Mental Health Technologies

Image by Joseph Mucira from Pixabay

Image courtesy of Imani Bahati of Unsplash.

Digital MH technologies will be key to overcoming barriers that limit access to mental health care

Adolescent mental health is a major medical crisis, and resources are few to support the rising rates of mental illness in this age range. And the statistics are staggering. At some point in their lives, 50% of all adolescents will have experienced mental disorders because of peer pressure, social media, too much work, and other stressful events happening within family circles and with other relationships (Burns et al., 2023). The National Alliance on Mental Illness (2024) found that one in five high school students have contemplated suicide, with one in ten going through with the act. And the rates are much higher with at-risk populations, such as with LGBTQ+ youth. In fact, three out of five adolescents who committed suicide had no prior history of mental health issues (Fitch, 2024). Finally, the Centers for Disease Control and Prevention’s Youth Risk Behavior Survey (2024) found that 20% of adolescents will have experienced a depressive episode within the last 12 months and that 40% of youth reported feeling so hopeless that they discontinued daily activities. According to Jason Kahn of Boston Children’s Hospital, the overwhelming demand for and insufficient supply of mental health specialists, exacerbated by the COVID-19 pandemic, have left many looking for alternatives (Fitch, 2024).

Digital mental health (MH) technologies such as mobile health (mHealth) and digital therapeutics (DTx) can bridge the gap and provide initial support until specialty care is available, reducing the risk for the further development of mental health issues. The benefits of digital MH technologies are many. mHealth and DTx overcome barriers that traditional therapies introduce, such as lack of engagement with treatment protocols and their physical side effects (Fitch, 2024). DTx expands equitable access of resources (Fitch 2024). Researchers have found that clinically tested DTx show comparable levels of effectiveness when compared to traditional therapies like cognitive behavioral therapy (CBT), Rational Emotive Behavior Education (REBE) interventions, or dialectical behavior therapy (DBT) (Choi et al., 2022).

Adolescents have been found to respond more favorably to mobile applications they can access on smartphones than with in-person treatment programs. According to Burns et al. (2023), digital mental health therapies increase engagement, are easier to use, and improves reach. Digital MH technologies come in many sizes and flavors, including video games, telemedicine and adjunctive mHealth strategies, self-directed and interactive exercises, and social media and messaging platforms.

Early treatment is crucial; DTx and mHealth offer tools that can address the barriers to mental health care access, potentially saving lives by facilitating timely interventions.

  • Digital Therapeutics Based on Virtual Reality and Gaming

    Game elements are incorporated into interventions that target specific behaviors and promote positive outcomes through CBT, DBT, or biofeedback. Players choose an avatar and navigate levels that test their attention, frustration and anxiety. As they play, clinicians remotely monitor physical readings from devices the players wear, such as EEG headbands (ATENTIVmynd, MindLight), heart monitors (Mightier), or eye movement trackers (RECOGNeyes) (Bevan Jones et al., 2023; Burns et al., 2023; Choi et al., 2022; Fitch, 2024). Virtual reality and gaming typically appeal to early adolescents.

  • Social Media and Messaging Platforms

    These mHealth apps mimic social media to foster a sense of connection by allowing users to create new content and share stories. Bevan Jones et al. (2023) views this form of digital MH technology as moderated group therapy since a specialist provides guidance. Moderated Online Social Therapy (MOST) and Supporting Our Valued Adolescents (SOVA) are two examples of mHealth social media apps. However, Burns et al. (2023) have noted that adolescents are less enthusiastic towards these types of apps, likening them to regular social media like X and Facebook.

  • Telemedicine and Adjunctive mHealth

    Adjunctive mHealth technologies work side-by-side with traditional behavioral therapies. These mobile apps empower adolescents and young adults to practice CBT skills for anxiety orders between counseling sessions. Adjunctive mHealth apps use interactive exercises that grants digital rewards for success. Direct connections can also be made to behavioral health specialists for brief, one-on-one interventions (Bevan Jones et al., 2023; Lu et al., 2021). Calm Harm, a therapeutic app that helps with urges to self-harm and SmartCAT, a mobile health platform that supplements CBT for anxiety disorders, are two examples of adjunctive apps. In SmartCAT, a clinician assigns challenges to the patient via a secured portal (Lu et al., 2021).

