#8 Know Thy Therapist (Part I): What you need to know about psychologists when running a mental health business

plus... $130m for Talkiatry, a spotlight on Unmind, $11m for a peer-support business and all the latest news in mental health

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Hi friends,

We’ve had a bunch of new subscribers recently. If you’re one of them, welcome!

The Hemingway Report is a community of people all interested in developing solutions to our mental health crisis and I’m delighted to have you as part of it.

Every week I share insights on mental health innovation as well as in-depth guides to building a successful organisation in this space.

This week, we're talking about psychologists.

The people at the very core of our mental health system and who often hold the power to make or break a mental health business. We share the key trends you need to know about these important people and what you can do to get them on board with your business.

But before we jump into all that…. Could you do me a favour? I’d love your contribution to some research we are doing on mental health businesses.

If you have two minutes to complete our survey, it would mean a lot. Thanks.

Be part of the research

This week in The Hemingway Report;

• Know Thy Therapist (Part I): The most important trends you need to know about psychologists
• Company spotlight on Unmind: the evidence-based, data-backed work wellbeing program
• Plus all the latest news in mental health innovation

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Know Thy Therapist (Part I)

OK. We need to talk.

About psychologists that is.

Why?

Because they are at the very core of our mental health system.

And if you want to build a successful mental health organisation, you need to have them on board - whether it’s as a customer, as a user or as an employee.

I see lots of businesses struggling because they are getting this wrong.

They don’t understand what is really going on with psychologists.

They don’t how to reach them or how to work with them.

I mean, one of the main challenges I highlighted in last week’s article about Headspace was the difficulty they are having partnering with therapists.

If you want to avoid these challenges, you need to really understand the life of a Psychologist - their motivations, their incentives, the realities of their daily working conditions and the major trends that are occurring in the profession.  

You also need to know the best way to reach them and how to approach them.

If Socrates was around to offer advice to mental health founders right now, instead of saying “know thyself”, I think he’d say “know thy therapist".

Yes, it’s that important.

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Earlier this year, I spent three months trying to understand all this.

I had gotten interested in the problem of burnout among psychologists and wanted to understand it more. So I reached out to hundreds of psychologists to complete research surveys and had in-depth conversations with dozens of them.

My research confirmed that burnout is a real problem.

Unfortunately, I also learned that it is not something with a straightforward solution - at least not one I am capable of developing at the moment.

So I moved on.

I gathered up all the data and pages of interview notes and shunted them into a Google Drive folder where they’ve been lying since, gathering digital dust.

Until last week that is.  

I had been chatting with some founders and a common thread was coming up. They all needed to get Psychologists on board with what they were doing, in one form or another.  

And it was not easy.  

So I thought it was time to dust off my research and see if there were any insights that might help founders understand more about Psychologists and how they can approach partnering with them.

Turns out, there was a shed load!  

I’m going to share all these insights in a two part series;

• Part I: The facts and trends you need to know about psychologists
• Part II: How to reach and engage with psychologists as a mental health business

Before I begin, I want to acknowledge that I'm discussing a broad category of professionals, each with unique backgrounds, perspectives, and experiences. The trends I highlight are based on the data I've gathered, conversations I've had, and research I've reviewed. While these trends apply to many, I recognise that individual differences exist and not every psychologist will align with the points I make.

Many of you reading this are psychologists yourselves and I’d love to know if these resonate with you - or if you have other insights I have not mentioned. Do let me know.  

Now, let’s get into the nine things you need to know about psychologists…

1. Their days are tough!

I asked one very experienced clinical psychologist why psychs were burning out. He told me a story that made it very clear.

“Think about a typical day of a psychologist. They are in small room, usually without windows, sitting face to face with someone who needs serious help. They have to be completely switched on, listening attentively. They do this for an hour, get a few minutes break, then do it again.

They might have six or seven of these sessions per day and in between, they rarely have co-workers to hang out with. They eat lunch alone, then go back into the therapy room, with no idea what sort of situation may come through the door.

