As the prevalence of mental illnesses like depression and anxiety continue to grow, clinical professionals have turned to mobile applications (apps) as tools for assisting their client’s treatment. Many professionals believe that these apps can be especially helpful for teenagers and young adults with mental and behavioral health issues due to their familiar and frequent use of technology (especially mobile devices) as a means of communication and information.
Today, there are thousands of mental health apps available in the iTunes and Android app stores and the number is constantly increasing. Those in favor of using mental health apps believe they can be helpful as a way to engage people who may be unwilling or unable to attend face-to-face therapy and provide support in between sessions. Professionals believe that these apps will work best when used in conjunction with medication and/or in-person therapy. Apps can also help clinicians gather data about their practice. Several apps provide HIPAA-compliant note taking (such as Insight Notes and Mobile Therapy) and can generate graphs and tables showing client improvement and deficit areas. Clinicians can use them to help determine which interventions are working best and which should be changed. The data can then be organized individually or graphed for a clinician’s entire practice to learn how interventions are working more broadly across their client population.
Those in opposition to apps believe that the use of this new technology creates consumer uncertainty and confusion. In fact, they inform us that there are more than 165,000 mobile applications available for health care, with the largest category for people with mental health disorders – managing everything from addiction to depression and schizophrenia. These challengers state that there is no required industry regulation or research and a plethora of opinions and reviews on app effectiveness, which results in confusion as to which apps are effective and should be utilized. Opponents further encourage clinicians to look for apps that come with research-based documentation of the evidence on which they are based, including research on the intervention underlying the app (such as cognitive-behavioral therapy), as well as research specifically associated with the app itself. Some also believe that the most reputable apps are generally those affiliated with academic research institutions or government funding agencies, as they are the most likely to detail to the industry the apps development and validation process.
The National Institute of Mental Health (NIMH) lists on their website the advantages and concerns regarding the use of apps (See Technology and the Future of Mental Health Treatment).
Here is their list of advantages:
Concerns listed focus on the need to assure that apps are safe and effective for the consumer. Here is the list of what NIMH suggests the industry concentrate on:
Between FY2009 and FY2015, NIMH awarded 404 grants totaling $445 million for technology-enhanced mental health interventions. These grants focused on studies of computer-based interventions designed to prevent or treat mental health disorders. Here is what NIMH generally supported with their grants:
- Feasibility, efficacy, and effectiveness research
- Technology for disorders such as schizophrenia, HIV, depression, anxiety, autism, suicide, and trauma
- More interventions for cognitive issues, illness management, behavior, and health communication
- Fewer interventions for a personal computer and more interventions for mobile devices
- More engaging ways to deliver therapies or skill development (for example, interactive formats or game-like approaches)
- Real-time (users exchanging information with peers or professionals as needed)
- Active and passive mobile assessment/monitoring
In addition, NIMH created and funded the National Advisory Mental Health Council Workgroup on Opportunities and Challenges of Developing Information Technologies on Behavioral and Social Science Research to track and guide the development of app technology.
Should Mental Health Providers Use Apps?
Technology-based solutions have the potential to play an important part in the future of mental health care, making mental health support and services more accessible and reducing barriers to clients seeking help. Technological solutions to self-management of mental health issues are particularly valuable to those individuals who are seeking help and support where services are limited geographically, such as in rural areas of our country. Providers expanding their services geographically in “low accessible” communities should consider the use of smartphone apps to supplement their tele-health capacities and to monitor mood, behavior, symptoms, and activities of their clients. Smartphones are not constrained by geography and are usually used privately by one individual. This means that smartphone apps can be extremely flexible and attractive to users. Users also prefer self-help support materials if they are delivered via a familiar medium, such as a personal smartphone. Smartphone apps are almost always accessible to users, so they can be used in any context and in almost any environment.
The American Psychological Association (APA) informs us that “several organizations provide resources and reviews of mobile health apps, to help clinicians stay abreast of the most effective and safest technologies.” APA and the Center for Technology in Behavioral Science also host webinars exploring the role of apps in clinical practice. This organization received more than 1,700 clinicians registering for a webinar event on this subject. The APA also suggests that clinicians analyzing an app should “Install it and try out every single possible scenario inside that app so that you know it very well. And always get feedback from patients on how an app is working for them.” Lastly, the APA recommends that clinicians be “mindful” of how the app they are using integrates into their treatment plans and goals of therapy (See Should you use an app to help that client?).
Mental health apps are not going to disappear and I can assure you that our industry has already adopted this technology for consumers. However, professionals agree that these apps need to be evidence-based and integrated into a comprehensive treatment plan for clients. I do believe the software industry will move to make these mental health apps research-based and outcome-oriented. We are just at the beginning of this movement to bring app technology to our industry, and providers should keep a close eye on how the trend progresses. I also believe that smartphone and other mobile devices will eventually have built-in firewalls that will insure confidentiality for our clients that use apps, texting, and emailing to communicate with mental health professionals. I am old enough to remember the first cell phones offered that looked and weighed much like our home telephones. Technology is moving at a fast pace and we need to stay informed and involved in how these innovations can assist us in becoming more efficient in engaging our clients and assisting them with their recovery. I will keep you posted on the latest technology innovations. For more information about this and other technology-based topics, consider attending the OPEN MINDS Technology and Informatics Institute scheduled for November 7-8th in Philadelphia. To learn more about this event and the exciting line up of speakers and sessions available, visit https://technology.openminds.com/.