A few years ago, I had the immeasurable pleasure of being invited to the launch of a Mental Health at Work program for our employees. I joined our colleagues in the Service Center in St Johns, Canada, for the kickoff of “Not Myself Today“. It’s a program that helps employees express themselves, especially when things aren’t going well for them.
The program offers resources to support mental health at work, for online and offline use. It is aimed at two things. First, it helps companies raise awareness and reduce stigma around mental health. Secondly, it provides tools and resources to connect workers to their own mental health, and take action if needed. And it’s evidence-based – more on that later. I thought it was a pity that it was a Canadian program only, but found that it is now available in Europe too. (And if you don’t know where St Johns is, look it up, or better yet, visit it – the town and its surroundings are stunningly beautiful.)
We had been launching Mental Health programs for employees for a while, but I liked this one because it offered so many different ways for employees to participate, and encouraged them to talk about their issues in a safe way while fostering empathy with others.
The annual Mental Health Awareness Month of May is always a good time to reflect on where we are and what else is needed to ensure people feel safe enough to ask for help when needed. This year has also seen a record number of investments in mental health solutions and apps, and so it’s an appropriate time to dive deeper into the topic of mental health apps and how they can support your employee well being strategy. But first, let’s take a deeper look at the issue.
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What does the science tell us?
As Mental Health America notes, “while 1 in 5 people will experience a mental illness during their lifetime, everyone faces challenges in life that can impact their mental health.” It’s important to distinguish between mental illnesses – that require a professional intervention – and mental health issues at work that can be supported by a program. A company should understand the purpose of their mental health program and craft a project very carefully. And if that program includes an app, it’s also critical to understand what that app can and can’t be used for.
There are very few guidelines and no professional certifications for mobile applications aimed at mental health concerns. They are not subject to official protocols the way health professionals are. Because many of these apps are relatively new, in-depth, peer-reviewed research into the effectiveness of these apps is generally missing, even though many providers make an abundance of claims. Because mental health professionals have raised concerns about these solutions, it’s very likely that more strict regulations, especially around claims without scientific evidence, are coming.
A 2019 study aimed at understanding the attributes of popular apps for mental health and how these qualities relate to consumer ratings, app quality and classification by the WHO health app classification framework found that nearly 50% of the 120 apps that were examined made claims that appeared medical. The researchers concluded that “due to the heterogeneity of the apps, we were unable to define a core set of features that would accurately assess app quality.”
In another study researchers went to the Apple and Google stores and identified 1,435 mental health apps. They then focused on the 73 highest ranking apps and looked at their claims: nearly 65% of the apps claimed to effectively diagnose conditions, improve symptoms or mood, or foster self-management. 44% used ‘scientific language’ to support these claims, yet the evidence wasn’t “commonly described” and 32% used anecdotal user reviews. In other words, claims were made without proper scientific evidence.
Another concern professionals have about mental health apps involves the lack of data security and privacy measures. Some of the apps require that people share personal data, and the companies that sell these solutions are not subjected to the strict medical privacy or confidentiality requirements that mental health professionals have to adhere to. This data, if leaked, could have far reaching consequences for an employee’s future. If an employer introduces apps that request an abundance of private data, this might also raise suspicion with employees – they will likely not use the app. To be safe, focus on apps that require a minimum of user data, as they will be more appropriate in a work environment.
It’s clear that there is a need for an agreement about standards, principles and practices when evaluating mental health apps, allowing employers to choose them with confidence. The World Psychiatric Association has released an Insight paper proposing that as a minimum, standards for these apps should include the consideration of: a) data safety and privacy, b) effectiveness, c) user experience/adherence, and d) data integration. And even though the standard has not developed into certification requirements (yet), when you are considering adding mental health apps to your toolkit, it’s prudent to use these 4 requirements to evaluate the quality and suitability of your selection.
Mental health app? Take your pick.
So let’s start by cautioning that apps are not a replacement for therapy, especially not for people with a mental illness. Secondly, be careful when selecting mental health apps for your workforce: make sure you understand what they are intended for and don’t introduce them making claims. Evaluate the tool against the 4 standards above. And if the vendor offers supporting research, vet it carefully and make sure it’s peer-reviewed. If it’s a vendor paid study, it usually isn’t.
Despite the caution, mental health apps can have benefits for people, especially by offering support and guidance. Many include surveys or self-help programs that lead to practical suggestions based on the user’s input. Mental health apps increasingly make use of chat bot scripts, that lead a user to a to-do list with helpful actions. Some apps connect people to human professionals and make suggestions for support groups. And a relatively new group of apps uses biometrics to track e.g. a person’s heart rate to understand stress fluctuations and makes appropriate suggestions.
There are many apps available and they vary in complexity and purpose: some focus on one issue, while others address more than one. Some apps help manage stress and anxiety using deep breathing and relaxation techniques. Other apps track the mood of people who suffer from depression and bipolar disorders. There are also apps offering self-help skills or addressing other therapeutic goals. Mental health comes in many forms and no app can cover the whole spectrum.
A key advantage of mental health apps is that they can reach people who would normally not seek treatment by removing the stigma associated with it. The anonymity of the app can offer a safe space to employees who might feel embarrassed to speak out in person, or to reach out to a mental health professional or simply lack the financial resources needed to address their issues.
