Mental health professionals used to be wary of apps. Now, they prescribe them

Long wait times for mental health appointments are pushing more people onto online services, but experts say smartphone apps can play an important role in providing care – provided they are backed by evidence.

Clinical psychologist Dr Aliza Werner-Seidler, a researcher at the Black Dog Institute, said surveys conducted by the institute suggested teenagers were waiting an average of three months for a first mental health appointment, leaving them vulnerable to poor quality online advice in the interim.

After initial wariness, more mental health professionals are encouraging patients to use apps. Credit: Digital Vision

“Maybe an influencer is sharing their experience of anxiety or depression, but that might not really helpful, or it may just contain misinformation,” she said.

Despite attempts by social media companies to clean up their platforms, Werner-Seidler said there continued to be ample content glorifying or normalising self-harm and eating disorders on social media.

“The way a social media algorithm works is that, once you’ve watched something, it feeds it to you more and more,” she said.

Werner-Seidler is co-designer of ClearlyMe, an app for children aged 12 to 17 developed in response to concerns about the age group’s access to mental health care, amid increasing rates of psychological distress.

The app, released publicly today, is believed to be the first clinically evaluated free app offering cognitive behavioural therapy, the gold standard for thought-based psychological therapy, specifically for teenagers.

A randomised control trial involving 569 children aged 12 to 17 with symptoms of depression found those who used ClearlyMe had significantly lower depressive symptoms and improvement in quality of life after six weeks. The improvements were seen whether the children had used the app by themselves or with SMS support.

Ruby Burgess, a 17-year-old from Victoria with experience of depression who was a youth advisor on the app, said she liked that she was able to do exercises to challenge negative thinking patterns at any time, without the stress of talking to someone.

“Young people can be confronted by using a helpline or something, so the difference was [with the app] you don’t have to talk to someone else, you can just sort of be working on it with yourself,” she said.

Black Dog aims to have 50,000 teenagers facing mental health challenges use the app over the next three years.

The Australian Commission on Safety and Quality in Health Care developed a set of standards for online mental health services in 2020, in response concerns about poor quality psychological therapy apps.

A 2018 study by Northwestern University found only 4 per cent of so-called mental health apps on the market had been clinically evaluated.

But QUT Emeritus Professor David Kavanagh, director of online mental health information service eMH Prac, said the industry was maturing, with more reputable institutions developing digital treatments, and referrals by practitioners to smartphone apps now commonplace.

The eMH Prac website lists 30 apps from Australia and abroad which have been clinically evaluated to be effective for treating a range of mental health issues, including mild to moderate anxiety, depression, insomnia and PTSD.

When teaching health professionals about digital tools, Kavanagh said the question being asked is no longer “is this a bad idea”, but “how can I use these things well”.

“If [a patient] only has a limited number of funded sessions under Medicare, you want to make the most of what you’ve got,” he said.

Australian Psychological Society President Dr Catriona Davis-McCabe agreed more people had turned to using mental health apps over the past few years while waiting to see a psychologist, or because it seemed impossible to get an appointment.

“They can be so good as an adjunct to treatment, between sessions,” she said. “But sometimes people do use apps that are not evidence-based or just not right for them.”

President of the Royal Australia and New Zealand College of Psychiatrists Dr Elizabeth Moore said she would advise someone looking for an evidence-based mental health app to visit the eMH Prac website.

Moore said evidence-based apps could be useful for people experience mild to moderate anxiety or depression.

“Our concern would be if someone has a more severe issue, then it would be best to see someone in person,” she said.

The Black Dog Institute can be reached here. Crisis support is available from Lifeline on 13 11 14, and Beyond Blue on 1300 22 4636.

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