space to give consumers confidence that their money is being well spent. Something similar tailored towards good mental health services isn’t far-fetched.
  2. There is also the sensitive nature of money. Specifically, in my version of events, money has to change hands for the healing to begin. That, realistically, is the whole issue with this — and one that I’ve sort of ignored until now. There are solutions to this though, including having the government pay for / subsidise services for those unable to afford it. This actually isn’t too dissimilar from what happens now. The major difference would be a wider range of high-quality options available.

It is undoubtedly a complicated and charged issue. I’m not ignorant to the dangers involved in mental health becoming a profitable sector. In every sector, there have always been those looking to exploit others. We have to be aware of that, for sure.

But I don’t think that should mean that businesses can’t exist in the mental health space. I really do believe that it is a good thing, and I’m really very excited to see what the new generation of mental health services looks like.