Women are less likely to receive CPR than men. Training on manikins with breasts could help

10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

If someone’s heart suddenly stops beating, they may only have minutes to live. Doing CPR (cardiopulmonary resusciation) can increase their chances of survival. CPR makes sure blood keeps pumping, providing oxygen to the brain and vital organs until specialist treatment arrives.

But research shows bystanders are less likely to intervene to perform CPR when that person is a woman. A recent Australian study analysed 4,491 cardiac arrests between 2017–19 and found bystanders were more likely to give CPR to men (74%) than women (65%).

Could this partly be because CPR training dummies (known as manikins) don’t have breasts? Our new research looked at manikins available worldwide to train people in performing CPR and found 95% are flat-chested.

Anatomically, breasts don’t change CPR technique. But they may influence whether people attempt it – and hesitation in these crucial moments could mean the difference between life and death.

Pixel-Shot/Shutterstock

Heart health disparities

Cardiovascular diseases – including heart disease, stroke and cardiac arrest – are the leading cause of death for women across the world.

But if a woman has a cardiac arrest outside hospital (meaning her heart stops pumping properly), she is 10% less likely to receive CPR than a man. Women are also less likely to survive CPR and more likely to have brain damage following cardiac arrests.

People cross a busy street in lined with trees in Melbourne.
Bystanders are less likely to intervene if a woman needs CPR, compared to a man. doublelee/Shutterstock

These are just some of many unequal health outcomes women experience, along with transgender and non-binary people. Compared to men, their symptoms are more likely to be dismissed or misdiagnosed, or it may take longer for them to receive a diagnosis.

Bystander reluctance

There is also increasing evidence women are less likely to receive CPR compared to men.

This may be partly due to bystander concerns they’ll be accused of sexual harassment, worry they might cause damage (in some cases based on a perception women are more “frail”) and discomfort about touching a woman’s breast.

Bystanders may also have trouble recognising a woman is experiencing a cardiac arrest.

Even in simulations of scenarios, researchers have found those who intervened were less likely to remove a woman’s clothing to prepare for resuscitation, compared to men. And women were less likely to receive CPR or defibrillation (an electric charge to restart the heart) – even when the training was an online game that didn’t involve touching anyone.

There is evidence that how people act in resuscitation training scenarios mirrors what they do in real emergencies. This means it’s vital to train people to recognise a cardiac arrest and be prepared to intervene, across genders and body types.

Skewed to male bodies

Most CPR training resources feature male bodies, or don’t specify a sex. If the bodies don’t have breasts, it implies a male default.

For example, a 2022 study looking at CPR training across North, Central and South America, found most manikins available were white (88%), male (94%) and lean (99%).

A woman's hands press down on a male manikin torso wearing a blue jacket.
It’s extremely rare for a manikin to have breasts or a larger body. M Isolation photo/Shutterstock

These studies reflect what we see in our own work, training other health practitioners to do CPR. We have noticed all the manikins available to for training are flat-chested. One of us (Rebecca) found it difficult to find any training manikins with breasts.

A single manikin with breasts

Our new research investigated what CPR manikins are available and how diverse they are. We identified 20 CPR manikins on the global market in 2023. Manikins are usually a torso with a head and no arms.

Of the 20 available, five (25%) were sold as “female” – but only one of these had breasts. That means 95% of available CPR training manikins were flat-chested.

We also looked at other features of diversity, including skin tone and larger bodies. We found 65% had more than one skin tone available, but just one was a larger size body. More research is needed on how these aspects affect bystanders in giving CPR.

Breasts don’t change CPR technique

CPR technique doesn’t change when someone has breasts. The barriers are cultural. And while you might feel uncomfortable, starting CPR as soon as possible could save a life.

Signs someone might need CPR include not breathing properly or at all, or not responding to you.

To perform effective CPR, you should:

  • put the heel of your hand on the middle of their chest
  • put your other hand on the top of the first hand, and interlock fingers (keep your arms straight)
  • press down hard, to a depth of about 5cm before releasing
  • push the chest at a rate of 100-120 beats per minute (you can sing a song) in your head to help keep time!)

https://www.youtube.com/embed/Plse2FOkV4Q?wmode=transparent&start=94 An example of how to do CPR – with a flat-chested manikin.

