Who decides whether a mental health app is suitable for children and young people?

Mental health smartphone apps have seen a dramatic growth over the past decade and our phones are filled with an array of personally selected apps. Which apps have become part of your automated daily routine? Which Apps do you log into before the start of your working day? What are your top three most frequently used Apps? Maybe this isn’t something we really think about much but such musings led me to consider how useful Apps can be and how Apps are perhaps being underutilised in the context of therapy interventions for children and young people, my area of clinical specialism. My question was, how do we know which apps are useful to this cohort and how can we harness their utility to improve clinical outcomes?

Here I share my ideas on how feedback from intended users could support successful implementation of apps as an adjunct to the clinical treatment offer to children and young people in mental health services and how a wider system approach can maximise the use of apps in this context.

App usage

We know that half of ten-year-olds now own their own smartphone and between the ages of nine and 10, smartphone ownership doubles – marking an important milestone in children’s digital independence as they prepare for secondary school. More than 10,000 mental health apps are available for download according to Connolly et al. offering features ranging from diagnostic screening, psychoeducation and relaxation exercises.  In 2018, the National Institutes of Health (NIH) funded over 112 studies on mental health apps  (Hansen and Scheier, 2019), reflecting almost double the number of studies funded in 2014 and investment in this area to mental health app companies was over $400million in venture capital investment in 2019 (Day, 2019). Taken together, this reflects a growing industry that would benefit from a greater understanding of how these apps are used by the intended audience, how effective they are and specifically which features are most important to children and young people as a distinct cohort, supporting more efficient investment in what works best for a population with distinct needs and preferences.

We know that mental health smartphone apps can aid self-management of conditions such as depression and anxiety yet as Connolly et al. (2020) observe, their effectiveness and potential for sustained use remains uncertain. As a Consultant Psychologist with a background in service implementation I’m curious about the barriers to implementing apps as part of a therapeutic offer, especially for children and young people. Why are mental health apps not part of our routine clinical offer to this cohort in 2021 and especially after such a contextual shift to remote working during the lockdown? Why are clinicians not using apps to enhance the work they are undertaking face to face? And how do we know which apps we should even be recommending?

The gap

The identified gap is that apps are not routinely reviewed by the intended users. We know that in a digital age, young people are influenced by their peers and less so (if at all1) by academic publications of randomised controlled trials. The information that is available in the academic and professional realms about app effectiveness is therefore both limited in the first instance, but also not reaching its intended audience. In turn the intended users of apps have not been afforded the opportunity to share their views on what makes an app helpful or useful to them. This prevents us from fully understanding how to harness the potential of mental health apps to enhance the quality of care for children and young people accessing mental health services.

Considerations for widespread implementation

A successful implementation of any new technology or service requires a focus not just on what is being implemented, but also understanding the characteristics and needs of the intended users. Here is where the research literature can support implementation by highlighting what needs our attention. So far, I’ve focused on the intended user considerations and examples of interventions are provided in Figure 1 to demonstrate the process of developing an app rating approach that might be generalisable to other similar settings.

The future

A future model would incorporate feedback from users to understand the effectiveness and suitability of mental health apps for children and young people. Successful implementation would firstly reflect a way in which feedback can be routinely linked to the App Library and later how apps can be integrated into healthcare systems. This is a bold ambition but one that would maximise the utility of apps to support the wellbeing of children and young people.

Conclusion

The benefits of a successful implementation of apps in mental health care pathways for children and young people seems to be contingent on their involvement in selecting apps that meets their needs. If they like something, they will tell others; if an app is useful it is likely others will use it.  Having a platform that provides user-based ratings for mental health apps will benefit providers, users and those working with them by understanding what works best and for whom. I hope to keep you updated on the developments in this area!

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