Business is booming for mental health apps. Is there cause for concern?

When a personal crisis emerged last summer, Ontario university student Marysa Marentette’s mental well-being began to fray.

Pandemic lockdowns persisted, and accessing in-person support was difficult, but the sponsored posts on her social feeds presented a solution: an online therapy platform that said it could offer her professional mental health care from practitioners who had been custom-selected for her through a matching process tailored to her needs.

As a full-time student, Marentette was entitled to a discounted rate for the platform, which claims on its website to “make professional therapy available anytime, anywhere, through a computer, tablet or smartphone.” Though it initially seemed like a good option at a time when traditional supports were scarce, she says the reality was an inconsistent service with a number of therapists who did not deliver on the platform’s promises of accessible, digital mental health care.

“Some of them will write you back and basically say,‘ I’m really busy, ’” she recalls. “I got assigned to one, dumped my trauma immediately, and just didn’t hear back for days. Or they just ghost you. ” Since billing begins once a match is made, Marentette says she was charged $ 60 a week for two months before she gave up and cancelled her account in frustration.

The rapidly growing online therapy sector has clearly not been without growing pains. Demand for virtual mental health services has increased dramatically in recent years, with Deloitte Global reporting a 60 per cent jump in consumer spending on mental health apps during the early days of the pandemic. By some estimates, there are as many as 20,000 such apps available for download. Deloitte projects a 20 per cent growth for 2022 and predicts that global consumer spending on the apps will reach close to $ 500 million (US) this year. With market share comes marketing: sponsored campaigns abound across Instagram and TikTok, with bold slogans such as Bloom’s self-description as “the app that produces serotonin in your brain.” Mental health professionals, however, encourage caution, saying virtual care has its merits, but more attention is needed on its limitations.

Big money

In addition to their ability to be delivered virtually, digital mental health services have a distinctly attractive characteristic: an approach to health care that promises to deliver on investment among a generation of tech-savvy young people in the throes of a mental health crisis. Venture capitalists are leading the charge.

In March, Toronto-based health-care startup Nurosene launched its digital mental health platform, the Nuro App, after extensive funding efforts that saw investments coming in from some high-profile firms as well as pop star Nick Jonas and NHL player James van Riemsdyk .

Meanwhile, BC’s Cognito Health announced it had raised $ 1.1 million for its “online, integrated mental health solution,” which offers everything from virtual physician visits to daily affirmations for a subscription fee of $ 99 a month. “With this money Cognito plans to fulfill their vision of expanding to the rest of Canada this year,” wrote CEO and co-founder Jason Cridge in a blog post.

To ensure they are compliant with the government health-care standards, mental health apps often enlist the services of other privately held tech companies. Their businesses, too, are booming.

For example, MedStack – a Toronto-based company offering data security and privacy compliance services to digital health-care platforms like Canada’s Inkblot Therapy – wrapped up a $ 3.1 million (US) funding round last fall. CEO Balaji Gopalan said at the time “the COVID-19 pandemic has elevated the awareness and importance of digital health innovation, establishing a permanent, new normal.”

‘Appification’ of care

Dr. David Gratzer, attending psychiatrist at the Center for Addiction and Mental Health, says there are significant concerns related to what he calls the “appification” of mental health care.

“The advantage of these apps is that you press once, you find this online community, you find a therapist that you think may be a good fit. But it’s a very unregulated market, ”he says. “And yes, it’s a market.”

Psychotherapists in this province are regulated by the College of Registered Psychotherapists of Ontario. Its members are accountable to this body, and anyone can complain to them about instances of malpractice or non-compliance with industry standards.

“But if you go to one of these apps and find a therapist who may not be in Ontario, or may not even be in North America, that regulatory safety is gone,” says Gratzer.

Proponents of digital mental health platforms generally tout the accessibility of their services as a main draw. Conducting appointments remotely can increase the frequency and ease with which some people can access services.

Dr. Idil Abdillahi, associate professor of Disability Studies at Ryerson University, says the concept of “access” is not as straightforward as it seems.

