Online Mental Health Resources that Charge a Fee – Threat or Resource?

Online Mental Health Resources that Charge a Fee – Threat or Resource? recently stumbled across two interesting websites that provide a wide range of resources for people interested in improving their mental health.  See Optimize with Brian Johnson and Open Forest. Both sites offer a wide variety of information about both specific mental health problems and general resources for improving, or even “optimizing” a person’s mental health functioning.


Patients who Google their therapist, and vice versa

Patients who Google their therapist, and vice versa

The 4-5-15 edition of the New York Times has a commentary by a psychoanalyst about the impact of browser searches on therapy. T he article, “Do You Google Your Shrink?”, is part of a regular NYT Sunday edition feature, “Couch,” which is described as featuring “essays by psychotherapists, patients and others about the experience of therapy- psychoanalysis, cognitive behavioral therapy, group therapy, marriage therapy, hypnotherapy or any other kind of curative talk between people behind closed doors.”


Survey about the MDH EHR Mandate, effective 1-1-15:  results, discussion and resources.

Survey about the MDH EHR Mandate, effective 1-1-15: results, discussion and resources.

First of all, thanks to all who participated in the survey and who provided helpful feedback about it. As of noon on Saturday, January 17, I have received 658 responses. This is a tremendous response. To provide some context, the Minnesota Mental Health Work Force Group sent out a survey, using much more resources (the work group had 36 members) and allowing more time for responses. They received 500 responses.

Brief Background of the Survey
I decided to do the survey after reading a series of postings on two MPA listserv’s which voiced intense concerns, confusion, and anxiety about the MDH DHR Mandate. It occurred to me, after reflecting about the discussion threads, that it would be helpful to have some objective information about what psychologists and other mental health professionals know about the Mandate, their attitudes about it, and how they plan to respond. The idea for the survey came together for me while on vacation over the holidays, and I actually had a small window of time for creating using the SurveyMonkey program. There were a few challenges involved, as I had never used SurveyMonkey before, had limited time, and had to create the survey while riding on a plane using a laptop, and the ride was fairly bumpy. I tried to articulate the concerns posted on the listservs, and also to add other options to give a range of possible responses for participants. Once I was done, I posted it from the airplane. The free SurveyMonkey program allows for a maximum of 100 responses, and I had no idea how many responses I would get. I thought that it would be fortunate if I received anywhere close to 100.

After 24 hours I had received 98 responses, so I knew that I was on the something but also that I would need to upgrade my version of SurveyMonkey. I also found that there were some unfortunate typos that I did not catch due to the small font that I was working with on the laptop on the bumpy plane ride. Also, I received some feedback about some additional questions that were recommended by several people who completed the initial survey. I corrected the unfortunate typos, and also added two more questions. I also revised some of the initial questions to make the language more clear. I believe this resulted in a better survey, but obviously it “corrupted the data” and it should be clear that this is a fairly casual survey that is not intended to be a truly scientific and definitive survey of all mental health providers in the state.

I posted the invitation to participate in the survey on every local listserv that I could locate, and also purchased a list from the Minnesota Board of Psychology ($5.00 !) The latter list provided emails from most, but not all, psychologists are licensed by the Board as of December, 2014. Obviously, this is not a current list and to complicate things a bit further several hundred of the emails were obsolete. I also posted the invitation on several LinkedIn groups, and was told that several people passed on the link to other professional groups. Overall, I believe that at least 3000 professionals of various disciplines received the invitation. Since the invitation was sent by email, mostly using listserv groups, it should be obvious that this is not a broad sample of all mental health providers, particularly those who do not participate in listservs or are otherwise savvy and knowledgeable about Internet resources.

Survey Results
You’re welcome to view the entire survey results. The following is a summary of what strikes me is the highlights. Questions 2 and 6 offered the option of a narrative response, and due to the high number of responses I am unable provide analysis of all of this data, but you are welcome to review the responses, most of which expressed concerns and frustrations about the Mandate.

