Ethical Development and Marketing of Mental Health Products and Services

"The definition of an ethical mental health business is trying to make your work unnecessary" - Happy Citta

Ever since I started working in the Civil Service, I've had a habit that most sensible people who want to survive and pay their bills in the modern world probably wouldn't recommend. Whenever I began a new role, I was looking for ways to make my job disappear. It wasn't because I disliked the work. Well... Maybe sometimes. It was because I often struggled with the big question of 'But Why?' when considering the purpose of the work and I could often see a simpler way.

Working in the public sector after working in private organisations gives you a slightly different perspective on finances. Every process, every meeting, every new role and every layer of administration is ultimately funded by taxpayers. Somewhere, somebody has worked hard to earn the money that keeps the organisation running, and I've always felt a responsibility to spend that money as though it were my own. Well, as a taxpayer myself, in a way it is!

Instead of asking, "How can I do a great job of what the boss asked for?", I often find myself asking more existential questions, like "What exactly is the purpose of this role?"

Sometimes I'd discover six people involved in a process that, with clearer ownership and fewer unnecessary meetings, perhaps four people could manage just as well. Sometimes four bodies could even be reduced to just one really motivated person. Reports being written because another report had once required them. Meetings arranged to prepare for meetings that were themselves preparing for another meeting.

I've always believed that if something can be made simpler, it usually should be and if that means I can share a better way of working to make my own job redundant, then I get quite excited by that possibility.

When I started Happy Citta, I assumed that mindset would have to change. After all, businesses aren't usually started with the intention of making themselves unnecessary.

Marketing textbooks talk about customer retention, loyalty, recurring revenue and lifetime customer value. Modern organisations invest huge amounts of time and money trying to understand how customers think, what influences their decisions and how to build relationships that last for years. Creating value for customers whilst ensuring the long-term success of the organisation sits at the heart of modern market thinking. Marketing, when it's done well, isn't just about selling products. It's about understanding people well enough to create something they genuinely need.

Which presents an awkward question. What happens when the thing you're trying to sell is 'freedom from needing your help'?

Because that's surely what mental health support hopes to achieve, isn't it? The intention for a counselling client isn't to take money from someone who stays in therapy forever. The intention for a coaching client isn't a long term project with someone who will never be confident without their coach. The ideal wellbeing app shouldn't become the emotional equivalent of an intravenous drip.

So from a business perspective, success in mental health organisations should be measured by something quite different from the obvious standard of increased sales and customer loyalty. It should be based on whether people eventually become able to leave your products and services behind.

A terrible business strategy, some understandably money-driven folk might say... Surely, if I do my job properly, won't I eventually run out of customers?

Well... I hope so!

What Marketing Generally Is and Does

This year I started my Masters degree in Organisational Psychology and, prior to this, I thought marketing was largely about advertising. Annoying advertising at that. Logos, slogans, an opinionated entrepreneur that interrupts my streaming show every three minutes. But marketing begins long before anybody writes an advert. It starts by trying to understand human behaviour.

Why do people choose one product over another? Why do we keep returning to certain brands? Why do habits form? Why do some ideas spread while others disappear? Modern marketing has become super-skilled at answering these questions, which is both impressive and ethically concerning.

In the book 'Leading Edge Marketing Research', behavioural economist Crawford Hollingworth paints a familiar picture of modern life. Our world, he argues, has become increasingly fast, connected and saturated with choice. We are expected to process more information than ever before whilst making hundreds of decisions every single day. As technology has accelerated, our lives have become "much more complex and time compressed".

"We are expected to process more information than ever before whilst making hundreds of decisions every single day. As technology has accelerated, our lives have become "much more complex and time compressed.""

Messages arrive before we've finished replying to the previous ones and streaming services ask what we'd like to watch before we've finished the programme we're already hooked on. Social media, sadly, offers us thousands of opinions before we've formed our own.

It's exhausting and because life is increasingly fast and cognitively overwhelming our brains have adapted in exactly the way you'd expect, we rely on shortcuts rather than deliberate decision making.

Behavioural economists call these shortcuts heuristics but we know them more simply as just our habits.

We stop carefully evaluating every option because we don't have the mental capacity to do so. Instead, we buy the same milk every week, drive the same roads to work and automatically click the same app without consciously deciding to.

Hollingworth argues that without these shortcuts, we'd become paralysed by choice. And once you understand how habits like this are formed, you can begin designing products around them. Behavioural economics describes this design process as 'choice architecture', which is the art of designing the environment in which decisions are made.

This might look like the order that subscription plan options appear on a website, or the "Customers also bought..." suggestions underneath Amazon purchases or the streak on your language-learning app.

None of these things force us to do anything, but they take away the need to make another decision and that shapes our behaviour and benefits the provider.

It's not always sinister and sometimes it's actually really important and helpful. Seatbelt reminders save lives and default pension enrolment encourages people to save for their retirement.

The ethical question isn't whether products influence behaviour. Every product ever created hopes to change behaviour in some way. But the question worth asking is usually... "Whose interests does that behaviour ultimately serve?"

The same behavioural science that can encourage someone to save for retirement can also encourage someone to keep scrolling long after they've stopped enjoying it. The same psychological principles that help someone remember to meditate each morning can also persuade them that breaking a 247-day streak represents a personal failure and the same emotional connection that builds trust can also become dependency.

Take infinite scrolling. It wasn't invented because someone thought, "How can we make people feel worse about themselves today?", it was designed to remove friction and create a smoother user experience by stopping the need for people to constantly click "Next Page." A brilliant design choice? Yes. But now how do we recognise and account for the fact that people rarely notice when they've consumed enough.

