By Sarah Lagan, B.S., and John Torous, M.D.
As any smartphone commercial will tell you, there is an app for everything — and mental health is no exception. More and more mobile apps are advertised as mental health tools, offering features to improve your mood, decrease your anxiety or connect you with a therapist. Some even promise to boost your happiness by a certain percentage in just a few days.
Bold claims like this are commonplace in the burgeoning mental health app marketplace. But how well do these tools deliver on their flashy promises? And are they readily accessible for people with mental illness seeking digital support?
Research and our initiatives at the Division of Digital Psychiatry at Harvard Medical School suggest that there are issues and limitations that app users need to be aware of. However, certain apps have the potential to be a successful supplement to mental health treatment if users find the right program to fit their individual needs.
Before downloading mental health apps, users must consider the drawbacks of relying on digital care.
While mental health apps are rising in visibility and popularity, with app searches for depression up over 150% in the last year, users still face accessibility barriers. Often, features of popular mental health apps are hidden behind a paywall, meaning that users have to pay a hefty subscription fee to access the full array of content. Additionally, apps claiming to be “free” may be offering a limited version to entice you to sign up for the paid version.
Another challenge mental health apps must confront is retention rate, as even the most popular platforms aren’t seeing their users stick with their services. While some studies and case reports have shown that apps can be a valuable tool for people with mental illness to learn about mental health, track symptoms and self-manage conditions, only a small portion of users return to the apps for a long period of time.
Perhaps the most concerning challenge surrounding mental health apps is the lack of specialized support for commonly searched mental health conditions. Our research found that an app store search using terms like “schizophrenia” or “bipolar disorder” does not return a significant number of apps that offer specialized education or support for these conditions. Instead of finding helpful resources, people still have to wade through many irrelevant, ineffective and stigmatizing apps.
Another critical issue with apps is how they present research surrounding the efficacy of their features. Accordingly, users need to be aware that some mental health apps make exaggerated claims that they are “evidence based.” In other words, apps may claim to follow legitimate treatment methods, such as cognitive behavioral therapy, that are proven to help people — when in fact, they are not.
Beyond issues of apps’ ability to provide quality care, users need to take into account the uncertainty surrounding data privacy. In the absence of stringent FDA oversight, even widely downloaded apps have raised concerns around privacy around undisclosed sharing, access and use of mental health data.
Despite these concerns, apps have potential to help people, especially when used as a tool in conjunction with treatment, and in a way that aligns with a user’s specific preferences. It’s essential to think of apps as a means to boost and extend care, not replace it.
However, finding the right app — like finding the right therapist, medication and lifestyle plan — can be tricky. With an estimated 10,000 mental health apps in the app stores, it can be overwhelming to comb through every search result to find the one with the tools and features you’re seeking.
While app store metrics (like stars, number of downloads and qualitative reviews) can provide some insight to apps’ popularity, they don’t necessarily indicate clinical utility or usability. Users can also get discouraged by trying a variety of apps that don’t meet their expectations and preferences.
So the question becomes: how can people find the right app?
As a follow-up to our research, we have developed a searchable database of mental health apps. MIND (the Mental health Index and Navigation Database) allows individuals to sort through mental health apps using the criteria that matter most to them. They can choose from more than 100 different filters across areas, ranging from privacy to cost to clinical foundation.
Ultimately, we hope this can be a tool to help individuals find the right mental health app given their unique preferences, personal background and clinical needs. Rather than designating any app as “good” or “bad,” the searchable database can identify which apps meet a potential user’s criteria.
Finding the right app is a great feeling, but it is only one step (of many) toward using technology effectively in the mental health field. Our team at Harvard Medical School has pioneered a digital clinic, where we help people supplement traditional face-to-face care with apps.
Recognizing that lack of familiarity may be a barrier to fully integrating technology into care, we’ve also spearheaded digital literacy trainings, conducting workshops at community health centers and clubhouses that serve people with mental illness. We’ve introduced a new member of a care team, the digital navigator, who can help both patients and clinicians navigate the app space and identify suitable tools. These are sharable programs, as creating accessible digital clinics and resources is critical for ensuring digital health remains equitable.
“Increasing happiness,” as apps may claim to do, is not a one-size-fits-all approach. However, a growing number of tools have the potential to help individuals find digital tools that align with their preferences and meet their expectations. As new digital clinics and ecosystems begin to emerge, ensuring that they’re accessible to everyone will be the next priority.
Dr. John Torous is a psychiatrist and clinical informaticist who directs the Division of Digital Psychiatry at Beth Israel Deaconess Medical Center.
Sarah Lagan is a medical student at UC San Diego and prior director of app evaluation at the Division of Digital Psychiatry at Beth Israel Deaconess Medical Center.
Author’s Note: the MIND project is supported by a philanthropic gift from the Argosy Foundation.
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