Can Your Phone Be Your Therapist? Young People’s Ethical Perspectives on the Use of Fully Automated Conversational Agents (Chatbots) in Mental Health Support
Open accessAbstract
Over the last decade, there has been an explosion of digital interventions that aim to either supplement or replace face-to-face mental health services. More recently, a number of automated conversational agents have also been made available, which respond to users in ways that mirror a real-life interaction. What are the social and ethical concerns that arise from these advances? In this article, we discuss, from a young person’s perspective, the strengths and limitations of using chatbots in mental health support. We also outline what we consider to be minimum ethical standards for these platforms, including issues surrounding privacy and confidentiality, efficacy, and safety, and review three existing platforms (Woebot, Joy, and Wysa) according to our proposed framework. It is our hope that this article will stimulate ethical debate among app developers, practitioners, young people, and other stakeholders, and inspire ethically responsible practice in digital mental health.
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Full automatization can pose significant challenges when used in mental health care with youths, such as limited capacity to respond to safety-critical situations, less personalization of content, or confidentiality issues.
“However, full automatization can pose significant challenges when used in mental health care with youths, such as limited capacity to respond to safety-critical situations, less personalization of the content or confidentiality issues21,22.”
From Use of automated conversational agents in improving young population mental health: a scoping review (2024) · cites this paper as [21]
Ethical reflections and discussion on chatbots and chatbot applications are already emerging.
“Ethical reflections and discussion on chatbots and chatbot applications are already emerging (e.g. [65, 91]).”
From Future directions for chatbot research: An interdisciplinary research agenda (2021) · cites this paper as [65]
With widespread smartphone use, digital tools could function as efficient, widely available mental health resources for orthopedic clinicians to offer their patients.
“With the widespread, everyday use of smartphones, these emerging digital tools could function as efficient, widely available mental health resources for orthopedic clinicians to offer their patients [16,20-22].”
From A Digital Mental Health Intervention in an Orthopedic Setting for Patients With Symptoms of Depression and/or Anxiety: Feasibility Prospective Cohort Study (2022) · cites this paper as [16]
Digital mental health interventions address accessibility-, cost-, convenience-, and stigma-related barriers to traditional in-person mental health treatment.
“Digital mental health interventions address the accessibility-, cost-, convenience-, and stigma-related barriers to traditional in-person mental health treatment [16].”
From A Digital Mental Health Intervention in an Orthopedic Setting for Patients With Symptoms of Depression and/or Anxiety: Feasibility Prospective Cohort Study (2022) · cites this paper as [16]
The lack of comprehensive evidence for the efficacy of autonomous conversational agents in clinical populations makes on-site human support necessary.
“This in combination with the lack of comprehensive evidence for their efficacy in clinical populations makes on-site human support necessary (33).”
From Computer-assisted avatar-based treatment for dysfunctional beliefs in depressive inpatients: A pilot study (2021) · cites this paper as [33]
Application of methods from cognitive behavioral therapy addressing maladaptive cognitions in patients with mild to severe depression necessitates on-site professional support to guide treatment and rapidly react to emerging adverse effects.
“These additional insights confirm that the application of methods from cognitive behavioral therapy addressing maladaptive cognitions in patients with mild to severe depression necessitates on-site professional support to be able to guide the treatment and rapidly react to emerging adverse effects, such as an exacerbation of symptoms (33).”
From Computer-assisted avatar-based treatment for dysfunctional beliefs in depressive inpatients: A pilot study (2021) · cites this paper as [33]
CBT is seldom used due to pervasive and persistent problems with access, cost, and stigma.
“However, CBT is seldom used due to pervasive and persistent problems with access, cost, and stigma [15-18].”
From Chatbot-Delivered Cognitive Behavioral Therapy in Adolescents With Depression and Anxiety During the COVID-19 Pandemic: Feasibility and Acceptability Study (2022) · cites this paper as [18]
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- Authors
- Kretzschmar, K., Tyroll, H., Pavarini, G., Manzini, A., Singh, I., & NeurOx Young People’s Advisory Group
- Affiliations
- University of Oxford (GB)
- Corresponding author
- Pavarini, Gabriela
- Venue
- Biomedical Informatics Insights
- Publisher
- SAGE Publications
- Published
- 2019-01
- Volume
- 11
- Pages
- 1178222619829083-1178222619829083
- ISSN
- 1178-2226 (ISSN-L)
- PMC
- PMC6402067
- OpenAlex
- W2920018355
- Cited by
- 270
- References
- 46
- Citations by year
- 2026: 31 · 2025: 49 · 2024: 37 · 2023: 47 · 2022: 37 · 2021: 33 · 2020: 32 · 2019: 4
- FWCI
- 29.94
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Locations
- Biomedical Informatics Insights (publishedVersion, cc-by-nc)
- Europe PMC (PubMed Central) (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
- Funders
- wellcome trust (104825/Z/14/Z, 203329/Z/16/Z, 203132/Z/16/Z)
- national institute for health research (IS-BRC-1215-20005)
- Topics
- Social Sciences › Psychology › Applied Psychology › Digital Mental Health Interventions
- Social Sciences › Safety Research › Ethics and Social Impacts of AI
- Social Sciences › Psychology › Social Psychology › Social Robot Interaction and HRI
- Keywords
- chatbots, digital mental health, youth, ethics, privacy and confidentiality, treatment efficacy and safety, Woebot, joy, Wysa, moral norms, mental health apps
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