Digital apps effective stopgap for mental healthcare access challenges

Digital health applications targeting depression and anxiety symptoms can support patients experiencing delays in securing initial mental healthcare appointments, according to new research.

Published in JAMA Network Open, the research assessed the efficacy of cognitive behavioral therapy (CBT)-based or mindfulness-based digital mental health apps in supporting patients waiting to have their first appointments with therapists and psychiatrists.

The demand for mental healthcare services skyrocketed during the COVID-19 pandemic. Pew Research Center surveys show that 41 percent of United States adults experienced high levels of psychological distress at some point during the pandemic. However, mental healthcare professionals are struggling to keep up with this growing demand, primarily due to the behavioral health workforce shortage. According to the latest federal data, 122 million Americans live in a mental health professional shortage area. Overall, 6,143 mental health professionals are needed to close the gap.

As a result, patients seeking mental healthcare services often face long wait times and delays in receiving the care they need.

Michigan Medicine researchers sought to determine where digital mental health apps can help support patients waiting to receive mental healthcare. They conducted a randomized clinical trial between May 13, 2020, and December 12, 2022, involving patients with appointments for outpatient psychiatry services within the University of Michigan Health System. The patients included in the study were 18 years or older with either a scheduled mental health appointment or an initial appointment completed within the past 60 days and daily access to a smartphone.

The 2,079 patients in the study were divided into one of five intervention arms: passive enhanced personalized feedback (EPF) only; Silvercloud mobile app use only; Silvercloud plus EPF; Headspace mobile app use only; and Headspace plus EPF.

EPF was provided through the MyDataHelps dashboard, which offered personalized tips and strategies to support mental healthcare. The Silvercloud app offered psychoeducation and self-guided modules introducing CBT skills via text, videos, and journaling exercises. The Headspace app offered various guided meditations and strategies for improving sleep, decreasing anxiety, and coping with stress.

Researchers found that depression scores decreased by 2.5 points from baseline to six-week follow-up across all five intervention arms. Not only that, but anxiety scores also significantly improved, dropping by 1.5 to 2 points from baseline to the six-week follow-up across all groups.

Additionally, scores of protection against suicide risk increased the most among participants using the Headspace app.

Thus, researchers concluded that while digital mental health apps cannot replace formal services, they help support patients facing long wait times to receive care.

“Having this type of option, especially for people who are motivated enough to seek an appointment and wait for it, could be very valuable when providers have long wait lists,” said study lead author Adam Horwitz, PhD, a psychologist and assistant professor in the Department of Psychiatry at the University of Michigan Medical School in a press release. “These individuals want to be doing something about their mental health but don’t yet have access, so this suggests that providing them with some sort of digital option when their motivation is already high, and they are ready to do something, could begin to make a difference.”

The research is critical as access to telemental healthcare — one of the most effective strategies to close mental healthcare gaps — is also declining.

Research published earlier this month showed that only 79 percent of mental health treatment facilities continued to offer telehealth after the COVID-19 public health emergency (PHE) expired in May 2023, compared to 81 percent before then.

Researchers contacted 1,404 facilities for the study in two waves: from December 2022 to March 2023 and September to November 2023.

Not only did the overall availability of telehealth decline but so did the availability of telehealth for comorbid mental health and alcohol use disorder (AUD) — from 559 facilities (76.3 percent) in the first wave to 457 (66.5 percent) in the second wave.