Student Mental Health Privacy

The Shrink Space co-founders, Beth and Aarti, sat down with Paubox CMO, Rick Kuwahara, as part of their Encrypted Interview Series where they chat with leaders in healthcare IT, compliance, and cybersecurity to pick their brains on trends and best practices. Paubox is a HIPAA-compliant email solution that The Shrink Space (TSS) has partnered with to ensure all messages sent via the TSS platform are encrypted. Keep reading to learn more about how TSS protects student mental health privacy. And for the full transcript check out the Paubox blog!

Early career and professional growth

Rick Kuwahara: Before you founded The Shrink Space, you both were practicing psychologists, so what drove you to start a digital health startup?

Aarti Khullar:  It was our personal, first-hand experience as graduate students trying to access care and then later on our professional experience as psychologists trying to facilitate effective referrals, which really motivated us to develop The Shrink Space. 

As graduate students, Beth and I both tried to find therapists and it was a daunting process. Like so many folks have experienced, insurance lists were ghost directories, providers were difficult to reach, and now over a decade later, the process remains largely the same – if not even more challenging for the Gen Z students who are now more accustomed to scheduling everything on their phone and computer.

Following our time in graduate school we both worked in college counseling centers, where we experienced the dramatic rise in student demand for clinical services. We were faced with increased administrative challenges to maintain accurate and up-to-date referral lists, but with limited resources we didn’t have the time or bandwidth to do so. 

Beth and I then transitioned into private practice where we faced the challenges of having no real seamless way to communicate our ever-changing practice needs to referring counseling centers and students. 

It’s because of these personal experiences and as student, counseling center staff member, and community provider, that Beth and I saw the tremendous need to build a technology solution that would streamline and alleviate the referral complexities for each of our users.  Ultimately, our goal is to improve emerging adults’ access to quality mental health care.

Challenges of growing a digital health startup

Rick: From an operations perspective, what’s been the biggest challenge or mission you have in growing The Shrink Space?

Aarti: As I mentioned, our mission is to improve access to quality mental healthcare. Students are very excited to move from a pen and paper referral process to a digital platform that gives them more control and transparency to find the best fit. Despite students’ enthusiasm, we have of course encountered challenges, and one of the biggest hurdles we’ve faced has been affecting systemic change. 

Healthcare, particularly mental healthcare, has lagged behind in terms of innovation. This is due to a number of reasons, which include hesitance to change as well as the need to ensure student mental health privacy. So for good reason, we’ve found that community providers and universities are at times cautious, particularly around integrating new mental health tech solutions. 

With this understanding, we work closely with our university and community providers to demonstrate how our software service 1) encrypts all PHI and maintains HIPAA-compliance and 2) reduces their administrative load thereby freeing up hours to do more of the clinical work they love and better support the rising number of students coming into their offices.

Technology and student mental health privacy

Rick: One thing Aarti mentioned earlier was how students are excited about The Shrink Space and being able to have access this way versus the old processes. But unfortunately, there still does seem to be a lot of stigma around mental health, especially for youth. How do you both see digital health being able to help with that?

Beth: It’s a great question and this is one that we’ve talked a lot about. We’ve put a lot of thought into the stigma around mental health, as we’ve been designing and building out our platform. We regularly solicit student feedback and employ a UI/UX design team to make sure we both understand and meet the technological expectations of students and young adults today. 

And in many ways we believe our mental health field needs to modernize, to meet students and youth where they’re at, which is often on their phones. Just as young adults expect to be able to make dinner reservations online, or they expect to be able to book their next vacation online, they also expect to be able to connect and book a therapy session online. 

The fact that this capability is not ubiquitous contributes to the stigma and mystery surrounding mental health treatment. 

On our site we’ve really designed it intentionally to be intuitive and accessible and to provide more transparency for students about the mental health search process. You’ll notice that much of our interface resembles what you might see on an OpenTable or an Airbnb.

And we’ve done this so that students feel a sense of familiarity, of comfort, and trust as they’re navigating our site, because we think that when an online experience feels familiar and expected, that this will help to contribute to a reduction in stigma. 

