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Digital's Expansion in Mental Health Demands Clinical Involvement, JAMA Authors Say


More than 10,000 mental health applications exist, but there is no formal system to weed out unsafe apps from those that are evidence-based.

Mental health professionals and societies must address the rise of digital applications for those seeking care, because the lack of standards puts patient safety and privacy at risk, according to a pair of physicians writing this week in JAMA Psychiatry.

John Touros, MD, of Beth Israel Deaconess Medical Center and Harvard Medical School; and Laura Weiss Roberts, MD, MA, of Stanford University School of Medicine, say the lack of FDA involvement in mobile applications in mental health means many patients unwittingly agree to give away their health data—and some get advice that is dangerous. The proliferation of apps has potential to do good, but the potential for harm demands a response from professional societies in mental health care, they write.

“it is time for clinical science to assume greater leadership, bringing greater trust and transparency,” Touros and Roberts wrote. “Application technology is not the limiting factor in adopting these digital tools—trust and transparency are.”

Touros and Roberts say the number of mental health applications that can be downloaded tops 10,000 and keeps growing, but right now the only entity governing clinical standards is Apple, which offers apps through its iTunes application. The authors say Apple recently discontinued several health apps and created a policy that requires any drug dosage recommendations “must come from the drug manufacturer, a hospital, university, health insurance company, or other approved entity, or receive approval by the FDA or one of its international counterparts.”

Beyond that, the frontier of mobile applications for mental health problems is a Wild West, with the authors citing an example of bipolar disorder patients being encouraged to have a stiff drink before going to bed. By contrast, a few applications are helpful adjuncts to a doctor’s care, yet there is no formal system for patients to separate evidence-based apps from harmful ones. The American Psychiatric Association did release a smartphone evaluation model to help clinicians separate safe apps from unsafe ones.

“This new reality is worrisome: studies suggest that most mental health apps in commercial marketplaces do not conform to clinical guidelines,” they write. “This situation exists partially because the FDA has taken a ‘hands-off’ approach toward health applications, meaning that most mental health applications do not fall under federal regulations.”

With proper oversight, digital health technology could be a helpful tool in psychiatric care, given the proliferation of smartphones and the “at-your-fingertips” nature of mobile apps. Digital health is already advancing in other areas of chronic disease management, and Medicare is weighing how to include digital health platforms as it prepares to pay for the Diabetes Prevention Program by January 2018.



Touros J, Roberts LW. Needed innovation in digital health and smartphone applications for mental health [published online April 5, 2017]. JAMA Psych. 2017.

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