Covid-19: Mental health app growth reveals unmet needs

Prescriptions for mental health apps rose during the pandemic. As did new apps for Covid-19 advice and tracing, but there is still no app for long Covid. By Kezia Parkins


he boon of mental health applications downloads during Covid-19 soared, and while interest will remain, there are bound to be some digital health apps that disappear. People will become more discriminating on the apps they use as they gauge benefit. Still, an unmet medical need exists with apps geared specifically to long Covid-19.

The 11 March marked the two-year anniversary of the Covid-19 pandemic declaration by the WHO, leading to worldwide and national lockdowns and strict ‘stay at home’ government guidelines. The uncertainty and effect of the invisible threat of Covid-19, being locked down, isolated and losing loved ones on mental health has been tremendous.

Those suffering from existing mental health problems saw symptoms exacerbated while those who reported no issues prior to the pandemic started to experience symptoms of sleep deprivation, stress, anxiety, depression and crippling fatigue.

In the UK, numerous studies reported patterns of declining mental health and wellbeing between March and May 2020, during the first lockdown. Many reports show this was followed by a period of improvement during July, August and September 2020 when lockdowns lifted: a juncture where levels were similar to before the pandemic started.

A second wave of deterioration in population mental health and wellbeing between October 2020 and February 2021 was observed, followed by another period of recovery but not to pre-pandemic levels.

These findings from the government's COVID-19: mental health and wellbeing surveillance report have been “broadly corroborated” by other studies also looking at anxiety, depressive symptoms, loneliness, sleep and stress. But the period of ‘recovery’ in summer 2020 was not observed in all studies, the report states.

During those strange times, we couldn’t go and see a doctor face to face about our mental ill-health or go to therapy appointments. Just as with most areas of healthcare impacted by the pandemic, mental health had to go digital.

ORCHA CEO Liz Ashall-Payne. Credit:

ORCHA, the Organisation for the Review of Care and Health Apps, an independent health app review service, provides app libraries for 70% of NHS regions. Founded in 2015, the organisation has reviewed 17,000 digital health products to date.

“Across our digital health libraries we saw a 6,500% increase in healthcare professionals recommending technologies to their patients,” says ORCHA’s founding CEO Liz Ashall-Payne in an interview with Medical Device Network.

This, says the CEO, was a direct result of the Covid-19 pandemic. “That's because people living with conditions or long-term health needs didn't want to enter into a healthcare environment for fear of getting Covid.”

Explosion of searches for mental health apps during lockdowns

An ORCHA 2021 report, which sheds light on the collective mental health of the nation during lockdown, revealed that searches for apps for critical mental health problems shot up.

Searches for depression rose by 156%, OCD by 422%, anxiety by 422% and stress by 113%. Searches for fear, anger and mood also rose considerably.

The most searched for apps were relating to mindfulness and relaxation which rose by 2483% and 437% respectively.

Ashall-Payne states that the organisation observed a 25% increase in downloads of health apps from pre-pandemic to now. “Every day 5 million people will download a health app and that's increasing all the time.”

Deloitte Global predicts that global spending on mobile mental health apps will reach close to $500 million in 2022 assuming an annual growth rate of 20%. That figure could be much higher considering these apps grew 32% - from $203 million to $269 million - from the first 10 months of 2019 to the same period in 2020.

App overdrive will whittle down

Today, there are nearly 400,000 digital health technologies. I think we're going to see a huge cull.

Mental health is a huge area of need where capacity has never been able to meet demand, “and that has never been more true than today,” Ashall-Payne says.

Thus, “there has been an explosion in innovators developing new digital health technologies. In the mental health space alone there are around 21,000 apps.” However, in the UK there are only around 600 approved mental health apps available for doctors to prescribe because only around 30% meet ORCHA’s stamp of approval.

Fast forward, Ashall-Payne says she believes there will be a great culling in apps and other health technologies.

“Today, there are nearly 400,000 digital health technologies. I think we're going to see a huge cull down to about 40/50,000. That will be driven by compliance so that high-quality technologies will be able to get to people easier than unsafe ones.”

