Pixels aren't people: mental health apps are growing in popularity, but human connection remains key

Pixels aren’t people: mental health apps are growing in popularity, but human connection remains key

Technological solutions to fill the void in mental health care are alluring. They may appear to be a cheap and scalable way to solve the thorny problem of mental distress, without requiring investment in people, communities and the broader causes of poor mental health such as racism, poverty or how we design our cities.

Consequently, there has been a huge growth in what is now called “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 doctors recommending apps to patients.

This growth is a response to growing issues of unmet mental health needs, shortage of clinicians and lack of access to mental health care in Aotearoa New Zealand.

But the growing investment in online mental health apps may overlook shortcomings in technology.

As a practitioner and researcher promoting mental health in communities, I see policy makers and funders dazzled by brilliant new applications, which can divert government investment in traditional mental health care – but expensive.

Here’s why we need more conversation and a rigorous assessment of e-mental health.

Technology at the service of mental health

There are 33 mental health apps listed on Aotearoa’s Health Navigator site, and another new bilingual mindfulness app was launched recently.

App development has accelerated since the pandemic, with three being funded through the NZ$500 million COVID-19 Response Health Program in 2020.

Read more: COVID-19: Telemedicine in mental health got off to a slow start – then the pandemic happened

Digital infrastructure and e-medicine is a key national priority: this year alone, the New Zealand government has allocated more than $600 million to invest in data and digital infrastructure for the health.

Proponents say the technology can counter isolation, anxiety, provide therapy and speed up access and quality of care. And while some benefit from e-mental health innovations, more research is needed to develop and test e-mental health interventions.

A major challenge is that individual technological solutions rely on the underlying assumption that individuals are responsible for their own health outcomes, without addressing the structural, political and social causes of ill health.

Depends on access to technology

Convenience and affordability are described as the most obvious benefits of local and international apps like Aroha Chatbot, Mentemia, and Happify.

Yet while mental health apps may be affordable for a middle-class resident of Auckland, Ahmedabad or Apia, online mental health solutions depend on people’s ability to afford platforms. technology (like smart phones) and data plans to drive them.

Digital technologies risk increasing disparities and often exclude those most in need of mental health support – the elderly, those on low incomes and those with serious mental health issues. These high-needs groups were identified as the least likely to use online mental health care.

Even when eHealth solutions are provided free to the user through public health funding and investment, the costs of digital health research and development are high. This means that mental health funding supports graphic design and technology companies instead of those providing person-to-person care, which we already know is essential for good mental health.

Other challenges that have emerged for the large-scale implementation of e-mental health options include complex regulatory issues such as ensuring that apps meet quality standards and how these apps can be used at home. beyond national borders. Apps also may not keep pace with new evidence and advances in mental health as well as clinicians. And while initial adoption and usage is often strong, ongoing app usage is less common.

Do the apps actually work?

Beyond access issues, other key questions need to be asked: do mental health apps work and for whom do they work?

There are clearly benefits for some people to have access to some form of immediate assistance through their phone or computer. But most research evaluating online mental health care only examines whether the apps are attractive and easy to use.

Fewer studies assess whether online mental health interventions improve mental health status or strengthen long-term mental health. When online mental health interventions are rigorously evaluated, use in a trial setting is often overestimated compared to real-world use.

However, pixels are not people, and online mental health care is no substitute for the real human connection that is at the heart of mental health recovery. Human connection has been identified as essential in the post-earthquake period for Ōtautahi Christchurch, and globally during the COVID-19 pandemic.

Read more: Coronavirus: new technologies can help maintain mental health in times of crisis

The apps are non-relational and rarely create social bonds and friendships between peers. My own research has shown that, above all, people with mental distress need support to build relationships, be socially included, participate in their communities, and have the opportunity to participate and co-design health care. mental.

Addressing mental health also requires moving beyond the individual to the collective. Action is needed to address the social and political factors that contribute to a person’s mental health.

Serious and complex global issues such as obesity, gender inequality, poor housing, colonialism, racism and barriers to social connections are major causes of poor mental health. Apps can help some people in addition to psychosocial care, but they cannot replace it.

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