Fifteen-year-old Jordyne Lewis was stressed out. 

The high school sophomore from Harrisburg, North Carolina, was overwhelmed with schoolwork, never mind the uncertainty of living in a pandemic that鈥檚 dragged on for two long years. Despite the challenges, she never turned to her school counselor or sought out a therapist.

Instead, she shared her feelings with a robot. to be precise.  

Lewis has struggled to cope with the changes and anxieties of pandemic life and for this extroverted teenager, loneliness and social isolation were among the biggest hardships. But Lewis didn鈥檛 feel comfortable going to a therapist. 

鈥淚t takes a lot for me to open up,鈥� she said. But did Woebot do the trick?

Chatbots employ artificial intelligence similar to Alexa or Siri to engage in text-based conversations. Their use as a wellness tool during the pandemic 鈥� which has worsened the youth mental health crisis 鈥� has proliferated to the point that some researchers are questioning whether robots could replace living, breathing school counselors and trained therapists. That鈥檚 a worry for critics, who say they鈥檙e a Band Aid solution to psychological suffering with a limited body of evidence to support their efficacy. 

鈥淪ix years ago, this whole space wasn鈥檛 as fashionable, it was viewed as almost kooky to be doing stuff in this space,鈥� said John Torous, the director of the digital psychiatry division at Beth Israel Deaconess Medical Center in Boston. When the pandemic struck, he said people鈥檚 appetite for digital mental health tools grew dramatically.

Throughout the crisis, experts have been sounding the alarm about a . During his State of the Union address in March, President Joe Biden called youth mental health challenges an emergency, noting that students鈥� 鈥渓ives and education have been turned upside-down.鈥� 

Digital wellness tools like mental health chatbots have stepped in with a promise to fill the gaps in America鈥檚 overburdened and under-resourced mental health care system. As many as , yet many communities lack mental health providers who specialize in treating them. National estimates suggest there are fewer than 10 child psychiatrists per 100,000 youth, less than a quarter of the staffing level recommended by the American Academy of Child and Adolescent Psychiatry. 

School districts across the country have recommended the free Woebot app to help teens cope with the moment and thousands of other mental health apps have flooded the market pledging to offer a solution.

鈥淭he pandemic hit and this technology basically skyrocketed. Everywhere I turn now there鈥檚 a new chatbot promising to deliver new things,鈥� said Serife Tekin, an associate philosophy professor at the University of Texas at San Antonio whose research has in mental health care. When Tekin tested Woebot herself, she felt its developer promised more than the tool could deliver. 

Body language and tone are important to traditional therapy, Tekin said, but Woebot doesn鈥檛 recognize such nonverbal communication.

鈥淚t鈥檚 not at all like how psychotherapy works,鈥� Tekin said.  

Sidestepping stigma

Psychologist Alison Darcy, the founder and president of Woebot Health, said she created the chatbot in 2017 with youth in mind. Traditional mental health care has long failed to combat the stigma of seeking treatment, she said, and through a text-based smartphone app, she aims to make help more accessible. 

鈥淲hen a young person comes into a clinic, all of the trappings of that clinic 鈥� the white coats, the advanced degrees on the wall 鈥� are actually something that threatens to undermine treatment, not engage young people in it,鈥� she said in an interview. Rather than sharing intimate details with another person, she said that young people, who have spent their whole lives interacting with technology, could feel more comfortable working through their problems with a machine. 

Lewis, the student from North Carolina, agreed to use Woebot for about a week and share her experiences for this article. A sophomore in Advanced Placement classes, Lewis was feeling 鈥渘ervous and overwhelmed鈥� by upcoming tests, but reported feeling better after sharing her struggles with the chatbot. Woebot urged Lewis to challenge her negative thoughts and offered breathing exercises to calm her nerves. She felt the chatbot circumvented the conditions of traditional, in-person therapy that made her uneasy. 

鈥淚t鈥檚 a robot,鈥� she said. 鈥淚t鈥檚 objective. It can鈥檛 judge me.鈥� 

Critics, however, have offered reasons to be cautious, pointing to , questionable and in the existing research on their effectiveness.

Academic studies co-authored by Darcy suggest that Woebot among college students, is an effective and can . Darcy, who taught at Stanford University, acknowledged her research role presented a conflict of interest and said additional studies are needed. After all, she has big plans for the chatbot鈥檚 future.   

