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AI CAN’T REPLACE HUMANS IN MENTAL HEALTH TREATMENT

  • 3 days ago
  • 5 min read

As more people turn to artificial intelligence (AI) agents for answers to everyday questions, mental health professionals warn that “helpful” advice from chatbots on issues such as stress, anxiety and depression can do more harm than good.

 

Interactions with AI-powered chatbots, particularly by vulnerable young people, have been linked in the USA, Canada and Europe to several cases of teen suicide, mass shootings, murder-suicides and psychological trauma and breakdown resulting in at least seven lawsuits[i] against ChatGPT creator OpenAI.

 

Similar legal actions have been taken against other AI companies, while some governments are taking steps to protect users and regulate how the technology is used in mental health diagnosis and treatment.

 

Professor Christopher Szabo, member of the South African Society of Psychiatrists (SASOP), said that the greatest risk of turning to AI for mental health support is “bad advice potentially with tragic outcomes”.

 

A recent study by Mental Health UK found that 1 in 3 adults (37%) were turning to AI chatbots for support with mental health and wellbeing[ii], and Prof Szabo said this was possibly similar in South Africa.

 

“At least a third of South African adults are likely to experience a mental health condition in their lifetimes, with anxiety, substance use and depression the most prevalent disorders.[iii] Beyond these diagnosable conditions, we also know that many more people are simply in poor mental health, struggling with the stresses of everyday life in uncertain and tough economic times,” he said.

 

“Given the rise of technology in all aspects of life, along with the stigma attached to asking for help with emotional and mental distress, issues of affordability and SA’s severe lack of mental health care professionals* and facilities, it is unsurprising that people are increasingly engaging with technology to find solutions to their emotional or mental health challenges.”

 

Prof Szabo said while there were many applications of AI and technology such as machine learning algorithms to enhance efficiency in the delivery of mental health – from administrative tasks through to screening, assessments and analysing patient data and behavioural patterns to assist in diagnosis and treatment plans – it could not replace the value of one-on-one personal interaction with a trained, experienced human therapist.

 

He said therapists are trained not only to support but also ask challenging questions of patients, to stimulate their thinking and understanding of a problem as part of a journey to mental wellness.

 

“AI chatbots can provide inaccurate or misleading information, false reassurance and reinforce harmful thinking. Because an AI is designed to always provide an answer, the chatbots have been known to ‘hallucinate’ or make up answers. Users are not always able to verify if the information provided is from a reputable source, making it difficult to determine if the advice is genuinely helpful.”

 

While there have been numerous reports of people developing highly personal “relationships” with an AI chatbot, he warned that while AI responses might seem “humanlike”, they are based on learnt data and predictability of language patterns.

 

“They can’t understand context or interpret the nuances and complexities in human interaction that come through shared, lived experiences. AI cannot read the signals of body language, eye contact, facial expressions or subtleties of language use, the very strengths of in-person contact with a trained mental health professional.

 

“It is not only about diagnosis of symptoms and prescription of treatment, but the quality of the interpersonal connection, the relationship developed between doctor and patient, that drives the positive impact of mental health treatment on a patient’s quality of life,” he said.

 

Prof Szabo also emphasised that, unlike in therapy with a registered mental healthcare practitioner, information shared with a chatbot is not confidential and they are not regulated as human therapists are by professional bodies.

 

“In addition, it is well documented that AI doesn’t respond well in crisis situations, and may actively make things worse by providing inaccurate information or respond in ways that are triggering for the user and escalate the risk of self-harm,” he said.

 

“There is a further risk of developing a dependency on a ‘relationship’ with an AI chatbot, putting a person’s interpersonal relationships at risk, which in turn may raise the need for human, mental healthcare treatment.”

 

While technologies such as apps for wellness or mindfulness can be useful supporting tools in daily life, Prof Szabo recommended that if a person finds themselves turning to AI because of mental distress or a reduced ability to function, they should contact a mental health professional or helpline such as those operated by the SA Depression and Anxiety Group (SADAG).

 

“A mental health professional is far better able to assess the need for care, as well as being both responsible and accountable. They can do what an AI cannot: provide accurate diagnosis and recommend courses of action such as counselling, therapy and medication that will make a meaningful difference to the patient’s life,” he said.


Prof Szabo said current legal challenges to AI developers’ liability for the influence of their chatbots may improve their future responses to mental health challenges and risks for vulnerable individuals.

 

“However, I do not believe there is yet enough guidance or regulation to protect vulnerable people. At the same time, the reality is that while AI developers may bear some responsibility, so too do any medical professionals who recommend AI interaction to their patients.”

 

Prof Szabo added that the ethical standards of mental healthcare professionals and their fiduciary duty of care demands that they have a working knowledge of AI and a “responsible innovation mindset” as to how the technology might be used in their patients’ best interests.

 

“Ethical issues and potential risks need to be considered upfront, not in response to problems after they have occurred. This should pertain to both developers and clinicians.”

“A balance needs to be achieved, where innovation is embraced but does not compromise the core human, ethical and legal principles that underpin trust in healthcare systems,” he said.

 

Where to get human help for mental health issues and suicide crisis counselling:

  • SADAG (SA Anxiety & Depression Group): 0800 567 567 (24/7, toll-free)

  • Motsepe Foundation Have Hope Helpline for tertiary students: 0800 000 242 (24/7, toll-free, operated by SADAG); or WhatsApp 087 163 2050 (8am-5pm)

  • Lifeline national counselling helpline: 0861 322 322 (share call rates) / safetalking@lifeline.org.za / Whatsapp: 060 715 4415

  • For helpline numbers, support via Whatsapp, callback request, info on free support groups and other mental health support resources: www.sadag.org

 

* Note on SA’s shortage of mental health professionals and access to treatment:

South Africa has only approximately 800 psychiatrists serving a population of over 60 million, of which only 25% work in the public sector[iv] which services the 85% of the population without medical aid.[v]

 

Here there are less than 1 psychiatrist per 100 000 people – even less in rural areas – and a similar figure for psychologists (0.97/100 000) and supporting health professionals such as social workers (1.83) and occupational therapists (1.5).[vi]

 

The lack of mental health professionals and facilities, affordability of treatment, and the stigma attached to asking for help for emotional or mental distress, are key reasons that between 75% and 90% of South Africans are unable to access treatment.[vii]

 

REFERENCES

 


 

 

[iii] Herman AA, Stein DJ, Seedat S, et al. 2009. The South African Stress and Health (SASH) Study: 12- month and lifetime prevalence of common mental disorders. South African Medical Journal. 2009 May. https://pmc.ncbi.nlm.nih.gov/articles/PMC3191537/#S11

 

[iv] Robertson L, Moosa Y, Thom R, Docrat S. 2022.  Does mental health matter, South Africa. Mental Health Matters, vol 9, issue 1.  https://www.sadag.org/index.php?option=com_content&view=article&id=3230:does-mental-health-matter-south-africa&catid=170&Itemid=568

 

 

[vi] Docrat S, Besada D, et al. 2019. Mental health system costs, resources and constraints in South Africa: a national survey. Journal: Health Policy Planning. 2019 Nov.  https://academic.oup.com/heapol/article/34/9/706/5572608

 

[vii] Morar T, Breedt JE, Mdaka N, Maaroganye K, Robertson L. 2024. Is mental health in South Africa moving forward? BJPsych Int. 2024 Feb. https://pmc.ncbi.nlm.nih.gov/articles/PMC10803769/

 

 
 
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