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Can AI solve our mental health access problem?
Last week I asked you what worries you most about AI in health. It was close, but your top answer was “AI giving bad health advice.” Last week’s poll results: You’re in good company. This concern was top of mind at a conference I joined at Stanford last week, where researchers, clinicians, and people who build AI systems spent a day debating trust and safety in health AI. Stepping back, I’m also hearing your emerging concerns about AI’s impact on our well-being generally. I see this as a matter of public health, and we’ll take it in pieces as we learn together. Today we’ll focus on AI chatbots used for therapy for mental health. Early this month, Governor Newsom vetoed Senate Bill 903, California’s most ambitious attempt to regulate AI use for mental health. It’s at the center of active debate, and raises the questions patients, family members, citizens, and voters will face as AI moves deeper into health care. Let’s work through it. What is “AI-based therapy”? It’s really two things: purpose-built mental health apps designed to deliver structured support, and general chatbots like ChatGPT, Claude, and Gemini that people increasingly use for emotional support—even if they weren’t built for it. Spoiler alert: I don’t know whether the shift toward AI therapy is good or bad. The evidence isn’t there yet. But I do know it’s already happening, and I have some ideas about how we can roll it out with safety in mind. The therapy dilemma, in a nutshell Mental health challenges are common, and strain health and well-being across populations. Therapy (interactive dialogue with a trained, empathetic practitioner) helps many people heal. The demand for licensed therapists far exceeds the supply in California, and AI-based therapy can narrow that gap. AI-based therapy remains novel, unproven, and not well tested. Right off the bat, we can see we’re dealing with trade-offs here. Since the main driver of demand for therapy from a robot is lack of access to therapy from a human, we’ll start there. It’s too hard to find and afford a human therapist California is short roughly 55,000 licensed, non-prescribing therapists and counselors, about 40% of what we need. Psychiatrists, who rely on talk therapy as a complement to prescribed medications, are even more scarce. Eight counties have none, and density ranges from 1.7 per 100,000 residents in San Benito County, to 68.1 in Marin County. My wife is a psychiatrist in Marin, and even here access is tight. If it’s hard in the best-supplied county, imagine rural Sierra County, or the San Joaquin Valley. In 2024, more than half of Californians who tried to make a mental health appointment struggled to find a provider who took their insurance, compared with 14% for physical health care. When Senate staff posed as “secret shopper” patients and called 120 mental health providers in Medicare Advantage networks, they landed an appointment less than once for every five tries. Insurers pay behavioral health clinicians about 22% less than medical and surgical clinicians for comparable office visits. On top of that, billing denials and prior authorizations hit hardest at the solo and small practices common in mental health. Psychiatrists opt out of Medicare at the highest rate of any specialty. In many places, a cash practice for therapy fills quickly with patients paying $250 or more an hour, with no insurance paperwork at all. Families who can pay cash find providers more easily. Those who rely on insurance, including Medi-Cal enrollees, older adults, rural residents, and non-English speakers, compete for what’s left. So we can’t pretend the human system works, and we can’t blame people for turning to AI for support when they’re in distress. AI is filling the gap It’s estimated that roughly a quarter of AI users use it for mental health support. If you have internet, it’s available 24/7, it’s cheap, and it speaks your language. Uninsured adults are about twice as likely as insured adults to do it (30% vs. 14%). It feels anonymous in ways that may enable people to ask things they’re unsure or embarrassed about. The largely hidden, personal use makes it hard to study whether it’s actually helping people with their mental health issues, but researchers are trying. Does AI therapy work? A 2026 analysis of nearly 40 randomized trials found chatbots showed a real but small reduction in depression symptoms. But most of these trials were compared to an alternative of no therapy, not a human therapist. So the benefit of AI therapy is probably real, but modest, and mostly untested against the alternative of human contact. We need more studies. Serious concerns OpenAI’s own estimate is that more than a million ChatGPT users each week show signs of suicidal planning or intent. These are high stakes encounters, and AI doesn’t always get it right. That’s partly because a chatbot can sound like a therapist, but it has no license, no duty of care, and it’s not clear who to hold accountable when it gets things wrong. AI is also designed to help users in whatever task they’re seeking to accomplish. People may feel like they’re getting therapy, but they’re mainly getting a convincing conversation. It’s easy for an AI companion to wander into gray areas, like playing along with “creative writing” that may be about the user’s own suicidal intent. Courts are driving safety conversations A wave of lawsuits have been filed on behalf of families claiming that chatbots pushed people they loved toward self-harm, including teens who died by suicide. The first settlements came this year. OpenAI is headquartered in San Francisco, and dozens of cases alleging that ChatGPT drove users to suicide or self-harm are now before a San Francisco judge. Character.ai has filed for bankruptcy after several states brought lawsuits accusing the chatbot of pushing dangerous content to kids. But the technology seems to be improving. Last month, an independent evaluation found that newer AI models “almost never endorse suicide.” That’s progress, but our societal appetite for even one preventable death is very low. So how do we move forward? Finding a middle ground Earlier this month the governor vetoed Senate Bill 903, a bill designed to place guardrails on the use of AI for therapy. The bill would have prohibited any AI-based platform from being advertised as psychotherapy, and would have required a licensed professional to review and approve each encounter where AI was used to support therapeutic decisions. Newsom called it overly broad, since even routine screening questions would have needed clinician sign-off. Knowing we’re already short on mental health providers, requiring human review of AI encounters may not relieve our access problems. Still, the answer