Lifestance: A mental health rollup headed for a breakdown(hindenburgresearch.com)
hindenburgresearch.com
Lifestance: A mental health rollup headed for a breakdown
https://hindenburgresearch.com/lifestance/
27 comments
Why wouldn't they be able to IPO? Making money off of pushing addictive chemicals to vulnerable people is a very attractive proposition. We know this because people will do it despite its being illegal. If you can make money, legally, doing something that hurts people, people will do it. Ask the Sacklers. Ask health insurers that deny coverage.
It would be fashionable to say "the cruelty is the point" but it's not - the cruelty is just icing. Whether it is 'cruel' or 'moral' never even enters into the picture. People invest in companies that make torture devices, sell addictive chemicals, develop nerve toxins, and slaughter animals wholesale, without a second thought, because there is money to be made.
It would be fashionable to say "the cruelty is the point" but it's not - the cruelty is just icing. Whether it is 'cruel' or 'moral' never even enters into the picture. People invest in companies that make torture devices, sell addictive chemicals, develop nerve toxins, and slaughter animals wholesale, without a second thought, because there is money to be made.
Thing is, how else do you want health care to work under capitalism? Health care is operating in Wall Street's world, and is thus subject to Wall Street's rules. If we had a different system where it wasn't subject to Wall Street then sure, but it is, so that's what we have.
Not to be defeatist, but for better or worse, this is the system we have. If they're getting medication to people that genuinely need it, more power to them. How they treated their employees is broken as fuck, so good riddance, but in the bigger picture, there are patients that need treatment and this is how they're able to get it.
Not to be defeatist, but for better or worse, this is the system we have. If they're getting medication to people that genuinely need it, more power to them. How they treated their employees is broken as fuck, so good riddance, but in the bigger picture, there are patients that need treatment and this is how they're able to get it.
Capitalism is not just what Wall Street wants. Plenty of firms in a wide variety of industries don't have a shareholder mandate to increase profits every quarter. They have to respond to the needs of Main Street, not Wall Street. They still operate under capitalism.
How else is health care supposed to work? How about government subsidies? How about price controls? "Public healthcare is such a complex beast that only 32 of the 33 most advanced economies in the world have made it work"
How else is health care supposed to work? How about government subsidies? How about price controls? "Public healthcare is such a complex beast that only 32 of the 33 most advanced economies in the world have made it work"
I mean, I'd love those things in greater quantities than we have now, so I agree with you, but until that happens, we gotta do the best we can in the system we got.
Let me guess, this is one of those online-only adderall-pushers that grew enormously during the pandemic, right?
They pushed more than just Adderall, of course:
> • LifeStance deals in controlled substances and medications like Xanax and Adderall that have huge potential for abuse, with prescription volume growth rivaling opiate prescriptions at their peak, according to health professionals.
> • Despite the potentially addictive nature of some of these medications, former LifeStance employees claim that medication prescribers have been advised to cut consultation times to maximize revenue, with some former clinicians having seen “30 patients a day”. Others described it as akin to “war medicine.”
> • LifeStance also rewarded its “highest-performing” medication prescribers with stock grants, according to the company’s CFO. A former practice owner told us the grants were tied to number of sessions a clinician conducts, an incentive that can encourage quantity over quality of care.
> • In December 2023, we signed up for an appointment with a LifeStance psychiatrist to better understand the company’s patient onboarding process. We were given a questionnaire developed by Pfizer and were asked if we were open to medication 13 minutes into our first session.
> • Despite reporting to the psychiatrist that we had been in a good mood since Christmas, 32 minutes into our first session we were offered Pfizer’s Zoloft for treating depression and anxiety. By the end of a 15-minute follow up session we were prescribed Zoloft.
> • LifeStance deals in controlled substances and medications like Xanax and Adderall that have huge potential for abuse, with prescription volume growth rivaling opiate prescriptions at their peak, according to health professionals.
