Mental health apps and services may be doing more harm than good

Cerebral will stop writing prescriptions for Adderall, Ritalin, and other controlled substances to new ADHD patients as concerns grow about telehealth companies’ prescribing practices. To make matters worse, a former executive at Cerebral, a well-funded online mental health startup, claims in a labor lawsuit that the company fired him after he complained that the company was too quick to prescribe powerful stimulant drugs. Do online mental health apps work?

Cerebral was a rising star in online health, but the quest for growth may have been its undoing. The problems at Cerebral as Business Insider reported that the Drug Enforcement Agency (DEA) is investigating the company. U.S. DEA agents interviewed former Cerebral employees about clinician licensing issues and allegations that some patients had set up multiple accounts to obtain more drugs, Insider reported, citing sources.

Mental wellness apps are basically the Wild West of therapy

Mental health apps claim to treat depression, anxiety, and other mental illnesses without therapy appointments. There’s no wait time, and every person with a smartphone has immediate access. In addition to their convenience, many apps are free. If this sounds too good to be true, you may be right.

According to a study published by the American Psychological Association, mood disorders and suicide-related events have significantly increased in the last decade within these age groups, especially among females and the wealthy.

In 2020, among the 52.9 million adults with AMI, 24.3 million (46.2%) received mental health services in the past year. More females with AMI (51.2%) received mental health services than males with AMI (37.4%).

A growing number of American adults are struggling with mental illness with each passing year. In 2019 alone, almost 20 percent of the United States population, nearly 50 million people, were diagnosed with a mental illness. That figure was from data gathered before the COVID-19 pandemic began and thrust an entirely new set of stressors on the American population. These unique stressors included but were indeed not limited to illness, job loss, isolation, rising medical costs, and financial insecurity.

When the COVID-19 pandemic hit, therapy apps and online services were already starting to gain popularity amongst people struggling with issues ranging from stress to severe mental illness. When offices went virtual, they secured their spot in the mental health space. While some applications like Talkspace and Betterhelp connect you with a licensed therapist, a substantial portion of the market has gone fully humanless. Friendly chatbots offer cognitive behavioral therapy; mood trackers prompt users with bipolar disorder to monitor their disposition; apps designed to help treat post-traumatic stress disorder claim to guide people through acute episodes with deep breathing exercises.

With no regulatory body actively vetting mental health apps, users are left to navigate an explosion of options that range from expert-recommended to potentially harmful. Many claims may or may not accurately reflect what these products offer, “It’s the wild west.”

Mental health apps have been around as long as the devices offer them, but starting in 2016, the digital tools exploded both in number and popularity. According to the American Psychological Association, there are approximately 10,000 to 20,000 mental health apps available. And the COVID-19 pandemic has likely given the market an added boost, Torous adds. Over the past year, Americans have only become more receptive to using technology to care for their health.

Some of the studies analyzed and even suggested that mHealth apps and services might be more effective than in-person therapy, though these findings should be taken with a grain of salt.

A body of work published since 2017 suggests that these apps work best when combined with in-person therapy. The number of mental health apps vetted by scientists pales compared to the plethora out there. And it’s nearly impossible to distinguish what’s legit from what’s not.

Here’s a great example. In a review of 52 apps for anxiety, an international team of psychologists found that sixty-seven percent had been developed without any guidance from a healthcare professional. In another study of apps for anxiety, scientists found that out of the 25 highest-rated apps for fear, exactly zero contained any content consistent with evidence-based treatments.

Some of the advice offered by these apps and services can be downright harmful. A 2015 review published in the Journal of Medical Internet Research, which analyzed the quality of mHealth apps, found that one app (the study didn’t call any apps by name) for bipolar disorder advised users experiencing a manic episode to “take a shot of hard liquor” to help them fall asleep. Another app cautioned that “sometimes bipolar disorder can transfer to another relative if they spend too much time with you and listen to your depressive life.”

Research looking at randomized controlled trials of mobile app mental health interventions with almost 50,000 patients did not find “convincing evidence” that any mobile app intervention greatly improved outcomes related to people’s anxiety, depression, smoking or drinking, thoughts of suicide, or feelings of well-being. While this sounds unfortunate, this may be related to the study methods in which researchers grouped interventions that may be completely different. A small trial with a positive effect could thus appear unhelpful if its products are combined with less helpful interventions.

 Many mHealth apps also collect sensitive mental-health data to sell for ad revenue. The most significant potential risk of this is the unknown. What’s going to happen to your data in the future? In 2020, hackers attacked mental health clinic Vastaamo, which had backed up all of its client data digitally, and demanded ransom from an estimated 30,000 current and former patients, threatening to leak their notes from therapy.

Does this mean we should give up? No. It means that mental help apps and services must be tightly regulated and reviewed. In-person is always better but may be embarrassing to some but can an online therapist treat patients?