During and after the COVID pandemic, there’s been an influx of digital mental health applications. Experts debate their usage and efficacy, particularly regarding ethical and privacy considerations: for example, in a 2023 FTC settlement, online therapy app BetterHelp was fined for its use of private health data. Digital health technologies (DHTs) have the capacity to facilitate mental health treatment for those who don’t have access to in-person services, but research around effectiveness and proper use is still nascent.
Shekhar Saxena, of the Department of Global Health and Population at the Harvard T. H. Chan School of Public Health and program director of Mental Health Leadership: Transformation Through Innovation, goes one step further. “Apps will be useful for many people, but they don’t answer the mental health crisis that we are facing,” he explains.
As Saxena sees it, there are two primary ways that DHTs are being utilized as mental health resources, with different levels of success: as direct-to-consumer services and as training tools for non-specialists.
Using Digital Health Technologies as Consumer Mental Health Resources
There’s a wide variety of online mental health apps available, marketed as helping users with challenges ranging from anxiety and depression to alcohol dependency. There are likely self-help options that will be helpful to some, but the majority of apps are commercially driven. “Most of them do not have a good evidence base; only a few have been approved by FDA as valid treatment methods. The vast majority of people who need mental health care are unlikely to benefit from mental health apps alone,” Saxena explains.
There is evidence to suggest that apps for mental health can be a net positive for young people, but that it depends on usability, efficiency, and capacity to engage—when there are technical issues or limited access to the service, for example, it can hinder adoption and usage. As this review notes, human go-betweens, sometimes called digital navigators, are necessary to assist users, and there’s increased risk of safety issues and breakdown in therapeutic relationships. As this review notes, there’s potential to reach patients who do not have access to in-person resources, including those who suffer from conflict and displacement, but this potential remains largely unexplored as of yet.
It’s critical, though, to focus on the ethical use of this technology; where, exactly, digital health technology will fit within the clinical workflow is yet to be determined. In short, more research is needed, and users should exercise caution when trying DHTs for the first time.
Using Digital Health Technologies for Non-Specialist Mental Health Providers
By contrast, available research suggests that as a tool for those who help deliver mental health care, “there are many methods to empower them to learn from the portals, to be trained, to be supervised, to be supported,” says Saxena. Mental health specialists are in short supply relative to the needs of patients; thus, health workers, volunteers, workplace administrators, and other community resources can benefit from DHTs as ways to train and connect with mental health specialists to extend mental health care in communities.
From a paper authored by Harvard’s John A. Naslund, Rahul Shidhaye, and Vikram Patel (who is a program director for the Mental Health Leadership program), there is evidence to suggest that DHTs benefit nonspecialist health workers—community and lay health workers, midwives, and nurses—providing evidence-based mental health care through “training, providing digital tools for diagnosis, guiding treatment, facilitating supervision, and integrating services,” as noted in the paper.
Citing Harvard’s EMPOWER digital platform, spearheaded by Patel and Naslund, Shekhar notes that digital mechanisms to train mental health care providers are demonstrating improvement in the efficacy and reach of mental health services.
“Digital mental health technology delivered to providers has been less utilized but has great potential to improve the effectiveness of manpower that we know is scarce,” he explains. “They have an amplifying effect on increasing the effectiveness and output of the people who provide mental health care.”
Harvard T.H. Chan School of Public Health offers Mental Health Leadership: Transformation Through Innovation, an online course to help health care leaders address the mental health needs of their communities with knowledge, skills, and support. The course covers a variety of other topics on mental health, besides digital technology.