AI Chatbots in Mental Health: Are We There Yet?

Introduction

In 2017, the tech giant IBM stated that Artificial Intelligence (AI) will transform the delivery of mental health care over the next five years by helping clinicians better predict, monitor and track conditions, and that “what we say and write will be used as indicators of our mental health and physical wellbeing” (IBM, 2017). In 2021, we are already seeing some of those promised transformations and positive impacts.

Chatbots, as part of AI devices, are natural language processing systems acting as a virtual conversational agent, mimicking human interactions. While this technology is still in its developmental phase, health chatbots could potentially increase access to healthcare, improve doctor–patient and services–patient communication, or help to manage the increasing demand for health services such as remote testing, medication adherence monitoring or teleconsultations. The chatbot technology allows for activities as specific as health surveys, setting up personal health-related reminders, communication with clinical teams, booking appointments, retrieving and analysing health data or the translation of diagnostic patterns considering behavioural indicators like physical activity, sleep or nutrition. Such technology could potentially alter the delivery of healthcare systems, increasing uptake, equity and cost-effectiveness of health services while narrowing the health and well-being gap, but these assumptions require further research.

The development of Cognitive Behavioural Therapy (CBT) chatbots, which mimic normal conversational style to deliver CBT interventions (Kirkpatrick et al., 2017; Inkster et al., 2018) are being developed, however the outcomes are still unclear given the initial stage of research. These advanced chatbots rely on AI techniques to implement the conversational style that mimics a normal conversation as if it were a human being on the other side interacting with the user.

The use of AI chatbots may also increase accessibility by overcoming some barriers associated with stigma in the demand for services. Due to stigma, individuals with psychopathology tend to have reduced social support, being mostly supported by family members. However, users are more prone to perceive chatbots as non-judgmental (Lovejoy et al., 2019). AI chatbots are increasingly being seen by psychiatrists, psychologists, therapists, politicians and tech companies as having a significant role in future mental health treatment and care, with developments in the field being driven by their particular agendas and goals. Nonetheless, it appears that key stakeholders are currently excluded from the discussions about AI in mental health – service users, carers, and families. If rights-based guidelines for ethical AI (AI HLEG, 2019) are to be implemented in mental health, then the implications of the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) needs to be considered. The UNCRPD have said that it is essential to involve disabled people (including those with psychosocial disabilities (Szmukler, Daw, & Callard, 2014) and their representative organisations in developments and decision-making that will affect their lives. It is therefore time to assess the situation, to question those who are driving this transformative agenda forward and to listen to excluded experts – those whose lives will be ultimately impacted by these technologies (Carr, 2020).