NPR issued a report on new apps that give teens easier, persistent access to mental help. The article begins by introducing readers to a smart phone app that allows teenagers struggling with eating disorders to record behaviors, complete exercises that teach coping strategies and exchange messages with a mental health coach. This and other tools like it allow users to check in and feel connected to a designated support network. Other apps focus on crisis intervention. Similar programs exist for users suffering from depression and anxiety.
Sure, It Could Help…Sort of
I could see how such a tool could be useful for people struggling with addiction. I can see its limitations, too.
First, though, let’s be optimistic: record keeping keeps some people honest. I’ve heard that the practice of monitoring your drinking, for example, can be a therapist’s first step in helping an alcoholic admit they’ve got to give up booze. An app that allows you to keep track of your drinking or using would keep the process anonymous. There may be less pressure because you don’t have to put it all out there to someone face-to-face. At the same time, unlike mere journaling, the app would provide you with important feedback. A virtual community can provide support without fear of disappointing anyone, from the safety and privacy of one’s own room.
I get it. I get that this may be exactly what some people need in the beginning. People in the early action or contemplation stages of recovery may dip in and out of meetings anonymously. People who are fearful to show even their face might check in, instead, on an app. Surely this might be some people’s preferred modality.
At the same time, I see some concerns. While dipping in and out anonymously might make sense in the beginning, eventually—and perhaps even from the start—some people need more. I’d go so far as to say that most people need more. For this reason, I just don’t see tech tools becoming long term solutions—nor do I think them to be a true answer to the problems the article lists as barriers for people who want or need more mental healthcare.
We still need to make healthcare more affordable. Poor people deserve access to traditional modalities—not just some crummy app. What’s more, developing an app won’t reduce stigma—if anything, it enables it. As a society, we still need to work to reduce stigma so that people who need it aren’t afraid to seek help.
Here’s What I Know
The idea of today’s tech tools reminds me of when I was in college, and I worked in rape crisis and domestic violence counseling. I met survivors in the hospital to provide short-term counseling, as well as counseled women and children in the shelter. I also, at times, operated the hotline—which, I suppose now, was like an olden-day form of these apps. While some people would call the hotline for information, most just wanted to check in—not with a friend who they feared might judge them or a family member they couldn’t trust. People wanted to talk with someone they perceived as something of an expert—someone who they’d maybe never speak to again and would probably never meet.
People wanted to talk to strangers about their problems, and we were happy to oblige. I helped people, and I get that—just like I get the utility of an app.
But I could only help so much. Lots of the people who called the hotline weren’t ready or able to change—at least not just then. For complicated reasons, they didn’t want a referral. They were welcome to call back—and some did—but at a certain point, there was little a hotline could offer.
Other people were ready to make a change, but there were obstacles—namely economics and stigma. These factors served then, as they do now, as a major deterrent for people seeking help for issues related to mental health, substance abuse and violence. For a drug user without insurance, for example, the best I could do was tell them to go to the ER, which—as anyone whose ever been there knows—is never really an answer. This, as far as I know, is still the best solution we’ve got. Oh sure, maybe someday it’ll be “Download this app.” Yeah, um not an improvement.
The Final Word
Bottom line is that traditional modalities—including good old face-to-face contact—can do what an app can’t. A therapist has the ability to read things the patient wouldn’t notice or know to input, such as body language. Most of us who’ve suffered from addiction know the failures of self help programs, which is what some of these apps sound like. To start with, how would a person know which app to try? If you had asked me 10 years ago what was wrong in my life, I would’ve told you that everything was perfect if only I could get an agent and lose five pounds. When it came to reporting my conduct I was rarely honest, even to myself. Sometimes we need healthcare professionals to make diagnosis. We need consistent guidance from professionals and other people that we’ve developed relationships with and learned to trust. A rape crisis counselor, for example, shows up at a pivotal moment, right when a victim needs support. I would swoop in and hold the person’s hand through scary and painful procedures but when it was over, all I could do was hand them a pamphlet. Where, I always wondered, would that woman go from here?
In my experience, guidance grows from a true knowledge of a person, not casual observation or, eh gads, “data.” We need human connection, not just in the short-term but in a sustaining, committed way. Tools and such are helpful, but in the end my recovery was the work of many enduring relationships. Friends, fellows and professionals bear witness to our lives. There’s no smart phone capable of that.
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