There are thousands of mental health apps available on the app market, offering services including meditation, mood tracking and counselling, among others. You would think such “health” and “wellbeing” apps – which often present as solutions for conditions such as anxiety and sleeplessness – would have been rigorously tested and verified. But this isn’t necessarily the case.

In fact, many may be taking your money and data in return for a service that does nothing for your mental health – at least, not in a way that’s backed by scientific evidence.

Bringing AI to mental health apps

Although some mental health apps connect users with a registered therapist, most provide a fully automated service that bypasses the human element. This means they’re not subject to the same standards of care and confidentiality as a registered mental health professional. Some aren’t even designed by mental health professionals.

These apps also increasingly claim to be incorporating artificial intelligence into their design to make personalised recommendations (such as for meditation or mindfulness) to users. However, they give little detail about this process. It’s possible the recommendations are based on a user’s previous activities, similar to Netflix’s recommendation algorithm.

Some apps such as Wysa, Youper and Woebot use AI-driven chatbots to deliver support, or even established therapeutic interventions such as cognitive behavioural therapy. But these apps usually don’t reveal what kinds of algorithms they use.

It’s likely most of these AI chatbots use rules-based systems that respond to users in accordance with predetermined rules (rather than learning on the go as adaptive models do). These rules would ideally prevent the unexpected (and often harmful and inappropriate) outputs AI chatbots have become known for – but there’s no guarantee.

The use of AI in this context comes with risks of biased, discriminatory or completely inapplicable information being provided to users. And these risks haven’t been adequately investigated.

Misleading marketing and a lack of supporting evidence

Mental health apps might be able to provide certain benefits to users if they are well designed and properly vetted and deployed. But even then they can’t be considered a substitute for professional therapy targeted towards conditions such as anxiety or depression.

The clinical value of automated mental health and mindfulness apps is still being assessed. Evidence of their efficacy is generally lacking.

Some apps make ambitious claims regarding their effectiveness and refer to studies that supposedly support their benefits. In many cases these claims are based on less-than-robust findings. For instance, they may be based on:

Moreover, any claims about reducing symptoms of poor mental health aren’t carried through in contract terms. The fine print will typically state the app does not claim to provide any physical, therapeutic or medical benefit (along with a host of other disclaimers). In other words, it isn’t obliged to successfully provide the service it promotes.

For some users, mental health apps may even cause harm, and lead to increases in the very symptoms people so often use them to address. The may happen, in part, as a result of creating more awareness of problems, without providing the tools needed to address them.

While a well-designed mental health app may bring benefits to a user, this shouldn’t be confused with evidence of efficacy.
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In the case of most mental health apps, research on their effectiveness won’t have considered individual differences such as socioeconomic status, age and other factors that can influence engagement. Most apps also will not indicate whether they’re an inclusive space for marginalised people, such as those from culturally and linguistically diverse, LGBTQ+ or neurodiverse communities.

Read more:
How effective is mindfulness for treating mental ill-health? And what about the apps?

Inadequate privacy protections

Mental health apps are subject to standard consumer protection and privacy laws. While data protection and cybersecurity practices vary between apps, an investigation by research foundation Mozilla concluded that most rank poorly.

For example, the mindfulness app Headspace collects data about users from a range of sources, and uses those data to advertise to users. Chatbot-based apps also commonly repurpose conversations to predict users’ moods, and use anonymised user data to train the language models underpinning the bots.

Many apps share so-called anonymised data with third parties, such as employers, that sponsor their use. Re-identification of these data can be relatively easy in some cases.

Australia’s Therapeutic Goods Administration (TGA) doesn’t require most mental health and wellbeing apps to go through the same testing and monitoring as other medical products. In most cases, they are lightly regulated as health and lifestyle products or tools for managing mental health that are excluded from TGA regulations (provided they meet certain criteria).

How can you choose an app?

Although consumers can access third-party rankings for various mental health apps, these often focus on just a few elements, such as usability or privacy. Different guides may also be inconsistent with each other.

Nonetheless, there are some steps you can take to figure out whether a particular mental health or mindfulness app might be useful for you.

1. consult your doctor, as they may have a better understanding of the efficacy of particular apps and/or how they might benefit you as an individual

2. check whether a mental health professional or trusted institution was involved in developing the app

3. check if the app has been rated by a third party, and compare different ratings

4. make use of free trials, but be careful of them shifting to paid subscriptions, and be wary about trials that require payment information upfront

5. stop using the app if you experience any adverse effects.

Overall, and most importantly, remember that an app is never a substitute for real help from a human professional.

Read more:
AI chatbots are still far from replacing human therapists

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Editors note: this story contains mentions of suicide.

After an unforgiving 15 hours and 52 minutes, Andy Donaldson was plucked from the treacherous Molokai Channel, Hawaii, and swiftly rushed to the hospital. His uvula had swollen to three times its normal size and his breathing grew increasingly laboured.

“I told the doctor what we’d been doing,” Donaldson tells ESPN. “His initial thought was that it was an allergic reaction and that I might have swallowed a jellyfish.

“Who knows what could’ve happened, it could well have been the case. There’s every chance. We were getting sloshed around. There were a lot of things going on.”

