I worry that these apps encourage people to catastrophize things, which is good for their profits, and bad for the mental health of their customers. I find it difficult to imagine a scenario where one of these app makers doesn't find a mental health issue that you need help with (and to pay them for). That sort of "diagnoses" can cause you to develop the disorder that they have diagnosed you with.
I am absolutely sure that if I had been given the out of ‘having anxiety’ as a young adult, my life would’ve gone very differently, and probably very much worse, than it has. I think I would’ve allowed myself to lean into my tendency to be introverted and possibly ended up friendless and alone, and in an unfulfilling job.
Note that I’m not denying that people might have mental illnesses that have deep rooted or physical causes that _need_ therapy or medication in order to live a fulfilling life.
That and the cultural norm that we're creating around mental illnesses. I mean, it's great that the few who truly do have mental disorders can be accepted socially but what are we doing to the thousands of kids that just need some structural social target to aim at?
Personally, I was an emotional basket case until well after college when I decided that I should give the "be normal" thing a try. Turns out being normal makes a lot of things easier in life.
It's amazing how much freedom you have to be weird on the inside when you're normal on the outside.
I don't think it is the right mindset. Mental health is a spectrum as much as "being fit" is a spectrum. Just because you aren't morbidly obese doesn't mean you won't benefit from learning how to take care of your body. Most people don't need a personal trainer and a dietician when they gained a few kilos extra. The same way everybody needs to understand how to heal their mind and recognize when things get difficult enough to benefit from professional health.
I guess my point is that I think kids should be hoping they don't have any medical condition instead of asking a therapist "Doc, can you find me a diagnosis that fits my current mood somewhere between asbergers and schizophrenia with a dash of manic depressive"
Of course. We are just going through a strange period of mental health. It used to be: "only very very serious problems are worth attention and in this case only professional can help you". This is why it was (and to an extent still is) stigmatized. Now we are moving towards "we all have mental health problems of different severity, mental health isn't binary". However, people still operate with the old dogma: "have a problem? Go to therapy, you can't help yourself, don't even try". That's why people tend to go to psychologists (and psychiatrists) more and more. Of course, many expect to get a prescription that fixes them magically the same way they want to have a pill for literally any medical problem.
However, just saying "there is nothing wrong with you" often means "your state does not fit any of predefined diagnoses" rather than "it is perfectly normal to feel that way". The same way people often complain about back pain and doctors can only say "there is no acute injury, Xray is fine, nothing I can do for you". It doesn't mean you can ignore it and go about your day. It means that most likely you have to find a lifestyle change to fix this yourself. It can be yoga, it can be getting a better chair and being more active, it can be a new mattress, etc.
Physical pain is more straightforward because most people understand that feeling pain is not normal, it means something is wrong. Nobody will tell you "if doc said you are okay, then your back pain is made up, you should stop being so dramatic".
How do you define being "normal?". How do you manage the tension between your inward and outward presentations of yourself? It seems exhausting, and that's coming from someone who does that currently and idealizes some magical place when those selves merge into the same person.
That's "normal" to me, when I don't have to put masks on to fit into a preconceived notion of who society wants me to be. That's also a big part of mental health, not boxing people into mental disorder diagnoses, but helping people figure themselves out and be comfortable in their own skin.
I define "normal" as things like wearing unremarkable clothing, eating at trendy restaurants, going sightseeing, saying grace at family dinners, keeping a decent job, bringing food to parties, keeping my lawn tidy, driving an unremarkable car, learning the art of small talk, etc.
People use these things to calibrate their interactions with a person they're meeting for the first time. Once people see you as "normal" they're more prone to listen when you start throwing out the weird ideas.
I've come to believe that weird is normal. No one has their shit together 100%.
Your version of normal is "don't rock the boat" normal. Rocking the boat is painful emotionally so don't do it normal.
I've spent a lot of time in therapy trying to undo that version of normal and figure out who I really am. And you're probably perfectly fine in your version of normal. Which really illustrates that mental health is very personal and multidimensional. It doesn't mean I'm fucked up and you're not or visa versa. Gotta meet people where they're at.
That’s conflating what people present to the world with their mind. It’s a very shallow understanding of what’s going on.
Regularly BASE jumping is seriously dangerous to the point where almost nothing else people do that’s “living on the edge” really compares. Think active war zone levels of danger, but they don’t need to dress up in spikes to show off how edgy they are. It’s possible to come off as a calm high school librarian while still being an extreme adrenaline junkie.
Next time you walk past a middle aged banker type in a sports coat consider they could be a furry, you just don’t know. Assuming someone seeming normal is actually normal is being blind to the possibilities.
>> That’s conflating what people present to the world with their mind. It’s a very shallow understanding of what’s going on
I was trying to contrast the external and internal presentations of self, not conflate them. My point is that a "normal" external presentation doesn't make someone a "normal" person. Someone can act, consume, and behave certain ways that help them feel normal, but in the end it's a coping or survival mechanism of sorts. If I fit in with the "in" crowd it affords social and economic status. That's the version of "normal" my comment was responding to.
The only way to define normal is the external representation, you never see the internal one.
Therefore someone that seems normal to all appearances is normal. If in the privacy of their own mind they pray to the invisible fairy living in their left nostril, well how do you know that’s not what 90% of people do?
Trying to be normal is normal. Being normal may have never been normal, but trying to be was and is.
That's what were losing, people don't even try to be normal anymore, because having a mental illness has been normalised.
It's not the right side of history, it's not progressive, it's not inclusive. There will be a price to pay and we'll only find out how much it is once we get the bill.
That is trivially falsified, the prevalence of mental illness is not really related to the acceptance in society (outside of society declaring things to be a mental illness, e.g. homosexuality). For example in Germany the incidence of people missing work days for mental health reasons is higher in regions with less academic jobs (a milieu which tends to be more open to these topics) and in the formerly socialist parts (where there was a higher tabooization of mental health topics). Similar patterns exist for suicide.
I think I know what you get at, but it is important to differentiate between e.g. someone with social anxiety overcoming their anxiety to take part in society (the good way of "trying to be normal") and someone repressing what should actually be worked on (the bad way, hurting both the person, and, long term, society).
The important point with all things regarding the human mind (education, psychology etc.) is that one strictly can't infer what actually happens from outside observation alone. Let's say there exist two persons, A and B, and both play 6 hours of videogames a day. But person A is a perfectly healthy introvert, while with person B this actually is addictive behaviour concealing mental health problems the person hasn't found the strength to confront yet. It depends on how they feel while playing, and how they feel when not playing.
Related: a lot of intellectual people don’t have a tv, and like to make a statement of it.