What about a defibrillator?

You don’t need to remove someone’s bra to perform CPR. But you may need to if a defibrillator is required.

A defibrillator is a device that applies an electric charge to restore the heartbeat. A bra with an underwire could cause a slight burn to the skin when the debrillator’s pads apply the electric charge. But if you can’t remove the bra, don’t let it delay care.

What should change?

Our research highlights the need for a range of CPR training manikins with breasts, as well as different body sizes.

Training resources need to better prepare people to intervene and perform CPR on people with breasts. We also need greater education about women’s risk of getting and dying from heart-related diseases.

Jessica Stokes-Parish, Assistant Professor in Medicine, Bond University and Rebecca A. Szabo, Honorary Senior Lecturer in Critical Care and Obstetrics, Gynaecology and Newborn Health, The University of Melbourne

This article is republished from The Conversation under a Creative Commons license. Read the original article.

Don’t Forget…

Did you arrive here from our newsletter? Don’t forget to return to the email to continue learning!

Recommended

  • Why it’s a bad idea to mix alcohol with some medications
  • Long COVID is real—here’s how patients can get treatment and support
    Needs on Long COVID: Managing symptoms sans FDA-approved treatment, accessing government benefits, and reducing reinfection risks.

Learn to Age Gracefully

Join the 98k+ American women taking control of their health & aging with our 100% free (and fun!) daily emails:

  • Healing Cracked Fingers

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    It’s Q&A Day at 10almonds!

    Have a question or a request? You can always hit “reply” to any of our emails, or use the feedback widget at the bottom!

    In cases where we’ve already covered something, we might link to what we wrote before, but will always be happy to revisit any of our topics again in the future too—there’s always more to say!

    As ever: if the question/request can be answered briefly, we’ll do it here in our Q&A Thursday edition. If not, we’ll make a main feature of it shortly afterwards!

    So, no question/request too big or small

    ❝Question. Suffer from cracked (split) finger tips in the cold weather. Very painful, is there something I can take to ward off this off. Appreciate your daily email.❞

    Ouch, painful indeed! Aside from good hydration (which is something we easily forget in cold weather), there’s no known internal guard against this*, but from the outside, oil-based moisturizers are the way to go.

    Olive oil, coconut oil, jojoba oil, and shea butter are all fine options.

    If the skin is broken such that infection is possible, then starting with an antiseptic ointment/cream is sensible. A good example product is Savlon, unless you are allergic to its active ingredient chlorhexidine.

    *However, if perchance you are also suffering from peripheral neuropathy (a common comorbidity of cracked skin in the extremities), then lion’s main mushroom can help with that.

    Writer’s anecdote: I myself started suffering from peripheral neuropathy in my hands earlier this year, doubtlessly due to some old injuries of mine.

    However, upon researching for the above articles, I was inspired to try lion’s mane mushroom for myself. I take it daily, and have now been free of symptoms of peripheral neuropathy for several months.

    Here’s an example product on Amazon, by the way

    Enjoy!

    Share This Post

  • How To Avoid Carer Burnout (Without Dropping Care)

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    How To Avoid Carer Burnout

    Sometimes in life we find ourselves in a caregiving role.

    Maybe we chose it. For example, by becoming a professional carer, or even just by being a parent.

    Oftentimes we didn’t. Sometimes because our own parents now need care from us, or because a partner becomes disabled.

    Philosophical note: an argument could be made for that latter also having been a pre-emptive choice; we probably at some point said words to the effect of “in sickness and in health”, hopefully with free will, and hopefully meant it. And of course, sometimes we enter into a relationship with someone who is already disabled.

    But, we are not a philosophy publication, and will henceforth keep to the practicalities.

    First: are you the right person?

    Sometimes, a caregiving role might fall upon you unasked-for, and it’s worth considering whether you are really up for it. Are you in a position to be that caregiver? Do you want to be that caregiver?