> • Despite the potentially addictive nature of some of these medications, former LifeStance employees claim that medication prescribers have been advised to cut consultation times to maximize revenue, with some former clinicians having seen “30 patients a day”. Others described it as akin to “war medicine.”
> • LifeStance also rewarded its “highest-performing” medication prescribers with stock grants, according to the company’s CFO. A former practice owner told us the grants were tied to number of sessions a clinician conducts, an incentive that can encourage quantity over quality of care.
> • In December 2023, we signed up for an appointment with a LifeStance psychiatrist to better understand the company’s patient onboarding process. We were given a questionnaire developed by Pfizer and were asked if we were open to medication 13 minutes into our first session.
> • Despite reporting to the psychiatrist that we had been in a good mood since Christmas, 32 minutes into our first session we were offered Pfizer’s Zoloft for treating depression and anxiety. By the end of a 15-minute follow up session we were prescribed Zoloft.
Been using Lifestance for my therapist/psychiatrist since it was one of the few places that took Medicaid.
Calling it a digital pill-mill seems inaccurate based on my experiences, but maybe other providers within the system are shadier than the ones I've interacted with.
My main complaint is that I've met with multiple therapists and none of them are really academic like I want my therapists to be. Good vibes does not work for me, show me some data.
Calling it a digital pill-mill seems inaccurate based on my experiences, but maybe other providers within the system are shadier than the ones I've interacted with.
My main complaint is that I've met with multiple therapists and none of them are really academic like I want my therapists to be. Good vibes does not work for me, show me some data.
That's exactly the "therapist vs. psychiatrist" divide mentioned in the article. If you want "academic," you aren't going to get it from people paid the same as “'mani-pedi or salon haircut' workers."
Psychiatrist is an MD (or DO) who has completed residency and can prescribe drugs. You can find therapists who have PhDs who are equal to or superior to psychiatrists in their knowledge and skills.
I don't really see any reason why a psychiatrist would be any better than a therapist (unless you need to be prescribed psychiatric drugs) once you control for general intelligence and experience. Very little of the med school education is relevant to what a therapist does.
I don't really see any reason why a psychiatrist would be any better than a therapist (unless you need to be prescribed psychiatric drugs) once you control for general intelligence and experience. Very little of the med school education is relevant to what a therapist does.
>Psychiatrist is an MD (or DO) who has completed residency and can prescribe drugs.
Correct on the important points here:
- They are trained as a medical doctor
- They went though an additional 4 years of training during residency as a medical doctor.
- Due to that additional training beyond PhDs, they are granted prescription privileges.
>You can find therapists who have PhDs who are equal to or superior to psychiatrists in their knowledge and skills.
You can, but:
- You usually won't, if we were to pick an example at random from "therapists".
- That isn't the sort of therapist we're discussing here, as the article points out.
- A PhD can be in anything, not just psychiatric disorders.
- A PhD requires significantly less training in treating patients than an MD.
>I don't really see any reason why a psychiatrist would be any better than a therapist
For the above reasons. The vast majority of self-labeled "therapists" don't go through as much training, and most of them are glorified life coaches. I don't intend to besmirch all therapists, but it should be clear to everyone that literally anyone can wake up one day and declare themselves a "therapist", and they magically become one, equal to every other "therapist", as far as legally required qualifications go.
Due to this, they're ill equipped to identify actual serious disorders that need better treatment than good vibes, like bipolar disorder. Trying to "tough that out" with a patient, whether because: the therapist doesn't want to admit they need an expert, as it means acknowledging the above hierarchy; or because the therapist can't prescribe so their inclination is nonprescription options; or because the therapist simply doesn't have the training to identify the disorder; it's a recipe for disaster.
Correct on the important points here:
- They are trained as a medical doctor
- They went though an additional 4 years of training during residency as a medical doctor.
- Due to that additional training beyond PhDs, they are granted prescription privileges.
>You can find therapists who have PhDs who are equal to or superior to psychiatrists in their knowledge and skills.
