Digital mental health apps have surged in prevalence in recent years as organisations seek to make support for mental health and wellbeing more accessible. Consumers value the convenience and low cost of apps and find many of these apps to be appealing and engaging.
As health practitioners it is easy to feel overwhelmed by the sheer number of options available. Choosing a good quality app to recommend to a patient or client can be daunting, particularly when we cannot always rely on the claims made by the developers. Fortunately, assessing the safety and quality of apps doesn’t have to be hard, once you know what to look out for.
Evaluating an app may require downloading it to check out the content, accessibility and user experience. While this can be initially time consuming, it can also be useful when it comes time to recommend the app to a patient or client as you will be able to speak to specific aspects of the content and functionality and why and how you think it could be useful for them.
Evaluating Safety and Quality
When evaluating an app to recommend to a patient or client for self-managed or supported use, consider the following criteria:
1. Evidence-Based Approaches
Clinical practice guidelines: When targeting a mental health condition, does the app adhere to accepted clinical practice guidelines?
Research backing: Is the app based on established, effective psychological principles and techniques? Has the app itself undergone testing? Check if the app has published studies or clinical trials that demonstrate its efficacy, such as an RCT.
Content validity: Review the content to check that the app does what it claims to do, what you need it to do, and aligns with an evidence-informed approach. Would you expect it to have benefit for your client?
2. Credibility of the Developers
Professional background: Investigate the qualifications of the person or team who created the app. This can usually be found in the About section of the app or on the app website. Apps created by licensed mental health professionals or backed by reputable mental health organisations or professional bodies might be more likely to be based on an evidence informed approach and follow appropriate clinical practice guidelines.
Funding: Who funded development of the app? Is it not-for-profit or for commercial gain? Check the privacy policy and terms and conditions for statements about whether data is shared or sold to third parties. If there is a cost attached to the app, does it seem appropriate for what it offers and the expected benefits?
3. User Experience and Accessibility
Accessibility: Is the app accessible and suitable for the patient or client you intend to use it with? Is it available on a platform that matches their device? Is the language accessible (e.g., for the age of the user and for culturally and linguistically diverse groups)? Are there accessibility features for users with disabilities?
Safety of content: Check the content of the app yourself to make sure that the user experience is safe. Consider the language, images and “values” embedded in the app. Is there any content that could be used inappropriately (such as inadvertent access to information on losing weight for someone with an eating disorder)? Does the app outline any limitations or disclaimers relating to clinical responsibility and when to seek professional help?
Cultural safety: Review the app’s content and consider whether the app is designed with diverse populations in mind. Culturally relevant content can enhance engagement and effectiveness and foster a sense of inclusivity. If wanting to recommend an app to a particular cultural group, check if the app has been tested or was co-designed with that population.
App usability and features: A good quality app should be user-friendly and intuitive to use. Is it likely to engage the user through personalisation, gamification, rewards etc? One way to assess user acceptability and engagement is to check reviews on the app store.
4. Data Security and Privacy
Privacy policies: All apps that collect personal information must comply with the relevant privacy laws within the jurisdiction that the app is developed in. In Australia, this is the Privacy Act .
Data management: Check the app’s Privacy Policy and Terms and Conditions for statements about what data is collected and how it is stored and used. What security measures are used (e.g., encryption)? Where is the data stored and who could have access to it? Information on data management is usually included in the app description in the app store, but more detail and a full privacy policy should be available within the app.
Security and safety: Look for statements about how the app keeps user data secure. When was the app last updated? Apps that are not being regularly updated (ideally at least annually) may pose more of a security risk.
Assessment Frameworks
A variety of frameworks have been developed across the globe to guide the assessment of health apps in domains considered essential for quality and safety. These frameworks can be useful in providing a structure for health practitioners to follow when assessing an app for use in practice.
Some notable examples are:
The Australian Digital Health Agency Assessment Framework for mHealth apps
Appendix C outlines the proposed criteria against which app developers can voluntarily assess themselves for compliance. Future plans include creation of an Apps Library which will list mHealth apps and their performance against the assessment criteria, providing a credible source to find trustworthy apps.
The National Safety and Quality Digital Mental Health Standards
The Standards evaluate digital services across 59 action areas and safeguards. They provide an online register that can be searched for accredited digital services, including apps. The Standards were introduced in November 2020, so currently few apps have been accredited, but it is expected that more might be added in the future as they go through the accreditation process.
Finding Quality Apps Through Online Directories
There are a number of online app libraries and directories listing apps that have been independently assessed to be safe and trustworthy.
Within Australia this includes:
These Australian directories are limited to apps and other digital services developed and funded within Australia that are free or low cost.
For a broader directory that includes apps developed outside of Australia, practitioners can visit:
M-Health Index and Navigation Database (MIND)
The MIND directory reviews apps against the APA App Evaluation Model and provides a summary of key information to assist users in choosing an app that meets their needs.
A Final Note on Safety
Mental health apps do not offer live monitoring by a clinician. While most are designed and suitable for self-guided use, monitoring or support by a health professional will still be necessary in the cases of severe or complex mental health presentations or if there are any clinical safety concerns. In these cases, progress and safety monitoring remains the responsibility of the referring clinician.
To find relevant training on digital mental health, including webinars and tip sheets for practitioners, check out our Resource Library.
Visit our eMH Directory to find apps to get started with.
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