Best Mental Health Apps: Using the “APA App Evaluation Model”

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HERE IS HOW

Mental health clients are increasingly using their smartphones to access mental health tools. Given that a large majority of the general population owns a smartphone using devices for behavioral health care allows for greater access and support for individuals who may otherwise be unable or unwilling to receive professional help. Identifying the best mental health apps is key to ensuring that clients utilize online tools that align with ethical and professional standards and evidence-based approaches.

Finding the Best Mental Health Apps

While the need for stand-alone behavioral and mental health tools has been strong, this TBHI blog post dated 2020 raised serious concerns about the ability of stand-alone apps to help consumers in need. That concern recently has been raised from a different perspective: the reliability of readily-available information about app selection from app stores. Searching for the best mental health app in a general app store can lead to many suggestions. Still, professionals are concerned that recommendations may be based more on popularity than quality. Reviews in public forums can be based on the total number of downloads and five-start rating systems that can be artificially inflated.

Empirical Evaluation of the APA App Evaluation Model

To quantify the issues related to behavioral and mental health app reviews in app stores, a related study was recently published by Rickard and colleagues. They examined 92 of the most popular and best mental health apps for depression, anxiety, and mood on Google Play and the Apple App Store (2022). They reviewed the apps along five dimensions:

1. Accessibility
2. Integrity
3. Clinical and Research Evidence Base
4. User Engagement
5. Interoperability.

Looking for the best mental health apps, the researchers first excluded those not meeting the APA App Evaluation Method criteria. The American Psychiatric Association has advanced that model to help clinicians, consumers, and other stakeholders find the best mental health apps. The APA website explains:

Our approach to rating mental health apps is grounded in the belief that any decision between you and a patient is a personal decision based on many factors, for which there is rarely a binary ‘yes’ or ‘no’ answer. For example, cognitive behavioral therapy is often appropriate for many patients, but certainly not all. This is because it requires getting to know the patient’s specific clinical case to make the best decision. However, selecting an app to use with a patient is slightly different from selecting a form of psychotherapy or medication. This is because this type of decision is not what psychiatrists and mental health clinicians are classically trained to do. It is still a fairly novel process with which many clinicians may be unfamiliar.

Thus, the goal of APA App Advisor’s evaluation process is to employ a hierarchical rating system and embedded rubric so that APA members, patients, and other providers, become familiar with important information that should be considered when picking an app, and how this differs from choosing more traditional therapeutic interventions. Evaluations include important considerations and choosing the correct app for a particular situation will hopefully result in better clinical decision-making, and improved patient outcomes.

A detailed discussion of the model is available here to guide both clinicians and users find the best mental health apps. The core of the APA App Evaluation Method involves these five steps for finding the best mental health app:

Step 1: Access and Background
Step 2: Privacy and Security
Step 3: Clinical Foundation
Step 4: Usability
Step 5: Data Integration towards Therapeutic Goal

Using the APA APP Evaluation Model

Rickard and colleagues then examined the relationship between the quality of the apps according to the APA APP Evaluation Model and the visibility given to the 92 selected apps in either Google Play or the Apple App Store. The apps were also organized according to function:

1. Mental health promotion or psychoeducation
2. Monitoring or tracking
3. Assessment or prevention
4. Intervention or treatment.

The researchers found that out of 10 apps most visible in the app stores, three met the APA app evaluation model criteria for research/clinical base and engagement/ease of use. Furthermore:

• Only one app met all five measures of the APA app evaluation model.
• There was no significant relationship between the app’s quality and visibility in the app store.

Study Conclusions

The researchers concluded that app customers could be vulnerable to selecting apps simply because of visibility and not necessarily the best mental health app for those in need. They also called for accountability among behavioral and mental health app developers. They suggest that app developers for behavioral health apps should be required to follow an established app evaluation model to meet minimum quality and integrity guidelines before releasing mental health apps for public consumption.

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