Chatbots for mental health and suicide prevention: Is this even ethical?

Many are dismayed and horrified at the concept of chatbots for mental health and suicide prevention. For some, the idea reflects a disconnected society where meaningful relationships are diminished, and the complexity of the human experience reduced to a computer algorithm. The limitations of chatbots are very real and it is unlikely that we will be able to design a computer programme that could replicate the complex therapeutic engagement between a therapist and client. However, we will present evidence supporting the use of chatbots in three areas. Firstly, chatbots may be valuable in empowering people who are receiving or considering treatment, to identify and manage their symptoms and identify when they might benefit from additional support. Secondly, people in a suicidal crisis often experience shame, and have great difficulty articulating their suicidal pain. Chatbots may present a non-judgemental platform upon which to explore alternatives. The systems themselves can promote treatments and increase the likelihood of their achieving the type of compassionate therapeutic interaction that can change lives. Thirdly, chatbots may improve equality of access for people who are marginalised, or who have limited resources. This includes minority ethnic groups, people who do not speak the local language, and those with lower levels of mental health literacy. These are the same groups that are most likely to be affected by clinician bias, and the same people who are more likely to die by suicide. Chatbots must be co-produced in conjunction with clinicians and with the voice of lived experience at the core. They must be based on a theoretical framework and theory of change, and their effects continually evaluated. However, with such technologies readily available and many of the most vulnerable not receiving services that are beneficial; one could argue that it is unethical not to explore this area.