Digital therapist: Increasing access to mental healthcare using mobile technologies

Despite a growing emphasis on improving mental healthcare, it can be hard to find the right psychotherapist — or really any therapist at all. More than half of US counties don’t offer any mental health services, according to The Washington Post. That’s more than 1,500 counties in the US without a single mental health provider — a chronic shortage of providers exists in almost all areas of the country. With 20 percent of adults in the US experiencing significant mental illness each year, according to the National Institute of Mental Health (NIMH), these mental health deserts have a wide-reaching impact. Mental illness in the US accounts for almost $200 billion in lost earnings each year, according to NIMH. The cost is significantly higher when medical comorbidities (such as chronic pain and heart disease) associated with mental illness, particularly depression, are also considered.

Mobile technologies offer a solution

Mobile technologies can help fill the gap between supply and demand for mental healthcare. Teletherapy is proving to be an important advancement, but teletherapy alone can’t address the overall lack of sufficiently trained providers in the way digital, mobile technologies can.

In 2015, at least two out of three people living in the US owned a smartphone — and this number is only increasing. The good news is that an overabundance of mobile health apps are marketed toward improving mental health. These apps provide many strategies to improve mental well-being at varying levels of sophistication. Some apps even have users track bothersome symptoms to better understand triggers for low mood or increased anxiety. Other apps provide a coping strategy or tool to improve mood or decrease stress — often with relaxation exercises — that users can access anytime. Other apps simply provide information about mental health to promote increased understanding. Some apps are designed to be stand-alone interventions, while others work in conjunction with traditional support methods.

Best practices for mental health apps

The flip side of these developments is that such a high supply of mental health apps can be confusing for both consumers and healthcare providers to sift through. However, this market will continue to advance, and new additions are welcome. Several important concepts can expedite improvements in this increasingly important field of mobile mental health interventions.

  • A mental healthcare expert must be integrated into the development team from early on through refinement and revisions. UX talent is an important element for effective, engaging apps, and coordination with a mental health expert is essential.
  • Apps should be based on intervention strategies proven to be effective before being marketed. Cognitive behavioral therapy (CBT), for example, has shown to be a scientifically sound intervention, both in-person and in digital instruction, for depression, anxiety and other conditions.
  • Scientific evaluation of mental health apps can boost the confidence of both healthcare providers and consumers in the validity of the app. In this rapid-fire market, scientific evaluation is often not timely. Involvement of an intervention expert in existing phases of app development (such as focus groups, data collection and refinement) can help to translate standard development processes into scientific evidence.
  • To date, the creation, marketing and use of mental health apps have occurred primarily independent of the healthcare system. Engaging primary care and mental healthcare providers as partners in app development and dissemination is likely to significantly increase app uptake and use and effectively deliver better overall health outcomes.

Best practices at work

As mobile health technologies advance and improve, more comprehensive offerings can be developed to integrate individuals, healthcare providers and healthcare systems. One app targeting depression and anxiety — Mevii — was developed by incorporating several proven strategies for intervention and carefully considering industry areas identified for improvement. The following are some features of Mevii:

  • Engagement of mental health experts throughout development
  • Gold-standard CBT principles as core content
  • Incorporation of patient-reported outcomes (PROs) for scientific evaluation
  • Tracking behaviors to provide users, developers and providers with feedback
  • Intervention strategies for psychoeducation, skills training and coping
  • The capability to provide outcome data in real-time
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Apps with these types of features should facilitate high user engagement and satisfaction as well as improve outcomes for both the individual user and stakeholders at all levels.

Supply and demand for mental healthcare apps are high, and US consumer access to this supply increases with smartphone ownership. The use of apps to fill provider gaps and to complement and extend existing mental healthcare is a welcome and needed advance. Readily available strategies can help deliver mental health apps that are valid, reliable and effective in providing individuals with relief. With continued work, the search for good psychotherapy may soon be right at one’s fingertips.

Written By

Tamara Somers, Ph.D.

Assistant Professor, Department of Psychiatry of Behavioral Sciences and Duke University Medical Center

Tamara Somers, Ph.D. is an Assistant Professor in the Department of Psychiatry of Behavioral Sciences and Duke University Medical Center. Her work focuses on the design, testing, and delivery of empirically supported behavioral/psychosocial interventions for stress and symptom management.…