Question 1 (professional affiliation)
567 of the respondents, or 87.1%, were psychologists. The good news is that this provides, I believe, a fairly robust sample of 3,783 Minnesota Licensed psychologists. Obviously, this survey did not obtain a very good sample of the rest of mental health disciplines.

Question 2 (How did you learn about the Mandate?)
About 12% of the respondents had not been aware of the Mandate prior to receiving my request to participate in the survey. About 32% became aware of it as a result of being informed by their professional organization, and since most of the respondents are psychologist this would be MPA. About 27% became aware of the mandate by talking to a friend or colleague.

Question 3 (How do you assess your own understanding of the Mandate?)
Only about 18% of the respondents categorize themselves as having a “complete” understanding of the Mandate. Almost half, about 47%, view themselves as having partial understanding but feeling unclear about some of the mandate. About 21% view themselves as not understanding most of it, and about 14% stated that they feel overwhelmed by it and that they do not understand it. There obviously is considerable concern, at least among psychologists, about feeling that they do not have adequate understanding about this major development.

Question 4 (What is your understanding of the penalty for not having an EHR as of 1-1-15?)
About 82% of the respondents accurately understand that there is not yet a penalty for not having an EHR 2015. About 12% feared that they would be in trouble for not having an EHR by 1-1-15, and the remainder, about 6%, fear that they will be in trouble if they do not have an EHR by 6-30-15.

Question 5 (What is your understanding of how the Mandate will be enforced?)
About 70% of the respondents believe that it is unclear at this time how the mandate will be enforced. About 25% have the understanding that there is no known enforcement process at this time. About 6% of the respondents have the inaccurate understanding that there are audit processes in place for enforcement.

Question 6 (What is your current plan for responding to the Mandate?)
I’m providing the actual results for this question as I think that this information may be particularly helpful for those who are wondering how to respond to the Mandate.

Answer Choices–
I have already purchased an EHR in response to learning about the Mandate. 7.39%

I have an EHR that was purchased prior to learning about the Mandate. 9.97%

My organization has, or will provide, an EHR. 24.74%

I plan to purchase an EHR in the next 6 months. 5.84%

I plan to purchase an EHR by the end of 2015. 9.28%

I am not planning to purchase an EHR at this time. 10.14%

I plan to retire specifically because of the EHR Mandate. 5.15% (30 responds)

I plan to retire, but not because of the EHR Mandate, and will not purchase an EHR. 3.95%

I do not have a plan at this time. 23.54% (137 responses)

For this question I also provided an option for people to make comments, and I received 109 narrative responses. Most express intense concern about the mandate. This is more than I can summarize, but you’re welcome to view the actual responses. (scroll down to Q6)

It is striking to note that 30 respondents state that they plan to retire specifically because of the mandate. Also, only about 7% have purchased an EHR in response to the mandate.

Question 7 (What is your opinion about patient confidentiality with an EHR?)
Another striking finding is that about 43% of the respondents are “extremely” concerned about confidentiality problems that may be associated with EHR communications. Only about 17% are confident that patient confidentiality will be protected. About 40% are either unclear about whether there will be problems with confidentiality or have some concern about this.

Question 8 (What is your expectation about the technical challenges of learning to use an EHR?)
50% of the respondents are confident to being able to use EHR, and the rest are either concerned about this or unclear about what will be required to learn to use any HR.

Question 9 (How much do you expect to pay for an EHR?)
About 40% of the respondents are unclear about how much an EHR will cost. The 23% report that there employer has, or will provide, an EHR that they will be able to use. For those who will have two provide their own EHR and have an estimate of the expense, most expect it to cost more than $500 a year. About 6% have, or expect to use, a free EHR.

Question 10 (What is your assessment of your professional organization’s response to the Mandate?)
About 23% of the respondents are not a member of a professional organization. About 35% view their professional organization, for most of them this would be MPA obviously, as having provided helpful information about the Mandate. Another striking finding from this survey is that, unfortunately, about 42% of the participants view their professional organization, once again primarily MPA, as having not kept them adequately informed about the Mandate. This obviously identifies some potential opportunities for MPA to improve in this area.

