IEEE Technology and Society Magazine - March 2023 - 32

Feature
including LGBT communities [61], disabled people
[62], and older adults [63].
Addressing inequality is, therefore, relevant to
the deployment of this technology. Marginalized
communities bear the brunt of societal burdens and
face greater uncertainty in their lives. Hence, the
combination of stigma and structural barriers exacerbates
the inequality faced by these groups given
the greater need to cope with how society is valuing
their presence. These barriers shape lived experiences.
If AI mental health apps are not attentive to
these communities-integrating culturally appropriate,
accessible, and inclusive elements into their
designs-they risk contributing to the widening and
perpetuation of these disparities.
Balancing Need and Risk
Current research on mental health raises
major questions as to whether the promises of this
approach, including ease of access, customizability
flexibility, and most of all effectiveness, will materialize
[64], [65], [66]. In this article, we have discussed
the justification for, and potential social implications
of, AI-based mental health applications. While
such applications could hypothetically expand the
capacity of a resource-scarce mental health system
through low-cost, anonymous, and immediate
support [67], we call attention to a number of
concerns, including weak empirical outcomes, displacement
of human interaction, lack of oversight,
and surveillance of vulnerable populations.
Such hyper-individualized and privatized appbased
interventions configure a user not as a community
member but as a problem to be solved in
the most financially and socially efficient ways.
Any technology that is implemented in this space
must meet the same standards and regulations
that apply to in-person services, and that strictly
protect the privacy and any user data being collected.
In the United States, this would be through
meeting requirements
established under the
Health Insurance Portability and Accountability
Act (HIPAA), to ensure the psychological autonomy
of the individual.
However, these concerns should not overshadow
the immense need for mental health services that
meet people where they are. If care through traditional
means cannot be procured due to cost, geography,
discrimination, or stigma, then meaningful,
effective, and immediate alternatives are necessary.
32
Whether those alternatives are AI-enabled digital
mental health applications, technologies that facilitate
remote human interaction, or a nontechnological
solution entirely, remain to be seen. But we
especially advocate for a human-in-the-loop configuration
for these applications, where the technology
can augment but not replace trained human care.
While the development of AI in this space may be
a well-intentioned response to the increasing mental
health crises, these applications must not, intentionally
or unintentionally, displace the availability
of human services. Otherwise, the choice to use AI
applications ceases to be a choice at all.
Investing in People
the inevitability of automated digital mental
health services is not a foregone conclusion, but
we must recognize the paradox of technological
potential: stretching out our hands for the safety of
a device, rather than a human clasp, if that clasp
is unavailable [68], [71]. We close with a call to
action to technologists, ethicists, clinicians, and
users, to imagine futures in which these kinds of
applications can be ethically, thoughtfully, and
justly distributed. The investment in technology
should not supersede the investment in people and
infrastructure to ensure that mental health solutions
become reachable for all.

Acknowledgments
This article has supplementary downloadable
material available at https://doi.org/MTS.2023.3241309,
provided by the author.
 References
[1] World Health Organization (WHO), " Depression
and other common mental disorders: Global health
estimates, " 2017. [Online]. Available: https://apps.who.
int/iris/bitstream/handle/10665/254610/WHO-MSDMER-2017.2-eng.pdf
[2]
C. Moreno et al., " How mental health care should
change as a consequence of the COVID-19
pandemic, " Lancet Psychiatry, vol. 7, no. 9, pp.
813-824, 2020, doi: 10.1016/S2215-0366(20)30307-2.
[3] M. Neary and S. M. Schueller, " State of the field of
mental health apps, " Cogn. Behav. Pract., vol. 25, no.
4, pp. 531-537, Nov. 2018.
[4] B. Pfefferbaum and C. S. North, " Mental health and
the COVID-19 pandemic, " New England J. Med., vol.
IEEE Technology and Society Magazine
https://doi.org/10.1109/MTS.2023.3241309 https://apps.who.int/iris/bitstream/handle/10665/254610/WHO-MSD-MER-2017.2-eng.pdf https://apps.who.int/iris/bitstream/handle/10665/254610/WHO-MSD-MER-2017.2-eng.pdf https://apps.who.int/iris/bitstream/handle/10665/254610/WHO-MSD-MER-2017.2-eng.pdf
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