Chatbots for Child Mental Health Care: Helpful, but Limited

An estimated 7.7 million children have at least one mental disorder. How can chatbots help?

Childhood: A carefree time for many. However, children today are exposed to myriad sources of stress: school pressure, activity-packed schedules, lack of sleep, bullying, family instability, world events, social media, and more. Mental health problems in children are dangerously increasing and it is important that we use all our innovative technologies to help them.

It is clear that far too many children struggle to cope with the pressures of everyday life. An estimated 7.7 million children1 have at least one mental disorder and half are not receiving the treatment they need. More broadly, an estimated 15 million children in the United States2 alone need a psychiatrist. More than 4 million children and adolescents have been diagnosed with anxiety and nearly 2 million have been diagnosed with depression, according to a study published in The Journal of Pediatrics.3 This leads to far too many tragic results. A study published in The New England Journal of Medicine reported that a fifth of child and adolescent deaths in 2016 were suicides.4th

But with such a high demand for doctors, there are only about 8,300 practicing child psychiatrists in this country.2 Accessing child psychiatry at a time when healthcare professionals are overwhelmed2 is at an all-time low, and the injustices of our healthcare system have become more evident than ever. Can artificial intelligence (AI) help alleviate some of these problems?

Chatbots: effective therapy?

AI in a broader sense is “already changing the world”.5 and has found applications in reading CT scan images, powering autonomous vehicles, aiding in national defense, and more. It’s a powerful technology that will be used in more and more fields, but how can it be applied to children’s mental health? Enter AI chatbots: programs designed to have realistic text- or voice-based conversations with patients and provide advice. They can be available 24/7 for conversations and infinitely scalable to help millions of people.

They already help in many situations. There are more than 40 different types of mental health chatbots, mostly focused on treating depression or autism.6 And they work: According to the results of a 2017 study by researchers at Stanford University School of Medicine and the developers of the aptly named “Woebot,” the bot was effective at reducing depression and was adopted by college students after just 2 weeks of therapy viewed as empathic along the lines of cognitive behavioral therapy, a well-known technique used by many human therapists.7th The study authors wrote:

“The number of participants reporting that the bot felt empathetic is notable, and comments describing the bot as ‘he’, ‘a friend’ and a ‘funny little dude’ suggest that the perceived The source of the empathy was Woebot rather than the bot developer.”7th

In another study, Australian teenagers were hired to help develop a mental health chatbot by providing information about its gender and the type of slang it was supposed to use. (They chose a gender-neutral bot named Ash, who was familiar with “brekky” for breakfast and “footy” for soccer.) The teens in this study reported that they were not always able to get help from existing school resources, and investigators hoped the chatbot would be able to fill in some of those gaps.8th

Chatbots have the potential to be a powerful tool to help millions – probably even more than the number of people who have been diagnosed with anxiety or depression. As many people struggle with their mental well-being without a formal diagnosis of a mental disorder, perhaps mental health chatbots could also help reduce the stigma associated with asking for help. But chatbots can’t be the only way to help the most vulnerable among us. AI tools need to be part of a holistic approach led by qualified and experienced doctors. Just as drugs aren’t the only means doctors use to treat illnesses or injuries, chatbots shouldn’t be the only way to improve children’s mental health.

“Good mental health and well-being is about more than just the absence of illness,” write the authors of the Australian study. “Focusing on positive coping and building resilience is important to establish a holistic approach to health that considers both the physical and psychological experiences of youth. It is clear that young people’s awareness of mental health and well-being has implications for promoting healthy well-being and preventing early mental health disorders.”8th

Final Thoughts

We are facing a serious mental health crisis among young people and we must use every means at our disposal to help. AI does not replace doctors – rather, it is a tool that enables the democratization of care and greater access to tackle non-complex mental health problems. Physicians will remain a valuable asset in treating more complex medical conditions. However, chatbots are a powerful tool that should be used more widely because anything that can be used to improve children’s well-being needs to be considered.

Mr. Trotyuk is a Graduate Fellow in Bioengineering and Computer Science at Stanford University School of Medicine. Dr Turban is Chief Fellow in Child and Adolescent Psychiatry at Stanford University School of Medicine.

references

1. Whitney DG, Peterson MD. Prevalence of mental health disorders at the national and state levels in the US and differences in mental health care utilization among children. JAMA Pediatric. 2019;173(4):389-391.

2. Turban J. The child psychiatrist won’t see you now. psychology today. June 2, 2017. Accessed November 4, 2021.

3. Ghandour RM, Sherman LJ, Vladutiu CJ, et al. Prevalence and treatment of depression, anxiety, and behavioral problems in US children. J Pediatr. 2019, 206: 256-267.e3.

4. Cunningham RM, Walton MA, Carter PM. The leading causes of death among children and adolescents in the United States. N Engl. J Med. 2018;379(25):2468-2475.

5. West DM, Allen JR. How artificial intelligence is changing the world. The Brookings Institution. April 24, 2018. Accessed November 4, 2021.

6. Abd-Alrazaq AA, Alajlani M., Alalwan AA, et al. An overview of the roles of chatbots in mental health: a scoping review. Int. J. Med. Inform. 2019;132:103978.

7. Fitzpatrick KK, Darcy A, Vierhile M. Providing cognitive behavioral therapy to young adults with symptoms of depression and anxiety using a fully automated conversational agent (Woebot): a randomized controlled trial. JMIR Ment Health. 2017;4(2):e19.

8. Grové C. Co-developing a mental health and well-being chatbot with and for young people. Frontline Psychiatry. 2021;11:606041. ❒

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