Bigger Isn’t Always Better. Neither Is Newer.

It’s football Saturday, and I would prefer to be enjoying football without finding another reason to question the direction of an entire industry.

Apparently, that was too much to ask.

Between the excitement and predictions, the conversation on GameDay turned toward a future I’m not especially excited about: a reported handshake agreement to expand the College Football Playoff to 24 teams in 2027. Final approval is still pending, but the proposed changes would eliminate the SEC Championship Game to make room for the expanded postseason. (dawgnation.com)

More teams. More opportunities. More football to sell. And potentially the loss of something many of us love.

I understand the appeal of giving more teams a chance. I also understand that college football is a business. Understanding the business rationale, however, does not obligate me to celebrate what it costs us. The rivalries, the stakes of a regular-season Saturday, the conference championship that meant something in its own right, those are part of why people care enough to watch in the first place.

You can keep expanding a product while gradually dismantling what made people love it. Which, unfortunately, brings me to mental health care.

I founded a business with “Innovations” in its name. Clearly, I am not opposed to change. There are things in this profession that desperately need changing, and protecting them because “this is how we’ve always done it” is hardly a defense.

But innovation should have to earn its applause.

Some changes improve care. Some make the administrative side of care more convenient. Others deserve serious scrutiny before we hand them the future of the profession.

We should be able to tell the difference.

Some changes are worth fighting for. Making it possible for someone to attend an appropriate therapy appointment without losing half a workday to travel is a practical improvement. Giving clinicians usable information about a client’s progress is another. Building training that requires clinicians to demonstrate skills, receive meaningful feedback, and correct weaknesses is the kind of change I want more of.

Measurement-based care belongs in that conversation. In my practice, I want assessment findings connected to what we are actually doing: what we are targeting, whether the client’s functioning is changing, and whether the treatment plan needs to change with it. A completed questionnaire sitting untouched in a chart does very little for the person who completed it.

The value comes from what the clinician understands and does next. Then there are the changes that are perfectly fine without deserving a parade.

Online scheduling. Automated reminders. Easier billing. A portal that does not require six passwords and a small act of faith. I appreciate convenience. I run a practice. Anything that makes necessary administrative work less cumbersome has my attention. But a smoother booking process tells us very little about what happens once the appointment begins. An attractive platform cannot establish whether the clinician recognizes a complicated presentation or knows when to reconsider an initial impression.

We can appreciate an operational improvement without presenting it as a clinical breakthrough.

The changes that concern me most are the ones that allow us to confuse growth with effectiveness.

-More appointments booked.

-More clinicians enrolled.

-More users on an app.

-More messages exchanged.

Those numbers may tell us something about reach, demand, or business performance. They do not, by themselves, tell us whether people are getting better.

Access matters enormously. Once someone gains access, we still owe them competent care. We should be asking what happens after the match, the intake, the subscription, or the download. Who notices when someone is deteriorating? Who reviews a treatment plan that has produced little change? Who is responsible when the promised benefit fails to materialize?

Technology makes these questions more urgent. I can see useful possibilities for tools that organize information and support a clinician’s work. I am far less comfortable with treating a fluent, reassuring response as evidence of clinical competence. NIMH identifies effectiveness, privacy, and the evaluation of mental health apps as ongoing concerns. A product’s availability is not proof that its claims have been established (National Institute of Mental Health, n.d.). (nimh.nih.gov)

And clinicians do not get to stand on the sidelines pointing at technology as though our own house is in order.

If we object to a platform reducing therapy to a series of agreeable responses, we should be willing to examine whether our own work has become repetitive reassurance without a clear treatment direction. If we criticize automated tools for missing complexity, we should expect clinicians to demonstrate that they can recognize and respond to it.

A license carries responsibility. So does calling ourselves specialists. I want training that goes beyond attendance. I want supervision that examines clinical reasoning, treatment selection, and what the clinician actually does when the original plan fails. I want continuing education that changes practice, rather than simply generating another certificate.

Accountability also requires some honesty about measurement itself. A score cannot explain an entire person, and collecting more data does not automatically produce better judgment. We need clinicians who can interpret findings in context, recognize limitations, discuss discrepancies, and use the information responsibly. Otherwise, we have simply digitized the paperwork and congratulated ourselves.

These are the problems behind my work at Untangled Mind Innovations: connecting assessment to clinical decisions, developing clearer treatment pathways, and strengthening the training and accountability that should support both.

My own tools should face those same questions. What problem do they address? What can they reasonably support? Where are their limits? What evidence would justify changing them?

Putting “innovation” in the name does not grant an exemption from scrutiny. I do not want the future of this profession decided solely by what is easiest to scale, sell, or automate. I want the people delivering care to be better prepared, better informed, and more accountable for the decisions they make. I want the people receiving care to have something more substantial than our confidence that we are helping.

Football can expand its postseason and still leave fans wondering what happened to the game they loved. Mental health care can expand its reach and still leave people without the quality of care they needed.

Before we celebrate the next handshake, I would like us to ask what we are agreeing to—and who will live with the consequences.