It’s emotionally demanding, it’s sedentary and it’s isolating.”

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That’s a very tough day and as a mental health business, you have to realise what they are going through and how little spare time they have.

One of the founders I spoke to recently was building a solution to allow patients to log notes in between sessions. I think this idea has merit. But he was suggesting that their psychologists would then be able to review all of their patients notes before the next session. This is asking them for even more of their time.

Tell me, where will they fit this in on their calendar?

2. Waitlists aren’t a psychologist problem, they’re a health system problem

The number of people waiting for mental health care is large and growing. This is a huge problem that needs to be solved and I’ve talked to a lot of people who are trying to tackle it.

But many of them are taking the wrong approach. They are relying on psychologists to try and solve it.

But this isn’t a psychologist problem. Of course, psychologists don’t want people on waitlists, they want to find ways for these people to get the care they need, faster.  

But they have no control over what happens to waitlists.

Nor are they incentivised to solve it.

From a purely business perspective, having a waitlist is actually a good thing. It means that they always have a steady stream of patients and subsequently, income. I’m not suggesting that psychs are motivated to have waitlists, I’m just saying that they do not have any financial incentive or the power, to actually impact waitlists.  

So if you’re building a solution to solve waitlists, you need to be pitching this to the people who are incentivised to solve this problem (i.e., health systems).

Also, if you need psychologists to adopt your solution in order to solve waitlist problems (which you probably will), then you have to have a tangible reason for them to do so. Limbic do this well. They are paid by the NHS and then convince psychologists to adopt their software by reducing their admin burden for new referrals.  

3. They are intrinsically motivated

Psychologists really do care about their patients.

I’m not sure how you could do this job if you didn’t. When you talk to psychologists, it’s clear just how much the desire to help patients is at the core of their motivation.

In general, they are an incredibly intrinsically motivated profession which is something “business minded” folks often overlook. Being aware of these other motivations will be helpful when trying to design solutions that psychologists actually want to use.

We actually asked psychologists what they would want more of in their job and this is what they said;

• To pursue my own interests more. Many psychologists have a specific area that they are passionate about. It might be a certain condition that they want to focus on, a specific type of treatment or even a segment of the population they want to serve. And they want to spend more time pursuing these interests. In fact, we found that the people who had found a way to do this, were typically happier in their roles.  One clinical psychologist we spoke to found a way to do this by splitting up his work. He made most of his income providing consulting services to organisations, which then allowed him to do his clinical work primarily for impact reasons (he could choose to not charge his clinical patients if he knew affordability was an issue) and even gave him time to pursue his passions, like writing a book. He loved his work.
• To have more control over my time and my work. The other largest contributor to job satisfaction among psychologists was the ability to have more control over their work. Telehealth has been a major win for this, with many psychologists choosing to provide more sessions remotely, with some even switching to only working through telehealth.  
• To have more social interaction. Working as a psychologist can be an extremely isolating profession and almost everyone we talked to wanted more social interaction. In fact, it was one of the main reasons people wanted to join a group practice - to just have people to chat to on their lunch break, grab coffee with or chat about challenging cases.  

4. Burnout is real

23% of the psychologists we surveyed said dealing with burnout was their single biggest challenge at work.

Spend some time in psychologist forums and you’ll see this everywhere -  the r/therapists subreddit has a weekly burnout check-in thread for its one hundred thousand members that gets flooded with comments.  

The literature also shows that this is a big problem. Research from Lin, Assefa and Stamm (2023) stated;

“the percentage of psychologists who reported not being able to meet the demand [of their job] rose from 30% in 2020 and 41% in 2021, to 46% in 2022. Almost half (45%) reported feeling burned out in 2022.”

