AI: The new frontier for mental health support?

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0:45Hey, everyone. Bob here. Today we have a special episode spotlighting the relationship between AI and mental health. Recently, OpenAI has faced several lawsuits alleging that its chatbot contributed to suicides or mental health breakdowns. We're sharing a conversation that I had a few weeks before the suits hit with two on-the-ground experts, Brown University's Ellie Pavlik, director of a new institute dedicated to exploring AI and mental health, and Soraya Darabi of VC firm TMV, an early investor in mental health AI startups. Ellie and Soraya talk candidly about the pros and cons of applying AI to emotional well-being, from chatbot therapy to AI friendships and romance.

1:33Recorded live at the Innovation at Brown showcase in Providence, Rhode Island, the conversation includes themes that are controversial and for some listeners potentially distressing, so please take care. I'm Bob Safian, and this is Rapid Response. I'm Bob Safian, live at Innovation at Brown Showcase, and I'm here with Brown University's Ellie Pavlik, director of a new institute on AI and mental health based at Brown, and Soraya Darabi, lead partner in VC firm TMV, which has$200 million under management and is a backer of mental health well-being startups, among many other things. Ellie, Soraya, thanks for joining us.

2:20Good to be here. Nice to see you, Bob. So among the many fields that have been disrupted by generative AI, mental health and the personal relationships we build with AI agents are among the most fraught. A recent study showed that one of the major uses of ChatGPT for users is mental health, which makes a lot of people uneasy. Ellie, I want to start with you. The new institute that you direct, known as ARIA, which stands for, I have to read this to get this right. I always have to read it too. AI Research Institute on Interaction for AI Assistance. It's a consortium of experts from a bunch of universities backed by$20 million in National Science Foundation funding.

3:07So what is the goal of ARIA? What are you hoping it delivers? Why is it here? Why is it here? You know, mental health is something that is very, I would say, I don't even know if it's polarizing. I think many people's first reaction is negative, the concept of AI mental health. So as you can tell from the name, we didn't actually start as a group that was trying to work on mental health. We were a group of researchers who are interested in the biggest, hardest problems with current AI technologies. What are the hardest things that people are trying to apply AI to that we don't think the current technology is quite up for?

3:40and mental health came up and actually was originally kind of taken off our list of things that we wanted to work on because it is so scary to think about if you get it wrong, like how big the risks are. And then we came back to it exactly because of this. We basically realized that, you know, this is happening. Like people are already using it. There's companies that are like startups. Some of them probably doing a great job. Some of them not. The truth is we actually have a hard time even being able to differentiate those right now. And then there are a ton of people just going to chatbots and using them as therapists.

4:11And so we're like, the worst thing that could happen is we don't actually have good scientific leadership around this. How do we decide what the technology can and can't do? How do we evaluate these kinds of things? How do we build it safely in a way that we can trust? There's questions like this. There's a demand for answers. And the reality is most of them we just can't answer right now. They depend on an understanding of the AI that we don't yet have, an understanding of humans and mental health that we don't yet have a kind of a level of discourse that society isn't up for. We don't have the vocabulary.

4:42We don't have the terms. Like there's just a lot that we can't do yet to make this happen the right way. So that's what ARIA is kind of trying to provide this, you know, public sector, academic kind of voice in to help lead this discussion. Soraya, like you, you're not waiting for this data to come out or for the final, you know, whatever academia might say, this consortium might say about it, you're already investing in companies that do this. I know you're an early stage investor in Slingshot AI, which delivers mental health support via the app Ash. Is Ash the kind of service that, you know, Ellie and her group should be wary about?

5:22Like, what were you thinking about when you decided to make this investment? Well, actually, I'm not hearing that Ellie's weary. I think she's being really pragmatic and realistic. In broad brushstrokes, just zooming back and talking about the sobering facts and the scale of this problem, 1 billion out of 8 billion people struggle with some sort of mental health issue. Fewer than 50 % of people seek out treatment. And then the people who do find the cost to be prohibitive. That recent study that you cited, it's probably the one from the Harvard Business Review, which came out in March of this year, which studied use cases of chat GPT and their analysis showed that the number one, four and seven out of 10 use cases for foundational models broadly are therapy or mental health related.

