Would you spend $40 on a meal? A workout class? A new T-shirt? To chat with a stranger about their life experience for half an hour?
The last is the business model behind Fello, a new app that pays people to tell their life stories to others going through the same stuff. Just like Uber and Airbnb let people make cash from their cars and homes, Fello lets you monetize your hard-won wisdom.
[time-brightcove not-tgx=”true”]The idea is to provide “a new type of support that you don’t get from going to a generic support group, perusing Reddit or Facebook groups, or meeting with a therapist,” says CEO Alyssa Pollack, a former executive at Uber Eats. The person on the other side of your screen isn’t a mental-health professional, but can speak to “the specific ‘lived experience’ that you’re going through.”
Though the app is new, the idea is not. Fello and other platforms like it are selling something that humans have long gotten for free: peer support. “It’s something that people naturally do,” says Kelly Davis, vice president of peer and youth advocacy at the nonprofit Mental Health America. “If you’re having a hard time, you often seek out someone else who went through something similar.”
Increasingly, that human tendency is being packaged and pitched as an answer to a deepening problem: traditional mental-health care is hard to find and hard to afford. Demand far outpaces supply, and providers often charge hundreds of dollars per session. The result is that more than half of U.S. adults with a mental illness did not receive treatment for their conditions as of 2022, according to Mental Health America. Overall, 42% of Americans say they’re concerned about their mental health, Harris Poll data finds, but only 10% of U.S. adults are seeing a therapist.
Peer support isn’t a complete fix. Lived experience can’t replace the years of training that mental-health professionals receive, especially for particularly sensitive situations or vulnerable groups. But some advocates, including policymakers within the Biden Administration, argue it helps meet needs. Peers may offer a more attainable and softer-touch form of support for people who don’t want or require clinical treatment—or a complementary approach for people who are in treatment but feel something is missing. A peer offers something unique: the kind of camaraderie and practical advice borne from going through something hard and making it to the other side.
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Keith Humphreys, a professor of psychiatry and behavioral sciences at Stanford University, says this kind of care can be invaluable for patients and the system at large. Some people going through a tough time—a career setback, relationship hurdle, or life transition—just need a sympathetic ear. If they can get that from a peer rather than a specialist, they could free up mental-health services for people who truly need them, and perhaps get a type of guidance better suited to their situation.
These days, people who want peer support have lots of options. Alcoholics Anonymous (AA) has been using community to help people get and stay sober for nearly a century, and has inspired spin-off groups like Narcotics Anonymous and Workaholics Anonymous. Peer-counseling centers are becoming popular at schools and colleges. The National Alliance on Mental Illness runs a free peer-to-peer mentorship program for people with mental-health conditions. Federal and state health officials have even drafted rigorous training and competency requirements for people who wish to become professional peer supporters. In most states, if individuals meet these standards—which usually involve at least 40 hours of training, sometimes augmented by additional supervision by mental-health professionals—they can bill their services to Medicaid.
Fello isn’t the first app to wade into these waters. (It’s not even the first founded by an ex-Uber employee—that would be Basis, which launched in 2018.) Platforms including HeyPeers, HearMe, TalkLife, and 7 Cups offer similar services. But virtual peer support isn’t always executed well. Some companies have reportedly dealt with safety issues, like bad actors who abuse the model to give harmful advice or prey on vulnerable people.
Fello is betting that because loneliness is at epidemic levels and people are clamoring for novel forms of mental-health support, it’s time for something new. “There’s been a major shift, even in the last five years, for people’s propensity to go get support,” Pollack says. Why not get it from a stranger on your phone?
The app, which launched in August, already has thousands of users and hundreds of peer supporters, called “Fellos,” Pollack says. People seeking help with substance use, parenting, or relationships are matched with people with no special qualifications other than having lived through something similar. To become a Fello, all someone has to do is clear a background check, submit references who can vouch that they’ve experienced what they claim to, complete roughly five hours of training—significantly less than would be required of state-certified peer supporters—and pass an assessment. The app charges $40 per 30-minute session, and the Fello pockets 70% of the fee.
Not all experts are buying it. Dr. John Torous, director of digital psychiatry at Beth Israel Deaconess Medical Center in Boston, says he has reservations about paying to chat with strangers who may be seen as alternatives to therapists, but who don’t have the training or licensure to back up that perception. “Who are these people, really?” he says. “That’s the part that’s concerning.”
