In the last few years, we’ve seen an explosion in the adoption of virtual care, with telehealth playing an especially large role in meeting patients’ mental health needs.
Indeed, according to a recent study from the Kaiser Family Foundation, 36 percent of outpatient visits for mental health and substance abuse issues were conducted via telehealth between March and August of 2021, compared to just 5 percent of other outpatient care visits.
On the surface, that’s great news: More access means more help for those who need it.
But building a virtual mental health or substance abuse program also presents an array of unique challenges — chief among them, quality control.
A recent report from the Wall Street Journal shines a harsh light on this problem. The piece details how some of the hottest names in the virtual mental health and substance abuse treatment spaces allegedly lost sight of patient experience in the pursuit of growth.
According to former patients and staff, these companies were so eager to keep up with demand for virtual care that they sacrificed their hiring, training and quality assurance standards. This lead to unhappy patients, overprescribed medications, disillusioned employees and more.
Here I’ll explore these and other quality control challenges facing virtual therapy and substance abuse programs, as well as how focusing on expansion over quality can prove disastrous long term.
In short: When it comes to quality control, “good enough” will never be good enough.
- By focusing on growth at all costs, some virtual mental health and substance abuse treatment companies have sacrificed quality control
- Poor quality control not only puts an organization’s reputation at risk, but also threatens the health and safety of patients (especially those facing mental health or substance abuse issues)
- Lax QA, hiring and training standards can also alienate an organizations most talented employees, leading to brain drain and poorer patient experiences long term
- New technologies now make QA on 100% of calls a possibility, so virtual care leaders should prioritize this along with rigorous training to develop talent and ensure the best possible experience for patients
Growth — but at what cost?
While the pandemic undoubtedly took a toll on many Americans’ mental health, it also prompted many people to re-establish mental health care or seek care for the first time — especially via telehealth.
Running parallel to this shift has been the rise of a slew of digital mental health companies offering quick, easy access to virtual support for everything from anxiety and depression to ADHD to opioid addiction. Fueled by venture capital and big advertising budgets, these companies have grown rapidly — perhaps too rapidly.
A key theme highlighted by the Wall Street Journal piece is how some of these companies may have prioritized rapid growth over care quality, leading to lax hiring, training and QA and compliance standards. The result: overloaded, disillusioned staff and (obviously) unhappy patients.
The piece documents some of these poor experiences and business practices in cringe-worthy detail:
In one patient’s account of their virtual therapy experience, the therapist spent much of their first call moving between rooms in her house, with another person even walking behind her during the session. Another session took place partly in the therapist’s moving car. Understandably, the patient wondered if they were getting their therapist’s full attention.
A different patient, a gay man seeking support after being kicked out of his family home due to his sexuality, requested an LGBTQ+ therapist. It seems that request was ignored: Not only was he assigned a therapist who didn’t specialize in LGBTQ+ issues, but that therapist also told him he needed to deny his sexuality to avoid sacrificing his relationship with his family.
Meanwhile, clinicians at one startup that focused on treating issues like ADHD said they felt pressured to prescribe drugs prone to abuse (including stimulants like Adderall). Now the company is facing federal investigations, has lost insurance networks and major pharmacies are refusing to fill some of its prescriptions.
These accounts are perhaps extreme examples, but they highlight just how wrong things can go when the bottom line is prioritized over patient care. Not only do patients suffer, but the business ultimately does as well.
That’s because in focusing on growth at all costs and taking a “good enough” attitude to quality control, these businesses may have sacrificed something impossible to buy back: their reputations.
See related: Virtual care QA is no longer just a “nice-to-have”
Beyond a few bad ratings
For organizations eager to grow rapidly or serving a large patient population with limited resources, a “good enough” attitude to quality control can be hard to avoid.
Virtual care QA can be difficult, so as long as extremely negative experiences are relatively rare and feedback is generally positive, things may seem to be on the right track. An organization’s customer satisfaction ratings can weather some poor interactions and new patients may still flock to the program.
But as the Wall Street Journal article showcases, enough bad experiences — even if they make up only a small percentage of all interactions — can do serious damage not only to an organization’s reputation, but also to patient health.
After all, people don’t sign up for virtual therapy to be trendy — they do so because they’re seeking help. If they have a bad experience, not only will they likely never come back to that company, but they may never get the help they need.
As one patient put it in the Wall Street Journal story: “I think I was just so turned off by that first experience, I kind of gave up on it.”
Losing customers is obviously bad for business, but that’s nothing compared to seeing patients continue to suffer with depression, fall deeper into addiction or lose their lives.
Given this, I think it’s fair to say that if you give up on quality control, you ultimately give up on the people you’re meant to care for.
Talented staff suffer, too
The health and safety of patients should obviously be any virtual mental health organization’s top priority. However, it’s worth noting that organizations that fail to prioritize quality control could also end up alienating their most talented therapists, coaches, intake specialists and other support staff.
Former therapists and other staff at several of the companies profiled in the Wall Street Journal piece expressed a similar attitude that their employers had “lowered the bar for hiring and training” to keep up with demand.
One therapist noted that while it had taken days for her to complete onboarding and start seeing patients when she first joined, new therapists were assigned patients immediately and told they could complete a (much shorter) training program later. Some companies allegedly even shortened their vetting process for new employees and had nonclinical workers conduct interviews.
Meanwhile, therapists, counselors and other support staff were allegedly expected to handle larger and larger patient loads with little additional support, while internal operations staff were expected to oversee hundreds or thousands of contracted providers on their own. Without the right technology and workflows, this situation makes comprehensive QA essentially impossible.
This approach to hiring, training and operations — unsustainable and focused on maximizing growth, not improving quality — is almost sure to lose in the long run. It not only leads to unprepared or overburdened staff (and, almost certainly, poor patient experiences), but it can also send an organization’s best employees heading for the door.
After all, the best therapists and counselors want to make a difference in their patients’ lives. They want to provide quality care. If an organization prioritizes patient acquisition over building sustainable workflows and maintaining quality standards, talented people will look for opportunities that better align with their calling.
Organizations that want to retain their best employees and make them even better should commit to higher hiring standards, continued training and regular feedback. They should also prioritize comprehensive QA to get a clearer picture on team performance and ensure talented staff are rewarded and underperforming or inexperienced staff are given the coaching they need to do their best work.
Bottom line: “Good enough” won’t do
It’s essential that we not lose sight of the importance of quality control, especially in the mental health and substance abuse space. Not only is it important for patients to receive the best possible care, but it’s also important for organizations to protect their reputations.
Instead of prioritizing patient acquisition and settling for “good enough” when it comes to quality control, virtual care companies should focus on optimizing the virtual care experience via high standards, rigorous vetting of staff and contracted employees, comprehensive QA and training.
This approach can allow organizations to grow at a responsible pace without sacrificing care quality and, potentially, their reputations and the safety of their patients.
See related: Low-hanging fruit for AI in virtual therapy