TL;DR: the mental health space is full of for-profit companies whose incentives are fundamentally misaligned with the people they serve. This creates unhelpful solutions that prioritize shareholder profits over actually helping people. It’s time for non-profits in mental health to stop focusing on just crisis services, and move into spaces like journaling that for-profits currently control. Armed with the same techniques and technology that for-profits currently use, with missions that align with the people that need help the most, we can maximize our impact on the mental health crisis.

The Problem

The world is in a mental health crisis — and it’s much worse than many people think. You’ve likely heard the ever-present statistic that 1 in 5 Americans experience a mental illness each year. Unfortunately, it’s gotten much worse over the past few years.

40% of Americans saw declines in their mental health over the course of the pandemic, and 50% of American adolescents have a mental health condition.

This is an all-out emergency, and we need all hands on deck to tackle these problems.

For those fortunate enough to have received mental health support, solutions have largely been driven by the existing for-profit healthcare industry. Similar to physical health, where medication has become the first thing patients and doctors turn to when ailments arise, medication of mental illness has become incredibly prevalent as a first means of treatment. And onthe other end of the treatment spectrum, there’s therapy.

Both of these solutions are similar in their weaknesses — they’re expensive, difficult to access, and have many different complex and poorly-understood varieties. These issues lead to vastly different outcomes for different types of people, and often lead to solutions that don’t reach the people who need them the most.

And on that last point, the facts are clear: the average offset between the start of a mental illness and treatment is still a staggering 11 years, and 7.7 million children in the US are estimated to have an undiagnosed, treatable mental health disorder.

So, how have other organizations stepped up to fill in the gaps? Much of the non-profit and government sector is busy dealing with the most acute cases, of which there are far too many. Existing programs like the Crisis Text Line, 988, and The Trevor Project can hardly keep up with demand.

Other for-profit services attempt to take a non-therapy-driven approach to mental health, especially pre-crisis. Headspace is a great example of this — meditation is proven to help people relax and feel better, and they provide a great paid service. Because of the popularity of Headspace, meditation has been pushed into the mainstream of mental health, and many people on mental health journeys have tried their services or services inspired by them.

Journaling is a similarly powerful habit that can help people better understand themselves and improve their mental health. The mental health benefits of journaling are well-researched and are broadly “understood” by the general public — and as a result, there are a number of popular apps out there that support journaling and journal-like activities. Day One is probably the most popular journal on the market (geared more towards life events and less towards mental health), and apps like Daylio also provide a mental health offering. I’m personally working on a journaling app called baseline that’s run by a non-profit — but more on that later.

Journaling: A Case Study

I’ll be focusing on journaling as a case study for the rest of this article, as I believe it clearly shows how for-profits alone can’t solve our mental health crisis. Journaling, especially using technology, has a myriad of benefits that makes it a great mental health tool:

1. Journaling helps people get better at describing their mental health. If you don’t have practice describing your feelings, how are you supposed to talk to others, or even yourself, about them? How are you supposed to reason with your own feelings and understand them? This also has huge implications for more significant mental health measures like therapy. In a study, 84% of UK young adults said that their dislike of talking about their “feelings, emotions, or thoughts” could stop them from seeking professional help. Sending people to therapy before they’ve broken this block is not only a huge waste of time, but it’s also a luxury that many people simply can’t afford.
2. Journaling helps people see how their mood changes over time. When combined with quantitative data, journaling can really clearly show people when their mood is trending up or down. This is where technology can really help — if your journals are on your phone, it’s really easy to see whatever visualization of your mood that you might want.
3. Journaling complements other mental health services really well. Mental health medication is infamous for its side effects, and many people become unsure about whether these side effects are worth the cure. Journaling can provide really clear answers to these types of questions. Additionally, therapists often run into clients who come into therapy and have completely forgotten everything they’ve been through. Journaling completely eliminates this problem. And if your journal is on your phone, you can write things down on the go, as they happen.

The Problem with For-Profit Solutions

And now we come to our first of two problems. These benefits are great, and the mental health impacts are self-evident — but they’re also currently really difficult to access for the people who need them most. Psychiatric conditions “occur at the highest rates in the poorest communities”, as both a “determinant and a consequence” of poverty. Children (who don’t have money to pay for services) are also more likely to have untreated mental health issues, especially LGBTQ+ children. Unfortunately, the top journaling services out there all utilize a paywall for a significant number of their most impactful features.

The second problem is born from the first. In the end, these for-profits’ primary goal isn’t to help people, as awful as that might sound. It’s to create returns for their shareholders. And because of that, their apps end up becoming structured to get subscriptions using a cheap initial dopamine hit, instead of by facilitating long-term improvements to mental health. (Don’t long-term subscriptions emphasize long-term benefits, you might ask? And to that I would say, Rocket Money and other financial apps have made millions helping people cancel subscriptions they’ve forgotten about. Once a subscription is created, it’s a revenue stream for months or even years after it stops providing utility.)

Look no further than Daylio for a strong example of how these perverse incentives can change the way journaling apps operate. Daylio’s website goes as far as to say, in the first sentence on their website, that they allow you to “capture your day without writing down a single word”, while in the same breath calling their app a “journal”. This is clearly nonsensical, and it does a significant disservice to their users by promising to help people with their mental health (in exchange for money) without helping them put the work in to actually do it. In fact, on that same website, they include a quote from The Guardian saying that their app only takes “5 seconds a day” to use!

These companies are selling magical remedies to mental health problems, not actual solutions.

This also really negatively impacts the way apps are advertised and targeted. After all, if you were a for-profit journaling company, and your job was to get as many subscriptions as possible, who would you target — affluent people who are on a “wellness” kick, or intersectionally disadvantaged people who really needed the help? It sounds cruel to say, but it’s the reality of the situation: when you’re forced to prioritize shareholder profits over all else, people who need help the most are left behind.

How can we do better?

The key to this problem, at least in the framework of what currently exists in the US, is non-profits. Unlike for-profits, these organizations can have aligned incentives with the problem at hand — they can be set up with a mission to help underprivileged people, and they can aim for long-term benefits instead of being forced to provide cheap, fast dopamine hits that yield subscriptions.

It’s clear that non-profits have the power to do this, too. Just look at the crisis sector: it’s largely controlled by non-profits. It’s time for that same focus to be put in the non-crisis space, using the power of technology that for-profits are already leveraging. It might seem strange for a non-profit to release and market an app as their primary product like a for-profit would, but I believe we should embrace it. For-profits have already perfected this playbook for releasing technology and making money. It’s time that we leverage that same system, but for impact instead of profit.

We’ve taken the first step in this direction by creating a non-profit to solve this exact issue: baseline health, which is creating a 100% free journaling and mood tracking app. We focus on a “writing-first” approach to journaling, and our internal metrics are based not on subscriptions or even installs, but on how long people stick with our service. Our hope is that we not only reach underserved communities and people, but also inspire other non-profits and founders to take the leap to make other mental health services available to the public for free, from meditation to peer therapy to habit tracking and beyond.