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Filtered field notes — system critique.

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All system critique posts.

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Private Equity's Nonprofit Joint Ventures in Behavioral Health

PESP's July 2026 report found 568 U.S. facilities, including behavioral health, run as nonprofit-PE joint ventures, with no federal disclosure required.

Jul 13, 2026 Matthew Sexton, LCSW

What Happens When Private Equity Buys Your Therapy Practice

A 2023 survey of 750 behavioral health workers found 65% report bigger caseloads and 93% report burnout under rising productivity targets. Here's what that means.

Jul 12, 2026 Matthew Sexton, LCSW

Mental Health Provider Shortage by State: 2026 Data

West Virginia, Delaware, and Arizona have the nation's worst mental health provider shortages, meeting under 11% of need (HRSA, as of December 2025). A state-by-state breakdown of where the gap is widest.

Jul 12, 2026 Matthew Sexton, LCSW

How to Find Out Who Owns Your Therapy Practice (2026)

Private equity closed 56 behavioral health deals in 2025 alone, part of a record 1,029 U.S. health care buyouts. Here is how to trace who owns your therapy practice.

Jul 12, 2026 Matthew Sexton, LCSW

1,400 FDA-Authorized AI Devices. Zero for Mental Health.

More than 1,400 AI medical devices carry FDA authorization. Mental health has zero. The gap reveals a regulatory system still ranking behavioral health last.

Jul 10, 2026 Matthew Sexton, LCSW

AI Mental Health Benefits: The Employer-Employee Trust Gap

83% of employers want AI running mental health benefits, but only 24% of employees use it — Prudential's 2026 data reveals a real employer-employee trust gap.

Jul 10, 2026 Matthew Sexton, LCSW

Therapist Burnout & Workforce Shortage: Why They're Quitting

137 million Americans live in a mental health shortage area, and 48% of behavioral health workers have considered quitting. Here's what's driving both.

Jul 06, 2026 Matthew Sexton, LCSW

Private Equity Bought the Couch: 56 Behavioral Health Deals

Private equity firms closed 56 behavioral health deals in 2025, inside a record-value year for health care buyouts. The research since is blunt: staffing gets cut.

Jul 06, 2026 Matthew Sexton, LCSW

Insurance Reimbursement Gap: 30% Less Than Private Pay

Insurance pays therapists $111 a session vs. $159 private pay, about 30% less — why therapists leave insurance panels, and why your card may not get an appointment.

Jul 06, 2026 Matthew Sexton, LCSW

Mental Health Provider Shortage Hits 137 Million Americans

137 million Americans — 40% of the country — live in a mental health provider shortage area, per HRSA, up 15 million in one year as insurers price clinicians out.

Jun 30, 2026 Matthew Sexton, LCSW

ERISA Mental Health Parity Loophole: Lawsuit Killed the Gains

ERIC, representing Fortune 500 employers covering 25 million workers, sued to block the 2024 mental health parity rule. Enforcement is now paused indefinitely.

Jun 30, 2026 Matthew Sexton, LCSW

Private Equity Behavioral Health Is Cracking: Summit BHC's Debt

$1.1 billion in debt: Summit BHC, private equity-backed, survived a 2025 debt exchange, then S&P's outlook flipped negative in June 2026 — and it's not alone.

Jun 29, 2026 Matthew Sexton, LCSW

Private Equity Has Now Acquired 574 Autism Therapy Centers

Researchers counted 574 autism therapy centers now owned by private equity across 42 states. Costs rise and services get cut next — here's what the research shows.

Jun 29, 2026 Matthew Sexton, LCSW

Mental Health Parity Rollback: What Changed in 2026

EBSA's staff dropped 20% as the Trump administration suspended 2024 mental health parity enforcement, leaving 136 million workers with weaker protections in 2026.

Jun 29, 2026 Matthew Sexton, LCSW

Psychiatrist Shortage: A 43% Demand Surge Is Coming

A May 2026 Psychiatric Services study projects psychiatrist demand rising 43.7% while supply falls 12.3% by 2037 — a structural failure, not a hiring gap.

Jun 28, 2026 Matthew Sexton, LCSW

Vertical Integration Is Turning Insurers Into Your Therapist

Cigna's Evernorth grew from 1,000 to more than 5,000 clinicians since 2024, targeting 15,000 by 2026 — the insurer now owns the therapist deciding your care.

Jun 28, 2026 Matthew Sexton, LCSW

$700M in Mental Health Funding Doesn't Close the Access Gap

HHS put $700M into 988 and CCBHCs June 17 — less than three months after DOL said it won't defend the MHPAEA rule that makes insurers actually cover care.

Jun 28, 2026 Matthew Sexton, LCSW

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