Tech therapy: Do mental health apps work and are they safe?

Clinical Effectiveness Specialist at Bupa
19 November 2019

Need to book a taxi? Fancy a burrito? Want to watch the latest Netflix series on your way to work? Whatever it is you want or need in today’s digital world – there’s an app for that. But on a more serious note, one type of app that’s exploded onto the scene are those designed to help you with your mental health.

Woman on a phone

What do mental health apps do?

Apps designed to help you manage your mental health are varied, offering you ways to reduce stress, anxiety, track your mood and build confidence to name just a few. They use a whole range of digital strategies to make them easy to use and engaging, such as music, games, diaries and guided exercises. And with one in six of us (in England alone) experiencing a mental health problem in any given week, the potential for tech-based help like this is huge.

What are the potential benefits of mental health apps?

Digital therapies are a core part of the future plan for mental health services. An NHS-led programme called Improving Access to Psychological Therapies (IAPT) currently treats over 1 million people a year. But it plans to reach almost double this by 2023/24 – and digital therapy products will play a crucial part in delivering this care. The core strategy is to use tried-and-tested online programmes and apps, with the support of a therapist, to achieve similar outcomes to face-to-face therapy alone.

Apps and online programmes enable people to take control of their treatment and proactively take steps to manage their mental health and wellbeing. What’s more, apps are quick, convenient, and easy to use and access. They are also a cost-effective way of meeting the growing demand for mental health support, reaching and supporting greater numbers of people.

What are the challenges?

There are over 10,000 mental health apps available to download from app stores, but there are no regulatory processes in place to assess how effective they are. This means that many (but not all) haven’t been developed or assessed by clinical experts and aren’t medically approved.

So when it comes to something as important as your mental health, how do you know the app you want to use is safe, effective and medically credible?

What to watch out for when choosing an app

Be wary of the language used to describe the app. Scientific language is often used to describe and ‘sell’ an app, but a recent review that looked at 73 apps found that only three of them had evidence to support their claims. This is concerning because using ‘medical’ and impressive language can falsely reassure you about the credibility of the app. At best it’s misleading but at worst it could put your safety at risk.

Unfortunately, choosing a mental health app isn’t as straightforward as selecting a product on Amazon. Where we might look at the user star ratings to choose a new toaster, we can’t rely on the same process for choosing a mental health app. Studies have shown that there’s an inconsistency between high star ratings and an app’s usability and medical credibility. So just because an app may have five stars from users, it doesn’t mean that it’s been proven to work.

The problem is that all health apps are really difficult to assess because they need such a broad and high level of expertise to thoroughly evaluate them. For example, data privacy, security and clinical effectiveness are just a few of the areas that need specialist knowledge and input.

How should mental health apps be assessed?

The good news is that healthcare leaders are addressing these issues and challenges. One approach is to assess the software developer, as opposed to the actual software or app. The US Food and Drug Administration (FDA) is currently developing this approach. NHS England, on the other hand, have developed a set of Digital Assessment Questions (DAQs) to assess individual apps. And experts have identified them as the current gold standard of app evaluation. The criteria look at seven quality markers that apps should follow and keep to.

Developers have to show:

  • how the app improves health and wellbeing, providing clinical evidence
  • they have taken all appropriate steps to make sure patients are safe when using the app
  • any personal data is handled safely and lawfully
  • the app is secure and all data is protected
  • the app is easy to use and accessible to everyone
  • the app can exchange data with other systems safely if it needs to (such as medical records)
  • the app is stable and that people can easily report errors to the developers to correct

Which apps should I use?

The NHS have used this framework to curate a library of 20 approved mental health apps. These apps have all been quality assured; they are safe, effective and secure.

Another resource is Good Thinking – this site has a library of apps for stress and sleep management, which have all gone through this rigorous assessment.

Another mental health app library that may be helpful is PsyberGuide. The apps featured here are all rated on their credibility, user experience and transparency, described below.

  • Credibility score – this shows the scientific evidence behind the app and how strong the evidence is.
  • User experience – this assesses how easy and accessible the app is to use and overall experience for the user.
  • Transparency score – this lets you know how clear the app’s privacy policy is, explaining how it handles and stores data.

Many of the apps here have Expert Reviews as well. But do look at the date of the review as some may be out of date.

