It took just three days after nine people were killed and scores were injured at the Astroworld Festival in Houston for Travis Scott to do what Travis Scott has always done: announce a partnership.

On Monday, Nov. 8, the rapper shared plans to provide Astroworld attendees with mental health resources. This included partnerships with organizations like the National Alliance on Mental Illness and Mental Health America and their respective Houston chapters. But there was also a partnership that had the distinct air of a promotional deal: Scott’s Cactus Jack Foundation would team up with BetterHelp to provide Astroworld attendees with one month of free one-on-one virtual therapy sessions.

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BetterHelp, which was founded in 2013 and acquired in 2015 by the telemedicine conglomerate Teladoc Health, Inc., bills itself as the world’s “largest online therapy platform.” For about $240 to $360 a month, users are linked with a licensed therapist, with whom they can chat largely through text, but also through voice and video calls. It is a service that, like so many other tech companies, appears to optimize and improve access to a widely needed thing — in this case, mental health care. But BetterHelp has garnered scrutiny over how it compensates therapists, what it does with user data, and if its approach to therapy is even effective.

The response to Scott’s partnership with BetterHelp was swift, cynical, and snarky. The writer Alex Press, in a piece for Jacobin, captured the general tenor, writing: “’Partnering’ with an app typically entails a celebrity being paid to promote a company; is Scott making money off the collaboration? Either way, such a move is more befitting a podcast advertisement than a deadly tragedy — imagine promo code SICKOMODE, or maybe MASSCASUALTYINCIDENT.”

In response to questions about whether Scott was being compensated for the collaboration, BetterHelp directed Rolling Stone to a company statement and FAQ page that stated the partnership is “not a sponsorship or paid endorsement of any kind,” and that Scott is not being paid. BetterHelp also addressed concerns that Astroworld attendees who signed up for the free month would be forfeiting any right to sue; the company’s exact language was “Is there any fine print saying that a person participating in this initiative is waiving any of their legal rights?” And their answer was, “No.”

The last part of the FAQ addressed BetterHelp’s data privacy practices: “Is information members enter on BetterHelp ever sold to any advertising platform or third party?” The company’s response was an emphatic, “No.”

On top of trying to temper the backlash with this information, BetterHelp updated its privacy policy and terms of service on Nov. 10. The updated privacy policy appears to include a more detailed breakdown of the kinds of data BetterHelp collects, as well as the various purposes for which that information may be “disclosed” to third parties. User data can still be shared with affiliates in BetterHelp’s “corporate group” or for various “business purposes.” And when it comes to advertising, the site says it’s use of tracking/data collection tools like cookies and web beacons means some activity will be sent to advertising partners “to optimize marketing”; users, however, can opt-out of cookies and web beacons, and BetterHelp states that any activity that takes place when a user is logged in and has started therapy is excluded.

A BetterHelp spokesperson did provide an additional statement to Input about the backlash, saying, “It’s disheartening to see the way misinformation is spreading about us, but we’re more saddened by the way this is hurting the perceptions of mental health care. Our goal has always been to normalize mental health by making therapy accessible. Coverage like this only hurts that greater cause.”

But this isn’t the first time BetterHealth has faced criticism. Last year, Jezebel tracked the way user data on BetterHelp — everything from age, gender identity, sexual orientation, and metadata about patient sessions to info about how recently a person had suicidal thoughts — ended up in the hands of companies like Facebook or the data analytics firm Mixpanel. In their response at the time, BetterHelp told Jezebel its data collection methods were standard and and that they “typically far exceed all applicable regulatory, ethical and legal requirements.”

In September, Jeff Guenther, a Portland, Oregon-based therapist and the founder of the therapist directory, TherapyDen.com, went viral on TikTok with videos critiquing various facets of BetterHelp, from their supposed data selling practices to measly therapist pay (about $30 a session) and policies like word count limits that hindered the kind of care therapists could provide (essentially, if a therapist goes over a certain word count in responding to a client, BetterHelp won’t compensate them for that extra work).

Why do therapists hate BetterHelp? #betterhelp #therapy #therapytiktok #therapist #mentalhealthmatters #trauma #siliconvalley

♬ original sound – TherapyDen

“It feels like BetterHelp is more concerned, like most tech companies, with their bottom line, how much revenue they’re bringing in, and how much money they’re bringing to their investors,” Guenther tells Rolling Stone. “This is a tech company that cares about making money. It doesn’t feel like they care about really meeting client needs or therapist needs. Although they present it that way in their marketing; they’re very savvy in their marketing.”