6:14I mean, we're talking about something that touches half of the planet. If you're looking at investing with an ethical lens, there's no greater TAM than people who have a mental health disorder of some sort. We've known the Slingshot AI team, which is the largest foundational model for psychology, for over a decade. We've followed their careers. We think exceptionally highly of the advisory board and panel they put together. But, you know, I think what really led us down the rabbit hole of caring deeply enough about mental health and AI to, frankly, start a fund dedicated to it, and we did that in December of last year, was really kind of going back to the fact that AI therapy is so stigmatized and people hear it and they immediately jump to the wrong conclusions.

7:03They jump to the hyperbolic examples of suicide. And yes, it's terrible. There have been incidents of deep codependence upon chat GPT or else otherwise, whereby young people in particular are susceptible to very scary things. And yet, those salacious headlines don't represent the vast number of folks whom we think will be well-serviced by these technologies. I mean, Ellie, these tools are moving and changing so fast. like how do you think about what you know your research can do and sort of what the impact can be or you know or is it as much about sort of creating guidelines that will help folks like Soraya and the folks who work at Slingshot to navigate?

7:52So there's kind of a few I would say like lanes in which we're thinking about things that will kind of converge and inform each other but you can think about separately. So one is things like guidelines, how to design systems and how to evaluate them. We're really thinking about like the development process for AI right now. Like what is the current process and what about that is not well suited for mental health? Like I would say, I was initially fundamentally skeptical. And one of the things that's made me more optimistic is the most optimistic in our team about the use of AI mental health are the people who will work most closely on mental health.

8:26So the physicians, the people who have spent time working on mental health technology, and like there's real potential here, right? The people who are most scared are the researchers who do basic science and have never thought about mental health. I also hear from students all the time. I got an email earlier today with someone who's like, I was so excited you work on this because me and my friends have all been talking about what a great like guide these chatbots have been, right? So there is real potential. But part of the problem with this development is it's not being developed for that use case, right?

8:55We're building these huge generalist systems and the same system that's going to be churning out new chemistry compounds is also going to be doing mental health support and is also going to be helping you cheat on your homework and is also going to be like formatting Excel formulas. Like what, right? Like maybe, maybe like we're in an innovative, like maybe that's true, but like we shouldn't take for granted that that's what this looks like. So I think one thing is just not getting too much in the exploit phase too soon of being like, look, we have a recipe for building big AI systems and it's exciting and therefore that's what we're doing and we're just going to run with this.

9:29But actually opening the discussion and seeing what do we want AI to do? What about our system might produce that technology and what won't? And from that perspective, we're really thinking about these more participatory design kinds of processes, thinking about, yeah, what do we want the technology to look like? Let's not assume it's a chatbot. Maybe it is. Maybe it's not. Let's think about this because the stakes are too high to just be like, let's run with the first thing. I think having companies trying to do stuff is part of that, right? We can't just sit in a room and think about it forever.

10:00We need to prototype stuff. There is a basic science development part, right? So there's, like I said, these big generalist systems. The reality is we know so little about them. My own lab's work and a lot of our work is kind of on understanding how language models work, Like what's happening inside? Because we kind of stumbled upon this. So when people talk about making them safe or placing guardrails, what we're really doing is guessing and checking, right? We won't really know what's happening. And we do need scientific leadership in conjunction with stuff being deployed. Like that needs to happen in real time now.

10:32And then we also need to be like, we're not, like, this is not the end of it. This is not the AI. And now we basically have this and we either have to make it work or scrap the whole thing, right? Like we're kind of at the start of stuff. So there needs to be a discussion about like, what else might I look like? What other learning algorithms? What other architectures? What other models? What other interfaces? Like there's so many options there. You said this phrase, like, you know, we kind of stumbled on this. So one, four and seven uses for, for chat GPT. Like, you know, it's not what it was created for.

