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  • Writer's pictureKarla Cloete
    • Oct 28, 2021
    • 5 min read

Mental health apps: Cape crusaders or data capers?

By Karla Cloete

Edited by Tasmiyah Randeree


Mental health care apps can be life-saving, but they also might be stealing your data.


Modern problems require modern solutions, usually in the form of an app. There’s an app for every problem you could possibly imagine. If you’ve never used an app geared towards mental well-being, you’ve at least seen the ads or heard the hype- think meditative YouTube ads for HeadSpace and the like. I use a few myself like DiveThru and I even volunteer as a lay counselor for an app called Postiveo (formerly Sparkspluss).


These apps are incredibly popular and for good reason. In a society where few people are able to access the care they need, these mobile health interventions (mHealth) can be distributed without any staff, with little resource investment, and with no budget. These apps can reach rural communities, and low-income areas, and bridge racial divides and disparities in existing mental health care systems. These apps can also be accessed privately - a hugely important innovation in communities where seeking help is largely stigmatized.


Globally, mental health issues are on the rise but health care systems can’t seem to keep up or provide equal access to care. It’s no surprise that mental health care apps have stepped in to fill the gap, with over two billion people using these services today. These apps are abundant, mostly free, and can be accessed instantaneously with over 10,000 in the app store to choose from. They cover everything from mood and symptom tracking, CBT, alcohol consumption, and meditation to appointments with real-life therapists.


These apps can significantly expand people’s access to care and increase the overall availability and quality of mental health treatment. This is incredibly important in a country like South Africa with glaring gaps in its mental health system. One-third of South Africans struggle with a mental illness but there are only 22 psychiatric intuitions in the country and only 1 in 10 patients receive treatment. Furthermore, South Africa was ranked one of the unhappiest countries in the Happy Planet Index.



A few systematic reviews of mHealth apps have found that they can have positive effects on symptoms of depression, smoking, and anxiety as reported by users. But these apps can sometimes come with built-in placebo effects to increase usage and to make the app more valuable and effective than they really are. These apps can provide crucial interim support for patients who don’t have 24/7 access to care.


A 2018 study compared evidence-based mHealth apps to traditional treatment interventions and they were found to alleviate some symptoms of moderate depression and subclinical anxiety. These apps were most effective when used in combination with therapy.


But not all these apps are safe to use as many of them don’t rely on evidence-based practices and contain a myriad of privacy concerns. These apps will usually be based on self-guided interventions or a self-monitoring approach. Although these apps have wide usage and high approval ratings, very few of them were created or tested in research settings. A 2021 study found that user rating of the apps, overall quality, aesthetics, and psychoeducation information didn’t correlate to evidence-based practices.


These apps also run the risk of overdiagnosing and misdiagnosing normal behaviors, cause unhealthy rumination on symptoms and excessive self-monitoring, and encourage users to self-diagnose. In 2015, the WHO’s survey found that 29% of these apps were dedicated to diagnosing, treating, and supporting mental health conditions.


The apps we assessed tended to encourage frequent use and promoted personal responsibility for improvement, the researchers found. The idea that the normal ups and downs of everyday life need treatment could drive use of these apps by people with minor concerns.

One study looked at the 36 highest-rated apps for depression and smoking and found that 29 of these shared users’ data with Google and Facebook but only 12 actually declared this practice in their privacy policy. Another study of 61 mHealth apps discovered that 41% of them didn’t even have a policy related to privacy.



It is incredibly hard to track what happens to our online data, and this is especially true when our digital footprints wander into health services. This data could be misused by employers and target vulnerable users with specialized advertising.


Consumer Report’s study into several popular apps like 7 Cups and BetterHelp found that these apps collected data used for targeted advertising, shared data with analytics services, and combined these with other data points like your location and your traffic to other websites often without user’s permission. Even more concerning is a study of 56 apps that found some requested irrelevant permissions like contact lists, text messages, and audio.


The reason these apps don’t have to protect users' data is that they aren’t bound by confidentiality or HIPAA codes like therapists are. Some apps will ask you to log in using your email or Facebook account which gives these companies access to the data in the app.


"Right now, it's like the Wild West, with zero protection," said Dr. David Grande, a policy director from the University of Pennsylvania. "Health privacy concerns are growing at an astronomical pace, but we still have a very antiquated view of them."

People don't understand all the digital footprints they're leaving behind each time they interact with health apps, and frankly, it's very hard to understand. Who on earth would want to read a long, complicated privacy agreement?

These concerns don’t mean you shouldn’t use these apps. Rather it means you need to be an informed user who knows what to look for.


Choosing apps that base their practice on evidence-based practices is one way to ensure your apps are safe and effective. For example, the FDA has already approved a substance abuse app in 2018. Always research the clinical effectiveness and carefully weigh the risks and benefits of using such a service.


Apps that are effective have 4 characteristics in common: real-time engagement and usage reminders for high engagement, a simple intuitive interface design that does not use clinical language, self-monitoring features, and emotional self-awareness.


Be wary of apps that ask you to log in with a Google or Facebook account; they are more likely to peep at your data. Furthermore, be careful of what permission you give the app and remember that apps shouldn’t be used as diagnostic tools nor should they replace a holistic approach in combination with professional guidance.


For resources on how to access South African mental health care services and safe spaces to find support click this link.


 

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