The data sharing issue is a murky one. A therapist collecting and selling information without informed consent would likely be a license-losing offense. But there are many instances in private practice or research where patient information is made public with that consent, and it’s also kosher under the Health Insurance Portability and Accountability Act (HIPAA) to share data so long as it’s properly anonymized. When it comes to BetterHelp, Guenther says, a version of that informed consent process is happening the same way it does when anyone signs up for any platform these days: Agreeing to the company’s terms of service and privacy policy.

“You have to check those before going to the next step to get a therapist [on BetterHelp],” he says. “And when they do, the client is giving up their rights to their data. BetterHelp is basically saying, ‘We’re going to take your data and share it or sell it. Are you OK with that?’ And the client is saying that it’s okay because that’s their data and they’re handing it over to BetterHelp.”

Ultimately it’s still pretty unclear what BetterHelp does with user information, or what happens to it when it ends up with members of its “corporate group” or “advertising partners” — “Whoever the fuck that is,” Guenther quips of those vague group names. “They don’t list it. Their ad network, who else is in their ad network?”

This kind of data collection is standard on the internet, but it’s obviously concerning to consider information gathered in the course of someone seeking mental health help being fed into the web’s endless feedback loop of browsing, advertising and optimization.

“It’s a little disconcerting under the best of circumstances when you start getting targeted ads,” says Dr. Lynn Bufka, a psychiatrist and senior director at the American Psychological Association. “I would have concerns about the quality of products being advertised to individuals [seeking mental health help]. When you’re in distress, it’s harder to sort through all that. And you may be particularly vulnerable to wanting the thing that looks awesome and promises to make a difference without necessarily critiquing it in a way that you might under other circumstances.”

On top of all this, there are genuine questions about the kind of care someone might get on BetterHelp. While the contracted therapists on the platform are licensed professionals (a guarantee BetterHelp could not make when it came under fire in 2018 after partnering with a handful of popular YouTubers), there’s still an element of chance embedded in the process of pairing therapists with patients. Patients can change therapists if they’re not satisfied, but Guenther notes the risks of a bad first match: “If you get a therapist and they’re not matched with you correctly, then you may never go back to therapy again.”

Additionally, much of the work on BetterHelp is be done via text, with plans offering unlimited messaging on top of occasional video or phone calls, depending on the therapist’s availability. As Bufka notes, phone and video therapy can be as effective as in-person visits, and telehealth has proven benefits — whether it’s keeping people safe during the pandemic, or expanding access to mental health help in rural areas. But some questions still linger about the efficacy of text-based therapy. Guenther, for instance, notes that an unlimited texting option essentially makes a therapist available 24/7, potentially hindering the patient’s ability to develop the kind of self-reliance that might normally be cultivated in the days in between a standard weekly appointment. (As Input also noted, BetterHelp only provides care to those over 18, making the service unavailable to anyone under that age that attended Astroworld. A 14-year-old and 16-year-old are among the nine victims of the crowd surge, while a nine-year-old was left in critical condition.)

Bufka adds, “We don’t have a lot of research suggesting that text-only communication accomplishes the same kinds of aims that a more traditional therapy delivered over the course of several sessions delivers. There’s no doubt that people could find text-based communication with somebody helpful. In a system that was better integrated, that would probably be a good initial step for many people, and might even be sufficient. But we just don’t have enough knowledge to know how best to make those decisions because of how our health care system is set up and the kind of research that’s been conducted today.”

What is undeniable is that it’s good for people to have access to mental health help. And even a fierce critic like Guenther acknowledges that BetterHelp and similar platforms, like Talk Space, are “tapping into something about the mental health industry that needs to change,” especially when it comes to expanding access and easily finding a therapist. And for those who attended Astroworld, while it’s obviously good to know as much about a platform before agreeing to any terms of service or privacy policies, a free month of chatting with someone on BetterHelp could be a decent way to start processing their feelings about the tragedy that unfolded.

“I would absolutely imagine that lots of people are feeling stressed and overwhelmed and are struggling right now,” Bufka says. “I mean, you were at a venue to have fun and people died. You may well have been packed-in and felt scared for your own well-being. Or maybe it was thrilling in the moment and only after did you hear about what happened to other people, and now you’re feeling horrible — could you have contributed, or how did I not realize what was going on? All of that would be normal responses to something really outside the norm. And I think that’s important for people to know — that if they’re feeling distressed and overwhelmed in a range of responses, emotional responses, that’s OK. And they should allow themselves to feel that.”

If you are struggling with mental health conditions, please reach out to a mental health care professional or contact the National Alliance on Mental Illness (NAMI) Monday through Friday from 10 a.m. to 6 p.m. EST at 800-950-NAMI (6264).

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