The impact COVID-19 has on our mental health is expected to last beyond any physical health issues. Fears of stigma mean our key workers are amongst the least likely to engage with traditional mental health services(1).

Digital therapies can achieve comparable outcomes to face-to-face therapy(2), and young men and boys say they would prefer online support, advice, and counseling (3). But how do you find the right Digital Health solutions? ORCHA has reviewed 584 mental health apps to find the best.

Today, we share a snapshot of the quality of apps across a wide range of mental health conditions, and Dr. Tom Micklewright discusses his views on apps that have scored well in ORCHA’s Review. 

What is the Health of Mental Health Apps?

Health apps are convenient and discreet, easily accessed with the tap of a button. But, amongst the 3,857 mental health apps available in unregulated app stores(3), which apps are safe?

Our Review Team has assessed apps that help people experiencing anxiety, depression, self-harm, panic attacks, and thinking of suicide. Each app was assessed against more than 260 criteria across Clinical Assurance, Data Privacy, and User Experience. We discovered that only 29.6% meet our quality threshold, and this figure dipped far lower for certain mental health conditions. We also identified gaps, where there are no apps designed to meet specific patient needs…

Read more here

Dr. Micklewright’s Review of Top Apps

There is no one Digital Health Technology that works for everyone with a mental health condition. To achieve good results, an app needs to engage and meet specific needs.

In the below video, Dr. Tom Micklewright shares his independent views on mental health apps that achieve good ORCHA Scores and are each designed to meet the needs of specific patient groups, including children, teenagers, students, those with suicidal thoughts, and autistic patients or patients with a learning difficulty.

ORCHA is part of the NHS England National Innovation Accelerator Programme. We work with health bodies across the world to unlock the power of Digital Health, including NHS organizations in 50% of regions. Our vision is to revolutionize care through the safe integration of digital health solutions into all aspects of health and care services, leading to more patient-centered, effective care. 

ORCHA provides tailored microsites and prescription services and helps organizations across the world to integrate health and care apps safely into practice. To find out how ORCHA can help you, please get in touch.

Sources

A full list of sources is detailed below our ‘What is the health of mental health apps?’ blog, which can be found here.

The impact COVID-19 has on our mental health is expected to last beyond any physical health issues. The virus itself, as well as the measures to safeguard lives that have come with it, have led to a rise in issues that cause mental ill health, such as loneliness, stress, financial worries, stigma and bereavement.  And fears of stigma, mean our key workers are still amongst the least likely to engage with traditional mental health services(1).

Mental health apps can help people experiencing anxiety, depression, self-harm, panic attacks and thinking of suicide.  There is evidence to show that digital therapies can achieve comparable outcomes to face-to-face therapy(2), when the content is right and supported by a suitably trained therapist. They can be embedded into services, transforming and extending support for patients.

Health apps are convenient and discrete, easily accessed with a tap of the button.  Young men and boys in particular are concerned about the stigma of receiving mental health support and say they would prefer online support, advice and counselling(3).

But, amongst the 3,857 mental health apps available in unregulated app stores(4), which ones are the best?

The Organisation for the Review of Care and Health Apps (ORCHA) has reviewed almost 600 mental health apps that help people experiencing anxiety, depression, self-harm, panic attacks, and thinking of suicide. Each app was assessed against more than 260 criteria across Clinical Assurance, Data Privacy, and User Experience.

Of these apps, only 29.6% meet quality thresholds(5); a figure that drops even lower for certain conditions, including:

• 27% for Addiction
• 26% for Suicide Prevention
• 23% for Insomnia
• 18% for eating disorders.
• 9% for Bipolar
• 5% for apps for OCD

Whilst reviewing mental health apps, the team also identified significant patient groups who do not yet appear to have apps that have been built to meet their needs. These include:

• Postnatal depression – although there are good apps to connect new mums with others, which will help mental health, there don’t appear to be any apps specifically designed to provide help with postnatal depression.
• Midlife – women are at risk of depression through the menopause and changes such as children leaving home and caring. Although there are good generalised depression apps, there don’t appear to be any for this specific need.
• Suicide – although there are apps to help people who are thinking about suicide, there don’t appear to be apps that provide support for loved ones following a suicide attempt of a family member or friend, or apps for those who have been bereaved by suicide.

ORCHA is calling for developers to get in touch if they have such a solution, or to consider building an app to meet one of these clear needs.