When we asked psychs why this was happening, they gave five main reasons;

1. Their jobs are incredibly emotionally demanding (exacerbated by a lack of support)
2. Their jobs are isolating
3. They have to deal with large administrative burdens  
4. They experience financial pressure
5. Client expectations are becoming increasingly hard to manage

Let’s double click on a few of these;

• Dealing with large administrative burdens Between client communications, billing, and writing notes, psychologists spend hours on admin tasks every week. They typically don’t enjoy this work (I mean, who would?) and find it tedious. Anything that can be done to reduce the admin burden of psychologists will be warmly welcomed.  
• Financial pressureConsidering the level of training required to become a practising psychologist, not to mention the huge social benefit they deliver, I really thought they would be paid more. Wages are good but not amazing, especially considering the cost of living crisis in most countries right now.  One of the main problems is that many psychologists (especially those in private practice) are paid by the hour. They have no leverage on their time, meaning that their income is capped by the hours they work and the rates patients are willing to pay, which is pretty standardised. What’s more, in many private practices, psychologists only take home between 60% and 70% of their consultation fee, the remainder going to the practice. As you become more experienced as a psychologist, your income does grow, but only moderately. The result of all this is that if you want to make more money, you simply have to work more hours. I spoke to one NHS clinical psychologist who was seeing her own private patients on evenings and weekends to earn an extra few bucks. This extra work increases the chances psychologists burn out.
• Client expectations are becoming increasingly hard to manage Many psychologists told me that their patients are coming in with increasingly challenging expectations for what they want from therapy. Of course, people have always wanted therapy to “fix them”, and to do so quickly, but I was told that these demands are becoming more and more prevalent. More patients are also coming in with pre-conceived ideas of what they are struggling with or what they need to do, as diagnosed by Dr. Google.  This is challenging for psychologists. Treatment takes time and bridging the gap between patient expectations and this reality is an additional burden.

5. More than just burnout: mental health amongst psychologists is a problem

Unfortunately, mental health among psychologists is also a real challenge.

A 2022 study found that more than 80% of mental health professionals reported a lifetime history of mental-health difficulties and nearly half (48%) reported a diagnosed mental disorder.  

But despite working in the mental health system, it is often not talked about as much. Students and professionals often feel they can’t talk openly about their own mental health, wanting to avoid negative judgements from co-workers and supervisors or losing credibility.

There is a lot of effort to increase the level of support for psychologists and increasing supervision. But this is often not enough, not widely available and stigma still exists within the profession.

Things are changing, but the change is slow. It’s pretty awful that the people we rely on to help us through our own mental health challenges, are often suffering themselves and not getting the support they need.

6. They are overwhelmed with new solutions

If you are someone running a mental health business, you likely have some new technology, device or treatment that you’d like to see Psychologists use.  

Psychologists are approached with solutions like yours every single day. Of course, many of them are great solutions. But some of them are not.

Figuring out which one is which is hard and takes time - something psychologists don’t have a lot of. They often feel overwhelmed by the amount of new solutions that are being introduced to their field.  

This is certainly not a reason to stop developing solutions or to not approach psychologists with them. Just be aware that you are not the only one pitching them a new way to do things.  

Also, like any profession, there is a wide spectrum of willingness to adopt new solutions. There are early adopters who are already convinced that we need new solutions to improve care and there are people on the other end of the spectrum who see no value in technology or have any interest in new solutions outside of what they already know.  

My advice to mental health businesses? Start by focusing on the early adopters. You will have a tough enough job convincing people to adopt your product, you don’t want to have to also convince them that your whole category of solutions is something they should consider.  

The “Crossing The Chasm” framework is a helpful way to think about this - perhaps I’ll write  a separate post on how to use this framework in mental health at some point…

Outside of this, you should share as much evidence about your solution as possible, in easily digestible formats. Make it easy for psychologists to know that you are legitimate and clearly communicate the benefits that your solution can bring to them and their patients.

7. They’re allergic to BS

Psychologists are highly sensitive to bulls**t. They tend to have a natural scepticism, especially towards for-profit businesses who are trying to work with them.

When we were reaching out to psychologists to conduct our research on psychologist burnout, we had dozens of people emailing us back asking “who are you?”, “why are you doing this?”, “how would this research be used?”, etc.

