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California Is Investing $500M in Therapy Apps for Youth. Advocates Fear It Won鈥檛 Pay Off.

California Is Investing $500M in Therapy Apps for Youth. Advocates Fear It Won鈥檛 Pay Off.

(Lydia Zuraw/KFF 国产精品视频 News)

With little pomp, California launched two apps at the start of the year offering free behavioral health services to youths to help them cope with everything from living with anxiety to body acceptance.

Through their phones, young people and some caregivers can meet BrightLife Kids and Soluna coaches, some who specialize in peer support or substance use disorders, for roughly 30-minute virtual counseling sessions that are best suited to those with more mild needs, typically those without a clinical diagnosis. The apps also feature self-directed activities, such as white noise sessions, guided breathing, and videos of ocean waves to help users relax.

鈥淲e believe they’re going to have not just great impact, but wide impact across California, especially in places where maybe it’s not so easy to find an in-person behavioral health visit or the kind of coaching and supports that parents and young people need,鈥 said Gov. Gavin Newsom鈥檚 health secretary, Mark Ghaly, during the Jan. 16 announcement.

The apps represent one of the Democratic governor鈥檚 major forays into health technology and come with four-year contracts valued at $498 million. California is believed to be the first state to offer a mental health app with free coaching to all young residents, according to the Department of 国产精品视频 Care Services, which operates the program.

However, the rollout has been slow. Only about 15,000 of the state鈥檚 12.6 million children and young adults have signed up for the apps, school counselors say they鈥檝e never heard of them, and one of the companies isn鈥檛 making its app available on Android phones until summer.

Advocates for youth question the wisdom of investing taxpayer dollars in two private companies. Social workers are concerned the companies鈥 coaches won鈥檛 properly identify youths who need referrals for clinical care. And the spending is drawing lawmaker scrutiny amid a state deficit pegged at as much as .

An App for That

Newsom鈥檚 administration says the apps fill a need for young Californians and their families to access professional telehealth for free, in multiple languages, and outside of standard 9-to-5 hours. It鈥檚 part of Newsom鈥檚 sweeping $4.7 billion for kids鈥 mental health, which was introduced in 2022 to increase access to mental health and substance use support services. In addition to launching virtual tools such as the teletherapy apps, the initiative is working to expand workforce capacity, especially in underserved areas.

鈥淭he reality is that we are rarely 6 feet away from our devices,鈥 said Sohil Sud, director of Newsom鈥檚 Children and Youth Behavioral 国产精品视频 Initiative. 鈥淭he question is how we can leverage technology as a resource for all California youth and families, not in place of, but in addition to, other behavioral health services that are being developed and expanded.鈥

The virtual platforms come amid rising depression and suicide rates among youth and a . Nearly half of California youths from the ages of 12 to 17 report having recently struggled with mental health issues, with nearly a third experiencing serious psychological distress, according to a by the UCLA Center for 国产精品视频 Policy Research. These rates are even higher for multiracial youths and those from low-income families.

But those supporting youth mental health at the local level question whether the apps will move the needle on climbing depression and suicide rates.

鈥淚t鈥檚 fair to applaud the state of California for aggressively seeking new tools,鈥 said Alex Briscoe of California Children鈥檚 Trust, a statewide initiative that, along with more than 100 local partners, works to improve the social and emotional health of children. 鈥淲e just don鈥檛 see it as fundamental. And we don鈥檛 believe the youth mental health crisis will be solved by technology projects built by a professional class who don鈥檛 share the lived experience of marginalized communities.鈥

The apps, BrightLife Kids and Soluna, are operated by two companies: Brightline, a 5-year-old venture capital-backed startup; and Kooth, a London-based publicly traded company that has experience in the U.K. and has also signed on some schools in Kentucky and Pennsylvania and a . In the first five months of Kooth鈥檚 Pennsylvania pilot, 6% of students who had access to the app signed up.

Brightline and Kooth represent a growing number of health tech in this space. They beat out dozens of other bidders including international consulting companies and other youth telehealth platforms that had already snapped up contracts in California.

Although the service is intended to be free with no insurance requirement, Brightline鈥檚 app, BrightLife Kids, is folded into and only accessible through the company鈥檚 main app, which asks for insurance information and directs users to paid licensed counseling options alongside the free coaching. After KFF 国产精品视频 News questioned why the free coaching was advertised below paid options, Brightline reordered the page so that, even if a child has high-acuity needs, free coaching shows up first.

The apps take an expansive view of behavioral health, making the tools available to all California youth under age 26 as well as caregivers of babies, toddlers, and children 12 and under. When KFF 国产精品视频 News asked to speak with an app user, Brightline connected a reporter with a mother whose 3-year-old daughter was learning to sleep on her own.