  • Self-Directed mHealth Interactive Apps

    Self-directed mHealth apps are self-contained tools that offer flexible and personalized activities to engage with mental health support. Tools include opportunities for guided self-reflection, journaling, and goal-setting. According to Bevans Jones et al. (2023), adolescents prefer to engage with self-directed mHealth apps such as Headspace for Teens, Soluna and Mindshift. California subsidizes Soluna, an app that targets adolescents and young adults ages 13 to 25. Soluna is part of the state’s CalHOPE initiative, which aims to provide accessible mental health resources to all Californians (Office of the California Surgeon General, 2023).  

  • School-Based Technologies and Interventions

    Some mHealth apps have been designed to integrate with school settings. In Australia, educators have implemented an internet-based program called Climate Schools Combined to address depression, anxiety and self-harm (Bevan Jones et al., 2023). The U.K. rolled out TootRoot to students to help address bullying and online abuse (McKeown, n.d.). California high schools and colleges began rolling out Soluna in 2023 to students to provide resources and guidance on how to handle day-to-day stressors. Professional telephone coaching is offered in 19 different languages (City of Lakewood, California, 2024).

Benefits of mHealth Digital Technologies

Broadens access and reduces cost

mHealth and DTx applications offer a cost-effective way to provide mental health support. Applications can be operated using computers, smartphones or tablets, are easy to use and offer coping strategies to address interim behavioral issues until a mental health specialist is available (Bevan Jones et al., 2023; Fitch, 2024). mHealth and DTx also facilitate equitable access to mental health services for underserved populations, such as the LGBTQIA+ communities.

Sustained therapeutic effects

DTx offers targeted interventions that address specific mental health problems. Studies show that therapeutic effects are comparable to traditional therapies like CBT, REBE and medications (Choi et al., 2022; Fitch, 2024).  DTx incorporates gaming elements to positively influence behaviors and reinforce adherence. Choi et al. (2022) has also found that DTx gaming changes cognitive functioning, with Mightier helping to control anger, REThink reducing irrational beliefs and enhancing emotional awareness, and MindLight offering ways to practice emotional responses. Lu et al. (2021) has also found that adjunctive mHealth offers an environment in which to practice skills learned from therapy sessions.

Offers connection and support

mHealth and DTx applications help clinicians address access and engagement issues, which are specific challenges for adolescents and young adults who typically get information from online sources.  mHealth and DTx can be personalized and offer a lot of fun and interactive tools, like goal setting, self-reflection and opportunities to chat with, engage via videoconference with or email mental health specialists (Bevan Jones et al., 2023; Burns et al., 2023; Lu et al., 2021).

Challenges

Confidentiality and privacy concerns persist

There are risks that come with the promise of new technologies, and one of the primary concerns centers around how personal (and very sensitive) data collected from smartphones will be used. GPS, photos, voice and usage tracking (known as cookies) give away a lot of information (Torous et al., 2019). The Kaiser Family Foundation also cites concerns around how HIPAA and non-HIPAA covered entities will use the information and how different telecommunications networks add to the risk (Wallce & Pestaina, 2023).

Localized programs make interoperability difficult

The many mHealth apps that are available means that standardizing how data is collected and reported in medical history as part of the electronic health record (EHR) will be difficult. To ensure that data collected by the app is available to licensed mental health providers to provide assistance when requested, developers of these apps should ensure some compatibility to EHR systems to promote interoperability and that data (by consent of the adolescent and their authorized representatives) can be transported securely between the platforms (Torous et al., 2019).

mHealth and DTx are big business, and more research is needed

Mobile mental health apps have increased since the COVID-19 pandemic, and although both mHealth and DTx have shown promise with its ability to treat mental health conditions through widespread accessibility, many believe that additional research is needed to understand the full effects of these interventions.

