Apps vs Humans: my concerns about mobile mental health applications

By: Hery DeHaan

Perhaps one of the many blessings of the digital age is the invention of apps to diagnose and treat mental health disorders.?In a situation where there is an acute shortage of mental health professionals and the high cost of engaging one in the private sector mental health apps are a God send. With a smart phone in everyone’s pockets and a plethora of both free and paid apps, mental health intervention is accessible anytime and anywhere. It is therapy on tap.

?With a mental health app one does not need to schedule an appointment or fill in a form or be on a waiting list. If you download an app it is there when you need it even when it is four o’clock in the morning.

?For those who are socially anxious logging in and ticking boxes to get their dose of treatment may be an effective way to get help for their mental health challenge. This method is fast, may cost very little if at all and the solution to the problem is immediate - provided the app user does what is required of him.

?For any mental health challenge to be resolved the onus is on the person who suffers from it who has to do what is prescribed.?A mental health challenge is not like a broken bone where a cast is placed on the injury and in six weeks the cast is removed and the?healing continues. Or an appendicitis where the surgeon removes the affected area while the patient is under sedation. It is the client who has to do what was agreed and an app is no exception. The difference is if the client does not do what his therapist and him had agreed there would be an exploration as to why this is so. If the client does not do what the app suggests there is no consequence.

?For the socially anxious person I wonder if logging in an app and engaging in a program would reinforce his anxiety about meeting another human being and worsen his lack of social skills. Wouldn’t it be better if his anxiety is challenged in stages?with support and encouragement from a health professional for it to be resolved?

?One of the researches done on a number of mental health apps reveals some efficacy at diagnosing mental health condition or improving symptoms.?However as a psychiatric nurse whose practice is based on evidence and licensing I find it disturbing that none of the apps referenced accreditation or certification. The researchers stated that despite the numerous positive feedback from consumers on the apps’ success,?these successes are simply not evidence based and some content are deemed to be harmful.

?If a therapist gives you the wrong information and have done you harm you have recourse to put matters right.?Mental health professionals are accountable and are bound by professional ethics and guidelines. I have yet to hear of an individual suing an app.

?While I appreciate that some apps are written by health professionals I am also aware that there are some techies out there who are jumping on the band wagon of producing mental health apps quickly to capture a slice of the market. I can see why some content can be inaccurate or harmful as it not written by the appropriate person.

?Most of us live in a fast paced world and we are used to having information at our finger tips. So if anything is amiss we want answers to our problems quickly and precisely. The app does exactly that. The app is also designed so that it can ‘mass treat’ everyone. It is a one size fit all treatment.?

?A therapist has to build rapport, gain trust and collaborate with her client to achieve a goal.?An app does not need to build rapport nor does it have to say or do anything to gain your trust. In a human to human relationship there are a thousand?nuances. There is transference and counter transference. There are blind spots and prejudices. There is humour. The therapist and the client each brings in his or her own personality and experiences into the relationship. Theirs is a dance. An app is organised data until it has a user who logs in and supplies a password.

?Some apps work on a subscription basis while others will give you freebies and will later ask you to purchase something.?If you are anything like me who is always on the look out for free things you will be hard pressed to purchase the full package and will never get the benefit of a proper treatment.?You get what you pay ( or do not pay ) for.

?A therapist may cause you the earth and I have heard that people have gone to their therapists for years and have become dependent on them. This is not ideal but always remember that the client always has the option to disengage. For my money a good therapist - whatever the discipline would teach you the tools to overcome your mental health challenge and then let you go in the nicest possible way. That is how I work and I suspect there are many others like me.

?Some mental health conditions are sub clinical and do not require a mental health intervention. All the client requires is a listening ear with healthy doses of empathy , not problem solving.?I doubt very much if an app at the moment can do that.

?The pandemic has changed how we work. With work from home becoming the norm we are all the more isolated from our colleagues and friends. The restrictions imposed by some governments on gatherings and social distancing make the need for us to connect all the more crucial.?The recovery model of mental health asserts that one of the crucial components of good mental health is the ability to connect with other people.?When you log in, you are looking down, your body is haunch over your phone.?Your fingers are ready to type or swipe and you are lost to the world around you. It is you, your phone and the technology that you engage in. I am struggling to see how this behaviour can promote mental health.

?Another thing that I’m struggling with is the elderly population. Singapore is catching up with Japan rapidly and not all our senior citizens are up to date with the latest technology. Although the government is providing opportunities for senior citizens to understand the basics we still have a long way to go. I cannot see an elderly lonely widower who is depressed using an app when what is required is human companionship and a conversation.

?I have discussed the pros and cons of mental health applications versus the pros and cons of mental health professionals in the treatment of mental health disorders. It is not because of the fact that I am human and a mental health professional but my leanings will be more in favour of the health professional for the above reasons.?Until someone can design an app that can recognise a sad or happy face or sense despair or joy in a person without that person uttering a single word, I would sooner pay premium prices and be on a waiting to list to see a mental health nurse.

??By Hery deHaan ( 2022)