“[e-Mental health is] mental health services and information delivered or enhanced through the Internet and related technologies.” ~ Professor Helen Christensen
With the increasing prevalence of technology in our daily lives, it has also made its way in how we maintain our health and the options we have for support and treatment. Technology has not only changed health administration systems, health record systems, and communication, but it has also changed the way individuals are informed of their own health and the way they make decisions. This is, in part, thanks to mobile applications (‘apps’).
In 2014, there were over 100,000 ‘Health & Fitness’ apps available through the Google Play Store alone, ranging from diet to sleep to women’s health, and many more and this number has since increased. In recognizing that health is both physical and mental, these apps have also extended to other areas, such as mindfulness, stress coping skills, mental health education, etc. These mental health-related apps are one significant part of the current health system transformation that is known as e-Mental health.
Why mental health apps?
Increased access to, and use of, the Internet.
Consider yourself. Look around at your family, friends, peers, even strangers on the street. How many people do you see on their phones?
In a 2015 paper on e-Mental health in Canada published by the Mental Health Commission of Canada, they reported that there are 25.5 million Canadian Internet users. They also cited another paper which reported that “22 million Canadians use mobile phones, of which 62% were smartphone users in 2012.”
Given then, the huge number of Canadians who use the Internet and who use smartphones, mental health apps could reach, support, and educate numerous Canadians.
Greater access to resources for rural and remote communities.
Another barrier to accessing mental health services is physical distance. Rural and remote communities usually have fewer health care professionals, especially specialists. So not only do they have to overcome long waitlists, but some of them need to spend large amounts of money and travel great distances just to see a healthcare professional. While apps do not replace professional help and cannot be used in emergency or crisis situations, they can still connect these individuals to information and support resources..
Lessen the burden on healthcare professionals.
One of the worst health care system problems that Canadians face is waitlists. Waitlists are one of the reasons why many people cannot access mental health services when they need it. And the consequences can be detrimental. For some, undiagnosed mental illnesses can result in academic or workplace failures. For example, when someone needs to provide proof of mental illness for academic or workplace accommodations. For others, untreated mental illnesses can worsen and put someone’s life at risk.
The convenience of mental health apps allows temporary help to those who cannot seek professional services. These apps can be very useful for those individuals who are looking to develop coping skills or are seeking to track their moods so that they can maintain good mental health.
Apps can also reduce the burden on healthcare professionals because they can provide information and support for family members and caregivers of individuals living with mental illness. When caregivers are more educated and informed, they may feel more confident in providing support while they wait to see a healthcare professional.
Increased empowerment.
Since there are numerous mental health-related apps, an individual has to make the conscious effort to not only download the app(s) they want, but to go through the list of apps available and decide which ones are right for them.
This process of doing so empowers one to reflect on their health and think about the steps they want to take to improve their health or to improve their general understanding. Self-efficacy*, as defined by psychologist Dr. Albert Bandura, is one of many personal determinants of health and aspects of health behaviours. Apps could potentially allow people to increase their self-efficacy and take greater control over their health.
*Self-efficacy: an individual’s belief in his or her capacity to execute behaviours necessary to produce specific performance attainments.
Increased role of peer support.
The transformation of the Canadian healthcare system has seen the increasing importance of peer support. Peer support is offered by persons-with-lived-experience to other individuals with similar experiences seeking emotional and social support and knowledge. Apps may elevate the role of peer support as apps can be another means of connecting people with similar experiences.
The problems with mental health apps
There are always two sides to a coin. While there are many advantages to the availability and increase in mental-health related apps, there are some impactful implications.
Apps can connect rural and remote communities to resources, and also decrease the burden on healthcare professionals. But the problem with this is that, we may begin to think that these apps are enough and that rural and remote communities are now well-equipped with healthcare support. But this is not true.
Apps are only one of many tools that one can use, whether for education or as a part of a treatment plan. For many individuals, these apps are not enough, and professional help is required. If we begin to assume that the accessibility issues faced by rural and remote communities are now eliminated by apps, we will only continue to impose inequities on these communities and worsen the challenges they face.
In addition, many rural and remote communities do not have easy or affordable Internet access. A “majority of Canadians having Internet access or being Internet users” does not mean everyone. In fact, even people living in urban areas may not have Internet access or use smartphones (for example, the homeless population or those living in hospitals). This creates, what the Mental Health Commission of Canada calls, a ‘digital divide’. Thinking about this digital divide, how, then, can everyone fully and seriously integrate apps into their plan of action? These apps can essentially discriminate against those remote or unstable populations who do not have the means to take advantage of these resources.
As with any new technology, there are doubts about how effective and reliable these apps are. When people are not on the same page, whether they are healthcare professionals, family, peers, etc., it makes it difficult for those who want to try and explore mobile options.
It may also be easy for some users to assume that these mobile tools are the only resources they need, disregarding the importance of seeking professional help and other social supports. However, there are currently no established methods of measuring the clinical effectiveness of mental health-related apps.
The future of mental health apps
We have not only seen an increase in the number of mental health-related apps, but also an increase in the number of entrepreneurs and researchers working on developing better mobile tools. More individuals are looking to measure the effectiveness of these tools, not just for persons-with-lived-experience, but also for healthcare professionals. It is likely that the healthcare system will continue to integrate these apps as another form of care and support.
Personally, I hope that apps keep up with the changing attitudes on mental health and help to reduce stigma. As more people are beginning to value their mental health just as much as their physical health, I hope that apps will evolve to help people ‘keep track’ of their mental health, just like how people use apps to count their steps or their calories. This will also allow people to understand their own mental health better.