Andy Donaldson is taking on the Oceans Seven Challenge, swimming some of the world’s most dangerous oceans, in the aid of mental health. Andy Donaldson

The Scotsman had just completed leg four of seven in his quest to conquer the formidable Oceans Seven Challenge — a near-200km swim across the world’s most dangerous seas — aiming to become the 23rd person in the world to complete the feat.

His purpose: to raise money and awareness for mental health, honouring his grandfather who suffered with depression, by representing research charity the Black Dog Institute.

Perth-based Donaldson set British records for both the English Channel and the North Channel — his opening two swims. He then earned his highest profile accolade with a world-record time of 4:33:50 to swim the Cook Strait, the body of water between the two New Zealand islands. His Hawaii trip was his first to return home without an accolade, but its completion remains his proudest accomplishment.

Conquering the Molokai channel — a notoriously unpredictable body of water separating Hawaii’s Molokai and Oahu islands — represented the passing of the halfway mark. But what was merely a figurative milestone ended up being so much more. The experience was life changing.

“We had a target to get 10 hours and came nowhere near that,” he says. “The conditions were a lot harder than expected.

Nicknamed the ‘Channel of Bones’, the Molokai Channel swim is a 42km stretch between Hawaii’s Molokai and Oahu islands. Andy Donaldson

“We would’ve been about 10km off-shore and this un-forecasted storm came through. We knew the winds would pick up but the weather forecast changed as we were out there, and it got a lot worse. The winds picked up to 25+ knots so not far off gale force winds. No one should be out there.

“I’m actually happy it went the way it did because I wouldn’t have learned anything if we just breezed through that one and smashed out a time. I wouldn’t have been put in those situations where it’s a real challenge. I think it’s been the most valuable swim of my entire career.”

Donaldson tackles the Strait of Gibraltar later in May before facing the 32km Catalina Channel and 19km Tsugaru Strait swims in June and July respectively. If, as projected, he completes the challenge in this timeframe, he will be the first person to ever complete all seven swims within 12 months.

A big win sparked big ambitions

Raised in the UK and a graduate of Loughborough University, Donaldson became accustomed to success in the pool, until the weight of pressure grew heavier and his love for the sport diminished.

These issues have been brought to the forefront of elite pool swimming, with Olympic gold medallist swimmer Kyle Chalmers and eight-time world champion Adam Peaty both publicising issues with mental health, citing the pressures of success.

Donaldson too struggled with the demanding environment, while he also felt himself losing his grip on the sport he loved. After a lengthy hiatus and a move to Australia, it wasn’t until his early adult years when he embraced the open water. There was a newfound freedom about being with the elements, away from the shackles of pool lanes.

With that presented an opportunity — the high-profile Rottnest channel swim. Donaldson had poured his recent years into chartered accountancy but took to the sea with ease to not only win the 19.7km race, ousting members of Australia’s national swimming team in the process, but also raising $9,000 for mental health charity the Kai Eardley Foundation.

Andy Donaldson saw off competition from Australia’s national swimming team to win the Rottnest channel swim. Andy Donaldson

“It made me think, you know, maybe there’s an opportunity here to do it again on a bigger scale and to use swimming as a vehicle to help others,” he says. “So that was really the genesis for going on to do this Oceans Seven challenge.

“Coming off the back of Rottnest I thought let’s aim quite high. We set some pretty big goals. We’re trying to do it in a year, no one has ever done that before.

“Also, to try break the record for the fastest accumulation of time. I thought if we did that, it might gain some traction and increase the exposure to the real purpose behind it which is a raise money and awareness for mental health.”

Donaldson began his challenge in August 2022, and immediately matched his ambitions with various accolades in his opening swims.

The feat seemed to be off to a blistering start with the Scotsman on course to set a world record for his opening swim in the English Channel. However, conditions worsened on his voyage and swept him four minutes behind his projected time. He set the fastest crossing of the channel recorded in the last decade, but fell shy of the ultimate world record accolade.

Donaldson maintains that his challenge does not revolve around setting world records, and the mere completion of each swim comes with its own seismic achievement. However, he is quite aware that such an accolade brings great exposure to his cause.

Andy Donaldson crossed the Cook Strait in 4:33:50, beating the previous world record by four minutes. Andy Donaldson

He fought back to secure a world record crossing for the Cook Strait, New Zealand, in March. His record beat the previous time, ironically, by four minutes.

“It’s pretty surreal to break a world record,” he says. “It’s one of those things you dream of as a kid and never really expect or believe will ever happen.

“Obviously with this challenge I wouldn’t have set goals if i didn’t think they were possible. With the English channel the world record is incredible … halfway through that swim we were probably on target for it but all of the sudden the conditions changed, we got swept down the coast and ended up having to swim an extra three kilometres.

“I think we were only four minutes off the world record on that one. Then in the Cook Strait we were four minutes under, so you know to experience both sides of it, I think is fantastic, you know you’ll take something from it either way.

“I can’t get ahead of myself. I don’t want to rest of my laurels or get complacent. it’s great that we’ve got this world record here up on the wall but I’m still having my eyes on the next one. So yeah, we’ll keep pushing.”

