7.1 Risks and challenges of mental health apps and computer programs

In practice, the quality and effectiveness of some mental health apps can be questioned. As with the internet more generally, there are no rules or limitations as to what providers can offer online – there’s no requirement to demonstrate beneficial outcomes, for instance – and there is no real protection for clients from fraud and deceit.

Activity 20: Risks and challenges

Timing: Allow approximately 10 minutes

Listen to the BBC journalist Jordan Dunbar talking about the risks and challenges of mental health apps and computer programs with Dr Terry Hanley and Fiona Ballantine-Dykes, Deputy CEO of BACP.

Download this audio clip.Audio player: act20_audio.mp3
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Fortunately, attitudes did change. There’s a whole new world out there that now allows people to access therapy through apps and online. It takes away the stigma and awkwardness of having to speak face-to-face or get time off work. For many people of my generation, opening up online is the way to go.
Professor Terry Hanley is from the Univeristy of Manchester.
As young people see the internet as a first point of call for accessing support, we’ll see the use of internet services increase. At the moment we don’t have the regulation, or we don’t monitor that type of support enough – so this ‘open-up’ generation, this generation that’s used to talking about mental health, are increasingly at risk of expolitation or abuse.
So it’s much easier to pretend to be a therapist online: you can make up as many qualifications as you want, you can say that you have the skills to work with all manner of issues, and that could all be lies. It’s very difficult to monitor who that person is. So they might have a criminal record, they may have a background of being an abusive counsellor and being struck off a register in a particular country. And without some serious research into that, most people wouldn’t stand a chance of finding out that that was the case.
I’ve spent a small fortune on apps to try and treat my depression and my most hated foe: insomnia. They look and sound beautiful, with the sparkly marketing to go with it. But I had just assumed, like most people, that they were monitored somehow – either by the government, or Android, or Apple. Does anyone check they aren’t harmful? Or even just pointless?
It’s bit like the Wild West at the moment in terms of the way it’s being regulated. There isn’t really anyone who’s particularly taking ownership whether or not the apps work, or whether or not they’re of benefit to particular people.
I think the only people who are very interested are the people developing the products themselves, and we can see that some of those organisations are taking it very seriously. And they’re undertaking lots of research, and systematic research, to explore whether or not their products work. But others seem very ‘surface-level’, and they’re almost fun products rather than actually serious products to support mental health and wellbeing.
Relatively recently the NHS used to have a list of – not recommended apps, but apps that people might want to use. And it had to take that down as a consequence of, actually, further scrutiny of that list of apps – because they were either not managing data sensitively enough or there wasn’t really any robust evidence behind the services that they were offering.
Fiona Ballantine-Dykes from the British Association of Counsellors and Psychotherapists [sic].
We’re actively engaged in two pieces of work at the moment. One is how to work safely online and how to ensure that you are properly trained to offer your services online, but also information and guidance for therapists and for the public about working online – those are in progress at the moment.
In terms of meeting standards, again the draft framework we’ve been looking at will include standards around working online. We already have some – BACP’s had some for some years – but, as you rightly pointed out, things change very rapidly, and we need to keep up with things. So that’s very much on our radar – very much in our thinking about how best to make sure that people are meeting standards.
If we were to make great strides in regulation, whether it be statutory or voluntary, and the BACP was doing great work – that is completely undone whenever I go onto my Instagram and there’s an American company, or a completely international company, offering me cheaper, easier-to-access therapy from all around the world because they don’t need to be registered here.
Well, again, that’s a massive challenge. We do have international members at BACP, actually, and our certificate proficiency can be accessed by people outside. But in terms of the regulatory, or not, frameworks in other countries – there’s absolutely nothing we can do about that.
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The rapid changes and developments in this area are clearly not without problems for clients and practitioners. At the time of writing, many apps and programs that are freely available have not been formally evaluated; the few that have are often not easily accessible. If you’re employing technology-based support, it is therefore important to rely on apps and programs that have been evaluated, and follow the advice of recommended providers (Bennion et al., 2017).

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7 Mental health apps and computer programs