More and more people are using mental health apps, a convenient digital solution to sky-high rates of mental distress and a dearth of professionals. They can be great – but what do they say about the way we respond to mental illness?
Almost every morning, Julia*, a professional living in Auckland, meditates with the Headspace app. Her phone’s screen pulses a gentle purple. She breathes deeply. “It feels comforting, like a safe space,” she says.
She meditates for 10 or 20 minutes at a time; sometimes she listens to sleep stories when she can’t sleep, or goes through one of the courses for responding to stress or anxiety. Over six years of occasional, and then near-daily use, she’s racked up over 10,000 minutes of meditation and gone through most of the app’s courses multiple times.
“I know I’ll be more effective and happier at work if I meditate,” she says. “It’s less a habit and more a coping mechanism – or a performance improver.”
Julia isn’t the only one. Globally, Headspace has been downloaded over 65 million times. Search “mental wellbeing” on an app store, and hundreds of options will pop up, including Headspace competitor Calm (25 million downloads) and a plethora of others: mood trackers, CBT thought diaries, therapy chatbots and apps advertising “self care pets”.
Closer to home there’s Groov, created by John Kirwan, which has resources for dealing with stressful experiences like floods, and glowing screens with breathing trackers to help people calm down. It’s been downloaded over 80,000 times. Other services, like Piki and The Lowdown, focus on young people – The Lowdown is a website with digital resources, while Piki has some digital resources but is mainly designed to connect people to online and in-person peer support and counselling.
It’s easy to see where the demand is coming from. New Zealand’s mental health workforce is under strain. Waiting lists are long, especially for young people and those with severe mental illness. People are encouraged to reach out for help, only to find that the help isn’t there – a devastating experience for patients and clinicians. Given this, of course apps are a response. There aren’t enough psychologists and counsellors, but most people have a phone in their pocket.
Some of these apps receive public money. Digital and telehealth services are important, says Caitlin Chester, Te Whatu Ora primary and community wellbeing manager, in an email. “These tools contribute to a growing range of options for help to ensure New Zealanders have support when and where they need it.” Groov, The Lowdown, Sparx and Headstrong are among the apps funded by Te Whatu Ora, as part of their focus on digital wellbeing.
“Digital tools can deliver more informed outcomes for the patient and practitioner, and be more efficient,” says Tim Packer, general manager at Rush, a digital agency that was contracted by Te Whatu Ora to develop The Lowdown and Ignite, a wellbeing app for businesses. Digital wellbeing tools can “help healthcare workers use their time effectively and understand their patients better,” he says.
Karolina Stasiak, a research psychologist at the University of Auckland who has been involved in developing digital mental health tools Sparx and Headstrong, puts it more bluntly: “We need skilled, well-trained, empathetic psychologists – but even if we start that training now, it won’t be enough.” Digital tools aren’t a replacement, but they can help, especially for people whose symptoms are mild.
Twenty years ago, a counsellor might have given you a worksheet to fill out to reflect on your behaviour and feelings, but now the same task can be done online, just with more flexibility and responsiveness to individual needs. “My phone is my news, my music, my friends, it counts my steps and tells me when to stand up, and mental health is part of that,” Stasiak says. “Phones are a delivery mechanism.”
Who are mental health apps for?
Young people are a focus of Stasiak’s work, and she concentrates on digital resources because that’s a good place to reach them. Initially a CD-ROM, Sparx is a game based on the principles of cognitive behavioural therapy (CBT), where the player explores a fantasy setting, learning to defeat Gloomy Negative Automatic Thoughts (GNATs).
After Sparx, Stasiak worked on Headstrong, a chat app she describes as “personal training for your mind”. Initially, they experimented with the chatbot function in Facebook Messenger, as they figured their audience would already have accounts there. Now it’s a separate app.
“We can use the way you grab your phone to check notifications, text people, exchange memes,” she says. “It’s a way to slow down and problem solve at a micro scale throughout the day.” With an interface similar to a text message, and a soothing picture in the background, the chatbot is supposed to feel like a sensible, calming virtual friend.
People who develop digital mental health resources, like Stasiak and Packer, make a good-faith effort to include the people they’re trying to help. Having a defined audience is a good start: Headstrong is aimed at teenagers who have their own phones and social media accounts, up to people in their early 20s. “We think about diversity of ethnicity and gender, make sure that the language and visual presentation works for those groups,” Stasiak says. The design process also includes lots of feedback from young people about what they do and don’t like. Packer agrees: working with rangatahi was crucial to giving The Lowdown “human-centred design”.
Scrolling through The Lowdown, this effort is obvious. Written resources are simple and clear, and videos feature young people from a range of backgrounds speaking about relationships, self esteem and more. The videos are relaxing, earnest and thoughtful, with high production values; it’s difficult to imagine how they would sit beside the fast-paced magnetism of shortform videos on TikTok, YouTube and Instagram.
