How a Toronto-made AI therapist could bridge the gap in Canada's mental health-care system

When Entisar Bukair needs a moment for self-care and to destress, she opens up the Mind-Easy app on her phone.

There, the London, Ont. lawyer is greeted by her friendly, artificial intelligence (AI) avatar, who leads her through breathing exercises and listens while she vents about her busy day.

The avatar, named Olivia, speaks back to Bukair in Arabic -- a feature of the app that allows users to select different languages for interactions.

A friend suggested the app to Bukair last November as she was looking for an easy and regular way to take care of her mental health. As a practising lawyer, she said being mindful of her own well-being is important when taking on other people's emotions.

"It feels super personalized and the avatars that are showing up, they look like me," Bukair told CTVNews.ca in an interview.

Bukair said she tried in-person therapy in the past, but felt like it was hard for her therapist to connect with her.

"They don't take into the fact that I am a veiled Muslim woman, because the person offering to me is not placing the same weight and significance that I would on these different intersectionalities and identities that I hold so dearly to my heart," Bukair said.

Artificial intelligence has been used in health care for years, but more recently it’s increasingly being incorporated into mental health care. Many telehealth companies are using AI to give personalized health care to patients, and most use text as a main form of communication. Companies such as Mindstrong, Headspace and Woebot Health provide personal chat rooms to converse with AI-powered "therapists.”

The COVID-19 pandemic showcased just how fragile the health-care system is, especially as professionals started leaving the industry due to being overworked or stressed. As mental health crises escalated, that side of the industry became overburdened, which is where experts believe AI could step in.

"Rather than thinking of [AI as] taking away jobs, we can think of it more as taking the population-based care that we've done in the past, where we average things," Carolyn McGregor, research chair of health and wellness and AI at Ontario Tech University, told CTVNews.ca in an interview."We're really trying to use technology now to make what's called precision public health or precision health, where we're really trying to tailor it to an individual."

In the case of Mind-Easy, the app aims to provide preventative mental health care while being culturally sensitive to different backgrounds. The tech startup was created by three University of Toronto graduates who saw gaps in Canada's current health-care system. The lengthy wait times to see a mental health professional in Canada, the lack of therapists or counsellors able to provide care in different languages and burnout from professionals are three main gaps the Mind-Easy founders set out to address.

"There is a huge shortage of therapists right now, not everywhere, but the reality of things is that not everybody can go to therapy and there's just not enough human capital to cater to the global problem of mental health," co-founder Alexandra Assouad said. "So we need machine-reliable solutions to optimize where human capital is actually employed in therapy."

The Mind-Easy app is free to download but additional access to more services will cost users about $12.99 a month or $102.99 for a year. By comparison, traditional therapy that’s not covered under a provincial health plan can cost between $50 to $300 a session.

For Bukair, the app is easy to use and provides a sense of security knowing the person she sees on the video call is not real.

Pictured is Entisar Bukair's AI named Olivia. (Screenshot)

"I do acknowledge the fact that it is like a robot at the end of the day," she said. "And it's going to be different than humans, for sure (but) I think the people that really gravitate to this app, like myself, are people that want to use something to supplement the human interaction that we already get in our everyday lives or through traditional mental health resources."

Dalia Ahmed, one of the founders of Mind-Easy and a psychotherapist, says the app is not there to diagnose or provide traditional talk therapy to users but instead focuses on preventative measures to boost one's mental health.

"Our mission is really to be able to create space for proactive and preventative mental health, because right now, it's super binary, you either have a diagnosis or you're waiting till crisis and intervention," she told CTVNews.ca in an interview.

HOW AI WORKS IN MIND-EASY

Mind-Easy is a relatively new app that has more than 15,000 users in 17 different countries across the world. The founders say there are about 2,000 active users per month.

Bukair, who was skeptical about the service initially, now visits the app at least twice a week to keep her own mental health in check.

Mind-Easy will send Bukair notifications reminding her to check in and complete an exercise. Sometimes the prompt will start by asking her how she feels that day and, based on Bukair's responses, the AI will give instructions.

Recently, Bukair told Olivia she was feeling calm and excited for her work day ahead.

"(Olivia) gave me a bunch of options to be like: What do you want to do with this calmness? Do you want to understand what calmness feels? Do you want to practice calmness?" Bukair recounted.

From there, Bukair said she could choose what to do. Sometimes it is breathing exercises, other times it could be a journal entry prompt. In that instance, Olivia suggested a two-minute video on calmness.

"But say I want more resources or say that video wasn't enough for me, you have an option of writing (in a chat) or speaking more," Bukair said.

Mind-Easy can be used similarly to how a counsellor is used, allowing a person to vent and then reflect on the session. Using natural language and different dialects, the AI can understand a person's voice. The second part of the AI used is the avatars; each one is unique to the person they are serving.

ChatGPT, a type of open AI, has raised concerns about whether the information provided to the user is factual. The text-based AI allows users to ask it a question and will respond in different mediums such as poems, stories or essays. Whereas this type of AI is scraping information from the internet, Mind-Easy's AI can only pull information from one place.

"We've incorporated a chatbot, which works off of therapeutic interventions, research and clinical information that we've worked to collect but also exists," Akanksha Shelat, co-founder of Mind-Easy, told CTVNews.ca in an interview. "We (then) break it down into a language that's understandable for day-to-day use and also for the person that we're talking to."

For the Mind-Easy founders, the connection to human-like technology is important when opening up about mental health.

"It's not just random text on screen or not just a general translation, it's an avatar talking to you and asking you, 'Hey, how are you feeling?'" Shelat said.

THE FUTURE OF AI IN MENTAL HEALTH CARE

AI has been used in health care before, but the look and type of the technology has changed, McGregor said.

"In mental health one of the things that are really important is to understand what's the local resources available to you, not only in your own country, but around in your region," McGregor said.

Using location data from a person's phone and heart rate from a smart watch, for example, McGregor said it is possible to have AI gather mental health-specific resources for a person and notify them of options when they are in need of support.

"It's a combination of developers working with people from the mental health sector to understand how to make those connections, and also making sure you have the right information about the area that you're in," she said.

With avatars like the ones used by Mind-Easy, McGregor says they are just the first layer of technology people see.

"We have to always keep in mind these avatars, as you see them on the screen, behind it is another piece of technology, that's giving it the sentence that it then needs to say to you," she said.

Applications that can access a person's data through wearable tech, such as watches or rings, can use AI to watch for indicators that a person's mental state is changing and personalize the care needed, McGregor said. A person’s breathing patterns are just one example of such indicators.

As AI continues to develop, the level of intimacy with technology in health care will eventually become the norm, she said. In order for patients to receive the level of detailed and personalized care, McGregor says AI is needed.

"It's just not practical for one doctor to be looking in so much detail at one person," she said.