Technology Trends: Mental Health Apps — Finding the Right One for Your Clients and You
By Martha Neary, MSc
Social Work Today
Vol. 19 No. 6 P. 8

As the availability of technologies such as smartphones increases, growing opportunities exist to facilitate care and management of mental health through apps. Recent estimates have suggested that between 10,000 and 20,000 mental health apps exist (Torous & Roberts, 2017; O’Loughlin, Neary, Adkins, & Schueller, 2018).

Apps offer a range of benefits. They are easily accessible, with lots of free options from which to choose, and can be used on the go and between appointments. While apps are no replacement for seeing a licensed professional, they can supplement existing care or offer a starting point for help-seeking when no other services exist.

Apps vary in what they offer. Some apps draw on well-established evidence-based practices, such as cognitive behavioral therapy. A range of “therapy”-style apps allow users to connect with licensed therapists, peers, or even chatbots (computer programs which mimic real-life human conversations) to talk through how they are feeling. Other apps allow tracking and monitoring of mood, symptoms, medications, or triggers. These are just some examples, and novel apps are being developed every day.

Consumers appear receptive towards using mental health apps (Proudfoot, 2013) and often look to trusted professionals, such as therapists and social workers, for app recommendations (O’Loughlin, Neary, Adkins, & Schueller, 2018). For professionals interested in integrating mental health apps into their practice, it’s challenging to determine which apps to use. There is a vast array of publicly available apps from which to choose, but few have been researched or vetted in any way. We propose the following three stages when making this determination.

Stage 1: Identify Some Contenders
The first stage is to explore the app marketplace and identify which apps are relevant and potentially beneficial to your clients. There are app clearinghouses that can help with this. Our nonprofit website, PsyberGuide.org, a Project of One Mind, is one such resource that reviews mental health apps. You can use our App Guide to find apps based on a combination of target conditions and/or treatment types (e.g., cognitive behavioral therapy, mindfulness, stress and anxiety). You can also filter based on audience (e.g., adolescents, military personnel, or LGBTQ+), platform (Android or iPhone), and cost.

We review apps on three metrics: credibility (the research, clinical, and technological support for an app), transparency (the clarity of an app’s privacy policy), and user experience (how fun, engaging, easy to use, etc. the app is). No app will work for everyone and no score alone will determine which app is the best fit. For example, if you are working with a client who has expressed skepticism about the security of technologies for health, they may be reassured by a strong transparency score. If clients are less tech savvy, they may need an app with an easy and engaging user experience. The credibility score is a good place to start, to ensure you’re recommending apps that are grounded in research and developed by a credible source.

Stage 2: Determine Relevance & Appropriateness
When you’ve used a clearinghouse or guide such as PsyberGuide to identify which apps are contenders, take a deeper dive into each of the apps to determine whether they are appropriate for your setting, client, and care plan. You can and should download the apps you’re considering and explore their full functionality. The American Psychiatric Association’s App Evaluation Framework is a helpful tool to guide you here (Torous et al., 2018).

It’s important at this stage of getting to know the apps to consider how various cultural considerations can impact uptake and use of digital health tools. Just as you tailor your treatment plans around the individual, cultural, and systemic factors with which each client presents, consider how the apps address factors such as ethnicity/race, language, gender identity, sexual orientation, age, socioeconomic status, and other aspects of identity and experience (Armstrong, Ortigo, Avery-Leaf, & Hoyt, 2019). Use your professional judgement to determine whether the app is an appropriate cultural fit for the client. Would the client visualize themselves in the examples and graphics in the app? Is the language inclusive and easy to follow? Would any content inadvertently activate triggers to a trauma response?

Unfortunately, digital health technologies are not always developed with or for diverse populations (Aguilera, 2018). It’s crucial here to look at not only what the app claims to address but also whether this claim is actually held up and if the app has been inclusively designed (Neary, 2019). It’s important that health apps are tailored to the needs of the target population in a relevant way. Not all tailoring, however well intentioned, is appropriate. Also reflect on your own biases: What is your relationship with technology? Do you see it as positive or frustrating? Do you tend to embrace or reject new technologies? (Armstrong et al., 2017).

