Mental health apps need people, too
- Ñî¹óåú´«Ã½ University
New study shows peers may be key to making depression and anxiety apps work in lower-resourced settings.
Digital mental health interventions – such as mood tracking and journalling apps, chatbots, and games – can be a cost-effective way to support adolescents where access to care is scarce and shortages of mental health professionals are acute.
Gamification has become one way of making these interventions more engaging, especially for young people. Instead of presenting therapy as a workbook or information sheet, gamified interventions may use stories, characters, goals, rewards and interactive challenges to help users practise psychological skills.
Depression and anxiety are the leading causes of disability among adolescents, with 20-30% of South Africans between the ages of 10 and 24-years-old affected. Left untreated, these conditions can affect social relationships, disrupt education and increase the likelihood of risky behaviours, suicide and self-harm. Early support can greatly improve later outcomes for young people.
Making digital mental health more human
“We’ve learnt that while apps are innovative, young people still need tools that feel relevant, safe and engaging, which often means a ‘real’ person to interact with alongside the technology. Digital tools can certainly expand the reach of mental health care, but they are not a replacement for human connection,” says Dr , senior researcher at the Ñî¹óåú´«Ã½ Rural Public Health and Health Transitions Research Unit (Agincourt).
Many digital mental health tools struggle to keep users engaged. Young people may download an app, try it once or twice, and then stop using it. For adolescents experiencing depression, motivation, trust and follow-through can be especially difficult.
Moffett, as part of the Digital Delivery of Behavioural Activation to overcome depression and facilitate social and economic transitions amongst adolescents (DoBAt), developed the Kuamsha app, which was supported by weekly phone calls from trained peer mentors.
Developed for use in South Africa and Uganda and co-created with adolescents, Kuamsha is a six-module interactive narrative game based on the core principles of behavioural activation – a psychological approach that helps improve low mood by gradually reconnecting people with meaningful, manageable activities that restore routine, pleasure and a sense of achievement.
Training the people behind the technology
A published in JMIR Mental Health strengthens the case for blended digital mental health care by focusing not on the app itself, but on the peer mentors who support adolescents using it.
“Our latest research looked at whether peer mentors could be recruited, trained, supervised and supported to deliver telephone-based guidance with fidelity and competence,” says Moffett. “While we know that adolescents like using the technology, we needed to understand what kind of human support is needed to make such an intervention meaningful in our contexts.”
Peer relationships are central during adolescence, a developmental period marked by social transition, heightened sensitivity to belonging, and growing independence from adult caregivers. A trained peer mentor may therefore offer something different from a clinician or a parent: a supportive, relatable point of contact who can help an adolescent stay engaged without making the intervention feel overly clinical.
The study included 13 peer mentors in South Africa and four in Uganda, all of whom met the minimum competency standard after training. When researchers independently reviewed recorded support calls, they found that peer mentors were generally delivering the intervention as intended, with high fidelity across both sites.
Moffett says that, to her knowledge, this is the first study to evaluate a structured peer mentor model within a digital mental health intervention in low- and middle-income countries.
The findings suggest that peer mentors can be trained to deliver low-intensity support alongside a digital intervention, provided they receive structured training, ongoing supervision and adequate support. The paper also highlights the importance of adequate supervision, incentives and, in settings where network disruptions are common, periodic in-person contact between peer mentors and supervisors.
A practical bridge to care
Specialist mental health services are often scarce, and adolescents may face stigma, transport barriers, long waiting times and limited access to youth-friendly care. A peer-supported digital intervention cannot solve these structural challenges on its own, but it may offer a practical bridge to care.
The new study does not claim that an app can replace mental health services. Instead, it points to a more grounded and potentially scalable model: app-enabled care supported by trained people.
“The next step is to test whether this support makes a measurable difference, whether better-trained and well-supervised peer mentors help adolescents engage more deeply with the intervention, and whether this leads to better mental health outcomes,” says Moffett.