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There are many mental health apps.Difficult to choose the right one

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From the tech industry’s point of view, mental health treatment is an area at stake.

In any year, 1 in 5 adults Federal estimates indicate that the United States is experiencing some form of mental illness.And According to the survey Only about half of them are being treated with systems that are understaffed and poorly distributed to meet demand.

For tech startups looking to invest in unmet needs, that’s more than 50 million potential customers.

Venture capital has invested more Over $ 2.4 billion The 2020 Digital Behavioral Health App (more than double the investment in 2019) promotes support and treatment for problems such as burnout, depression, and attention deficit hyperactivity disorder. At least seven mental health app companies have achieved “Unicorn” status and are worth over $ 1 billion.

But despite the growing hype of the industry, researchers and businesses are struggling to prove that these apps really work.Estimated 20,000 mental health apps Only five have been officially scrutinized and approved by the Food and Drug Administration for download to PCs and smartphones, primarily taking a hands-on approach to space regulation.

“Development really goes beyond science,” said Stephen Schuler, a clinical psychologist at the University of California, Irvine, who specializes in the development and evaluation of digital mental health products.

Type “depression” or “anxiety” in the app store and you’ll see a dizzying list of results. There are thousands of “Wellness” apps, including headspaces that help people counsel people about breathing techniques and other techniques and feel more careful. Apps such as Woebot and TalkLife profess to help manage conditions such as anxiety and postpartum depression using games, mood journaling, or text exchange with peers and automated bots.

Some apps are intended for use with face-to-face therapy, while others are intended for use alone. Some of the most popular, such as Talkspace, BetterHelp, and Ginger, promise access to treatment by a qualified therapist via text message, phone, or video. Others, including Brightside and Cerebral, connect users to psychiatrists who can prescribe antidepressants.

Most products make money by charging consumers a monthly or annual fee using additional purchase options such as video sessions with therapists. Others contract directly with your employer or insurance company.

And yes, only a few of these apps have promising research to back them up.For example, some studies have found cognitive-behavioral therapy, which is the mainstay of treatment for depression and anxiety, aimed at helping patients change their negative thinking patterns. effective Delivered using a web-based platform, such as directly by a licensed professional. And the pandemic strengthened the claim that patients are willing to exchange direct visits for ease of online connectivity.

“Digital mental health can be seen as a way to extend the mental resources we have,” said David Mall, head of the Behavioral Intervention Technology Center at Northwestern University’s Feinberg School of Medicine. For example, the step care model allows patients with milder symptoms to be treated with technology while booking face-to-face care for patients who need something more.

The challenge for consumers is to separate potentially useful or potentially harmful apps from distracting apps.

Some companies that offer mental health treatments have been doing something completely different these days. For example, online distributors of erectile dysfunction and hair loss treatment have begun offering psychiatric assessments and prescribing and selling antidepressants.

Technology companies are essentially for-profit, rushing to compete in saturated markets, and many companies sell products with attractive user interfaces, but there is little evidence of their effectiveness. .. 2020 analysis When Australian researchers reviewed nearly 300 apps for anxiety and depression, only 6% of companies that boasted an evidence-based framework in their product app store description published evidence. I found out.

Also, star ratings and download sums don’t provide much context. April study The Beth Israel Deaconess Medical Center and Harvard Medical School have found that there is little correlation between app store metrics and treatment quality.

“No one is competing for privacy, security, or evidence. We are competing for aesthetics, page ranking, and brand awareness marketing,” said the digital spirit of the Beth Israel Dicones Medical Center. Dr. John Taurus, director of the department and one of the authors of the April study, said. “There is a tacit understanding that apps are better than nothing, but what if it’s worse than nothing?”

One problem is the geriatric psychiatrist, McLean Institute of PsychiatryThe kind of randomized controlled trials that can prove the effectiveness of an app is much slower than the rapid innovation of technology and can take years. “In general, the healthcare and technology industries are operating at very different paces,” says Vahia.

Dr. David Mou, a psychiatrist at Massachusetts General Hospital and Chief Medical Officer at Cerebral, agreed that all new health care should be done carefully and conservatively to avoid harm to patients. .. But some people in the mental health sector have drawn all the companies in the same brush, saying they can’t tell the difference between a data-driven company and one that’s trying to grow at any cost.

