Thanks to the pandemic, there is heightened interest in new effective options for preventing and treating anxiety, depression, and other psychiatric illnesses. Human resources managers are looking for new ways to support their employees. Data from the U.S. Centers for Disease Control and Preventions (CDC) suggests that the mental health of younger people and minorities has been especially impacted.
In the last 12 months, our research team at the division of digital psychiatry at Beth Israel Deaconess Medical Center, an affiliate of Harvard Medical School, fielded a dramatic increase in questions related to digital mental health, specifically digital mental health apps. Here are three of the most common questions that arose in conversations with physicians, senior executives, and HR managers, and our answers, which are based on our experiences in clinical care, clinical research studies, and industry analysis.
1. Should my company offer access to mental health apps?
The best thing you can do for your employees is to offer them robust health care coverage at a reasonable price. This coverage should include comprehensive mental health care that makes face-to-face therapy with a licensed clinician affordable and accessible. A mental health app on its own is not an equal substitute. That’s because to date, there isn’t evidence that self-help apps are as effective as therapy or medication in treating mental illness. But they may be able to help some people better cope with stress and symptoms related to anxiety or depression.
Consequently, mental health apps should only be used to complement therapy and other forms of self-care, such as exercise, healthy diet, and restful sleep. Like any complementary therapy, apps will not solve the root cause of mental health problems if there are underlying systematic workplace factors related to toxic cultures, abuse, and so on. HR managers should rule out these broader causes before focusing on app options.
Evaluating evidence for the usefulness of an app can be challenging. While we are seeing a rise in published studies and are hopeful evidence that substantiates mental health apps will grow, the science behind the apps that employers offer employees is still limited. Indeed, we have found that the majority of commercially available apps make claims related to mental health that they cannot back up with scientific evidence. Therefore, HR managers must decide — based on their budget, their workforce’s unique set of needs, and often on an individual-by-individual basis — whether the benefits of easy access and lower cost afforded by mental health apps are compelling enough with or without rigorous research that validates their efficacy.
Another consideration is that many mental health apps today are increasingly supported by coaches — as opposed to licensed clinicians — to drive engagement, which should give HR managers pause. HR managers will want to explore who these coaches are and what professional degrees or other accreditations, if any, they hold. Sometimes this information can be obtained by simply browsing a company’s website. If it’s not obvious, managers should reach out to the company directly and ask or consult a mental health professional who understands accreditations and the education they require.
2. What is the best app I can offer my employees to help them manage stress or anxiety?
While apps themselves are unable to treat a mental health condition, they can offer employees access to new tools, skills, and resources that may help them better cope and manage. There are hundreds of apps offering immediate access to mindfulness exercises, mood tracking, mental health education, specific therapy skills, biofeedback, and more. Each can potentially be useful towards reducing stress, negative thoughts, or even cravings related to addictions. But we don’t think there is a single best mental health app for everyone and recommend that HR managers seek apps that can address employees’ specific needs.
We avoid lists of “top 10 apps” because of their subjective ranking and how quickly apps update and even reinvent themselves. We have seen many app rating websites posting reviews of defunct apps and even found that 28% of apps recommended to students by colleges were no longer available for download. A good rule of thumb empirically derived from our team is that if a rating is more than six months old, ignore it and anything else on that list or website.
We also caution against evaluating apps on the basis of the number of times they’ve been downloaded, their star ratings, or advertising. While a handful of apps have emerged as the most popular or well known, these are not always the most effective tools.
HR managers should look deeper and ask tougher questions: What in the workplace may be contributing to stress or anxiety? What does this mean for mental health of employees and what resources do they need to cope? If employees have variable hours, then an app that primes users for sleep might be beneficial, whereas if burnout is a concern, then making conversations with licensed therapists available to employees might be more important.
To help HR managers make sense of the growing number of available apps and find the best match for their employees’ specific needs, our team built and maintains an evidence-based, free, online resource, the M-Health Index and Navigation Database, which is supported by a charitable gift from the Argosy Foundation. The database includes information on more than 400 apps across 105 dimensions, including costs, supported conditions, functionalities, features, evidence, engagement, and privacy.
3. How do I evaluate the economic impact of a digital mental health product?
We know that the burden of mental health is costly, and it is effective to prevent and treating mental illness. Many websites for mental health apps make claims about return on investment and savings that are designed to attract HR managers. But while there aren’t definitive numbers (yet) that indicate the cost-effectiveness of digital mental health tools, we advise HR managers to consider four types of data to estimate potential savings.
First, managers should estimate the cost due to the conditions (e.g., lost productivity) per employee. Second, managers should request engagement data to learn the average percentage of users who will remain active on the app after two weeks. This information is seldom publicly available, but it’s critical: Research suggests that average engagement rates may be as low as 5% after two weeks. Third, managers should ask the company for estimates of the app’s positive impact on mental health in terms of a percent reduction in symptoms. Fourth, managers should seek data on the duration (the fraction of a year) the intervention will offer a sustained effect.
Multiplying these four numbers together will give managers an estimate of the potential cost benefit of an app per employee over one year. For example, $5,000 of lost productivity x a 25% reduction in depression scores x a three-month duration of effect (25% of a year) equals approximately $312 dollars per year. But if engagement is 5%, then multiplying $312 by 5% yields a value of approximately $16. We offer more details of the model and sample calculations in this published paper. Through the process of asking these questions and gathering relevant data, managers are simultaneously learning about their employees needs and how the digital mental health product may or may not help them.
While we have not yet seen apps offering a satisfaction or performance guarantee, managers should demand benchmarks for results and hold companies responsible for delivering on them. The best apps will not be afraid to sell themselves through results. As the space matures and companies merge, HR managers may soon be able to select customized app bundles and offer employers a suite of digital tools.
Decisions around digital mental health products for employees should be based not on marketing or their alleged popularity but on the evidence, engagement, and the types of therapists associated with the product. Except for telehealth apps offering a synchronous (i.e., video or phone call) connection to a licensed therapist or psychiatrist, they should be used only to augment, not replace, evidence-based care. And when choosing these digital products, HR managers should strive to identify their employees’ specific needs and find the offerings that can best address them.
Sources: Harvard Business Review