International School Mental Healthcare Access, Truman Group, and the Real Issue Schools Need to Solve
Last month I had a long and insightful conversation with Dr. Sean Truman, founder and Chief Medical Officer of the Truman Group, one of the leading global providers of telehealth mental healthcare for expatriates and particularly for international educators. What struck me most was his clarity of mission: everything comes back to preserving people’s access to care. Nothing else comes close.
Sean is fully aware that international schools are under immense pressure to control their health insurance premiums and that mental health is a significant cost driver. He shared one data point that really stood out. Across the Truman Group, the average number of psychotherapy sessions per patient is 12-14 sessions.
This surprised me at first. Many faculty members tell us they see their therapist weekly and rely heavily on these sessions. But Sean’s point is simple: the goal of therapy is improvement. It is not meant to be endless. You do not visit a physiotherapist every week indefinitely. You go to resolve the issue. Psychotherapy should work the same way.
That idea matters because it reframes the debate. Instead of focusing on the total annual benefit limit, we should be ensuring that the first 12-14 sessions are accessible and affordable. That is where the meaningful clinical work happens.
This is where collaboration is needed across insurers, providers, brokers and schools. We need to design plans that do two things at once:
- Ensure people can still access high-quality care when they need it most
- Manage long-term claim costs through smart benefit design, not blunt reductions
This is the opposite direction of some current moves in the market. If mental health becomes financially inaccessible – for example through overly aggressive caps (that are too low) or forced platform-only solutions – the whole system loses. Stigma increases. Outcomes worsen. Costs actually rise. And faculty wellbeing takes a hit.
A Second Conversation That Made the Picture Clearer
This week I had a follow-up call with Sean, and again his message was consistent:
“The goal is to preserve people’s access to care.”
This echoes my position exactly. But it also highlights the tension the market is struggling with. Many school leaders, insurers, and brokers see Truman Group as an expensive, problematic provider. I understand that view. Another broker recently said to me, “Truman Group’s prices are insane – there must be cheaper options that can do this.”
Truman Group is indeed at the higher end of the pricing range. Therapy sessions cost US$225 (US$245 for direct-bill clients), while there are of course many telehealth mental healthcare providers (that also target expats) charging closer to US$150, and other providers are lower still. So there is a real price difference.
Perhaps the question we should be asking though is not, “Are they expensive?” The question should be, “Are they effective?”
The feedback we see from Truman Group patients is consistently strong. Sean is intentionally unapologetic about pricing because he believes the value is there – and many clients agree. The point is not to defend Truman Group, but to recognise reality: they are part of the ecosystem, and faculty clearly benefit from having access to them.
So instead of trying to freeze them out, the right approach is to design benefit structures that:
- give people choice,
- ensure reasonable cost sharing for higher-cost providers, and
- keep the first few sessions attainable, regardless of provider.
A tiered provider approach is the pragmatic middle ground.
Where Do We Go From Here?
This is the part I feel personally passionate about. We must stop letting the conversation become “providers vs. insurers” or “expensive vs. cheap.” Those debates are symptoms, not solutions.
The real goal is simple: Preserve people’s access to quality mental healthcare.
We do that by:
- designing plans with affordable early access to therapy
- using data-driven session caps or cost sharing, not blanket restrictions
- providing tiered provider options, including higher-cost, high-quality providers like Truman Group
- ensuring insurers provide accurate, credible claims data
- evaluating outcomes, not assumptions
- optimising plans instead of cutting blindly
This is not rocket science. But it requires cooperation, transparency and data – something the international school sector doesn’t always have.
The worst outcome is not high costs. The worst outcome is making care inaccessible.
PS: Sean mentioned on our call that he grew up in Kenya and he feels many problems can be solved with a cup of tea and and a biscuit (or biscuits!) hence the featured image above – and since I grew up in the UK, its hard to disagree 🍵🍪
PPS: I am very passionate about the goal of preserving our clients’ members access to sufficient and quality healthcare, and I appreciate that at times that passion might come across as “too personal”. However, every international school I speak with considers adequate access to mental healthcare to be a non-negotiable part of faculty wellbeing. I would therefore describe One World Cover’s commitment to doing exactly that to be a professional commitment rooted in experience and the conversations we have with international schools nearly every day. Recognising however that my views might be considered “too personal” by some, I asked an AI language model/chatbot for their general perspective on all of this (because I was genuinely curious), based on what they have seen and read online, and you can read that feedback here.
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