    It may be that you do, and would actively fight off anyone or anything that tried to stop you. If so, great, now you only need to make sure that you are actually in a position to provide the care in question.

    It may be that you do want to, but your circumstances don’t allow you to do as good a job of it as you’d like, or it means you have to drop other responsibilities, or you need extra help. We’ll cover these things later.

    It may be that you don’t want to, but you feel obliged, or “have to”. If that’s the case, it will be better for everyone if you acknowledge that, and find someone else to do it. Nobody wants to feel a burden, and nobody wants someone providing care to be resentful of that. The result of such is two people being miserable; that’s not good for anyone. Better to give the job to someone who actually wants to (a professional, if necessary).

    So, be honest (first with yourself, then with whoever may be necessary) about your own preferences and situation, and take steps to ensure you’re only in a caregiving role that you have the means and the will to provide.

    Second: are you out of your depth?

    Some people have had a life that’s prepared them for being a carer. Maybe they worked in the caring profession, maybe they have always been the family caregiver for one reason or another.

    Yet, even if that describes you… Sometimes someone’s care needs may be beyond your abilities. After all, not all care needs are equal, and someone’s condition can (and more often than not, will) deteriorate.

    So, learn. Learn about the person’s condition(s), medications, medical equipment, etc. If you can, take courses and such. The more you invest in your own development in this regard, the more easily you will handle the care, and the less it will take out of you.

    And, don’t be afraid to ask for help. Maybe the person knows their condition better than you, and certainly there’s a good chance they know their care needs best. And certainly, there are always professionals that can be contacted to ask for advice.

    Sometimes, a team effort may be required, and there’s no shame in that either. Whether it means enlisting help from family/friends or professionals, sometimes “many hands make light work”.

    Check out: Caregiver Action Network: Organizations Near Me

    A very good resource-hub for help, advice, & community

    Third: put your own oxygen mask on first

    Like the advice to put on one’s own oxygen mask first before helping others (in the event of a cabin depressurization in an airplane), the rationale is the same here. You can’t help others if you are running on empty yourself.

    As a carer, sometimes you may have to put someone else’s needs above yours, both in general and in the moment. But, you do have needs too, and cannot neglect them (for long).

    One sleepless night looking after someone else is… a small sacrifice for a loved one, perhaps. But several in a row starts to become unsustainable.

    Sometimes it will be necessary to do the best you can, and accept that you cannot do everything all the time.

    There’s a saying amongst engineers that applies here too: “if you don’t schedule time for maintenance, your equipment will schedule it for you”.

    In other words: if you don’t give your body rest, your body will break down and oblige you to rest. Please be aware this goes for mental effort too; your brain is just another organ.

    So, plan ahead, schedule breaks, find someone to take over, set up your cared-for-person with the resources to care for themself as well as possible (do this anyway, of course—independence is generally good so far as it’s possible), and make the time/effort to get you what you need for you. Sleep, distraction, a change of scenery, whatever it may be.

    Lastly: what if it’s you?

    If you’re reading this and you’re the person who has the higher care needs, then firstly:all strength to you. You have the hardest job here; let’s not forget that.

    About that independence: well-intentioned people may forget that, so don’t be afraid to remind them when “I would prefer to do that myself”. Maintaining independence is generally good for the health, even if sometimes it is more work for all concerned than someone else doing it for you. The goal, after all, is your wellbeing, so this shouldn’t be cast aside lightly.

    On the flipside: you don’t have to be strong all the time; nobody should.

    Being disabled can also be quite isolating (this is probably not a revelation to you), so if you can find community with other people with the same or similar condition(s), even if it’s just online, that can go a very, very long way to making things easier. Both practically, in terms of sharing tips, and psychologically, in terms of just not feeling alone.

    See also: How To Beat Loneliness & Isolation

    Share This Post

  • Walnuts vs Cashews – Which is Healthier?

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Our Verdict

    When comparing walnuts to cashews, we picked the walnuts.

    Why?

    It was close! In terms of macros, walnuts have about 2x the fiber, while cashews have slightly more protein. In the specific category of fats, walnuts have more fat. Looking further into it: walnuts’ fats are mostly polyunsaturated, while cashews’ fats are mostly monounsaturated, both of which are considered healthy.

