JMIR Publications

ABSTRACT

Background:

Approximately 20% of U.S. adults identify as having a mental illness. Structural and other barriers prevent many people from receiving mental health services. Digital mental health applications may improve access to mental health services. However, how and why people engage with licensed counselors through a digital, real-time, text-based mental health support application in non-experimental settings is unknown.

Objective:

To evaluate how people engage with Counslr, a 24 hour, digital, text-based mental health support application where users interact with licensed counselors in real-time on their mobile devices.

Methods:

The study population (users) consisted of students whose schools/universities/colleges partnered with Counslr and employees whose organizations also partnered with Counslr. Users participated in text-based mental health support sessions. In these sessions, users engaged with licensed counselors through digital, text-based mental health support sessions. Users could initiate an on-demand session or schedule a session 24 hours a day. User engagement patterns were evaluated through session length, session day, session time, and self-reported reason(s) for initiating the session. The data was stratified by user type (students or employees) and session type (on-demand or scheduled) to evaluate whether differences existed in usage patterns and self-reported reasons for initiating sessions by user and session types.

Results:

Most students (62.9%) and employees (63.6%) accessed Counslr through on-demand sessions. The average and median session times were 40.0 (σ=15.3) and 45.0 minutes. On-demand sessions (37.9 minutes) were shorter (ρ=.001) than scheduled sessions (43.5 minutes). Most users (80.1%) accessed Counslr between 7pm and 5am. The hour users accessed Counslr did not statistically differ by user or session type. Primary self-reported reasons for accessing Counslr were relationship reasons, depression, and anxiety; however, users initiated sessions for a variety of reasons. Statistically significant differences existed between user types and session types in terms of why people initiated a session.

Conclusions:

The novel findings of this study illustrate that real-time, digital mental health support applications, that offer people the opportunity to engage with licensed counselors outside of standard office hours for a variety of mental health conditions, may help address structural barriers to accessing mental health support services.