Mental Health Foundation Scotland (MHFS) has issued a stark warning over the use of AI to help combat mental health problems.

One of the latest technology-based treatments is an artificially intelligent chatbot called Woebot, which has also been developed into an app. It was created by a clinical psychologist at Stanford University and has been designed specifically to help people cope with feelings of depression and anxiety.

Woebot uses the principles of cognitive-behavioural therapy, one of the most heavily researched clinical approaches to treating depression.

While technology may be useful for some people in certain instances, the MHFS has urged caution over the adoption of new technology in mental health treatment.

Chris O’Sullivan, head of business development and engagement at the Mental Health Foundation, said: “We’re at the beginning of exploring ways in which digital technology can be applied in mental health support. Innovation is good to see but that needs to be accompanied by robust research and evaluation – to help define the problems digital can solve, to test apps and technologies we use for safety and effectiveness, and to enable people to make good choices, whether they are purchasing tools themselves, or health authorities are investing in them.”

Digital health interventions

MHFS is championing better mental health through increased use of digital health interventions, in a six-country European Union partnership. Its eMen project is looking at ways to test and refine digital approaches to mental health support. Through the project, the foundation is inviting governments, service providers, healthcare professionals service users, policy makers and e-mental health developers across the UK to: promote digital health; host and participate in project events; support the testing of e-interventions; and develop policy levers.

O’Sullivan added: “AI and chatbots are an interesting concept in mental health. People use their smart phones, and often conduct complex and personal relationships via text on personal devices. So using a chatbot may well feel natural to many people. Often people have trouble making sense of their thoughts and feelings when distressed – writing these down and making sense of these through interaction with a chatbot might be a way to help people explore or frame concerns.

“People with anxiety and depression also frequently report that they feel their concerns are a burden to others, or not worth troubling health professionals about. It’s also possible to see how a chatbot that provides reassurance or redirects people to their self-management strategies could be helpful. Finally, it isn’t always possible to be open about feelings of distress – whether that’s in work or in our personal lives. The opportunity to access tailored support through an AI-based app guiding you to resources for your needs could be helpful.”

It is, however, important to recognise that there are also profound challenges to address, explained O’Sullivan. Digital innovations are often rapidly developed and brought to market without the level of testing for safety and effectiveness other medical devices or treatments receive. It can be hard to know as a user whether the app you purchase is proven to work.

O’Sullivan said: “When people are baring their souls, or expressing thoughts of suicide, for example, we must be confident that a chatbot will respond appropriately and not either fail or suggest unhelpful or simplistic responses. We also need to consider uniquely digital challenges – such as what happens to the deeply personal data collected by apps about their users. There is also a real risk that relatively low cost digital interventions can be seen as replacements for high quality mental health services.”

O’Sullivan believes that digital services may well play a part in helping people access human help, support them whilst they do so, or provide additional support but it will be a long time before purely digital interactions can replace the input of a trained human able to infer, see body language, and reach out with compassion to a distressed person.

He said: “We need to move forward with digital tools in mental health support – the potential is huge – but we need to do so carefully, to avoid some clear risks.”