Providers using more apps in treatment but with caution
Privacy issues are common concern
Since the pandemic, the saying, `there’s an app for that,” is applying to more mental health providers, who have incorporated virtual tools into their delivery of care.
A website that evaluates apps on cost, features, privacy, and clinical evidence called Mindapps.org was developed by clinical psychologists while working on a study.
The study, published in December 2022 in the JAMA Network Open, covered a cross-sectional review of more than 500 mental health apps, showing most overlapped in offerings ranging from psychoeducation to goal tracking and mindfulness.
The study’s co-author is John Torous, MD, MBI, director of the digital psychiatry division at Beth Israel Deaconess Medical Center in Boston.
Torous and his colleagues continue to update the database, Mindapps.org, every six months and currently have 700 apps listed.
“For decades now, we’ve always had self-help resources, but that alone doesn’t make a difference,” Torous said.
Torous spoke about the similarity of features. A majority focus on depression and anxiety, but others issues are covered as well. The study noted that only a small percentage of apps address mental health conditions like schizophrenia, however.
Apps, which should be evidence-based, are only a piece of the therapist’s work, according to Torous.
“I think mental health apps are good to augment care if you can find a good one,” he said. “But they are definitely not a replacement for care. What is great about our database is that you can find the right match.“
Apps give patients a feeling of more control over their care as they practice skills using their phones. “It can turbo charge your therapy. That’s what so wonderful about this!” Torous said.
On the flip side, apps come with a warning. The American Psychiatric Association (APA) cautioned that while mobile health technologies may be convenient, users should be wary. It may not be completely secure and could potentially sell patient data without their knowledge.
Also, apps may offer incorrect data, misleading information or be ineffective in treatment.
The association also pointed out that one app might work for one patient but not another, just like a medication or type of therapy is not a one size fits all situation.
The study co-authored by Torous includes privacy issues as a common thread.
Clinicians like Charmain Jackman, Ph.D., use mental health apps to supplement one-on-one therapy. Jackman is the founder of InnoPsych, a site that connects therapists and patients who are Black, Indigenous, or people of color. She is also a child and adolescent psychologist who previously worked at a Boston High School and whose practice now is geared to treating women of color.
Some of the apps she recommends are Liberate, Shine, and Libbie.
“I think I started using apps before the pandemic because I worked with teens,” she said. “I gave them another resource when they were not with me. The idea was to give them the opportunity to practice skills—I mean, that’s the beauty of apps—without having to be with a therapist.”
Jackman added that there is so much money in mental health tech, especially since the pandemic. However, there are no federal guidelines to monitor them, so the consumer is at risk because they do not know what to seek.
Torous’ study indicated 77 percent of the apps they reviewed had a privacy policy, but the rest did not. That means for those that do not have a policy, personal data can be distributed elsewhere.
“Apps are vague about third parties,” he explained. “It could be sold to Facebook or it could be sold to data brokers. There’s a specific market for health data. And if the app calls itself a ‘wellness device’ it gets even murkier because they can skirt around HIPAA. Privacy should not be assumed. Some patients may not care, but all patients should be informed.”
Jason Owen, Ph.D, MPH, is a clinical psychologist and the team lead for the Public Digital Health and Innovation Program for the National Center for PTSD.
Owen and his team build mental health apps for PTSD as well as related concerns that often overlap. For example, PTSD frequently coincides with mood disturbance, relationship difficulties, and sleep.
He said that apps should not only be engaging to the patient but also evidence-based, private, free, and accessible to all people including those with physical impairments like sight or hearing.
Owen noted that apps can be an introduction to therapy for those who are not yet connected to a therapist. They can be useful for between-session practice and for reinforcing principles and techniques learned in a therapy session, he said.
Apps can also be useful for extending the benefits of therapy once it has ended, according to Owen. Because apps are available on phones, they are great for “in-the-moment management of distress,” he said.
Privacy is a priority for him as well.
“Of course, an app is not a replacement for therapy,” he said. “For non-VA apps, privacy is a huge concern and often left out of most media when discussing mental health apps. Look closely at privacy policies; nearly all commercial apps vacuum your data and sell it and connect it with credit card data. The big players require you to pay subscriptions, are ad-based, and too often make their money by selling your mental health data to others.”
Although the consensus is that apps are a great tool providing research is done beforehand,
mental health professionals share a definitive “buyer beware” sentiment.
Owen added, “I don’t think apps are going anywhere. Hybrid care is here to stay.”