Digital resources can also improve accessibility. “For people with disabilities or neurodivergence, using a phone could be easier or less intimidating than having to go to an unfamiliar space and talk to people you don’t know,” says Susan Wardell, an anthropologist at the University of Otago who has studied social media and young people.
With that said, downloading an app, of course, is not the same as actually using it. When a doctor at her student health service recommended she use Piki, Melissa* explored a few of the online tools, but decided they weren’t for her. She had developed symptoms of mild depression and anxiety, and found studying “hideously stressful”, she says. “At the time, I just wanted to pass my exams.” She says it was “very belittling” to be told to download an app for help.
Even if you do use an app, it might not help in the ways that you hope. Emma Vitz, a Spinoff contributor who lives in Sydney, used Headspace every day for over a year, clocking up more than 7,500 minutes on it – more than five days of 24/7 meditation. She was hoping it would help her manage her chronic pain but when she realised she didn’t notice any difference, she stopped using it.
What do these apps say about how we live?
Beyond the day-to-day realities of using apps like Headspace or Groov lie bigger questions about what we really mean when we say mental health, says Wardell. “Is mental health merely the absence of mental illness? How often do we expect to be happy?” she asks. An app can give you a mood tracker or a number of minutes you’ve used it, creating a sense of achievement, but ideas about health have to go beyond merely what is quantifiable.
“We can see ourselves in numbers, as a graph or an app,” she says, connecting mental health apps to other ways ever-present phones train people to keep track of themselves, like with period apps. “With the body, it can turn your body into a project, to have an ideal goal,” Wardell says. With the mind, it’s harder. Apps might nudge you towards being calmer, or at least more attentive to your emotions. “We have to ask: how should we feel? What is a desirable way to be?”
In some ways, the internet makes therapy and resources more available than ever. People learn therapy speak, describing reactions as “trauma responses”. Counsellors make TikToks with advice on how to break up with your friends. On YouTube and TikTok and Instagram, people talk honestly and openly about mental health and mental illness. Sometimes, those same people have referral codes to affordable digital therapy services like Better Help, even if those counsellors aren’t licensed, data isn’t protected and the company is not a great employer.
It can be a lucrative business: Julia’s go-to app, Headspace, costs $19 a month for a full subscription, though there are some free features. Meditation apps – or rather, the companies behind them – make hundreds of millions of dollars a year. “If they help people who are struggling, that’s fantastic,” Wardell says. “But there are risks – who designs them? Who is making money?”
That said, mental health apps can also make mental health easier to talk about and acknowledge, especially for groups where that isn’t the norm. Piki didn’t work for Melissa, but she appreciates that simply having “things that are small, more accessible, less embarrassing” to use might help people who aren’t already “massive oversharers”. Julia hasn’t talked to many people about using Headspace. “It feels kind of taboo, like you might be presuming something about the person you recommend it to.”
Talking about mental health apps is difficult, too, because of the vagueness of language that permeates this area. While “wellbeing” is a worthy consideration, the word has been overused to the point of near-meaninglessness. So too “mental health journey”. Hundreds of apps all use the same language of wellbeing, but it can be hard for users to evaluate which ones are effective or reliable. That’s frustrating to Stasiak.
“Lots of companies and private entrepreneurs are jumping on the wellbeing bandwagon – I think there are more than 200,000 apps in the health and wellbeing space,” she says. “Some are really good and some are really bad. I wish we could regulate them.”
Some problems an app can’t solve
Apps are also an individual-focused response, Wardell says. “On an app, people are caring for themselves – it’s very efficient to get people to care for themselves, rather than the healthcare system.” While many people seek out apps of their own accord, the fact that our healthcare system is directly funding digital mental healthcare says a lot.
“We know that mental health is relational, it’s situational, it’s about culture and society and living conditions – it’s about all these bigger things that are harder to solve,” Wardell says. Apps have their place, but they can’t ask: why are so many people anxious? Why are so many people stressed, or scared, or sad? “How can someone who lives in shitty housing and doesn’t have the opportunity to get a job, or who is structurally disadvantaged, how happy can that person become from sitting with apps that tell them to think good thoughts?”
“People are stressed because they don’t have money, or they have to work full time while doing uni, just to afford it. An app won’t fix that,” says Melissa. When she asked for help, she was strung out, desperately tired, worried about her study and relationships – and already spending too much time on her phone. Thoughtfully designed apps and digital resources can help people experiencing distress before things get too bad, but it would be even better not to experience that distress in the first place.
“Phones are an oddly intimate thing,” says Wardell. “We carry them in our pockets against our skin all day.” That intimacy, she says, makes phones incredibly powerful. “They can shape how you see yourself and your thoughts. These apps are developed with a whole lot of good intent – we want to make sure we use that power thoughtfully.”
*some names have been changed to preserve privacy