'Wild West' mental health apps offer both gold and 'digital snake oil'

Mental health apps hold the potential to help Canadians in need find proper care, but psychiatrists caution that many aren't of high quality.

Apps aim to bridge gaps in access to effective care across Canada

Only 13 per cent of Canadians with depression will have access to cognitive behavioural therapy, says Dr. David Gratzer. (CBC)

Mental health apps hold the potential to help Canadians in need find proper care, but psychiatrists caution that many aren't of high quality. 

Publicly provided counselling therapy isn't available to people with depression and anxiety, fuelling demand for an estimated 10,000 mental health and wellness apps that offer access to therapy quickly and in some cases cheaply, regardless of whether physicians or therapists are physically nearby.

The American Psychiatric Association has set high standards for apps and says people need to be informed.

"I think it definitely is the Wild West," said Dr. John Torous, co-director of the digital psychiatry program at Beth Israel Deaconess Medical Center in Boston.

"Like anything in the Wild West, there is a lot of potential. There is definitely gold, but there is a lot of [what] you could almost say is digital snake oil too, and separating out those two right now is difficult."

Torous cited one study in which researchers rated more than 700 apps that claimed to offer mindfulness.

"Only about four per cent actually offered what we would consider high-quality, therapeutic, useful mindfulness. And [for] the other 96 per cent, it is unclear what they were offering, but it probably wasn't useful or evidence-based."

Torous said researchers found some suicide apps have been offering incorrect and even dangerous information. 

What's more, Torous said, many of the apps don't have privacy policies telling you what happens to personal information you may enter.

Usability in the long term, and whether the data can also be used by someone's health-care team, are other important factors, experts say.

Change mind set

Vancouver resident Diana Apuada turns to meditation apps to practise relaxation techniques and visualizations to cope with anxiety and depression more efficiently. 

Apuada said she experimented with apps for about two years to see what worked well for her.

"I was finally accepted for a counsellor, but it took me three years," Apuada said. "Whereas if I have the app, right now, it might help me. For major issues I will see a counsellor."

When she feels nervous, Apuada said her heart can race and she might have headaches and other physical sensations. She'll use an offline app to find a guided meditation that recommends techniques that fit her mood at any given time.  

"I recently had to take a driving test, and weeks before I'd been using these apps just to kind of get myself in the right mindset," Apuada said. "When I actually do my test I feel a lot more calm."

Many apps don't require a diagnosis to use, she said.

In contrast, at Scarborough and Rouge Hospital in Toronto, doctors and counsellors introduced their Internet Cognitive Behavioural Therapy 2.0 service to help outpatients with mild to moderate depression or anxiety to gain skills surrounding how their thoughts influence mood and behaviour.

"There's as much evidence for cognitive behavioural therapy as there is pills for mild to moderate depression," said Dr. David Gratzer, a staff psychiatrist at Scarborough and Rouge Hospital, where he's the co-lead for the e-therapies program.

"And yet the Canadian data [indicate that] only 13 per cent of Canadians with depression will have access to CBT."

Technology has the potential to help bridge the divide, Gratzer said. That's why the hospital adapted traditional face-to-face cognitive behavioural therapy of 12 to 15 sessions, turning it into sessions delivered online.

Individuals with anxiety or depression complete the sessions at their own pace, and then a therapist reviews the homework assignments and has an emailed conversation or phone calls as needed.

Given the strong links between cancer treatment and depression, the hospital also offers an internet-based mindfulness program for patients who've spent a whole day at the chemo clinic.

With files from CBC's Melanie Glanz