We also have a social media presence and a blog for our students so that we are further normalizing mental healthcare and the process of accessing  treatment. 

Keeping student trust with data security

Rick: One of the biggest challenges with any piece of healthcare technology is being able to keep the data private and secure. When you envisioned The Shrink Space, how early did you take into consideration securing all the PHI (protected health information) you’d be handling?

Aarti: Yes, this is a very important question. Beth and I went into this assuming that protecting student PHI would be the industry standard. As psychologists we understand the high priority our field places on HIPAA and so our expectation was that our technology would be no different.

The thought was that any time student PHI was being handled, particularly on behalf of the university, we would need to keep it secure. As such, this has always been one of our goals.

When a student goes to therapy they expect confidentiality. We believe they should expect the same from The Shrink Space technology. 

All that being said, we also understand ensuring student mental health privacy on a platform can pose challenges and many third-party vendors have chosen not to maintain compliance. Beth and I decided early on that student mental health privacy was of paramount importance and so we’ve prioritized it. For us this has meant features are more costly and timely to build. It can also be difficult at times to balance the information a university counseling center requests while simultaneously protecting patient privacy.

However, our work as psychologists in university mental health has been extremely helpful in informing the user flow and consent process that provides counseling centers with data while also maintaining compliance and protecting our students’ privacy.

Ultimately, we’re very happy we built a secure backend infrastructure from the start as it now allows us to add more sophisticated features, such as gaining student consent to share referral dispositions to their university counseling centers as well as a number of other future features, which will allow us to facilitate the flow of information between each of our users. And ultimately that is the goal of HIPAA, to help with care coordination and information flow. 

Rick: That’s a good point what you said about HIPAA. A lot of people feel HIPAA actually can sometimes hurt information flow with this regulation. So that’s a big challenge you guys are taking on working with those universities. It’s great that you are taking security into consideration as you’re designing a platform. That must have been a great help when you were actually going out to universities. I’m sure they had some worries about the security of everything. 

Aarti:  Yes, many of the schools we partner with have expressed relief knowing that we’re compliant as many schools either have a procurement process that requires HIPAA and VPAT-compliance, or is quickly moving in that direction. Many schools are also uncertain about the application of HIPAA for their third-party mental health vendors. We believe that if the university counseling center is expected to be compliant and they are trusting The Shrink Space with a portion of their student care coordination, then we should continue to handle any student PHI in the same way they’re expected to.

Looking to the future 

Rick: So, what’s your vision going forward in the next 10 years?

Beth: Our vision, just as Aarti is mentioning, is to continue to improve the mental healthcare coordination process through our platform for all three of our users. 

For university counseling centers, we plan to continue to grow and improve so that our service is more seamlessly integrated with other third party services that universities might already use. For example, something like EMR systems to make sure that we’re integrating with them, with the overall goal of really saving them more administrative time. 

For students and young adults on our platform, it’s really to help them efficiently connect with mental health providers so that they can spend more time in therapy actually working through the things that they need to, rather than spending time trying to find a therapist or even feeling demoralized when the referrals given to them are just not a good fit for a number of reasons.

And then lastly, for our community providers, we want to continue to improve their practice management by automating parts of the referral process that are easily automated, so that then therapists can spend more time doing the part of the work that they love doing – the very human component of therapy that we believe no technology can ever replace. 

And beyond that, I think we hope to one day become the one stop shop for mental healthcare providers, as a space they can come to find renters for their private practice offices, to join consultation groups about client issues, to look for supervisors, etc.

What this means for you today

Thanks to Paubox all the messages you send to your future therapist on the TSS platform are encrypted! This means you can message a therapist and trust that no one besides the person you send it to is reading it. The Shrink Space team takes data privacy very seriously which is why we also encrypt all protected health information on our platform. As such, no PHI is ever given to your school without your explicit consent. To learn more about how we work check out this post. If you have any questions about our how we handle student data and security please reach out to us at contact@theshrinkspace.com.

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