Since the roll-out of the Improving Access to Psychological Therapies (IAPT) service in 2007-8, NHS primary care psychological therapy has been monopolised by short-term cognitive behavioural therapy (CBT). What is now called NHS Talking Therapies (NHS TT) hardly qualifies as psychotherapy at all. It might more appropriately be called psychological education, encouraging people to adapt to the conditions of their lives.
At the same time, the service is grossly ineffective and wasteful of resources. Nearly two million people were referred to NHSTT last year. Two-thirds of them dropped out before finishing a course of treatment. Less than 20 per cent of referrals were deemed to have recovered from their mental health condition.
Nearly half of NHSTT providers are private companies or charities. At the moment, they see about a fifth of patients, but the proportion is growing. At the same time, the recruitment and training of therapists is growing significantly faster among private providers. Between 2019 and 2022, the NHS therapy workforce grew by 37%, while the non-NHS sector grew by 84%.
It is the private companies that are currently developing Artificial Intelligence – in partnership with American Big Data companies like Google and Microsoft. They are recording millions of NHSTT sessions, and using machine learning to break these sessions down into key words and phrases that therapist and client use. By comparing these ‘language events’ with patients’ session-by-session self-assessment, AI is learning therapy talk and presenting itself as human.
Private providers developing AI therapy, using recorded NHS sessions
Private providers developing AI therapy include: ieso (sic) Digital Health; Limbic Access and Limbic Care; Trent Psychological Therapies, partnered by the US company Lyssn; the Indian company Wysa; and Silvercloud, owned by Amwell (American Well) and partnered with Microsoft.
For example, ieso has over 12,000 NHS TT referrals a year across 25 NHS Trusts. It has recorded over one million NHS therapy sessions, broken down into 20 million language events. See ieso’s 2020 TED talk for a visual representation of the kind of session-by-session analysis ieso is programming into its machine learning processes. The company wants to expand its AI into the US, European and African markets.
What does AI Therapy mean for the NHS and patients?
Privatisation of services and data
Digitalisation involves a rapid expansion of ‘partnerships’ between NHS services and the private sector tech companies. As we know, digital tech is being welcomed enthusiastically by government and policy makers as ‘technosalvation’ for the NHS. NHS data is being harvested by private providers and the Big Data companies. The development of AI therapy is expanding the sale of confidential data and providing the basis for digital programs and software platforms, which will be sold back to the UK and all round the world.
Baking in the monopoly of short-term behavioural therapy
NHS TT is already offering a very truncated and utilitarian version of psychotherapy, in the form of short-term Cognitive Behavioural Therapy and its derivatives. Courses of therapeutic treatment average eight sessions, and only a third of its 1.8 million patients actually complete a treatment plan. Its one-size-fits-all approach, which includes tick-box assessments at the end of each session, will be baked into AI therapy via machine learning and algorithms.
The digital therapist will be programmed to offer what appears to be a personal response to patients’ communications, including simulated empathy and spontaneity. In fact, its responses will be framed within a very simplistic model of human emotions and experience, a sophisticated mimicry of what it ‘learns’ from its clients, and a tool-box of behavioural strategies for recovering our capacity to adapt to the conditions of our lives.
The deskilling of the NHS workforce
An important dimension of the hollowing out of NHS therapy by AI is the deskilling of its workforce. Before IAPT, NHS counsellors and psychotherapists were characteristically trained over three or four years, usually requiring their own personal therapy and a number of training clients individually supervised weekly.
Currently, the training of NHS TT therapists consists of one year (45 hours) for Low Intensity, and one year (60 hours) for CBT High Intensity practitioners. Neither are required to have experience of their own personal therapy.
AI will initially be used to support human therapists and to gradually provide more access for a service currently unable to cope with demand. However, over the next few years, AI will begin to replace therapists. Job growth will be in the area of managing the technology performing the tasks of triage, referral and administration, as well as conducting and recording the therapy and procuring outcome results.
Human therapists, like other care workers, could soon be among the lowest-paid workers in the economy.
For the full article go to:
Part 1 Machina Ex Deo: AI and the future of NHS Talking Therapies
Part 2 Machina Ex Deo: State therapy and the hollowing out of intersubjectivity
Paul Atkinson. December 2024
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