“Don’t worry, be Appy” was the catchy title of a panel discussion on the growing phenomenon of mental health apps during this year’s First Fortnight festival on the interface between arts/culture and mental health.
With more than 90 per cent of the population now using smartphones, people are more likely to turn to technology for help for both short-term anxiety and depression and other more enduring mental health problems including bipolar disorder.
But how useful are mental health apps as a tool for looking after your mental health? And, more importantly, how can the average person distinguish between a valuable, clinically tested mental health app and one that looks convincing but lacks accurate information and professional endorsement?
Rick Rossiter, one of the panellists at the aforementioned talk is a mental health services user and consultant on e-health. He says it's difficult for people to choose from the thousands of mental health apps on Goggle Play or in the Apple App Store. "The problem with some free mental health apps is that you don't get a core element of who exactly they are looking after. And, then there are apps which just share knowledge compared to those that are connected to moderators – health professionals or volunteers who give feedback, monitor people's progress and intervene if more help is needed."
Gavin Doherty, associate professor at the School of Computer Science and Statistics at Trinity College Dublin, was another panellist at the mental health and technology talk. He says people now go online as part of their health information-seeking. "The vast majority of mental health apps aren't helpful, so the key is to look to reputable and trusted sources such as the NHS Choices and the HSE sites for [recommended] mental health apps," says Doherty.
Dr Séamus Mac Suibhne, psychiatrist and member of the Health Service Executive research technology team says that while the task of vetting all apps for their clinical usefulness is virtually impossible, it would be helpful if the Cochrane Collaboration [a global independent network of researchers] had a specific e-health element so it could partner with internet companies to give a meaningful rubber stamp to specific mental health apps.
A six-month pilot programme using Silver Cloud for people with bipolar disorder will start in Irish mental health services in Cork, Dublin, Kildare and Kilkenny in March
“There is potential for the use of mental health apps to engage people with diagnosed conditions – particularly younger patients who might stop going to their outpatients appointments,” says Dr Mac Suibhne. However, he cautions their use as a replacement to therapy. “A lot of apps claim to use a psychotherapeutic approach but psychotherapy is about a human encounter and an app can’t replace that,” he says.
On a personal level, Dr Mac Suibhne recommends Sleepio, an evidenced-based app that helps monitor and improve sleep patterns. He has also recommended to patients the Virtual Hope Box, a relaxation and stress-management app developed by the US military for post-traumatic stress disorder.
Silver Cloud is one mental health app, grounded in cognitive behaviour therapy, that is used by the Irish depression support group Aware and throughout the NHS in the UK following extensive clinical evaluation. "The big advantage of technology like Silver Cloud is that it can reach people earlier because there is no stigma attached to using it. It's easier to get better if you haven't yet lost your job or your relationship due to mental distress. People can learn how to manage their moods, have better self-esteem, not let thing bother them so much and become more resilient," says Prof Gavin Doherty, who is a co-founder of Silver Cloud.
A six-month pilot programme using Silver Cloud for people with bipolar disorder will start in Irish mental health services in Cork, Dublin, Kildare and Kilkenny in March. "It isn't an emergency intervention. We plan to use it as an online recovery toolbox similar to the self-management programme Wellness Recovery Action Plan (Wrap)," says Dr Mac Suibhne. So, participants will monitor their symptoms online, identify triggers and early warning signs to make plans to stay well or look for help in a crisis.
“The aim is to have it as a bridge from an acute episode to longer-term care. The key is that professionals can link in to monitor progress and each participant will have a key worker.”
Prof Doherty adds that research during the development of Silver Cloud found age not to be a barrier to usage. "Once an app is designed well and people have a reason to use it, it's suitable for all ages. We've had people in their 80s using Silver Cloud through the NHS in the UK. In the future we'd like to see more options online for people with mental health problems in Ireland, supported by HSE staff."
As awareness of clinically recommended mental health apps grows, Rick Rossiter would also like to see GPs and carers come on board. “It would be a great benefit if GPs could prescribe certain apps appropriate to the diagnosis of the patient. It could be particularly beneficial for young people who don’t want to go to a psychiatrist. And we need to get to the point where apps are used by both mental health service users and their carers – because you get important information from carers looking after people with mental health problems.”
Dr Mac Suibhne suggests that once electronic health records are rolled out fully, the potential for clinically evaluated apps will grow. “We need the novelty element of using apps to wear off and that maturation process is currently happening.”
Four recommended mental health apps
There are apps to diagnose depression, track moods and help people to think more positively such as online gratitude journals. There are apps pitched at people struggling with anxiety, schizophrenia, post-traumatic stress disorder, eating disorders and addictions. The problem is many of them aren’t clinically tested or recommended by health professionals. Here are four mental health apps that have been endorsed by mental health professionals.
Silver Cloud: This is a mental health platform, developed by researchers in Trinity College Dublin and clinically tested with mental health services in Ireland and the UK. It has specific programmes for people suffering from depression, anxiety, eating issues, stress or chronic illnesses. Participants are linked up with a key worker who monitors their progress and offers feedback.
Sleepio: Developed by London based Big Health, which was co-founded by sleep scientist Colin Espie, this clinically-tested app offers help with insomnia. It teaches users how to manage anxious and intrusive thoughts, learn relaxation techniques and establish a sleep-friendly environment and routine.
Virtual Hope Box: First developed by the US military to help sufferers of post-traumatic stress disorder, this app has tools to help people relax and think more positively. Patients and healthcare providers can work together to personalize the virtual hope box.
FearFighter: Recommended by the NHS, this mental health app is a cognitive behaviour therapy online course to treat phobias and panic attacks. It has nine hour-long sessions explaining anxiety and how to combat it.