“When we talk about access, who are you talking about access for? Not everyone has access to the internet, or can use a phone, or see properly, ”she says. “The public is not even thinking about the quality of service – they’re stuck on the idea of ​​access.”

Is privacy protected?

A chief concern, too, is privacy. While compliance services like MedStack exist, it’s difficult to get a sense of the measures in place to protect users’ sensitive health data – and that data is valuable.

The non-profit Mozilla Foundation regularly evaluates internet privacy standards. It recently released a list of the top mental health and prayer apps that “fail spectacularly at privacy, security” and are identified as having strong concerns related to the management of user data.

The report described mental health apps as “a data harvesting bonanza” and identified youth as a prime target: “When teens share information on these apps, it could be leaked, hacked, or used to target them with personalized ads and marketing for years to come. ”

BetterHelp is among the apps listed in the Mozilla privacy report. It is based in Silicon Valley, but its reach is far. Marentette signed up for this service last summer after seeing it advertised online. She says it seemed like she was getting matched with random people, many of whom did not respond to her or promised to get in touch at a later point, but never did.

Heela Gonen, vice-president of partnerships for BetterHelp, says the service rigorously tracks and records complaints from users and while less than one per cent of sessions have been reported as being missed by therapists in 2022, she acknowledges it does happen.

Gonen also says the data from complaints is used to improve service: “Complaints are recorded, tracked, trended and reported with the goal of achieving optimal outcomes enhancing the BetterHelp member and client experience,” she says via email.

In Canada, the government reaction to the app boom has come in the form of competition, not regulation. In January, it released the PocketWell app, part of the “Wellness Together Canada” platform, which allows users to measure and track their mental well-being as well as access support resources. According to Health Canada, over half of Wellness Together Canada users are between the ages of 19 and 29.

Abdillahi, in an article co-written with Anne Rucchetto and Madeleine DeWelles, criticized the digital form of the response response, writing that “it is somewhat ironic the Canadian government would introduce an app as a solution to mental health issues two years into a pandemic that has resulted in excessive screen time, which is widely known to be detrimental to child and adult health. ” Perhaps more significantly, PocketWell, according to Abdillahi and her colleagues, will extract “significant amounts of data from users.”

Anna Maddison, senior media relations adviser for Health Canada, says the platform that hosts Wellness Together Canada and PocketWell – Greenspace Mental Health Ltd. – has been reviewed and approved by an independent auditing firm to ensure its operations adhere to the industry’s best practices.

Maddison says specific details on Greenspace’s response protocol for privacy breaches cannot be disclosed as they are “protected proprietary information.” She acknowledges that “Greenspace also shares aggregate and de-identified data,” but says this information is kept “in the strictest confidence.”

The drug dilemma

One factor allowing for the proliferation of mental health apps may be their outward resemblance to in-person alternatives. Mental health care is usually talk-heavy, and often uses tools like questionnaires to evaluate patient needs. These are relatively simple to digitize compared to the treatment of many other kinds of health problems that require sophisticated medical equipment and lab tests.

The treatment of mental illness, though, can sometimes require medication. The remote prescription of these drugs – many of which may be controlled substances – has been problematic south of the border.

In May, Cerebral – a telehealth startup based in California – was hit with a grand jury subpoena in New York after former employees alleged the company had pressured practitioners to prescribe medications for attention-deficit / hyperactivity disorder (ADHD) such as Adderall and Ritalin without proper screening. Cerebral is valued at $ 4.8 billion.

Cerebral has since said it will stop prescribing controlled substances to new patients for ADHD, the New York Times reported. Its president and chief medical officer, Dr. David Mou, told the newspaper the company is “very judicious in how we prescribe medications.”

Health-care practices are by nature constantly evolving as technological innovation paves the way for increased understanding of medical conditions and new treatments. This is true for both physical and mental ailments.

CAMH’s Dr. Gratzer stresses there are excellent practitioners who provide virtual care, and that some people can benefit from the convenience and accessibility offered by apps.

“I think there’s a role for virtual care,” he says. “But I also think there’s a role for transparency, and accountability, and basic standards.”

Bobbe Hayes is a freelance writer based in the GTA.

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