I was like that for a while, but then as I got older I realised it was much smarter to buy a tv, put it in the living room, and never use it. Now people think I’m normal and I never get questioned about why I don’t have a tv, why I read so much, do I think I’m above popular culture etc.
Amusingly, I did once get busted when a friend wanted to use said TV and it turned out the card in the cable box had expired months before. Didn’t even know it had a card - the cable box came with my broadband/phone line package. Got rid of the box after that.
I guess the more modern equivalent would be to watch an episode or two of Netflix shows now and then.
I think the more normal thing to do would be not to buy a TV and just don't make a meal out of explaining why. 'I would never use it, ' is pretty sufficient
I think you're living in a bubble in this regard. It seems odd to me to worry about this, and in fact odd that visitors would both notice the absence of a TV and comment on it.
Data point: We don't have a TV in my student house, and no one has commented on that, even though we have had on average maybe 5 visitors per week for over a year. Offhand I'd estimate that about 50 unique people have seen our living room. I'm in Sweden.
Speculation: The common factor is you. You influence your visitors with regards to what topics to talk about and how to treat these topics.
I try to see things less from a "mental health" perspective and more from an "emotional health" one. I'd be really curious to see how people who work as psychologists and psychiatrists might delineate between a mental health issue and an emotional health issue. Perhaps it's just semantics and they wouldn't see a difference, I guess I'm just looking for ways to address some emotional challenges separately from potential mental health challenges.
I don't know anyone who thinks of 'having anxiety' as an out, identifying it as something that's negatively impacting your life is just the first step in making changes to reduce its presence. Furthermore the vast majority of people, with or without mental illness, are happier and more supported with some amount of therapy. If you can get that from your friends/partner alone, great, but often times it's quite beneficial for your relationships to take some of that emotional burden off of those people as well.
I'm quite concerned about the rate of medication being prescribed these days, often as a band-aid fix when people really are in need of serious life/habit changes. But I'm really surprised by the amount of people in this thread talking down on psychology and psychotherapy.
Someone I know has social anxiety. They told me that when they read about it and could finally give it a name, it really helped. Up to that point, they just felt like they were an oddball. They couldn't really explain to anyone, which made it feel like they couldn't get help or do anything constructive about it. Being able to name it lets you know that other people also have it. It can help you feel more "normal". It can help you research ways to work with it.
Of course, falling back on a diagnosed condition and using it as a crutch or an excuse for bad behaviour can be awful. I used to know a person with BPD, who absolutely loved being able to let herself off the hook for terrible behaviour. She would easily make friends, and sometimes would keep them for a few years. But eventually, one by one and sometimes in groups, they would cut her out of their lives because she was utterly toxic and selfish. So naming your problem can be positive or negative, but I think that depends on the nature of the problem.
I found putting a name to anxiety helped a great deal. I spent most of my childhood not really sure why some situations filled me with crippling fear - and felt like a failure because of it. As an adult I've realised it's a form of anxiety - and also that anxiety definitely runs in my mother's family.
I think my teenage years would have been easier if my family had been willing to talk about our anxiety rather than just pretend it didn't exist.
There is of course a danger that the diagnosis becomes an excuse - which is
a particular problem with something like social anxiety where (at least in my experience) the only path to improvement is to face your fear and do whatever you're anxious about.
I’m struggling with this now with one of my children. All of the professional/medical support she is receiving is reinforcing the same notion and I’m left with nothing but an intuition that it’s ultimately destructive or at least limiting.
She has been and still is going through some tremendously stressful situations however and I’m trying to balance that against the fact that more stress is on the way. I completely agree with you but it’s tough.
This is a tough one and also one of my fears with my child. Take comfort in knowing that despite how powerful external forces may seem that you as her parent have an even more powerful influence. A wise man once told me "kids will never ever do what you say but will always do what you do". I would show her that obstacles are intrinsic to life. We are wired for struggle. Our struggles are what define us. Even when we have no struggles we tend to manufacture them just so we can overcome them and give meaning to our life. If she wants to give her struggle a label as x condition then that's fine, what matters is what her path should be to overcome that condition.
Jordan Peterson talks about this a lot, especially in "12 Rules For Life" and in his lectures about his daughter's medical condition. I couldn't find the relevant quote but he touches on it in this lecture segment [1]
Just letting you know that I downvoted you not because of the advice - which is pretty good - but because of the link to Jordan Peterson, who is generally a pretty nasty pseudo-intellectual piece of work.
Thank you for your opinion. I figured a lot of people would have mixed feelings about him but I wanted to give credit to where the advice was coming from. Personally, I've gotten a lot of value from his work.
With enough of a benzo habit that he had to detox in an induced coma, besides.
Can happen to anyone, of course, and it's not necessarily a reflection on character in its own right, but it is worth taking some thought on the value of advice on how to keep your life together when it comes from someone who's demonstrated such an inability to keep his own life together.
Even on the simplest things - his constant line is "clean your room", and every time you see him on a Zoom interview from home it's wall-to-wall clutter in the background. Granted, "clean your room" is pretty uncontroversial, and is good advice - as is that you should pet a cat when you find the chance. But, in this as in everything else, epistemology matters: you do want to consider the source.
Consider that maybe you had some luck, good fortune, or support structures that helped you pull yourself out of your anxiety, and it didn't turn inward on you.
Anxiety is not a disorder that causes or relates to introversion or extroversion.
Glad you're in a good place now but be careful on pumping yourself up at the expense of people who are truly struggling with anxiety. It's a mothafuka, not an out.
A diagnosis of anxiety is usually not an out but the beginning of the hard work of improvement. The generally accepted treatment for anxiety is therapy that will encourage you to put yourself into manageable but challenging situations where you can practice overcoming your fears, while finding and rooting out the mental fallacies that those fears are originating from.
No competent medical professional would've told you "You have anxiety, so go sit at home neglecting your social life." That's the OPPOSITE of what people with anxiety should be doing.
Having it as an out is doing it wrong and totally missing the point. It's a framework for understanding yourself/the patient, and how they behave, and not as an excuse for poor behavior. That's not to deny that some people certainly use it that way, but anything, including treatment plans, can be misused.
I don’t think you deserve to be downvoted for saying this. I agree. But I think there’s a bigger chance that I would have “done it wrong and totally missed the point” than not.
It's not a question of whether it's misused. It's whether it's misused so often that it's a bad idea.
And while I hope most professionals can be trusted to use it appropriately, I think the whole "awareness" thing makes a lot of laypeople (including self-diagnosed people and people connected to them or actual patients) misused it horribly. The latest I've seen is "mental health days". I'm sure some professionals would advocate taking some time off in specific circumstances, but is it wise to reward yourself for being stressed by having a holiday? That seems about as wise as telling an alcoholic to take sick leave as a reward for their big hangovers. I'm not a mental health professional, but the people who give advice on taking "mental health days" do not seem to be either.