鈥業t鈥檚 Like Crickets鈥

Despite being months into the launch and having millions in marketing funds, the companies don鈥檛 have a definitive rollout timeline. Brightline said it hopes to have deployed teams across the state to present the tools in person by midyear. Kooth said developing a strategy to hit every school would be 鈥渢he main focus for this calendar year.鈥

鈥淚t鈥檚 a big state 鈥 58 counties,鈥 Bob McCullough of Kooth said. 鈥淚t鈥檒l take us a while to get to all of them.鈥

So far BrightLife Kids is available only on Apple phones. Brightline said it鈥檚 aiming to launch the Android version over the summer.

鈥淣obody鈥檚 really done anything like this at this magnitude, I think, in the U.S. before,鈥 said Naomi Allen, a co-founder and the CEO of Brightline. 鈥淲e鈥檙e very much in the early innings. We鈥檙e already learning a lot.鈥

The contracts, obtained by KFF 国产精品视频 News through a records request, show the companies operating the two apps could earn as much as $498 million through the contract term, which ends in June 2027, months after Newsom is set to leave office. And the state is spending hundreds of millions more on Newsom鈥檚 virtual behavioral health strategy. The state said it aims to make the apps available long-term, depending on usage.

The state said 15,000 people signed up in the first three months. When KFF 国产精品视频 News asked how many of those users actively engaged with the app, it declined to say, noting that data would be released this summer.

KFF 国产精品视频 News reached out to nearly a dozen California mental health professionals and youths. None of them were aware of the apps.

鈥淚’m not hearing anything,鈥 said Loretta Whitson, executive director of the California Association of School Counselors. 鈥淚t’s like crickets.鈥

Whitson said she doesn鈥檛 think the apps are on 鈥渁nyone鈥檚鈥 radar in schools, and she doesn鈥檛 know of any schools that are actively advertising them. Brightline will be presenting its tool to the counselor association in May, but Whitson said the company didn鈥檛 reach out to plan the meeting; she did.

Two young adults stand on a sidewalk just outside a building. Both have dark hair and are smiling at the camera.
Kelly Merchant, a student at College of the Desert in Palm Desert, California, and Allen Pahl, a recent graduate, say they like Soluna鈥檚 engaging content and the ability it offers to speak to a coach outside the 9-to-5 schedule. None of the youths KFF 国产精品视频 News interviewed had heard of the app previously.(Molly Castle Work/KFF 国产精品视频 News)

Concern Over Referrals

Whitson isn鈥檛 comfortable promoting the apps just yet. Although both companies said they have a clinical team on staff to assist, Whitson said she鈥檚 concerned that the coaches, who aren鈥檛 all licensed therapists, won鈥檛 have the training to detect when users need more help and refer them to clinical care.

This sentiment was echoed by other school-based social workers, who also noted the apps鈥 duplicative nature 鈥 in some counties, like Los Angeles, youths can access free virtual counseling sessions through Hazel 国产精品视频, a for-profit company. Nonprofits, too, have entered this space. For example, , a peer-to-peer hotline operated by Southern California-based Didi Hirsch Mental 国产精品视频 Services, is free nationwide.

While the state is also funneling money to the schools as part of Newsom鈥檚 master plan, students and school-based mental health professionals voiced confusion at the large app investment when, in many school districts, few in-person counseling roles exist, and in some cases are dwindling.

Kelly Merchant, a student at College of the Desert in Palm Desert, noted that it can be hard to access in-person therapy at her school. She believes the community college, which has about 15,000 students, has only one full-time counselor and one part-time bilingual counselor. She and several students interviewed by KFF 国产精品视频 News said they appreciated having engaging content on their phone and the ability to speak to a coach, but all said they鈥檇 prefer in-person therapy.

鈥淭here are a lot of people who are seeking therapy, and people close to me that I know. But their insurances are taking forever, and they’re on the waitlist,鈥 Merchant said. 鈥淎nd, like, you’re seeing all these people struggle.鈥

Fiscal conservatives question whether the money could be spent more effectively, like to bolster county efforts and existing youth behavioral health programs.

Republican state Sen. Roger Niello, vice chair of the Senate Budget and Fiscal Review Committee, noted that California is forecasted to face deficits for the next three years, and taxpayer watchdogs worry the apps might cost even more in the long run.

鈥淲hat starts as a small financial commitment can become uncontrollable expenses down the road,鈥 said Susan Shelley of the Howard Jarvis Taxpayers Association.

This article was produced by KFF 国产精品视频 News, which publishes , an editorially independent service of the .

[Correction: This article was revised at 8:55 p.m. ET on April 26, 2024,
to correct details about the BrightLife Kids app for Android.]