Navigating The Wild West of Youth Mental Health Apps
A guide to sifting the duds from the gems.
Do not dwell in the past.
Concentrate on the present.
Happiness is here and now.
Such overtures are no longer the exclusive domain of Tibetan Buddhist monks intoning time-honored meditations from the sanctified confines of pillared prayer halls. Increasingly, deep introspection comes packaged in the form of apps offering relief to sufferers of mental health issues through guided mindfulness exercises, breathing techniques and mood trackers that aim to declutter modern-day minds.
Fueling this demand for portable treatments is a dire need for more and better access to mental health resources, particularly for adolescents and youth.
The World Health Organization (WHO) estimates that 10–20% of children and adolescents worldwide experience mental health disorders. The costly consequences of failing to ensure youth access to quality mental health resources are well documented. These include expulsion in early education, later unemployment and higher incarceration rates.
Sadly, young people most in need of mental health services often don’t seek or get access to them.
The social stigma of asking for help, a shortage of mental health professionals in schools, and lack of awareness amongst parents, educators and medical providers all play a part. It’s unsurprising then that some are turning to their most constant of companions — their mobile devices — to help alleviate conditions like depression, low self-esteem, eating disorders and anxiety.
Apps claiming to improve mental health number in their thousands. Few are supported by evidence-based research. Some misinform users in ways that can be downright dangerous. The chair of the American Psychiatric Association’s Smartphone App Evaluation Task Force once designated the mental health app space as “the Wild West of health care.”
If it seems like the rules of the jungle prevail, that’s due in part to the prohibitive costs of carrying out research to confirm the efficacy of interventions. Randomized controlled trials (RCTs), widely accepted as the gold standard for clinical trials, take an average of 5.5 years to complete. The snappy pace of app store economics, technological advances and consumer expectations simply don’t accommodate such lengthy turnaround times.
That’s not to say there aren’t other ways to assess an app’s medical effectiveness. Researchers have put forward alternative, but no less rigorous evaluative methods more suited to mobile health solutions, including iterative participatory research and single case designs.
There are strong incentives for articulating a framework that can reliably evaluate and compare mental health apps, given their potential to improve mental health care access for young people. Apps are:
- convenient, accessible anytime and anywhere;
- anonymous, useful for overcoming the stigma of seeking help;
- cost-effective, often more so than traditional care; and
- appealing to youth, for whom attractive graphic and UX design leads to increased engagement.
Mobile apps can also connect users to professional help and supportive social networks, reinforce new skills and provide ongoing monitoring and support. A recent Australian National survey found that young people prefer consulting the internet over teachers, school counselors or parents.
The lack of any universal accreditation system can roadblock attempts to pair at-risk youth with mental health apps that actually work. To address this, some government initiatives and youth-focused organizations like ReachOut.com curate apps using the Mobile App Rating Scale (MARS), a widely cited research-based tool for assessing the quality of mobile health apps. Some detractors, however, worry an accreditation system risks setting overly rigid and arbitrary standards.
Still, there are certain factors health professionals and app developers can and should consider when thinking about whether an app will help, not harm.
Advice issued by leading public health agencies and experts on how to separate out the duds from the gems can be collated into a common check list. Generally, effective youth mental health apps:
- Feature targeted, research-based interventions. Practices included in the app should be proven to have a positive impact for the specific condition it aims to target. For example, studies have shown that Internet- or app-based cognitive behavioral therapy (CBT) is as effective as conventional CBT for disorders that respond well to CBT, like depression or anxiety.
- Avoid the negative impacts of mental illness labeling. People experiencing low-level symptoms of a disorder can suffer harm when using an app that assumes they have a clinical diagnosis. Instead, apps should recognize that mental health falls on a continuum, and that learning general coping strategies can be just as important.
- Can be tailored to individual needs. Tailoring refers to an app’s ability to recommend specific solutions to suit specific needs and characteristics. For example, many apps offer guided meditation, but don’t guide users toward meditation when they are feeling anxious. Tailoring greatly reduces the overwhelming complexity of choices involved with finding the right intervention. It also allows users to develop skills sequentially in real-time and in ways that fit them best.
- Know their limits. Apps should offer recommendations on what to do if symptoms show no signs of improvement or worsen. Through the use of data analytics and incorporating standard clinical protocols, they should have a process for ‘red flags’ — identifying when issues need to be escalated, and prompting users to contact their GPs or mental health professionals.
- Are built by multi-disciplinary teams. Reviews have shown that interventions are more reputable if they are the result of close collaboration between experts in the tech and health sectors, or are clearly affiliated with academic research institutions or government funding agencies.
- Hold your attention. An app is only effective if it keeps users engaged for weeks or months at a time. Indeed, more and more recognition is being given to the potential for game-based technology to promote desired health-related behaviors.
- Are capable of measuring behavior in real-time. Self-monitoring is a core part of many evidence-based therapeutic interventions, including CBT. Apps that record data while users go about their daily routines, undergo challenges, or directly experience stressors help improve the accuracy of users’ reflections and enable better feedback and evaluation of their progress.
At a time of rising prevalence and incidence of youth mental health issues, mental health apps offer the connectivity, accessibility, timeliness, scalability, and interactivity that could help fill the gap for evidence-based treatments.
However, if better health tech interventions are to be developed, strides must continue to be made in assessing their usability and effectiveness. In addition, app developers and clinicians bear a responsibility to consider and meticulously work through key issues that crop up when integrating them into clinical practice.
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Cogniss Magazine is published by Cogniss, a platform for building Human Transformation apps — apps that use applied neuroscience and psychology to drive better learning, health and behavior change outcomes.