And that's just the latest one that bugged me. There's an endless list of advice (both for people with mental illness, and people around them) that seems to be vaguely related to mental health advice, but isn't, and it's accepted because it sounds "nice".
> is it wise to reward yourself for being stressed by having a holiday?
Yes. No matter what the fashion of the moment moves anyone to call it, it absolutely is wise to take a break and recover when you can do that without letting anyone down. The stress will still be there tomorrow, and if you're on a good team, you don't have to carry it alone. As long as you don't shade out when it really needs to be all hands on deck, you're fine. It's not hard to spot the ones who abuse it, and at this point in my career I don't find it hard to avoid places where they're welcome.
Better that than needlessly go one day closer to burnout, don't you think? Speaking of which - to conceive of it as a "reward", and an undue one at that, strikes me as sounding like nothing more strongly than burnout. There's a place you get to where it feels like you're thriving on the misery, but that's only because it's been so long since you had anything to compare it to. The next place down from there is worse.
So yeah, I don't begrudge it of my colleagues when they take the time they need, nor do they of me. We've all seen what happens when you don't. None of us wants to see any more of it. You don't want to either, especially not from the inside. Not everyone makes it back.
I'm not sure I get what you're trying to say, what's wrong with advocating for people to take personal time off when they are feeling burnt out or tired from repetitive stress? I'm struggling to understand why that's misuse or in anyway similar to an alcoholic.
Note - if a medical professional is saying someone is unfit to go to work and needs some recovery time, that's different. I'm talking about self-proscribed mental health days.
It's one of several things people are very confident are good for mental health, but I've not seen it actually pushed by any mental health professional (at least, not in the way that it's often used).
I'm not totally against the idea of "chucking a sickie" (a time honored Australian tradition) to get some personal admin done, or just take a break. But I've seen no evidence that it's a good coping strategy if you're got actual problems.
If there's a problem at work, you're better off actually dealing with it either fixing the problem (which might be you or it might be external, or a bit of both) or looking for a new job.
Many mental health problems are cycles of short-term rewards for long-term pain, a lot like addictions. I think this is basically the "B" in CBT - maladaptive behavioural responses to stressors (which need to be replaced with more useful responses) - https://en.wikipedia.org/wiki/Coping#Negative_techniques_(ma...
> Whereas adaptive coping strategies improve functioning, a maladaptive coping technique (also termed non-coping) will just reduce symptoms while maintaining or strengthening the stressor. Maladaptive techniques are only effective as a short-term rather than long-term coping process.
> Examples of maladaptive behavior strategies include dissociation, sensitization, safety behaviors, anxious avoidance, rationalisation and escape (including self-medication).
> These coping strategies interfere with the person's ability to unlearn, or break apart, the paired association between the situation and the associated anxiety symptoms. These are maladaptive strategies as they serve to maintain the disorder.
Note, I'm not an expert on this. But I suspect neither are a lot of people disagreeing with me.
More generally, a lot of what seems like "good advice" on mental health could be just reinforcing maladaptive coping techniques, because the seem like common sense (they are how many people cope with problems, even though they're not helpful in the long run).
And I'm guessing that the people who would be most harmed by bad advice (or advice that might be good in some situations, but bad in others) will be the people probably should be taking very different advice (e.g. "deal with those underlying problems" instead of "take a day off if it's getting too much").
If my parents had noticed that I had severe social anxiety they might have considered getting me help and I potentially wouldn't have ended up as disconnected and friendless as I have via being enabled for much of my life.
I didn't know anxiety was a treatable condition until I was 21. And I've only been able to actually go get help years after that.
No doubt.
To me all this relates to an implicit dualism and just not taking mental health seriously still. I just don't think we ever will while viewing the mind as one thing and the body as another. There will always be this bias that we would consider morally really off if discussing a "physical" health problem.
Even being aware of this I have a bias with typing out "mental health" without realizing it.
We are probably doomed until "brain health" replaces "mental health" in common language.
I had really bad social anxiety about a decade ago but the treatment for my ingrown toe nail was so much better and taken more seriously than a problem with my brain. The first person I went to about it had a community college degree and said they didn't believe in medication. Just incredible.
On the other hand if you have an undiagnosed disorder, you may live your life never being your own friend, always fighting with what you see as character flaws. This leaves you stuck in a rut until the diagnosis, which finally lets you look at and apply constructive solutions.
I was convinced by a therapist (who first convinced my parents) that I have aspergers after talking to them for like 20 minutes and taking an IQ test. At first, it seemed pointless to care one way or another, but for a brief time I bought into it and started viewing myself as disabled or special and it started influencing my behavior and relationships. Then I came to my senses and swore off of it and have been so much better off since.
Because dysfunctional thought when alone cannot be challenged, and becomes self reinforcing. A therapist helps a patient examine the ways in which their thinking is detrimental to their wellbeing.
Theoretically, maybe. But they could just as likely, or maybe more likely, just make it worse. They definitely made it worse it ny case. It was a very reckless process, from my perspective.
"Thought" is a very broad term. You cannot "swear off" a broken leg. That doesn't negate the existence of the placebo effect, or people who do ridiculous things like walk a mile for help without realizing it's broken.
And with psychology just remember Freud. Not that things haven't gotten better, but I still consider that there could be real possibility of either miss- or overdiagnosis...
I find the advertising for them really uncomfortable to be honest. One thing I've heard on a few podcast adverts (so I assume it's copy from the company rather than hosts personal feelings) for BetterHelp is that it's bad to put your mental health concerns on your family/friends, that you don't want to burden them. They have their own concerns, they don't want to hear yours. Whereas mental health charities, especially those focused on men, often have campaigns around getting people to talk to each other. My concern is that the way these companies are marketed will discourage people who can't afford their product from talking to their family/friends and leave them struggling alone.
And from the article, people who can't afford their product describes a lot of people:
> So she joined BetterHelp, a popular therapy app. She paid $65 each week but spent most of her time waiting for her assigned counsellor to respond.
My fiancé is a licensed therapist and is quick to elaborate on the myriad ways that BetterHelp is an absolutely terrible company, for client and therapist alike.
I also used it for a couple months a few years ago and gained nothing from it. Seeing an “actual” therapist afterwards made the differences in quality of treatment immediately obvious.
I’ve had a similar concern regarding mental health through NDIS in Australia. There seems to be a requirement for a diagnosis in order to receive care through the NDIS (mental health care system).
Which results in practitioners giving a diagnosis immediately based on “I think you might have this, so let’s connect you with a psychologist/etc to dig deeper and find out”.
