Four Questions with Jonathan Seltzer

Jonathan Seltzer is the CEO of SimplePractice, the EHR and practice management platform used by more than 275,000 independent behavioural health clinicians. He spoke with Second Opinion about what the mental health market looks like from underneath that base: where coverage has shifted, why phantom networks persist, how he reads the rise of the mental health MSO, and what he makes of consumers turning to general-purpose AI for emotional support.

The Four Questions series is sponsored by

This conversation has been edited for length and clarity.

SO: Let's start with SimplePractice itself. What was the original mission, and how has the company evolved?

Jonathan Seltzer: SimplePractice was founded in 2012 with a straightforward mission: to give behavioral health clinicians the tools they need to run their practices. We started as an electronic health record and practice management platform for solo mental health practitioners, allowing them to securely store patient records and manage their businesses.

Fourteen years later, more than 275,000 clinicians operate on SimplePractice. Collectively, they're delivering care representing more than $14 billion in annual practice-level revenue.

To put that in perspective, consider the scale of some of the newer mental health platforms. Our customers are delivering care at a significant scale: in 2026, approximately 10.5 million Americans received care through clinicians using SimplePractice, across 110+ million appointments. About half of those sessions are in-person.

And on that foundation, we are bringing a portfolio of products to market that allows the broader healthcare ecosystem to tap into mental healthcare clinicians directly into their own workflows. Solving for ghost directories, middleman markups, and the siloed approach to mental and physical health.

SO: Mental health has historically operated somewhat separately from the rest of healthcare. What's changing?

Jonathan Seltzer: We're increasingly accepting that mental health is healthcare. Mental and physical health are deeply intertwined, and it's hard to improve one without supporting the other. I think at the policy level, we're still in the early days of figuring out what that means, but we are certainly seeing a shift in benefit coverage where historically, mental healthcare was predominantly cash-pay. Today, the visit volume flowing through practices on SimplePractice is split roughly evenly between private pay and insurance, with providers taking insurance work with on average 5 plans. That's a huge change in a short period.

But coverage alone hasn't fixed access. Fragmentation is still producing ghastly numbers. Last week, JAMA Health Forum published a paper that showed only 9% of those that sought care, got care. Ghost or phantom networks simply don't need to exist with modern tech. It's why we launched the SimpleConnect API earlier this year for payer provider directories. It integrates calendaring directly and removes stale data and phantom slots.

The supply is there, and that's what excites me on behalf of our customers. More than 25K of SimplePractice customers are mental health clinicians in the 10 states with the lowest mental health access. 80% of clinicians that are rural are actively accepting new clients, most of which have open availability within the next 7 days.

SO: We've seen billions of dollars invested in companies like Headway, Rula and SonderMind. How do you see mental health MSOs evolving? And how does SimplePractice fit in as we see more consolidation?

Jonathan Seltzer: I think clinicians and physicians generally want to maintain their independence. And unlike many other parts of healthcare, mental health remains a largely independent market. Our approach is to build the software and infrastructure that allow clinicians to operate small businesses while also connecting them to the broader healthcare system.

One of our biggest opportunities is convincing payers that they don't have to contract with large provider groups, MSOs or other intermediaries to drive access. They can look to a platform like SimplePractice, where infrastructure like SimpleConnect provides the same tooling to run and manage their networks, just without the 14% markup.

Ultimately these platforms are just driving up costs borne by Employers and Providers. It started with their underlying economics coming down to the spread between the reimbursement rate they negotiate with a payer for a service — say, a 90837 psychotherapy session and what they pay the clinician actually delivering that care. As the clinician, in many cases, you don't actually hold the payer contract. You're effectively being told: Come bill under my contract, and I'll take a portion of the reimbursement.

We're taking a fundamentally different approach: providing great software that lets independent practices keep their autonomy, own their relationships with clients and payers, and control their economics.

SO: Can mental healthcare become more accountable? One criticism of the therapy industry is that patients can stay in treatment indefinitely, without a clear diagnosis, treatment plan or measurable outcome. How should we think about therapy that goes on forever?

Jonathan Seltzer: I think we should always be asking what we're treating and whether care is actually working. We still have a tremendous amount of work to do to establish clearer standards of care and better ways to measure outcomes.

At the same time, there's an enormous amount of untreated mental illness in this country. Roughly half of people who need mental healthcare aren't receiving it.

Untreated mental health conditions can also have an enormous downstream cost, both for individuals and for the healthcare system. In some cases, those costs can be many multiples of what earlier intervention might have required.

We need to find ways to bring better insights back to therapists, without undermining their clinical judgment. That could mean better measurement, more structured treatment planning and technology that helps clinicians understand what is and isn't working.

SO: We're seeing a wave of AI-powered mental health chatbots. Some people are already turning to general-purpose AI for emotional support. How seriously should we take that trend?

Jonathan Seltzer: Very seriously, but with considerable caution.

We've already seen chatbots achieve meaningful scale, often without the kind of regulation or clinical oversight we'd expect in traditional healthcare.

There's research suggesting that emotional and social support is one of the major ways consumers are using generative AI. ChatGPT is a quintessential example of a scaled chatbot in our space. It covers a very broad spectrum of needs, from everyday emotional support to people dealing with potentially serious mental health conditions.

I think we have to treat direct-to-consumer mental health AI with a great deal of care and empirical rigor.

I'm skeptical of the idea that putting a foundation model behind a chatbot, giving it a clever name and calling it an AI therapist constitutes a major clinical breakthrough.

We should remember that the first mental health chatbot, ELIZA, dates back to the 1960s. So this isn't an entirely new concept. What's changed is the sophistication of the technology and the scale at which it can be deployed. But sophisticated conversation isn't the same thing as effective treatment. We need evidence, clinical validation and appropriate safeguards.

SO: Where do you see the most promising applications of AI in mental healthcare?

Jonathan Seltzer: We're particularly interested in clinician-in-the-loop and clinician-enablement approaches.

We are actively exploring questions like: How do we use AI to surface useful insights and bring them back to the treating clinician? How do we support the work clinicians are already doing, rather than trying to replace them? How do we simplify the administrative side of care, from paneling and credentialing to compliance and claims, so clinicians can spend more time with patients?

That could include AI session prep, in-session note taking, natural-language tools for homework and treatment planning, claims assistants, and systems that help therapists understand what's happening with patients between appointments.

For the therapy seeker, if technology can help people get support earlier, identify when they need professional care or stay engaged between appointments, that could be enormously valuable.

We often cite an average delay of around 11 years between the onset of mental health symptoms and treatment. That's an extraordinary gap that needs to be addressed.

About Jonathan Seltzer

Jonathan Seltzer is the CEO of SimplePractice, the industry-leading EHR and practice management platform built to help solo and group practitioners thrive and retain their independence. Since joining in 2019, Jonathan has held several leadership roles, including Chief Operating Officer and President, before being named CEO in 2024. Under his leadership, SimplePractice has grown to serve more than 250,000 independent practitioners. An advocate for clinician independence, he believes supporting solo and small practices is essential to expanding access to mental health care.

This Four Questions is sponsored by SimplePractice. Second Opinion wrote the questions; the answers are Jonathan Seltzer's own.