Ethical Issues Surrounding Artificial Intelligence Technologies in Mental Health: Pychotherapy Chatbots

The last few decades have witnessed a substantial increase in the number and needs of individuals with mental disorders and other mental health concerns. Unfortunately, the increase has not been met with a parallel rise in treatments and interventions available to these communities. Consider the 2016 statistics in the US: 18.3% of all US adults were diagnosed with a mental disorder, and of these, only 43.1% received some kind of treatment, e.g., inpatient or outpatient counseling or prescription medication (Substance Abuse and Mental Health Services Administration 2017). The need-availability gap widened during the COVID-19 pandemic (KFF analysis of US Census Bureau, Household Pulse Survey, 2020–2021). For example, about four in ten adults in the US reported symptoms of anxiety or depressive disorder, up from one in ten reporting these symptoms from January to June 2019. Reasons for the gap between the rising demand for mental health treatment and available resources include the stresses of the pandemic, shortage of mental health professionals, especially in remote and rural areas, individuals’ inability to recognize their mental health problems, high cost of mental healthcare, stigma attached to having mental disorders, and increased needs of vulnerable populations, such as refugees, immigrants, or veterans. In the face of these problems, recent advances in applications of artificial intelligence in medicine and psychiatry give some reason for optimism, as their proponents believe these technologies will fill the need-availability gap by enhancing resources for mental healthcare. One technology that has generated significant enthusiasm is the artificially intelligent chatbots, or what I will call Chat_Bots. Chat_Bots are purported to provide Cognitive Behavior Therapy (CBT) to their users with the aim of helping them improve their mental health and/or address their mental disorders. In the face of the increased interest in these technologies among researchers and the public at large, a plethora of connected questions has emerged: Are Chat_Bots effective tools for mental disorder diagnosis and treatment? Which ethical standards should guide their development and use? Must research on the artificial intelligence-assisted behavioral intervention technology be prioritized over improving other diagnostic and treatment strategies, such as in-person psychotherapy? Should this technology be funded publicly or privately? This chapter will examine some of the ethical issues concerning the use of Chat_Bots. First, I will review what Chat_Bots are and the contexts in which they are used, with some examples. Second, I will critically evaluate the promises of the proponents of Chat_Bots technology and address the ethical concerns lying therein.