Finally, there are concerns about ownership of the data and how the information collected can be disclosed based on whether a company is HIPAA or non-HIPAA bound (Wallace & Pestaina, 2023).

mHealth and DTx integrate into broader systems that aids in diagnosis and treatment

  • An EHR is an electronic version of the patient’s medical chart and includes relevant information that can help providers make intervention and treatment decisions. Some mHealth apps are able to integrate into the EHR, while others require some tweaking. This represents a challenge for interoperability, but it also represents a challenge to privacy and security policies.

  • AI, or machine learning, is being incorporated into mHealth apps to create a more personalized experience for adolescents. Machine learning is used in chatbots and chartbots. With increasing reliance on these technologies as front-line advocates, it will be important for developers to monitor and make adjustments if performance (or the experience) begins to suffer.

References

Bevan Jones, R., Hussain, F., Agha, S. S., Weavers, B., Lucassen, M., Merry, S., Stallard, P., Simpson, S. A., & Rice, F. (2023). Digital technologies to support adolescents with depression and anxiety: review. BJPsych Advances, 29(4), 239–253. https://doi.org/10.1192/bja.2022.3

Burns, Q., Voida, S., Weibel, N., Laerhoven, K. V., Tentori, M., & Zhou, Z. (2023). Investigating Mobile Mental Health App Designs to Foster Engagement Among Adolescents. Adjunct Proceedings of the 2023 ACM International Joint Conference on Pervasive and Ubiquitous Computing & the 2023 ACM International Symposium on Wearable Computing, 118–122. https://doi.org/10.1145/3594739.3610703

Centers for Disease Control and Prevention (2024). Youth Risk Behavior Survey Data Summary & Trends Report: 2013-2023. CDC. https://www.cdc.gov/yrbs/dstr/pdf/YRBS-2023-Data-Summary-Trend-Report.pdf.

Choi, E., Yoon, E.-H., & Park, M.-H. (2022). Game-based digital therapeutics for children and adolescents: Their therapeutic effects on mental health problems, the sustainability of the therapeutic effects and the transfer of cognitive functions. Frontiers in Psychiatry, 13, 986687–986687. https://doi.org/10.3389/fpsyt.2022.986687

City of Lakewood, California (2024, August 19). Soluna app provides mental health support for teens. https://www.lakewoodca.gov/News/City-projects-and-announcements/Soluna-app-provides-mental-health-support-for-teens.

Fitch, J. (2024). Background on digital therapeutics and what they can do for mental health. Contemporary Pediatrics (Montvale, N.J.), 40(8), 20–22.

Fitch, J. (2024). Youth suicide decedents and documented preceding mental health diagnoses. Contemporary Pediatrics (Montvale, N.J.), 40(8), 23–24.

Lu, C., Chu, W., Madden, S., Parmanto, B., & Silk, J. S. (2021). Adolescent Perspectives on How an Adjunctive Mobile App for Social Anxiety Treatment Impacts Treatment Engagement in Telehealth Group Therapy. Social Sciences (Basel), 10(10), 397-. https://doi.org/10.3390/socsci10100397

McKeown, Sal (n.d.). Apps for mental health. The Good Schools Guide. https://www.goodschoolsguide.co.uk/special-educational-needs/help-and-advice/apps-for-mental-health.

National Alliance on Mental Health (2024, September). NAMI 2023 State Legislation Issue Brief Series: Trends in State Policy: Youth Mental Health. https://www.nami.org/wp-content/uploads/2024/09/NAMI-2023StateLegBrief-YouthMentalHealth.pdf.

Torous, J., Andersson, G., Bertagnoli, A., Christensen, H., Cuijpers, P., Firth, J., Haim, A., Hsin, H., Hollis, C., Lewis, S., Mohr, D. C., Pratap, A., Roux, S., Sherrill, J., & Arean, P. A. (2019). Towards a consensus around standards for smartphone apps and digital mental health. World Psychiatry, 18(1), 97–98. https://doi.org/10.1002/wps.20592

Wallace, R., & Pestaina, K. (2023, June). Rise in use of mental health apps raises new policy issues. KFF. https://www.kff.org/mental-health/issue-brief/rise-in-use-of-mental-health-apps-raises-new-policy-issues/.