Therapists sound alarm on BetterHelp’s rapid UK expansion

British therapists have criticised US online counselling start-up BetterHelp’s rapid UK expansion, warning that its recruitment processes, pay structure and a lack of UK support staff risk compromising client safety.

BetterHelp, owned by $4bn US-listed Teladoc Health, is one of several digital mental health companies that have surged in popularity in recent years, driven by higher demand for virtual therapy during the pandemic.

Over the past year, the US-based platform has spent heavily on podcast and TikTok advertising in the UK, with ads saying it has recruited “over 1,000 therapists” already in the country.

But while BetterHelp promises “affordable” and “convenient” access to “licensed, accredited professionals” on its website, this is misleading in the UK, where therapists do not have licences, unlike their American counterparts.

Four UK counsellors who spoke to the Financial Times about their roles with BetterHelp also said they were not accredited with a UK membership body, a lengthy and voluntary process that is not a barrier for practice.

This reflected a broader lack of understanding of the UK market, therapists said. “It’s like they’ve taken the US model and spread it worldwide without bothering to find out about where they are practising,” one said.

BetterHelp initially told the FT that its UK therapists “must be accredited by” member organisations. Accreditation with the British Association for Counselling and Psychotherapy requires 450 hours of client work and assessment.

Asked about the unaccredited counsellors it had recruited, BetterHelp later said they must simply be “registered” with the BACP or other bodies — a shorter process that requires graduating from a BACP accredited course.

Founded in 2013, BetterHelp was acquired in 2015 for $3.5mn by Teladoc, which owns several healthtech brands. BetterHelp’s growth surged during the pandemic, and in 2022 revenues rose 41 per cent to $1bn, making up almost half of Teladoc’s total revenue with more than 400,000 paying members.

The growth has come with controversy. Last month, the US Federal Trade Commission ordered BetterHelp to pay $7.8mn in a settlement, saying it had shared more than 7mn customers’ health information with social media companies including Facebook and Snapchat.

In the UK, BetterHelp’s expansion comes at a time when demand for therapy is growing but NHS mental health services are increasingly stretched.

Seven British counsellors that spoke to the FT raised concerns about BetterHelp’s recruitment drive, which has seen therapists offered signing-on bonuses of up to $1,000.

After submitting documentation and information about their professional experience, new recruits have an informal call with a US-based employee.

“Everything I said was ‘super awesome’ and it didn’t seem like a professional interview in any shape or form,” one therapist said.

Therapists were not asked about safeguarding scenarios, unlike in other recruitment processes for similar roles, and, once they started seeing clients, had no access to UK-based support staff.

“There was no rigour at all and no robust procedures to ensure I was a safe counsellor,” said Sally Jenkins, a BACP-registered therapist based in Swansea who joined the platform in August 2022. “There’s no supervisor or boss. There’s no one to phone,” she added.

BetterHelp said its “therapist onboarding process is extremely robust”, with only 25 per cent of applicants being approved.

A BetterHelp recruitment ad tells UK counsellors they can earn up to £100,000 a year through the platform but all nine therapists who spoke to the FT found that pay fell below the amount they charged in private practice.

Working in a “gig-economy model”, therapists on the platform said they earned a base rate of $30 an hour for their first five hours, $35 for the following five and pay rises incrementally for each additional five hours worked.

They do not earn a full session’s pay if clients fail to attend or if the technology fails. As therapists’ payments are structured in dollars, pay also fluctuates with exchange rates. BetterHelp said it did “compensate therapists for repeat missed client appointments”.

“Their pay structure is very unethical,” said Andrew Flynn, a Hartlepool-based counsellor who joined BetterHelp in September 2022.

Subscribing UK clients pay between £40 to £70 per week — a similar rate to Flynn’s private practice Talking Spaces, which charges £60 per session. But, as BetterHelp sessions last for 45 minutes, he received around £18 per client, on a $30 per hour rate.

The system encouraged “burnout”, Flynn said. Within weeks of joining, he was working six sessions a day but soon started to feel overwhelmed and reduced his hours. “You could get [£100,000 a year] if you did 45 hours a week. Honestly, I think you’d die,” he added.

The BACP previously advised that therapists avoid more than 20 hours of client contact in a 37.5 hour week but removed these guidelines in 2017 to distinguish between the strains of different kinds of therapy, said Caroline Jesper, the body’s head of professional standards.

“It’s down to the individual therapist to make an ethical judgment,” Jesper said. “It’s quite obvious that [40 clients per week] would be too high a caseload for anyone to manage.” BetterHelp did not respond to questions about its payment structure.

One therapist said he enjoyed the variety BetterHelp offered, as the “client base comes from a wider variety of professions” to his regular work. He has worked 35 hours a week on the platform, “enough to get an adequate remuneration”.

As BetterHelp matches counsellors with clients, it is also simple for newly qualified therapists to get work. All the therapists who spoke with the FT found BetterHelp was flexible with their other roles.

While the platform is simple to access for users seeking therapy, six counsellors said BetterHelp was poorly set up for serious cases and emergencies.

“If I have a client who is suicidal, I can’t reach the client except through the platform,” said Flynn. “It’s not ethical for me not to [automatically] have the client’s emergency contact details.”

British therapists can also work with international clients. Jenkins found this opportunity “fascinating” but added, “I’d try and get someone’s GP’s number but what do I do if I don’t speak the language?”, echoing a concern raised by several therapists.

BetterHelp said it had a “supportive community forum where we (as well as veteran therapists) provide tips and education”. In response to Flynn’s concerns, BetterHelp said it provided clients’ contact details “in the event of emergencies”, which can be requested through the platform. Its clinical operations team responds to queries within two business days in most cases, it added.

Disillusioned with the platform’s low pay and perceived safeguarding issues, seven therapists have either reduced their hours to a handful of clients, let their accounts lie dormant or left the platform entirely.

“It’s kind of dominating everything you see but it’s not really ‘better help’ that people receive,” said Flynn. “What are they offering that’s better?”