Comment by shafyy
7 days ago
The issue is that if we go down this path, what will happen is that the gap between access to real therapy and "LLM therapy" will widen, because the political line will be "we have LLM therapy for almost free that's better than nothing, why do we need to reform health care to give equal access for everybody?".
The real issue that needs to be solved is that we need to make health care accessible to everybody, regardless of wealth or income. For example, in Germany, where I live, there are also long waitlists for therapists or specialists in general. But not if you have a high income, then you can get private insurance and get an appointment literally the next day.
So, we need to get rid of this two class insurance system, and then make sure we have enough supply of doctors and specialists so that the waits are not 3 months.
>> The real issue that needs to be solved is that we need to make health care accessible to everybody, regardless of wealth or income.
Good therapists are IMHO hard to come by. Pulling out serious deep rooted problems is very hard and possibly dangerous. Therapist burn out is a real problem. Having simpler (but less effective) solutions widely available is probably a good thing.
> Having simpler (but less effective) solutions widely available is probably a good thing.
And those solutions are not LLMs. It's been shown elsewhere (and in the OP, it seems) that LLMs are very bad therapists, severe malpractice bad.
So you're saying that there are no professional therapists that can do the same bad? I think that the issue is more subtle, and as with everything, nothing is really black and white.
I have, for instance, used LLMs a couple of times to assess and reflect over the few situations I have been questioning myself about recently. And I thought it did really well, much better than what most of my well-thought friends would do. Some proper advice and reflection. I did this in 1hr of my spare time completely randomly (before I went to a sleep) and without extra time spent on finding the (right) therapist, waiting on the list, going physically into his/her office, spending that 1hr there, and finally paying some cash. So, for me in this particular case this was an obvious win.
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Yes, and those simpler solutions don't have to involve LLMs. Support groups, fostering community through more local activities and places of belonging, funding social workers. I'm sure there's more.
> Support groups, fostering community through more local activities and places of belonging, funding social workers. I'm sure there's more.
In a post-labor-centric economy (if that's where we are heading with AI/automation) those are also among the things we'll need to figure out how to pay more people to do anyways.
There's tremendous value for society in paying people to care for the wellness of others, their communities, and the local and global environment. So therapists, park builders, environmental remediators, and more.
Communities composed of the wealthy already do this quite successfully for themselves today, as anyone who has driven through prosperous areas full of wellness services has observed.
The problem is we have to come up with ways of quantifying that value monetarily so it "makes sense" to markets and the signals they follow, which will otherwise completely ignore universal wellness as an objective, or even actively move against it, under the belief that the non-wealthy do not deserve the wellness that the wealthy enjoy.
Friends.
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I live in Canada and it's illegal to take private insurance if you also take public insurance.
The private healthcare system is virtually nonexistent and is dominated by scammers.
The public healthcare system still has months-long wait times.
If you want to avoid waitlists you need surplus capacity, which public healthcare doesn't provide.
I live in Canada as well. As far as I can tell there is basically no access to psychologists under the public healthcare system. You're just supposed to pay cash at about $150/hr to talk to a therapist (if you know differently please tell us!). For some people that's fine, but it's an absurd situation if, for example, you're underemployed/poor and facing related mental health challenges. Obviously paying that much to talk to someone can just aggravate the underlying problem.
Some people can access mental health care in the public system through their family doctor. But most people do not have access to this because there are not enough of this type of doctor. As far as I know the only other way is to wait until some sort of crisis then enter the hospital and there -might- be a chance to talk to a psychiatrist.
CAMH and other hospitals provide free outpatient mental health services from psychiatrists to the underemployed/poor.
As you acknowledge, if you end up so badly that you are committed, you can get a referral. They might be underfunded and understaffed but it exists.
"Might be a chance to talk to a psychiatrist" is inaccurate. You will see a psychiatrist quickly if you go to a hospital in Toronto. Can't say the same about rural areas.
The USA is much worse and we shouldn't try to generalize from their experiences. America has hundreds of free outpatient mental health clinics and their goal is to "suicide-bait" you into saying the wrong thing. Then they involuntarily commit you and bill Medicaid/insurance until it runs out.
Those are the hospitals you will never see a psychiatrist in, because they focus on profit and churn.
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> it's illegal to take private insurance if you also take public insurance.
This seems like an odd excluded middle. In the UK, you can have private health insurance if you want, but you can always fall back on the NHS; the one wrinkle is that you may not always be able to take a prescription from the private to the public system without getting re-evaluated. (e.g for ADHD)
> which public healthcare doesn't provide
== taxpayers aren't willing to pay for.
