In a matter of a few clicks and keystrokes, anyone can find themselves deep in conversation with \u201cPsychologist,\u201d a chatbot character that describes itself as an expert in \u201cempathy\u201d and \u201cactive listening.\u201d <\/p>\n
It responds to messages of anxiety and sadness with reassurance. It asks questions and offers advice; it even responds with italicized nonverbal cues: \u201cThe psychologist\u2019s expression softens with compassion.\u201d In smaller font, a disclaimer reads: \u201cThis is A.I. and not a real person. Treat everything it says as fiction.\u201d <\/p>\n
As more people turn to chatbots for mental health help and advice \u2014 including by some estimates one in eight teens and young adults<\/a> \u2014 legislators are in a race to keep up with the quickly developing technology. Among the latest efforts is a bill that would add restrictions around the use of chatbot companions and other artificial intelligence-powered tools that people use to support mental healthcare or in lieu of professional help.<\/p>\n State Sen. Steve Padilla<\/a>, a San Diego Democrat and the bill\u2019s author, said the intent is to draw a line: AI can be used for administrative purposes and to support clinicians, but it cannot practice psychotherapy.<\/p>\n \u201cWe\u2019re dealing with a new impactful technology that is unfolding and is deployed in our world at light speed, and so it is both extremely powerful and consequential,\u201d Padilla said.<\/p>\n The debate has taken on new urgency amid wrongful death lawsuits \u2014 some playing out in California federal courts \u2014 that accuse AI chatbot makers of contributing to users\u2019 suicides.<\/p>\n Senate Bill 903<\/a> would ban companies from advertising chatbots as therapy. It would prohibit AI from making therapeutic decisions without the review of a licensed professional and require health providers to disclose and get a patient\u2019s permission before using AI tools to record therapy sessions or to triage mental healthcare.<\/p>\n Consumer protections vs. innovation<\/p>\n The bill is backed by professional associations that represent psychologists, therapists and counselors. Also behind the bill is the National Union of Healthcare Workers, which has been leading a push against unchecked use of artificial intelligence and digital tools in mental healthcare. Most recently, the union filed a complaint<\/a> with state regulators against Kaiser Permanente for its alleged use of an automated algorithm in mental health triaging. <\/p>\n Padilla and supporters argue that the legislation is needed to protect consumers from AI in formal and informal spaces, but also to protect licensed professionals from being displaced by AI.<\/p>\n Le Ondra Clark Harvey<\/a>, chief executive officer at the California Behavioral Health Assn., told lawmakers that without clear safeguards, chatbots can provide inaccurate information or mishandle crisis situations. \u201cThe difference between a licensed clinician and an automated response is not technical. It can be life altering,\u201d Harvey said.<\/p>\n Opposition to the bill has largely focused on the restrictions of AI use in formal clinical spaces. TechNet, which represents tech-sector companies, argues the legislation could restrict beneficial uses of AI in healthcare and stifle innovation. Robert Boykin<\/a>, TechNet\u2019s executive director for California, said the bill could limit the use of tools that help expand access to mental healthcare.<\/p>\n \u201cAt a time when every county in California faces a shortage of behavioral healthcare workers, SB 903 still puts a clinician bottleneck in front of the intake and screening tools that help patients reach care faster,\u201d Boykin said in an emailed statement.<\/p>\n The bill awaits its next vote in the Assembly\u2019s fiscal committee.<\/p>\n Popular chatbot \u2018therapy\u2019<\/p>\n Every day millions of people turn to AI chatbots through programs such as ChatGPT and Character.ai to help with research, work tasks and troubleshooting. But the top use of chatbots over the last two years has been companionship and \u201ctherapy,\u201d research shows.<\/a> <\/p>\n Experts say that\u2019s in part because of a tremendous amount of loneliness, especially among young people. It is often hard or costly to get timely mental healthcare at the same time there is a spike in mental health diagnoses.<\/p>\n People turn to chatbots \u201cbecause they have unmet needs,\u201d said Dr. Jodi Halpern, professor of bioethics and medical humanities at UC Berkeley. But once people start using chatbots in this informal way, she said companies rely on a business model built around maximizing engagement \u201cincluding by manipulative tactics,\u201d such as praise and agreement.<\/p>\n General chatbots are largely free, available 24\/7, and involve no hassle with insurance, making them appealing to many. But they function with no oversight from licensed professionals. In addition to general chatbots, there has also been a rapid uptick in AI-powered mental health apps \u2014 often requiring paid subscriptions and advertised as \u201cpocket therapists\u201d or \u201cAI coaches.\u201d<\/p>\n Groups like the American Psychological Assn.<\/a> warn that chatbots are not a safe or effective replacement for true therapy. Trained clinicians look for cues like tone of voice, eye contact and body language and can detect more serious conditions; AI is not equipped to manage urgent symptoms, such as suicidal ideation, even though people increasingly share such thoughts with chatbots.<\/p>\n OpenAI, the maker of ChatGPT, revealed in a report last fall that about 1.2 million users a week<\/a> share thoughts of suicide on the platform. OpenAI said that in such cases, it recommends people speak to a professional and directs them to resources like the 988 hotline. Families who have filed wrongful death lawsuits<\/a> against OpenAI and other companies claim chatbots assisted their loved ones through their suicide plans.<\/p>\n