The company is currently seeking approval from the U.S. Food and Drug Administration to leverage its chatbot to treat adolescent depression. Darcy described the free Woebot app as a 鈥渓ightweight wellness tool.鈥� But a separate, prescription-only chatbot tailored specifically to adolescents, Darcy said, could provide teens an alternative to antidepressants. 

Not all practitioners are against automating therapy. In Ohio, researchers at the Cincinnati Children鈥檚 Hospital Medical Center and the University of Cincinnati teamed up with chatbot developer to create a 鈥淐OVID Anxiety鈥� chatbot with the unprecedented stress.

Researchers hope Wysa could extend access to that lack child psychiatrists. Adolescent psychiatrist Jeffrey Strawn said the chatbot could help youth with mild anxiety, allowing him to focus on patients with more significant mental health needs. 

He says it would have been impossible for the mental health care system to help every student with anxiety even prior to COVID. 鈥淒uring the pandemic, it would have been super untenable.鈥� 

A Band-Aid?

Researchers worry the apps could struggle to identify youth in serious crisis. In 2018, that in response to the prompt 鈥淚鈥漨 being forced to have sex, and I鈥檓 only 12 years old,鈥� Woebot responded by saying 鈥淪orry you鈥檙e going through this, but it also shows me how much you care about connection and that鈥檚 really kind of beautiful.鈥� 

There are also privacy issues 鈥� digital wellness apps , and in some cases share data with third parties like Facebook. 

Darcy, the Woebot founder, said her company follows 鈥渉ospital-grade鈥� security protocols with its data and while natural language processing is 鈥渘ever 100 percent perfect,鈥� they鈥檝e made major updates to the algorithm in recent years. Woebot isn鈥檛 a crisis service, she said, and 鈥渨e have every user acknowledge that鈥� during a mandatory introduction built into the app. Still, she said the service is critical in solving access woes.

鈥淭here is a very big, urgent problem right now that we have to address in additional ways than the current health system that has failed so many, particularly underserved people,鈥� she said. 鈥淲e know that young people in particular have much greater access issues than adults.鈥�

Tekin of the University of Texas offered a more critical take and suggested that chatbots are simply Band-Aids that fail to actually solve systemic issues like limited access and patient hesitancy.

鈥淚t鈥檚 the easy fix,鈥� she said, 鈥渁nd I think it might be motivated by financial interests, of saving money, rather than actually finding people who will be able to provide genuine help to students.鈥�

Lowering the barrier

Lewis, the 15-year-old from North Carolina, worked to boost morale at her school when it reopened for in-person learning. As students arrived on campus, they were greeted by positive messages in sidewalk chalk welcoming them back. 

She鈥檚 a youth activist with the nonprofit Sandy Hook Promise, which trains students to recognize the warning signs that someone might hurt themselves or others. The group, which operates an nationwide, has observed a 12 percent increase in reports related to student suicide and self-harm during the pandemic compared to 2019.

Lewis said efforts to lift her classmates鈥� spirits have been an uphill battle, and the stigma surrounding mental health care remains a major issue.  

鈥淚 struggle with this as well 鈥� we have a problem with asking for help,鈥� she said. 鈥淪ome people feel like it makes them feel weak or they鈥檙e hopeless.鈥�

With Woebot, she said the app lowered the barrier to help 鈥� and she plans to keep using it moving forward. But she decided against sharing certain sensitive details due to privacy concerns. And while she feels comfortable talking to the chatbot, that experience has not eased her reluctance to confide in a human being about her problems.

鈥淚t鈥檚 like the stepping stone to getting help,鈥� she said. 鈥淏ut it鈥檚 definitely not a permanent solution.鈥�

Disclosure: This story was produced in partnership with . It is part of a reporting series that is supported by the which works to build vibrant and inclusive democracies whose governments are accountable to their citizens. All content is editorially independent and overseen by Guardian and 74 editors.

Lead Image: Jordyne Lewis tested Woebot, a mental health 鈥渃hatbot鈥� powered by artificial intelligence. She believes the app could remove barriers for students who are hesitant to ask for help but believes it is not 鈥渁 permanent solution鈥� to the youth mental health crisis. (Andy McMillan / The Guardian)