May 2, 2022 - Technology

Mental health app boom raises alarms

Illustration of an app-like brain with an alarm icon on it

Illustration: Sarah Grillo/Axios

The same pandemic-driven boom in mental health and wellness apps that helped ease two years of COVID-driven discontents is now raising alarms over privacy, efficacy and a blurring of the line between formal medical treatment and general self-care.

Why it matters: Online services for mental health have given more people easy access to help than ever before, and the sector is booming with investment.

Yes, but: Not every mental health problem can be solved with an app, and consumers are confused by the range of options available — faced with advertising for apps that can sometimes conflate serious mental health issues with vaguer well-being concerns.

  • "We need to become more sophisticated and differentiate between the apps and what they're trying to do," René Quashie, vice president of policy and regulatory affairs for digital health at the Consumer Technology Association, told Axios.
  • "There's a difference between somebody who's got serious depressive symptoms, and somebody who is going through a stressful period in their life," and apps should be clear about their aims and abilities, Quashie said.

What they're saying: Experts who spoke to Axios said mental health apps fall into two camps: those that connect patients to clinicians and those that don't, instead offering chatbots, mood trackers and guided breathing exercises.

  • "I think we all want for there to be great ways to see our doctors remotely... but when you move to online, you have to think about the modality of treatment, and whether it's going to be effective," Christina Farr, a health-tech investor at Omers Ventures, told Axios.
  • For example, Farr said, cognitive behavior therapy is especially popular for online health services, but it isn't going to work for every patient.

Privacy and efficacy questions: Privacy policies for mental health apps are all over the place.

  • Problems are more common with apps that don't include clinical intervention, and thus aren't subject to health privacy rules, and the lack of a comprehensive federal privacy law makes that worse, Quashie said.
  • A 2018 study published in the journal Internet Interventions found that fewer than half of 116 apps for depression surveyed had any privacy policy. In 2021 Consumer Reports found that some popular mental health apps were sharing data with Meta and other companies, and tracking for targeted advertising.
  • Research from January looking at mobile apps for mental health failed to find "convincing evidence" that any app intervention significantly helped with people’s anxiety, depression, smoking or drinking, thoughts of suicide, or feelings of well-being.

There's also controversy around apps that diagnose and prescribe stimulants for treating attention deficit disorders. Those apps grew in popularity thanks to a pandemic-era waiver that allows companies to prescribe controlled substances online, but now some are facing accusations that they are "Adderall mills."

The other side: Connecting to a therapist via app can be a lifeline for people, especially during COVID-19 lockdowns.

  • Studies suggest that in some cases, online therapy with a licensed provider can work just as well as in-person. "We can actually say, whether you do it over Zoom or in real life, that those outcomes are pretty similar," Stephanie Collier, an instructor in psychiatry at Harvard Medical School, told Axios.
  • Tiffanie Mouzoon, a 41-year-old woman in from Orange County, Calif., told Axios she started using TalkSpace to text with a therapist when she was in recovery from an injury and unable to go anywhere in person.
  • She said using the app took away the stigma of seeking mental health help. "I hit it off with my therapist," she said. "It's just really been there for me during a lot of my recovery. When you go to therapy, everyone's kind of looking at the clock... Through the day, if I needed to talk to her, I could just text her."

By the numbers: $4.4 billion flowed into mental health apps globally in 2021. $1.4 has been poured into the industry thus far in 2022, according to data provided to Axios by Pitchbook. 406 mental health startup deals were made in 2021, with 126 so far in 2022.

  • Top companies include Cerebral, Lyra, Spring Health, Calm and Sondermind. Each of these services, except meditation app Calm, connects users with clinicians.

The bottom line: In an ideal world where everyone has resources and time for traditional therapy, mental health apps may be best viewed as a supplement, not a panacea. Collier from Harvard said apps without human intervention are best used as a "complimentary way to reinforce skills."

  • "Probably nothing beats that one-on-one connection, face to face," said Mouzoon, who used TalkSpace. "In addition to my therapy, I would have the app — that's how I would design my life if I could."
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