The natural stopping point disappeared, so the product became easier to use... But much harder to leave. The same principle appears everywhere. Our decisions are shaped by the environment around us, the way choices are presented, and the small cues that guide us towards one option over another. That's an extraordinary amount of influence for a marketer.

And that, I think, is where organisations working in mental health hold a uniquely crucial ethical position, because more often than in many other industries, our 'consumers' don't arrive feeling clear and confident about the path ahead, they arrive overwhelmed, exhausted, lonely, anxious and sometimes frightened.

Which means they're not usually in a position to linger at the shop window comparing products or check a review site, they're often looking for somewhere safe to stand in a moment of desperation.

So despite that we are all just trying to get by, trying to make a living, trying to run or build a business... It is actually the responsibility of the wellbeing and mental health practitioners in our culture to hold that umbrella out for those people, while they shelter for a moment while they consider their options, even when our own arms get tired too.

Behavioural science and our ability to understand our consumer isn't the problem, what matters is the intention behind how we use it and the approach we take to developing and sharing our services and products to the relevant people.

Nobody wants products designed by people who don't understand their customer needs and we can't help the people who need it if we can't reach them and appeal to them, so truly appealing to your audience is still important, but it should be less about pushy advertising and more about ensuring that your research recognises the problems that these people truly need to solve.

Researchers discovered that something as simple as changing the default option on organ donation dramatically changed participation rates.

Countries that asked people to actively opt in saw far fewer donors than countries where donation was the default and people had to opt out instead.

Nothing else had changed. The people hadn't become more generous overnight. The options were exactly the same. Only the default had changed.

It's a wonderful example because it shows that the same psychological principle can be used for profoundly positive outcomes.

Thousands of lives have undoubtedly been saved because of that choice architecture.

"People don't understand and can't necessarily articulate the reasons why they buy things." - Also a sentence from Leading Edge Marketing Research. I suspect the same is true of many of our digital habits.

Ask someone why they opened Instagram seventeen times today and they're unlikely to have an answer. Most of us don't, we just find ourselves there. If that sounds familiar, it's because behavioural economists know that "We are cognitive misers by nature." so we are, again, avoiding making decisions.

Alvin Toffler's words, written more than fifty years ago, feel strangely prophetic today. In Future Shock, he warned that too much change in too short a period of time could leave us feeling overwhelmed, anxious and disorientated. His answer was to find what he called 'islands of stability'. Places, people and routines that help us remain grounded amidst constant change.

Mental health organisations often become exactly those islands. People are looking for certainty, reassurance and for somewhere that feels emotionally safe. Which is a huge privilege when you are a provider of just that, but it's also a huge responsibility, because once someone trusts you in that way, you have a choice. You can use that trust to encourage dependence, or you can use it to build their independence.

Whenever we intentionally influence behaviour, we're making ethical decisions, whether we realise it or not.

So in this space, it's no longer enough for organisations to ask, "Does this work?" when they should be asking, "Should we be doing this?"

If behavioural science helps someone stop smoking, wonderful.

If thoughtful design encourages people to save for retirement, brilliant.

If a cleverly framed message persuades someone to seek therapy before reaching crisis point, perfect.

The ability to influence behaviour isn't something to fear. Used well, it has the power to improve lives. But this is where I believe organisations working in wellbeing, coaching and mental health have a responsibility that many other industries don't need to be quite as mindful of.

So, if traditional marketing and business strategy celebrates customer retention, customer lifetime value, recurring revenue, engagement and loyalty, then what should be the metrics of a successful, ethical, mental health organisation?

If we start by assuming that many visitors to this article are entrepreneurs in the mental health space, rather than employed by charities or public sector, I'd recommend firstly a few self-reflective questions to consider as a business owner:

1. Does this product or service help people build skills and confidence they can use without me?
2. Am I making this decision because it improves someone’s wellbeing, or because it increases their engagement with my business?
3. Does my marketing help people make an informed choice, or imply that I alone have the answer?
4. If this worked exactly as intended, would people eventually need it less and would I regard that as success, or be secretly disappointed at them leaving my service?
5. Are people leaving stronger than they arrived, or are we becoming another thing they feel unable to manage without?

I'm describing the thought process of a very well-adjusted mental health business owner aren't I? But let's address the elephant in the room...

"That's all very noble, but businesses still have bills to pay."

The other ethical responsibility that often gets overlooked is the responsibility to remain sustainable. A therapist who burns out or goes bust helps nobody. Running an ethical business doesn't mean rejecting profit. It means recognising that profit is what allows the mission to continue.

The distinction is one of priority. In this line of work, and recognising the nature of the intended clientele, profit should sustain the purpose but it should never BE the purpose.

But I think these two goals are less contradictory than they first appear. Businesses that genuinely improve people's lives build trust. Trust creates recommendations. Recommendations create reputation. And reputation creates sustainable growth in a way that no amount of manipulative marketing ever can.

So, rather than replacing the commercial metrics of revenue or new referrals, any wellbeing organisation (whether entrepreneurial or part of a larger business) could consider adding metrics alongside the standard commercial business and marketing ones with something more like:

By recognising where conventional measures of commercial success conflict with the very outcomes we're trying to create, we are already shifting the intentions significantly in favour of the client, so acting intentionally on that understanding is the next positive step we can and should be taking for the benefit of, honestly? Everyone that actually matters in this conversation.

So, if one day someone closes my app, stops booking appointments, deletes my reminders and gets on with living a happier, healthier life, I don't think that's a customer I've lost, I think that's a huge success, and I think that's the outcome we should have been working towards all along.

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