Beware of the “App-ification” of Mental Health Care!

Recently, there has been a proliferation of mental health care “Apps” (a software application that can be downloaded – installing an app on your mobile). These mental health care “Apps” promote 24/7 access through texting and also more economical access to a “therapist”. These “Apps”, on a positive note, appear to help when experiencing milder symptoms but there is limited research, often with inconclusive or contradicting results.

However, there are multiple areas of concern that have risen as more users have gone through this experience. On the surface, there appears to be many benefits and promises made by these mental health “Apps” but beware and consider the following.

. Privacy: Privacy and confidentiality is one of the most fundamental principles of the psychotherapy process. An individual opens up to a psychotherapist and shares private information, “secrets”, etc. This, by law, is confirmed explicitly by the psychotherapist whenever starting with a new client. The explicit promise and understanding are that this information will be kept safe and fully confidential. However, surprisingly and frightening, this is not always the case! Many “App” therapy business regard treatment transcripts as a data-mining resource. Also, there have been instances where “big brother” has been “watching” over exchanges between therapist and client, intervening and, at times, “correcting” the therapist for redirecting clients to outside services or resources as needed.

. Fake Reviews: Former employees of a major mental health “App” provided testimony that their company, while employed, provided many employees with “burner” phones to help avoid app stores detecting fake reviews. This was done in an effort to improve ratings that historically where around the three out of five stars rating.

. Unethical and Deceptive Advertising: Promoting fake reviews, publishing false information about “spike” in traffic (to create false impression of service being rapidly adopted) is unethical and deceptive. Ethical guidelines of the Psychology profession explicitly warn against taking advantage of potential vulnerabilities of clients to promote their practice (e.g. giving business cards during a funeral service). Some App companies have seized moments of national anxiety (e.g. politics, COVID-19, etc.) to promote their business. One official Tweeter account representing one of these “apps” responded to a client’s concern over unethical advertising by answering: “medical professionals need people to buy things”. This tweet was later deleted.

. Corporate Model: Some of these “Apps” have been contracted by major corporations (e.g. Kroger, JetBlue, etc.) to provide employees access to these “Apps” as part of employee benefits. With this, “Apps” being part of a corporate model, often, corporate employees are given priority over other individual clients.

. Limited Research Support: The National Association of Mental Illness (NAMI) reported that while 64% of these apps make supportive claims about the evidence that inspired their app, only 1.4% have actually applied that evidence to their app and shared the results in a scientifically reviewed paper.

. Hidden Costs and Disclaimers: Also, according to NAMI, many users have faced significant hidden costs. When these hidden costs are taken into account, it questions any significant advertised savings. As per NAMI: “Buried deep in the terms and conditions of most apps, including therapy apps, is a statement that the app is not actually offering any medical or mental health services.  Instead this mouse-print text notes the app is a self-help tool and therefore not subject to medical rules around clinical claims, privacy and confidentiality”.

. A different “Therapy?” experience: The 24/7 unlimited texting therapy promises potential new clients that your therapist will see your message and will respond, as needed, throughout the day. On the other hand, when recruiting therapists, the “App” company attempts to lure therapist with “set your business hours”. A conflicting set of promises! Also, the lack of boundaries that is established by a 24/7 texting approach is a real problem (modeling the setting of healthy boundaries at different levels is part of the psychotherapy process and benefits). Other benefits of the psychotherapy process that include regular, scheduled check-ins, sessions with a clear beginning and end, and with clear next steps are at risk when engaging in a “free flow” format of these apps. Furthermore, anyone having the need for this kind of attention or severity would be better served by a clear session help by phone or video.

The Psychotherapy Action Network (a therapists advocacy group), reached out to the American Psychological Association (APA) and to Olympian Michael Phelps calling one of these “App” companies: “problematic treatment provider who aggressively sells an untested , risky treatment”.  The APA cautioned against relying on “text therapy”. The APA went a step further and stopped allowing therapy-tech exhibiting at their conferences.

This article is based on different sources among them an article from the New York Times (“Talkspace Has Issues. How Do You Feel About That?) published August 9, 2020 and NAMI’s 2019 article “Digital Therapy Apps: Good or Bad?