BetterHelp. Maybe you were scrolling through your Instagram stories when you first saw their ads. Perhaps, they sponsored your favorite YouTuber in their latest video. Or maybe you first heard about them during the commercial break of your favorite show. No matter how you’ve heard of the company, there’s no dispute that BetterHelp has made its online mental health resources and counseling services widely known in today’s digitalized environment.

Founded in 2013, BetterHelp intends “to remove the traditional barriers to therapy and make mental health care more accessible to everyone.” The online service works by connecting users to a network of licensed therapists. With the COVID-19 pandemic triggering a 25% increase in the prevalence of anxiety and depression worldwide and 38% of psychologists maintaining a waitlist for new patients in 2022, many people have turned to online solutions like BetterHelp to seek necessary care. 

Although online mental health services may improve access, they still face many of the same problems as traditional services, including breaking the stigma around mental health discussion and building client trust. BetterHelp has attempted to tackle both of these issues through its sponsorship initiatives with influencers and celebrities. By utilizing the platforms and the trust these influencers have already built with their viewer base, Betterhelp is able to reach a greater audience. However, one challenge that remains unique to online mental health services is the increased privacy concerns.

In March 2023, the Federal Trade Commission (FTC) issued a proposed order and settlement with BetterHelp for $7.8 million to partially refund customers after the FTC found the company leaked confidential health information to third parties between 2013 and 2020. While BetterHelp claims throughout the signup process that personal health data will only be used for limited purposes such as providing counseling services, the FTC complaint found that BetterHelp revealed users’ email addresses, IP addresses, and health questionnaire information to social media platforms such as Facebook, Snapchat, Criteo, and Pinterest. Such health questionnaire information could include whether or not a user has experienced depression or suicidal thoughts or is taking any medication. 

The complaint brought by the FTC brought renewed attention to how our data is collected and utilized on the Internet. You might think, “I give out my email address to so many sites every day…how’s this case any different?” However, in the context of online mental health services, one’s email is a part of the information protected under The Health Insurance Portability and Accountability Act of 1996 (HIPAA). When BetterHelp discloses an email to a third party, that third party now knows that person is seeking or receiving mental health care. An email is inherently health information when it can be used to identify people and can be given out by a particular service like BetterHelp. 

The information collected and disclosed by BetterHelp can also explain why the company seems to dominate social media. BetterHelp placed no limits on what third parties can do with the information, meaning third parties are allowed to use the sensitive information for internal research and to improve advertising. Companies like Facebook can target users with similar profiles to the ones provided by BetterHelp with ads for BetterHelp’s services. And BetterHelp users were targeted with ads themselves asking to refer the service to their friends. In this way, BetterHelp received thousands of new users.

To seek mental health care is a serious decision that should not be pressured by profit or corporate interests. Customers come to BetterHelp in a vulnerable position—they shouldn’t have to worry about how their information is being processed at the same time. When BetterHelp misrepresents privacy policies and shows unavoidable prompts in the signup process, customers are not building a relationship from a foundation of trust. 

Although BetterHelp now has new disclosures for those signing up and settlement payments have started to roll out in June 2024, the service has left an irreparable mark for many consumers. Many wouldn’t want to go back to an in-person therapist who has broken their trust, so why would an online service be any different? The truth is, there are many ways technology can be used for good, without breaking trust like BetterHelp. Many in-person mental health clinics now provide telehealth options that offer increased flexibility while remaining reputable. Medicaid provides coverage to a list of telehealth service providers. Technology and digitalization can be an important tool to expand healthcare access—as long as the correct precautions are taken.

In the future lies more digitalization of traditionally brick-and-mortar services. While this BetterHelp case marks the first time the FTC has returned funds to consumers whose health data was compromised, consumers must remain vigilant with their online privacy. A high frequency of ads doesn’t translate to better service. Nor do celebrity sponsorships absolve a company of HIPAA violations. Consumers should realize that the telehealth market is expansive and that there is always more than one choice. So when it comes to mental health care, there are better options than BetterHelp.