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The hardest thing to do when you’re feeling suicidal is to reach out to talk to someone. Therapy apps like TalkSpace and BetterHelp are designed to help make it easier to talk to a therapist by connecting you directly to someone you can message or call any time. But they face a challenge when it comes to helping patients who are suicidal.
According to statistics from a 2019 report from nonprofit Mental Health America (MHA) on mental health in America, a whopping 56.4% of Americans (or over 24 million people) with a mental illness receive no treatment for their condition. The report provides a number of reasons for this — ranging from not having insurance coverage, mental health care not being covered by insurance, or the high costs of care — but the conclusion is staggering. Americans aren’t getting the mental health care they need.
That may be one of the reasons that therapy apps, which connect you directly with a therapist for a weekly or monthly fee, have grown so much in popularity. BetterHelp boasts over a million users, and competitor TalkSpace similarly claims to have had over a million users since going on the market. While both apps advise against using their services as your sole form of therapy, allowing users to message or call their assigned therapist — rather than having to wait for a preset appointment in an office — can be a helpful additional tool.
But these apps come with (at least) one serious limitation: They can’t be used to handle patients with suicidal thoughts. In the terms of service for both TalkSpace and BetterHelp, suicidal users are given a large, all-caps warning not to use their apps at all, and instead to reach out to a suicide hotline, or call 911. TalkSpace even offers a massive list of hotlines you can call in various countries.
Meanwhile, the problem of suicide in the United States is only getting more desperate. According to MHA’s report, over 9.8 million adults in the United States reported having serious suicidal thoughts, which is around 4% of all the adults in the country and about 200,000 more people than the organization reported the previous year. That total is over six and a half times the number of people who reportedly use BetterHelp and TalkSpace combined.
The number of people who act on their suicidal thoughts has similarly risen. According to data from the Center for Disease Control, the suicide rate in the United States has grown over 30% in half of the states since 1999. This data only takes into account people who have committed suicide, not people who struggle with suicidal thoughts or mental illnesses that can lead to suicide.
If you’re part of that 4% who are considering suicide, you may find yourself turned away at the metaphorical door of apps like TalkSpace or BetterHelp. When signing up for the latter, you’re asked a series of questions that include whether you’ve had “thoughts that you would be better off dead” in the past two weeks or “When is the last time you had a plan for suicide?”
That last question may be a hard filter for the service. The options for answering this question include “Never,” “Over a year ago,” “Over a week ago,” or “This week.” Running through the questionnaire once and answering any of the first three answers, I was directed to an account creation screen at the end. However, when I answered with all the same answers — except changing the answer to this question to “This week” — I was hit with the following screen:
In other words, if you’ve had plans to commit suicide this week, BetterHelp will direct you elsewhere for help.
Similarly, TalkSpace connects you directly with a person when you sign up, who can talk you through what you need. In this case, I asked outright if they could help someone struggling with suicidal thoughts. I was told “We don’t have crisis services available so we would recommend that you contact local support or the hotline.” However, the person I spoke to did say TalkSpace could “be a long-term resource around issues related to depression.”
These services have reason to be hesitant. For therapists — both traditional, and the kind you’ll connect with through these apps — dealing with suicidal patients can be tricky. Some states require therapists to report any serious threats their patients make against their own lives to police or emergency services. If a patient is suicidal and a therapist doesn’t take appropriate action, it can open them up to legal liability.
In the past, apps like TalkSpace weren’t always able to provide that information to emergency services at all. According to a report from The Verge in 2016, therapists often didn’t have access to a patient’s name or contact info. In the time since, the company has improved these features and now therapists can access a person’s emergency contact info and, according to the company, can even pull their IP address to potentially help find their location.
To a certain extent, the challenge of preventing suicide and treating suicidal thoughts isn’t unique to therapy apps.
Unfortunately, it’s not quite as simple as calling someone in the case of an emergency. Suicidal ideation — a term used to describe suicidal thoughts — can include passing thoughts a patient might never act on or unwelcome intrusive thoughts that contradict what a person might actually want. According to data from the CDC, millions more people have suicidal thoughts than the number of people who actually follow through. Not every expression of suicidal thoughts in therapy is an emergency, and forcing involuntary treatment on a patient can sometimes make the situation worse.
To a certain extent, the challenge of preventing suicide and treating suicidal thoughts isn’t unique to therapy apps. Unfortunately, therapy apps have very little in the way of external infrastructure they can rely on. They can send someone to a crisis hotline, but that’s about it. Compare that to traditional therapy, which can often lean on other options your health care might offer, such as voluntary inpatient services, medication, or neurological testing.
Nevertheless, it puts patients in a difficult situation. If you’ve hit the point where you’re considering carrying out a plan for suicide, reaching out for help is incredibly scary. It can mean you lose your freedom, your privacy, and it can hurt your friends or family in ways you never intended. Feeling suicidal is one of the most vulnerable places a person with a mental illness can be. Unfortunately, it’s also the area that our mental health system is often least equipped to handle, and therapy apps are no better than traditional methods at dealing with it.
If you’ve struggled with suicidal thoughts, you can call the National Suicide Hotline at 1–800–273–8255