You can, but:
- You usually won't, if we were to pick an example at random from "therapists".
- That isn't the sort of therapist we're discussing here, as the article points out.
- A PhD can be in anything, not just psychiatric disorders.
- A PhD requires significantly less training in treating patients than an MD.
>I don't really see any reason why a psychiatrist would be any better than a therapist
For the above reasons. The vast majority of self-labeled "therapists" don't go through as much training, and most of them are glorified life coaches. I don't intend to besmirch all therapists, but it should be clear to everyone that literally anyone can wake up one day and declare themselves a "therapist", and they magically become one, equal to every other "therapist", as far as legally required qualifications go.
Due to this, they're ill equipped to identify actual serious disorders that need better treatment than good vibes, like bipolar disorder. Trying to "tough that out" with a patient, whether because: the therapist doesn't want to admit they need an expert, as it means acknowledging the above hierarchy; or because the therapist can't prescribe so their inclination is nonprescription options; or because the therapist simply doesn't have the training to identify the disorder; it's a recipe for disaster.
On the therapy side, though, I'd hazard a guess that if their PhD was in an appropriate discipline, it would show at least some potential that they take this seriously, rather than "what is the minimum effort and education I can undertake to throw my shingle out as a therapist?"
> * they're ill equipped to identify actual serious disorders that need better treatment than good vibes, like bipolar disorder. Trying to "tough that out" with a patient, whether because: the therapist doesn't want to admit they need an expert, as it means acknowledging the above hierarchy; or because the therapist can't prescribe so their inclination is nonprescription options; or because the therapist simply doesn't have the training to identify the disorder; it's a recipe for disaster.*
I believe too much credit and merit is given to psychiatrists. I'm not arguing that an average psychiatrist is less knowledgeable than an average psychologist, therapist, or licensed councilor/social-worker. I, as well as much of society, benefit from the existence of both fields.
However, despite psychiatrists going through a more academically and scientifically rigorous training program, I often find the work of psychiatrists to be anything but scientific. If anything, psychiatry is more of an art than a science.
I try to have clemency for the field psychiatry, but it can be difficult at times. We are talking about a field that has to work with the nebulous black-box that is the human mind, which is no easy feat. To my understanding, we treat mental disorders as if they are organic diseases, and many of the said disorders, if not all, have consistently failed to demonstrate any reliable evidence of an organic etiology or biomarker for diagnostic purposes beyond a reasonable doubt. The field also relies on completely arbitrary heuristics based on vague symptoms to diagnose conditions many of which have significant overlap.
I have read plenty of peer reviewed psychiatric papers and journals. While it is not my field of expertise, I have noticed that in much of the academic and scientific literature there seems to be a better attempt at making a quantitative assessments in terms of the efficacy of various treatments. Obviously, nothing is perfect, but that is neither here nor there.
Speaking of treatments, we also have countless medications used to treat psychiatric conditions with little more than hypotheses as to how or why many of the commonly used medications actually provide relief.
I have been diagnosed with ADHD, and I had to go through many rounds of psychometric testing and questionnaires in order to receive a diagnosis (administered and proctored by a Psy.D). After I received the diagnosis, the treatment from psychiatrists have been nothing more than throwing pills at a wall and seeing what sticks. After over a decade of treatment from a multitude of medical professionals, there has yet to be a single attempt to quantifiably measure whether or not the medications I have trialed actually provide relief. During the whole entire decade long ordeal, I have never once had blood drawn, thyroid checked, a sleep study, neurological evaluation, etc.. If I quack like a duck, waddle like a duck, then I am a duck, right?
Anyway, while psychometric testing practices are not without subjection to plenty of scrutiny and criticism, such testing still seems to have been the only attempt at some sort of empirical analysis in my entire treatment process. Everything else has been nothing more than a series of brute-forced attempts.
If the success of treatments are predominately measured by the greatest reduction in symptoms with the least amount of adverse side-effects, then I sometimes wonder if a pharmacists with training in various mental conditions could almost entirely replace psychiatrists?
