Consumer Perspectives on the Use of Artificial Intelligence Technology and Automation in Crisis Support Services: Mixed Methods Study.

BACKGROUND: Emerging technologies, such as artificial intelligence (AI), have the potential to enhance service responsiveness and quality, improve reach to underserved groups, and help address the lack of workforce capacity in health and mental health care. However, little research has been conducted on the acceptability of AI, particularly in mental health and crisis support, and how this may inform the development of responsible and responsive innovation in the area. OBJECTIVE: This study aims to explore the level of support for the use of technology and automation, such as AI, in Lifeline's crisis support services in Australia; the likelihood of service use if technology and automation were implemented; the impact of demographic characteristics on the level of support and likelihood of service use; and reasons for not using Lifeline's crisis support services if technology and automation were implemented in the future. METHODS: A mixed methods study involving a computer-assisted telephone interview and a web-based survey was undertaken from 2019 to 2020 to explore expectations and anticipated outcomes of Lifeline's crisis support services in a nationally representative community sample (n=1300) and a Lifeline help-seeker sample (n=553). Participants were aged between 18 and 93 years. Quantitative descriptive analysis, binary logistic regression models, and qualitative thematic analysis were conducted to address the research objectives. RESULTS: One-third of the community and help-seeker participants did not support the collection of information about service users through technology and automation (ie, via AI), and approximately half of the participants reported that they would be less likely to use the service if automation was introduced. Significant demographic differences were observed between the community and help-seeker samples. Of the demographics, only older age predicted being less likely to endorse technology and automation to tailor Lifeline's crisis support service and use such services (odds ratio 1.48-1.66, 99% CI 1.03-2.38; P<.001 to P=.005). The most common reason for reluctance, reported by both samples, was that respondents wanted to speak to a real person, assuming that human counselors would be replaced by automated robots or machine services. CONCLUSIONS: Although Lifeline plans to always have a real person providing crisis support, help-seekers automatically fear this will not be the case if new technology and automation such as AI are introduced. Consequently, incorporating innovative use of technology to improve help-seeker outcomes in such services will require careful messaging and assurance that the human connection will continue.

Community expectations and anticipated outcomes for crisis support services-Lifeline Australia.

Crisis lines provide a critical first line of mental wellbeing support for community members in distress. Given the increasing referral to such services, there is a need to understand what the expectations of the community are around the role of such services in our public health responses. A computer assisted telephone interview was undertaken between 28th October and 30th November 2019. The aim was to explore expectations and anticipated outcomes of Lifeline Australia's crisis support services from a nationally representative community sample (N = 1,300). Analysis was undertaken to determine if demographic variables (age, gender, indigenous status, country of birth, culturally and linguistically diverse (CALD) status, sexual orientation, household composition, region and State/territory) and past service use affected community expectations. Results showed that a majority of respondents expected Lifeline to listen and provide support, recommend other services, and provide information. Help-seekers were expected to feel heard and listened to, receive safety advice or support to stay safe, and feel more hopeful. Lifeline was expected to prioritise people feeling suicidal, in immediate personal crisis, and experiencing domestic violence. Findings reveal that community members hold expectations for Lifeline Australia to serve as a suicide prevention and general crisis support service, which are congruent with the service's aims. There was little variation in community expectations of crisis support services based on demographic factors and past service use. The results show that the community has extensive and diverse expectations for this national crisis service to meet both short and longer-term needs for all vulnerable members of the community-entailing a very substantial public health service responsibility.

Implementation of a Pilot SMS-Based Crisis Support Service in Australia.