That’s simply the bureaucratic path through the system.
But my concern is that patients looking for an answer hear, and identify with, “I have xxxx, that explains it!!”
When you also take into account that some symptoms are comorbid, and may entirely disappear upon the underlying issue being resolved or managed.
And that’s just the bureaucratic incentives. I’m unclear on the professional & revenue incentives for diagnosis and referral to other professionals, possibly within the same umbrella organisation.
Hyperbole aside, access to mental health services isn't going to invent mental health issues for most people. There's an extremely large underserved population without access to any mental health services. And even with access it can take months to get an appointment.
The services need to be as highly regulated as offline mental health services to protect patients. Besides that, it's a many times over net positive on society if people get the help they need.
It's a net positive even if a few people need attention and get that by faking or acting out a mental health disorder.
I've been working in this space for about 10 years. I've struggled with the business side of things, especially pricing and more so, the idea of it being easier to have return customers than new customers. Prior to working in this, I worked in development economics consulting in East Africa and also struggled with the idea that if development aid is working, then many consultants work themselves out of a job. If the market is large enough, yes, people can help one customer fully resolve a problem and then move to another, yet, it still can seem easier to maintain the same customer.
That being said, I imagine that same idea comes into play in most service-related fields that are trying to solve a problem: consulting, law, healthcare, and more. But maybe it feels more scary because with emotional health, it can cut deeper than most consulting gigs.
> Something I really worry about with these apps is that they now have a financial incentive to find more people with mental health issues.
And thank goodness they are getting more people in. The biggest problem in mental health is that the majority of people who need help don't get it.
> Mental health issues can spread socially
No they can't. There is zero evidence that you can get clinical depression, bipolar disorder, schizophrenia, borderline personality disorder, or anything else serious socially.
> There is zero evidence that you can get clinical depression ... socially
it's more likely that because someone you know or interact with socially admitting to having depression, and thus, clear the stigma for yourself to also admit/recognize it too. Might actually be a good outcome.
Financial incentives to "get everyone in" are very much not a good thing.
It wasn't too long ago that ADD/ADHD panic was absolutely massive. Half the boys at my school were on ADHD meds. Any time a boy acted out, teachers at my school would make a call to their parents to persuade them to see a doctor and get some ritalin or whatever else they handed out by the bucketful. I was a quiet kid and sometimes--maybe once a week--would have goofy moments and that was enough to have my family get a call. 10 year old boys aren't meant to be chained down to desks all day--meds and ADD panic were a way for people to solve a "problem" of energetic kids and someone was glad to make money off it. Some kids do legitimately have disorders and need help, but some things we just grow out of.
This stuff shouldn't be for profit. Someone, somewhere, is all too eager to get people hooked on the idea that they have a problem and the only cure is what they're selling. Digital marketers and tech investors in particular are eager to jump on this. They love preying on the vulnerable and making them feel more vulnerable.
I think back on Finnish school system. Where lessons were 45 minute with 15 minute break outside every hour. I can see that sort of regime clearly helping the boys with normal attention spans and need to get some energy off...
And I think just this alone helped to manage most of them to regular adulthood.
I don't necessarily agree with the premise of the OP we're responding to, but apps and computer services have the ability to scale in ways that other mental health organizations don't, especially if they have a lot of investor funding to burn. A service that was used by ten thousand people in January could be used by a quarter of the country by June, and it can quickly command the market and put its competitors out of business.
I will also preface by saying, that there very much is an issue with having for-profit (mental) health system.
That said, I don't think what you're pointing at goes beyond issue of monopolization (giving one side of the market relatively more power) and those previously mentioned. To give an example, you'd achieve the same problem if they simply created 'mental health board' interest group with PR and lobbying - those can be very powerful, my personal favourite example being pork producers making 'bacon' a cool thing. Putting competition out of business seems tangential to other points in the thread, unless I'm missing something.
The problem is inherent, apps just streamline process and make it more clear. Relaying on disorganization of some class to produce friction that will limit their whole effectiveness (including part that is clearly harmful) is a delay tactic at best, not a solution.
Your linked wikipedia article describes behaviors or emotions spreading through social groups, but this doesn't mean that mental illness spreads through social groups. "Contagion" doesn't mean "illness", it means "meme".
Is there actually research showing that mental illnesses spread through social groups?
Yes. The most common are those experienced by young people- teenaged girls. Ex: eating disorders, self harm, and personality disorders. There's also been recent findings relating to involuntary movement disorders. (Women claim to have tourettes like symptoms. They watched a lot of social media -> picked up involuntary habits that look similar. Not tourettes, but a psychological issue.) Could start here for research:
> Findings in this literature are consistent with social modeling/learning of NSSI increasing risk of initial engagement in NSSI among individuals with certain individual and/or psychiatric characteristics.
I'm not sure I understand what you're saying here. Behaviors and emotions are descriptive of the "issue" part of mental health issues. Behaviors and emotions are the symptoms.
I think I'm not understanding your initial point - are you saying that these apps need to find people with mental health issues (which makes sense), or that these apps are incentivized to start inducing mental health issues in people in order to increase their customer base, and that's something we need to worry about?
I see in your initial comment, you talk about these apps diagnosing people and that causing somebody to develop the actual disease (I guess like a reverse placebo).
OP is trying to say you might have some tendencies that aren't problematic, but once you find a group who normalizes or somehow inadvertently encourages (i.e. via searching for profits) those behaviors that it turns into a real problem.
Whether that set of behaviors is just a behavioral problem or a diagnosable disease, I'll leave that to the experts.
DBT is an evidence-based psychotherapy and it specifically calls out catastrophizing as one of the 10 unhelpful thinking styles. Whether practitioners should be specifically trained in DBT vs some other modality is up for debate, but catastrophizing's not this unknown systemic risk - it's just more of healthcare under capitalism, which is rife with these sort of issues.
My company started offering one of these, and wanted permission to disclose... something (never figured out if it was just name/email, or more) to them to onboard me.
I asked about data use, including disclosure back to my employer, and never got more than a pointer to their (predictably useless) privacy policy. They (the vendor) deliberately avoided answering anything related to disclosure.
How many different angles have we seen on, "...and if we hoover up enough data, profit!"
The article is talking about subpoenas – court orders for disclosure of relevant records, which override ethical and contractual confidentiality obligations, unless the person holding the confidential documents persuades the court to quash or limit the scope of the order. https://www.apa.org/monitor/2016/07-08/ce-corner
> How many different angles have we seen on, "...and if we hoover up enough data, profit!"
Something I see happen all the time:
1. Organization hoovers up data incidentally as they build a product.
2. Privacy concerns are raised internally, but the organization genuinely has no intention of misusing the data so concerns aren't taken seriously and they're not addressed.
