The techno-utopian fantasy that apps will magically solve teens’ mental health problems is unfounded

In the past decade rapid expansion in the development of mental health apps has been accompanied by a great deal of techno-hype about how digital solutions will revolutionise and democratise mental healthcare. Techno-optimists imagine a technological utopia in which everyone magically and effortlessly has access to affordable and effective mental healthcare on demand and from anywhere at the touch of a button.

Apps certainly have the potential to increase access to high-quality mental healthcare, especially for adolescents. Having grown up in technology-rich environments, young people are comfortable using digital technologies and are open to the idea of receiving psychological help online.

It is estimated that more than 85% of the world’s population owns a smartphone, and it is enticing to imagine how these devices might be used to put mental healthcare in the hands of everyone who has a smart device. Entrepreneurs have already seen the potential of digital solutions to mental health problems and in 2018 there were more than 22,750 apps in iTunes and Google Play stores claiming to improve mental health.

But has the plethora of mental health apps had any discernible impact on adolescent mental health? It is hard to find evidence at a population level that the proliferation of mental health apps has led to marked improvements in adolescent wellbeing. If anything, mental health outcomes globally keep worsening even as access to digital treatments increases, a phenomena known as the digital mental health paradox.

Dr John Torous, director of the digital psychiatry division at Harvard Medical School, describes two hypotheses that could explain the digital paradox.

The “harm hypothesis” postulates that any potential benefits from access to mental health apps have been offset by the harmful effects of living in an increasingly digital world.

The “illusion of innovation” hypothesis contends that apps are basically ineffective because of a lack of real innovation and because most apps either do not work or are simply not engaging enough to retain users.

Supporters of the harm hypothesis argue that the consequences of living in a technology-rich environment (such as excessive screen time and social media use) are so toxic to wellbeing that they displace any potential benefits from increased access to mental health apps.

But are social media and screen time really so detrimental to mental health? Before prescribing apps to adolescents with mental health problems we need to understand the potential psychological harms of digital technologies.

Recent high-quality studies suggest that for most people social media use and screen time have minimal impact on mental health. However, most studies focus narrowly on adults, have only investigated correlations (not causation), and have failed to identify any consistent or large positive effects.

Although large-scale rigorous studies on adolescents have found small positive associations between poor mental health and duration of daily technology use, they do not distinguish cause from effect and thus cannot explain if poor mental health causes adolescents to spend more time using digital technologies, or vice versa.

It is certainly true that for some vulnerable teenagers, social media use can have serious mental health consequences, and there is a need for rigorous research to understand which adolescents are at risk, why they are at risk, and what can be done to ameliorate risk.

It is too simplistic to say that social media and screen time are equally harmful for all adolescents. To understand the impact of technology on mental health we need a life course perspective, which acknowledges that psychological vulnerability is heightened at specific periods of development.

A longitudinal study of 17,409 adolescents aged 10-21 years old found clear developmental windows of sensitivity to harmful effects of social media use. For males these windows of sensitivity occur at 14-15 and 19 years old, while for females the windows occur at 11-13 and 19 years old.

Supporters of the lack of innovation hypothesis argue that we have not seen marked benefits from mental health apps because a lack of any real innovation in app development has created serious problems with poor uptake and low levels of sustained use. The uptake of mental health apps has certainly been slow, mostly because of concerns about privacy and scepticism about effectiveness.

Privacy concerns

Techno-fixes