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Mental health in the digital age: there’s an app for that!

  • The use of self-care apps is booming
  • A logical step in the evolution of self-help materials
  • Adding a new element to traditional mental health services

The National Institute of Mental Health (NIMH) lists mental illness as the leading cause of disability among young Americans. And mood and anxiety disorders such as depression, bipolar disorder, and schizophrenia are affecting more and more people. These numbers are expected to continue to grow for the foreseeable future, and millennials are responding by looking for help in unconventional places, such as their smartphones. This isn’t a momentary fad, but a clearly established trend that’s picking up pace. Consider, for instance, that the fifth annual Makovsky/Kelton “Pulse of Online Health” study conducted in 2015 revealed that two-thirds of Americans already prefered digital health management to conventional alternatives.

Self-care apps are booming for good reasons. They provide faster, cheaper, more confidential, and more convenient access to mental health services. This is particularly important in places where such services may not be readily available. And while some healthcare professionals have raised concerns about their effectiveness and safety, numerous studies have shown that they can help alleviate symptoms of psychological stress. Does that mean we will all soon be accessing mental health services through our smartphones?

The use of self-care apps is booming

According to Flurry Analytics, the use of health and fitness apps experienced a growth of more than 330 per cent from 2014 to 2017. And Apple reports that we’re witnessing an unprecedented rise of apps focused on mental health, mindfulness, and stress reduction. In fact, Apple included self-care in its list of the top four breakout trends for 2017, and there are now more than 165,000 health-related apps in the Apple iStore. They can be divided into several sub-categories, with self-care apps proving particularly popular. These aim to reduce stress and improve mental health through guided meditation, breathing exercises, and encouraging positive thoughts.

To get a sense of the size of this trend, consider that BBC Research predicts that the mobile health industry will be worth $21.5 billion this year. And leading app analytics platform Sensor Tower recently revealed that the top 10 grossing self-care apps have earned a combined iOS and Android revenue of $15 million in the United States and $27 million worldwide in just the first quarter of this year. That represents a revenue increase of approximately 170 per cent compared to the first quarter of 2017. Most of these apps are free to download, but accessing the lion’s share of their content requires a monthly subscription – and there’s clearly a lot of money to be made this way.

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According to Flurry Analytics, the use of health and fitness apps experienced a growth of more than 330 per cent from 2014 to 2017.

However, more than 90 per cent of that revenue was generated by only two mindfulness and meditation apps: Calm and Headspace. It’s not exactly clear why they’re so dominant. It might have something to do with the fact that the users of health and fitness apps have demonstrated remarkable loyalty, with 96 per cent of them using only one app. And it’s entirely possible that Calm and Headspace were simply in the right place at the right time and were able to take advantage of an emerging trend. It also doesn’t hurt that they’ve managed to secure endorsements from celebrities like Emma Watson and Gwyneth Paltrow.

A logical step in the evolution of self-help materials

Whatever the reasons for their popularity, the rise of self-care apps is well understood. According to Dr Rebecca Grist, from the Child and Adolescent Mental Health Group at Bath University, it’s a result of recent advancements in smartphone technology and the growing accessibility of smartphones to people around the world. “Apps are a logical step in the evolution of ‘self-help’ materials – in the early 2000’s bibliotherapy was introduced – these are books which contain standardised information based on interventions like cognitive behavioural therapy. Then came computerised and internet based programs, and now we are seeing the development of mental health apps,” Dr Grist explains.

Millennials are also more comfortable interacting with technology because they grew up with it, inclining them toward digital healthcare solutions. “If you are designing a healthcare delivery system for kids and focusing solely on building traditional infrastructures, you are designing an approach that is very different to their world. It is expensive, and it is not necessarily catering for them,” notes Dr John Mann, a psychiatrist and professor of translational neuroscience at Columbia University.

Another reason for the explosion of self-care apps is that not everyone who’s affected by mental illness receives appropriate care. Whether it’s because such services aren’t accessible where they live, or they’re simply ashamed to be seen talking to a therapist, only one-third of those affected actually seek treatment, the World Health Organization reports. This is where mobile apps shine, offering confidential and convenient access to mental health services wherever you might be, at any time of day or night.

There are also financial incentives driving this trend. Developing an app costs much less than building traditional mental health infrastructures. “There are many reasons for emphasising web-based interventions and apps – they are suitable for youth, they are less expensive and many countries do not even have the choice, because of the poor state of their mental health infrastructures,” Mann adds.

Indeed, research suggests that mindfulness and meditation exercises can reduce anxiety and mental stress. And in 2014, researchers from Johns Hopkins University evaluated almost 19,000 studies that attempted to determine the efficiency of meditation and concluded that meditation may result in small to moderate improvement in negative dimensions of psychological stress such as anxiety, depression, and pain. It’s important to realise, then, that these apps aren’t just popular, they’re often effective, too.

Adding a new element to traditional mental health services

However, self-care apps have also attracted criticism, especially when not grounded in science or proven therapeutic measures. “Despite the benefits to health of such interventions, companies … often entirely neglect to integrate scientific or behavioural evidence into their devices,” warns a recent report from the Vitality Institute. According to Steve Flatt, the director of the Psychological Therapies Unit in Liverpool, it’s quite possible that some of these apps do provide a benefit, but we still don’t know enough to say how much or how often that’s true.

Clearly, profit is driving availability, even when the science isn’t there. “Everyone sees a gravy train and are not hesitating to jump on board even if there is little of [sic] no evidence of utility, on the basis that there is a vast amount of money to be made,” said Flatt. “This field is currently in its infancy and can be likened to the snake oil salesmen of the 1860s.” And Brian Pomering, a PwC partner specialising in healthcare, brings up the question of responsibility, asking who will be to blame if something goes wrong. This is particularly true for text therapy apps that connect patients with healthcare professionals over the internet or phone. Several of these apps have been accused of shady business practices, poor quality of care, and general disregard for the health of their users. A 2016 investigation of the Talkspace text therapy app by The Verge alleged that the company placed more emphasis on profit than on the wellbeing of their therapists or patients, and could even be potentially dangerous. The app guarantees anonymity to its clients, which makes it very difficult for therapists to report those they consider a danger to themselves or others to the authorities.

While some concerns still remain, the potential benefits of self-care apps are too important to ignore. They provide users with quicker access to help, more convenience, greater anonymity, and better control over their mental health. However, it’s worth noting that while there’s evidence that self-care apps can help reduce stress and anxiety, they shouldn’t be viewed as a full replacement for traditional therapy – especially for those who suffer from more serious conditions such as depression. Perhaps the best approach is to look at them as a complementary tool that adds a new element to traditional mental health services.

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