Question 11 (What is your opinion about potential benefits of having an EHR?)
About 31% expect having an EHR to enhance coordination of care. Unfortunately, the remainder view having an EHR as either not improving coordination of care (about 34%) or as potentially causing harm (about 35%). This obviously signifies a major disconnect between the policy makers who have mandated that we have EHR’s, and are advocating for the benefits of this, and mental health professionals in the trenches who have significant concerns about EHR’s.

Question 12 (If given a choice, would you opt out of using an EHR?)
Finally, another striking finding is that, if given the option of opting out of using an EHR, 70% of the respondents would do this.


It is clear that many, probably a majority, of psychologists have strong concerns about the Mandate and are opposed to it. Many view their professional organization, primarily MPA, as having “dropped the ball” in regard to monitoring their concerns and advocating for their members.

Many postings on MPA listservs and the narrative comments on my survey advocate for trying to get the Mandate rescinded. This is all very unfortunate, as the Mandate was established by law, not the MDH, and the chances of getting it rescinded are slim-to-none. On the other hand, there has been some discussion about getting it altered, primary to address confidentiality concerns. The chances of this are, I believe, slim- but this may be worth a try. For those who are interested in this, see the “Resources” section below for information about a potential petition for change.

EHR’s clearly are going to be significant part of health care reform, and there are many powerful forces that driving these reforms. In order to have any impact, it will be necessary for mental health professionals to get a lot more organized and to speak more as a group. Joining your state professional organization and being an active member is the most effective way to do this- but then this leaves us with questions about whether these organizations can function in competent and effective ways that meet the needs of their members. The survey appears to indicate that a significant number of psychologists view MPA as having not met their needs in regard to the Mandate. This leaves MPA, I suggest, with the responsibility of demonstrating to the members, and psychologists considering becoming members, that the organization understands the needs and concerns of Minnesota psychologists and can respond to them more effectively than it has done in the past.

Also, the survey finds that some mental health professionals have much more positive attitudes about the Mandate, have either purchased an EHR or in the process of this, and view having an EHR as helping with exchange of information and coordination of care for the people who matter the most, their patients.

Finally, the survey finds that many participants are in need of more information about the Mandate and EHRs. One option for this would be to sign up for my (see the “sign up for email” option on the right) and I will be posting regular updates about the issues involved and options for responding. It seems, at least to me, to be advisable for those who do not have an EHR to make sure that they are exchanging information and coordinating care with their patient’s psychiatrist, primary care provider and any other health care professionals who are important players in the patient’s health care. This is both good clinical practice and also may potentially help your case if you somehow come to someone’s attention for being out of compliance with the Mandate (I think that this is extremely unlikely, at least in 2015, but you will want to track how the Mandate is enforced over the next several years).

The Minnesota Department of Health website has several documents, but -as is often the case for MDH and other state agencies – they are written in somewhat dense and bureaucratic language. Many mental health professionals experience abrupt and profound cognitive fatigue when reading such documents, but it is important to get informed and worth at least looking at some of the documents. A good one to start with is Guidance for Understanding the Minnesota 2015 Interoperable EHR Mandate. This document has several links to other resources, but understanding many of the documents requires some understanding of basic concepts such as “inter-interoperability” and “HIE” (health information exchange) technologies. I will be researching all of this and posting regularly, at least monthly, on my blog as a work on my own understanding of the Mandate and my own plan for managing the requirements of the Mandate as a solo practitioner.

Stephen Huey, Ph.D., L.P. has a website with his open letter to fellow psychotherapists and a very through and thoughtful document in support of his concerns (25 pp!) Steve clearly has tapped into the concerns of many fellow psychotherapists.  He is advocating for a petition, and if you would like to participate you should contact him at If you have not yet read his documents, I highly recommend that you take a look at them, as they are excellent sources of information, explained in non-bureaucratic English, and he also provides thoughtful commentary.

