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NHS should remove unproven apps from library

No proof of effectiveness for 85% of NHS-accredited depression treatment apps

Louise Prime

Tuesday, 13 October 2015

The NHS should remove from its apps library most of the depression treatment apps because patients don’t realise that there is no proof that they work, insist experts. They are concerned that patients may be falsely reassured by the apparent ‘seal of approval’ from the NHS by their inclusion in the library. In Evidence Based Mental Health, they report* today that 85% of the app-based psychological interventions currently recommended by the NHS have never been properly evaluated.

Simon Leigh and Steve Flatt, of the Management School at the University of Liverpool, and Liverpool Psychological Therapies Unit Community Interest Company (respectively), point out that half of the people in England with mental health problems have to wait more than three months for any NHS treatment, and one in ten wait longer than a year – and that during these long waits, their condition worsens in two-third of cases, with one in six attempting suicide. So, they say, people are increasingly turning to interactive online and app-based mental health treatments.

Although this has the apparent benefit of saving money for a cash-strapped NHS, they warn: “Apps are by no means a perfect solution to our nation’s mounting mental health requirements, and are characterised by numerous shortfalls. These often stem from the frequent lack of an underlying evidence base, a lack of scientific credibility and subsequent limited clinical effectiveness, but also from issues including an over-reliance on apps, equity in access and increased anxiety resulting from self-diagnosis.”

They looked into the evidence base for apps for depression, of which in 2013 they found 1,536 available for download; but there were only 32 published articles regarding apps for depression. They said their finding of high availability and low evidence base was similar to the situation with app-based treatments for several other psychological disorders.

They nevertheless found that some apps are highly effective, with good recovery rates. They said: “One NHS accredited app boasts recovery rates of 58%, some 14% higher than the 44% average achieved by IAPT [increasing access to psychological therapies] over the same period, and 8% higher the NHS national target of 50%.”

They argue that although the use of apps could potentially promote health service efficiency, as well as supporting the NHS with its promise of ‘equal access for equal need’, there must be more stringent regulation, vetting and quality control in this area.

They conclude: “In order to ensure that apps don’t do more harm than good, it is important that those presently recommended by the NHS apps library that either fail to demonstrate the evidence underlying the methodological approach taken, or evidence of effectiveness in use, are removed.”

* Leigh S, Flatt S. Perspective: App based psychological interventions: friend or foe? Evidence Based Mental Health, 2015. DOI: 10.1136/en-2015-102203

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