Apps offer a wide variety of features such as real-time monitoring, recording, and gamification, that help increase a person’s understanding and engagement with their mental health treatment. But people who download a mental health app without an assessment are putting themselves at risk.

Before recommending a mental health app, read its independent evaluation on the ORCHA App Library at: appfinder.orcha.co.uk

Sources:

1) Research relating to various groups of key workers…

For healthcare providers:

Ross C, Goldner E. Stigma, negative attitudes and discrimination towards mental illness within the nursing profession: a review of the literature. J Psychiatr Ment Health Nurs. 2009;16(6):558–567. [PubMed] [Google Scholar]

Schulze B. Stigma and mental health professionals: a review of the evidence on an intricate relationship. Int Rev Psychiatry. 2007;19(2):137–155. [PubMed] [Google Scholar]

Wallace JE. Mental health and stigma in the medical profession. Health (London). 2012;16(1):3–8. doi:10.1177/1363459310371080. [PubMed] [Google Scholar]

Adams EF, Lee AJ, Pritchard CW, et al. What stops us from healing the healers: a survey of help-seeking behavior, stigmatisation and depression within the medical profession. Int J Soc Psychiatry. 2010;56(4):359–370. [PubMed] [Google Scholar]

For teachers:

https://www.nuffieldfoundation.org/news/more-teachers-reporting-mental-health-problems-than-ever…. The findings show that around 5% of teachers in England now say that they suffer from a long-lasting mental health problem which has lasted (or is likely to last) for more than 12 months.

For police:

Stuart H. Mental Illness Stigma Expressed by Police to Police. Isr J Psychiatry Relat Sci. 2017;54(1):18-23.

Edwards AM, Kotera Y. Mental Health in the UK Police Force: a Qualitative Investigation into the Stigma with Mental Illness. International Journal of Mental Health and Addiction (2020)

2) Healthcare Conferences UK: Improving Outcomes Through Digital Psychological Therapies & Digital IAPT; NICE: Improving Access to Psychological Therapies (IAPT); Centre for Mental Health: Covid-19 and the nation’s mental health

3) YoungMinds research reports that children and young people often look for support and advice online for their mental health – young men and boys in particular have said they would prefer online support, advice and counselling – but this support is not always available.

4) Analysis of Google Play and Apple Stores, searching for ‘mental health’ matches within the title and description of apps in the fitness and medical categories.

5) Based on ORCHA assessment of a sample of 584 apps, assessing these against 260 criteria across Clinical Assurance, Data Privacy, and User Experience.

Procuring health and care apps through the Dynamic Purchasing System

Digital self-management resources such as apps have played a vital role in supporting patients throughout the COVID-19 crisis. As the response to the pandemic continues, NHS London Procurement Partnership (NHS LPP) is offering support to procure safe, secure apps through its Health and Social Care Apps Dynamic Purchasing System (DPS).

Developed in partnership with ORCHA, NHS LPP’s DPS allows NHS organisations to rapidly procure quality assured digital health solutions at scale. This partnership ensures that suppliers through the DPS comply with strict and rigid rules around patient safety and data standards, meeting the need for an easy to access, safe and compliant route through which to procure health and social care applications to benefit patients, clinicians and non-clinical staff.

For health services wanting to procure a new app for their patients, the DPS offers a shortlist of suppliers whose apps have been pre-assessed for security, clinical merit, patient accessibility, and patient safety. All apps that apply for the DPS undergo an assessment by ORCHA, which informs which suppliers are awarded a place by NHS LPP on the DPS.

ORCHA carries out reviews of thousands of apps across all health and care conditions. The ORCHA Review process scores apps according to key assessment criteria relating to Clinical Assurance, Data Privacy and User Experience. Full details on the ORCHA Review can be found here.

ORCHA’s ability to have digital products reviewed quickly, combined with the thorough process for digital solutions to qualify for the DPS, enables a streamlined and compliant route to market for safe and efficient mHealth apps and services. The DPS provides NHS organisations with a trusted, searchable, one-stop-shop for digital health solutions.

NHS England uses the DPS to procure MyType1Diabetes app

The NHS LPP DPS has recently been used by NHS England to procure the new MyType1Diabetes app, now available to patients across England to help them manage their condition during the coronavirus pandemic. The app includes videos and eLearning courses, to help people better understand their condition and increase their confidence in managing it.