Science-backed apps

It’s also important to point out that just because a mental health app isn’t listed in an approved library, it doesn’t necessarily mean that it lacks these markers of quality and credibility. Some of the most popular mental health apps aren’t listed in these libraries but do have scientific evidence that they work. For example, Headspace, the mindfulness app, has 16 published studies in science journals, all of which indicate that the app reduces stress, irritability and improves overall wellbeing. There are also over 65 research studies in progress assessing the clinical soundness of the app.

Another example is Calm, which has a growing evidence base. One study showed that an eight-week programme improved stress, mindfulness and self-compassion in a group of students. Several other studies have been done with more on the way.

Concluding thoughts – what’s the future?

Despite quality frameworks and curated libraries, navigating the expanding world of mental health apps remains a challenge for us all, but these do give us a great starting point. Evidence frameworks and regulations in the digital health space will continue to grow, along with other emerging technologies such as artificial intelligence (AI) and chatbots. And, as a result, it seems highly likely that we will see the regulation of mental health apps continue to improve, with more of the most popular apps included in approved libraries.

There’s no denying the increasing demand for mental health support and although technology will undoubtedly assist, it’s important that we still consider and address the underlying causes of mental health problems. For some, the accessibility and anonymity of an app is perfect, but we must also remember the value of reaching out and supporting one another.




If you’re worried about your mental health, our direct access service aims to provide you with the advice, support and treatment you need as quickly as possible. If you’re covered by your health insurance, you’ll be able to get mental health advice and support usually without the need for a GP referral. Learn more today.

Ella Hewton
Clinical Effectiveness Specialist at Bupa

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    • Adult Psychiatric Morbidity Survey: Survey of Mental Health and Wellbeing, England, 2014, webarchive.nationalarchives.gov.uk, published 29 September 2016
    • Torus J, Roberts LW. Needed Innovation in Digital Health and Smartphone Applications for Mental Health: Transparency and Trust. JAMA Psychiatry. 2017 May 1;74(5):437-438. doi:10.1001/jamapsychiatry.2017.0262
    • Singh K, Drouin K, Newmark LP, et al. Many Mobile Health Apps Target High-Need, High-Cost Populations, But Gaps Remain. Health Affairs 2016; 35:12. doi:10.1377/hlthaff.2016.0578
    • Donker T, Petrie K, Proudfoot J, et al. Smartphones for Smarter Delivery of Mental Health Programs: A Systematic Review. J Med Internet Res 2013; 15(11). doi:10.2196/jmir.2791
    • Larsen, M.E., Huckvale, K., Nicholas, J. et al. Using science to sell apps: Evaluation of mental health app store quality claims. npj Digit. Med. 2, 18 (2019) doi:10.1038/s41746-019-0093-1
    • Digital health software pre-certification (pre-cert) program. Food and Drug Administration (FSA). www.fda.gov, published 18 July 2019
    • Nielsen SL, Rimpiläinen S. Report on International Practice on Digital Apps. Computer And Information Sciences. Digital Health And Care Institute (D.H.I.), pureportal.strath.ac.uk, published 1 April 2018
    • Larsen, M.E., Huckvale, K., Nicholas, J. et al. Using science to sell apps: Evaluation of mental health app store quality claims. npj Digit. Med. 2, 18 (2019) doi:10.1038/s41746-019-0093-1
    • Research shows Headspace works. Headpace. www.headspace.com, accessed 6 November 2019
    • Economides, M., Martman, J., Bell, M.J. et al. Improvements in Stress, Affect, and Irritability Following Brief Use of a Mindfulness-based Smartphone App: A Randomized Controlled Trial. Mindfulness (2018) 9: 1584. https://doi.org/10.1007/s12671-018-0905-4
    • Howells, A., Ivtzan, I. & Eiroa-Orosa, F.J. Putting the ‘app’ in Happiness: A Randomised Controlled Trial of a Smartphone-Based Mindfulness Intervention to Enhance Wellbeing. J Happiness Stud (2016) 17: 163. https://doi.org/10.1007/s10902-014-9589-1
    • Calm science. Calm. blog.calm.com, accessed 6 November 2019
    • Huberty J, Green J, Glissmann C, et al. Efficacy of the Mindfulness Meditation Mobile App “Calm” to Reduce Stress Among College Students: Randomized Controlled Trial. JMIR Mhealth Uhealth 2019; 7(6):e14273. doi: 10.2196/14273

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