    Notwithstanding being both high in calories, neither nut is associated with weight gain—largely because of their low glycemic indices (of which, walnuts enjoy the slightly lower GI, but both are low-GI foods)

    When it comes to vitamins, walnuts have more of vitamins A, B2, B3 B6, B9, and C, while cashews have more of vitamins B1, B5, E, and K. Because of the variation in their respective margins of difference, this is at best a moderate victory for walnuts, though.

    In the category of minerals, cashews get their day, as walnuts have more calcium and manganese, while cashews have more copper, iron, magnesium, phosphorus, potassium, selenium, and zinc.

    In short: unless you’re allergic, we recommend enjoying both of these nuts (and others) for a full range of benefits. However, if you’re going to pick one, walnuts win the day.

    Want to learn more?

    You might like to read:

    Why You Should Diversify Your Nuts

    Take care!

    Share This Post

Related Posts

  • Why it’s a bad idea to mix alcohol with some medications
  • Knitting helps Tom Daley switch off. Its mental health benefits are not just for Olympians

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    Olympian Tom Daley is the most decorated diver in Britain’s history. He is also an avid knitter. At the Paris 2024 Olympics Daley added a fifth medal to his collection – and caught the world’s attention knitting a bright blue “Paris 24” jumper while travelling to the games and in the stands.

    At the Tokyo Olympics, where Daley was first spotted knitting, he explained its positive impact on his mental health.

    It just turned into my mindfulness, my meditation, my calm and my way to escape the stresses of everyday life and, in particular, going to an Olympics.

    The mental health benefits of knitting are well established. So why is someone famous like Daley knitting in public still so surprising?

    Africa Voice/Shutterstock

    Knitting is gendered

    Knitting is usually associated with women – especially older women – as a hobby done at home. In a large international survey of knitting, 99% of respondents identified as female.

    But the history of yarn crafts and gender is more tangled. In Europe in the middle ages, knitting guilds were exclusive and reserved for men. They were part of a respected Europe-wide trade addressing a demand for knitted products that could not be satisfied by domestic workers alone.

    The industrial revolution made the production of clothed goods cheaper and faster than hand-knitting. Knitting and other needle crafts became a leisure activity for women, done in the private sphere of the home.

    World Wars I and II turned the spotlight back on knitting as a “patriotic duty”, but it was still largely taken up by women.

    During COVID lockdowns, knitting saw another resurgence. But knitting still most often makes headlines when men – especially famous men like Daley or actor Ryan Gosling – do it.

    Men who knit are often seen as subverting the stereotype it’s an activity for older women.

    Knitting the stress away

    Knitting can produce a sense of pride and accomplishment. But for an elite sportsperson like Daley – whose accomplishments already include four gold medals and one silver – its benefits lie elsewhere.

    Olympics-level sport relies on perfect scores and world records. When it comes to knitting, many of the mental health benefits are associated with the process, rather than the end result.

    Daley says knitting is the “one thing” that allows him to switch off completely, describing it as “my therapy”. https://www.youtube.com/embed/6wwXGOki–c?wmode=transparent&start=0

    The Olympian says he could

    knit for hours on end, honestly. There’s something that’s so satisfying to me about just having that rhythm and that little “click-clack” of the knitting needles. There is not a day that goes by where I don’t knit.

    Knitting can create a “flow” state through rhythmic, repetitive movements of the yarn and needle. Flow offers us a balance between challenge, accessibility and a sense of control.

    It’s been shown to have benefits relieving stress in high-pressure jobs beyond elite sport. Among surgeons, knitting has been found to improve wellbeing as well as manual dexterity, crucial to their role.

    For other health professionals – including oncology nurses and mental health workers – knitting has helped to reduce “compassion fatigue” and burnout. Participants described the soothing noise of their knitting needles. They developed and strengthened team bonds through collective knitting practices. https://www.youtube.com/embed/dTTJjD_q2Ik?wmode=transparent&start=0 A Swiss psychiatrist says for those with trauma, knitting yarn can be like “knitting the two halves” of the brain “back together”.

