Hi friend,

Talkspace, Lifestance, Acadia and BetterHelp just released their 2025 earnings.

The data and commentary give us a peak inside some of the world’s largest mental health organisations - their performance, their economics and where they’re placing their bets. It also gives us insights into broader market trends and how investors are assessing this space.

Some businesses are seeing rate increases, others have driven significant productivity gains, two outpatient mental health providers hit a full year of profitability and one of those saw their stock run up 48%.

This market has its thorns, but as of March 2026, we’re seeing green shoots.

In today’s edition of The Hemingway Report I share everything you should now, from the commercial to the clinical, that was in these 2025 earnings reports.

Let’s get into it.

The Key Takeaways:

1. Outpatient mental health reaches profitability.

   Talkspace and Lifestance are now operating profitably, both delivering positive net income for the year and expecting to do the same in 2026. They’ve proven that outpatient mental health business can operate profitably by using payers to achieve scale and driving operational efficiency. BetterHelp, which was late to this payer shift, has not fared so well, with their revenue continuing to decline.

2. Talkspace separates itself in the market

   LifeStance, Acadia, Teladoc and Kooth have all seen their share prices decline since the start of 2025. Talkspace bucks the trend, with their share price up 48% since January 1st 2025. Yes, they’ve had strong financial results, but they’ve also been able to achieve multiple expansion, with their EV/Revenue doubling from 1.7 to 3.4 in the last 12 months. Their AI narrative may account for some of this pricing difference - it’s a differentiator for them compared to a business like LifeStance. A small amount of AI upside might be being priced into Talkspace’s stock.

3. Some (but not much) hope for rates

   The bad news? LifeStance’s revenue per session was flat YoY, with an average revenue per session of $158.43. That’s based on data from almost nine million sessions so it’s a good sample. The good news? Talkspace revenue per session from their payer channel was up approximately 5% YoY to $106 (and up 3.4% for Q4). Both Talkspace and Lifestance expect low single-digit rate growth in 2026, but it will be a fight. Payers continue to attempt to get their behavioural health costs under control whilst still ensuring adequate access.

4. Growth driven by network productivity improvements

   While there is some hope for rates, any increases have been modest. Most growth has come from expanded clinician networks and increasing network productivity. LifeStance grew their network by 9% YoY and also delivered a 7% increase in clinician productivity in H2 which is significant - especially when applied across more than eight thousand clinicians. Their revenue per clinician also increased by 4% to $183K per year. These improvements were driven by a collection of operational and technical improvements.

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