AI chatbots cannot replace human interactions in the pursuit of more inclusive mental healthcare

Abstract

What will the future of mental healthcare look like for those who currently fall through the gaps? There is hope that AI chatbots will meet a rising demand on healthcare systems to provide care to meet the shadow pandemic in mental health. Chatbots are viewed as improving efficiency, affordability, convenience, and patient-driven access with an implicit assumption that this will improve health equity and social inclusion. There are, however, three critically therapeutic aspects of in-person outpatient mental healthcare that are overlooked in discussions about chatbot alternatives: 1) the way mental illness compromises an individual's motivational and self-advocacy capacities, especially for those who are socially marginalized; 2) the embodied nature of empathic communication during any clinical encounter that involves attending to complex non-verbal cues; and 3) how social connections provided by in-person clinics provide indirect social benefits that are not part of a clinical checklist. These three challenges entail corresponding ethical risks of not meeting the obligation to respect patients as persons, to provide empathic care as part of beneficence, and to provide care inclusively to meet demands for fairness and justice. This short communication makes the case for why humans, not chatbots, should be available as first-line mental healthcare providers.