“They look at us and say we’re all VC-backed brothers in the basement trying to redesign their healthcare,” Mou said. “And that’s not true. It might have been true 10 years ago, but it’s not true today.” The long-term winner is one that “is evidence-based and measures quality like crazy.” He said it would be.

Cerebral offers online treatment and medication management and delivery for a variety of psychiatric disorders. Monthly subscription fees range from $ 29 to $ 325, depending on the level and frequency of care and insurance coverage. Mou said Cerebral can already show some benefits. Many top hospital systems may wait months for care, but people at stake can contact their cerebral care providers almost immediately, he said. “Within minutes, you can talk to someone on one of our instant live visits. It’s a big win in itself.”

Even critics of the technology blast quickly admit that mental health’s current physical store system is outdated and inadequate. In recent years, the issues surrounding mental illness and lack of access to treatment have permeated public dialogue. Brain ailments that many families once squirreled out of sight have contributed to celebrity culture and supper chat.

However, even if advocates move forward with acceptance, it has proven stubbornly difficult to truly improve the lives of people with mental illness. Over the past few decades, the United States has succeeded in reducing mortality from cancer, heart disease and other major illnesses, but deaths from suicide and drug overdose continue to increase.

Federal law theoretically requires insurers to cover mental illness like any other illness.But Finding affordable care remains a challenge, Primarily due to a shortage of qualified mental health professionals and ongoing inequality in insurance coverage.

In countries with a vast population without family doctors and health insurance, most people have mobile phones, but connecting people to treatment through mobile apps seems like a logical solution. I will. And for some, online treatment is an attractive option because they have the opportunity to talk anonymously about their mental health challenges.

Still, many experts who welcome the potential for innovation in mental health treatments admit that consumers have little guidance on how to choose reputable options. “Wellness” apps that promote a healthy lifestyle and apps that help people manage their illness without offering specific treatment suggestions can circumvent FDA regulations. However, according to industry experts, even those that provide patient-specific diagnostic and treatment recommendations that appear to fit the FDA’s authority head-on do not appear to be in the FDA’s attention.

“The FDA was really, really lazy in implementing digital health for reasons that aren’t entirely clear to me,” said Bradley Merrill Thompson, an Epstein Becker Green lawyer who advises businesses on FDA regulation. “Everyone spent 20 minutes in the app store and found dozens of examples of apps claiming medical devices. Even if the FDA didn’t try to curb them, they did so for a while. It was. “

In response to a question from KHN regarding the authorities’ approach to regulating mental health apps, the FDA issued a brief statement. “When circumstances change and new needs arise, the FDA is ready to address and address these challenges, especially in the area of ​​mental health,” the statement reads in part. “We want more evidence-based products in this area, so we continue to work to facilitate the development of additional safe and effective therapies for patients who depend on these products. I’m out. “

Dr. Tom Insel, a psychiatrist and neuroscientist, has a unique view of the evolving landscape. In 2015, Insel resigned as director of the National Institute of Mental Health. This is a position I have been in since 2002, exchanging government halls with Silicon Valley’s open floor plans for digital mental health. He started with Google’s Verily and then co-founded Mindstrong Health, a startup that studies how to use smartphone technology to predict and diagnose mental health crises. He has since left to advise California authorities on behavioral health issues.

Insel believes in the potential of digital mental health, but said it will take time to find its highest and best use. He said, for example, most of the apps on the market focus on access issues. They make care more convenient. But they overlook the more basic problem: quality. Unlike most medical disciplines, mental health providers rarely measure whether the care they provide improves their patients.

“We don’t just need to increase access. We don’t just recreate the system of a physical store and let people do it over the phone or zoom,” says Insel. Instead, he argued that digital health should focus on measuring whether treatment improves people’s lives.

“There is no doubt that this area will change the treatment and diagnosis of mental health,” Insel said. “But we are in the first act of a five-act drama. We don’t think it’s close to the kind of solution we need in the real world.”

This story was created by KHN (Kaiser Health News), one of the three major operating programs KFF (Kaiser Family Foundation), a donated non-profit organization.

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