3. Some years pass (sometimes only one or two).
4. Newcomers to the organization now start misusing the data because, hey, it's there. If you have it, why not use it?
I witnessed 1, 2, and 3 at my previous job (not mental health data but the data I was concerned about was just as personal and vulnerable to abuse), praying 4 never happens but given the company’s been acquired, I’m not optimistic things will get better.
When I point this pattern out in other contexts (like talking about how instrumentation can become surveillance after collection), people get upset with me.
We have had potential employers who wanted employee data back to them and our answer has been a flat out no to them.
We have also had legal consultation on this due to the continuous pressure and can confirm it is not legally required to share your data to the employer at-least in the EU.
Question: With all the industry wide bad practices, how do we convince you that we don't share your data with your employer?
>how do we convince you that we don't share your data with your employer?
On the top of your privacy policy, put a big fucking banner that plainly indicates that you don't now and never will.
But seriously, we now live in an era where the only rational assumption is Zero Trust: that everything about you that can be gleaned, can and will be sold.
Specifically though, isn't this considered HIPPA "protected" data?
> How many different angles have we seen on, "...and if we hoover up enough data, profit!"
Even doctor's offices do this now. I've been to a few that ask you to sign away your rights to privacy so that they can sell your medical information to their partners. It's gross.
I was scammed by Talkspace. After I signed up, I was never able to actually talk to anyone. I paid almost $500, and every time I would go into book a time to talk to my therapist, their calendar would be unavailable. I would then contact the therapist via the messaging feature and be told to try earlier in the week next week.
I tried this for several weeks before switching therapists. I did this several times with the same result each time. Every time I would be able to easily message the therapist and get a response, but when it came to actually booking a video appointment, they were conveniently unavailable.
I finally grew frustrated and cancelled my account, and requested a refund. A few days later I received a confirmation with no refund. I sent a support message and received a link to an FAQ page that said I “wasn’t eligible for a refund”. How can it be that a company feels comfortable taking almost $500 and literally providing no service at all?
Finally after several weeks and starting a charge back process with my bank, I received a refund. Looking back, the “messages” I received from the “therapists” and “match agents” had a distinct bot feeling to them. I wouldn’t be shocked if they were fully or partially automated.
It’s unconscionable to pray upon people trying to get therapy, but something tells me that’s exactly what many of these companies are doing: they just expect you to forget about it and once the 90 day dispute window is up, you’re out of luck.
I will never again use one of these online services (likely VC-backed and tech heavy). They are taking advantage of people with depression and mental illness for profit. Judging by other experiences I’ve found online, I’m not the only one.
It's particularly unconscionable because people who need therapy are likely less able to defend themselves against scamming, e.g. the depressed will just not have the energy to start the charge-back process or feel they're getting what they deserve anyway.
Or they'll just give up on therapy because in their mind, they tried and it didn't work out for them. I've been there myself: you put in the effort to seek help, it backfired through no fault of your own, and that is enough to set you back such that you're in a worse place than you were before.
A bad experience with therapy, or an experience with a bad therapist, can do a hell of a lot of damage.
> It’s unconscionable to pray upon people trying to get therapy, but something tells me that’s exactly what many of these companies are doing: they just expect you to forget about it and once the 90 day dispute window is up, you’re out of luck.
They also expect vulnerable populations of people with untreated/under-treated mental illness won't advocate for themselves as much as other populations, and they're probably right. It's gross.
With regard to your experience with Talkspace, consider reporting them to your state's consumer board and Attorney General.
I always thought of these apps as a sketchy byproduct of US's weird/malfunctioning health system -- kind of like how people use painkillers to forget about their toothache instead of going to a dentist.
Can't pay for a medical doctor to treat your mental health condition? Here's an app!
>... kind of like how people use painkillers to forget about their toothache instead of going to a dentist.
I used to use whiskey for this when the pain became unbearable. Would take half a shot, then invert and tilt my head, letting it sit for a minute on one side of my upper jaw. Sometimes I'd spit if there was a lot of blood. Did the trick though, was usually enough relief to get me through until the toothache went away.
For a time I probably had more alcohol intake from that then I did actually drinking, despite it being a seldom occurrence.
Note: I say this being fully aware of how dangerous some types of untreated toothaches can be, so if you can afford care, get it. It might save your life.
I did something similar when my wisdom teeth came in shortly after I turned 21. When it hurt, I would drink, and when it stopped hurting, I stopped drinking.
It's not just about pay. Even if it was 100% affordable there's a shortage of mental health workers compared to demand. See the NYT Article from a few days ago [1]. The solution we have right now couldn't scale.
I'm not saying that an app, or technology in general, can fix everything, but surely we can drum up some sort of support tool that doesn't leave people high and dry, and doesn't rely on an impossible scaling up of a limited supply of skilled professionals doing 1:1 therapy. I'm not saying you can ever replace 1:1 therapy or even in-person therapy, because I don't think that's how we've evolved to need care, but I know that there is research to support that meta-level awareness of your own mental health is an important step.
There's (probably) not a silver bullet tech solution out there, and I think it's frankly a minefield and a losing battle for most startups, but definitely for investor-backed startups. I think this space really needs open standards and privacy-first solution that keeps people in charge of their own data, while also giving better tools to the experts who are out there now, and enables at least a minimal level of several options for therapy (self-led, group, facilitated, etc) for the varying levels of need, to free up 1:1 sessions for those in the greatest need rather than just the highest bidder as capitalism often favors.
People are not on any meaningful scale in the US using pain killers to avoid dental care, unless you mean something like aspirin. Or rather, as someone who worked in public health related tech for many years, I've never see any data or heard anyone mention anything like that.
“In 2019, before the coronavirus pandemic made dental visits difficult, a third of adults under 65 hadn't had a dental exam or cleaning in the past 12 months, according to the report from the U.S. Centers for Disease Control and Prevention.” - from Internet.
I am seriously impressed that 2/3 of US adults have had dental care within a year.
I live in New Zealand, which is fairly first world, but I don’t think we would have a figure that high. Note we have social health care, but that doesn’t include dental work (except for emergency dental care and limited care for people on benefits.)
My mom couldn't afford it, she spent years not being able to go to the dentist and eventually got the money to do some root canals. It almost certainly is a thing.
Not really a big contradiction unless you want to be really pedantic. Over the counter painkillers and prescription painkillers are very different beasts. Painkillers as a social ill pretty much exclusively refers to the latter. Nobody would say “I’m on painkillers” while taking aspirin.
> Nobody would say “I’m on painkillers” while taking aspirin.
Really? That's exactly what one would say in my country... though they'd more likely to be talking about paracetamol. The strongest one that most people know about is Panadeine Forte (paracetamol + codeine).