Apps like Fello operate in a gray area: their peer supporters aren’t professionals, but they’re not quite friends either. That makes Torous uneasy. “We don’t want to make having a conversation costly,” Torous says. “That would be a bad trend for society, if you have to pay to talk.”
At the core of this debate is a straightforward question: can hearing about someone else’s life improve your own?
The science on peer support is mixed. For starters, it might not be great for the person dispensing the advice. Although some peer supporters report gaining resilience and insight into their own conditions, it can be emotionally taxing to relive challenging experiences over and over again. Many peer supporters do just fine psychologically, or even grow and find community, but the practice introduces the risk of burnout and emotional exhaustion, studies suggest.
Among people receiving peer support, there’s minimal evidence to suggest the practice leads to “clinical recovery”—the sort of symptom reduction a traditional medical provider would measure. A 2019 research review concluded that there is “no high-quality evidence” to say whether the practice works for people with serious mental illnesses like schizophrenia.
But peer support does seem to boost the chances of “personal recovery,” or the ability to build a satisfying and meaningful life even if symptoms persist, according to a 2023 study. Other studies suggest peer support fosters belonging, community, social connectedness, resilience, belief in oneself, hope, and empowerment—all of which can contribute to overall well-being, even if those attributes are harder to measure than clinical symptoms.
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Keris Myrick, vice president of partnerships and innovation at the mental-health advocacy organization Inseparable and a peer-support expert, says it’s a mistake to expect peer support to achieve the same things as traditional mental-health care—or to replace it—when that was never the goal.
A medical professional may be focused on treating someone’s condition. But a peer supporter doesn’t “really care what the person’s diagnosis is,” Myrick says. They’re “walking alongside” someone, helping with whatever “the person identifies that they want to work on,” whether that’s a medical issue or not. Even though the goal isn’t necessarily to lessen specific symptoms, that sometimes happens, Myrick says. Studies have shown that people who receive peer support are less likely to have repeat psychiatric hospitalizations.
Myrick, who has schizophrenia and obsessive-compulsive disorder, knows the power of a good peer. When she was first diagnosed, she felt something was missing from her “conventional” regimen of therapy and medication. “I remember meeting with my psychologist and saying, ‘You wouldn’t understand. You haven’t been through it,’” she remembers. As a Black woman, she longed for someone who could relate to her.
Myrick stuck with her traditional care. But it was another woman of color living with mental illness who helped her solve problems like how to stay in graduate school and showed her that it was possible to live a rich, fulfilling life post-diagnosis. She “gave me the hope and the evidence that recovery was real and possible,” Myrick says. “I had to actually see it.”
There’s real power in being around people who get what you’re dealing with, says Humphreys, from Stanford. In 2020, he published a research review that found AA is not only effective at maintaining sobriety, but more effective than cognitive behavioral therapy. Humphreys thinks that’s because participants can tap into shared understanding and see sober living in action.
In most cases, Humphreys says, there’s no downside to trying peer support as a first resort. “If somebody says, ‘I felt a little tightness in my chest when I was running,’ I wouldn’t say, ‘You immediately need to go to a cardiac surgeon.’ I would say, ‘Go to your primary-care doctor,’” he says. “You go to the lowest-level thing” first.
There are limits, though. Peer counselors—particularly those who have not gone through extensive training—may not know what to do when faced with an emergency, like someone at imminent risk of self-harm. A 2023 report by Mental Health America found that only around half of student peer counselors felt their organizations offered enough training on handling crises. Davis, who wrote that report, adds that peer supporters, particularly students, may be out of their depth with less-common conditions like psychosis and schizophrenia.
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Myrick adds that the model can go sideways when a peer supporter tries to act like a “mini clinician,” rather than an equal. A key tenet of peer support is that “you’re not diagnosing people” or “telling them to take or not take medicine,” Davis agrees. If a relationship veers into that territory, it can have consequences for treatment.
Peer support can be transformative. But the danger is that it’s easy to offer either “too much or too little,” as one 2023 research review put it. A peer may either overstep the bounds of what their relationship is supposed to be, or may not have enough training to make a real difference.
That’s a particular risk as peer support becomes the latest service to get the gig-economy treatment. Startups may or may not emulate the rigorous, research-backed training that certified peer supporters receive. Without that foundation, Myrick says, businesses are selling little more than the chance to talk to a stranger masquerading as a friend.
And, as Myrick says, “I want to have friends who will be my friend without having to give them 40 bucks.”