The mental challenge of the Oceans Seven

It was 11:45 p.m.. Donaldson stood poised in just Speedos before plunging into the 14-degree renowned shark-infested waters of the Cook Strait. The Oceans Seven challenge forbids the use of wetsuits, all while hosting some of the world’s coldest waters.

Each leg of the challenge varies so vastly from the last. The Strait of Gibraltar represents the shortest distance in 14km, while the mammoth Molokai Channel stands as the largest feat at 44km. These distances alone stand a huge test of endurance, without the added implications of unfavourable conditions — which were particularly notable in his Hawaii venture.

“I was thrown around like a ragdoll in a washing machine I just felt violently sick, getting tossed around,” he says. “I was throwing up as a result. I’m taking on drinks every 20 minutes but I couldn’t keep it down.”

Such is the nature of these lengthy voyages that Donaldson is often swimming in complete darkness. Unaware of his surroundings, “lonely,” with his only guidance coming from a support boat, his source of encouragement as he navigates the tricky waters. But Donaldson is still at the mercy of what lies beneath.

Doctors told Andy Donaldson he had swallowed a jellyfish following his near-16 hour swim across the Molokai Channel, Hawaii. Andy Donaldson

He was twice stung by Lions Mane jellyfish, one of the most venomous of its kind, while navigating the North Channel. Its presence in the region is rife, and threat was so severe that a designated “jellyfish spotter” was called out for the 34km swim.

Yet with all these factors standing in way of his physical wellbeing, what Donaldson has found toughest is how the feat has challenged him mentally.

“When you talk about the mental aspect, with most sports, for example a football game, the players know which day, which minute the ref is going to be kicking off,” he says. “But with many of these swims you’re usually waiting for the weather and the right conditions.

“So, in the instance of New Zealand I turned up at the start of February and didn’t get to swim till the start of March. There’s that mental aspect of hanging around and staying calm because any minute the organisers can call you up to do the swim.”

He was pushed to his psychological limits in the Molokai waters. Intense conditions meant his pace reduced by nearly half, and his efforts to battle the elements at times felt like treading water. He channeled his mentality to take it one stroke at a time, and even though it seemed if the weather worsened he would have to give in, that was never an option. The motivation of his cause, raising money for mental health purposes, was too strong.

“I’d never experienced pain for adversity both physically and mentally like that in my life and here we were after 16 hours of battling having managed to find a way through,” he says. “I was sitting there absolutely broken but at the same time, just so delighted with what we done.”

‘I’m trying to do all these swims for something bigger than myself’

“My grandfather who was my biggest role model growing up really struggled with depression, and I’ve lost friends to suicide,” Donaldson says.

He does not need any external motivation in his quest for his record-breaking feat. He himself has suffered with mental health, but above all else, he is driven by seeing the effect it has had on those close to him.

Donaldson has raised over $19,000 for mental health research organisation the Black Dog Institute in this challenge alone. The charity is one of its kind in Australia, the only medical research institute to investigate mental health across the lifespan.

It has provided an additional fire. He is not only completing these swims for his own personal goals, after seeing people he was close to suffer mentally, representing the charity means a whole lot more.

Andy Donaldson is raising money for mental health charity the Black Dog Institute in honour of his grandfather, who suffered with depression. Andy Donaldson

“It’s so key to have the right motivation,” he says. “I’ve got my own wants to do these, I also want to do some good for charity, there’s a big reason why we’re doing it, to represent the Black Dog Institute. In those moments, that’s what I’m thinking of. I suppose bigger purposes, things that are bigger than yourself, I believe that’s how you come through those toughest moments.”

Donaldson recalls the pain of his Molokai swim. With his body giving up, his cause was the only thing keeping him going. Physical torment would not deter him from honouring his biggest role-model, his late grandfather. Donaldson’s focus never deterred.

“As soon as I got back on dry and land and could have a shower and process what had happened, I was just overwhelmed with this wave of emotion,” he says. “It was this massive challenge of adversity became one of the most meaningful moments of my life.

“There were certainly moments I thought of him [his grandfather], he’s been such a big role model in my life. Someone I’ll always look up to, always aspire to be like, to become like. It’s amazing the impact that some people can have on your life, even when they’re not around.”

Andy Donaldson broke British records for his crossing of the North and English Channel, while breaking the world record for his swim across the Cook Strait, New Zealand. Andy Donaldson

Just days before heading to Gibraltar to tackle his next leg of the challenge, Donaldson is still feeling the effects of his Molokai venture. Physically and emotionally drained, he has no time to rest. With three swims left to complete set out in a two-month timeframe, the challenge gets no easier.

Having completed his opening four swims — including the three longest of the challenge — in 37 hours, 38 minutes and 47 seconds, Donaldson is on track to clinch the record for the fastest accumulation of time across the seven channels. The record currently stands at 64 hours 35 minutes.

But whether he achieves that or not, his ultimate goal of raising money and awareness for mental health has already been attained.

“The better we can understand mental health, the better equipped we are to help people,” he says. “With it being such a big issue in this day and age, I think that’s one of the most important things we can support.”

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