Background: Australia's first short message service (SMS) crisis support service was launched by Lifeline Australia in July 2018. The pilot program was independently evaluated over a 240-day period. Aims: We aimed to examine the experiences of key staff employed in the Lifeline Text pilot and identify the skills and types of support required to deliver a high-quality SMS-based crisis support service. Method: In total, 22 interviews were conducted with 14 Lifeline Text crisis supporters and in-shift supervisors (supervisors) at two time points in September 2018 and March 2019. A modified framework approach was adopted to undertake qualitative data analyses. Results: Delivering crisis support via text was initially challenging as a result of the need to translate skills from telephone crisis support to the SMS platform. This was compounded by the high degree of suicidality of help-seekers and volatility in demand for the service. Limitations: The independent evaluators were not involved in the design of the pilot. Conclusion: Lifeline text is providing an important and necessary service, using a novel mode of delivery in Australia. Maintaining service quality at peak demand, with many distressed and suicidal help-seekers, requires specialized training, experience, and exceptional skills.

Evaluation of Outcomes for Help Seekers Accessing a Pilot SMS-Based Crisis Intervention Service in Australia.

Background: In July 2018, Lifeline Australia launched Australia's first short message service (SMS) crisis support service. Lifeline Text aims to reduce psychological distress and increase coping and social connectedness among help seekers, particularly those who prefer text-based communication. Aims: We aimed to independently evaluate the pilot SMS service over a 240-day period. Method: The service evaluation used operational data, pre and postconversation automated questions, and an online survey to assess outcomes. Results: There were 7,315 contacts during operational hours, of which 5,266 progressed to the queue and 99.2% were answered. Suicide was actively being considered by 1,554 help seekers, and 171 were assessed at imminent risk. Commonly discussed topics were mental health problems, issues relating to the self and identity, and family relationship difficulties. Limitations: This was an evaluation of a pilot service focusing on demand and short-term outcomes. Conclusion: The service succeeded in reaching some under-served groups. On average, help seekers were significantly less distressed, felt more confident in their ability to cope and felt greater connection to others, following the text intervention. The demand for Lifeline Text and the high level of suicidality of help seekers show it is meeting urgent needs in the community.

Acceptability and utility of an electronic psychosocial assessment (myAssessment) to increase self-disclosure in youth mental healthcare: a quasi-experimental study.

BACKGROUND: Technology is increasingly being used in youth mental healthcare to support service delivery and improve health outcomes. The current study trialed a new electronic psychosocial application (myAssessment) that aims to provide a holistic assessment of relevant risk and protective factors in youth mental healthcare. The study aimed to determine whether myAssessment was acceptable to all users, and whether it affected: reporting of certain behaviors and ratings of self-disclosure; youth ratings of control, fears of judgmental reactions or time-efficiency; clinician ratings of time-efficiency or their ability to formulate a treatment plan; and the therapeutic alliance. METHOD: The application was tested at a youth mental health service using a quasi-experimental two phase Treatment-as-Usual/Intervention design. Three hundred thirty nine youth and 13 clinicians participated across both phases. Reporting of behaviors, self-disclosure, youth control, judgmental reactions, time efficiency, ability to formulate treatment plans, and the therapeutic alliance were compared between groups. RESULTS: myAssessment was found to be widely accepted by both young people and clinicians. Use of myAssessment resulted in reporting of behaviors that were 2.78 through 10.38 times higher for a variety of substances (use of tobacco, alcohol, cannabis, sedatives, hallucinogens, and opioids), in identifying non-heterosexual sexual orientation, having had sex, an STI check, sex without a condom, having felt pressured to have sex in the past, having self-harmed, and in having put themselves in an unsafe situation. Participants who used the application also reported being less likely to lie on past experiences of being bullied, substance use, and self-harm. Use of the application resulted in improved youth ratings of time efficiency in session. The application was found to have no impact on youth control, judgmental reactions, formulation of treatment plans, or the therapeutic alliance. CONCLUSIONS: Electronic psychosocial assessments can increase rates of self-disclosure and, therefore, provide an earlier and more comprehensive picture of young people's risks without negatively impacting the therapeutic alliance. Additionally, this type of technology has been shown to be widely accepted by both young people and clinicians and can improve youth beliefs that there is enough time in session to speak about what is most important to them.

