Mental health apps alone could be harmful
ABC News published today an excellent warning about how mental health apps could be harmful - if they do not have a human layer of personalised, clinical expertise. With nearly 9 million Australians aged between 16 and 85 experiencing a mental disorder at some time in their life, the article talked about how mental health care is becoming less accessible and Australians are increasingly relying on technology for mental health care.
However, whilst mental health apps "offer the promise of reduced costs compared to traditional therapy", they are largely unregulated and "experts fear vulnerable users could be harmed", the article warns.
Today's news article is another reminder about how important it is to combine a technology-based approach with a human-based approach.
Employer-funded mental health apps
In the workplace context, as employee expectations rise - with 92 per cent of employees believing in the importance of their employers providing mental wellbeing support - many organisations are looking to self-help digital tools to either supplement or replace their employee assistance programs (EAPs).
But, whilst digital solutions have the potential to deliver low-cost, low-effort, and easy wins, they can also bring drawbacks, for example:
- Digital self-help tools that replace EAPs (or new-style support programs) can increase an organisation's risk by removing the expertise of human triage, support, and follow-up; and
- Self-help tools that supplement EAPs (or new-style support programs) can add another layer to a complex support ecosystem - that employees already find hard to navigate - unless they combine seamlessly with their existing wellbeing support service to provide a single entry point for support services.
What does the evidence say?
Self-help apps can provide valuable initial guidance, but they should complement, not substitute, professional health care and robust clinical governance. They should enhance a more holistic and comprehensive employee wellbeing strategy, not be the strategy.
Lack of ongoing engagement
Self-help apps risk user drop-off. This can result in delays to care or the absence of care (if there is no human support or ongoing follow-up).
"Widely celebrated as the solution to the supply and demand imbalance in mental health care, digital mental health interventions have flooded the marketplace to supplement specialty mental health care. However, the evidence supporting their efficacy is mixed [see also here], and engagement with digital mental health interventions, particularly mobile apps that lack ancillary human interaction, is abysmal. Users are unlikely to use these interventions more than a few times," conclude Rudd and Beidas.
Carlo, Ghomi, Renn and Areán concur; "the vast majority [of health apps] remain largely unevaluated… [and] even when apps are evidence-based, their public health impact is often curbed by poor adherence".
"Furthermore, the movement of specialty mental health care, an intensive public health intervention, from the hands of clinicians and into standalone digital interventions ignores decades of research about the importance of social support and may further isolate individuals who need human connection the most. Given the robust social support literature, it is not surprising that digital interventions with the highest levels of engagement are those that include some form of human interaction," said Rudd and Beidas.
Gaps in patient assessment
Digital app users often struggle to fit their circumstances into the predefined categories in an app. Limitations of the tools can also lead to a 'Dr Google' type of self-diagnosis. This represents a dangerous gap in patient assessment because it neglects that many wellbeing issues are complex and multilayered.
For example, "around 51 per cent of Sonder's support cases are caused by something other than the issue stated. [To illustrate,] self-diagnosed financial stress might, upon professional triage, uncover a need for urgent safety support for domestic violence, plus mental health support for isolation, depression, and suicide ideation all underwritten by a complex medical problem," says Dr Jamie Phillips, Medical Director and Head of Member Support at Sonder.
Jason Vella, Head of Psychology, Sonder
Sonder's Head of Psychology, Jason Vella, B.A. Psych., Grad Dip Sc. Psych., Assoc. MAPS,
"The recent proliferation of apps purporting to assist with mental health means that you can get what may seem like reasonable help with everything from mindfulness to mood and sleep hygiene to habit change.
However, the lack of regulation leaves consumers to identify for themselves if the recommendations they are receiving are evidence-based or represent current best practice.
Even the best apps create an expectation that often complex life stressors should be easily manageable on our own, simply by virtue of the application of generic advice delivered by our phone notifications.
Sonder uses our app to provide evidence-based education and tools, but more importantly, is a 24/7 gateway to an ecosystem of healthcare professionals available to help our members develop insight and genuine change."
Dr Jamie Phillips, Medical Director, Sonder
Sonder's Medical Director, Dr Jamie Phillips, MB ChB, AFCHSM, DIMC RCS(Edin), MRCGP(UK), FACRRM(EM), comments:
"This is a difficult one for me as a doctor who works for a technology company because it would be great if digital-only, self-help tools were the answer - it would enable us to scale the health part of Sonder really, really easily.
But it's just not true. What the evidence shows is that self-help apps are useful in terms of an introduction on initial guidance, but they should complement, not replace, professional, well-governed, health and wellbeing support.
It is important that we have the right balance of technology and the right balance of humans to make sure that we look after our people in a safe, effective, and reproducible way."
We invite you to watch Dr Jamie explain his perspective in the video below (or read the transcript here):
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Sonder is an Active Care technology company that helps organisations improve the wellbeing of their people so they perform at their best. Our mobile app provides immediate, 24/7 support from a team of safety, medical, and mental health professionals - plus onsite help for time-sensitive scenarios. Accredited by the Australian Council on Healthcare Standards (ACHS), our platform gives leaders the insights they need to act on tomorrow's wellbeing challenges today.