Another advantage, especially when using chatbot based apps, is the surprising finding that people are more willing to discuss these types of issues with a bot. Turns out, employees don’t feel they can talk about mental health issues with their colleagues or managers for fear they would be judged and that it might negatively impact their career. An impersonal bot, that is not judgemental but offers helpful suggestions is perceived as a great alternative to help them find solutions to their problems.
And finally, recent studies find that mental health issues often stem from financial issues. People who have debts worry about them constantly, and even more so at work. One study concluded that people experiencing mental health problems are three and a half times more likely to be in problem debt than people without mental health problems. And so, while it’s great to educate your employees on their mental health, educating them on financial responsibilities might be just as effective. Before you introduce a solution, or an app, make sure you understand what would be most beneficial to your employees by (anonymously) asking them what would make a difference.
What are the technologies underneath mental health apps?
The technology behind these mental health apps is evolving rapidly and new innovations are being introduced on a regular basis. So, what will the next big thing be?
Personalized chatbots – since many people find it easier to talk about their mental health with a bot, and chatbot developments move fast, it’s only a matter of time before chatbots will be able to personalize the help they offer. Some apps already make use of simple algorithms to determine what might be the cause of a person’s stress, anxiety or depression. And as these algorithms become more sophisticated, they will be able to offer suggestions that are more and more relevant to each user.
Virtual reality is a relatively new technology, but its application in mental health comes with great expectations. VR allows people to recreate stressful situations and apply different habits for a better outcome. Even though at the moment VR headsets are expensive and mostly used in a therapeutic setting, as they become more mainstream, mental health will be one of the areas where its application will be very useful.
Emotion tracking technology is in the early stages, and used to understand a person’s emotions by “reading” facial expressions, listening to your voice or analyzing your keystrokes. Until now, emotion tracking is mostly done through journaling, but technology is able to much more accurately describe a person’s emotions and track it continuously. Properly tracking emotions is complex, but it can help employees by giving an early warning sign when they “sense” a change in behavior, and suggest an alternative approach.
Biofeedback falls into the same category. It usually comes with a wearable device. A lot of people already use these devices to track their physical activity, like daily steps and workouts. More sophisticated wearables will capture markers in response to signals from the body, make people aware of their emotional state and suggest an action to lower their stress levels.
Eventually, these technologies and apps will be able to fully tailor their help to the individual, using information about their medical history, their mental health, their financial situation and more. While this might be the direction, it’s questionable if employees want to share that kind of detail with an employer sponsored app. On the other hand, they might be willing to set aside their privacy in exchange for demonstrable helpful, tailored advice.
Is it time for a Chief Wellness Officer?
But don’t rely on technology only, you need human intervention as well. The new role of Chief Wellness Officer popped up during the pandemic to help address workforce well-being, as employers realized that maintaining productivity required more than a well equipped work station at home. Addressing the physical and mental well-being of workers who were confined to their homes was just as important. And while you might not need a full time CWO, or add them to your executive team, you should consider tasking someone with the responsibilities. What are they?
First of all, CWOs are responsible for identifying the cause of worker anxiety and selecting and deploying resources to help them deal with these issues. They also advice the leadership team on pandemic policies and procedures, with a special focus on how they will affect employee morale and well-being.
CWOs also make sure that resources are in place to help employees deal with mental and physical health issues not related to the pandemic, but focused on improving overall well-being, while making it part of business-as-usual. Addressing mental health is not a short term project, and CWOs help you should become ingrained in your operational practices. This includes short term interventions to address an immediate problem to long term approaches like digital and/or physical programs so employees stay well and are productive. CWOs also ensure employees use mental health apps with the appropriate guidance, and educate them on what they are meant for, and when to seek professional help.
CWOs have a critical task in helping employees return to the office, if that’s desired, and making sure there are health protocols in place. Going forward, they will be added to a companies’ emergency response team, making sure that employee health and wellness are properly addressed during a next disaster (not limited to a pandemic only).
Where do you begin?
Start by thinking about the purpose: what do you want to achieve – and involve a subset of your employees to give you guidance. The overall market for behavioral & mental health care is exploding, and the pandemic has boosted the number of apps that are available.
The next step is to check if your government sponsors or subsidized a national program, or if there is a local professional association that can give guidance and point you in the right direction. If you are part of business network, as around for recommendations. Considering the multitude of apps, it’s almost impossible to find a list of independently vetted apps. Evaluating dozens of apps on your own is not practical either.
As recommended above, an app should support a larger mental health program, not stand on its own. And a mental health program doesn’t necessarily need an app. However, when you add an app to the program, check at least for:
- What’s the philosophy behind the app? Providers that claim to “cure” anything are a no-go.
- Does the provider deliver services to companies like yours? Ask for a reference to speak to them in order to ascertain their appropriateness for your workforce.
- How is the personalized experience? Invite employees to a user group and let them evaluate your top three.
It goes without saying that the normal provider checks with regards to partnering, security, privacy etc. still apply. And that you can find some inspirations in the accompanying overview of companies offering a mental health solutions.
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