Young People's Views on Electronic Mental Health Assessment: Prefer to Type than Talk?

For mental health professionals to provide personalized early interventions, young people need to disclose sensitive information to a clinician they are unlikely to have yet formed a relationship with. We conducted in-depth qualitative interviews with 129 young people aged 12-25 years from several sites across Australia to gauge views on whether young people thought that an electronic psychosocial assessment tool could help them initially disclose personal information. Additionally, we were interested in whether young people from different demographic groups held similar views around using the e-tool. Results provided support for the use of an e-tool, with most young people stating that it could help in the disclosure of particularly embarrassing problems. The main advantages reported were that the e-tool would support disclosure without fear of judgment by health professionals, and would enable young people greater input in deciding what to focus on. Young people who held a preference to simply talk were most concerned about the clinician missing non-verbal cues. These findings highlight the value of incorporating electronic options within clinical practice, but also the need for health professionals to work within a flexible framework guided by the individual preferences of each of their clients.

Adolescent's preferred modes of delivery for mental health services.

BACKGROUND: Mental health interventions for young people are increasingly being delivered online. This is occurring due to an assumption that young people prefer online interventions because they address some of the well-established help-seeking barriers. METHOD: A self-report questionnaire investigating preferences for mental health care delivery was administered to a nonclinical sample of 231 young people aged 15-19. RESULTS: The strongest help-seeking intention in response to a scenario describing symptoms of depression was for face-to-face services, followed by not seeking help at all. Only 16% expressed a preference for online treatment. CONCLUSION: The assumption that a majority of young people will prefer online delivery of mental health treatment was not supported, although boys showed a stronger relative preference for online modes.

The role of self-help in the treatment of mild anxiety disorders in young people: an evidence-based review.

Anxiety disorders are the most common mental health problems experienced by young people, and even mild anxiety can significantly limit social, emotional, and cognitive development into adulthood. It is, therefore, essential that anxiety is treated as early and effectively as possible. Young people are unlikely, however, to seek professional treatment for their problems, increasing their chance of serious long-term problems such as impaired peer relations and low self-esteem. The barriers young people face to accessing services are well documented, and self-help resources may provide an alternative option to respond to early manifestations of anxiety disorders. This article reviews the potential benefits of self-help treatments for anxiety and the evidence for their effectiveness. Despite using inclusive review criteria, only six relevant studies were found. The results of these studies show that there is some evidence for the use of self-help interventions for anxiety in young people, but like the research with adult populations, the overall quality of the studies is poor and there is need for further and more rigorous research.

Psychosocial assessments for young people: a systematic review examining acceptability, disclosure and engagement, and predictive utility.

Adolescence and young adulthood are often turbulent periods in a person's life. There are high rates of accidental deaths, suicide, mental health concerns, substance use, and sexual experimentation. Health care professionals need to conduct holistic assessments of clients in these developmental life stages to identify psychosocial risks and provide targeted early intervention and implement prevention strategies. The most useful psychosocial assessments for most health care professionals are those that can provide a complete picture of the young person's life and circumstances. This article identifies psychosocial assessment instruments that can be used as an initial assessment and engagement tool with the general population of young people presenting for health care. We review the psychometric properties of each of the instruments, determining what type of instrument is most acceptable to young people, whether any can increase disclosure and improve engagement between young people and health professionals, and whether they have predictive utility. The search strategy complied with the relevant sections of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. A total of 89 published articles were identified, covering 31 different assessment instruments. Results indicated that those that were self-administered were most acceptable to young people, although it is unclear whether pen-and-paper or computer formats were preferred. Most psychosocial assessments can improve rates of disclosure and enhance engagement between young people and health professionals; however, worryingly, we found evidence that clinicians did not always respond to some of the most serious identified risks. Only for one instrument was there any mention of predictive utility. Future research should employ longitudinal approaches to determine the predictive utility of psychosocial assessments and focus on whether the use of new technologies can improve rates of disclosure.