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Experts caution about use of unmonitored mental health app forums

Last Updated Apr 29, 2016 at 5:55 am EDT

The Koko app lets people post what they might be worried or stressed about and get feedback from other users on how they deal with their problems. Photo via iTunes.

Thousands of apps claim to offer help to people struggling with mental health illnesses but experts warn the so-called e-therapy can pose risks, especially when professionals are not involved.

Many apps have interactive features, such as discussion boards or group chat rooms, where users with depression, anxiety, post-traumatic stress disorder or addictions can share their experiences.

Dr. Kimberley Da Silva, a psychologist with North Shore Stress and Anxiety Clinic in North Vancouver, says it’s important mental-health professionals monitor, support and add their voices to these conversations.

Someone in a dark place might be sharing ineffective coping strategies through the apps, Da Silva says.

“(It) can influence other people to kind of attempt those strategies, even though they’re not healthy.”

Koko, for example, is one app designed by students at the Massachusetts Institute of Technology in Boston that is based solely on user interaction. People post what they might be worried or stressed about and get feedback from other users on how they deal with their problems.

The app – one of more than an estimated 3,000 mental-health apps for Android, Apple, and Microsoft currently on the market – has never been examined by health professionals, according to its co-founder Robert Morris.

A separate program picks out any abusive or malicious words and flagged posts get sent to a human moderator for vetting, says Koko co-founder, Robert Morris.

“Users are continually reminded that the app is not a formal mental-health resource, and it doesn’t claim to be,” Morris says. “There are many references and links to direct people to [other] resources.”

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Peter Yellowlees, a professor of psychiatry at the University of California, says the vast majority of the apps have had no rigorous scientific review.

“While patients have access to an exponentially increasing number of apps, the research literature has not kept pace,” Yellowlees said in a release this week.

At the Toronto-based Centre for Addiction and Mental Health, senior director David Wiljer agrees research into the apps is needed.

The apps can help by allowing users to relate to others by sharing personal experiences and different coping strategies, Wiljer says. At the same time, he says the unmonitored forums carry a substantial risk.

“Perhaps multiple perspectives aren’t shared, or misinformation could be shared,” Wiljer says.

Foveocare, an app that claims to offer online mental-health therapy, allows users to interact in open or private chat rooms.

The Calgary-based developer, Daman Parmar, says his staff monitor conversations but mental-health professionals are not involved because he believes peer-to-peer interaction on its own can be effective.

“When users feel like there’s other people going through a similar situation, it makes them feel better when they’re not alone,” Parmar says.

Da Silva, a youth psychologist, says she understands why teens in particular might feel comfortable using the apps to share and listen to other people’s personal stories.

“(It) is still sort of the stigma that a lot of teens experience: that they’re not normal if they’re dealing with anxiety or depression,” Da Silva says.

At the same time, she stresses the importance of a professional presence to monitor what’s said and to at least offer constructive help for those posting about their mental illness.

“I don’t think it’s beneficial just to have a forum for negativity,” Da Silva says, “without anybody saying ‘Hey, there are ways to manage this, it’s not easy, but it can be done.'”