Mental health plus ad profiles, what could go wrong? I can't help but wonder about the moral fiber of the mental health professionals they say they consulted for this.
I find this troubling, there are so many potential ethical issues with this application of language models. Maybe it would be more appropriate for models to issue safety refusals and help the user learn how to get help from a licensed mental health professional
In the United States at least there’s a huge lack of mental health professionals, they’re expensive, insurance goes out of their way to make it inaccessible, and wait times for appointments can be months out. For psychiatrists in some regions there are zero that accept insurance and there can be a six or longer month wait. Many regions have no inpatient beds or any sort.
My parents are clinical psychologists with 40 years experience, and they both agree LLMs could be a great boon to many many unserved people if made well. They think this is a wonderful avenue of research. But agree in the moment it’s not ready. I think the ethics of allowing people to suffer due to economics while ignoring a technology that can help them is worse, no? Telling them to seek a health professional when none are available is worse ?
I agree that accessibility is a big problem, and take your point about ignoring technology that could help, but if the technology if not there yet then I think more research and discourse is warranted before deploying it widely. As a society we need to decide what kind of requirements we expect of these systems, then agree on standards of performance
Is it ok for models to offer specific mental health interventions, or just provide neutral information? To what degree is that technically achievable? Does the answer depend on the scenario?
Health care workers have mandated reporting responsibilities (in the US, I assume other countries are similar) for some situations. Should models be bound by this responsibility as well? (I think yes but it is a thorny question). How to achieve that while preserving patient privacy for issues that don’t fall under mandated reporting rules?
We also have standards of care for health workers. Benchmarks are good, but that’s similar to a licensing requirement, and we have accountability mechanisms when people don’t adhere to their ethical and professional duties. What should be the liability situation when a model responds out of standard resulting in harm (to the standard of evidence we would hold a human health worker)?
Maybe I am not plugged in to this space enough, but my impression is these questions aren’t really in the foreground
> I think the ethics of allowing people to suffer due to economics while ignoring a technology that can help them is worse, no? Telling them to seek a health professional when none are available is worse ?
Not necessarily. Half-measures—especially those that try to offer technological solutions to social problems—allow the actual root problems to remain unaddressed, fester, and grow. The ACA was a hack for a failing system, and then when that quit working, more hacks were added on top, and on and on. LLMs are just another hack that let the can get kicked down the road once more.
If and until actual meaningful health care system reforms happen, the rich will continue getting their $63,000 14-day concierge service from Mass General Brigham whenever they feel blue, and the rest of us will end up getting Doctor Amazon telling us to practice deep breathing and buy some supplements.
The transcripts of mental health professionals could likely have an improvement in the baseline below-average experiences of most folks with such supports.
In other words, mental health professionals will resist this technology to replace them until they realize they can put it in front of people like a new kind of web form, at which time the same will become amazing and wonderful.
At the very least, a tool like this could serve as an anti-virus and firewall for poor and harmful experiences from mental health professionals towards clients.
This seems to miss the point for me, therapy is a series of 20+ conversations, steered by the therapist.
Current LLMs would instead be steered by previous tokens, meaning the patient does. So someone that for example has schizophrenia may actually convince the LLM it's true.
This is a multi-session problem, or at least this is how I've solved it in the past (i.e. the user chat/report thread isn't the one driving the conversation, the sub-sessions/workflows are guiding the analysis).
p.s. there's some interesting literature on how in some circumstances (i.e. religious delusions), where actually validating the patient - basically confirming their experience can lead to rapid recovery (however this approach is not found in western culture). I do agree with you in terms of the risks of LLM's driving folks deeper into delusional beliefs & behaviors - it's very real.
Mental health plus ad profiles, what could go wrong? I can't help but wonder about the moral fiber of the mental health professionals they say they consulted for this.
Wondering when the first insurance/etc. company is announcing a "partnership with OpenAI", i.e. shoveling all the data of their members to OAI :-D
I find this troubling, there are so many potential ethical issues with this application of language models. Maybe it would be more appropriate for models to issue safety refusals and help the user learn how to get help from a licensed mental health professional
In the United States at least there’s a huge lack of mental health professionals, they’re expensive, insurance goes out of their way to make it inaccessible, and wait times for appointments can be months out. For psychiatrists in some regions there are zero that accept insurance and there can be a six or longer month wait. Many regions have no inpatient beds or any sort.
My parents are clinical psychologists with 40 years experience, and they both agree LLMs could be a great boon to many many unserved people if made well. They think this is a wonderful avenue of research. But agree in the moment it’s not ready. I think the ethics of allowing people to suffer due to economics while ignoring a technology that can help them is worse, no? Telling them to seek a health professional when none are available is worse ?
I agree that accessibility is a big problem, and take your point about ignoring technology that could help, but if the technology if not there yet then I think more research and discourse is warranted before deploying it widely. As a society we need to decide what kind of requirements we expect of these systems, then agree on standards of performance
Is it ok for models to offer specific mental health interventions, or just provide neutral information? To what degree is that technically achievable? Does the answer depend on the scenario?
Health care workers have mandated reporting responsibilities (in the US, I assume other countries are similar) for some situations. Should models be bound by this responsibility as well? (I think yes but it is a thorny question). How to achieve that while preserving patient privacy for issues that don’t fall under mandated reporting rules?
We also have standards of care for health workers. Benchmarks are good, but that’s similar to a licensing requirement, and we have accountability mechanisms when people don’t adhere to their ethical and professional duties. What should be the liability situation when a model responds out of standard resulting in harm (to the standard of evidence we would hold a human health worker)?
Maybe I am not plugged in to this space enough, but my impression is these questions aren’t really in the foreground
> I think the ethics of allowing people to suffer due to economics while ignoring a technology that can help them is worse, no? Telling them to seek a health professional when none are available is worse ?
Not necessarily. Half-measures—especially those that try to offer technological solutions to social problems—allow the actual root problems to remain unaddressed, fester, and grow. The ACA was a hack for a failing system, and then when that quit working, more hacks were added on top, and on and on. LLMs are just another hack that let the can get kicked down the road once more.
If and until actual meaningful health care system reforms happen, the rich will continue getting their $63,000 14-day concierge service from Mass General Brigham whenever they feel blue, and the rest of us will end up getting Doctor Amazon telling us to practice deep breathing and buy some supplements.
The transcripts of mental health professionals could likely have an improvement in the baseline below-average experiences of most folks with such supports.
In other words, mental health professionals will resist this technology to replace them until they realize they can put it in front of people like a new kind of web form, at which time the same will become amazing and wonderful.
At the very least, a tool like this could serve as an anti-virus and firewall for poor and harmful experiences from mental health professionals towards clients.
This seems to miss the point for me, therapy is a series of 20+ conversations, steered by the therapist.
Current LLMs would instead be steered by previous tokens, meaning the patient does. So someone that for example has schizophrenia may actually convince the LLM it's true.
This is a multi-session problem, or at least this is how I've solved it in the past (i.e. the user chat/report thread isn't the one driving the conversation, the sub-sessions/workflows are guiding the analysis).
p.s. there's some interesting literature on how in some circumstances (i.e. religious delusions), where actually validating the patient - basically confirming their experience can lead to rapid recovery (however this approach is not found in western culture). I do agree with you in terms of the risks of LLM's driving folks deeper into delusional beliefs & behaviors - it's very real.