I've been to a few Psychologists, and two Psychiatrists.
I asked the first one about his fee. I went in not knowing. I had this horrid anxiety that just wouldn't go away. He says, "pay me what you think I'm worth."
I was in such angony, but did't want to piss this guy off. He had a good reputation. He offered no medication, and had this rediculious theory my anxiety was post traumatic syndrome from the '88 earthquake.
Anyway ge told me his fee was $450.00. I paid it and left.
I saw a Phd. Psychologist I found in the yellow pages. I talked and talked. I cried, and cried. Nothing was stopping the daily anxiety.
I ended up finding a Psychiatrist who didn't rape me on price. He put me on two very addictive drugs, and I've been on them decades. The mandatory appointments are tedious. I get absolutely nothing out of them. I've been on the same dose, so I think i'm just addicted, and any perceived pharmaceutical help
is placebo.
Anyway--unless you hear voices (really bad voices that are bothering you greatly I added that tidbit about voices because they found schizophrenics do better long term without meds), or ready to commit suicide; I would stay away from the entire profession.
Oh yea, in your twenties and thirties, they are rough decades. If you don't bust a gasket consider yourself lucky.
If I had a do over, I don't think I would have ever seeked help. It's kinda a joke. It's definitely an art.
Damn, I'm really sorry to hear you went through all that.
The amount of anxiety I've had to _accept_ treatment into my life is because of stories like this. It's been a different though helpful journey for me, but also a lot of questioning, self tracking (to have some reassurance of a change in state over long periods of time), and a little experimentation.
But as a simple counterpoint to this, I'm getting a lot out of therapy, as are most of my friends who are in therapy. It's not doing what I thought it would - it hasn't fixed my depression overnight, or cured my irritability - but it's providing a different framework to think about the world and relate to people, and I like who I am an awful lot more than I like the person I was.
It's expensive for me, at 60 bucks a session on a not-particularly-high wage, and I regularly revisit the idea of stopping, but I think I'm still getting something useful and insightful out of most appointments, so I'm keeping on going.
Same here, I would have never paid if insurance didn't cover it. I also realized a lot of my problems were due to being young and I think I would have gotten over it all anyway.
The problem is that there is no requirement for these apps to actually work. They might work, or might not. But that doesn’t really impact whether scientists get grants. They make the funders/government look like they care about mental health and these apps are cheap compared to more traditional mental health and psychiatric therapies. The scientists are desperate for the next round of grants funding and are happy to produce something that makes the government funding them look good.
This kind of thing is pretty common in science. It can be hard to see from the outside, but it is so obvious once you have been involved in grant writing.
Well to be honest there is no requirement for mental health treatment to be evidence based so there are a ton on providers that are basically witch doctors. You need to screen hard because state licensing only protects you from harm does not ensure providers actually offer services that work.
used to work in a lab focused on this sort of thing and the money did indeed flow for personalized e-health and digital interventions mediated by smartphone or browser interface
maybe things have changed since but I didn't see much incentive for the researchers involved to compare the long term effects of this form of treatment to other options or stop and wonder about the implications, although I'm certain some would like to given a different funding landscape
I built an app for emotional journaling back around 2012 called iFeelio[0]. One of the reasons I've stopped working on it was the fear I had that it would get hacked. Despite having it be local-only (no permission to connect to the internet on Android) and using an encrypted database, I worried about nation-state/NSO-like hacking and how it could be much worse than WhatsApp or an encrypted messenger getting hacked.
That being said, seeing so many people create apps for emotions without taking such a a stringent approach frustrates me and has me thinking about revamping the app.
If anyone reading this is interested, please reach out to me at the email in my profile and I'd be glad to chat. Or just comment here and I'll reply :-)
Your precautions in particular no internet access and encrypted db sound really thorough. The end users will probably have ended up using less secure alternatives like a cloud driven alternative or the standard notetaking app on their phones. Let's just take for granted that if a nation state actor wants too spy on someone they'll do so one way or another.
In the end the end users would be worse off with the alternatives as you say. However you mentioned it wasn't the only reason. And of course litigation is a danger with these things.
> In the end the end users would be worse off with the alternatives as you say.
I really appreciate this point. It helps me reflect on the cost of inaction: "If people are going to use apps like this anyway, you not building the app may hurt them but not giving them a more secure option."
> Let's just take for granted that if a nation state actor wants too spy on someone they'll do so one way or another.
> And of course litigation is a danger with these things.
Yea, I suppose if they were to hack into iOS or Android to access a local-only encrypted file, then those two platforms may be equally if not more liable than I would be. So maybe the legal aspects wouldn't be so bad.
disclosure: I hold an equity position in an end to end encrypted, trust on first use communications app, not really relevant to this conversation so no value in naming them.
I'm not terribly surprised at the number of services that have popped up in the last few years, but considering the sensitivity of the data (in many cases, info that most would consider to be some of our deepest feelings on a topic that we wouldn't want just anyone to hear about), I'm surprised at the lack of ventures working to distance themselves from the content of the conversations. It just feels like in this specific niche, protection of data would be a much bigger selling point than most others.
I'd imagine any suitably well-funded chat service with end to end encryption could fund a subsidiary venture to build out a therapy-focused implementation of such, and especially in the world of therapy, hand-written notes would probably be preferred anyway, so there shouldn't be much in the way of storage of data aside from directory data for individual users of the service and probably card transaction pointers to a third party processor, plus a handful of other bits that still shouldn't be anywhere near as compromising as actual contents of conversation.
Open to discussion on the topic. There's probably an angle I'm not seeing.
Sometimes, it's a good idea to keep things off computers, unless you can be sure of the quality and security (which is a challenge. Everyone says they are "secure," but we keep having clusterf**ks like this).
> I'm surprised at the lack of ventures working to distance themselves from the content of the conversations.
Me too. I struggle to understand why most communication platforms don't try to do end-to-end encryption. From what I've seen, it can one, be a lot more complicated technically and two, hard to make a user experience that people enjoy. However, I don't know if people starting companies think enough about the ramifications of knowing (and storing) what people are saying to each other, legally and emotionally.
I've been wanting to do more work online, especially over the pandemic, helping people express emotions and I've often balked at platforms because they don't have e2ee or they say they do and then are found out to not have it (ie Zoom). Most people may not desire this, but as someone who wants to run classes and have conversations about deep emotions, I strongly want almost all of the platforms to be e2ee. I would love gather.town, Discourse, Discord, Guilded, Clubhouse, and many other communication platforms to have e2ee as default.
I want this for personal conversations but I strongly want/need this for professional conversations, and because it hasn't really been there on many of these platforms, I've just not had those conversations.
