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Can we rely on mental health apps?

Tagged In:  Mental Health, NHS

Online mental health apps may seem like an obvious answer to enable easier, faster access to treatment such as talking therapies. But how effective and viable are they?

In 2013 NHS England launched a pilot Health Apps Library, including a number of recommended online mental health apps providing services such as computerised cognitive behavioural therapy (CCBT). The pilot has now ended and the concept is being reviewed to 'consider how a wider endorsement model for patient-focused health apps could be put in place'.

As we discussed in a previous blog post, the Government wants to increase access to the Improving Access to Talking Therapies (IAPT) programme, and is committed to providing more staff and resources to deliver that aim. However, it's widely acknowledged that this will take time, not least because it relies on bringing more trained psychotherapists and mental health nurses into the system. In the meantime, and to support face-to-face mental health services in the future, it's believed that online mental health apps may have a role to play. In September, Life Sciences Minister George Freeman announced a £650,000 fund to develop new mental health apps for the NHS.

There are many apps out there, although only a selection have so far been officially approved by the NHS. One such example is Big White Wall, an online 24/7 community which supports people experiencing common mental health problems such as depression and anxiety. Others include FearFighter, a CBT-based online self-help course for treating panic and phobias, and SilverCloud, a safe, secure online space offering personalised programmes to help people experiencing mental and behavioural issues, including depression, anxiety, eating disorders and obsessive compulsive disorder (OCD).

Words of caution

Some health experts have expressed concerns about the use of mental health apps, claiming there is limited evidence of their effectiveness. There have also been strong warnings that they must not be seen as a replacement for direct access to experienced, highly-trained professionals such as psychiatrists, psychologists and mental health nurses. "Apps are by no means a perfect solution to our nation's mounting mental health requirements, and are characterised by numerous shortfalls," wrote Liverpool University Health Economist Simon Leigh in a recent article for Evidence-Based Mental Health. 

Of course, this isn't the manufacturing sector. Therefore, it's highly unlikely thousands of mental health jobs will be replaced by computers any time soon, if ever. The government and health planners are clearly aware of the issues and risks associated with increasing use of mental health apps, as is shown by their ongoing major reassessment of the apps library project. What's more, many of the NHS-recommended apps complement rather than replace conventional one-to-one therapies given directly by trained mental health professionals. For example, Buddy is a mobile phone diary app that's designed to be used alongside face-to-face sessions with a psychotherapist.

"I encourage my patients to consider using some of the more well-established apps to augment the work we do together, " commented US-based clinical psychologist Dr Simon Rego in a recent interview with Health and Beauty magazine. "In this way, apps could be considered the modern version of a self-help book." 

When it comes to using apps more widely, the article also revealed some scepticism amongst leading psychotherapists, including Australian parenting and relationships specialist Dr Karen Phillips. She accepts they can be of benefit in hypnotherapy, but not in the 'complicated, dialogue-based realm of psychotherapy' because they 'cannot read body language, emotions or voice tone'.

In 2013-14, almost one million people were referred into IAPT services for common mental health problems such as depression and anxiety disorders. Mental health apps may have their place in helping the NHS respond to rising demand, however, technology has its limitations and has a long way to go before it can match the skills, expertise and effectiveness of our valuable mental health workforce.

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