Technological solutions to fill the gap in mental health care are alluring. They can appear to be a cheap, scalable way to solve the knotty problem of mental distress, investment in people, communities and broader causes of mental ill-health such as racism, poverty or the way we design our cities.
Author
Kaaren Mathias
Senior Lecturer in public health, University of Canterbury
Consequently, there has been huge growth in what’s now termed “e-mental health care” – mental health services and information delivered or enhanced through the internet and related technologies. In 2021, we saw a 6,500% increase in .
This growth is a response to growing problems of , shortage of clinicians, and a in Aotearoa New Zealand.
But the increasing investment in e-mental health apps can ignore the shortcomings of technology.
As both a practitioner and researcher promoting mental health in communities, I see policy makers and funders dazzled by shiny new apps, which can divert the government’s investment in traditional – but costly – mental health care.
Here’s why we need more conversation and rigorous evaluation of e-mental health.
Technology to help mental health
There are 33 mental health apps listed on Aotearoa’s site, and another new bilingual mindfulness app was .
App development has accelerated since the pandemic, with three funded through the NZ$500 million health package in 2020.
Digital infrastructure and e-medicine is a key priority nationally: this year alone, the New Zealand government earmarked over $600 million to invest in in the health system.
Supporters claim technology can counter isolation, anxiety, provide therapy and . And while there are some who benefit from , to develop and test e-mental health interventions.
A key challenge is that individual technological solutions build on the underlying assumption that individuals are responsible for their own health outcomes, without addressing the structural, political and social causes of ill-health.
Dependent on access to technology
are described as the most obvious advantages of local and international apps like Aroha Chatbot, Mentemia and Happify.
Yet while mental health apps might be affordable for a middle class resident of Auckland, Ahmedabad or Apia, e-mental health solutions depend on people being able to afford technology platforms (like smart phones) and data plans to drive them.
Digital technologies and often exclude the people who most need mental health support – , people with low incomes, and those with severe mental health problems. These high-need groups have been identified as those .
Even when e-health solutions are provided free to the user through government health funding and investment, . This means mental health funding supports graphic design and tech companies instead of those who provide person-to-person care, which we already know is central for good mental health.
Other challenges that have emerged for large-scale implementation of e-mental health options include such as ensuring apps meet quality standards, and how such apps can be used across national borders. Apps also may not keep pace with new evidence and as well as clinicians can. And while there is often strong initial uptake and use, .
Do the apps actually work?
Beyond the issues of access, other key questions need to be asked: do mental health apps work, and who do they work for?
There are clearly benefits for some people to have access to some form of immediate assistance via their phone or computer. But most research evaluating e-mental health care only looks at whether apps are .
Fewer studies assess whether e-mental health interventions or strengthen mental health long term. When e-mental health interventions are evaluated rigorously, usage in a trial setting is compared to usage in the real world.
However pixels are not people, and e-mental health care is not a substitute for the genuine human connection that is core to mental health recovery. Human connection was identified as period for Ōtautahi Christchurch, and .
Apps are not relational and rarely support building social connections and peer friendships. has shown that, most of all, people with mental distress need support to build relationships, , and have the opportunity to mental health care.
Addressing mental health also requires moving past the individual to the collective. It requires action to address factors that contribute to a person’s mental health.
Serious and complex global problems such as obesity, gender inequality, poor housing, colonialism, racism and barriers to social connectedness are the biggest causes of poor mental health. Apps can help some people as an adjunct to psycho-social care, but they cannot replace it.
Kaaren Mathias has received funding from the Economic Social Research Council and the Mariwala Health Initiative and is affiliated with Burans, a non-profit mental health provider based in North India.
