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The health coaching industry was initially focused on fitness and lifestyle goals but is now a common service line in the behavioral health industry, aided in part by the rise of digital health platforms and telehealth.
Coaching can address systemic issues in behavioral health care, including the lack of clinicians, and offer patients unique benefits, including additional contact time and 24/7 access.
“We think of coaching as the ‘in-between’ support that can help members stay on track and feel supported between their therapy visits,” Dr. Jenna Glover, vice president of care services at Headspace, told Behavioral Health Business. “We feel strongly that mental health and well-being require more than just a one-hour therapy or psychiatry visit each month.”
Santa Monica, California-based digital behavioral health provider Headspace offers a full spectrum of mental health supports, including self-guided meditation and mindfulness content, coaching, therapy and psychiatry. It merged with Ginger in 2021 to create a platform worth $3 billion.
Still, the behavioral health coaching industry lacks comprehensive regulation and standards, requiring patients to do additional research.
While standardizing coaching requirements may be necessary, concerns exist that increased regulation could hinder access to coaches in their current form.
Coaching services are often offered as part of behavioral health platforms that include other services such as therapy or wellness-oriented programs. Some behavioral health coaches connect with patients virtually via instant chat functions, while others meet with patients in-person or via phone.
Who are behavioral health coaches?
Coaches occupy a middle ground between peer specialists and licensed clinical practitioners and often work on a preventative model.
They can supplement work with a therapist or work with lower-acuity cases that do not warrant therapy. Coaching is not a replacement for therapy.
“The primary difference [between therapy and coaching] is in the scope and focus of their conversations,” Kara Williams, vice president of coaching and operations at WebMD Health Services, told Behavioral Health Business in an email. “Our mental health coaches partner with participants to help them evolve and strengthen their self-narratives by leveraging various therapy modalities that account for their unique needs.”
New York City-based WebMD, an Internet Brands company, provides health care and wellness products, along with other services, to employers, health plans and public entities. Its offerings include a stress and resiliency program, chronic pain management, biometric health screenings and health coaching.
WebMD Health Services recently expanded an existing health coaching program to include mental health coaching, offering one-on-one support for mental and emotional health.
Users connect with coaches digitally or via phone by self-referral or through a digital health assessment, which may flag them as high risk in areas such as alcohol use, anxiety, depression and stress.
The company acquired Limeade, an employee well-being company, in August 2023. It partnered with Togetherall, an anonymous peer support organization, in January of this year.
While therapy is used for chronic needs, coaches deal with specific challenges or help establish healthier life patterns.
“Not everyone needs a therapeutic alliance and be specifically in a therapy relationship to deal with what is often a lifestyle challenge or a transitional challenge,” Sean Bell, general manager of behavioral health at Spring Health, told Behavioral Health Business.
Some people may prefer to work with a therapist initially because they do not understand what coaching is, Bell said. Therapists may then refer patients to coaching as a way to deal with basic cognitive behavioral challenges and relatively straightforward barriers.
New York City-based Spring Health is a comprehensive mental health solution for employers and health plans and now serves over 4,500 clients, including General Mills, Bain, and Instacart. The unicorn raised $71 million in April 2023, bringing its valuation to $2.5 billion.
Many providers use coaches to help members deal with stressors in their everyday lives.
“Coaching takes an active, goal-oriented approach to address a wide array of sub-acute mental health challenges, ranging from sleep issues, relationship challenges, work-life balance and more,” Glover said.
Companies like Spring and Headspace offer coaching programs along with clinical offerings like therapy or psychiatry. These coaches may work alongside clinicians to help patients achieve their goals.
Other coaches may need to refer higher-acuity patients to clinicians.
“Our certified behavioral health and wellness (CBHW) coaches are trained to know when to tackle and when to refer to all types of concerns,” Debra Wein, CEO and founder of Wellness Workdays, told BHB in an email. “They are trained to make referrals to licensed mental health professionals and understand the partners and benefits available to the employee, so support is seamless and effective.”
