As director of the University of Florida’s Counseling and Wellness Center, Sherry Benton could never keep up with the student demand for services. Adding three new positions bought the center only two waitlist-free weeks. Knowing the school could never hire its way out of the resource shortage, she and Bob Clark, a seasoned software developer and veteran health care executive, created a wellness and mental health app for students.
TAO Connect is just one of dozens of mental health apps permeating college campuses in recent years. In addition to increasing the bandwidth of college counseling centers, they offer information and resources on wellness and mental health issues. But as student demand for mental health services grows, and more colleges turn to digital platforms, experts say universities must begin to consider their role as stewards of sensitive student information and the consequences of encouraging or mandating these technologies.
The rise in student wellness applications arrives at a time when mental health problems among college students have dramatically risen. Three out of five U.S. college students experience overwhelming anxiety, and two of five students reported debilitating depression, according to a 2018 survey from the American College Health Association.
Despite the epidemic, though, only around 15% of undergraduates seek help at university counseling centers. These apps have begun to fill students’ needs by providing ongoing access to traditional mental health services without barriers such as counselor availability or stigma.
Universities customize the TAO Connect experience by selecting from a curated store of options: It offers hundreds of videos, several hundred interactive exercises, a mindfulness library, self-assessments and logs to practice new skills.
Now on more than 150 college campuses, incoming freshmen are encouraged to download the app. At many schools, first-year students are also required to sign up for various online services. Some university clients also incorporate modules — like a seven-part resilience course — into their core curriculum, and others have opted to use the platform’s units on anger management, communication skills and substance abuse in student discipline and conflict resolution.
To many, the growing prevalence of mental health apps for students, a generation for whom digital technology is the norm, makes sense.
“If someone wants help, they don’t care how they get that help,” said Lynn E. Linde, chief knowledge and learning officer for the American Counseling Association. “They aren’t looking at whether this person is adequately credentialed and are they protecting my rights. They just want help immediately.”
Yet she worried that students may be giving up more information than they realize, and she was concerned about the level of coercion a school can exert by requiring students to accept terms of service they otherwise wouldn’t agree to.
“Millennials understand that with the use of their apps they’re giving up privacy rights. They don’t think to question it,” Linde added.
YOU at College, another student wellness application, is also advertised as specifically benefiting freshmen, many of whom are making a transition away from home for the first time.
The software, developed in 2014 by Joe Conrad, chief executive of Grit Digital Health, approached the growing demand for services by acknowledging mental health issues as a common part of the college experience.
Now on 55 private and public college campuses, with 40,000 accounts, the platform is introduced during new-student orientation, where freshmen can create a profile that acts as a personalized well-being website throughout their schooling experience.
Mental health apps thrive on data; the more an app learns about a user, the more it can customize the experience.
Often, these apps measure student progress with routine assessments that prompt students to track their thoughts, physical activity, diet and symptoms. Some evaluations ask about dating life, alcohol consumption and illegal drug use. Others, like YOU at College’s 18-question “reality check,” cover topics ranging from stress and anxiety to friend networks and sleep patterns. Once completed, students receive report cards and suggested content for areas that may need improvement.
In traditional medical settings, there are privacy protections for personal health information. Universities that receive federal funding are also subject to laws that protect the privacy of some educational records.
The Health Insurance Portability and Accountability Act (HIPAA) “does not apply to user-generated data from the platforms,” including reality checks, self-assessments and quizzes, according to Lori Andrews, director of Illinois Tech’s Institute for Science, Law and Technology. Andrews is also an internationally recognized expert on emerging technologies.
If another app picks up intimate information from a mental health or well-being app, details entered by the student aren’t covered and can be sent elsewhere. And, Andrews said, because HIPAA protections only apply to medical information, data such as location, sleep cycles, and number of steps taken daily, though they may reflect a change in health or could be used to predict health status, are not legally considered “health information.”
In 2018, the Institute for Science, Law and Technology analyzed the privacy policies and permissions of hundreds of mobile medical apps. It found that only 38% had privacy policies pre-download. The available policies were often difficult to locate and challenging to understand for adults, let alone teens.
Many terms of service stated the policy could change at any time without notice to the user, or they included a catchall provision that said the company would make every attempt to be HIPAA-compliant, but didn’t guarantee information privacy.
“By agreeing to use those platforms, you were essentially relinquishing privacy rights,” Andrews said.