isn’t no oversight. Here’s one feasible short term solution. Rather than reviewing each encounter, a licensed clinician can design the guardrails: what counts as a crisis, what triggers an immediate handoff to a human, and what gets sampled for audit each month. The AI runs inside that structure. Conversations get checked, failures get reported, and a real clinician owns the framework. Medicine already has models to learn from. The FDA process for rolling out newly approved medications is an example. After a product reaches patients, we keep watching for adverse events. Patient-facing AI needs the same “digital pharmacovigilance”: systematic tracking of harms, near misses, and the types of groups that get hurt and why. It’s also critical that users know that they can reach a human if they’re in crisis. Most chatbots now include messages like these: Bottom line The rush to use unproven AI tools for mental health support is mostly a workaround, a sign of a health system people can’t get into. We need better access to proven care from licensed clinicians. That takes reimbursement that makes accepting insurance viable, and a bigger workforce. But, built and tested well, AI could be part of the answer. It could be the 2 a.m. check-in when no one else is awake, or a way for patients to practice skills their therapist taught them. It could be the first step to get someone the right level of care, and take paperwork off clinicians’ plates so they spend more time with patients. None of this is simple. The SB 903 veto doesn’t end the debate, and the legislature will be back. In the meantime, those of us using these tools need to stay informed, ask hard questions, and hold the companies building them accountable. I’ll try to do my part, and we’ll keep learning together. Love,Matt P.S. If you or someone you know is struggling with mental health challenges, emotional distress, substance use problems, or just needs to talk, call or text 988- you’ll reach a real person— or chat at 988lifeline.org 24/7. Dr. Matt Willis is the author of Your Local Epidemiologist in California. A California native, he’s served as a primary care physician, CDC epidemiologist, and public health officer for Marin County, where he guided the pandemic response. He lives in Marin with his family and their dogs, Teddy and Ramona. Thank you Cynthia He, MD, PhD, and Parnika Saxena, MD, for their guidance in preparing this article. Cynthia works in an outpatient mental health clinic, treating patients who have Medi-Cal or, sometimes, no insurance. Parnika works in an inpatient psychiatric unit, treating patients with public or private insurance or self-pay ability. All opinions are their own and do not represent their employers.
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South Texas Health System (@stxhealthsystem)
0 likes, 1 comments - stxhealthsystem on October 11, 2026: "Lead the Future of Healthcare with STHS: South Texas Health System, the Rio Grande Valley’s largest integrated healthcare network, is seeking experienced, driven healthcare professionals who are passionate about delivering quality, compassionate care to join our leadership team. Current leadership opportunities include: • Assistant Chief Nursing Officer (STHS Edinburg/Cornerstone) • System Market Director – Freestanding Emergency Department (STHS) • Director of Nursing, ICU (STHS Heart) • Director of Nursing, ER (STHS McAllen) At STHS, our leaders help shape the future of healthcare by advancing clinical excellence, enhancing operational effectiveness and empowering care teams to achieve their fullest potential. Through their commitment to safety, quality and patient-centered care, they make a lasting impact on the health and well-being of the communities we serve. If you're ready to lead with purpose, inspire excellence and make a meaningful difference, explore these opportunities and take the next step in your career with an organization that values leadership, service and innovation. For details and to apply, visit the link in our bio.".
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U.S. Department of Health and Human Services (HHS) Recommends Science-Based Thresholds to Target Dangerous Enhanced Kratom Products
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Rochester Area Chamber of Commerce voices support for controversial Pine Island data center
The Rochester Area Chamber of Commerce, the second largest chamber in the state, announced it is formally backing Google’s massive and controversial data center proposal, known as Project Skyway.
Editorial: The Case for Impeachment — What would the founders do?
When the Founding Fathers gathered in Philadelphia 250 years ago to “form a more perfect Union,” they studied the collapse of the Greek and Roman republics with an eye toward
North East charities and businesses wrestle with diesel cost
Cancer charity Daft as a Brush and Teesside Minibus Hire say they are struggling with pump prices.
Jeremy McNichols downgraded to out
Washington Commanders RB Jeremy McNichols ruled out with quad injury
How rural Utah became the front line of America’s AI data center backlash
Officials who approved permits are losing seats. Hundreds of projects are stalled. Researchers say water and transparency are the breaking point
Packers Send Playmaker to Injured Reserve Ahead of Bears Matchup
The injuries just keep on piling up for the Green Bay Packers. They have a long list of players on the final injury report ahead of their Week 5 matchup against the Chicago Bears. Green Bay also already has four guys on injured reserve, and was forced to add a fifth on Saturday. Green Bay […] The post Packers Send Playmaker to Injured Reserve Ahead of Bears Matchup appeared first on HEAVY.
Vasco and Remo name line-ups for São Januário clash
Vasco and Remo have named their lineups for this Saturday's (10) Brasileirão clash at São Januário.Both teams are in the bottom half of the table, but are in contrasting form.Vasco have won three s...
Matthew Lillard recalls thinking post-“Scream” night shoot that movie was ‘lame’ and he’d become a TV star
Around this time, he filmed a pilot that never aired.
Leeds manager & players agree on 1 thing about Arsenal
Leeds United’s manager and players were complimentary of Arsenal’s mentality, following the Gunners’ comeback win on Saturday.Photo by Alex Pantling/Getty ImagesLeeds United put in a good perfor...
Inter 0-0 Parma
INTER 0-0 PARMAINTER (3-5-2): 1 Martinez; 28 Pavard, 31 Bisseck, 30 Carlos Augusto; 17 Diouf, 8 Sucic, 20 Calhanoglu, 22 Mkhitaryan, 32 Dimarco; 94 Esposito, 9 Thuram. Substitutes: 12 Di Gennaro, 49 P...
IMG Academy vs. New Palestine highlights
Nationally-ranked IMG Academy defeated New Palestine 49-7 on Friday
Now everyone is starting to look into the Bahamas, or …
Now everyone is starting to look into the Bahamas, or …