Mental health on your phone

Have you ever wondered what the first app you installed on your smartphone was?

You probably don't remember it, let alone the twentieth or thirtieth. These days, we use apps for almost everything. To plan a trip or watch a movie. To navigate by motorcycle, track your period, or manage stress. We can download an app for almost anything.

In recent years , mental health apps have proliferated, available to anyone and in many cases completely free. The wealth of resources offered by these apps makes preventative and therapeutic interventions much more accessible and cost-effective.

Furthermore, mental health apps can offer greater privacy and confidentiality. They can provide a safe channel for people who are embarrassed to use traditional in-person methods for fear of being labeled, stigmatized, or due to other reluctance.

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To test this, we can access our device's app store and perform a quick search. Searching for "mental health therapy" will yield a wealth of results, allowing us to find and download all sorts of apps in a matter of minutes. These apps incorporate proven techniques such as cognitive behavioral therapy and acceptance and commitment therapy, addressing everything from depression to recovery from eating disorders, anxiety, post-traumatic stress disorder, obsessive-compulsive disorder, and much more.

However, it is important to emphasize that many of these applications lack scientific publications to support their effectiveness and can be counterproductive, even harmful, to the people who use them.

How do I know which apps are right for me?

Before you begin, remember: If you have any doubts about whether a mental health app is right for you, always be cautious. Consulting a mental health professional is the best way to be sure.

Some health experts agree that apps will play an important role in the future of mental health care, as they will provide innovative solutions for the prevention and self-management of disorders.

An interesting option, also for professionals, is to rely on official seals and accreditations, granted by entities that verify and evaluate applications. In Catalonia, we have the app accreditation service of the Fundació Tic Salut i Social (FTSS), which assesses an application's trustworthiness through a series of criteria.

If we compare the thousands of results displayed in app stores today with the dozens of apps that are accredited annually, we'll see a substantial difference. Therefore, solutions must be found to empower both the public and healthcare professionals. Thus, sometimes it will be necessary to personally evaluate the mental health apps available on the market to decide whether they offer sufficient guarantees for use.

The FTSS accreditation model has a solid foundation of over 120 criteria, distributed across four thematic areas that help us understand what to look for when choosing a health app. These four areas are: usability and accessibility, technology, security, and finally, functionality and content.

Each section comprises several criteria that allow you to evaluate a health app and determine its suitability. Below are the key aspects to consider in each section, along with some of the most prominent criteria, as examples, for anyone wishing to make an informed initial decision regarding health apps.

Technology block

This block It focuses on the efficient and reliable operation of the application, which must meet acceptable minimum functionality standards to ensure robustness and consistency.

• It can be found in official app stores and is installed and uninstalled properly.
• It's stable, doesn't stop unexpectedly, doesn't freeze, and handles context changes. For example, it will allow you to answer a call and then continue what you were doing without losing any information.

Usability and accessibility block

It is important that the application offers intuitive use, a design appropriate for its function, and allows universal and inclusive access for people with functional diversity.

• The main elements (text, images, buttons, etc.) are easily identifiable and simple to use. Furthermore, the text font is clear and easy to read.

Security lock

This section focuses on the mechanisms that allow for the preservation of the privacy of the data generated and the confidentiality of its transmission.

• Clearly explain your data protection policy. The data collected is essential for the app to function. Inform users about the data being collected, the purpose of the collection, and who will have access to it.
• It informs and requests the necessary permissions to access the device's various services, and these are consistent and justified. (Permissions to access GPS, microphone, etc.)

Functional and content block

Last but not least, it's essential to consider the quality of the content and the usefulness of the app's features. Check if the app clearly explains its benefits, if a professional was involved in its design, and if updates are provided. These are key aspects for trusting a health app.

• The useful functionalities and user benefits incorporated by the app are well specified and their scope is clear.
• It clearly states who owns the app and the sources of funding, promotion or sponsorship.
• The sources of information, based on scientific evidence, used to develop the content and the date of update are indicated.
• The user is informed of the risks involved in using the app .
• Help and contact mechanisms are made available to the user.

Is there a specific system for mental health applications?

For professionals, the American Psychiatric Association (APA) has developed an app self-assessment system to help nurses, psychiatrists, clinical psychologists, and other mental health professionals evaluate the effectiveness and risks of mobile apps and web-based solutions. It consists of an examination of items organized into five areas of interest.

