Considering digital mental health tools for your employees

Digital mental health tools—direct-to-consumer wellness such as phone apps and computer software—can be useful to fill the gaps in employee mental health needs. Whether employees use them in concert with an existing therapeutic relationship or as a stand-alone tool, they may benefit from the ease of accessibility. Digital mental health tools that utilize evidence-based interventions can be particularly useful at providing mental health education such as teaching coping skills and coaching relaxation and emotion regulation—valuable skills for the entire workforce, not just those in need of professional services.

Employers wishing to augment a robust mental health benefit—including coverage for therapy—are increasingly considering the addition of digital mental health tools for their employees.

Studies have repeatedly shown that telehealth treatment—e.g., therapy conducted over video call—is as effective as in-person treatment. However, the research on digital mental health tools is a little less straightforward. Because there is a wide range of offerings and approaches, overall efficacy can be difficult to assess. Yet, we have gained some key insights.

“A large number of randomized controlled trials have consistently shown that coached digital mental health treatments, offered through websites and apps, are effective in treating common mental health problems such as depression and anxiety,” said David Mohr, PhD, director of the Center for Behavioral Intervention Technologies at Northwestern University.

Coaching conducted by paraprofessionals (trained and supervised by a licensed clinician) usually helps users stay engaged with digital tools and can also include support around learning psychological skills. This type of coaching typically consists of contact via messaging and occasional brief phone calls.

The few studies that have compared coached digital mental health tools with psychotherapy show a similar magnitude of improvements in treatment of depression and anxiety.

Conversely, studies of fully automated digital tools (i.e., uncoached) have shown less-promising results.

“This is likely because large numbers of people do not stay engaged in digital mental health tools without coaching long enough to gain benefit,” said Mohr. “Thus, fully automated digital mental health tools may be effective for those who stay engaged with them, but the great majority will not stay engaged without a coach.”

The digital mental health tools available in the app store are unregulated; therefore, we see a high degree of variability in quality. So, whether coached or not, to be truly effective, it is crucial that digital tools utilize only evidence-based approaches.

Direct-to-consumer wellness apps are not to be confused with specific software-based therapeutic interventions known as “digital therapeutics”—which are regulated by the Food and Drug Administration (as “Software as a Medical Device”) with the expectation that they demonstrate a high degree of effectiveness.

While the consumer app industry is not regulated, there are tools to help sift through what is available. And there are reputable resources that provide expert review of consumer mental health apps, such as One Mind PsyberGuideopens in new window for employers.

Employers are among the largest purchasers of digital mental health tools. Despite the potential for additional expense, there are benefits to consider.

Employees whose mental health needs are being met are more productive, more present, and more organizationally committed to their workplaces. So, up-front costs have great potential to yield savings over the longer term.

Digital mental health tools can reach individuals who might not otherwise engage in any mental or behavioral health treatment. And some tools can act as triage by helping to identify employees who need more personalized care but might otherwise go untreated. Other digital tools can augment treatment already being provided at a relatively low cost.

Because digital mental health tools are a relatively recent phenomenon, there is no single method of providing them to your employees. Some employers include them as part of their health care benefits package. Others may merely suggest a particular app to their workers. Most insurance providers do not cover the general purchase/usage fees of mental health apps; however, some now include specific, recommended apps within their offerings. Employers considering a digital mental health tool for their workers should first consult with their existing insurance providers.

This landscape may change, however. Legislation is working its way through Congress to require Medicare and Medicaid coverage for digital therapeutics. Unlike more generalized mental health and wellness apps, digital therapeutics include specific software-based treatment interventions that are recommended by a health care professional within the framework of an existing therapeutic relationship. Although this coverage has not yet passed, the fact that it is being considered may indicate growing support for coverage of more generalized digital mental health tools.

Any mental health app you provide your employees should utilize methods that are backed by research, so look for the developer’s commitment to using evidence-based approaches. Also, match the purpose of the app to best meet your employee needs (e.g., mindfulness, meditation, sleep, stress), and check for the appropriateness of content and cultural responsiveness.

If considering a digital tool with a coaching component, be sure that coaches are trained and supervised by licensed clinicians.

When considering pricing, understand that there is no single model. Some apps are free, others allow limited free usage but charge for greater functionality, while others offer free usage but promote paid coaching or therapy. Employers offering a tool to a large number of people may find pricing as a flat fee, on a per-user basis, or as some hybrid of the two.

And “free” may not be “free.” As with any app, review data privacy and security policies, which are of importance if users will be sharing personal behavioral information within the app.

There is a push for increased and expanded access to mental health care with a greater focus on early intervention and prevention of serious illness. The crucible of the COVID-19 pandemic created an acute need for viable socially distanced mental health care tools including wearables and digital interventions, which, in turn, demonstrated rich possibilities in complex mental health treatment areas such as attention-deficit/hyperactivity disorder (ADHD), anxiety, depression, and substance abuse.

However, the effects of the pandemic have also created an epidemic-level need for greater mental health services. Employers wishing to help meet that need can begin by offering their employees robust mental health benefits anchored by coverage of therapy (both in-person and telehealth). For those looking to expand employee mental health benefits further, with the appropriate considerations, the right digital mental health tool can play a vital role in filling health care and well-being gaps for your employees.