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What does it take to be an effective mental health app?

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Someone holds an iPhone in their left hand, the home screen of the smartphone visible.

With the stresses of the pandemic, companies offering mental health services by app are finding a surge in new interest. Odd Andersen/AFP via Getty Images

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Accessing mental health care has long been difficult, and the pandemic has further increased the strain. And there are thousands of mental health apps — about 20,000 and counting — designed to tackle the problem.

They range from mood trackers, guided mindfulness exercises and apps with chatbots that teach coping skills. Spending on them has grown quickly since 2019 and is predicted to reach about $500 million this year, according to a report from Deloitte.

But not all these apps are backed by science. Stephen Schueller is a professor of psychological science at University of California, Irvine, and the executive director of One Mind PsyberGuide, which provides expert ratings for hundreds of wellness apps. He talked to host Meghan McCarty Carino about how the apps are rated. The following is an edited transcript of their conversation.

Stephen Schueller (Photo courtesy Han Parker)

Stephen Schueller: We look at credibility — is there evidence to suggest that this thing can actually be beneficial? We look at user experience, which answers the question: How likely is it that I’ll stick with this product? Is it easy to learn, easy to use? Is it free of technical glitches? And then, we look at transparency around data security and privacy, where we do a thorough review of the data security and privacy practices to understand what happens to your data if you enter it into that application. What we find is that most of the tools with the best user experience often score more poorly on our credibility scale. They don’t have as much evidence behind that. And I think one of the reasons for that is the folks who have a lot of expertise to create science-backed solutions and evidence-based products often don’t have the resources or the expertise in creating things that are really easy to use and smooth and engaging.

Meghan McCarty Carino: How can we start to close that gap between apps with a good user experience versus apps with evidence-based protocols?

Schueller: I think one way to close that gap is to have more individuals with clinical expertise working in companies. And I do think that’s the shift we’ve seen in recent years. I think we’re seeing companies hire more clinical officers, research officers, different folks who come with that experiencing of delivering and evaluating evidence-based interventions, and so I think that’s great. I think another thing we need to do is we need to figure out how to incentivize those companies to do rigorous research and really show that their tools have effectiveness behind them. And I think that’s a place where there’s still some considerable gaps, and we have to think about what are the different ways we can help incentivize companies and have policy, regulation or other ways that really helps the products that have demonstrated that rise to the top.

McCarty Carino: What are some of the privacy implications here?

Schueller: A lot of folks have the assumption that these tools fall under HIPAA regulations, which is not the case for many of them. HIPAA [the federal law restricting release of medical information] covers information that’s shared with a covered entity or health provider. And many of these tools don’t count as a health provider. And so there are actually very little regulations around what they have to do with your data. Many tools might share your data with a third party. There might be very minimal sort of production under the data that’s present in that application.

McCarty Carino: So how can consumers differentiate between legitimate mental health care apps and those that are less legit?

Schueller: I think one thing that I would really suggest for a consumer is if you’re looking at a product to look at how recently was that product updated. Teams that are investing resources to make legitimate products are investing resources to keep them up to date. If you are working with a professional, bring that product to a professional and see if it aligns with their idea of what the treatment you’re receiving is or something that would be beneficial to you. I think another thing to just pay attention to is that if you start to use a tool, is it helping you? Do you feel like you’re getting better? I really want to make sure that people realize that there’s no one-size-fits-all solution, and these tools aren’t for everyone. And that they’re not alternatives to traditional mental health services.

McCarty Carino: So what are these apps in relation to traditional mental health services? How can they kind of interact with one another?

Schueller: Yeah, I definitely don’t think they’re a substitute. But I think the thing to recognize and appreciate is that [in] many places, people can’t get access to care. Or if you do try to get in to see a professional, you might get put on a long waiting list. And so this might be a tool that might be able to be like an on-ramp to care. Maybe you can start to use an app to learn some skills or strategies as you’re waiting to see a professional. They might also sort of supplement the care you’re receiving from a professional. But I think we have to appreciate one of the reasons why these tools have entered the national dialogue a little bit more is because we really don’t have enough providers and we don’t have enough support services for everyone in need. Even if we’re ever able to get to that point, it’s going to take a long time to get there. And so I think we really need to think about how do we help build up the toolbox of different resources? And technology can be a tool to help support those in need.

Related links: More insight from Meghan McCarty Carino

The One Mind PsyberGuide to mental wellness apps sorts reviews of mental health care apps by various challenges such as stress and anxiety, PTSD, productivity, sleep but also assigns each a rating for credibility, user experience and transparency.

Two of the most popular apps, according to the Deloitte report, are Calm and Headspace, mindfulness meditation apps that scored pretty well on the One Mind PsyberGuide.

As for the shortage of mental health providers and affordable access to their services, Congress is actually making some moves on that front.

Two Senate committees are working to produce a proposal by this summer, according to the Associated Press. There are also efforts in committee in the House of Representatives.

It’s an issue that seems to have bipartisan interest, but will there be progress anytime soon? Let’s say that for now, you might want to keep those stress-reduction apps handy.

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