    Another study showed knitting in primary school may boost children’s executive function. That includes the ability to pay attention, remember relevant details and block out distractions.

    As a regular creative practice, it has also been used in the treatment of grief, depression and subduing intrusive thoughts, as well countering chronic pain and cognitive decline.

    Knitting is a community

    The evidence for the benefits of knitting is often based on self-reporting. These studies tend to produce consistent results and involve large population samples.

    This may point to another benefit of knitting: its social aspect.

    Knitting and other yarn crafts can be done alone, and usually require simple materials. But they also provide a chance to socialise by bringing people together around a common interest, which can help reduce loneliness.

    The free needle craft database and social network Ravelry contains more than one million patterns, contributed by users. “Yarn bombing” projects aim to engage the community and beautify public places by covering objects such as benches and stop signs with wool.

    The interest in Daley’s knitting online videos have formed a community of their own.

    In them he shows the process of making the jumper, not just the finished product. That includes where he “went wrong” and had to unwind his work.

    His pride in the finished product – a little bit wonky, but “made with love” – can be a refreshing antidote to the flawless achievements often on display at the Olympics.

    Michelle O’Shea, Senior Lecturer, School of Business, Western Sydney University and Gabrielle Weidemann, Associate Professor in Psychological Science, Western Sydney University

    This article is republished from The Conversation under a Creative Commons license. Read the original article.

    Don’t Forget…

    Did you arrive here from our newsletter? Don’t forget to return to the email to continue learning!

    Learn to Age Gracefully

    Join the 98k+ American women taking control of their health & aging with our 100% free (and fun!) daily emails:

  • Nudge – by Richard Thaler & Cass Sunstein

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    How often in life do we make a suboptimal decision that ends up plaguing us for a long time afterwards? Sometimes, a single good or bad decision can even directly change the rest of our life.

    So, it really is important that we try to optimize the decisions we do make.

    Professors Richard Thaler and Cass Sunstein look at all kinds of decision-making in this book. Their goal, as per the subtitle, is “improving decisions about health, wealth, and happiness”.

    For the most part, the book concentrates on “nudges”. Small factors that influence our decisions one way or another.

    Most importantly: that some of them are very good reasons to be nudged; others, very bad ones. And they often look similar.

    Where this book excels is in highlighting the many ways we make decisions without even thinking about it… or we think about it, but only down a prescribed, foreseen track, to an externally expected conclusion (for example, an insurance company offering three packages, but two of them exist only to direct you to the “correct” choice).

    A weakness of the book is that in some aspects it’s a little inconsistent. The authors describe their economic philosophy as “libertarian paternalism”, and as libertarians they’re against mandates, except when as paternalists they’re for them. But, if we take away their labels, this boils down to “some mandates can be good and some can be bad”, which would not be so inconsistent after all.

    Bottom line: if you’d like to better understand your own decision-making processes through the eyes of policy-setting economists (especially Sunstein, who worked for the White House Office of Information & Regulatory Affairs) whose job it is to make sure you make the “right” decisions, then this is a very enlightening book.

    Click here to check out Nudge and improve your decision-making clarity!

    Don’t Forget…

    Did you arrive here from our newsletter? Don’t forget to return to the email to continue learning!

    Learn to Age Gracefully

    Join the 98k+ American women taking control of their health & aging with our 100% free (and fun!) daily emails:

  • California Is Investing $500M in Therapy Apps for Youth. Advocates Fear It Won’t Pay Off.

    10almonds is reader-supported. We may, at no cost to you, receive a portion of sales if you purchase a product through a link in this article.

    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.

    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.

    “We believe they’re going to have not just great impact, but wide impact across California, especially in places where maybe it’s not so easy to find an in-person behavioral health visit or the kind of coaching and supports that parents and young people need,” said Gov. Gavin Newsom’s health secretary, Mark Ghaly, during the Jan. 16 announcement.

    The apps represent one of the Democratic governor’s 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.

