Beyond the App: A CARE Framework for Evaluating Human Agency, Relational Care, and Justice in Digital Mental Health

Digital mental health is often framed as a problem of access that technology can solve through scalability, personalization, and continuous monitoring. Yet the expansion of apps, telepsychology, passive sensing, and generative artificial intelligence also transforms what counts as psychological knowledge, how distress is interpreted, and who assumes responsibility for care. This essay advances a relational–ecological account of digital mental health grounded in five propositions: psychological distress cannot be reduced to computational signals; digital access is not equivalent to meaningful care; personalization without contextual justice can intensify inequity; privacy and informed refusal are therapeutic conditions rather than merely regulatory constraints; and successful innovation must preserve human agency and accountable therapeutic relationships. Drawing on intervention research, implementation science, digital phenotyping, critical data studies, and minority-stress perspectives, the essay proposes the CARE framework—Context, Agency, Relationships, and Equity—as a normative evaluative heuristic for design, evaluation, and governance that complements existing app-evaluation and implementation frameworks. Privacy and informed refusal are treated as components of Agency, each domain is paired with indicators and illustrative failure conditions, and the framework is applied to three archetypal technologies. Rather than reject digital technologies, the argument identifies the conditions under which they can extend psychological care without reproducing surveillance, exclusion, or technological solutionism. Future research should test the six propositions derived from the framework and foreground clinically meaningful outcomes, subgroup validity, longitudinal harms, hybrid care pathways, and participatory governance.