⚡ Quick Summary
A recent scoping review examined the ethical challenges associated with conversational artificial intelligence (CAI) in mental health care, highlighting critical themes such as safety, privacy, and accountability. The study emphasizes the need for further research to establish ethical guidelines for the responsible use of CAI technologies in therapeutic settings.
🔍 Key Details
- 📊 Articles Reviewed: 101 articles, primarily published from 2018 onwards
- 🧩 Themes Identified: 10 key ethical themes
- ⚙️ Methodology: Systematic search across multiple databases
- 🏆 Key Findings: Majority of articles focused on safety and harm, privacy, and accountability
🔑 Key Takeaways
- 🛡️ Safety and Harm: Discussed in 51.5% of articles, focusing on suicidality and crisis management.
- 🔍 Transparency: 25.7% of articles highlighted the importance of explicability and trust in CAI.
- 🤝 Accountability: 30.7% of articles addressed the need for clear responsibility in CAI interactions.
- 💔 Empathy: 28.7% of articles raised concerns about the lack of human-like empathy in CAI.
- ⚖️ Justice: 40.6% of articles discussed health inequalities related to digital literacy.
- 🔒 Privacy: A significant concern, mentioned in 61.4% of articles.
- 👥 Job Concerns: 15.8% of articles expressed worries about CAI impacting healthcare workers’ roles.
- 📈 Effectiveness: 37.6% of articles evaluated the therapeutic effectiveness of CAI.
- 🔮 Future Research: Identified gaps in stakeholder perspectives and the need for normative analysis.
📚 Background
The integration of conversational AI into mental health care represents a significant advancement in digital health technologies. However, as these tools become more prevalent, it is crucial to address the ethical implications of their use. This scoping review aims to provide a comprehensive overview of the ethical challenges that arise when CAI functions as a therapist for individuals facing mental health issues.
🗒️ Study
The study involved a systematic search across various databases, including PubMed and Scopus, to identify articles discussing the ethical challenges of CAI in mental health care. A total of 101 articles were included, with a focus on those published from 2018 onwards. The researchers categorized the ethical challenges into distinct themes based on their prevalence in the literature.
📈 Results
The review revealed that the most frequently discussed ethical themes included safety and harm, privacy and confidentiality, and accountability. Notably, 51.5% of articles addressed safety concerns, particularly regarding suicidality and crisis management. Additionally, privacy issues were highlighted in 61.4% of the articles, underscoring the importance of protecting user data in CAI applications.
🌍 Impact and Implications
The findings of this review have significant implications for the future of mental health care. As CAI technologies continue to evolve, it is essential to establish ethical guidelines that ensure their responsible use. Addressing the identified gaps in research can help inform the development of CAI applications that prioritize user safety, privacy, and effective therapeutic outcomes. This could ultimately enhance access to mental health care for diverse populations.
🔮 Conclusion
This scoping review highlights the critical ethical challenges associated with the use of conversational AI in mental health care. While the potential benefits of CAI are promising, it is vital to address the ethical concerns raised in the literature. Continued research is necessary to develop comprehensive guidelines that ensure the responsible integration of CAI technologies into therapeutic practices, ultimately improving mental health care delivery.
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Exploring the Ethical Challenges of Conversational AI in Mental Health Care: Scoping Review.
Abstract
BACKGROUND: Conversational artificial intelligence (CAI) is emerging as a promising digital technology for mental health care. CAI apps, such as psychotherapeutic chatbots, are available in app stores, but their use raises ethical concerns.
OBJECTIVE: We aimed to provide a comprehensive overview of ethical considerations surrounding CAI as a therapist for individuals with mental health issues.
METHODS: We conducted a systematic search across PubMed, Embase, APA PsycINFO, Web of Science, Scopus, the Philosopher’s Index, and ACM Digital Library databases. Our search comprised 3 elements: embodied artificial intelligence, ethics, and mental health. We defined CAI as a conversational agent that interacts with a person and uses artificial intelligence to formulate output. We included articles discussing the ethical challenges of CAI functioning in the role of a therapist for individuals with mental health issues. We added additional articles through snowball searching. We included articles in English or Dutch. All types of articles were considered except abstracts of symposia. Screening for eligibility was done by 2 independent researchers (MRM and TS or AvB). An initial charting form was created based on the expected considerations and revised and complemented during the charting process. The ethical challenges were divided into themes. When a concern occurred in more than 2 articles, we identified it as a distinct theme.
RESULTS: We included 101 articles, of which 95% (n=96) were published in 2018 or later. Most were reviews (n=22, 21.8%) followed by commentaries (n=17, 16.8%). The following 10 themes were distinguished: (1) safety and harm (discussed in 52/101, 51.5% of articles); the most common topics within this theme were suicidality and crisis management, harmful or wrong suggestions, and the risk of dependency on CAI; (2) explicability, transparency, and trust (n=26, 25.7%), including topics such as the effects of “black box” algorithms on trust; (3) responsibility and accountability (n=31, 30.7%); (4) empathy and humanness (n=29, 28.7%); (5) justice (n=41, 40.6%), including themes such as health inequalities due to differences in digital literacy; (6) anthropomorphization and deception (n=24, 23.8%); (7) autonomy (n=12, 11.9%); (8) effectiveness (n=38, 37.6%); (9) privacy and confidentiality (n=62, 61.4%); and (10) concerns for health care workers’ jobs (n=16, 15.8%). Other themes were discussed in 9.9% (n=10) of the identified articles.
CONCLUSIONS: Our scoping review has comprehensively covered ethical aspects of CAI in mental health care. While certain themes remain underexplored and stakeholders’ perspectives are insufficiently represented, this study highlights critical areas for further research. These include evaluating the risks and benefits of CAI in comparison to human therapists, determining its appropriate roles in therapeutic contexts and its impact on care access, and addressing accountability. Addressing these gaps can inform normative analysis and guide the development of ethical guidelines for responsible CAI use in mental health care.
Author: [‘Rahsepar Meadi M’, ‘Sillekens T’, ‘Metselaar S’, ‘van Balkom A’, ‘Bernstein J’, ‘Batelaan N’]
Journal: JMIR Ment Health
Citation: Rahsepar Meadi M, et al. Exploring the Ethical Challenges of Conversational AI in Mental Health Care: Scoping Review. Exploring the Ethical Challenges of Conversational AI in Mental Health Care: Scoping Review. 2025; 12:e60432. doi: 10.2196/60432