It's a slippery slope and we really don't want a 2 class system. If you start allowing doctors to bill for things that public insurance covers, you're 30 seconds away from a losing the egalitarianism that Canadians value. You can pay out of pocket for whatever you want, you can tell the doctor not to bill any insurance, and in some clinics (in my experience not many) that will get you seen faster, but it's not really common and it's very expensive.
Drugs aren't considered healthcare for whatever reason. If I got an ADHD pill in a hospital that's free, but if I wanted to get the same at an outpatient pharmacy it'll cost money in most cases.
Ditto for dental.
So while there isn't any overlap between public and private, there's still a gap. Though our drugs cost 10% of American prices.
This isn’t universal at all. Quebec and Ontario allow for visits and payments to private doctors — usually offered under a subscription model, so that the “subscription” can be picked up by employers in lieu of “insurance”. It’s definitely smaller than in the states, but it’s big enough that it’s in use by the upper-middle class.
In the USA we have huge waitlists for most all types of healthcare. Private healthcare doesn't provide surplus capacity either.
We do? https://worldpopulationreview.com/country-rankings/health-ca... seems to show we are high on the 1 day wait, but not so much on the specialist waits.
That said, I think it would be safe to say I don't understand this statistic. Needing a day of answer from your health provider feels rare to me. The few times I've needed that, I would go to an emergency room.
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Depends on how large your insurance network is and how well served your region is. I've never had to wait longer than a month to see a specialist aside from non-critical checkups/exams. Granted I pay extra for the "broad network" option at my employer, I'm in a decently well-populated area in suburban Maryland so there's plenty of providers, and I did have to call around to multiple providers to find openings sometimes when I was a new patient.
Everything else wrong with US healthcare aside, I'm pretty sure we have better wait times on average.
The only thing I've ever run into a waitlist was for a neurologist. I'm not really sure what you're referring to.
I've seen waitlists for some specialists.
Maybe I'm just lucky, but it's usually within a couple weeks.
Just going to point out that down here in the US, there is tons of waiting with private insurance. Good luck seeing your actual primary care doctor (not some other doctor or physician's assistant) within 3 months. Specialists? Prepare to wait even longer. On an HMO insurance, make that even longer.
While private vs public might affect supply, there are other big factors going on that are limiting access to care.
That’s very much a local issue and also patient choice.
I have zero issues getting a same day appoint where I am, specialist appointments within a couple weeks.
But I also don’t go to a major university medical center which has long waits even for primary care.
> The public healthcare system still has months-long wait times.
I pay an expensive monthly premium and I still have monthly-long wait times in the US. (Putting this here because many people think that the "benefit" of the US healthcare model is that you get "fast/immediate" care instead of "slow/long waits" in those "socialist" countries.
Don't forget that we also deal with mountains of confusing paperwork from multiple competing bureaucracies!
> So, we need to get rid of this two class insurance system, and then make sure we have enough supply of doctors and specialists so that the waits are not 3 months.
Germany has reduced funding for training doctors. So clearly the opposite is true.
> For example, in Germany, where I live, there are also long waitlists for therapists or specialists in general. But not if you have a high income, then you can get private insurance and get an appointment literally the next day.
And the German government wants to (or is implementing policies to) achieve the opposite and further reduce access to medical specialists of any kind. Both by taking away funding and taking away spots for education. So they're BOTH taking away access to medical care now, and creating a situation where access to medical specialists will keep reducing for at least the next 7 years. Minimum.
Yeah, I am not saying Germany is doing it right :D Just explained how it works here and what I think should be improved.
It really looks that's how a lot of countries intend to solve the crisis they are causing by destroying medical care now: restrict it to fewer and fewer people, without lowering the taxes that pay for it, of course. Great medical care for the select few. No medical care for you and me.
And with the traditional difference between socialists and rightists. Socialists will have their party pick who gets medical care, not you and me. Rightists will make it more expensive, which means you and me can't pay for it.
I think it would be great to make mental healthcare accessible to everyone who could benefit from it, but have you actually run the numbers on that? How much would it cost and where would the money come from? Any sort of individual counseling or talk therapy is tremendously expensive due to the Baumol effect.
And even if we somehow magically solve the funding problem, where will the workers come from? Only a tiny fraction of people are really cut out to be effective mental health practitioners. I'm pretty sure that I'd be terrible at it, and you couldn't pay me enough to try.
This addresses the key problem. The lack of access to therapists is due to lack of therapists, because the demand far outweighs supply. It is simply not possible to train the number of therapists that we need, so technological advancement is probably the correct answer.
How do you know the demand is the key problem and not a symptom downstream of the root problem?