I have an article about coordination of care, written with a psychiatrist colleague, John Simon, MD, that has been accepted for publication by a local magazine, “Minnesota Physician,” in their next issue. Dr. Simon and I discuss coordination of care between between behavioral specialists, particularly psychiatrists and therapists, and also between behavioral specialists and primary medical providers. We discuss the benefits of coordination of care, current barriers to adequate coordination of care and options for overcoming these barriers. I will provide a posting on my blog when the magazine is published and the article is available to the professional community. You could also keep an eye out for free copies that are often available at medical buildings. You may also consider attending the publisher’s upcoming Minnesota Health Care Roundtable, “The New Face of Health Care: expanding medical professional relationships.” The conference objectives are:

We will examine many of the new partnerships that are emerging between medical doctors and   other medical professionals. We will look at the ways leveraging these new relationships can     improve access to care while reducing costs and improving outcomes. We will consider points of resistance to forming these kinds of health care teams and what should be avoided in creating them. We will discuss what the proper oversight for these relationships should entail and how to maximize the coordination of care that they require.

I recommend it for both for learning about expanding relationships with medical professionals and as an excellent opportunity for networking with medical colleagues.

I will post regular, probably about monthly, updates about the Mandate and coordination of care issues on my blog, and you are welcome to sign up my blog. 

Using consumer EEG headsets for relaxation training- for early adapters only?

Using consumer EEG headsets for relaxation training- for early adapters only? had a  posting on 10-1-14 about interesting consumer technology, “How I Wore A Brainwave-Reading Headset For A Week And Learned to Calm My Mind.” It provides a summary of how EEG devices have evolved from specialized, and expensive, medical equipment to consumer devices that are potentially more affordable, with prices ranging from $99 to $399.  Of course, you get more with the more expensive devices.



The Minnesota Psychological Association sponsored a presentation by Eric Harris, Ed.D., J.D,  on Sept. 18, 2014 about ethical dilemmas in our current complex and challenging practice environment.  Dr. Harris works for the American Psychological Association Insurance Trust and is an expert on how to reduce risk of complaints, malpractice litigation and other potentially severe problems. He spent a lot of time talking about the challenges, and risks, presented by information on the Internet about psychologists and other mental health professionals. Sometimes the information is posted by the professional, and sometimes it is posted by others.

Among Dr. Harris’ recommendations was that we routinely do a browser  search on our name.  He noted that it is increasingly common for potential mental health service consumers to use browser searches to locate potential mental health professionals, and even to research their background , including ratings on medical review sites and postings from previous people who have used their services. He recommended that we focus on  the information on the first page of the browser search, as most people only look at the information on that page, but that we also scan information on the next few pages, just in case there is something problematic on page 2 or 3.

I have done this several times previously, always with interesting and sometimes surprising results.  Dr. Harris’ advice reminded me that I was overdue to Google myself, so I recently did a search on “Richard Sethre, Psy.D., L.P.” – and was pretty shocked by what I found.  Here is a summary, offered perhaps for a bit of entertainment and also perhaps to motivate the reader to do his own search.

On the first page I was pleased to find that the first item was a review on a medical site that gave me 5 stars.  Next was a link to my LinkedIn page, and the third hit was a link to my professional website.  Off to a good start!  Unfortunately things went downhill for the rest of the page, and for the next two pages.

The 4th site was a link to a another review, the only other one that I could locate about me, which gave me only 3 of  stars.  Ouch!  The good news was that the review itself is kind of incoherent, and maybed readers will find it to not be credible.  On the other hand, for that site there are 64 psychologists in my area and the fact that I had an average of 3 stars gave me the ranking of number 4 out of the 64 – sometimes it is better to be noticed, I guess, than ignored, even if the notice is kind of lukewarm.

The next site was a picture, from my vacation early this year, of my wife in a swimsuit lounging in a pool in Mexico.  Needless to say, that was not what I expected to find and I was pretty upset about it- until I figured out that I was the one who posted it on the Internet – by sharing it with friends using Google+.  The next site on the page was another Google+ picture that I had posted, of my nephew, and included an inane comment that I had attached to the photo about a computer problem that I was having.  On  the next page there were YouTube videos of my wife playing with dolphins from another vacation- all posted by me and shared with friends.

