Stress Might Take Your Therapist Out Before AI Does

By Janet Z. Li

In 2020, there were approximately 20,000 registered working psychologists in Canada, a number that has nearly doubled since 2015. 1 While at first glance this may seem like steep improvement in terms of access to mental health care, this increase is seemingly insignificant when compared to the approximate 5 million Canadians who express a need for mental health treatment every year. 2 Factoring in the effects of the COVID-19 pandemic, during which time over 50% of Canadians reported worsening mental health, 2 the need for therapeutic services is of critical importance.

Over the last decade, there has been a global rise in mental health initiatives, such as Bell Let’s Talk and Time to Change, which are designed, not only to encourage much-needed conversation with affected individuals, but also to bring a more holistic approach towards supporting and educating the general population. Programs like these are highlighting how debilitating untreated mental illness can be, with an additional emphasis on the importance and overall benefit of therapy in improving wellbeing as well as a better understanding of one’s own mental health. However, while our communities are becoming better educated, the access to quicker, affordable, and more personalized psychotherapeutic services is becoming unattainable.

In a parallel timeframe, the world of artificial intelligence has also seen explosive growth, particularly within the healthcare sector. Estimated to reach a market value of over 180 billion US dollars by 2030, 3 this current 20 billion US dollar market is beginning to cause tension within the field itself as recent technological advances have caused a rise in AI-assisted techniques; will AI replace psychologists?

In 2022 almost 50% of psychologists in the U.S. reported feelings of burnout and an inability to meet increasing demand.4 While practitioners in all clinical subfields of psychology and psychiatry are being pushed to their limits, the desolate plea for psychiatric help is only getting louder, with studies showing that mental health or addiction-related emergency department visit rates in certain Canadian provinces increased by 89.1% between 2006 and 2017,5 a number that is continuing to climb. Another consideration is the cost of producing mental health specialists. In North America, an individual is required to complete either a doctorate degree followed by clinical training or a medical degree with specialization. Altogether, the process can necessitate up to 15 years of higher education, and with the average cost of a doctoral degree in the U.S. being 40 thousand dollars per year of tuition alone6 and that of medical school being 60 thousand,7 incoming practitioners can wind up with hundreds of thousands of dollars of debt before even starting their official practice.

Looking beyond practitioners themselves, the system is crumbling from within due to prominent barriers in accessibility and affordability. Structural barriers plague this field, particularly in countries experiencing socioeconomic conflicts and rural areas of developed countries. In the Northern United States, surveys show that 45% of individuals with a clinical-level mental problem in 2020 did not seek professional help, with over half of these cases being due to high expenses and a lack of access.8 Even under extensive healthcare coverage, therapy sessions can easily cost over $100 out-of-pocket per session which can snowball with recurring appointments.

As such, arguments can sensibly be made in favor of implementing a fully AI-based mental health care system that eliminates these long-lasting impediments. Interactive chatbots and avatars that engage with patients in the form of a virtual psychotherapist can remediate accessibility issues with the touch of a button. Travel times no longer have to be considered when weighing cost-benefit, living in remote rural areas no longer has to come with disadvantages, and above all, ridiculous month-to-year-long waitlists for one appointment can finally be a thing of the past. Instead of one psychologist working with 15-25 clients, a well-programmed AI intervention has the potential to cater to entire communities and populations. In addition to creating a more equitable framework, digitized mental health care has the allure of a clean slate—the possibility of creating an upgraded system free of inconsistent human biases and inequalities. Stigma-free initiatives in machine and deep learning are gaining a foothold worldwide and demonstrating the benefits of virtual care that is both flexible and accurate. Studies show that certain algorithms have over 90% accuracy in spotting behavioral symptoms indicative of anxiety and 100% accuracy at predicting who among at-risk teens are likely to develop psychosis.9

It’s easy to think that AI could be the solution to most of these problems, and while that may have merit, a completely digital mental health care system is not without its own limitations. A central point of concern is the ability of AI to comprehend and reciprocate the entire spectrum of human emotion. This is especially important in mental health since human psychology is defined as the study of people’s minds and behaviours. A second doubt is the inherent human value of tradition and the apprehension of novelty. People may push back against opening up to or putting their trust in a robot. Technological mistakes are a normal part of any robotic system, and with skeptics underscoring the danger of such advanced AI, many are hesitant to rely on non-human technologies that have the potential to override human control. Research also shows that data and models predominantly remain private and there is little collaboration between researchers,10 putting transparency and real-world viability of AI models into question.

Will AI replace psychologists? The answer is still unclear. The debate becomes even more nuanced when delving into the four levels of AI, which range from reactive machines to self-aware entities. Current research is hovering in the middle of this spectrum and is a long way away from developing fully conscious AI that has the same empathic abilities as human beings.10 At present, lab-based initiatives are being translated into clinical applications despite only being labeled as a supporting role in therapy. Compared to other healthcare fields such as radiology or pathology where AI demonstrates better accuracy than humans, digitized mental healthcare has yet to fully substantiate the bold claims and aspirations we have imposed upon it. However, if advancements continue to be made at the rate they are today, we have a good chance of welcoming AI robots into psychotherapeutic practice in the near future.

References

1. Number of psychologists Canada 2008-2018. Statista. https://www. statista.com/statistics/806108/psychologist-number-in-canada/.

2. Government of Canada. 2016. Mental Illness in Canada - Data Blog - Chronic Disease Infobase | Public Health Agency of Canada. Canadaca. https://health-infobase.canada.ca/datalab/mental-illness-blog.html.

3. AI in healthcare market size worldwide 2030. Statista. https://www. statista.com/statistics/1334826/ai-in-healthcare-market-size-worldwide/#:~:text=It%20was%20forecast%20that%20the.

4. 2023. Apaorg. [accessed 2023 Apr 9]. https://www.apa.org/ monitor/2023/04/psychologists-covid-burnout#:~:text=Faced%20 with%20the%20increased%20workload.

5. Chiu M, Gatov E, Fung K, et al. Deconstructing The Rise In Mental Health-Related ED Visits Among Children And Youth In Ontario, Canada. Health Aff (Millwood). 2020 Oct;39(10):1728-1736. doi: 10.1377/hlthaff.2020.00232. PMID: 33017254.

6. How Much Does a Ph.D. Cost? | BestColleges. wwwbestcollegescom. [accessed 2023 Apr 9]. https://www.bestcolleges.com/research/ cost-of-phd/.

7. Tuition at Every Medical School in the United States (Updated in 2019). Shemmassian Academic Consulting. https://www.shemmassianconsulting.com/blog/medical-school-tuition.

8. Nietzel MT. Almost Half Of Americans Don’t Seek Professional Help For Mental Disorders. Forbes. [accessed 2023 Apr 9]. https:// www.forbes.com/sites/michaeltnietzel/2021/05/24/why-so-many-americans-do-not-seek-professional-help-for-mental-disorders/?sh=149654ba3de7.

9. LaFrance A. 2015 Aug 26. The Algorithm that Predicts Psychosis. The Atlantic. https://www.theatlantic.com/technology/archive/2015/08/speech-analysis-schizophrenia-algorithm/402265/.

10. Daren S. 2021 Oct 12. Will AI replace Psychologists | Future of Psychology. InData Labs. https://indatalabs.com/blog/will-ai-replace-psychologists.