I believe too much credit and merit is given to psychiatrists. I'm not arguing that an average psychiatrist is less knowledgeable than an average psychologist, therapist, or licensed councilor/social-worker. I, as well as much of society, benefit from the existence of both fields.
However, despite psychiatrists going through a more academically and scientifically rigorous training program, I often find the work of psychiatrists to be anything but scientific. If anything, psychiatry is more of an art than a science.
I try to have clemency for the field psychiatry, but it can be difficult at times. We are talking about a field that has to work with the nebulous black-box that is the human mind, which is no easy feat. To my understanding, we treat mental disorders as if they are organic diseases, and many of the said disorders, if not all, have consistently failed to demonstrate any reliable evidence of an organic etiology or biomarker for diagnostic purposes beyond a reasonable doubt. The field also relies on completely arbitrary heuristics based on vague symptoms to diagnose conditions many of which have significant overlap.
I have read plenty of peer reviewed psychiatric papers and journals. While it is not my field of expertise, I have noticed that in much of the academic and scientific literature there seems to be a better attempt at making a quantitative assessments in terms of the efficacy of various treatments. Obviously, nothing is perfect, but that is neither here nor there.
Speaking of treatments, we also have countless medications used to treat psychiatric conditions with little more than hypotheses as to how or why many of the commonly used medications actually provide relief.
I have been diagnosed with ADHD, and I had to go through many rounds of psychometric testing and questionnaires in order to receive a diagnosis (administered and proctored by a Psy.D). After I received the diagnosis, the treatment from psychiatrists have been nothing more than throwing pills at a wall and seeing what sticks. After over a decade of treatment from a multitude of medical professionals, there has yet to be a single attempt to quantifiably measure whether or not the medications I have trialed actually provide relief. During the whole entire decade long ordeal, I have never once had blood drawn, thyroid checked, a sleep study, neurological evaluation, etc.. If I quack like a duck, waddle like a duck, then I am a duck, right?
Anyway, while psychometric testing practices are not without subjection to plenty of scrutiny and criticism, such testing still seems to have been the only attempt at some sort of empirical analysis in my entire treatment process. Everything else has been nothing more than a series of brute-forced attempts.
If the success of treatments are predominately measured by the greatest reduction in symptoms with the least amount of adverse side-effects, then I sometimes wonder if a pharmacists with training in various mental conditions could almost entirely replace psychiatrists?
I am not quite sure how your post relates to mine, but your struggle seems tough. As someone who also has ADD, I can sympathize.
Consider letting go of your strict expectation of measurement (a blood draw, for example, wouldn't evaluate if you're feeling better or not, nor would a thyroid test), and evaluate for yourself if a treatment is making you feel better or worse, more effective or less, over a sufficient observation period. If worse, bring it up with your care provider.
Also consider the possibility that ADD isn't something you can therapy away, but it is something you can control some negative side effects of, with medication, and honestly it's kind of a superpower. Many successful people have had it.
Anyways, I'm sorry it's taken so long for you to feel good about yourself. That sucks.
Consider letting go of your strict expectation of measurement (a blood draw, for example, wouldn't evaluate if you're feeling better or not, nor would a thyroid test), and evaluate for yourself if a treatment is making you feel better or worse, more effective or less, over a sufficient observation period. If worse, bring it up with your care provider.
Also consider the possibility that ADD isn't something you can therapy away, but it is something you can control some negative side effects of, with medication, and honestly it's kind of a superpower. Many successful people have had it.
Anyways, I'm sorry it's taken so long for you to feel good about yourself. That sucks.
I appreciate your sympathetic and empathic vibes. What ever struggles you may be going through/gone through, I hope you know I feel the same for you.
My point, which I probably failed to convey, was that the field of psychiatry is about 50% bullshit. Psychology is probably about 75% bullshit. Arguing which is more equipped to treat a condition is like arguing if either Greek Oracles or Astrologers can predict the future better.