After about an hour of research, I figured out how to delete these posts.  All was good, I thought, until I redid the browser search  and found 2 more new Google+ photos  of my family on the first page.  Of course, I used my new Google+ knowledge to delete them, but I began to wonder about a pattern, so I repeated the search –  and found 2 more Google+ posts on the first page, again!  It now was evident that the browser (Google Chrome) has some sort of algorithm that results in a search of Google+ and posting 2 images on the first page, as long as there are Google+ posts to mine for data.  I went to my Google+ account and eventually figured out how to delete all of my posts, and that solved my problem- but if I had not done Dr. Harris’ recommended search I would have never known that anyone searching for me as a psychologist would see pictures and videos of my family and read my messages about the pictures.

Back to my browser search- I found a whole bunch of links to medical review sites.  Most of them had information that was many years out of date.  Very few of them had accurate information about my current office address and phone number. One of them has my office located in Plato, MN, and and another has me in Baxter, MN,  I have passed through Baxter once in my past, only long enough to have a cup of coffee and not long enough to open an office, or even be misunderstood to have opened an office.  As far as Plato, MN goes, I had  never heard of it and had to do a browser search to verify that it even exists.  Also, these posts also me listed as an “abortion provider.”  Another post, from the same company, had me officing in Nelson, MN, but the name of the office was of a MD, not me. There was no evident way to contact this company to request that this blatantly inaccurate information be deleted. Interestingly, when I did later redid the search the bizarre links which had me practicing abortion services in rural MN did not show up- even though I had not, to my knowledge, any anything to get the obnoxious information removed.

I spent about two hours writing messages to the sites that provided either a “notify us of incorrect information” option or a “contact us” email address. So far, I have heard back from two.  One of them actually updated their information about me.

The other site that responded to my request had a guy call me (they obviously have my current phone number) to try to sell me a service which he claimed would provide correct information to “50 to 60” medical review sites.”  We did not get to the price for this service, as I was in no mood for a sales pitch and I pointed out that I had not asked to be on these sites, they had somehow obtained inaccurate information about me, I was doing him, and them, a favor by providing accurate information, and I was NOT going to pay anyone to fix their mistake. I guess, in retrospect, I may have ranted a bit, but if that was the case he was unfazed, and took the position that it should be worth it to me to pay to have accurate information on the Internet about my practice.  I ended up having to hang up on him in order to escape his relentless sales pitch.

The last alarming link was on page 3.  I had almost decided to stop my review after looking at page 2, but I went on to page 3 and found a link to a financial site that provides information about employee benefit programs and profit sharing plans.  To my utter amazement, I found that they had posted information from one of my tax returns that included the amount of funds in my profit sharing account AND my home address.  Of course, I have sent two  strongly worded messages to that company requesting that this info be deleted, which appears to be run by sociopaths, and have not had a response.

Thanks goodness it is on page 3 and buried under 15 boring medical review sites, most of which have my address from 1995 and other obsolete, but harmless, information.

Dr. Harris provided advice about what to do in this sort of situation (he did not anticipate my unique situation, but did have similar examples in regard to pictures and personal information being revealed by browser searches).  He recommended that we take control, as much as possible, of our Internet presence by having our own website and posting items, like a blog, on the website which result in visits to the website.  This will, hopefully and with perhaps a bit of luck, result in more hits on the browser search about your website, your postings, your presentations, etc, and will -once again hopefully and with a bit of luck – drive the obnoxious hits back to the second page and beyond.   Of course, he also recommended doing regular searches to stay on top of inaccurate or personal information.

Richard Sethre, Psy.D., L.P.

Bariatric Issues:  potential use of activity tracker data by insurance companies to set premiums

Bariatric Issues: potential use of activity tracker data by insurance companies to set premiums

The online magazine published an interesting article on 9-11-14, “Insurance Companies Want To Use Your Personal Data to Determine Your Premiums”  The article discussed how insurance companies are beginning to use data from their member’s various devices to set premium rates.  The most common current example is the use of data from a car device that is used to track the driver’s behavior. The article also discusses the plans of insurance companies to expand this to include home monitoring devices and, more of interest to wellness professionals and consumers, activity tracking devices.