Yes, There’s an App for That, and No, It Doesn’t Work. But That’s Changing.


appIn any 12-month period, 21% of youth will have a diagnosable mental health disorder. In the US alone, that adds up to millions of young people every year. Even if we could identify them all, not all of them could be treated—at least not in the traditional way. But isn’t the traditional way all there is?

Well, no, says Dr. David Mohr, Director of the Center for Behavioral Intervention Technologies (CBIT) at Northwestern University. Mobile phones, tablets, sensors and computers have tremendous capacity to deliver mental health treatment and support in far easier and cheaper ways—ways that can reach many more youth who need help. We just need to figure out the best ways to do it.

Mohr cautions that we’re not quite there yet.

To make his point, Mohr, who appeared last month at a National Institute of Medicine-sponsored panel in Washington, D.C. on prevention science in children’s mental health, pointed to the 40,000 health-related apps currently available for smartphones. About 2,000 of them are for specific conditions. Most of them are free. So much for the good news. The bad news is that most have never been studied for effectiveness; most that are downloaded aren’t used; those that are used aren’t used consistently; and there’s no way of knowing what small percentage of them ever reach the people who could actually benefit from them.

“Stand-alone web-based treatments probably work for some people, but generally do not have a big impact. If you put a human behind it in the form of a coach, you get much larger effect sizes — effect sizes that start to look like the kind of effect sizes you see in treatment.”

Even if they have been studied and are targeted to exactly the right people, they still probably won’t work very well. Mohr cites MoodGYM, a popular app from Australia that is supposed to prevent depression. Yet evaluations showed that people who used the app did just as well by visiting informational websites about depression.

Not surprisingly, simply referring young people to a canned resource, even one with interactive features, isn’t enough to change complex behaviors. For that, youth need actual people, even if those people are behind-the-scenes coaches who the youth never or rarely actually see.

“Stand-alone web-based treatments probably work for some people,” Mohr said, “but generally do not have a big impact. If you put a human behind it in the form of a coach, you get much larger effect sizes—effect sizes that start to look like the kind of effect sizes you see in treatment. And this coach support does not have to be 45 minutes with the therapist on the phone. A lot of this coaching [involves only] very brief phone calls or text support.”

Checking in with a client—even conducting substantial therapy—online, via email or text, isn’t as flimsy an idea as it sounds, Mohr says, since research indicates that “leaner” communication stripped of traditional visual cues forces both parties to make positive assumptions about the other. The client simply has to believe the practitioner wants to help and is an expert in helping. Both sides are accountable to the other, but in e-relationships, the accountability is embedded in the technology itself.

Other uses of mobile technology  include:

  • Directly texting young people to remind them to take a medication, or even having a ‘smart’ medication dispenser that texts the practitioner when the client has missed a dose.
  • With  permission, using ‘mobile sensing’ to harvest data from clients’ phones, such as where they are and what they’re looking at on the internet—information that could be critical for clients at risk.

Better apps are coming, too—ones that actually work when used consistently and in tandem with a practitioner. In the meantime, Mohr advises mental health experts to build the principles behind the treatment, not the apps themselves. That should be done in partnership with the tech folks, who can be charged with rapidly developing prototypes (many of which can include components that have already been developed), and then helping to test them. Practitioners also need to be thinking about how BITS can be embedded in existing mental health delivery systems, because how practitioners adapt to them is as important as how clients do.

~ Melanie Wilson, Youth Catalytics Research Director



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