Plan sponsors should tread carefully when mulling mental-health apps

With more than 1,400 mental-health apps available for download, and more entering the marketplace every day, are these tools an effective way for employers to support employee well-being?

The journal Nature Digital Medicine, which estimated the number above, also found only 2.6 per cent of apps that are clinically relevant specifically for depression provided evidence to substantiate these claims.

But Ryan Weiss, vice-president of group customer product and experience at Great-West Life Assurance Co., says in the insurer’s experience, plan members with “ready access to health-care services via a number of access points are better able to manage their health and the health of their families.”

Read: Manulife launches wellness app for Canadian group benefits plan members

The group benefits industry has yet to develop their own mental-health apps because it can be costly and many good options are already available. However, insurers are enhancing their digital health-care offerings. In September, Manulife Financial Corp. rolled out its Vitality wellness app, which includes mental well-being assessments, for group benefits plans. And People Corp. launched a professional assessment tool, virtual therapy and psychiatric collaboration.


Percentage of people by age who have used a mental-health app, according to a 2018 study by the Journal of Medical Internet Research:

25 and younger

25 to 35

36 to 45

46 to 55

56 and older

“We really saw a gap in the services offered,” says Judith Plotkin, vice-president of strategic health solutions at People Corp. “[Employee assistance programs] and online tools can help, but for people needing ongoing therapy, it has been hard to get access to affordable treatment. There are long waiting lists and costly therapists.”

EY Canada offers employees access to a video on-demand service through its employee assistance program, as well as a digital cognitive behavioural therapy tool, says Kimberly Allen, the organization’s total rewards leader. “So these are probably the most significant ones that we offer plan members.”

Read: EY Canada raises mental-health benefits to $5,000 for all staff

The offerings are plentiful, but with little evidence substantiating these tools’ effectiveness, what should employers consider when including them in their benefits plan?

Breaking stigma around mental health

The data on online therapy and tele-psychology is mixed, says Laura Cavanagh, a psychology and behavioural sciences professor at Seneca College. “A lot of times . . . these studies compare individuals getting online therapy to individuals on a wait list, and then they see improvement in the people getting the therapy. But it’s hard to say whether that improvement is equivalent to what they would have seen if they had gotten in-person therapy.”

But putting the apps’ effectiveness aside, with so many options available to support people with mental-health issues, one potential benefit is their contribution to breaking down stigma and access. “By normalizing getting mentally healthy and making it easy removes stigma,” says Plotkin. “Increases in access increase conversation, and all of that is really important.”

While mental-health awareness has improved, the stigma is still prevalent, especially in terms of seeking out help, says Cavanagh. “At least that’s my clinical, but also anecdotal, sense. I have lots of students willing to disclose their mental-health issues, but are still resistant to treatment, which is kind of surprising, because they’re in a psychology program.”

Read: Mental-health stigma still entrenched in workplace: study

And for people who wouldn’t typically seek in-person treatment, there’s real value in discretely downloading mental-health apps to a phone, she adds. “For lots of people who seek online treatment, it’s not that the other option would be in-person treatment, but is [more about] . . . if they had to go in person to a therapist, they just wouldn’t do it.”


According to a 2018 survey by Northwestern University’s Center for Behavioral Intervention Technologies, participants found health apps through:

Social media

Personal searches

Word of mouth

Professional sources, such as medical providers

This adds value around access to treatment for mental-health issues in a global societal sense, says Cavanagh. “Having something available on your phone is a huge benefit and helps people in a longer-term therapy situation, but it also helps those seeking assistance in a crisis situation.”

Help that’s available in real time — on-demand, where individuals are located, without any kind of extra burden preventing them from accessing care — is beneficial, but dealing with the stigma that still exists is an important part of the conversation, she says.

“There are people who will not go to an in-person therapist who might access it online, which is great. But I don’t know if that will help demystify treatment. If people know other people seek treatment, they . . . say, ‘Oh, maybe I could do that, too.’ So I think it’s helpful for access, but could perpetuate [the idea] this is a shameful thing, that it’s better to do it privately.”

