Mental Health on your phone

Do you remember the first app you installed on your smartphone? You probably don’t remember it, let alone the twentieth or thirtieth. Today we use apps for just about everything. To plan a trip, or to watch a movie. To go on a trip by motorbike, to monitor your period or to control stress. You can download an app for almost anything. In recent years, there have been a proliferation of mental health apps, available to anyone and often completely free. These mental health apps offer a large number of resources that make preventive or therapeutic activities, in many cases, more accessible, and cost-effective. In addition, mental health apps can allow for greater privacy and confidentiality. These can provide a safe space for people who may be embarrassed to use the usual face-to-face channels for fear of being labelled, stigmatized, or otherwise reluctant.

Mental health apps offer a large number of resources that make preventive or therapeutic activities more accessible, and cost-effective.

You can do a quick test by accessing the app store on your phone and doing a quick search. If you search for “Mental Health Therapy”, a huge number of results will pop up that will allow you in a matter of minutes, to find and download apps of all kinds. Apps that incorporate proven techniques such as cognitive-behavioural therapy and acceptance and commitment therapy, and that address from depression to recovery from eating disorders, anxiety, post-traumatic stress disorder, obsessive compulsive disorder and much more. However, it is also worth noting the fact that a large number of these apps are not endorsed by scientific publications that support their effectiveness and that these can be counterproductive even sometimes harmful to the people who use them.

How do I know which apps I should use?

Before you start remember: If you have any questions about the suitability of a mental health app, proceed with caution. To be sure, the option is always to consult a health professional.

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

An interesting option, also for professionals, is to rely on official seals and accreditations, which are used to verify apps and which subject them to evaluation. In Catalonia there is the App accreditation offered by the TIC Salut Social Foundation, which evaluates the confidence in an app using a series of criteria. 

If you compare the thousands of results displayed today in App stores with the dozens of apps that are accredited annually, you will see that there is a substantial difference. So sometimes it will be necessary for oneself to evaluate the mental health applications that exist on the market and to decide for oneself whether they offer sufficient guarantees to be used.

Before you start remember: If you have any questions about the suitability of a mental health app, proceed with caution. To be sure, the option is always to consult a health professional.

The FTSS accreditation model has a solid foundation of more than 120 criteria divided into four themed blocks, which help in deciding what to look for when choosing a health app. These four blocks are: Usability and accessibility, technology, security and finally, functionality and content.

Each of these blocks contains several criteria that enable you to evaluate the health app and decide if it is appropriate. Below you will find the key aspects that need to be considered in each of the blocks and some of the most relevant criteria as an example, so that anyone who wants to, can make an informed initial decision regarding health apps.

Technological block: This block focuses on whether the app works efficiently and reliably. The app must conform to acceptable minimums of functionality to ensure robustness and consistency.

· It is found on official app stores and it installs and uninstalls properly.

· It is stable, does not stop deliberately, does not freeze and supports context changes. For example, it allows you to answer a call and then continue with what you were doing without losing any information.

Usability and accessibility block: It is important that the app can be used intuitively, a design appropriate to its function and that it allows universal and inclusive access to people with functional diversity.

· The main elements (text, images, buttons, etc.) are identifiable and easy to use. In addition, the font ensures the text is intelligible and easy to read.

Security Block: With regard to this block, it is important that the app has mechanisms that preserve the privacy of the data generated and the confidentiality of its transmission.

· It clearly informs about the data protection policy. The data collected is essential for the functioning of the App. The person is informed of the data that is collected, for what purpose and who will have access to it.

· It informs and requests the necessary permissions to access the different services on the device and these are coherent or justified. (Permissions to access GPS, microphone, etc.)

Functional and content block: Last but not least, it is important to pay attention to the quality of the content and the usefulness of the functions that the app offers. Checking if the app

reports its benefits, if a professional has been involved in the design of the App, or if it notifies about updates are key to ensuring trust in a health app.

· The utilities and/or benefits for the user included in the App are well specified and accessible.

· The owner of the App and the sources of funding, promotion or sponsorship are clearly stated.

· The sources of information based on scientific evidence, used to prepare 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 Apps? As 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 assess the effectiveness and risks of mobile applications and web solutions consisting of an evaluation of items organized in five areas of interest.

What makes this model more interesting is that they have released a short version. This version details the basic questions that should be asked before using or prescribing an app and can be used as a good starting point. Below are the questions included in the short version of the APA model:

· On which platforms or operating systems does the app work? Does it also work on a desktop computer?

· Has the app been updated in the last 180 days?

· Is there a transparent privacy policy that is clear and accessible before use?

· Does the application collect and/or send confidential data? If so, does it claim to do it securely?

· Do academic institutions, end-user feedback, or research studies show that the app provides certain specific benefits?

· Does the app have a relevant function for the pathology or protection factor/risk it addresses?

· Does the app seem easy to use?

· Can data be shared and interpreted easily? Is this data appropriate for the purpose of the app?

4 local examples:

Both public entities and some companies, even some individuals, have developed and published these sorts of solutions aimed at the field of mental health. Below are some local examples.

1. Gestioemocional.cat

Developer: Ministry of Health Government of Catalonia.

Subject: Emotional health Platforms: WebApp

Access: Open and free.

Description:

This app has been developed to respond to the emotional needs of the population during the covid-19 lockdown period.

It enables an assessment of the person’s mental health, offers tools to manage symptoms of discomfort, to access mental health professionals and even receive instructions and advice on what to do in each situation. The app provides access to these resources through a series of questions that, if necessary, would end up opening a channel of contact with a mental health professional.

2. TCApp

Developer: HealthApp.SL

Subject: Eating disorders. Platforms: IOS, Android

Access: Through prescription from a professional

Description:

TCApp is an App used in the therapy for Anorexia, Bulimia and other Eating Disorders. Its function is as a support in the therapy for recovering from these disorders from a gamification perspective.

The application allows the person who uses it: – To record emotions and their degree of intensity. – Explain what they ate, when and take a picture. – Keep a personal diary, where they can comment to the therapist whatever they thinks is appropriate. – Receive communications from the therapist via the mobile app. – Win prizes for the records and advance in therapy.

The app allows the therapist to: – Monitor the therapy of the patients they treat. – Identify negative emotions and risk situations using a colour code. – Communicate directly with patients through the App. – Create custom reports for specific time periods. – Use reports to draw conclusions.

The app has been developed with the collaboration of a panel of experts in the field of mental health. In addition, this app can only be used under the prescription and control of a professional therapist.

3. Intimind

Developer: Creaconcepto

Subject: Meditation

Description:

Meditation or mindfulness app featuring a method developed by psychologists who are experts in this field. It proposes an adapted programme that requires 10 minutes daily.

It offers an introductory programme with 7 free sessions. It also has specific subscription payment programmes for: stress, improved work performance, personal relationships and emotional balance.

4. notOK

Developer: Bee & Bug

Subject: Depression / Anxiety Platforms: IOS, Android

Access: Free and open, allows donations.

Description:

This app is the only one in this list that is not local. But we believe that the exception is worthwhile both for its characteristics and for the story behind its creation.

The app had been developed by a teenager with a mental health disorder and his sister. The developers say it is very useful for people who often have suicidal thoughts or behaviours. It has a red button that when pressed, sends five of your closest friends or family a message with your current GPS location and a message that says “Hello, I’m not okay! Call me, write to me, or come and pick me up”. The two creators are Hannah and Charlie Lucas.