Mental health apps and the internet are becoming more widely used to circumvent the sometimes inaccessible or intimidating world of psychotherapy.
A new study from researchers in South Africa seeks to explore how college students talk about therapy, mental health apps, and their subjective experiences in navigating both approaches to mental health treatment. The authors find university students paint themselves as “willing and unwilling cyborgs.” This refers to how the students who participated in this study relied on technology as a solution to their internal problems while being wary of the simultaneous shortcomings and potential benefits of online mental health services.
Poor student mental health—and the promise of mental health apps (or e-mental health)—are framed as an epidemic and remedy, respectively:
“In expressing optimism about and a willingness to use digital technologies to support their mental health, participants assume the role of ‘good citizens’ and participate in the expansion and intensification of a neoliberal orientation to individual “responsibilization” of healthcare, while also rendering themselves competent to manage their own mental health… They believe apps will help them reshape their own brains without the need for input from a mental health professional, thus configuring their brains as a ‘site of choice, prudence, and responsibility for each individual,’” the authors write, adding:
“Interestingly, our participants also present themselves as unwilling digital cyborgs, by articulating some reluctance to completely trust technology, showing cognizance that they are participating in a capitalist economy, demonstrating skepticism about the legitimacy of apps, and expressing suspicion of app producers’ motives. They resist being positioned as consumers of mental healthcare and explicitly ask for regulation and control to create safety, and the endorsement of “professionals” to create trust.”
The research was led by Ryan Van Der Poll and Bronwyne Coetzee from Stellenbosch University, along with Jason Bantjes of the South African Medical Research Council and the University of Cape Town.
The digital age has seen exponential growth in mental health apps, a response to a burgeoning mental health crisis among youth, particularly in university settings where demand for accessible care outstrips supply. College students, many grappling with unprecedented levels of stress and mental health challenges, find themselves at a crossroads: while these apps promise instant, private, and often lower-cost access to mental health resources, they also navigate a landscape where the impersonal nature of digital care clashes with their need for genuine human support.
As researchers Ryan Van Der Poll, Bronwyne Coetzee, and Jason Bantjes explore in their recent study, these young adults are digital natives navigating innumerable mental health discourses online. Yet, their reception of mental health apps is tinged with ambivalence—caught between the allure of accessibility and the cold touch of technology’s reach into the intimate sphere of mental well-being.
Their study did not examine the number of people engaging with mental health apps, nor did it examine the effectiveness of apps versus mental healthcare professionals provided by college students’ campuses. Instead, the researchers sought to explore the subjective experiences of college students. In short, how did students feel about mental healthcare apps and therapy? And how did students position themselves in the realms of their mental health and their treatment?
An initial recruitment of approximately 20,000 college students was eventually reduced to only 51 participants selected for this study. The participants were asked to answer questions in both online and in-person focus groups about their perceived control over their mental health, their perception of student counseling services available on campus, and their perception of e-mental health.
Many college-age students have described how their mental health has been affected, leading them to spiral, lose control, and feel overwhelmed. One student, Kaya, shared her experience and said:
“… sometimes it’s just too much, [and] you don’t want to turn to your parents or your friends or something because you don’t want to seem like a failure.”
Other participants shared this feeling, and it is one of the main reasons why many students are hesitant to seek help.
The link between neoliberal values and the stigma surrounding mental health has been well-documented, stemming from the capitalist-driven notion that mental illness equates to personal failure, while success ostensibly confers immunity to depression and suicidal thoughts. This misconception, as highlighted by the study, is widespread and detrimental to those dealing with mental health issues.
Evelyn, a student, encapsulates the pressure to conform, stating, “… everybody is supposed to be coping. … and you don’t want to be that one person that is not.” Echoing this sentiment, Ayesha adds, “… there is a lot of stigma on the campus … the prevailing attitude is, ‘Yes, everybody is struggling, so if we can struggle through it, then why can’t you?’”
College students in this study discussed their mental health issues as something that was shameful, embarrassing, or taboo. In this way, their shared experience of mental health problems actually divided them, rather than united them, because of stigma and fear. Furthermore, students reported that concealing their mental health issues represented a kind of strength or resiliency—a harmful misconception perpetuated by a dominant culture valuing stoic independence.