I’m not saying psychologists are wrong to be sceptical and to ask these questions, I’m just saying it’s something you need to be aware of.  

Be transparent about who you are and what your intentions are. After all, they have a lot of experience understanding people and uncovering their true motivations.

8. They manage a lot of risk

Psychologists have a huge amount of responsibility. And part of this, is adhering to a bunch of legal obligations.

They regularly need to make judgement calls on whether they report certain behaviours to authorities - and if they get this wrong, they can be held liable.  

I have heard many stories of patients bringing cases against their psychologists, which is an additional issue for the psychologist to deal with.

Of course, some of these are completely legitimate and there needs to be a course of action for the patients in that case.

But many do not have a strong case and the psychologist has done nothing wrong.

In either case, it is an additional burden on the lives of psychologists. I spoke to the CEO of one large telehealth provider who said he employs a legal counsel to handle such cases in order to support and protect the psychologists that he employs.  

9. They rarely see the full impact of their work

One psychologist told me about a major frustration he had.

“Sometimes patients just cancel an appointment and you never hear from them again. Did they have a bad experience? Did things get worse for them? Or did they fully recover and not need treatment anymore? I have no idea.”

It must be tough to spend time with people, helping them, being deeply invested in their care journey, only to never find out what happened. I’m not sure what you can do with this information, I just thought it was an interesting insight into the profession that I wasn’t previously aware of.  

So there you have it. Nine important things you should know about psychologists when running a mental health business. We should have a little “do you know your therapist?” quiz to test how well you did.

I hope this has been helpful. Next week we’ll be covering how to effectively reach out, engage and partner with psychologists to support your business - I’ll see you there!

Mental Health News

Here’s your roundup of the top news in mental health this week;

• Psychiatry provider Talkiatry raises $130m as part of series C funding, led by Andreessen Horowitz.
• Marigold Health, a virtual peer-support startup for people with substance use disorder and mental health concerns, raises $11m in Series A funding (BHBusiness)
• Neuroflow, a leading provider of behavioural healthtech infrastructure, acquires Owl, a care company for behavioural health providers, to offer over 400 behavioural health assessments (PRWeb)
• Rejoyn becomes the first mobile phone application cleared by the FDA for treating depression, featuring exercises aimed at improving deficits in working memory which some studies show play a role in MDD (Psychiatry Online)
• Child mental health services on the Isle of Man to receive £4m cash injection to bring down waiting lists of 1,200 children (Yahoo News)
• Two executives, the CEO and clinical president, of ADHD startup Done Global, were arrested for an alleged $100m scheme to defraud taxpayers and provide medically illegitimate access to Adderall prescriptions (Healthcare Innovation)

Company Spotlight: Unmind

• What they do: A workplace wellbeing platform that is backed by science and data
• Headquarters: London, United Kingdom
• Founders: Dr. Nick Taylor and Steve Peralta
• Founded: 2016

Unmind is a workplace wellbeing platform, which extends beyond the typical employee assistance program offerings, to provide organisations with solutions for career development, wellbeing support and mental health management.  

They take a scientific and “whole organisation approach” in their training programmes, wellbeing strategy development initiatives, online on-demand courses and mental health support. By scientific, we mean their solutions are developed with their expertise in clinical psychology, positive psychology and organisational psychology. By “whole organisation approach”, we mean they provide these solutions for all levels of the organisation from employees to the C-suite.  

This is all provided in an all-in-one platform so that the entire organisation can benefit from their solutions.  

Most recently, Unmind acquired Dublin-based employee mental healthcare platform Frankie Health and launched Unmind Talk off the back of it. Their last funding round was in 2021, when they raised $47m in their Series B round, aiming to use the capital for international expansion, recruitment and product development. The lead investor of the Series B funding is EQT Ventures, and they rolled out Unmind for their entire organisation.

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Make it this far? Fair play! Reply to this email and let me know what you thought.

That’s all for this week.

Keep fighting the good fight!

Steve Duke

Founder of The Hemingway Group

P.S. feel free to connect with me on LinkedIn