To me, it seems like the biggest risk in the long term isn't in whether or not people get treated. The article demonstrates that the technology needed to make widely available mental health treatment options is being explored and worked on. The danger in my mind comes afterwards when the technology is performing acceptably but not comprehensively. It seems like at that stage there is a possibility of people not seeking more rigorous/advanced treatment from a professional, once they have the opportunity to do so, because they may already view the app as being good enough and any failures to improve beyond what they've already experienced through the app as personal failures rather than treatment failures.

Here in the UK, most people with moderately severe depression or anxiety have to wait several months to get access to CBT. That will usually comprise of six one-hour sessions, often with a mental health care practitioner rather than a clinical psychologist. Patients with less severe symptoms will be triaged to a telephone-based service, an online service or self-help books.

That's a perfectly typical story for a high-income country with an excellent healthcare system. Access to psychotherapy is routinely and severely rationed because of cost. In lower-income countries, the picture is far worse. For most people, the choice is not between nuanced treatment and convenient treatment, but between cheap treatment and no treatment.

In all honesty, I'm struggling to contain my anger at your comment - it's quite clear that you're from an extremely privileged background. $150 for a weekly session with a psychotherapist is an unimaginable luxury for the vast majority of people in the world.

I'd love for everyone to be able to access a clinical psychotherapist on demand, but it simply isn't going to happen. There isn't the money or the political will to make it happen. I welcome innovative approaches to psychotherapy, provided they're evidence-based and rigorously evaluated. We have a real opportunity to improve the wellbeing of hundreds of millions of people. I think that rejecting these possibilities because of a hypothetical risk is utterly churlish.

However:

> Here in the UK, most people with moderately severe depression or anxiety have to wait several months to get access to CBT

Here's the data for Jan 2017: http://www.content.digital.nhs.uk/catalogue/PUB23831

> 90.2 per cent waited less than 6 weeks and 98.7 per cent waited less than 18 weeks to enter treatment

Most people wait less than 6 weeks to start treatment.

I agree about the rest of your comment: the CBT model should be 12 to 14 weeks of one hour sessions face to face with a therapist (we're not sure if the experience level of the therapist makes much difference), and many people are getting a much reduced version of this: 6 to 8 weeks, of 45 minute sessions, sometimes in groups or over the phone.

Now then, you're right about access to care. If you felt like I was being dismissive of the idea that someone might lack the available funds to get proper treatment for a mental disorder then I apologize. My statement about the long term wasn't to suggest that the access problem is solved now or that it will be solved within the next few decades which in my mind represent the near term as far as timescales go. I simply meant to imply that, assuming the app continues to show promise and is eventually completed as a functional product, and that similar derivative programs aimed at helping treat different mental illnesses can be developed, the concern after those accomplishments becomes ensuring that they don't dissuade patients from pursuing other more appropriate treatment paths once/if their situations improve to that point. I did not mean this as being the only concern or the primary concern afterwards. It was simply the concern I voiced because it was interesting to me when I thought about it and so I shared it.

I'm making assumptions so I may of course be wrong, but my guess is that the latter part of what I just talked about was what upset you. I didn't mean to imply that patients could simply change their situation and go after a different treatment paths. I simply meant that, in a world where the only consideration is treatment appropriateness, I thought it was worth considering the secondary effects app based treatment could have on patient treatment seeking. I didn't mean this to discredit app based treatments as a viable tool and I see no reason they couldn't work in isolation, synergistically with other treatments, or any other variation of "I'm sure they can work" that might be appropriate to this discussion. That seems to be the other interpretation you made from my post, that I was being dismissive of the app compared to other treatments, and this was not something I realized I was communicating. However, since, as far as I can tell, this was the reason you accused me of being churlish I thought it worth clarifying.

Psychiatric hospitals across the developed world are discharging actively suicidal patients on a daily basis, because they're marginally less suicidal than the dozens of people who are waiting for a bed. Beyond suicide, there are vast increases in drug and alcohol related deaths in impoverished communities. We're in the midst of a mental health emergency and need all the help we can get.

You're speculating about whether an app might hypothetically dissuade people from seeking better treatment at some point in the distant future. I think my response is downright charitable.

Consider another hypothetical scenario. A great famine has struck. Someone is dying every 40 seconds. The UN start helicoptering in bulk quantities of freeze-dried rations. I remark that there is a great danger in providing food aid, because it might dissuade people from eating a balanced diet of fresh fruit and vegetables. What response would I expect?

Qu'ils mangent de la brioche.

Edit: Maybe it _is_ all a scheme by Big Insurance to give the masses minimal treatment and doesn't actually solve their problems but provides the illusion of a solution while sucking them into a vile dependence on closed-source AI personalities to feel any sense of therapy. Technology enables so many insidious business practices I don't know what to believe anymore.

This kind of technology in medicine is about enabling human doctors to treat patients better with more (hopefully meaningful) data points at their fingertips. You might be surprised how far behind the medical industry is when it comes to reaching out to the smartphone generation.

There are therapists, and there are books on CBT. This is an extension of the second, more than the first. It's really nothing more than an electronic version of a choose-your-own-adventure book

That's not even touching where you've just pointed out that we're essentially now decreeing that poor people get to talk to machines and rich people get to talk to humans, or the fact that insurance companies will jump at the chance to force the cheap AI down everyone's throats before they pay for human therapy, etc etc...

The status quo is poor people talk to social contacts (eg, friends, family, church community, etc) while rich people talk to professionals (eg, therapists).

This is a change in that poor people are being moved to a professionally manufactured tool, which isn't necessarily an improvement -- it's just replacing an established, ad hoc system with an unknown technical one.

There's every possibility that it would make the situation worse and it's hubris on the part of the medical community that a tool built by them is better than informal therapists.

For some people (particularly those who have large extended families), that is indeed the status quo, but for others not so much.

If your home environment is not supportive (you can imagine responses ranging from "everybody gets depressed sometimes, just work harder and things will get better" to "grow a pair"), or even abusive, and you aren't in a position to get professional help, a tool like this (though given various other concerns, perhaps not this specific one) could very well be the only alternative to no treatment at all.

What comes to mind though, isn't an automated therapist per-se, but something closer to the "Young Lady's Illustrated Primer" (from the novel The Diamond Age).

Everyone talks to social contacts. CBT therapy is something entirely different.

Parts of CBT and DBT are skill training in emotional and cognitive behavioural regulation, that people have not mastered sufficiently on their own. You can teach these skills, and I'd argue they should be mandatory classes on them through middle school. IMHO, they are the most valuable skills that you can learn, bar none.

>There's every possibility that it would make the situation worse and it's hubris on the part of the medical community that a tool built by them is better than informal therapists.

There's hubris in your assumption of how therapy works, or in the tools it incorporates today. This application was released, along with a study demonstrating it's efficacy. It's not the first of it's type - it's just the chatbot format of a self help book. There will be much better versions, I'm sure, over time.

Or, you might talk with friends about what's bugging you, but they're not going to necessarily explore how your feelings relate to external factors, or ask questions to help you understand yourself. A therapist's job is very different from the role of a friend.

Moreover, CBT and DBT, which is where therapy is currently focused for most issues, involves a lot of mental re-tooling and training.

This part of therapy is like learning any other process, and is approached and practiced like any other skill.

Just because you're not talking with a human about the data you're generating _today_ doesn't mean it won't bring interesting discussions to bear in the future.