There are certain regulations that make it much harder to implement E2E.
The data in a therapy app can be considered part of a clients medical file and the medical file has various compliance regulations affecting it e.g the data has to be accessible for the organisation for 15+ years.
This has created a structure making E2E almost illegal in some healthcare domains as the policy ensures that the client data can be accessible to future therapists and accessible to the organisation under catastrophic scenarios.
Only the app being E2E enabled is half the picture, the regulation has to either change or the compliance to the regulation by the mental health organisation has to be creatively done to ensure a complaint E2E implementation.
This makes it a bigger, costlier problem than making therapy more effective and hence a ton of hesitation as unfortunately you don't 'need' to do it.
I think it might depend on whether or not U.S. insurance companies are involved. If so HIPAA is a real liability as a company. For example, a former colleague worked at a high profile private research facility that had their HIPAA firewall breached and their entire department was fired. Assuming that chat logs on these apps could fall into that same class of data in the U.S., that's a huge amount of risk/liability as a company.
My phone use is responsible for 99% of any mental health issues I might face. The idea of solving a mental health issue with an app is crazy to me. Like treating drug addiction with more drugs (which I’m aware is a thing).
At least for some things, which I'd call more emotional health rather than mental health, I think it's possible. When I was developing an app for this about 10 years ago, my goal was precisely that: use the phone to check in more with myself and less with other people. I even hacked together a solution on Android where when I would receive a notification from Facebook or Whatsapp or whatever, I would also trigger a notification from the app to checkin with myself. Basically hijacking the attention seeker from the social media network and trying to redirect it towards myself.
While that little notification hijacking didn't seem to help much, the app I built for journaling really helped me get more in touch with how I was feeling and feel more confident in my ability to express it.
Speaking of cybersecurity and shady marketing tactics: that website offers a "free depression test," but when you fill out the survey, they tell you that you have to give them your email address to see the results. Meaning that the test results are sent over unencrypted email.
I think at some level, if strong security / end-to-end encryption is not seamlessly baked into the products we already use, things like this may keep happening. I don't know too many emotional health professionals who are also very knowledgeable in cybersecurity, so people may just use the defaults.
Which is why I like Signal and WhatsApp (to some extent) for doing it behind the scenes. I'm willing to bet most people have no idea how public email tends to be.
I love Dr Burns' work. I sometimes wonder if a company which wanted to provide good customer service would do Testing at the start and end of every support case.
(And not "how did we do?" email surveys which mean "punish the call handler for anything less than 5 stars")
My therapist hasn't done this, but I do find the decompression of therapy to usually reflect how valuable it was to me anyway.
Tracking my anxiety with Daylio has really helped as well. Gives me much better metrics for how my anxiety changes over time and with different medications. Hardest part has been keeping the scale consistent even when my baseline amount of anxiety seems to change.
I might be wrong but in EU any app that is going to give you advice about health improvement etc is considered a medical device and regulated accordingly. As long it just tracks and shows you data, it's not a medical device.
I am not convinced these are safe to use. I am concerned they just report back to your employer, when they are provided as a benefit, so they can “better manage attrition.” Or to large data brokers otherwise.
Unless these tools are open source and can be compiled from the source, I don’t want to entrust them with my emotions or thoughts.
I will absolutely never use a digital service for mental health. There have been breach of personal data with very little consequences for the leakers. Mental health/wellness data is also an incredible data set to mine for targeting ads (as others have pointed out).
This is also the main reason I use a paper notebook as my diary for journaling. I’m ok with the trade off of not having backups: the alternative of this data being mined and leaked online is not a risk I’m willing to take. In fact, I simply don’t feel comfortable writing online honestly at all, my brain is conditioned to believe anything in the cloud is simply not secure.
>my brain is conditioned to believe anything in the cloud is simply not secure
Technically untrue, but true nonetheless.
There are a lot of techniques for ensuring the security of data. Techniques where even the supplier of the service cannot access your data.
But they do not add (in the general case) to the bottom line.
In another generation (or two) users may get educated to insist on it. But for now the refrain "I have nothing to hide, why should I care about privacy?" is very common.
My reply is "you have nothing to hide, now. When you do it will be too late".
I worked for a mental health software startup until 2017, and even then it was worrying how many market entrants didn't seem to bother with clinical guidelines to mental health. The modern crop of tools are jamming together elements of Uber/Doordash and online dating apps....wellness on demand! Swipe right on your preferred therapist!
Most users that haven't gone to therapy or read how CBT works won't know that much of actual therapy is boring homework. You're not paying to vent to a sympathetic ear. You are discussing your issues and then doing homework where you identify negative thinking patterns, and the daily triggers that launch those thoughts. That is not something that should be done through the equivalent of a Drift chatbot, but rather through scheduled, regular conversations.
The CEO of my former company was a practicing psychiatrist who resisted the "gamified" nature of modern wellness apps, and set up the software to use DSM-5 criteria for assessing issues. Based on the info provided, it generated a PDF with symptoms related to recognized disorderds, which were to be discussed with a general practitioner at their next appointment. It wasn't supposed to replace the role of actual therapy, but rather to provide decision support to both patients and care providers.
Privacy is the most obvious concern that comes to mind with apps like these, but I feel like there are potentially even bigger problems.
Companies are shielded from a significant amount of liability by using apps. If a company positions itself such that its mental health practitioners and patients are both users, then Section 230 of the CDA shields the app owners from almost all liability for what happens on their app. If, for example, and doctor commits malpractice or otherwise does something illegal, the company that runs the app has absolutely no legal obligation to do anything about it as they have no liability when it comes to how users use their service. This has had some pretty horrifying results in the US, and courts all the way up the the Supreme Court[1] have confirmed that, as per the CDA, operators of interactive computer services are shielded from liability for user content and actions, even if those computer services are knowingly used for fraud and assault[1].
Also, these app-based marketplaces further commodify the mental health profession. Look at any app-based marketplace or employer. Is quality what comes to mind? To me, what I see is a race to the bottom in terms of quality and compensation to sellers or workers. I think a Wish.com, but for psychiatrists, will become exactly that. Whoever owns the apps will make a lot of money, though.
I can't believe anyone takes these apps seriously. Of all the things wrong with mental health care, "a shortage of apps" was not even in the running to make the list. Talk to someone who has struggled with depression for decades and tell me if you think an app is going to help. Or look at the inhumane treatment people receive in inpatient settings, and the failure to make even the most basic follow-ups after they're released (other than a letter from the hospital asking for a donation). Read any first-person account of mental illness and you will see a picture of desperate suffering with needs barely and inconsistently met by a condescending industry that can't even figure out what it is they're treating or how to treat it with any reliability. It's a horrible situation, and it's not going to be solved by an app.