Hingham, Massachusetts-based Wellness Workdays is a corporate wellness company with coaches who meet employees primarily in person at workplaces to build relationships and address mental health concerns. Coaching is also available through a telephone, electronic communication or a hybrid model.
Coaching qualifications and training
The coaching industry is largely unregulated. Companies that offer coaching have different requirements and training processes.
At Wellness Workdays, all coaches have a degree in health education “or similar” and then must pass an intensive training program.
“The training is quite robust and involves further health education, cognitive behavior therapy (CBT), motivational interviewing, coping mechanisms as well as training and quality assurance with more seasoned experts,” Wein said.
Each company’s requirements are different, though many providers, including WebMD, Headspace and Spring Health require some type of certification
Other providers have a less conventional approach. At The Carolyn Costin Institute, coaches come from “all over the map.”
The Carolyn Costin Institute virtually trains students to become certified eating disorder coaches. It is part of a philanthropic foundation founded by Carolyn Costin, the organization’s CEO, and has trained more than 100 eating disorder coaches in 20 countries.
Coaches are required to have a referral letter and a bachelor’s degree, although some may have lived experiences that Costin determines to be equivalent. All coaches must be fully recovered from their own eating disorder, which under Costin’s definition, means recovery lasting at least two years.
Costin’s training program includes a year and a half of training, an internship and exams.
The coaching field’s lack of unified competency standards means consumers currently may be uncertain of a given coach’s background and capabilities.
“It’s not a regulated industry, just like at one point neither were dietitians,” Costin said. “I think that it’s up to the person [seeking coaching] who’s looking to find out the coach’s training.”
While some believe more needs to be done to standardize the industry, changing regulations may inhibit current coaches’ practices.
“More needs to be done to standardize requirements for coaches more broadly, and regulation of the industry could offer some standardization; however, it can also hinder access to coaching in the current state,” Glover said.
While coaches can occupy a much-needed niche to support patients seeking behavior changes or improved behavioral health, the industry must clearly advertise its benefits and limitations to patients.
“Coaching isn’t therapy and we have to be clear about this,” Glover said. “However, coaches can play a foundational role in supporting the critical skill-building work that mental resilience and mindfulness require throughout our daily lives.”
The benefits of coaches
Coaching platforms can help mitigate multiple issues plaguing the behavioral health industry.
Offering coaching as a stand-alone service or as a supplement can help alleviate the behavioral health staffing crisis and allow people with lower-acuity needs to quickly access support.
“The best part is with our mental health program, individuals have immediate access to our mental health coaches whereas in some areas there’s a two to three month wait time for therapists due to high demand,” Williams said.
Coaches often have more availability than clinicians. For instance, Headspace’s coaches are available around the clock, 365 days a year. Users are connected to a coach within two minutes on average.
In some instances, coaches can go beyond what a clinician can do.
One example of how behavioral health coaches can be used is to help people with eating disorders prepare to consume a food they have previously habitually avoided. Coaches can step in to facilitate the process.
“A coach can work with the treatment team and communicate about the goals and then the coach will go out to pizza with the client or eat pizza with the client on Zoom, and then stay with them for an hour afterward to avoid the purging,” Costin said.
Coaches can help with other parts of recovery that clinicians cannot because of ethical reasons.
“When someone is getting out of residential or inpatient treatment for an eating disorder, coaches can go to their homes and help them set up their kitchens, grocery shop for the first time … get rid of diet pills or laxatives,” Costin said.
As the need for mental health support outpaces supply, behavioral health coaching is poised to grow even further.
“Over time, we believe that coaches will become even more important and ingrained into the continuum of care as demand continues to rise for mental health support,” Glover said.
Companies featured in this article:
Headspace Health, Spring Health, The Carolyn Costin Institute, WebMD Health Services, Wellness Workdays