11:01And yet people love it for that. It makes me think about 20 years ago when everybody was freaking out about the fact that kids were on video games all day. And now because of that, we have Khan Academy and Duolingo. Fear mongering is good, actually, because it creates a precedence for the guardrails that I think are absolutely necessary for us to safeguard our children from anything that could be disastrous. But at the same time, if we run in fear, we're just repeating history. And it's probably time to just embrace the snowball, which will become an avalanche in mere seconds. AI is going to be omnipresent everywhere.

11:35Everything that we see and touch will be in some way supercharged by AI. So if we're not understanding it to our deepest capabilities, then we're actually doing ourselves a great disservice. To this point of, yeah, people are drawn to AI for this particular use case. So on our team in ARIA, like we have a lot of computer scientists who build AI systems, but actually a lot of our teams do kind of developmental psychology, core cognitive science, neuroscience. There are questions to say like, why, right? The why's in the how's, like what are people getting out of this? What need is it filling? I think this is a really important question to be asking soon.

12:12I think you're completely right. Fear mongering has a positive role to play. You don't want to get too caught on it. And you can point historically to examples of like people freaked out and it turned out okay. There's also cases like social media, like maybe people didn't freak out enough, right? Like, and I would not say it turned out okay. People can agree to disagree and there's, you know, there's plus and minuses. But the point is like, these aren't questions that really, like we are in a position that we can start asking questions. You can't do things perfectly, but you can start to, you know, you can run studies.

12:43You can say, what is the process that's happening? What is it like when someone's talking to a chatbot? Is it similar to talking to a human? What is missing there? Is this going to be okay long-term? What about young people who are doing this in core developmental stages? What about somebody who's in a state of acute psychological distress as opposed to as a general maintenance thing? What about somebody who's struggling with substance abuse? Like these are all different questions. They're going to have different answers. Again, I think just, I feel very strongly that the one LLM that just is one interface for everything is, I think a lot is unknown, but I would bet that that's not going to be the final thing that we're going to want, right?

13:17And I think we can do these things carefully if we're having conversations in the open. And if we're having like healthy disagreement, like you have companies trying to move forward and people pushing back and regulators and a lot of people in part of the conversation, we can make this happen the right way at the right pace. We don't want fear of everything to cause it to break into what I think AI commonly is now, which is like the hypers and the naysayers. And this prevents any kind of reasonable middle ground progress because you're basically like with us or you're against us. And then that's not productive.

13:47But I think we're at a point right now where we can have like a really sober conversation and say, we have an opportunity here, but let's not move too fast, but let's not let fear prevent us from doing anything. You mentioned, Soraya, that you mentioned kids. I mean, adults also are using these tools, right? I mean, it's not just kids. Well, in fact, it's not just adults, but it's predominantly men. And this is super interesting. So in addition to Slingshot, we're also investors in a company called Daylight Health, which allows nurses and folks who assist doctors the ability to offer mental health services, which PCPs, primary care physicians, normally don't have time to do.

14:26But we learn in our research and diligence for that particular investment that the vast majority of men feel too nervous to admit to anyone other than their primary care physician that they're dealing with symptoms of depression and anxiety. And the most beautiful part about AI therapy, if you use it well, or technologies like Daylight Health, is that it provides a certain amount of accessibility and acceptance. I'm curious what you think about AI support in other forms. I'm thinking about sort of the friendships and even romantic relationships that people have started to develop with AI agents.

15:04You know, when OpenAI released GPT-5, like there was this outcry because thousands of people lost their boyfriends and girlfriends or, you know, their Reddit groups with thousands of people on them about virtual romantic partners. Like, is that progress? Like, is that opportunity for allowing people to have connection that they crave and need? Or is it just scary? Again, I know I'm going to the extremes again, but... I mean, maybe. I heard someone in Silicon Valley, someone high profile say that gun violence is completely out of control in America. And maybe what we need to do is get AI romantic companions.

15:43And I mean, that's an extreme example, right, of a particular solve for a terrible epidemic. But, you know, we can't immediately write off the fact that AI relationships are bad because it's not what we're normally used to. I know that, I mean, I love the movie Lars and the Real Girl because I think that movie in particular addresses the thought of a fake companions so beautifully and so eloquently in that, you know, we're all just out there seeking community and companionship and whatever form it comes in should be socially acceptable. I agree. I think, you know, I'm first and foremost a scientist.

