It has endless mental health applications.  How do you choose the best ones?  - MedCity News

Mental health apps have skyrocketed in popularity in recent years, offering users support in a way that is convenient and accessible. But there is an in between 10,000 and 20,000 apps for mental health and wellness available to users and not all of them are supported by evidence. So how can people sift through the many options to find the right ones for their mental health?

About Dr. Shiri Sadeh-Sharwit, Chief Clinical Officer of Eleos Hello and practicing mental health clinician, there are a few things she checks off her list when considering which solutions to recommend to patients. The first is the startup’s mission.

“Is this company trying to solve a real problem and improve the lives of people in need or the professionals who support them?” she said. “Or is it a solution in search of a problem? I prefer companies that support the mission of affordable, accessible, evidence-based care that can be scaled.”

Sadeh-Sharvit prefers companies that have teams of experienced professionals with clinical experience. To her, this signals that the solutions are likely to be more ethical and appropriate for the field. She then examines whether the services offered through the startup are supported by evidence, such as cognitive behavioral therapy. That’s what she looks like for peer-reviewed papers to ensure solutions really work and are validated. In this regard, she would like to see a real-world randomized controlled trial that compares the company’s products with an active control group.

Privacy and security are also a top priority given the sensitive nature of mental health care. Equally important is the user experience, as a positive experience can influence how well a treatment works.

Last but not least on her checklist is a sustainable business model.

“In order to continue to offer services to clients, I want to make sure that they will be able to remain financially viable,” she said.

One of the companies that Sadeh-Sharvit believes is more research-based and ethical is Poor, an AI powered chatbot. And 2017 randomized controlled trialsl of young adults using Woebot found that the chatbot significantly reduced symptoms of depression compared to a control group. Sadeh-Sharvit said she has colleagues and friends working at Woebot, and she briefly worked as an unpaid consultant for the company in 2017. She also pointed to SilverCloud and Veterans Affairs’ self-help apps as good examples of mental health solutions.

Sadeh-Sharvit’s comments were echoed by Dr. Don Mordecai, Kaiser Permanente’s national mental health and wellness leader. The integrated health system wants to ensure members have access to an app that offers mindfulness as well as support from real people. That’s why the organization works with the mental health app Calm and a mental coaching company ginger.

When evaluating companies to contract with, Kaiser Permanente prefers that they have a certain level of maturity and familiarity with HIPAA and privacy regulations, Mordecai said.

“We’re not very interested in the brand new app with the greatest idea,” he said.

Like Sadeh-Sharvit, Mordecai also values ​​the significant amount of data available about the solution’s effectiveness. In other words, a digital product that has some clear clinical data behind it.

“There are a lot of companies that I contact all the time that have a good idea, may have a good interface, and are looking for someone to partner with to do these kinds of studies,” Mordecai said. “That’s usually not us. Because we’re really looking to implement these things at scale, not spend a lot of time proving the studies for these companies.”

However, with apps like Calm, there’s a lower bar when it comes to data because they teach mindfulness instead of using clinical principles to improve users’ mental health, Mordecai said. However, Calm has still done research on its app, including one that tested its effect in the workplace through a randomized controlled trial. The study found to improve mental health, sleep and productivity.

Ginger — which united with mindfulness company Headspace in 2021 to create Headspace Health — also conducted extensive research into its services. And 2021 study found that 47% of ginger users saw a reduction in anxiety symptoms. In addition, 2019 study of Headspace found it reduced anxiety by 19% and depression symptoms by 29%. The combined entity recently released a call third-party researchers to conduct more research on how his company impacts mental health and wellness outcomes.

When doing this research, it’s important that the treatment group is large and diverse, said Katie DiPerna Cook, senior vice president of partnerships at Headspace Health.

“We need to make sure that we’re not just studying those who are more likely to access care, but that we’re really expanding to a broader population,” she said.

She added that companies need to continually test their products.

“I think as a digital mental health provider, we have such a responsibility to study outcomes and make sure we’re getting people better faster … It’s not just one and you’re better,” Cook said. “We have to study and follow people over time.”

But many companies don’t conduct this kind of rigorous research on their products. Instead, many are turning to “Mickey Mouse trials,” said Deepak Gopalakrishna, chief executive of OxfordVR. The virtual reality company has been treating severe mental illness recently united with BehaVR.

“When you go to most digital technology websites, you see ‘trials’ that are like 15 to 20 patients, certainly not large enough to qualify for something statistically significant, a proper analysis,” he said. “This data is not done, the population size is not large enough, the population is not the right population. The endpoints selected don’t really support the claims people are making in the market.”

Other indicators that a study is not reliable are those that confuse correlation with causation, as well as those that rely on incentives to participate, according to Jennifer Gentile, senior vice president of clinical innovation at Yes. She is also an attending psychologist at Boston Children’s Hospital.

[A] it is a concern when participation and completion of training is highly incentivized,” she wrote in an email. “I worry about whether patients will use the tools without incentives.”

Common incentives for research participants include cash payments and gift cards.

Whatever the process for choosing a behavioral health company, the job doesn’t end with the selection.

“It has to be a dynamic, ongoing process,” Mordecai said. “Part of that is us saying, ‘This app is really up to speed.’ They’re refreshing it, it’s super popular. But that other app doesn’t seem to be grabbing people anymore. When we look at the interface and materials, they don’t seem to invest in it. That’s one of the criteria where we can say, ‘Well, it’s time to move away from this one.'”

Photo: Bogdan Skripnik, Getty Images

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