AI-enabled self-referral system may bridge the accessibility gap for ethnic and gender minorities in mental health treatment

By Dr. Sushama R. Chaphalkar, PhD.Feb 5 2024Reviewed by Danielle Ellis, B.Sc.

In a recent observational study published in Nature Medicine, researchers assessed the impact of an artificial intelligence (AI)-powered self-referral chatbot on diversity and volume of patient referrals in gender, ethnicity, and sexual orientation. They found that as compared to control services, the services utilizing the AI chatbot experienced a substantial increase in referrals, particularly among minorities, potentially owing to the human-free nature of the bot.

Background

Mental health, acknowledged as a global priority by the World Health Organization, faces increased challenges across the global population. Limited access to mental healthcare continues to persist due to structural issues like underfunding and understaffing. Additionally, individuals with mental health problems often face barriers such as stigma, negative attitudes, and structural obstacles, especially those from minority and disadvantaged backgrounds. The initial step in mental healthcare involves seeking help and referrals, which are crucial for timely support and preventing adverse outcomes. However, evidence shows that individuals from minority groups encounter stronger barriers and stigma in accessing care.

Digital technologies, including AI, present potential solutions to address these challenges, offering flexibility and reduced stigma. While digital technologies show promise in improving mental healthcare efficiency, their marginal impact on diverse demographics seeking help remains less explored. Digital solutions such as chatbots may assist individuals in overcoming barriers and enhance accessibility.

Therefore, researchers in the present study introduced "Limbic Access," a personalized, AI-enabled chatbot designed for self-referrals in mental healthcare, aiming to optimize the referral process by autonomously collecting patient information. The impact of the chatbot was evaluated via an observational study.

About the study

The present retrospective observational study investigates the impact of Limbic Access on National Health Services Talking Therapies referrals for anxiety and depression in the United Kingdom. The chatbot collected clinical information using standardized questionnaires such as Patient Health Questionnaire (PHQ-9) and Generalized Anxiety Disorder Assessment (GAD-7) and employed a semi-standardized structure. AI-driven adaptability helped customize empathetic responses and further tailored data collection based on the patient's mental health condition, optimizing engagement and efficiency.

Analyzing data from ∼129,400 patients across 28 services (14 with the chatbot and 14 controls), the study compared referral patterns before and after chatbot implementation. The services with an online webform for referrals were selected as controls. While the chatbot approach offered personalization, the online webform did not. Controls were matched for various variables, including demographic characteristics. The mechanisms underlying the potential difference in referrals through the AI chatbot were explored by analyzing the qualitative feedback provided by 42,332 individuals after referral completion.

The statistical analysis involved chi-squared tests, logistic regression, one-way analysis of variance, and sensitivity analyses.

Results and discussion

The services using the AI chatbot showed a significant 15% increase in total referrals as compared to a 6% increase in those of control services during the same period. The two approaches did not differ in their baseline demographic compositions. Referrals from nonbinary individuals exhibited a significant 179% increase in services utilizing the personalized self-referral chatbot, in contrast with a 5% decrease in control services. Additionally, the referrals were found to increase across genders in the services using the chatbot– 16% for males and 18% for females as compared to 5% and 6%, respectively, for control services. No significant variations in referral numbers were observed based on individuals' sexuality.

The use of the AI chatbot led to a significant 29% rise in referrals for ethnic minorities, surpassing the 10% increase observed in matched control services. White individuals also experienced a 15% increase, significantly higher than the 4% rise in matched services.

Detailed analysis revealed a 39% increase for Asian and Asian British groups, a 40% increase for Black and Black British individuals, and a 15% increase for mixed ethnic groups in services employing the self-referral chatbot, outperforming the respective control services. However, the difference was not significant for mixed ethnic and other ethnic groups as compared to matched controls.

Qualitative data analysis via natural language processing revealed distinct patterns across demographic groups. Overall, 89% of feedback was positive, emphasizing convenience, hope, and reduced stigma. Notably, gender minority individuals highlighted the absence of human involvement, addressing potential stigma and judgment.

Asian and Black ethnic groups mentioned increased self-realization but expressed less hopefulness. Neutral feedback was higher for Asian and Black ethnic groups, indicating potential barriers to seeking mental health support. Human-coded analysis validated these findings, highlighting the relevance and robustness of observed patterns.

The general increase in referrals and improved diversity with the use of the chatbot did not appear to affect clinical assessment wait times or number of assessments negatively. This indicates that the quality of care was maintained. An additional study comparing the AI chatbot, a general chatbot, and the standard webform demonstrated that the personalized AI-enabled chatbot significantly outperformed the overall user experience.

Conclusion

The present study emphasizes the potential role of AI-based chatbots in enhancing digital self-referral formats and accessibility to mental healthcare services. In the future, these findings could aid global health strategies and initiatives to reduce the burden of mental health conditions as well as the inequality in access to healthcare.