Artificial intelligence is rapidly reshaping healthcare, but its growing role in psychiatry raises questions that extend beyond technological capability. It challenges some of medicine’s most enduring ethical principles: beneficence, nonmaleficence, autonomy, and justice.
“AI is already here, and our patients are already using it,” says Sonya Chistov, MD, psychiatry resident at Sheppard Pratt. “The question is not whether it will influence psychiatric care but how we respond to it.”
AI has the potential to advance beneficence by increasing access to mental health support. Emerging platforms are being designed to supplement care between appointments, offering patients coping strategies, reminders of previously discussed therapeutic techniques, and streamlined communication with providers. Such tools could reduce barriers to care, particularly in underserved communities facing significant shortages of mental health professionals.
At the same time, psychiatrists must consider the principle of nonmaleficence—avoiding harm. General-purpose AI systems are not trained as therapists, and studies suggest they can be overly affirming, reinforce maladaptive beliefs, or provide reassurance in situations where tolerance for uncertainty is the therapeutic goal. Patients experiencing psychosis, obsessive-compulsive disorder, eating disorders, or health anxiety may be particularly vulnerable to misleading or overly certain responses.
Justice presents another challenge. AI systems are created by humans and trained on human-generated data, making them susceptible to bias. Research has demonstrated that responses may differ based on race, gender, age, or psychiatric diagnosis, potentially perpetuating stigma and inequitable recommendations.
Patient autonomy also takes on new meaning in an AI-enabled world. Increasingly, individuals seek guidance from chatbots before, during, or after clinical encounters, creating what some scholars describe as an “artificial third” within the therapeutic relationship. Understanding how patients use AI may become as important as assessing substance use, sleep habits, or screen time.
For psychiatrists, the ethical imperative is clear: Engage with these technologies thoughtfully, recognize both their promise and limitations, and remain committed to the human connection at the center of psychiatric care.
Questions to consider asking your patients about AI
Do you use AI companions or character-based chatbots?
Do you use AI tools for mental health advice?
Have you discussed treatment recommendations with an AI chatbot?
Has information from AI influenced decisions about medications, therapy, or seeking care?