Trustees Approve Council on Women’s Mental Health, Discuss AI and Venture Capital

The Board heard reports on two subjects of gathering concern and some controversy: care and treatment of individuals seeking gender transition and the emergence of artificial intelligence and its possible uses in psychiatry.

“The push to limit gender-affirming care for youth is part of a larger, politically motivated agenda to enact legislation to limit the human rights of LGBTQ+ people and women’s health/reproductive rights,” said Area 2 Trustee Kenneth Ashley, M.D., who delivered the report. He is the director of outpatient consultation-liaison psychiatry at Mt. Sinai Beth Israel Hospital. “The strategy often involves use of medical mis- and dis-information. This movement is not limited to the U.S.”

He presented the guidelines of the World Professional Association of Transgender Health (WPATH) Standards of Care, which are mirrored in the Endocrine Society guidelines for transgender care.

Ashley noted that the quality of evidence supporting gender-affirming care is not high but added, “The majority of treatments/interventions in medicine do not have high-quality evidence, yet there is rarely any recommendation for their discontinuation, but instead a demand for more research.”

He also presented the findings of a 2019 study in the Nordic Journal of Psychiatry, which found that the need for psychiatric treatment after gender reassignment was lower and that symptoms of depression, anxiety, suicidality, self-harm, conduct disorder, and attention-deficit/hyperactivity disorder were diminished, in some instances markedly so: The prevalence of depression and anxiety following reassignment was 15% for each compared with 54% and 48%, respectively, prior to reassignment.

“Withholding treatment is not a neutral act, but often causes psychiatric morbidity and mortality,” Ashley told Psychiatric News. He added that reports of regret by patients who have undergone gender reassignment are rare, with some studies reporting cases of regret under 1%.

German Velez, M.D., the resident-fellow member trustee, provided a broad overview of challenges confronting psychiatry by the rapid emergence of artificial (or augmented) intelligence (AI) and by the acquisition by private equity firms and venture capitalists of psychiatric practices and hospitals. Velez noted that venture capital has already invested heavily in mental health apps, though with some disappointing returns on investment.

He stressed that these emerging trends should be tempered by the professional ethics and regard for patient autonomy and integrity that psychiatrists can bring to bear.

“AI has been explored for some time, resulting in the development of chatbot therapists and AI-based therapy session analysis to enhance efficiency and accessibility,” he told Psychiatric News. “However, concerns linger regarding privacy, transparency, therapeutic strategies, and legal liability, as many apps lack robust evidence of their effectiveness. Ensuring patient safety and efficacy in the digital mental health industry requires standardized regulations and oversight. While AI can expand access to mental health tools, ethical considerations and limitations must be carefully taken into account.”

The subject sparked a vigorous discussion by the Board, reflecting the speed with which AI may transform every facet of society. “We need to be humble and acknowledge that this is a massive juggernaut coming at everyone,” said APA Treasurer Richard Summers, M.D. “We should stick to what we are good at—thinking about what quality psychiatric treatment is, what a good outcome looks like, what is equitable and appropriate for diverse populations, and what is ethical. The Roadmap for the Future of Psychiatry [developed under the presidency of immediate past president Rebecca Brendel, M.D., J.D.] was our attempt to answer these questions pre-AI. Now I think we are looking at how to take that roadmap and adapt it to this new element.” ■

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