Real savings for employers

Over the past few years, organizations, such as EY and Starbucks, have been boosting their mental-health coverage. But employers are more commonly limiting their funding, according to Weiss. He says digital services are necessary because “they can help stretch the same mental-health dollar a lot further and provide increased access for the same treatment dollars.”

Lizann Reitmeier, Canadian health practice leader at Buck, says employers may be feeling the cost of offering mental-health apps as a benefit. However, she asks, “Is it a given it’s an increasing cost or is it just a shifting cost? Because that therapy would already have been covered. It just may not have been online, so there’s potential additional access there.”

Read: Specific solutions required to move dial on mental-health treatment, costs

Where mental-health apps are available, she notes, they’re included in benefits plans, so employers aren’t actually incurring any additional costs. “If the employee has an app and they’re actually staying healthy because they’re using that app, then it’s definitely a win for the employer.”

For EY’s offerings, it looks at the value of the investment rather than the return on investment, says Allen. “We feel that if we’re allowing our employees to bring their full selves to work, and using these tools that we can provide, it’s just another positive benefit.”


The Ottawa Institute of Cognitive Behavioural Therapy cites the following as evidence-based mental-health apps, though the organization notes these are self-help in nature and shouldn’t be used as a replacement for therapy:

  • Calm — Guided meditation that can help with overall mental health.
  • Headspace — Guided meditation that can help with overall mental health.
  • Moodnotes — A thought-record app that helps track and improve thoughts.
  • nOCD — Guides users through exercises that may help them manage symptoms of obsessive compulsive disorder.
  • Pacifica — Provides CBT-based exercises and symptom tracking that help with anxiety and stress.
  • PTSD Coach — Provides self-help information and symptom tracking related to post-traumatic stress disorder.
  • TruReach — Provides five-minute CBT lessons that teach skills to help deal with anxiety and depression.

Ethics and privacy

As with any website or online tool, people should be aware of how their data is stored and used. It’s a matter of buyer beware, says Paula Allen, vice-president of research and analytics at Morneau Shepell Ltd.

“There’s a million [mental-health] apps you can get on [Apple Inc.’s] App Store. And I really wonder about some of them, because, just even looking at them, you’re not sure whether they have a really good clinical basis. You wonder about the way they’re using your data, or the privacy of your data.”

That’s why it’s important to go through a trusted provider, she says, noting it’s also important to ensure the services delivered are appropriate and clinically valid. “If it’s your existing employee assistance program, you’re much better off than [going with] somebody who has just put up a shingle last week.”

Read: Head to head: Should Canada’s workplace mental-health standard be mandatory?

In the case of Great-West Life’s products, it complies with privacy guidelines and applicable laws and regulations, says Weiss, which also means vendors are subject to rigorous vetting. “The technologies used here are not off the shelf, but are built specifically for the health-care needs of our members and subject to stringent privacy and security testing. Any confidential information a member shares within a digital solution will be subject to the same strict confidentiality requirements as any non-digital or traditional therapies.”

Indeed, as long as these tools are compliant with current Canadian privacy legislation at both the federal and provincial level, there shouldn’t be a problem, says Plotkin. “I think if you are sloppy with your digital information, it can be a problem. But we are health professionals running these apps, for the most part . . . and as long as we put those firewalls in place and all of the provisions needed for privacy, we should be fine.”

However, a 2015 British study published in BMC Medicine found the 35 health apps listed as safe and trusted by the National Health Service in 2013 actually transmitted identifying information over the internet about their users, including email addresses, names and birth dates, and two-thirds of these apps failed to encrypt the data they received.

But besides the potential that users will lose information into the ether, Reitmeier doesn’t see a concern because there wouldn’t be a way to tie specific plan members to their employer. However, she believes users should be cautious about what personal information they share. “I think each person has their own threshold. Everyone has their own idea of what they want to put out there for people to see.”

Of course, ethical responsibility also exists on the part of a practitioner delivering in-person treatment, says Cavanagh, but it can be more difficult for employees using mental-health apps to determine how much their online privacy is protected.

Alethea Spiridon is managing editor of Benefits Canada.