There are apps that can help with nearly every aspect of your health. There are apps to fix your running form, to monitor your diet, to talk to a doctor, and even to monitor a woman’s fertility.
As more doctors become “doctorpreneurs” and contribute to the inventions of such healthcare-specific technology, they will steer digital health to meet gaps in our current healthcare system.
One such gap? Mental health.
According to the National Alliance on Mental Illness, an estimated 1 in 5 American adults experiences mental illness in a given year. While these illnesses are not always visible to others, conditions like depression, post-traumatic stress disorder (PTSD), and schizophrenia can have a serious impact. People living with serious mental illness have an increased risk of having chronic medical conditions as well.
Getting treatment for mental health issues can be difficult. Therapy and medication are expensive. Additionally, for someone with a serious mental illness, simply getting out of bed can be a challenge, much less making it to medical appointments.
Even for those without serious mental health issues, mild anxiety, stress, or difficulty coping with emotions can make life more difficult than it needs to be. So it should come as no surprise that health tech is turning its attention to mental health.
The rewards of mental health apps don’t come without risks. Here is an overview of the benefits of mental health apps, and how they can (and perhaps can’t) be used.
A Survey of the Mental Health App Landscape
Over 6 million people downloaded Headspace, a meditation app developed by a former Tibetan Buddhist monk. The app features meditations for anxiety, depression, and stress, and claims to have more than 6 million users. Actors Jessica Alba and Jared Leto are among its investors.
Headspace CEO Sean Brecker says, “Our goal is to help people prioritize the health of their minds by taking proactive steps for a healthier, happier life. Mental health disorders are a global issue that needs to be addressed through innovation, technology, and funding. The World Economic Forum predicts the economic costs of mental health issues will balloon to $6 trillion by 2030 — more than cancer, diabetes, and respiratory ailments combined.”
The popularity of apps like Headspace shows there’s an appetite for apps that target the mind. They are beginning to pop up everywhere you look. A 2015 study found that nearly one-third of disease-specific mobile health apps dealt with mental health issues.
That includes apps like Joyable, which raised $8 million in 2015 to develop an app providing cognitive behavioral therapy (CBT) for Americans with clinical social anxiety. Users are matched with coaches to help them work through their anxiety and, like Headspace, the app offers 10-minute online exercises the user can complete anywhere, anytime.
Big Health is another example. It’s a venture-funded company, with the slogan “Good mental health without pills or potions.” Big Health is developing a suite of CBT apps. Its first program, Sleepio, targets insomnia and sleep disorders. Users with the most severe sleep problems get access to a program based on cognitive behavioral therapy.
Big Health claims Sleepio not only helps insomnia-sufferers get some much-needed rest but also that it helps people make changes that alleviate anxiety and depression, according to a clinical audit.
The potential is enormous. Mobile mental health apps can put a digital lifeline in the pocket of anyone suffering from mental illness. This is particularly groundbreaking in rural and low-income regions, where access to help can be difficult to come by.
If mental health apps are successful in reducing the severity of mental illness for even a fraction of the Americans who live with them, they have the potential to help hundreds of thousands of people worldwide.
What the Science Says
Yet while venture capitalists and average users may be on board, some mental health professionals have their reservations about the effectiveness of mental health apps. The Anxiety and Depression Association of America maintains an online directory where mental health professionals rate mental health apps. Scrolling through the list of apps to treat PTSD, anxiety disorders, obsessive-compulsive disorder, and more, it’s easy to see that mental health professionals aren’t convinced that many of these apps are backed by solid research.
Peer-reviewed journals reach the same conclusions. In a 2013 review of mobile phone apps in the Journal of Medical Internet Research, Tara Donker, PhD, concluded:
“Mental health apps have the potential to be effective and may significantly improve treatment accessibility. However, the majority of apps that are currently available lack scientific evidence about their efficacy. The public needs to be educated on how to identify the few evidence-based mental health apps available in the public domain to date. Further rigorous research is required to develop and test evidence-based programs.”
Big companies like Headspace and Big Health have doctors and medical professionals on board to vet their programs. But there are lots of apps out there, and they don’t always go through proper vetting before reaching app stores.
As John Torous, a psychiatrist at Harvard Medical School and chair of the American Psychiatric Association’s Smartphone App Evaluation Task Force told Nature, “If you type in ‘depression,’ its [sic] hard to know if the apps that you get back are high quality, if they work, if they’re even safe to use. Right now it almost feels like the Wild West of health care.”
For some users, the biggest risks are that they will waste their time and money on an app that doesn’t help them. But there are more serious risks, too.
Many apps use peer counselors who do not understand the complexities of treating serious mental health issues, rather than trained medical professionals. The risk of receiving incorrect or even harmful information could lead to dangerous outcomes. Apps may lead to misdiagnoses and mistreatment by their users. The risks go on and on.
As technology outpaces the science, it also moves faster than government regulation. The Food and Drug Administration (FDA) has said it will only regulate the health apps that present the highest risks to patients if they work improperly.
Right now, it may be a case of too much, too soon. Mental health apps show incredible promise in improving the health of those with mental illness — especially when used in conjunction with, rather as separate from, therapy and medication — but more research is needed.
Responsible health app creators need to wait to release their apps until after clinical studies have proved the apps’ efficacy. And app users should demand to see the science behind the claims for their favorite mental health apps.