The first criteria when assessing a health app is evidence of effectiveness leading to good outcomes for patients. The app would then be considered for ‘NICE evaluated’ status: the gold standard for apps.

“At the minute, there's a massive, missed opportunity. People are downloading technologies that don't work, or they're not downloading anything and therefore not getting the potential benefits,” Ashall-Payne says.

Still, “if a product has been able to achieve positive impact for one demographic profile, it doesn't mean it will work for everybody.” Likewise, she compares to how medical professional understand there can be multiple therapies for patients, such as antidepressants.

Where apps can have the biggest impact

Lots of people would like a combination which is actually where we see the biggest impact.

Digital mental health products and digital and virtual therapy have been shown to be comparable to real-life therapy for many patients.

“It depends on the person, says Ashall-Payne. “Some people want face-to-face therapy, some people prefer a digital intervention and lots of people would like a combination which is actually where we see the biggest impact.”

Specifically, through working with the NHS initiative Improving Access to Psychological Therapy Pathway (IAPT), ORCHA has observed a “huge impact” for digital therapies between face-to-face visits which the organisation classes as both in-person and video calls with a therapist.

“Where services in the NHS can't provide support, such as in between therapy sessions, while somebody is waiting,… or postdischarge,-those are the best places to provide ongoing support through digital health,” Ashall-Payne says.

Long-Covid: A new unmet area of need?

Along with an increase of poor mental health, Covid-19 bought with it a brand new, and therefore poorly understood, neurological condition: long Covid. An estimated 1.3 million people living in the UK were experiencing self-reported long Covid (symptoms persisting for more than four weeks after first suspected infection with Covid-19) as of 2 January.

Symptoms include chronic fatigue, brain fog, breathlessness and depression. The condition will undoubtedly cause mounting pressure on primary care services in the years to come.

“During the pandemic, people massively increased their web searches for products that will look after the symptoms of Covid,” says Ashall-Payne. “About three months later we saw this huge acceleration of digital technologies for Covid and the world of innovation really stepping up.”

In March 2021, ORCHA released its list of top-scoring apps across each of the long Covid symptoms with the aim of helping healthcare providers make informed decisions for their patients.

Topping the list of already existing apps that could address long Covid-19 symptoms are: Fibricheck, which measures heart rate when a finger is placed over a smartphone camera; Lumosity, a brain training app to help beat brain fog; and Wysa, the much-praised AI penguin chatbot that helps tackle depression through simple self-care tasks.

However, despite the increasing prevalence of long COVID, there was no evidence of apps dedicated specifically to supporting this patient group and there still isn’t, indicating an unmet need.

Meanwhile, in the first seven months of 2020, ORCHA observed a 1087.5% rise in apps for acute Covid-19. At the time of the report, there were more than 750 apps to help inform, track or gather data in this space.

Future calls for clearer guidelines, and higher prescription rate

Ashall-Payne believes that “digital health is going to be the new medicine.”

“In the same way that doctors are trained in drugs, we need to train doctors in what [digital therapies] to prescribe, and really importantly, how to prescribe.”

Within the NHS regions that ORCHA services, the organisation provides prescription infrastructure. With it, a doctor can recommend a technology directly to a patient's phone. An important feature considering the oversaturation of apps for mental health with similar names means there is a risk of downloading an unapproved, unrecommended and potentially unsafe app.

ORCHA has a team of digital health assessors who are trained to become experts in one of the four NHS User Experience (NHSX) Digital Technology Assessment Criteria (DTAC) categories.

Digital tools receive a pass or fail in four categories: clinical safety, data protection, technical security, and interoperability. Ashall-Payne says as these roles are so niche and require a lot of training the organisation actually created a degree at Warwick University.

“The really important part of assessing these technologies is you can't just do it once. You have to re-assess every time that technology updates or changes.”

That’s because a popular mental health app like Headspace can update as regularly as every two weeks, which could introduce new risk.

Ashall-Payne says helping innovators understand what their technologies require to be approved for NHS use is a critical need. Therefore ORCHA is currently involved in a government-funded project through Innovate UK to create a ‘regulation wizard.’