Mental health care experts weighed in on the potential benefits and risks associated with new technology tools used for mental health care during dsm magazine’s Lifting the Veil event on June 13.

The four panelists shared details on the evolution of technology within mental health care in the past five years, the increased accessibility and convenience that telehealth services provide and a preference among students at Des Moines University to return to in-person interactions.

Speakers included:

• Ryan Crane, executive director of the National Alliance on Mental Illness (NAMI) Iowa
• Joshua Larson, co-founder of Numinous Games
• Jon Lensing, CEO of OpenLoop
• Dr. Ciara Lewis, director of Des Moines University’s Student Counseling Center

Therapy visits on Zoom to AI companions

Lensing said the evolution of technology within mental health care in the past five years started with therapy visits being conducted via Zoom after the COVID-19 pandemic started disrupting everyday life.

Those Zoom visits expanded to include psychiatry and prescribers, who were able to send prescriptions directly to a patient’s local pharmacy.

“But now there’s this sort of new mix that we’re noticing — telehealth 2.0 within the mental behavioral space, and it’s taken … the early-stage telehealth portion of these video visits, the convenience of the accessibility of it and now marrying it with what we would call wraparound care, so all the support pieces,” Lensing said.

Those support pieces include AI companions that check in on patients on a daily basis, whereas therapists might be there with them for only an hour every week.

“These AI companions are checking in every few hours,” Lensing said. “‘Hey, how are you feeling right now? Did this work out for you? Did you try this new tactic that you discussed in your last session?’ That’s pulling down stuff from the care plans of the therapist and then kind of bringing that back into the daily living of these patients.”

Students prefer in-person services again

Lewis said that, in the past several years, the Student Counseling Center at Des Moines University has seen a strong preference among students for in-person services again.

“So there’s maybe a little bit of post-pandemic trauma related to everything having been virtual,” she said. “So a lot of our students prefer the in-person appointments. But [our telehealth platform] has been a really helpful option for our students who might be rotating all over the state to still be able to receive services and to be able to connect.”

The Des Moines University Student Counseling Center is not using any AI tools in its services.

“On a personal note, just as a psychologist, I think AI definitely has the potential to have some really positive mental health impact but also poses some pretty significant risks, too,” Lewis said.

Therapy chatbots could be on the horizon

Crane said he believes chat therapy, or AI therapy, will be available to patients sometime in the future but not anytime soon and possibly not even within the next five years.

He said it will be important for large language models to be trained so they don’t share clinically or medically inaccurate information or don’t react inappropriately to a deep disclosure that a patient has provided.

“This is not six or 12 months out; this is far out,” Crane said. “The other piece that in addition to those two kinds of exciting futuristic nuggets is one that’s a little more practical and is getting a little bit more traction is the opting of people to allow themselves to be guinea pigs with some of this chat stuff, and it’s happening now. …

“I do think even though it sounds kind of dystopian and kind of weird and kind of uncomfortable for us, currently, I do see a future where some really highly refined AI-type chatbots are providing some kind of therapy,” Crane said. “And the reason that I like this or the reason that that doesn’t freak me out and make me go Orwellian, is because of access. A lot of young people are way more comfortable online than we are.”

Risk assessment important to consider in training of AI models

One of the top concerns is the AI tools’ ability to assess whether someone is at risk of harm to self or others.

“Some of the bots that exist currently don’t even actually prompt a user to seek help, even if the person directly names a word like suicide or self-harm,” Lewis said. “I think there’s a huge area of risk there and additional training that’s going to be so important for this technology to catch up to.”

Lewis said she has not found a tool that is doing any kind of homicidal ideation risk assessment, which she said is incredibly important.

“As a licensed professional, I would have a duty to warn if something like that should occur, alerting law enforcement, of course, but then also warning the intended potential victim,” Lewis said. “And so where does that duty to warn fall with something like AI? So I think there are some really important, safety-related and risk assessment-related areas where that training needs to grow a bit more.”

New technologies expand options and help put patients first

New technologies in health care, including telehealth services, have increased access for patients and have improved convenience.

“I think as health care providers, we’ve always said, [the] patient comes first. But in traditional health care, oftentimes, it’s like, ‘Yes, [the] patient is what we’re trying to work toward, but it’s you’re going to come to our site, you’re going to go to this place, you’re going to be on our schedule, our time,’” Lensing said.

Now, patients have more options for when they receive care, where they receive it and how they receive it.

“It’s user choice, it’s patient choice at the end of the day, and I think technology’s only further empowering that, and it’s putting the patient’s care back in their control,” Lensing said. “You know, as opposed to like, ‘Hey, you have this one health system that’s local to you, and everything that you do is going to be driven through that, right?’ So this optionality is good. I think it’ll help meet patients where they want to be met.

“I’m really excited about the next five to 10 years in the health care space. I think the pandemic issued in some miraculous innovation and I’m excited to watch it continue to unfold.”

Breakthroughs on understanding how AI works

While attending a futurist conference in California in June, Larson met someone who is working on creating software to better understand the inner workings of AI.

“There’s been some recent breakthroughs and research that allows you to understand more deeply how the AI works,” he said. “Up until now, a lot of people think of it as a black box, and that’s concerning, especially with something as high stakes as mental health.”

Larson said having more knowledge about how it works will allow for the creation of safer guardrails and the ability to provide a safe experience for people.