What's interesting about this model is that they've published a summary version. This version shows... The fundamental questions that need to be asked before using or prescribing an application, and which can be a good starting point. The questions in the short version of the APA model are as follows:

1. On which platforms or operating systems does the application work? Does it also work on a desktop computer?
2. Has the app been updated in the last 180 days?
3. Is there a transparent, clear, and accessible privacy policy before using it?
4. Does the app collect or send sensitive data? If so, does it claim to do so securely?
5. Do academic institutions, end-user feedback, or research studies provide evidence that the application offers any specific benefits?
6. Does the application have a relevant function for the pathology or protective or risk factor it addresses?
7. Does it seem easy to use?
8. Is it possible to easily share and interpret the data? Is this data suitable for the application's purpose?

Some examples

Both public entities and some private companies, and even some individuals, have developed and published solutions of this type, aimed at the field of mental health.

The following are some relevant examples.

Emotional management.cat

• Developer: Department of Health. Government of Catalonia.
• Topic: emotional health.
• Platforms: WebApp .
• Access: free and open to all.
• Description: This app was developed to address the emotional needs of the population during the COVID-19 lockdown. It facilitates mental health assessments, provides tools for managing symptoms of distress, connects users with healthcare professionals, and even offers guidance and advice on how to proceed in different situations. The app allows access to these resources through a series of questions that, if necessary, facilitate contact with a mental health professional.

TCApp

• Developer: HealthApp.SL
• Topic: Eating disorders.
• Platforms: iOS , Android .
• Access: by prescription of a professional.
• Description: The TCApp application is used in the therapy of anorexia, bulimia, and other eating disorders. It provides support in the recovery treatment of these disorders from a game-based perspective.

The application allows the user to:

• Record emotions and their degree of intensity.
• Explain what he/she ate, when, and take a photograph.
• Keep a personal journal where you can explain to the therapist what you consider appropriate.
• Receive communications from the therapist through the app on your mobile phone.
• Earn rewards for your records and progress in therapy.

The application allows the therapist to:

• To monitor the therapy of the patients he/she treats.
• Identify negative emotions and risky situations using a color code.
• Communicate directly with patients through the app .
• Create custom reports for specific time periods.
• Use the reports to draw conclusions.

The app is developed in collaboration with a panel of mental health experts. Furthermore, this app can only be used with a prescription and under the supervision of a professional therapist.

Intimind

• Developer: Creaconcepto.
• Topic: meditation.
• Platforms: iOS , Android
• Access: Free for 7 sessions; afterwards, a paid subscription is required.
• Description: A meditation or mindfulness app. It's based on a method developed by expert psychologists. It offers a personalized program requiring 10 minutes a day. A starter plan with 7 free sessions is available. It also offers paid subscription programs specifically designed for stress management, improving work performance, personal relationships, and emotional well-being.

notOK

• Developer: Bee & Bug
• Topic: Depression and Anxiety
• Platforms: iOS , Android
• Access: free and open, donations allowed.
• Description: Unlike the other apps presented, this one isn't a proximity app. However, it's worth knowing about, both for its features and the story behind its creation. It was conceived by a teenager with a mental health disorder and his sister. The developers claim it's very useful for people who frequently have suicidal thoughts or behaviors. It includes a red button that, when activated, sends a message to five nearby friends or family members with the user's real-time GPS location and the text, "Hi, I'm not okay! Call, text, or come get me." Its creators are Hannah and Charlie Lucas.

Simple

• Developer: IMIM Hospital del Mar
• Topic: bipolar disorder
• Platforms: iOS, Android
• Access: exclusive to those included in the study, can be requested.
• Description: This app offers the ability to track the mood of people with bipolar disorder. It sends personalized messages tailored to each individual on a daily basis. It also allows users to schedule medication times, record relapse symptoms and stressful events, and offers other features.

It is for the exclusive use of participants and collaborators of the Simple project, developed by the Bipolar Disorders Program of Barcelona (IDIBABPS, IMIM, CIBERSAM).

For now, it is only possible to access the application and its functions using a user ID and password provided by the project researchers.

Key information about apps

Interest in the use of technological applications and tools, both among the general public and healthcare professionals, is increasing daily. Therefore, it is important to be clear on a number of issues that will help us avoid unpleasant surprises.

One of the most important aspects is knowing who is responsible for the app , who is behind the solution (entities, professionals, companies), and what their sources of funding are. It's also crucial to verify that the information is up-to-date and that user data privacy is not compromised.

Finally, the key premise is that, if at any point we decide to use a tool (mobile app or web app ) to control or monitor our mental health, we should first consult our reference health professional, who will be better able to guide us than anyone else on its suitability from a clinical point of view.

This article was originally published on the Fundació TIC Salut Social website.