Adults with type 1 diabetes can access the app directly by going to myType1diabetes.nhs.uk

New health categories added to the procurement framework

As of Thursday 16^th July 2020, thirteen new, condition-specific categories have been added to NHS LPP’s Dynamic Purchasing System:

Category 13 – Blood

Category 14 – Dental

Category 15 – Ear / Nose / Throat / Mouth

Category 16 – Education

Category 17 – Eyes

Category 18 – First Aid

Category 19 – Gastrointestinal

Category 20 – Kidney / Genito-Urinary

Category 21 – Men’s Health

Category 22 – Sexual Health

Category 23 – Skin

Category 24 – Tropical Diseases

Category 25 – Woman’s Health

COVID-19 specific categories, developed in partnership with ORCHA, have also been recently added to the DPS to help with the NHS’s response to the pandemic:

• COVID-19 Support Solutions
• Chest/Lung, which includes the sub-categories of asthma, coughs, chest infection, and COPD.

These categories provide further COVID-19 solutions for the NHS to procure, at a time when digital health has never been more important.

As ORCHA broadens the scope of its Review process, web-based apps are now also included on the DPS, in additional to iOS and Android mobile device apps.

How to procure apps through the DPS

NHS organisations looking to procure digital health solutions can access the DPS by visiting healthappsdps.orcha.co.uk

The site provides drop-down options for each health and care category on the DPS, allowing organisations to easily see which apps and digital solutions are available for procurement. Transparent information is available on how each solution has scored in terms of its clinical assurance, data privacy and user experience, meaning organisations can make informed decisions as to which apps to procure.

More information on the DPS is available on the NHS London Procurement Partnership DPS webpage, or you can register for the DPS online now.

How digital health developers can apply for inclusion on the DPS

Digital health app developers and suppliers who want to apply for inclusion on the DPS should visit lppsourcing.org, select the ‘find opportunities’ option after logging in to LPP Sourcing, then select NHS London Procurement Partnership from the Organisations drop-down.

If you have a relevant digital health solution, you can apply to be part of the DPS here.

In order to view the opportunity, select the ‘find opportunities’ option on the landing page once you have logged in to LPP Sourcing. From there, select NHS London Procurement Partnership from the Organisations drop down. A list of current opportunities should load. From this list, please select ‘Health and Social Care Apps DPS.’ When this page has loaded, please select ‘Register interest in this opportunity’; you will be taken to the opportunity where you can review all documentation, and, should you wish to, begin the electronic questionnaire by clicking on the green icon at the bottom of the page. To reply to each question, please click on the edit link within the Question Sets box.

COVID-19 has led to a dramatic increase in Digital Health within NHS services.  But as lockdown restrictions are lifted, experts fear the industry’s mHealth progress could stall or even reverse. The Organisation for the Review of Care and Health Apps (ORCHA) publishes in JMIR mHealth and uHealth research that quantifies for the first time what is most required by healthcare professionals to prescribe Digital Health, and reveals what factors are limiting adoption.

The team at ORCHA found a NHS badge for Digital Health overwhelmingly came in as the most important factor for take-up, followed by peer opinion and personal use of the technology.  Although published studies after often called for, these were named, but it would take 5 published studies to be as convincing as one NHS stamp of approval, and 2 published studies to be as convincing as a peer recommendation of the app.

Two factors were also identified that directly correlate with a drop in Digital Health usage. Both patient age and the cost of digital health were linked with a reduced likelihood of prescribing.  This is worrying because, as people age and become more susceptible to long-term health conditions, they are less likely to be recommended digital health to manage their health.  A drop in prescription for paid-for digital health is also a concern, as it may reflect an inherent lack of understanding of the value digital health brings.

On a positive note, only 8% of healthcare professionals are reluctant to use digital health. These are most likely to be aged over 55 or not using a health app themselves, giving organisations clear routes to target education programmes.

Commenting on the research, Simon Leigh, Health Economist, ORCHA, said: “Now is a critical time for Digital Health. Adoption has rocketed during COVID-19, but as the requirement for remote consultations fades, so too may the industry’s take-up of digital health.

“This research reveals the underlying attitudes and wants from healthcare professionals. It’s important for providers to consider these needs, if the NHS is to achieve its long-term digital transformation ambitions.”

Health economists at ORCHA conducted research with 230 UK healthcare professionals, using a series of focus groups, ranking exercises, and a discrete choice experiment. The research can be found here: https://mhealth.jmir.org/2020/7/e17704/