Appointment with the chatbot: A paradigm shift in mental healthcare

Yashodeep Sengupta

Once upon a time depression was considered an aberration in human society. If you were clinically depressed, you were one of the very few with such a condition. Sadly, as it stood last year, WHO reported that more than 264 million people of all ages suffer from depression in the world. And that’s only reported or diagnosed cases. Moreover, the annual economic costs of depression in the US alone stands at hundreds of billion.

And then came the Covid-19 pandemic, with lockdowns, social distancing, sedentary lifestyles, stress and a looming sense of fear and panic among all. This has added to a massive surge in an already alarming rate of depression and anxiety in people the world over. Due to the pandemic, not only has the scale of patients with depression risen to large proportions but demand for mental health services has also increased by leaps and bounds — going far beyond the supply of trained professionals. With such a mismatch, how do healthcare service providers tackle this menace that can have a tremendous impact in the times to come?

The new counsellors

Enter machines, the new medics. Believe it or not, the next time you schedule an appointment with a counsellor, it very well might turn out to be a chatbot! Health agencies like WHO, CDC have already started using chatbots to offer emotional support to patients in these pandemic times. CDC’s Clara chatbot engages with you to learn about symptoms and concerns, and provide you information regularly updated on its database. There’s more. While Woebot, a therapy chatbot, uses peer-reviewed clinical data to back up its analyses during its increased usage in the pandemic, Therachat provides doctors with the full record of chats with insights into frequently used positive and negative words. There’s Wysa (with a cute penguin as an icon) also, an AI-based mental and wellness app that uses evidence-based cognitive behavioral therapy (CBT), dialectical behavior therapy (DBT), meditation, breathing, yoga, motivational interviewing and micro-actions to create mental resilience skills.

Welcome to the world where AI and its branches like machine learning, predictive analytics and natural language processing (NLP), are opening up a new paradigm in mental healthcare and support, and giving healthcare institutions the much-required arsenal to combat a growing increase of patient cases with depression in the post-Covid-19 world.

However, chatbots in the mental health space existed even in pre-Covid times. In 2016, when a Syrian refugee in his 20s was counselled by a therapist, little did he know what was happening backstage. Because the ‘therapist’ was a psychotherapy chatbot called Karim, discussing mental health through text messages with him. This was a watershed moment in chatbot history. Deploying counsellors for thousands of affected refugees — complaining of nervousness, self-isolation, unabated crying, etc. — who could speak the local language (Arabic), being of service 24×7, and being paid for it, was a big challenge. That is when Karim, created by an AI-startup X2AI, was pressed into service.

Like Karim, a host of other ‘chatbot counsellors’ mushroomed soon enough, sensing social requirements, technological potential and, of course, business opportunities. For instance, Moodkit and Moodnote are apps that process chats, texts, images and voice journals to help users alleviate symptoms of depression. Others like Pacifica and Joy leverage CBT to address anxiety issues through meditation, health tracking tools, activity trackers, etc.

And now, in the post-Covid world, chatbots are emerging as game-changers in critical healthcare areas like counselling. Even the FDA has suspended some of its usual rules to allow more and more digital chatbot counsellors to step into the game and share the burden of patients reaching out for support. Doctors are referring patients to digital therapists, which has also encouraged many businesses to develop apps and bots that can fit the bill and ride the surging wave.

Studies show that people — mostly the millennials — find it easier to disclose their mental health issues to anonymous chatbots rather than a human being due to the fear of being judged, stigmatized or isolated. An Oracle survey shows how a whopping 82% believe robots can support their mental health better than humans.

Benefits of ‘digital therapists’

The biggest benefit of chatbots is their reach. Most of them are free — or affordable — and are found online either as apps or on messenger platforms like Facebook and Slack. Because chatbots are digital, they transcend boundaries and reach out to millions of people in a tap, anytime, anywhere — even in conflict zones where mental health cases are abundant. There are chatbots being developed to help violence victims in Brazil and the HIV-affected in Nigeria.

Moreover, chatbots are considered independent information disseminators. They are not influenced by people, position, proximity or power. Clear, unbiased facts based on research and delivered in a no-nonsense and practical manner is a masterstroke that attracts people towards chatbots while seeking mental support. Their 24×7 availability also makes chatbots a clear favorite.

The technology powering such chatbots under the hood is mostly the potent combination of NLP and CBT. Also, chatbots are constantly (machine) learning. For instance, X2AI can detect patterns in phrasing, diction, typing speed, sentence length, and other parameters to discern various emotional states. In case they detect any possible life threatening action through keywords like “cut”, “end” or “kill”, there’s provision for human intervention. Michiel Rauws, co-founder, X2AI, says they can even train a chatbot that can perform Freudian dream analysis in “a week or two”.

A promising future

When it comes to chatbots trying to transform the mental health space, the stage is still nascent. Despite their widespread appeal, chatbots still have a few grey areas to work upon. For instance, chatbots cannot replace therapists altogether at this moment. If they sense patients need more attention or support, they refer them to the chatbots’ human counterparts. They are still evolving to catch on subtle nuances, cues and hints that a human therapist perhaps would.

However, things sure look bright on the horizon. With stronger (machine) learning, customized approach and an overarching rise in technology prowess, most of these issues are getting addressed by businesses betting big on chatbots for mental healthcare. With an already high demand, seasoned technology companies are already raising the bar with high-skilled offerings in predictive analytics, machine learning and NLP. Their coming together can sure pave way for a new era in mental healthcare.

A version of the article appeared here.


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