Given their feelings of isolation and apprehension about their mental health, it’s clear why students might hesitate to seek on-campus support. However, the obstacles weren’t solely internal. Many faced practical barriers to accessing counseling services, such as not knowing the location or appropriate contact for assistance. Others encountered delays in securing appointments, which involved exposing their private struggles in multiple emails—a daunting prospect for those already bearing the weight of stigma. The scarcity of available counselors tasked with aiding a large student body resulted in lengthy waits for help. Additionally, students described the on-campus support system as too “serious,” “formal,” and “structured,” finding the gravity of the process itself to be intimidating.
These barriers are what led the participants to use e-mental health services to treat themselves. Apps represent a platform for students to help themselves at their own pace. This doesn’t mean that students were unaware of the risks involved—rather, students felt as though they were not going to receive the in-person help that they desired, so using e-mental health services was something of an inevitability.
Students reported a disbelief that the apps would actually help them, and that they would just try it for the sake of trying something. There were a wide range of positive and negative experiences with e-mental health. Some students found it helpful, while other students found it helpful only for a brief period of time before their mental states regressed. Still, the biggest sentiment around e-mental health was one of optimism. Participants saw mental health apps as a good adjunct to a larger support network, and considered the future of mental health apps a good way for people to start themselves on a journey of improving their mental states.
One common theme in the responses was the time efficiency of e-mental health. Multiple people reported on the luxury of being able to access emergency resources at any time, and felt better about not necessarily needing to get out of bed to get emotional support. However, this trend also represents the nature of e-mental health as a band-aid solution, as it is currently positioned.
Participants shared the fantasy of being able to receive mental healthcare completely anonymously, or without ever having to leave their room. While these things would help people who are currently unable to access mental healthcare, and strictly represent positives for people without a support system, they also represent problems with society. The authors highlight that people should not be afraid to talk about their mental health. The goal of making mental healthcare more accessible is only ideal if it can come alongside the destigmatization of mental health discussion itself.
This qualitative study delved into university students’ perspectives on mental health apps, revealing a complex relationship where students identify as both proponents and critics of digital health technology. They acknowledge the pervasive influence of technology in their lives, yet they maintain a conscious separation from it, using apps as instruments for self-guidance. Their dual stance reflects an underlying techno-optimism intertwined with a critical view of technology’s role in self-improvement. This duality embodies the metaphorical cyborg concept—embracing technology’s potential while resisting the neoliberal push towards individual responsibility in healthcare.
The students’ narratives painted a picture of mental health apps as accessible sanctuaries, contrasting with the formal, daunting nature of traditional mental health services. They saw these apps as tools for self-regulation, envisaging a future where mental health care is seamlessly integrated into their private spaces, thus bypassing institutional barriers. However, they also reduced mental illness to a personal level, mirroring broader societal tendencies that overlook systemic and cultural contributors to mental health. Although optimistic about the empowering potential of apps, students also expressed skepticism, seeking professional validation and regulatory oversight for these digital solutions. Their discussions reflect broader societal discourses on mental health, from neuroplasticity to self-help, shaping their identity as willing and skeptical participants in the digital health revolution.
The study under discussion mainly focuses on how students perceive e-mental health, but it does not provide any statistical data. It is a qualitative study, not a quantitative survey, and its sample size is relatively small. Due to the complexity of the questions, only a limited number of students were included in the study. Thus, the conclusions derived from this research cannot be generalized to larger populations.
Instead of making generalizations, the authors aimed to document how students talk about e-mental health, neoliberalism, and technology as a solution to mental health issues. Their findings offer insight into how young adults think about mental health and the services that address mental health problems. These discussions create and reinforce broader narratives that extend across cultures and regions. Therefore, the authors recommend further research that uses this study as a foundation to examine how e-mental health fits or does not fit into the broader ecosystem of psychological healthcare.
Van Der Poll, R., Coetzee, B., & Bantjes, J. (2023). Willing and unwilling digital cyborg assemblages: University students talk about mental health apps. DIGITAL HEALTH, 9, 20552076231210658. https://doi.org/10.1177/20552076231210658 (Link)