Depression is the most common type of mental illness, affecting some 350 million people globally and contributing to other problems like obesity, cardiovascular disease, and cancer. But it often goes undiagnosed, and once you know you suffer from it, sometimes the most difficult part of treatment is just being able to regularly sit down on a therapist's couch.
That’s why Britain’s National Health Service has begun encouraging doctors to prescribe people suffering from depression—and teenagers in particular—a thoroughly modern kind of treatment: apps.
Norman Lamb, Minister of State for Care and Support in the U.K., told The Times last week that treatment-by-app was a way of meeting teens on familiar ground.
"If you’re a teenager and your world revolves around digital access, we must make sure you get access to therapy online. So these programs are being developed."
The initiative—which involves a doctor prescribing an app alongside medication or face-to-face therapy sessions—is meant, says Lamb, to achieve "a much more seamless service that allows you access online, face to face or over the telephone, whichever is appropriate."
After a diagnosis, a patient may still be given a course of medicine and offered face-to-face cognitive behavioral therapy sessions. But under the new program, the doctor also now has the option of medically prescribing an app to help with treatment.
While Britain's nationalized health system hasn't endorsed a single preferred mental health app, it already recommends a handful of apps that allow patients to assess their moods and set goals and reminders—for medication or therapy sessions—that can be sent via alerts or text messages.
Such tools can be helpful in encouraging patients who may be reluctant to attend face-to-face sessions due to shame or embarrassment, or as a stopgap measure, while patients are waiting for treatment—sometimes for over a year.
A recent report by the U.K. coalition of mental health charities We Need to Talk said that one in 10 patients are waiting for more than a year to be assessed for treatment like cognitive behavioral therapy. One in six—thousands of people across the U.K.—have attempted suicide while on an NHS waitlist for psychological treatment, the report said, and two-thirds said their condition had worsened before they had a chance to see a mental health professional.
Lamb has called these long wait times "unacceptable," and said the health agency would be implementing access and waiting time standards for mental health beginning next year.
The app initiative is part of a broader NHS effort to modernize and enhance youth mental health care in Britain, says Lamb, who has also urged doctors against putting patients on anti-depressants as a "sort of default position."
Though using apps as treatment may sound bizarre to older generations of patients and medical professionals, Lamb is quick to point out that there is firm evidence that app-based therapy has been proven to work in expanding access to treatment and to reducing costs.
That proof comes from, among other places, a web-based and mobile app called Big White Wall. The app, launched in 2007 by a British social entrepreneur named Jen Hyatt, is a hybrid of a social network and task manager for people suffering from depression and other mental health issues. The site allows users to post thoughts, drawings, and pictures in an anonymized forum that is moderated 24/7, and to advice from experts online, leave reviews of therapists, and take Internet-based cognitive behavioral therapy courses.
The site boasts impressive success rates in helping people deal with their psychological distress, noting that 75% of its members used the site to discuss a mental health issue for the first time in their lives. Eighty percent reported that Big White Wall helped them self-manage their psychological distress, and a staggering 95% of users reported one or more improvements in well-being, according to the company, which also cites peer-reviewed studies on its website. In May it launched a U.S. version.
While Big White Wall is subscription only, at £24 ($37) per month, some of the country's local health service areas subsidize its use among patients, and it's available for free to families and veterans. The National Health Service recently praised the app in a report on how the agency plans to modernize health services for everyone in the United Kingdom by adopting a more digital approach.
Another application cited by the NHS, Buddy App, uses a combination of website tools and SMS to keep patients on schedule for appointments and medication, and help them keep a diary of their emotions. The app, produced by London-based Sidekick Studios, is also being rolled out across the country through partnerships with local health care services.
In addition to a raft of apps dedicated to improving mindfulness, a number of apps have emerged in recent years intended for monitoring mental health.
One app recently designed by computer scientists at Dartmouth College uses an Android phone’s sensors to passively monitor a user’s well-being, for instance by counting steps, monitoring sleeping patterns, or estimating how often a user was involved in face-to-face conversation, all of which can be helpful indicators in diagnosing depression, say researchers. MoodTune, a free app developed in part by Harvard psychiatry professor Diego Pizzagalli, offers users simple games meant to help treat depression.
Part of the NHS's five-year plan to modernize includes progressive steps to make the agency a "digital pioneer" in global health care. As The Times reports, patients will be able to view all their health data including test results, doctors reports, and complete medical records in a single online hub by 2018.
Part of this initiative also involves embracing lifelogging and health-focused smart devices. Patients who use fitness devices like the Jawbone Up or Nike FuelBand, for example, will be able to upload their stats directly to their own NHS file so the information can be seen by their doctors. The service should also fully support other digital health tech initiatives like Apple’s HealthKit.
As Tim Kelsey, NHS England’s director for patients and information, told The Times: "We must embrace modern technology to help us lead healthier lives, and if we want, to take more control when we are ill. Our ambition is to make the NHS a digital pioneer for our patients and citizens."
The NHS cites research indicating that telemedicine for other aliments like heart disease has contributed to lower hospitalization rates and greater patient satisfaction. But the effort is also part of continual cost-saving measures that have been implemented by U.K. health officials amid growing budget cuts across the country's health care system.
Meanwhile, research has shown that globally, diagnoses of severe anxiety and depression in teens continues to soar, especially among girls. Between the 1980s and the 2000s, the number of British teens aged 15 to 16 suffering from depression nearly doubled, according to a major longitudinal study. Now one in 10 young people in the U.K. aged five to 16—or about 80,000 children and teens, says U.K. nonprofit Young Minds—suffer from a diagnosable mental health disorder.
In August, researchers in Australia looked at 19 studies conducted across 12 countries and found that teenage girls in Northern Europe, the U.K., and China are specifically experiencing an increase in mental health problems. Among the risk factors cited in the study were cultural, educational, and economic issues, but some have also blamed social media, where competition and bullying can be stressful for teens.
But the NHS and other mental health professionals see social media as a valuable tool for addressing teens directly. "Sometimes young people can be scared and or feel intimidated about phoning their doctor whereas online there are able to engage more freely," Lucie Russell, director of media at the mental health charity Young Minds, told the Daily Mail.
She warned however that apps should "always lead on to phone or face to face support" with doctors and therapists, and be used primarily as an educational and communication tool, "so that they can work out what sort of services they're looking for."
Along with digital submission and record keeping, the NHS, which provides free health care to Britain's 63.2 million residents, intends to emphasize app-based therapy in other treatments too. The agency already curates an official Health Apps Library which points patients to free and paid offerings on the web and in Apple's and Google's app stores.
In the near future the agency intends to award Kitemark recognition to apps or websites "that could help patients to improve their health, such as reminders to take medication, tools to track blood pressure or ways to spot signs of stress," reports The Times. Apps offering cognitive behavioral therapy will be given priority for official approval from the NHS.
Will this new world of doctor-prescribed apps have a real world effect on our health? The results look promising so far, at least where depression is concerned. But as with most health issues and treatment, any app-based treatment benefits could vary greatly from patient to patient depending on individual circumstances.
But for teens at least, who are used to communicating online, an app could be just what the doctor ordered.