I would love to had a long format discussion with a psychiatrist and pick his or her brain about this topic. Not necessarily from a treatment point of view. I just want their opinions and insights on topics like we are discussing in this thread.
> Also consider the possibility that ADD isn't something you can therapy away, but it is something you can control some negative side effects of, with medication
I have considered this. I've been treated for a decade now, and I can say with confidence that I figured this one out within a few months of treatment. I've tried countless treatments, multiple times, etc.. I can say with great confidence that what I am currently taking is the "least worst of them all." On an average day, I maybe get like 20% to 40% reduction in symptoms. Better than nothing, but not exactly the help I was hoping for. I'm still paralyzed by executive dysfunction, but the tricky part is that things other than ADHD can cause this, so it's difficult to separate the signal from the noise.
> honestly it's kind of a superpower
Perhaps at one time in our evolution, I would agree. However, in modern times, I strongly disagree. I do not see any situations in which it can benefit somebody. I find that many people who were successful with ADHD were successful despite of ADHD and not because of ADHD.
My point, which I probably failed to convey, was that the field of psychiatry is about 50% bullshit. Psychology is probably about 75% bullshit. Arguing which is more equipped to treat a condition is like arguing if either Greek Oracles or Astrologers can predict the future better.
I would love to had a long format discussion with a psychiatrist and pick his or her brain about this topic. Not necessarily from a treatment point of view. I just want their opinions and insights on topics like we are discussing in this thread.
> Also consider the possibility that ADD isn't something you can therapy away, but it is something you can control some negative side effects of, with medication
I have considered this. I've been treated for a decade now, and I can say with confidence that I figured this one out within a few months of treatment. I've tried countless treatments, multiple times, etc.. I can say with great confidence that what I am currently taking is the "least worst of them all." On an average day, I maybe get like 20% to 40% reduction in symptoms. Better than nothing, but not exactly the help I was hoping for. I'm still paralyzed by executive dysfunction, but the tricky part is that things other than ADHD can cause this, so it's difficult to separate the signal from the noise.
> honestly it's kind of a superpower
Perhaps at one time in our evolution, I would agree. However, in modern times, I strongly disagree. I do not see any situations in which it can benefit somebody. I find that many people who were successful with ADHD were successful despite of ADHD and not because of ADHD.
From the claims, it appears Lifestance charged therapists to be part of the network but were treated as employees, resulting in some therapists owing more than they made. Ouch!
I wonder why they didn't operate as a lead gen agency to avoid the employment issues. Maybe this is how they were able to IPO. It made it seem like they had real assets with a network of on staff therapists and nurses.
I wonder why they didn't operate as a lead gen agency to avoid the employment issues. Maybe this is how they were able to IPO. It made it seem like they had real assets with a network of on staff therapists and nurses.
From the doc: LifeStance provides advances to clinicians who expect to eventually reach the company’s lofty compensation promises. This often results in burdensome debt when expectations fall short. One former LifeStance manager described the situation as “a crappy thing, to owe your employer money.”
This is so messed up. It shouldn't happen. If a company thinks some compensation is warranted, it should be given as pay, period.
Sometimes I'm amazed at what contemporary society thinks is reasonable in terms of compensation norms. This is obviously extreme if true but it's like the US has been collectively brainwashed in terms of merit, pay, and compensation practices.
Sometimes I'm amazed at what contemporary society thinks is reasonable in terms of compensation norms. This is obviously extreme if true but it's like the US has been collectively brainwashed in terms of merit, pay, and compensation practices.
I've been seeing this model popup a lot in the lead gen space. Practitioners pay a fee to be part of a network with the promise of getting a steady stream of clients. Lifestance took it to a new level with practitioners being employees and then not delivering on the promise.
And this is the type of shit that should have been snuffed out during the IPO vetting process, and something VC firms with any brains at all would have taken a huge objection to before investing.
