Why we need mental health chatbots

Mental healthcare is in crisis. Depression is the leading cause of disability globally, and the cost of mental illness to society has doubled in the last 10 years in every region of the world. Yet, the global median spending on mental health is just 2.8% of government health spending. In the US, 9 million adults report having serious thoughts of suicide in the previous year. Staggeringly, more than 8% of young people in the US report having made a serious suicide attempt in the previous year (Mental Health America, 2015). There are simply not enough mental health professionals to meet this demand.

The truth about good therapy

The popular idea about therapy is that it holds a kind of special magic that can only be delivered by individuals who are highly trained in this mysterious art form. The truth is that modern approaches to mental health revolve around practical information gathering and problem solving.

The best example of this is cognitive behavior therapy (CBT). CBT is probably the most effective approach to depression and anxiety developed to date. Decades of scientific study show its effectiveness for lots of problems ranging from depression and anxiety to sleep. It is also effective across the lifespan being used by children through older adults. CBT is highly structured and practical, and involves a lot of learning, so it lends itself well to being delivered over the internet. Internet-delivered CBT has been shown to be as effective as therapist delivered CBT for both anxiety and depression. Why is this important? Because if something this useful can be delivered using the internet, then it has the capacity to reach the millions of people all over the world who struggle with their mental health.

The challenges of internet delivered CBT

The internet can increase access, in a way that in-person therapy simply cannot. With this kind of global scale, even modest symptom reduction has the potential to be hugely impactful in lowering the overall burden of disease.

So shouldn’t this solve our supply and demand problem? Alas, there are two catches. The first is that internet-delivered CBT is best when there is a trained guide/coach to check in over the phone. While lesser trained health coaches are in more supply than fully trained, doctoral-level therapists, including any human in the loop will always limit its scalability. The second problem is about engagement. Internet-based CBT approaches suffer from poor adherence; said differently, they feel like homework, and are simply not engaging enough to hold people’s interest. This ultimately undermines their efficacy for those who don’t stick the course.

How Woebot overcomes these challenges

Within the larger goal of achieving true scalability, Woebot aims to address both of these problems. As an automated coach, Woebot helps you practice good thinking hygiene, but he’s also just fun to talk to. People find Woebot easier to engage with than other apps because it’s just a conversation. This is not surprising when you consider that humans have been conversing for about 160,000 years, but we’ve only been designing apps for 10. There’s nothing magic about Woebot, he just asks how you’re doing (mood tracking) and teaches you core CBT concepts in these short conversations (online learning).

Woebot knows his place (…as part of a comprehensive mental healthcare ecosystem)

Woebot will never replace therapy or therapists, and it is not trying to. There is no replacement for human connection — but that is not the point here. The point is that there are millions of people around the world that will never see a therapist, despite the fact that doing so could help them immensely. As a system, we need to get smarter with how we deliver service, and offer lower-intensity options to those who can make use of them. We should be helping people avoid the clinician’s office if we can to free up those precious human resources for those dealing with things that need human intervention.

On an individual level, however, there are so many reasons why people find it hard to reach out. We often say that when you are feeling low, “you should talk to someone”. But insisting that this is the only way to get help leaves behind all of those for whom that is not an option. What if it’s 3am? He won’t do the job of a therapist, but in our experience, that’s not what people want or expect from him either.

It’s nowhere near perfect, but it’s a start.