16:18So it's like, I don't, there's not a huge value to us speculating on this. Like, is it good? Is it bad? I think there is an instinctive like judgment that comes to it. Like, oh, that's weird. But like, like this is, you know, again, this kind of classic, like something is new and different. The default, because so much of the discourse around AI is kind of like a human. So we think of it as replacing human companionship. But a pretty powerful analogy that I think it's also maybe more like right now is journaling. And that's actually something that would be great if more people did this personal reflection, like actually externalizing your thought process.

16:52And I know some of the people who work on mental health within ARIA have been looking on these kind of AI-assisted journals. You know, a good therapist will do this, kind of just get you to think through your own life experiences to reflect, practice gratitude, you know, think about your goals and ambitions, work through something that you might be having trouble voicing to other people. It's a really valuable process to go through. So we shouldn't just right away say the process of somebody playing out a fantasy, working through an imaginary scenario, talking while being by themselves in a room is a bad thing.

17:25It could be a positive thing. If it's replacing other things, it could be a negative thing. So I think there's, again, just questions to ask and research that needs to happen to say, what is happening? What are the risks that we should be aware of and start tracking it? And hopefully we can course correct if it's going in the wrong direction. I wasn't quite sure how Ellie and Soraya were gonna respond to my questions about AI-based relationships. The idea makes so many people uncomfortable, but as they both say, if folks are using it, then we shouldn't just dismiss it. Still, we do need to understand it.

18:01So how do we judge whether AI is helping or hurting our cognitive state? We'll talk about that after the break. Stay with us.

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21:32Yesterday, I was at an event where Siddhartha Mukherjee, the author of The Emperor of All Maladies, was talking. He's got an AI company called Manus AI. And he was saying how customer service representatives that are now becoming AI agents, that once you're done with your customer service, that agent may say to you, so what else is going on? You know, how else are you doing? And it's like he's saying it's going to be like this. Your customer service agent and your therapist are like going to come together. And I don't know whether when you hear that, like Ellie's laughing. I don't know whether Soroya is thinking like, hmm, is that a market I can like.

22:13But are we going to need to train all of the agents that are everywhere to be more understanding about, you know, the mental health impacts? because it's so alluring for us to have that conversation? Oftentimes when people talk about AI therapy, some of the big headlines for what one might be concerned about include AI can't be empathetic because it doesn't have real lived experiences. No, I'm not interested in these add-on experiences and making everyone a bot or everything a bot. And also, AI will figure out empathy soon enough. And some argue it already has, because the data of speaking to millions of people about millions of problems will ultimately result in some version of a lived experience.

23:05And through that, we can create this inference layer of hopefully ethics and empathy that may be applied to other things. So maybe not the customer experience guy, but maybe when you go to the grocery store, the grocers will be trained on how to speak to you more cordially. And that might be rooted in data. And yeah, perhaps that's really cool. Is there a way you research differently when you're, I mean, you're looking at sort of the cognitive reactions we're having, right? Is there a way you research that differently because it's an AI or is it sort of we're humans, AI is not changing the way our brains work.

23:44So like it's the same. First, I want to touch on this concept of empathy, because I think this is a really good example of what I mean about there being like questions we want to answer right now and just the levels at which we don't have the scientific understanding to answer them. we take for granted humans have empathy and lived experience and models don't. The truth is we don't have really good definitions of these things, right? What do we really mean by a word like understand or empathize? Like when we talk about like it's important for humans to get empathy from another, like be more specific.

24:22What do they actually need? Because some of these things we can imagine approximating with AI, some of these things we can't, which is the one that has the positive effect on that person's life. this is a really good opportunity to not pretend we know more than we do. You think about something like CBT as a therapeutic device. There have been successful trials of AI-assisted bots that are basically just reminding you to think through things in a certain way, kind of reprogram your brain. This doesn't depend on like a deep psychoanalytic, like, oh, yeah, no, your mom was totally the one in the wrong there.