    However, the rollout has been slow. Only about 15,000 of the state’s 12.6 million children and young adults have signed up for the apps, school counselors say they’ve never heard of them, and one of the companies isn’t making its app available on Android phones until summer.

    Advocates for youth question the wisdom of investing taxpayer dollars in two private companies. Social workers are concerned the companies’ coaches won’t 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.

    An App for That

    Newsom’s 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’s part of Newsom’s sweeping $4.7 billion master plan for kids’ 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.

    “The reality is that we are rarely 6 feet away from our devices,” said Sohil Sud, director of Newsom’s Children and Youth Behavioral Health Initiative. “The 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.”

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

    But those supporting youth mental health at the local level question whether the apps will move the needle on climbing depression and suicide rates.

    “It’s fair to applaud the state of California for aggressively seeking new tools,” said Alex Briscoe of California Children’s Trust, a statewide initiative that, along with more than 100 local partners, works to improve the social and emotional health of children. “We just don’t see it as fundamental. And we don’t believe the youth mental health crisis will be solved by technology projects built by a professional class who don’t share the lived experience of marginalized communities.”

    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. In the first five months of Kooth’s Pennsylvania pilot, 6% of students who had access to the app signed up.

    Brightline and Kooth represent a growing number of health tech firms seeking to profit 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.

    Although the service is intended to be free with no insurance requirement, Brightline’s app, BrightLife Kids, is folded into and only accessible through the company’s 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.

    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.

    ‘It’s Like Crickets’

    Despite being months into the launch and having millions in marketing funds, the companies don’t 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 “the main focus for this calendar year.”

    “It’s a big state — 58 counties,” Bob McCullough of Kooth said. “It’ll take us a while to get to all of them.”

    So far BrightLife Kids is available only on Apple phones. Brightline said it’s aiming to launch the Android version over the summer.

    “Nobody’s really done anything like this at this magnitude, I think, in the U.S. before,” said Naomi Allen, a co-founder and the CEO of Brightline. “We’re very much in the early innings. We’re already learning a lot.”

    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’s virtual behavioral health strategy. The state said it aims to make the apps available long-term, depending on usage.

    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.

    KFF Health News reached out to nearly a dozen California mental health professionals and youths. None of them were aware of the apps.

    “I’m not hearing anything,” said Loretta Whitson, executive director of the California Association of School Counselors. “It’s like crickets.”

    Whitson said she doesn’t think the apps are on “anyone’s” radar in schools, and she doesn’t 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’t reach out to plan the meeting; she did.

    Concern Over Referrals

    Whitson isn’t comfortable promoting the apps just yet. Although both companies said they have a clinical team on staff to assist, Whitson said she’s concerned that the coaches, who aren’t all licensed therapists, won’t have the training to detect when users need more help and refer them to clinical care.

    This sentiment was echoed by other school-based social workers, who also noted the apps’ duplicative nature — in some counties, like Los Angeles, youths can access free virtual counseling sessions through Hazel Health, a for-profit company. Nonprofits, too, have entered this space. For example, Teen Line, a peer-to-peer hotline operated by Southern California-based Didi Hirsch Mental Health Services, is free nationwide.

    While the state is also funneling money to the schools as part of Newsom’s 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.

    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’d prefer in-person therapy.

    “There 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’re on the waitlist,” Merchant said. “And, like, you’re seeing all these people struggle.”

    Fiscal conservatives question whether the money could be spent more effectively, like to bolster county efforts and existing youth behavioral health programs.

    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.

    “What starts as a small financial commitment can become uncontrollable expenses down the road,” said Susan Shelley of the Howard Jarvis Taxpayers Association.

    This article was produced by KFF Health News, which publishes California Healthline, an editorially independent service of the California Health Care Foundation. 

    KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

    USE OUR CONTENT

    This story can be republished for free (details).

    KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

    Subscribe to KFF Health News’ free Morning Briefing.

    Don’t Forget…

    Did you arrive here from our newsletter? Don’t forget to return to the email to continue learning!

    Learn to Age Gracefully

    Join the 98k+ American women taking control of their health & aging with our 100% free (and fun!) daily emails: