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.<\/p>\n

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.<\/p>\n

\u201cWe believe they\u2019re going to have not just great impact, but wide impact across California, especially in places where maybe it\u2019s not so easy to find an in-person behavioral health visit or the kind of coaching and supports that parents and young people need,\u201d said Gov. Gavin Newsom\u2019s health secretary, Mark Ghaly, during the Jan. 16 announcement.<\/p>\n

The apps represent one of the Democratic governor\u2019s 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 Health Care Services, which operates the program.<\/p>\n

However, the rollout has been slow. So slow that one of the companies has missed a deadline to make its app available on Android phones. Only about 15,000 of the state\u2019s 12.6 million children and young adults have signed up for the apps, and school counselors say they\u2019ve never heard of them.<\/p>\n

Advocates for youth question the wisdom of investing taxpayer dollars in two private companies. Social workers are concerned the companies\u2019 coaches won\u2019t 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 $73 billion<\/a>.<\/p>\n

An App for That<\/strong><\/p>\n

Newsom\u2019s 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\u2019s part of Newsom\u2019s sweeping $4.7 billion master plan<\/a> for kids\u2019 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.<\/p>\n

\u201cThe reality is that we are rarely 6 feet away from our devices,\u201d said Sohil Sud, director of Newsom\u2019s Children and Youth Behavioral Health Initiative. \u201cThe 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.\u201d<\/p>\n

The virtual platforms come amid rising depression and suicide rates among youth and a shortage of mental health providers<\/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 2021 study<\/a> by the UCLA Center for Health Policy Research. These rates are even higher for multiracial youths and those from low-income families.<\/p>\n

But those supporting youth mental health at the local level question whether the apps will move the needle on climbing depression and suicide rates.<\/p>\n

\u201cIt\u2019s fair to applaud the state of California for aggressively seeking new tools,\u201d said Alex Briscoe of California Children\u2019s Trust, a statewide initiative that, along with more than 100 local partners, works to improve the social and emotional health of children. \u201cWe just don\u2019t see it as fundamental. And we don\u2019t believe the youth mental health crisis will be solved by technology projects built by a professional class who don\u2019t share the lived experience of marginalized communities.\u201d<\/p>\n

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 health plan in Illinois<\/a>. In the first five months of Kooth\u2019s Pennsylvania pilot, 6% of students who had access to the app signed up.<\/p>\n

Brightline and Kooth represent a growing number of health tech firms seeking to profit<\/a> 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.<\/p>\n

Although the service is intended to be free with no insurance requirement, Brightline\u2019s app, BrightLife Kids, is folded into and only accessible through the company\u2019s main app, which asks for insurance information and directs users to paid licensed counseling options alongside the free coaching. After KFF Health 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.<\/p>\n

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 Health 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.<\/p>\n

\u2018It\u2019s Like Crickets\u2019<\/strong><\/p>\n

Despite being months into the launch and having millions in marketing funds, the companies don\u2019t 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 \u201cthe main focus for this calendar year.\u201d<\/p>\n

\u201cIt\u2019s a big state \u2014 58 counties,\u201d Bob McCullough of Kooth said. \u201cIt\u2019ll take us a while to get to all of them.\u201d<\/p>\n

Brightline\u2019s contract states that the company was required to launch downloadable apps for iOS and Android phones by January, but so far BrightLife Kids is available only on Apple phones. Brightline said it\u2019s aiming to launch the Android version over the summer.<\/p>\n

\u201cNobody\u2019s really done anything like this at this magnitude, I think, in the U.S. before,\u201d said Naomi Allen, a co-founder and the CEO of Brightline. \u201cWe\u2019re very much in the early innings. We\u2019re already learning a lot.\u201d<\/p>\n

The contracts, obtained by KFF Health 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\u2019s virtual behavioral health strategy. The state said it aims to make the apps available long-term, depending on usage.<\/p>\n

The state said 15,000 people signed up in the first three months. When KFF Health News asked how many of those users actively engaged with the app, it declined to say, noting that data would be released this summer.<\/p>\n

KFF Health News reached out to nearly a dozen California mental health professionals and youths. None of them were aware of the apps.<\/p>\n

\u201cI\u2019m not hearing anything,\u201d said Loretta Whitson, executive director of the California Association of School Counselors. \u201cIt\u2019s like crickets.\u201d<\/p>\n

Whitson said she doesn\u2019t think the apps are on \u201canyone\u2019s\u201d radar in schools, and she doesn\u2019t 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\u2019t reach out to plan the meeting; she did.<\/p>\n

Kelly Merchant, a student at College of the Desert in Palm Desert, California, and Allen Pahl, a recent graduate, say they like Soluna\u2019s engaging content and the ability it offers to speak to a coach outside the 9-to-5 schedule. None of the youths KFF Health News interviewed had heard of the app previously.(Molly Castle Work\/KFF Health News)<\/span><\/figcaption><\/figure>\n
Concern Over Referrals<\/strong><\/p>\n
Whitson isn\u2019t comfortable promoting the apps just yet. Although both companies said they have a clinical team on staff to assist, Whitson said she\u2019s concerned that the coaches, who aren\u2019t all licensed therapists, won\u2019t have the training to detect when users need more help and refer them to clinical care.<\/p>\n
This sentiment was echoed by other school-based social workers, who also noted the apps\u2019 duplicative nature \u2014 in some counties, like Los Angeles, youths can access free virtual counseling sessions through Hazel Health<\/a>, a for-profit company. Nonprofits, too, have entered this space. For example, Teen Line<\/a>, a peer-to-peer hotline operated by Southern California-based Didi Hirsch Mental Health Services, is free nationwide.<\/p>\n
While the state is also funneling money to the schools as part of Newsom\u2019s 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.<\/p>\n
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 Health News said they appreciated having engaging content on their phone and the ability to speak to a coach, but all said they\u2019d prefer in-person therapy.<\/p>\n
\u201cThere 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\u2019re on the waitlist,\u201d Merchant said. \u201cAnd, like, you\u2019re seeing all these people struggle.\u201d<\/p>\n
Fiscal conservatives question whether the money could be spent more effectively, like to bolster county efforts and existing youth behavioral health programs.<\/p>\n
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.<\/p>\n
\u201cWhat starts as a small financial commitment can become uncontrollable expenses down the road,\u201d said Susan Shelley of the Howard Jarvis Taxpayers Association.<\/p>\n
This article was produced by <\/em>KFF Health News<\/em><\/a>, which publishes <\/em>California Healthline<\/em><\/a>, an editorially independent service of the <\/em>California Health Care Foundation<\/em><\/a>.<\/em>\u00a0<\/p>\n
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