Several of the National Health Service’s mental health apps should be removed from the NHS Health Apps Library, because the apps lack evidence of their effectiveness, an article suggests.
The authors, researchers Simon Leigh of the Management School at the University of Liverpool, England, and Steve Flatt of the Liverpool Psychological Therapies Unit Community Interest Company, specifically fire shots at most of the NHS apps for the management of depression and anxiety. After assessing the metrics used to evaluate mental health apps currently in the library, they found that only four of the apps dedicated to the management of depression and anxiety “provide any evidence of patient-reported outcomes to substantiate claims of effectiveness” and only two apply validated metrics, including the generalized anxiety disorder 7-item scale (GAD-7) and 9-item patient health questionnaire (PHQ-9) to assess clinical performance.
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“As such, confidence in, and the validity of the claims made by apps that fail to apply such metrics must be considered as low at best, suggesting that the true clinical value of over 85% of NHS accredited mental health apps is at present impossible to determine,” they wrote.
The authors criticized many mental health apps sponsored by the NHS and other organizations, but they also advocate for the use of mental health apps that meet certain specifications, including those that “demonstrate evidence of real-world clinical effectiveness prior to receiving a seal of approval from a world-leading health care system and [be] recommended for patients in need of high-quality psychological interventions.”
Among the reasons the article’s authors list for supporting the idea of mental health apps is the possibility of such tools helping to decrease the wait time for receiving treatment, citing grim expected outcomes for patients currently waiting for mental health services in the United Kingdom. For example, 1 in 6 patients on waiting lists for mental health are expected to attempt suicide.
The writers also laud app-based psychological interventions’ potential to remove financial barriers to treatment and the fact that the use of some mental health apps has led to symptom improvement among patients with mental health issues.
“Given the ever increasing demands and limited supply of NHS mental health services, coupled with barriers to care, including a desire for anonymity, indirect financial costs, and impaired access to treatment centers, the use of apps may not only promote health service efficiency, but also support the NHS in returning to its seminal promise of equal access for equal need,” the authors wrote.
They added: “However, if this is to be an effective venture, this space clearly requires more stringent regulation, vetting, and quality control,”
Reacting to the article, a spokesperson for NHS England said: “This study illustrates that digital tools can act as powerful psychological interventions. It’s vital that patients know which apps to choose and that’s why we are working to upgrade the Health Apps Library, which launched as a pilot site in 2013 and reviews and recommends apps against a defined set of criteria. Earlier this year, we launched the Mental Health Apps Library, which features apps and digital tools that are compliant with IAPT [increasing access to psychological therapies] quality standards and offer National Institute of Health and Care Excellence approved treatments that can demonstrate effectiveness in treating mild and moderate depression and anxiety.”
Read the full article in Evidence-Based Mental Health (doi: 10.1136/eb-20150102203).