The Digital Psychotherapists
A whole new fleet of mental health mobile apps have hit the market, treating everything from alcoholism to schizophrenia. Will they be able to reduce the extraordinary waiting times for mental health patients?
Average waiting times for mental health patients worldwide are too long. In Germany the average waiting time is 19.9 weeks. In the U.K., it is estimated that around 25% of mental health patients wait more than 3 months and 6% at least a year. This wait to access causes symptoms to exacerbate or become chronic. A Royal College of Psychiatrists survey found that in the U.K. more than a third (37%) of those who faced a wait to access specialist help saw their mental health deteriorate during that time. In Germany alone this delay for treatment contributes 44 billion euros in costs for treating the worsened disease.
Waiting time aside, in Europe and the USA, 50%–78% of people with mental health symptoms or disorders do not receive treatment at all.
“Sadly, only a small percentage of people actively seek professional help for their mental health problems. This could be for any number of reasons: they may not be physically able to leave their homes due to severe anxiety or lack of mobility, or they may not have the financial means.” -Sal Raichbad, PsyD, LCSW
In low- and middle-income countries where provision is lower, the proportion of people with mental health problems that remain untreated is even higher.
Can our smartphones be part of the solution?
Many mental health care practitioners believe so. Evidence-based smartphone-therapy could help prevent a worsened condition, bridge the waiting time, and provide effective aftercare.
By 2020, it is estimated that there will be 6.1 billion mobile phone users and a net addition of 3 billion smartphone users globally (Ericsson, 2015). Therefore, mobile health offers an extraordinarily powerful platform for monitoring and management of mental health symptoms and disorders.
To add, a mobile approach to mental health care may be more accessible to patients. A study published in Psychiatric Services found that around 60% of mental health patients are lost when asked to come to a clinic, as opposed to 44% using the mobile app. The mobile approach was not only more accessible to them, clinically it was as helpful as group sessions conducted in person.
Moreover, relapses are common once patients are back in their usual environment where conscious and subconscious patterns of behavior return. App-therapy could help curb relapses.
Mental health care practitioners have expressed their enthusiasm about mental health apps potential for closing the mental health care gap. But all this hype should be taken with a grain of salt.
Though many psychologists and psychiatrists believe mental health apps can be useful for people who cannot go to sessions as often as they would like, they are quick to add they are not a substitute for therapy. Indeed, they think mental health care apps work most effectively in combination with in-person therapy.
Mental health care apps face some serious challenges. In general, the field lacks regulation of quality and privacy, user-patients engage with apps inconsistently, and there is often a narrow focus on one disorder per app.
It is crucial that mHealth apps are well-designed in order to properly provide care.
The most efficient mental health apps have these four characteristics:
1.High Patient Engagement
Since user-patients often engage with mental health apps with virtually no oversight, they must be intrinsically motivated to use these apps for treatment.
How do you do that?
Real-time engagement is key. It requires recognizing the user-patient’s action and quickly providing a message or next-best action to drive further engagement. Not unlike a face-to-face conversation, it involves the ability to recognize and interact with the app’s patients at the speed and cadence that matters to them.
Usage reminders and gamified interactions also provide intrinsic motivation for users.
2. Simple UI and UX
The app must be intuitive for the best quality treatment. It has been proven that patients demonstrate faster behavior changes if the cognitive demands of an app are reduced. This is of particular relevance because depression and anxiety impair working memory (short-term memory linked to immediate conscious perceptual and linguistic processing).
How do you reduce the cognitive demand of an app?
By using pictures rather than text, reducing sentence lengths and using inclusive nonclinical language.
3. Transdiagnostic Capabilities
More often than not psychological disorders are comorbid. Transdiagnostic apps can increase patient engagement and treatment efficacy by eliminating the need to use several apps for treatment.
4. Self-monitoring Features
Self-monitoring activities such as reporting one’s thoughts, behaviors and actions increase patients’ emotional self-awareness; in other words, their ability to identify and understand their emotions. Increased emotional self-awareness reduces symptoms of mental illness and improves coping skills.
The current mental health app conundrum
Though there is an abundance of mental health apps on the market (a recent survey identified more than 15,000 mobile apps for health care, 29% of which specialized in mental health), only a small fraction of them are scientifically-proven to treat mental illness.
That’s because scientific studies take time — something the app design market is not used to. Conducting randomized control trials (RCTs) and publishing results is a slow process that does not align with the rapid development cycle of apps. Trials often have extensive eligibility criteria, which slows recruitment and decreases generalizability.
Perhaps mental health apps really are the long-awaited for solution to the mental health gap, but only if they take the time to be scientifically-tested.
