Chatbots for Child Mental Health Care: Helpful, but Limited

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Childhood: a carefree time for many. However, children today face countless sources of stress: academic pressure, schedules crammed with activities, lack of sleep, bullying, family instability, world events, social media, and more. Mental health issues among children are growing at a dangerous rate, and it is important that we use all of our innovative technologies to help them.

It is clear that far too many children are having trouble coping with the stresses of daily life. An estimated 7.7 million children¹ have at least 1 mental health disorder, and half are not receiving the treatment they need. More broadly, an estimated 15 million children in the United States² alone are in need of a psychiatrist. More than 4 million children and teenagers 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 is resulting in far too many tragic outcomes. A study published in The New England Journal of Medicine reported that a fifth of deaths among children and adolescents in 2016 were suicides.⁴

Yet with such a high demand for doctors, there are only approximately 8300 practicing child psychiatrists in this country.² At a time when health care professionals are stretched thin, access to child psychiatry² is at an all-time low, and the inequities of our health care system have been made clearer than ever. Can artificial intelligence (AI) help alleviate some of these problems?

Chatbots: Effective Therapy?

AI, more broadly, is already “transforming the world,”⁵ and has found uses reading CT scan images, powering autonomous vehicles, assisting with national defense, and more. It is a powerful technology that will continue to be used in more areas, but how can it be applied to children’s mental health? Enter AI chatbots: programs designed to carry on realistic text- or voice-based conversations with patients and offer advice. They can be available to talk 24/7 and could be infinitely scalable, providing help to millions more people.

They are already helping in many situations. More than 40 different kinds of mental health chatbots exist, mostly focused on treating depression or autism.⁶ And they work: According to findings from a 2017 study by investigators from Stanford University School of Medicine and the developers of the aptly named “Woebot,” the bot was effective in reducing depression and seen as empathetic among college students after just 2 weeks of therapy modeled after cognitive behavioral therapy, a well-known method employed by many human therapists.⁷ The study authors wrote:

“The number of participants reporting that the bot felt empathic is noteworthy, and comments that referred to the bot as ‘he,’ ‘a friend,’ and a ‘fun little dude’ suggest that the perceived source of empathy was Woebot rather than the bot’s developers.”⁷

In another study, Australian teenagers were tasked with helping develop a mental health chatbot, providing input on its gender and the type of slang it should use. (They chose a gender-neutral bot named Ash that was familiar with “brekky” for breakfast and “footy” for football.) The teenagers in that study said they were not always able to get help from existing school resources, and the investigators hoped the chatbot would be able to fill some of those gaps.⁸

Chatbots have the potential to be a powerful tool to help millions—likely even more than the number of individuals diagnosed with anxiety or depression. As many individuals struggle with their mental well-being without a formal diagnosis of a mental health disorder, perhaps mental health chatbots could also help reduce the stigma associated with asking for help. But chatbots cannot be the only way we provide help to the most vulnerable among us. AI tools must be part of a holistic approach led by qualified and experienced doctors. Just as medication is not the only tool doctors use to treat illness or injury, chatbots must not be the only way we improve the mental health of children.

“Good mental health and well-being is about more than just a lack of illness,” the authors of the Australian study wrote. “Focusing on positive coping and building resiliency is important in establishing a holistic approach to health, addressing both physical and psychological experiences of youth. It is clear that young people being aware of mental health and well-being literacy has implications for the promotion of healthy well-being and early prevention of mental health disorders.”⁸

Concluding Thoughts

We are facing a serious mental health crisis among young individuals, and we must use every tool at our disposal to help. AI is not replacing doctors—rather, it is a tool that allows for the democratization of care and increased access to combat noncomplex mental health issues. Doctors will remain a valuable asset for treating more complex disorders. However, chatbots are a powerful tool that should be adopted more widely because anything that can be used to improve the well-being of children must be considered.

Mr Trotsyuk 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. US national and state-level prevalence of mental health disorders and disparities of mental health care use in children. JAMA Pediatr. 2019;173(4):389-391.

2. Turban J. The child psychiatrist will not 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 conduct problems in US children. J Pediatr. 2019;206:256-267.e3.

4. Cunningham RM, Walton MA, Carter PM. The major causes of death in 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 transforming 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 features of chatbots in mental health: a scoping review. Int J Med Inform. 2019;132:103978.

7. Fitzpatrick KK, Darcy A, Vierhile M. Delivering cognitive behavior 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 wellbeing chatbot with and for young people. Front Psychiatry. 2021;11:606041. ❒