Mental health apps skyrocketed in popularity in recent years, offering consumers support in a way that’s convenient and affordable. But there are between 10,000 and 20,000 mental health and wellness apps available for consumers, and not all of them are backed by evidence. So how can people sift through the numerous options to find the right ones for their mental health?
For Dr. Shiri Sadeh-Sharvit, chief clinical officer of Eleos Health and a practicing mental health clinician, there are several things she checks off from her list when considering which solutions to recommend to patients. The first is the startup’s mission.
When Investment Rhymes with Canada
Canada has a proud history of achievement in the areas of science and technology, and the field of biomanufacturing and life sciences is no exception.
“Is this company trying to solve a real problem and improve the lives of people in need or the professionals supporting them?” she said. “Or is this a solution searching for a problem? I prefer companies that support the mission of affordable, accessible, evidence-based care that could be scalable.”
Sadeh-Sharvit prefers companies that have teams of experienced professionals with clinical backgrounds. To her, that signals the solutions are likely more ethical and relevant to the field. Next, she checks to see if services offered through the startup are backed by evidence, like cognitive-behavioral therapy. For that, she looks for peer-reviewed papers to ensure the solutions do indeed work and are validated. In this regard, she’d like to see a randomized controlled trial in real-world settings that compare the company’s products to an active control group.
Privacy and security are also a a top priority given the sensitive nature of mental health care. Equally important is user experience because a positive experience can affect how well a treatment works.
Last, but not least, on her checklist is a sustainable business model.
“In order to keep offering services to clients, I want to make sure that they will be able to maintain their financial viability,” she said.
One of the companies Sadeh-Sharvit feels is more grounded in research and follows ethical rules is Woebot, an AI-powered chatbot. A 2017 randomized controlled trial of young adults using Woebot found that the chatbot significantly reduced symptoms of depression compared to the control group. Sadeh-Sharvit said she has colleagues and friends working at Woebot and briefly served as an unpaid consultant for the company in 2017. She also listed SilverCloud and the Veterans Affairs’ self help apps as good examples of mental health solutions.
Sadeh-Sharvit’s comments were echoed by Dr. Don Mordecai, national leader for mental health and wellness at Kaiser Permanente. The integrated health system wants to ensure the members have access to an app that offers mindfulness, as well as real-person support. That’s why the organization works with mental wellness app Calm and mental coaching company Ginger.
When evaluating companies to contract with, Kaiser Permanente prefers they have a certain level of maturity and knowledge of HIPAA and privacy regulations, Mordecai said.
“We’re not super interested in the brand new, coolest-sounding-idea app,” he stated.
Like Sadeh-Sharvit, Mordecai also prizes a sizable volume of data available on the solution’s effectiveness. In other words, a digital product that has some clear clinical data behind it.
“There are plenty of companies I get contacted by all the time who have a good idea, they may have a good interface and they’re looking for somebody they can partner with to do these kinds of studies,” Mordecai said. “That’s generally not us. Because we’re really looking to bring these things in at a certain amount of scale, not spend a lot of time proving out the studies for these companies.”
However, with apps like Calm, there’s a lower bar when it comes to data because it’s teaching mindfulness rather than using clinical principles to improve users’ mental health, Mordecai said. That said, Calm has still done studies on its app, including one that tested its effect in the workplace through a randomized controlled trial. The study found that it improved mental health, sleep and productivity.
Ginger — which merged with mindfulness company Headspace in 2021 to create Headspace Health — has also conducted extensive research on its services. A 2021 study determined that 47% of Ginger users saw a decrease in anxiety symptoms. In addition, a 2019 study on Headspace found it reduced anxiety by 19% and depression symptoms by 29%. The conjoined entity recently put out a call to third-party researchers to conduct more studies on how its company affects mental health and wellness outcomes.
When doing this research, it’s important that the treatment group is sizable and diverse, said Katie DiPerna Cook, senior vice president of partnerships at Headspace Health.
“We need to make sure that we’re not just studying those who are more likely to access care, but that we’re really expanding to a broader population,” she said.
She added that companies should be continuously testing their products.
“I think that as a digital mental healthcare provider, we have such a responsibility to be studying outcomes and making sure that we’re getting people better faster … It’s not just one and you’re better,” Cook said. “We need to be studying and following people over time.”
But a lot of companies don’t conduct this kind of rigorous research on their products. Instead, many are turning to “Mickey Mouse trials,” declared Deepak Gopalakrishna, CEO of OxfordVR. The virtual reality company treats severe mental illness and recently merged with BehaVR.
“When you go to most digital technologies’ websites, you see ‘trials’ that are like 15 to 20 patients, certainly not big enough to qualify for anything statistically significant, the appropriate analysis,” he said. “That data has not been done, the population size isn’t big enough, the population isn’t the right population. The endpoints selected don’t actually back up the claims that people are making in the market.”
Other indicators that show a study isn’t robust are those that confuse correlation with causation, as well as those that rely on incentives to get participation, according to Jennifer Gentile, senior vice president of clinical innovation at Ieso. She is also an attending psychologist at Boston Children’s Hospital.
“[A] concerning factor is when study participation and completion is heavily incentivized,” she wrote in an email. “It worries me whether patients will use the tools without incentives.”
Common incentives for research participants include cash payments and gift cards.
Whatever be the process for choosing a behavioral health company, the work doesn’t end with the selection.
“This should be a dynamic, continuous process,” Mordecai said. “Part of that is us saying, ‘This app is really keeping up. They’re refreshing it, it’s super popular. But this other app doesn’t seem to be grabbing people anymore. When we look at the interface and the materials, they don’t seem to be investing in it.’ That’s one criteria where we might say ‘Well, it’s time to move off from that one.’”
Photo credit: Bohdan Skrypnyk, Getty Images
