Talking to Machines (Part 2)

How AI may radically restructure mental health care.

Many clinicians are asking whether AI will replace mental healthcare. (I wrote about this in last week’s piece Talking to Machines Part 1 – LINK. I think that’s the wrong question.

The more important question? What happens when AI becomes “good enough” for most routine mental healthcare.

In this piece, I envision that AI many not simply replace clinicians. It will. But it will also drastically reshape how care is delivered.

The skills that clinicians will need to function in an AI world are not what’s going on in training now.

A Core Premise

AI likely won’t eliminate mental health care or the need for clinicians. This is good news, right?

Many people will begin with AI-based mental health support.

• There are a number of healthcare systems that are already replacing “frontline” human intake coordinators and initial assessments with AI-tools and chatbots.
• Some are even using chatbots for “AI therapy”

Many people will start with AI, looking for some answers. Some will get the help they need and —stop there, go no further. Others may come back to AI many times. Still others will seek fewer more specialize clinicians searching for answers to complex problems that have yet to find resolutions, or ask for help for illnesses which are refractory to treatment.

AI Will Drive Changes to Mental Health Care

Key factors will drive a radical change in mental health care delivery.

• AI will offer low cost care, can easily scale to provide care for large populations.
• AI will provide 24/7 availability.
• Financial incentives for insurers and health care systems will accelerate the uses of AI.
• Standards of care will shift to “good enough results “ for most patients.

AI Will Bring Automation

AI will be able to deliver routine outpatient mental health care including diagnostic screenings, assessments of risk, medication management for mental health problem and simple addictions. It will offer ongoing continuous mental and physical health monitoring and automated documentation. AI will deliver of basic manualized treatment such as CBT or DBT. It will enable referrals to other resources our patients may need.

AI care will be less likely for complex trauma, complex addictions, severe personality disorders, emergency psychiatry, inpatient care, addiction detox, long term rehabilitation, forensic psychiatry, and treatment-resistant cases.

Expected Change in the Workforce

AI is already heralding a marked reduction in the number of mental health clinicians needed for routine care.

Demand will grow for specialists with strong relational skills, who can also provide diagnostic depth and complex case formulation.

Clinician may still be needed to make difficult decision with clinical uncertainty, conduct complex risk assessment of suicide, violence, and capacity, and take care of the serious and persistent mentally ill. The clinician of the future will need to effectively master and use AI tools.

How should mental health profession prepare for the future?

Clinician should shift toward more complex, specialize, and system-level roles. Develop expertise in areas which require deep human relational and judgment skills. Become clinically capable of holding patients accountable for their choices will also be crucial.

The Future

The future of mental health is likely to be more specialized, more technologically integrated, and more demanding of high-level clinical skill.

While AI will dominate routine care, human clinicians will hopefully remain essential for ethics, complex issues and deep therapeutic work.

Thoughts?

Is this a realistic assessment? What do you think?

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Other Recent Articles of Mine

• A Practical Way to Treat Patients with Borderline Personality Disorder
• In the Wild with Patients Who Have a Personality Disorder

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Robert E. Feinstein, MD

Professor of Clinical Psychiatry, Zucker School of Medicine at Hofstra/Northwell

Psychiatrist, Psychoanalyst, Educator, and Supervisor Contact: Feinster@RobFeinsteinMD.com

Owner & Founder Empathian LLC ( An Online Mental Health Education Company) Empathian.com

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