The Role of AI in Counseling: Applications, Ethical Challenges, and Implications for LMICs

Abstract

Mental health disorders are one of the key worldwide issues in terms of public health, and a significant percentage of morbidity is revealed in low- and middle-income nations (LMICs), where the lack of specialization and a scarcity of mental health professionals, limited resources, and the overarching stigmatization of mental health concerns obstruct access to services. Over the years, AI-based tools, especially conversational agents and mental health chatbots, have become a scalable and cost-effective method to provide counseling services. This current review discusses the uses of AI in counseling and its existing evidence on effectiveness and user experience, which critically reflects on the ethical, cultural, and practical issues related to its application in LMICs. Existing studies suggest that AI-based chatbots could lead to a slight decrease in psychological distress, improve access, foster anonymity, and encourage help-seeking behavior, especially among young adults. Nevertheless, serious issues are to be addressed in terms of data privacy, informed consent, biases of algorithms, the culture-appropriateness, crisis management, and the threat of over-reliance on AI systems. Further, it was revealed that most empirical studies belong to high-income nations, restricting the applicability of the findings in the LMICs. The effective implementation of AI-based tools in the LMICs needs a culturally appropriate design, tailored language, rigorous ethical considerations, and the incorporation of human-driven mental health services. The incorporation of AI-based tools should not be used as a replacement but as an aid to the current healthcare systems. The paper concludes that despite the potential of AI in meeting the treatment gaps in LMICs, the responsible implementation of AI requires clear governance, human responsibility, contextualized and tailored design to establish ethical and sustainable delivery of mental health care.