Lyra Health Limits Access to High-Quality Treatments for “Our Own Good”
Originally published on the Psychotherapy Action Network (PsiAN) Forum
By Irene Yancher, PsyD
Lyra Health, a Silicon Valley startup, has raised $675M+ in funding to connect employees of companies, such as Facebook, to mental health treatment. However, Lyra’s clients are actually the corporations — they are the ones who pay for the Lyra service. To succeed, Lyra must make a compelling sales pitch to their corporate clients and also grow quickly to raise venture capital. It seems that Lyra’s main strategy for achieving these goals is to promote cost-minimizing, brief treatments and to disparage high-caliber, long-term treatments it does not offer. Instead of owning its desire to minimize costs, Lyra uses marketing strategies to claim they are limiting care options for our own good.
In a fear-inducing November 2019 white paper, titled “Research suggests most health plan providers are not practicing evidence-based treatments,” Lyra claims that “72% of behavioral health providers surveyed were not practicing evidence-based therapies or were practicing harmful therapies.”
Lyra’s paper poses as “research” but is actually marketing that promotes its own services. Lyra cherry-picks studies to claim that the therapies they offer are “evidence-based” and ignores studies that show strong evidence for therapies they do not offer. The paper also previously made an entirely false, fear-mongering claim, which has since been removed, that psychoanalysis causes harm.
These claims have not gone unnoticed. A division of the American Psychological Association, the Society for Psychoanalysis and Psychoanalytic Psychology (SPPP), responded with a letter to David Ebersman, CEO of Lyra. The SPPP stated that “Unwitting consumers and other companies might accept the authority of this white paper, which contains false information, thereby restricting their options for treatments that work.” Additionally, SPPP wrote that Lyra’s previous “(mis)characterization of psychoanalysis goes beyond mere misrepresentation and may amount to libel and consumer fraud.”
Let’s look at the therapies that Lyra cherry-picks as “evidence-based.” They tend to be brief, cost-minimizing therapies, such as CBT for generalized anxiety disorder, and behavioral activation for depression. The treatments focus on symptoms, not underlying causes, and typically range from 8 to 12 sessions. This approach to mental health care directly contradicts a judicial ruling against the insurance giant United Behavioral Health, which states that “effective treatment requires treatment of the individual’s underlying condition and is not limited to alleviation of the individual’s current symptoms.” This is analogous to the idea that medical doctors who treat chronic headaches have to do more than just prescribe pain relief; they must also investigate and treat the underlying cause. The ruling rises above theoretical and academic loyalties and financial incentives.
Lyra cherry-picking brief treatments as “evidence-based” is also problematic. Several high-caliber studies show that “on average, clinically meaningful change begins around the six-month mark and grows from there.” Research also shows that the benefits of psychoanalytic therapies (which typically extend beyond 12 sessions) tend to increase over time, while the benefits of non-psychoanalytic therapies (such as the ones that Lyra tends to promote) tend to decay over time.
It’s easier to sell cheaper, shorter treatments to large companies. And it’s even easier to sell cheaper treatments if you market them as superior to others. And it’s perhaps easiest to sell cheaper treatments if you scare people into believing that other treatments are actually harmful. It’s almost as though Lyra took a page out of Gob Bluth’s marketing strategy: “a Frozen Banana that won’t make you sick and kill you!” Lyra is incentivized to please its corporate clients, whose goals may not always be aligned with that of the individual patient.
This is the story of Lyra promoting brief, cost-minimizing therapies, refusing to reimburse for certain long-term, evidence-based treatments, and making false claims that the latter are not evidence-based. The therapies they offer may temporarily reduce symptoms, but this is not because of their brand name, or the way in which they package together various interventions. Instead, it’s factors that are common to many treatments, such as helping patients express emotions and develop trust in the therapeutic relationship, that are shown to be effective. Acknowledging these mechanisms of change, however, would not benefit Lyra. It would be much harder to compete with entities that do offer long-term, evidence-based therapies focused on both symptom reduction and the underlying condition. Lyra patients might ask why certain treatments are not accessible to them.
Marketing claims are powerful. They quickly tell our brain how to categorize and think about something. Some claims we’ve learned to ignore, or at least take with a large grain of salt (e.g., “World’s Best Burger!”). However, when it comes to the relatively opaque world of mental health, we may still accept marketing claims without question. Unlike decisions about which burger to eat, healthcare decisions have significant implications. A patient who doesn’t respond adequately to a brief, CBT treatment, and who could be helped by an evidence-based treatment that Lyra does not offer, could miss out on an opportunity to heal. The effects could range from missed days of work to a severe depression that takes away the patient’s ability to work at all, to enjoy life, or to sustain relationships. We cannot allow the financial interests of one startup to denigrate high-quality treatments and to limit patients to brief therapies that may not work for them.
Irene Yancher, PsyD is a psychotherapist practicing in San Francisco.