"So, your whole business model is effectively a digital pill mill for ADHD stimulants and antidepressants, and the mechanism for service delivery involves putting your service providers into debt so they can cut corner after corner to get more and more people taking this medication faster than if a customer went through the traditional evaluation-and-prescription model with a real doctor?"
Yeah, that's fucking dumb. I'd nope out of that so quickly. ADHD pills are over prescribed (often to the wrong people), and that's super dangerous. I have pretty severe ADHD and even I don't think these pills should proliferate as much as they have society-wide.
"So, your whole business model is effectively a digital pill mill for ADHD stimulants and antidepressants, and the mechanism for service delivery involves putting your service providers into debt so they can cut corner after corner to get more and more people taking this medication faster than if a customer went through the traditional evaluation-and-prescription model with a real doctor?"
Yeah, that's fucking dumb. I'd nope out of that so quickly. ADHD pills are over prescribed (often to the wrong people), and that's super dangerous. I have pretty severe ADHD and even I don't think these pills should proliferate as much as they have society-wide.
This company bought out my local psychiatry group and ran it into the ground. What once was a fairly personal experience grew into cold, emotionless online pill pushing.
I could literally ask for anything I wanted and would get it. It didn’t feel right at all. I no longer do business with them but am warning people to stay away.
I could literally ask for anything I wanted and would get it. It didn’t feel right at all. I no longer do business with them but am warning people to stay away.
> “They’re not able to collect, and then they don’t pay you because they would have paid you based on the appointment that you conducted. Right? But because they were not able to collect because they were so inefficient, you end up not getting paid.”
I wonder if this is legally wage theft? Based on my layman's quick reading I think yes in California, but no federally unless it brings you below minimum wage. Imagine if you're a factory worker, and the warehouse storing all the widgets burns down. So they tell you that they're retroactively not paying you for last month's labor because they lost the product of it, independent of anything you did.
I wonder if this is legally wage theft? Based on my layman's quick reading I think yes in California, but no federally unless it brings you below minimum wage. Imagine if you're a factory worker, and the warehouse storing all the widgets burns down. So they tell you that they're retroactively not paying you for last month's labor because they lost the product of it, independent of anything you did.
Lifestance bought up the practice I was going to a couple years ago, and I have continued to see the same people. Haven't heard any complaints from them, will have to ask at my next appointment I guess
Looks like a trash business but I'm not so sure it's a good short. Extractive, value negative businesses can go on a long time eating up profits from like locusts from real businesses.
Their IPO was Jun 9 2021
I'm just baffled at how they messed this up. They provide infrastructure for therapists and psychiatrists to source patients. Mental health needs have only accelerated since the pandemic.
Laughable is the claim that therapy doesn't "scale." Of course it doesn't! The thing that makes it not scale is exactly the thing that people are there for.
Laughable is the claim that therapy doesn't "scale." Of course it doesn't! The thing that makes it not scale is exactly the thing that people are there for.
Not every business or service can "scale", and even fewer can do so in the way Wall Street wants.
That doesn't mean it isn't a viable business or service; or isn't one that provides a valuable resource to society.
And Wall Street / VC firms need to accept that.
A person's individual needs for medication is not something VCs or Wall Street should be getting in the middle of, no matter how enticing the returns have the potential to be. You get it wrong, you could affect someone's life permanently in a very dangerous way.
That doesn't mean it isn't a viable business or service; or isn't one that provides a valuable resource to society.
And Wall Street / VC firms need to accept that.
A person's individual needs for medication is not something VCs or Wall Street should be getting in the middle of, no matter how enticing the returns have the potential to be. You get it wrong, you could affect someone's life permanently in a very dangerous way.
From what I can tell - this is a digital pill-mill targeting some of the most vulnerable members of modern society.
Pardon my french here, but how the fuck was this able to IPO? And more than that, what firms actually bought into this?
EDIT: not every facet of the Health/Wellness/Medical industry needs to be subject to Wall Street's rules. Why don't people understand that by now?