In other words, why is the demand so high that it outstrips supply? That might get you a didn’t solution than “technological advancement.”
Let's solve that productivity issue!
The classic view of one reclining on a couch, and the professional listening, seems to have a lot of downtime for the professional. The occasional sound of affirmation, 'go on', 'yes, yes' may be heard, but often a lot is the patient talking.
We could easily move this to text or video, but let's choose text. Best would be some form of speech to text, but AI driven and with a shorthand for emoted quality.
I suggest we assign primary emotions to primary colours, using three base emotions as primaries, and the professional would be able to read the emotions at play, and quantity, merely by the resulting colour of text. Larger print or bold or what not, could be used for more intense speech, eg yelling.
This would allow one professional to allow multiples to speak, yet they could simply wait for the text to appear, consider it, and respond vocally. Any perceived delay in response, could be derided by the concept of "I needed time to think on your words".
Thus the patient speaks, the professional's voice responds, the illusion of complete dedication to one patient is whole. Yet anywhere from 4 to 10 patients could be served in parallel with such a system, and remotely too!
I'm fairly sure I could whip this entire platform up over a weekend.
This solves the surmised shortages, for one could do the work of 10. It also helps the environment, with people not traveling to an office for their appointment.
Hmm. Maybe I should pursue this, and be bought out by Amazon so it can be included in Prime Plus or whatever.
/s... Right...?
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I agree with the principal here, and beleive that it's noble.
However, it boils down to "Don't advance technology, wait 'till we fix society", which is futile - regardless of whether it's right.
Correct, but the alternative of don't fix society, just use technology is equally destructive.
LLM therapy lacks important safeguards. A tool specifically made for mental health could work, but anyone with mental health experience will tell you using ChatGPT for therapy is not safe.
Why do we need to make mental healthcare available to everyone?
For all of human history people have got along just fine, happily in fact, without “universal access to mental health care”
This just sounds like a bandaid. The bigger problem is we’ve created a society so toxic to the human soul that we need universal access to drugs and talk therapy or risk having significant chunks of the population fall off the map
> For all of human history people have got along just fine, happily in fact, without “universal access to mental health care”
Mixing up "some people survived" and "everyone was fine" is a common mistake.
Some folks who're able to thrive today on drugs and therapy are the "tragically wandered off in a snowstorm" of past eras.
It's the same token as more people dying from cancer than ever before. Yes, modern society creates many more cancer patients than ever, but less people are dying early from things that aren't cancer than ever.
We live in a society that, for the most people, has the best quality of life than ever in history. But in having that increase, we eliminate many problems that must be replaced by other problems.
In this case, a mental health crisis comprised of people who either wouldn't have survived to that point, or whose results went unremarked or shrugged off as something else in the past. In terms of violent outbursts, we also have easier access to more destructive weapons (even those that aren't guns) and more density of population on whom violence can be inflicted.
> For all of human history people have got along just fine, happily in fact, without “universal access to mental health care”
Can we please stop with these incredibly low-effort arguments that are just blatantly untrue with about 5 seconds of inspection? If I have to hear "well humans did just fine before!" one more time I'm going to lose my mind.
No, no they did not. We can't ask them because they're dead now. The ones we can ask are the ones who survived. We might call this a "survivorship bias".
There's practically infinite graphs showing the trends of survivability and quality of life throughout time. Less infants die now, less adults die now, we live longer, we live happier, we live with less illnesses. There's less polio, less measles, less tuberculosis, you fucking name it.
I mean, for god's sake before modern medicine infant mortality was close to 50%. Women would have 10 children, maybe 4 would make it to adult hood, and she'd die giving birth to the 10th. That's assuming she didn't get unlucky and die on the first one because her body wasn't perfectly set to give birth. Shoulder dystocia? Too fucking bad, you lost the lottery, go die now.
>Why do we need to make mental healthcare available to everyone?
Why do we need to make physical healthcare available to everyone? For most all of human history, bones were set by family. Yeah, ok, often the patient was hobbled for life. I guess it makes sense to get treated by a professional...wait, perhaps we've stumbled upon something here...
Just fine? Happily?
Surely many wars and deaths would have been prevented with better mental strategies.
No one is stopping you from making society better...
In the mean time it's best we all have
I suggest you put the terms "warfare," "genocide," and "slavery" into Wikipedia and then tell us how fine people got along.
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That’s nice sounding, in the USA currently we’re headed the opposite direction and those in power are throwing off millions from their insurance. So for now, the LLM therapist is actually more useful to us. Healthcare won’t be actually improved until the current party is out of power, which is seeming less likely over the years.