Nearly half of the world’s mental health patients lack access to treatment, but well over half of those diagnosed with a mental illness have access to a smartphone. This striking fact highlights the paradigm shift in care that psychiatry is poised to lead around mobile health (mHealth).
While there are numerous definitions of Digital Mental Health, or mHealth, we focus on asynchronous mobile technologies, including smartphone apps, text messaging, email, and online forums. The goals of mHealth are to improve health outcomes through convenient, patient-driven access to mental health support and self-management tools.
The most common uses for mHealth apps today are focused on promoting patient self-help and augmenting clinical support via data and physician consultation. Digital solutions have the potential to strengthen the therapeutic alliance and improve clinical outcomes while lowering costs, but can come with risks.
The following gives a brief introduction to the broad considerations for psychiatrists when engaging with mobile health (mHealth) solutions. Below this introduction you will find our full resource document: Digital Mental Health 101: What Clinicians Need to Know When Getting Started.
- The mHealth App Landscape: The app ecosphere is constantly evolving, with 90,000 new digital health apps released in 2020 alone and over 10,000 related to mental health. These apps can perform myriad functions: symptom tracking, habit formation or targeted behavior change, peer support and more. Sometimes these apps are meant to be used as an adjunctive in coordination with a mental health professional while many “health and wellness”- apps are intended for unguided self-help.
- Understanding the Technology
- Hardware Considerations: Clinicians can establish patient access to hardware through a few questions, including whether the patient has access to a mobile device and stable internet or a data plan, and whether the patient feels comfortable using it.
- Software Considerations: Additional considerations include: Whether the app will work on the patient’s device or operating system; If the patient has internet access or if the app can operate offline; and If the app is accessible to the patient’s level of digital literacy and any accommodations the patient requires (e.g., cultural and linguistic appropriateness, visual limitations).
- Addressing App and Technology Literacy: Onboarding and change management processes should go beyond the app to include assistance with basic technology functions such as accessibility, battery charging, operating system issues, device security, and data privacy.
- Access and Digital Inclusion: As of 2021, 7% of US adults say they do not use the internet. In the context of health and mental health, digital inclusion means ensuring a person has the knowledge, confidence, and skills to engage with digital health services across a variety of media and platforms. Strategies to boost digital literacy include training peer specialists as digital navigators.
- Goodness of Fit - Reviewing App Options: APA’s expert consensus-driven App Evaluation Model provides guidance for psychiatrists and other health care providers when choosing an app to recommend for patient use. These hierarchical criteria include: basic facts about the app and its developer; risks, privacy, and security; clinical evidence; ease of use; and interoperability.
- Ethical and Legal Considerations: When in doubt, core medical ethical principles of beneficence, nonmaleficence, justice, and autonomy can be used to guide decision-making.
Digital Mental Health 101: What Clinicians Need to Know When Getting Started
This APA Resource Document is an introduction to the broad considerations that should be understood by mental health professionals and patients alike when engaging with mobile health (mHealth) solutions.
View the three sections of the full resource and download in parts below:
Part One: Getting Started in mHealth: The Landscape of Apps and Access
- Background, Terminology, and Concepts
- App Categorization. “Health and wellness” vs. “Medical” Categories
- Apps, Privacy, HIPAA, and OCR
- Understanding the technology: a quick roadmap
- Moving from Digital Divide to Digital Inclusion
Part Two: Applying mHealth: Identifying and Supporting the Use of Apps
- Clinical Applications and Overview of Considerations within Specific Patient Populations and Settings
- Outpatient Psychiatric Settings
- Inpatient Psychiatric Settings
- Integrated Care Settings
- Child and Adolescent Psychiatry Setting
- Geriatric Psychiatry Setting
- Serious Mental Illness
- Emergency Psychiatric Settings and Patients in Crisis
- Peer Support Psychiatry Resources
- Dual Diagnosis Psychiatry Setting
- Psychiatric Nursing Considerations
- Goodness of Fit: Reviewing App Options and Evaluation Models
- Sustainability and Engagement Factors
Part Three: What’s Next: The Future of mHealth Ethics, Coverage, and Practice
- Ethical and Legal Considerations
- Ethical Concerns and Patient Privacy
- Harms, Risks, and Benefits
- Patient Autonomy, Patient Consent, Liability, and Use of mHealth
- Other Legal and Ethical Considerations
- Payment Models, Billing, and Coverage
- Future Directions & Other Applications for This Work