Veterans Mental Health Crisis: The Case for Artificial Intelligence Solutions
Sally Barksdale
The United States faces a serious mental healthcare crisis among veterans that threatens the foundation of our armed services and political-social contract. Since 2005, the number of veterans who have died by suicide is greater than the number of soldiers who died in the wars in Vietnam, Iraq, and Afghanistan, combined: nearly 18 veterans commit suicide each day.2,3 The Department of Veterans Affairs (VA) – with a 2023 budget of over $370 billion – is responsible for managing the healthcare and benefits for the nearly 19 million veterans in the United States. Despite maintaining the second highest budget of any governmental agency, the VA falls drastically short in its mental healthcare for veterans.2 Current treatment options offered have proven effective; however, with multi-year waiting lists for appointments, they are utterly inaccessible. Nearly 800,000 applications for healthcare have yet to be filled by the VA, and many veterans lament having appointments canceled and never rescheduled or providers leaving with no replacement to handle their patients.3 Despite budget increases, the United States can no longer afford to fund adequate mental health care for veterans within the confines of current policy. Instead, we must consider alternative policy options that allow the VA to expand access to quick, affordable mental health treatment options for veterans.
The VA’s issues with meeting demand for health appointments began in the 1990s, when policy shifted to include middle class veterans in VA hospital eligibility and expanded to fund outpatient clinics. Unfortunately, the budget did not expand to meet these new expectations. This created a supply and demand deficiency that continues to increase today, with hundreds of thousands of healthcare applications backlogged within the administration.3 The VA currently offers virtual mental health programs in addition to traditional in-person therapy, including a telemental health program that connects veterans to a therapist in the comfort of their home.4 While this provides rural and disabled veterans with greater accessibility, it fails to address the persisting issue of the shortage of the number of available appointments due to a lack of providers. This results in exorbitant wait times even for virtual therapy and raises the question: how can we overcome accessibility barriers and connect each veteran to the mental health services they need within a reasonable amount of time?
This challenge will require innovative solutions. Though person-to-person therapy remains the traditional model for mental health care, artificial intelligence (AI)-based therapy programs are growing in popularity. Such programs deliver effective cognitive behavioral therapy techniques and mental health management via AI-powered chatbots.5 While this may seem like a large variation from traditional interpersonal psychotherapy, both rely on the same principles. Current mental health practices require that clinicians accurately assess and diagnose complex mental states, under constraints including lack of resources or information. While a busy therapist may have limited time to assess a patient, resulting in a hasty or superficial assessment, chat bots do not face the same issue.6 Through artificial intelligence, chat bots assess large datasets to find patterns to make these distinctions without the resource limitations of traditional therapists. Studies show that such programs can even effectively mimic the therapeutic alliance built in traditional therapy. Multiple programs have shown efficacy for the treatment of anxiety and PTSD, which many veterans suffer from.7,8 Furthermore, artificial intelligence programs are far cheaper than in-person therapy and can help provide care within the VA’s current budget.9
While it has demonstrated efficacy, AI-based psychotherapy is not without its limitations: namely, computer-based programs have demonstrated a tendency towards developing patient bias. There are still many unknowns with such novel programs. For example, questions can be raised surrounding the feasibility of whether artificial intelligence can be trained to understand the life and trauma of war veterans in the same way humans can. This paper does not intend to assert the superiority of AI-based therapy to traditional in-person therapy or suggest it as a complete replacement. However, in the face of massive supply issues, new strategies must be considered, even if temporary. AI chat programs would ideally allow for increased access to mental health care, and veterans would no longer have to wait months or years to receive treatment. In the face of mental health crises, veterans cannot afford to wait months or even days to receive care, nor should they have to. With careful consideration of the limitations of novel virtual therapeutic techniques, the VA can decrease its inpatient overload and provide easy, accessible solutions for those waiting for appointments without expending large costs.
References
[1] Timmons AC, Duong JB, Simo Fiallo N, Lee T, Vo HP, Ahle MW, et al. A call to action on assessing and mitigating bias in artificial intelligence applications for Mental Health. Perspectives on Psychological Science. 2022 Dec 9;18(5):1062–96. doi:10.1177/17456916221134490
[2] Ebert DD, Harrer M, Apolinário-Hagen J, Baumeister H. Digital Interventions for Mental Disorders: Key features, efficacy, and potential for artificial intelligence applications. Frontiers in Psychiatry. 2019;583–627. doi:10.1007/978-981-32-9721-0_29
[3] Malgaroli M, Hull TD, Schultebraucks K. Digital Health and Artificial Intelligence for PTSD: Improving Treatment Delivery Through Personalization. Psychiatric Annals. 2021 Jan;51(1):21–6. doi:10.3928/00485713-20201203-01
[4] Su S, Wang Y, Jiang W, Zhao W, Gao R, Wu Y, et al. Efficacy of Artificial Intelligence-Assisted Psychotherapy in Patients with Anxiety Disorders: A Prospective, National Multicenter Randomized Controlled Trial Protocol. Frontiers in Psychiatry. 2022 Jan 20;12. doi:10.3389/fpsyt.2021.799917
[5] Koutsouleris N, Hauser TU, Skvortsova V, De Choudhury M. From Promise to Practice: Towards the Realization of AI-informed Mental Health Care. The Lancet Digital Health. 2022 Nov;4(11). doi:10.1016/s2589-7500(22)00153-4
[6] Fitzpatrick KK, Darcy A, Vierhile M. Delivering cognitive behavior therapy to young adults with symptoms of depression and anxiety using a fully automated conversational agent (Woebot): A randomized controlled trial. JMIR Mental Health. 2017 Jun 6;4(2). doi:10.2196/mental.7785
[7] VA Telehealth [Internet]. Department of Veteran Affairs; [cited 2023 Feb]. Available from: https://telehealth.va.gov/type/home
[8] [Internet]. Department of Veteran Affairs; 2022 [cited 2023 Feb]. Available from: https://static.carahsoft.com/concrete/files/9516/4884/4213/Veterans_Affairs.pdf
[9] Keefe M. New G.I. Bill. The Denver Post. Denver, Colorado; 2008.
[10] VA: The Human Cost of War. (Unknown): Steeplechase Films; 2018.
[11] [Internet]. 2022 [cited 2023 Mar]. Available from: https://www.mentalhealth.va.gov/docs/data-sheets/2022/2022-National-Veteran-Suicide-Prevention-Annual-Report-FINAL-508.pdf
In 2023, the number of undocumented immigrants, or UIs, crossing the U.S.-Mexico border was at an all-time high, with 250,000 border crossings in December alone. Upon arriving in the United States, however, many migrants are met with a harsh reality: they have little to no access to medical care.