Access barriers should also be considered. While digital health is often touted as the solution to all problems on the grounds that “everyone has a smartphone,” this isn’t the case, particularly when we consider that the average price tag on a smartphone now surpasses $500 (Statista, 2019). Discuss with your clients whether they have access to a smartphone, and whether it is shared with someone else (e.g., a partner or family member). Check whether the apps you’re considering require network connectivity, which will mean that they are unsuitable for those without data plans. Familiarity with technology should not be assumed. Users of health apps are more likely to be younger with higher levels of education and e-health literacy skills (Bol, Helberger, & Weert, 2018). Many clients will need additional support and scaffolding as they become familiar with using apps (making it all the more important that you also be familiar with whatever app you recommend).

Stage 3: Integrating Apps Into Your Practice
When you’ve selected an app, appropriately introducing it to your client plays a critical role in persistent use (Ruzek, 2018). Although primarily tailored for military health providers, the Department of Defense Mobile Health Practice Guide (Armstrong et al., 2017) is a comprehensive resource that can be used by professionals across the care spectrum and offers a number of practical tips for the introduction of apps. An effective introduction should first present a clear rationale for using the app—what is the benefit to the client? Describe the main purpose of the app and its key features and demonstrate the tool with the client. This should be a collaborative process. Actively discuss client perceptions and receptiveness, and work with the client to figure out how using the app might fit into their daily life. The process doesn’t end at introduction; regularly review client experiences with the app, discuss challenges and benefits, and address any obstacles to use or issues of nonadoption.

— Martha Neary, MSc, is project manager of PsyberGuide, based at University of California, Irvine. Her broad and varied research interests include health care disparities among minority populations, the integration of technology into mental health interventions, and early education, particularly in the areas of health and sexuality.

Acknowledgements: Thanks to Stephen Schueller, PhD, and Colleen Stiles-Shields, PhD, LCSW, for their review and input.

References
Aguilera, A. (2018, February 15). Disparities and digital health [Blog post]. Retrieved from https://psyberguide.org/blog/guest-blog/disparities-and-digital-health/.

Armstrong, C., Edwards-Stewart, A., Ciulla, R., Bush, N., Cooper, D., Kinn, J., et al. (2017). U.S. Department of Defense Mobile Health Practice Guide (3rd ed.). Washington, DC: Defense Health Agency.

Armstrong, C. M., Ortigo, K. M., Avery-Leaf, S. N., & Hoyt, T. V. (2019). Cultural considerations in using mobile health in clinical care with military and veteran populations. Psychological Services, 16(2), 276-280.

Bol, N., Helberger, N., & Weert, J. C. M. (2018). Differences in mobile health app use: A source of new digital inequalities? The Information Society, 34(3), 183-193.

Neary, M. (2019, April 1). “Insert token here”: Moving towards more inclusive app design [Blog post]. Retrieved from https://psyberguide.org/blog/insert-token-here-moving-towards-more-inclusive-app-design/.

O’Loughlin, K., Neary, M., Adkins, E. C., & Schueller, S. M. (2018). Reviewing the data security and privacy policies of mobile apps for depression. Internet Interventions, 15, 110-115.

Proudfoot, J. (2013). The future is in our hands: the role of mobile phones in the prevention and management of mental disorders. Australian & New Zealand Journal of Psychiatry, 47(2), 111-113.

Ruzek, J. (2018, October 15). Bringing apps into the treatment process [Blog post]. Retrieved from https://psyberguide.org/blog/guest-blog/bringing-apps-into-the-treatment-process/.

Statista. (2019). U.S. average smartphone price 2018-2023. Retrieved September 6, 2019, from https://www.statista.com/statistics/619830/smartphone-average-price-in-the-us/.

Torous, J. B., Chan, S. R., Gipson, S. Y. T., Kim, J. W., Nguyen, T., Luo, J., et al. (2018). A hierarchical framework for evaluation and informed decision making regarding smartphone apps for clinical care. Psychiatric Services, 69(5), 498-500.

Torous, J., & Roberts, L. W. (2017). Needed innovation in digital health and smartphone applications for mental health: transparency and trust. JAMA Psychiatry, 74(5), 437-438.