Navigating Use of Mobile Apps in Practice

In 2016, after practicing psychology for a little over 5 years I decided to return to graduate school to study Human Factors Engineering. Apart from being a lover of learning and a glutton for punishment, I had begun to realize both the importance of technology in mental health and the deficits in the design of those technologies. Fast forward 5 years and another degree later, I have learned even more about this.

The use of mobile applications to address health and mental health is growing exponentially. According to IQVIA (2017) there are over 300,000 health related mobile applications available and nearly 100 more being added daily. Of the overall number of health apps, more than 10,000 relate to mental health (Torous et al., 2018). Despite the apparent proliferation of mental health applications, 90% of all current mental health app use can be narrowed down to just two apps, Calm and Headspace (Wasil et al., 2020). Some of that may be due to the lack of usability, credibility, and trustworthiness of some of the apps on the market.

Anyone can create an application and put it in the Android or Apple app marketplaces. An app’s existence doesn’t ensure its origins, safety, or quality. For example, looking at suicide prevention applications, researchers have found that many applications are not designed with the user in mind, do not solve problems most users care about, are not seen as trustworthy, and are unhelpful in emergencies (Torous et al., 2018). Furthermore, many individuals using mental health applications are experiencing one or more mental health conditions. Some of these conditions including depression, anxiety, bipolar disorder, and schizophrenia have been shown to impact cognitive functioning (Bosaipo, et al., 2017; Stergiopoulos, et al., 2015; Bora and Pantelis, 2015; Rock, et al., 2014; Keefe and Eesley 2006; Heaton, et al., 2001; McKenna 1994). 

Combining the usability issues with existing applications and the needs of users with mental health concerns, highlights the importance of psychologists and other mental health practitioners to be versed in the art of evaluating and recommending applications that are safe, usable, and useful. Applications should always be reviewed by a mental health professional before they recommend them to clients. There are three important topics to consider when reviewing applications for use by those with mental health concerns: security, credibility, and usability.

Clients often trust their mental health providers and trust that information that they are providing to them is credible. This makes reviewing an application’s information even more paramount than when you are using an app for personal use. When examining an application’s information credibility, it is important to look at multiple criteria including:

  • Can you locate the sources of information?
  • Is the information accurate and of good quality?
  • Does the information source have good integrity and is it trustworthy?

Most mental health professionals are well versed in privacy and security of information when it pertains to client records. It is at the core of what they do and helps their clients to feel safe. Applications present risks to that privacy and security. Many applications are for profit and will seek personal and financial information. This may be intrusive to clients already struggling with concerns about stigma, privacy, or safety. Some applications may allow clients to store personal information like safety plans, thought diaries, and mood charts. Because this information can be sensitive it is also important that applications that collect this information have security built in to protect it. Applications can also have GPS or activity tracking features. This information also needs to be protected and used in a way that is consistent with a client’s preferences and safety. Some important points to consider in terms of evaluating privacy and security:

  • Is the application transparent about information policy, what is shared, and with who?
  • Is the user agreement easily accessible?
  • Does the application collect personal or sensitive information?
  • Does the application allow for password protection?
  • Is the application tracking your client’s usage or location?
  • Are there others in the client’s life that may be able to access sensitive information from the application?
  • Does the app allow the user to transmit personal information without encryption?
  • Does the app access the phones address book, microphone, camera, or location without permission?

Last but certainly not least important, usability. One of the primary reasons why people discontinue use of an otherwise useful interface is poor usability. Applications that are not usable can be difficult to navigate. Because of cognitive impacts of mental illness, the user needs of those with some mental health diagnoses may be different than those of the general population. For example, a recommendation for an application for someone in the general population may be the use of bright colors. This is not recommended because bright colors can be overwhelming for someone experiencing psychotic symptoms or concentration difficulties.  Some usability principals to consider when reviewing applications:

  • Is the application easy to navigate? Can you find what you are looking for?
  • Does it malfunction or crash unexpectedly?
  • Is the interface cluttered, distracting, or overwhelming?
  • Does the app provide accessibility features for those with hearing or vision impairment?
  • Is there user support or help built into the application?
  • Are icons, buttons, and other app features consistent throughout?
  • Is the text written at a level that all users can understand regardless of education level?

Those are just some of the important questions and points to consider as you are reviewing applications for recommendation to your clients. If you need some assistance doing this, there is a great resource called the One Mind PsyberGuide that can help to point you in the direction of some good quality apps.


Bora, E., & Pantelis, C. (2015). Meta-analysis of cognitive impairment in first-episode bipolar disorder: comparison with first-episode schizophrenia and healthy controls. Schizophrenia bulletin, 41(5), 1095-1104.

Bosaipo, N. B., Foss, M. P., Young, A. H., & Juruena, M. F. (2017). Neuropsychological changes in melancholic and atypical depression: a systematic review. Neuroscience & Biobehavioral Reviews, 73, 309-325.

Heaton, R. K., Gladsjo, J. A., Palmer, B. W., Kuck, J., Marcotte, T. D., & Jeste, D. V. (2001). Stability and course of neuropsychological deficits in schizophrenia. Archives of general psychiatry, 58(1), 24-32.

IQVIA. (2017) The Growing Value of Digital Health: Evidence and Impact on Human Health and  the Healthcare System. Retrieved from on January 18, 2018.

Keefe, R. S. E., & Eesley, C. E. (2006). Neurocognitive impairments. In J. A. Lieberman, T. S. Stroup & D. O. Perkins (Eds.), Textbook of schizophrenia. Arlington, VA: American Psychiatric Publishing.

McKenna, PJ. Schizophrenia and Related Syndromes. Oxford: Oxford University Press, 1994.

Rock, P. L., Roiser, J. P., Riedel, W. J., & Blackwell, A. D. (2014). Cognitive impairment in depression: a systematic review and meta-analysis. Psychological medicine, 44(10), 2029-2040.

Stergiopoulos, V., Cusi, A., Bekele, T., Skosireva, A., Latimer, E., Schütz, C., ... & Rourke, S. B. (2015). Neurocognitive impairment in a large sample of homeless adults with mental illness. Acta Psychiatrica Scandinavica, 131(4), 256-268.

Torous, J., Nicholas, J., Larsen, M. E., Firth, J., & Christensen, H. (2018). Clinical review of user engagement with mental health smartphone apps: evidence, theory and improvements. Evidence-based mental health, 21(3), 116-119.

Wasil, A. R., Gillespie, S., Shingleton, R., Wilks, C. R., & Weisz, J. R. (2020). Examining the reach of smartphone apps for depression and anxiety. The American journal of psychiatry.


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