Should Your Company provide mental health apps to employees?

Thanks to the pandemic, there is heightened interest in new options for preventing and treating anxiety, depression and other psychiatric illnesses. In particular, human resources managers are increasingly looking for ways to support their employees.

Our research team at the division of digital psychiatry at Beth Israel Deaconess Medical Center regularly fields questions related to digital mental health and digital mental health apps. Here are three of the most common questions and our answers, based on our experiences in clinical care, clinical research studies and industry analysis.

1. Should my company offer access to mental health apps?

The best thing you can do for your employees is to offer them robust health care coverage at a reasonable price. This coverage should include comprehensive mental health care that makes face-to-face therapy affordable and accessible. A mental health app on its own is not an equal substitute. That’s because to date, there isn’t evidence that self-help apps are as effective as therapy or medication in treating mental illness. But they may be able to help some people better cope with stress and symptoms related to anxiety or depression.

Consequently, mental health apps should only be used to complement therapy and other forms of self-care, such as exercise, a healthy diet and sleep. Furthermore, apps alone will not solve mental health problems if there are underlying workplace causes related to a toxic culture, abuse, and so on.

Evaluating the usefulness of an app can also be challenging.

While we are seeing a rise in published studies, the science behind the apps that employers offer employees is still limited. Indeed, we have found that the majority of commercially available apps make claims related to mental health that they cannot back up with scientific evidence. HR managers must decide—based on their budget and their workforce’s unique set of needs—whether the benefits of easy access and low cost afforded by mental health apps are compelling enough without rigorous research validating their efficacy.

2. What is the best app I can offer my employees to help them manage stress or anxiety?

While apps themselves are unable to treat a mental health condition, they can offer employees access to new tools, skills and resources that may help them manage their feelings. There are hundreds of apps offering immediate access to mindfulness exercises, mood tracking, mental health education, specific therapy skills and more. Each can potentially be useful in reducing stress, negative thoughts or even cravings related to addictions. But we don’t think there is a single best mental health app for everyone and recommend that HR managers seek apps that can address employees’ specific needs.

We also caution against evaluating apps on the basis of the number of times they’ve been downloaded, their star ratings or the way they are advertised. While a handful of apps have emerged as the most popular and well-known, these are not always the most effective tools.

HR managers should look deeper and ask tougher questions: What in the workplace may be contributing to stress or anxiety? What does this mean for the mental health of employees, and what resources will they need to cope? If employees have variable hours, then an app that primes users for sleep might be beneficial. If burnout is a concern, making conversations with licensed therapists available to employees might be more important.

3. How do I evaluate the economic impact of a digital mental health product?

We know that the burden of mental health is costly, and that preventing and treating mental illness can be an effective solution. Many websites for mental health apps make claims about return on investment and savings that are designed to attract HR managers. But while there aren’t definitive numbers yet that indicate the cost-effectiveness of digital mental health tools, we advise HR managers to consider four types of data to estimate potential savings.

First, managers should estimate the cost due to the conditions per employee (e.g., lost productivity). Second, managers should request engagement data to learn the average percentage of users who remain active on the app after two weeks. This information is seldom publicly available, but it’s critical: Research suggests that average engagement rates may be as low as 5% after two weeks. Third, managers should ask the company offering the app for estimates of the platform’s positive impact on mental health in terms of symptom reduction. Fourth, managers should seek data on how likely the app is to have a sustained effect on the employees' well-being going forward.

Multiplying these four numbers together will give managers an estimate of the potential cost benefit of an app per employee over one year. For example, $5,000 of lost productivity times a 25% reduction in depression scores times a threemonth duration of effect (25% of a year) equals approximately $312 dollars per year. But if engagement is 5%, then multiplying $312 by 5% yields a value of approximately $16. We offer more details of the model and sample calculations in this published paper. Through the process of asking these questions and gathering relevant data, managers are simultaneously learning about their employees needs and how the digital mental health product may or may not help them.

While we have not yet seen apps offering a satisfaction or performance guarantee, managers should demand bench marks for results and hold companies responsible for delivering on them. The best apps will not be afraid to sell themselves through their results.

As the space matures and companies merge, HR managers may soon be able to select customized app bundles and offer employers a suite of digital tools.

Decisions around digital mental health products for employees should be based not on marketing or their alleged popularity but on the evidence, engagement and the types of services associated with the product. Except for telehealth apps offering a synchronous (i.e., video or phone call) connection to a licensed therapist or psychiatrist, they should be used only to augment, not replace, evidence-based care. And when choosing these digital products, HR managers should strive to identify their employees’ specific needs and find the offerings that can best address them.