NEW YORK, NY – Recently, many news headlines have been focused on mental health-related situations. We’ve seen everything from suicides of survivors of gun violence and Olympic athletes to class action lawsuits against health insurance companies for negligence of mental health care. While these are some of the more dramatic examples, they help to illustrate a tipping point because of their prevalence in the media.
For every case that bubbles to the surface, there are countless others that exist that are truly affecting many peoples’ quality of life. In fact, 1 out of 5 adults experience mental illness each year and, in many instances, these coincide with things like drug use, anxiety and stress disorders, and PTSD. It may seem obvious that this issue revolves around a gap or need that society needs to address; however, it happens to be, that with this critical mass of mental health care challenges, there are, in fact, several tools, or apps, that have been created to fill that void. And for the purposes of this post, we’re focusing on apps that provide self-help tools versus paid remote therapy subscriptions. While these apps may exist, there’s been less mainstream coverage discussing these tools, and like anything behavioral, the user experience, clinical guidance, motivation and support are crucial to success, which makes understanding this landscape tricky at face value.
Many of these apps focus on things like mood tracking, cognitive behavioral therapy, and mindfulness – providing tools for users to manage stress, anxiety and depressive thinking. While many of these tools are proven to be effective in treating patients, most often they are utilized with the help of a health care provider. But with the increased need for mental health care and severe payer issues in obtaining care, many of these apps are using the opportunity to provide services for free or through monthly subscription plans.
In fact, noticing the need for these tools, the US Department of Veteran Affairs went forward to develop an app called CBT-i Coach to address the after-effects of serving in the military, such as insomnia and PTSD. There are others that have led the pack including Pacifica, Moodpath, Inner Hour, Journey, and more. Not only are their user interfaces much more polished, but they also offer a base level of care, with the option of purchasing additional tools, services and coaching services. If navigating these apps alone, it can be overwhelming; patients may find themselves questioning what to use and how to use it. The positive and negative factor about having a wealth of these apps is that while choosing the right one may be a challenge, there are also plenty of options available that may fit a patient’s lifestyle.
Having these options is important, because people respond to different dynamics of behavior and psychology. With mental health care, it’s obvious that there will never fully be a one-size-fits-all approach. Each of these apps is not necessarily meant to provide long-term care, though over time use of these tools can make an impact, but there are many different features that provide short-term or daily tools.
A few apps serve as journals that may or may not prompt users to record mood and thinking on a daily basis using CBT principles. With this, the notifications could be an important consideration depending on an individual’s behavior. In one instance, someone may be incredibly proactive to engage with the app and input their daily narrative, but in other instances, existing behavior or depression could require the need for notifications and reminders.
Another series of apps may provide users with short-form courses to help them evaluate and consider how to approach challenges and obstacles, providing interactive ways to engage with the content. Again, considering behavior is crucial here. Depending on an individual’s behavior, they may be motivated to go through the content alone in an effort to be as in control of their own care. In other instances, providing some form of recognition or motivation or reminder may be an important need to make sure people are using the appropriate tools and receiving as much of the benefit as possible.
While many apps provide the tools, often times, they provide an outlet to journal thinking, moods or feelings, and they may provide additional content, but it’s a bit more singular in its interaction. One app, Wysa, revolves around personalized care using a chatbot and creates a two-way communicating pathway. While somewhat robotic in nature, its conversational style of input and education keeps the user engaged and interested. After asking some questions, the chatbot is able to provide users with resources appropriate to their issues (with a disclaimer on what it will address versus the issues a provider will be best suited to help with).
The unique factor of Wysa is that while it curates materials (that are accessible for a minor monthly fee) like many of the other apps, it has a very easy-to-use format in which to input mood tracking and journaling using a conversational chat or text-like input system. The benefit is that it fits in with simple and existing behaviors, taking some of the stigma and formality away from using the apps. Through its conversational interface, it allows users to engage in an action-oriented dialogue by providing explanations, talking through the tools and methods, and prompting such things as reframing thoughts through conversation. There are several tools directly accessible through the chat and can be activated using simple hashtags.
Another app, SuperBetter, seems to focus on behavioral mindsets as a foundation of its user experience. The goal of this app is to help build personal resilience and motivation, which is done by gamifying the content and support mechanics. Again, they focus on having a base level, free version of the app, with the opportunity to pay for premium features. While navigating the user experience is tricky at first, the app helps users create goals, choose “power packs” and gain points based on activities, or quests, they finish. Obstacles are positioned as “bad guys” and the user’s end goal is to essentially be their own super hero.
Other apps also utilize gamification, but not necessarily as the only focus of the user experience. Happify, provides individuals with specific tracks (both free and premium options are available) including games, behavioral activities, educational and statistical content, emotional health tracking and more. The content is specifically designed by behavioral experts to change habits and build resilience over time. These examples are illustrative of another key consideration: user experience. Obviously, incorporation of behavioral science is important, but the way users navigate and engage with content is a crucial point.
Some of these new apps are featured on Google Play, the App Store or written about by publications or media outlets like the New York Times, Forbes and others. These editorial highlights can influence trial of various apps, however, there is no singular approach that will work for everyone.
While some players in this space may rise to the top, there may be an ongoing need for an array of these products in the space. Having trialed several of these apps, most of them did not fit my lifestyle: some were too difficult to interact with due to the complexities of interface, and many just did not have resonant features, engagement, motivation or content.
Moving forward, it may be imperative for some of these apps to move beyond the science of mental health to also consider the nuances of user experience. For those that are not using motivational behavioral techniques, they may need to adjust to the curve or fall behind in keeping users engaged and committed to working with their tools toward a positive result. And given this influx of new mental health, tool-based apps, there’s much to learn within the space. There is an inherent need, but as the market becomes flooded, these apps will need to do better to establish a pattern of loyalty to truly help people to see results. Furthermore, there’s a lack of awareness of many of these apps, let alone an understanding of how to navigate them to fit your individual lifestyle.
In today’s age of rapid new technology developments, for app-based mental health tools the age-old method of trial and error seems to reign supreme. With mental health needs reaching a critical mass, a plethora of mental health tools are becoming available, but potential users must be committed to spending time exploring the options. And, a few questions remain:
- Are having so many options a hindrance or a benefit?
- While these apps are an asset, how can we create a better system for people to navigate them all?
- Without appropriate tools when they need them, are people in a race against time to avoid declining further?
- Are there ways for HCPs and PCPs to become more educated about the various apps to better assist their patients with care outside their offices?
These considerations are important as the mental health app landscape continues to unfold. There’s no question that there’s a need for these tools, but we have to consider how these companies can build upon their efforts to reach more people and help them work toward positive outcomes, especially in a space where insurance-based mental health care coverage is exceptionally limited. The hope is that as time progresses, this market will evolve for the better to reach a goal where we see a shift that makes a societal impact.