The Mental Health Profession Tipping Point

I am concerned about the current trajectory of the mental health field. So are most of the mental health professionals I talk to.

The truth is, many of us have worried about affordability, access, and quality for years. These concerns are legitimate. Most of us entered this field because we care deeply about people and their wellbeing. But that same care often means we don't have the bandwidth or knowledge to address the systemic issues threatening our profession. And those issues are real. They're evolving, and they're setting us up for catastrophic outcomes for the people who need our services and for those of us passionate about providing them.

The mental health profession is at a tipping point. Affordability, access, and quality have been on the radar of licensing boards, educational programs, and ethics committees for decades. Yet we haven't moved toward real solutions. In many cases, we've lost ground and gained new problems. This kind of systemic imbalance is unsustainable in any industry. So the market did what markets do: it recognized a broken system and stepped in to solve it. Normally, when market forces drive sustainable change, we call it "advancing the field." But in mental health care, I'd argue that systemic changes introduced by those who lack critical clinical knowledge, foresight, and accountability are dangerous. And they will have disastrous consequences.

Kurt Lewin's Change Theory offers a useful framework for understanding how we got here. Lewin saw stability as equilibrium between driving forces for change and restraining forces resisting it. Effective change happens when resistance weakens and motivation for change increases. His model involves three stages:

1. Unfreeze: Create awareness that the status quo is no longer effective. In doing so, this starts to weaken resistance and increase motivation for change.

   
   

2. Change: Implement new process/systems, while emphasizing and reinforcing wins.

   
   

3. Refreeze: Stabilize new behaviors by integrating them into culture and reward behaviors that support the new system to prevent returning to the status quo.

   
   

The negative impacts on our field, such as clinician burnout, lack of access, and increased insurance constraints have created the conditions necessary for change. It is clear to most that the status quo is ineffective. I believe we are in a position of readiness for change. We're unfrozen. Unfortunately, many of the changes we are seeing aren't being driven by our field. This is the real threat. The "solutions" aren't solving our problems. They are being marketed as solutions while fundamentally changing the landscape of our profession.

Two forces are reshaping mental health in particularly concerning ways. The first is venture capital. I spoke with a venture capitalist at a major online mental health tech company recently. When they launched in 2019, they started with 35 contracted clinicians. Now, just six years later, they have over 55,000 contracted clinicians. A company that markets itself as a "tech company" now controls a massive segment of the online behavioral health market. They didn't enter the field to advance clinical care. They entered to scale a business model. Like it or not, it is filling a gap for both clients and clinicians, or they wouldn't be successful.

The second force is AI. AI in healthcare isn't new, but the evolution of chatbots has accelerated dramatically. They're replacing clinicians and health coaches as the provider of choice. They are free, accessible, always available, and solving problems we've failed to address. The uncomfortable truth for mental health professionals is this: regardless of our arguments about the danger and potential destructiveness of venture capital and AI, they are bringing practical solutions to real-world problems that we, as a profession, are still not solving.

We can continue to rely on fear-based arguments about why these changes are bad, or we can bring innovative solutions to the table. If we continue to use fear tactics, we are certainly headed for extinction. However, I don't believe we need to raise the white flag yet. There is still time for mental health professionals to assume control of the changes being implemented. It will require us to approach the future of our profession with fresh perspectives and willingness to take risks. We cannot continue with the status quo of service delivery, funding, and education, and expect to solve modern day problems.

The question isn't whether mental health care will become more digital, it already has. The question is whether human clinicians will lead that integration, ensuring safety, ethical practice, and clinical excellence. Or, whether we will be displaced by those who value scalability over care. I'm choosing to step into this arena because it matters. I'm inviting you to join me.

I would be remiss if I didn't encourage action at the conclusion of this post. I suspect mental health professionals fall along a continuum of awareness of the state of our profession. Now is the time to connect all mental health professionals, regardless of discipline. Invite your colleagues to this virtual table. We need mental health professionals to be the drivers of change!

Finally, if you are a mental health professional and you don't know what people needing help have to navigate when searching for your services, take a minute to Google "mental health help" + your city. What do you notice? Venture capital platforms such as BetterHelp, TalkSpace, etc.? AI chatbots? What surprised you? Comment below with your experiences and thoughts.

In Part 2, I'll address what mental health professionals need to become in this evolving landscape, and why our role is more critical now than it has ever been!