Mental illness is by its very definition debilitating, leaving the suffering unable to help themselves. Those battling with depression, schizophrenia, bipolar issues, addiction often lose or are on the verge of losing their jobs and friends, possessions, homes, control of their lives.
These types of issues just scream for a social safety net and free treatment for those who need it: we all pay income tax when things are good, so that there is somebody there to help us when things turn bad, even if we have no money, even if we are unable to ask for help, even if, on the heights of despair and irrationality, we staunchly reject help.
It's a telling sign of the times that, instead of talking about social solidarity, pure market driven solutions that profit by charging their patients are taken seriously in this space.
Having worked in health care for service provider like hospitals, medical offices and health care IT/Data Management/Analysis for health insurance funds, I would consider myself crazy to touch those apps with a ten foot pole, even if in dire need.
But then again, I'm one of those mentally healthy bastards having worked for them and stayed sane.
Paranoid that is.
It probably would be a start to encrypt the data down to field level.
Not everybody in IT and data mangling needs to know them.
But then again, who cares?
Or rather more important, who pays?
“No universal standards for storing “emotional data” exist. John Torous of Harvard Medical School, who has reviewed 650 mental-health apps, describes their privacy policies as abysmal. Some share information with advertisers. “When I first joined BetterHelp, I started to see targeted ads with words that I had used on the app to describe my personal experiences,” reports one user”
>I could drum up a dark fantastical setting of HR departments buying this data and screening candidates with it. Hopefully this patient data gets HIPAA treatment and is more protected.
> When I first joined BetterHelp, I started to see targeted ads with words that I had used on the app to describe my personal experiences
Selling data from therapy sessions to advertisers is downright abusive!
Personally, after an initial good experience with BetterHelp, and then a hiatus, I had to stop using them because all of their therapists became evangelists for Critical Theory and were literally telling me that I ought to feel guilty for my race and gender, and work to atone for it. To be fair, I think this is a bigger probelm with the APA and not BetterHelp specifically. But a therapist who cannot abstain from judgement should not be a therapist.
Wow unless you were specifically bringing up racial issues as a personal problem I can’t even imagine how that would come up. I went to a therapist for years and had no idea what his politics were.
That is remarkably unprofessional for someone who should be a qualified clinical psychologist, not to mention that it is completely unempathetic and lacks compassion.
Because the data is given by the user, to the app. For example, MyFitnessPal can share the weights you give in check-ins to advertisers or whomever. But if you had a app from a health provider or health insurance company that you logged exercises with, then HIPPA would be applicable because both of those two are covered entities.
An app could be considered a health info clearinghouse if it receives data from a covered entity, in which case HIPPA would be applicable. But as far as I have seen, these mental health apps are paywalled audio snippets about different mental issues.
You can see here [2] what entities HIPPA applies to. A app would probably fall under the rightmost "clearinghouse" column. But, that is only if the app receives data from another cover entity. If the app uses data provided voluntarily from and by the user to the app, the app is not a covered entity. [1]
Aren’t the apps just matching providers and hosting communication? In which case the providers fall under the first column? At some point, there must be a provider, right?
I've been working on something that could improve privacy for websites like this. It's basically end-to-end encryption for websites, so you could have a chat with a therapist without the middle-man being able to decrypt the data. Of course the challenge is that these companies are selling or otherwise profiting off the data, so it's hard to see why they would use it unless you can convince them that the privacy is, itself, a big enough differentiator.
These service providers largely don't even offer licensed medical doctors but social workers. Licensed psychologists charge professional rates and avoid transactional experiences.
I'm surprised that this doesn't fall close to the FDA's approval process for medical devices. When I worked at a medical device company and had external training on the requirements, they specified that even a toothbrush could be considered a class 1 medical device[0][1], worthy of a 510k filing. Maybe the apps in question are simply "communications programs" for communications between doctors/therapists and patients, but in that case it seems like HIPAA would apply to these. If they have any algorithms whatsoever, they are definitely medical devices, IMO, though I couldn't find a classification for anything like a "mental health algorithm software" type device. It could be that mental health apps are a gap that the FDA hasn't closed yet?
Overall, it seems to be just another case of "move fast and break things" where the "things" are laws. I am not impressed by the corporate greed that seems to be driven by the insane amounts of venture capitalism we have today. To me, it seems like commercial activity in every industry has been hit with an "unethical stick" and all anyone cares about is $$$$$$$$$$$$$$$$$$$$$$$$$.
> I'm surprised that this doesn't fall close to the FDA's approval process for medical devices.
It will, but it takes a while. So far, medical apps where basically ignored by regulation, but that is about to change. In Germany, you can now register apps as "digital health apps" with regulators [1]. This created a new market, because now the app can be paid for by insurance policies. Hence, most apps already approved are in the "mental health" category and charge about €2,000 per year. Cheap compared to traditional treatments, expensive for a consumer app.
This has benefits and downsides.
Main benefits: Apps must comply with regulatory affairs. There must be data to support that the apps work as advertised. App developers must think about risk for the user/patient and how to manage it.
Main drawbacks: Considering the replication crisis in psychology, there is incentive to create weak evidence. Apps can claim to work, because they did a bunch of studies, but in reality, the app is useless. Since customers don't have to pay for them, but insurance companies do, there is less pushback from actual customers. Why would they care about a free product not working as advertised?
So far, this is something within Germany. I can imagine that other countries will follow. Add the new Medical Device Regulation (MDR), which harmonizes medical device regulations within the EU. The next step will be some global harmonization and thus, enabling these kinds of new markets for prescribed apps.
>Providers who submit HIPAA transactions, like claims, electronically are covered.
If you aren't doing any sort of "transactions" (ie not submitting insurance claims) then you don't have to comply with HIPAA - even if you are providing health services and are storing and processing health information.
The "I" in HIPAA stands for "insurance," as a general rule, if an insurance company is never involved HIPAA probably doesn't apply.
HIPAA is extremely misunderstood, people think it is a general medical privacy law, but it is not, it's a law that regulates insurance companies.
It's been a few years since I read through HIPAA. If insurance pays, generally it will be a HIPAA entity. However, a company can be a "hybrid" entity and logically separate it's HIPAA and non-HIPAA services. So, just because a company accepts insurance, doesn't mean all services are HIPAA compliant.
Lastly, I think (but don't quote me on this), there's a way for an insurer to cover something as a "benefit" of sorts without it being tied to HIPAA.
At the end of the day, my understanding is everything is tied back to CMS.
Slightly OT, but here's a mood tracking app I wrote (on-topic inasmuch as it's free, and collects absolutely no data notwithstanding using CloudKit to synchronise state).
