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Should AI be used in ethical healthcare decision-making? 
World needs more psychologists {Below}

ai mental health

Should AI be used in ethical 

healthcare decision-making?

By Monica E. Oss, M.S.

     Artificial intelligence (AI) and ChatGPT have captured popular press attention. From writing resumes to planning travel adventures to completing law school applications, people are wild about the potential uses of AI to make their lives easier.

    There is just as much coverage of the promise of ChatGPT in health and human services. 

Getting AI-infused life coaching and mental health counseling has been with us for a while, but the emergence of ChatGPT is taking it to a new level. There is AI as counselor and coach and AI in the therapeutic process.   

     I’ve always thought AI has great potential to diagnose all physical and

mental conditions. Almost a decade ago, I sat in on a presentation of the impressive

results of using AI to review structured mental health interviews and make diagnoses. More

broadly, AI has many diagnostic applications across the mental health field. 

    But to me, the big questions are how and how much AI, and its many derivatives, should be

used in clinical decision support. An article in the BMC Medical Ethics poses the question, should

AI be used to support clinical ethical decision-making? As we move to more value-based

reimbursement with downside financial risk and try to elevate health care professionals to

practice at the ‘very top’ of their license, who and how decisions are made about who gets what

interventions—and for what—loom large.

    On one hand, using computing power to ‘digest’ the growing volume of medical literature and knowledge is an advantage. No human healthcare professional can keep up with it all. But any decision-making algorithm is captive to the research, the assumptions, and previous datasets that are part of its universe.

    Ideally, the ‘input’ in every clinical decision-making tool should be transparent. Any enhanced clinical decision-making support tools should be created for consumer-directed care, increasing the information available to consumers to make more informed decisions about managing their health conditions.

    With the amount of money going into AI investments in health care, new models will be coming soon. 


References available from the author.

This article is reprinted with permission from Open Minds Daily Executive Briefing 7-24-23.

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    Monica E. Oss, M.S. is the founder of OPEN MINDS and serves as its chief executive officer, executive editor of its publications and websites, and executive lead of its consulting engagements. For 30 years, Ms. Oss has led the OPEN MINDS team, its research on health and human service market trends, and its national consulting practice. She is the author of numerous books and articles focused on the strategic and marketing implications of the evolving health and human service field. The Open Minds website is, and her email is

Severe need for more psychologists

By Amanda Riedel, M.A., and

Leihua Edstrom, Ph.D., ABSNP

     There is a severe supply and demand problem in health service psychology.

     As the country’s mental health needs continue to grow after the COVID-19 pandemic, the need for psychologists is more significant than ever. It is estimated that one in five Americans will experience a mental health illness yearly.

severe need for psychogogists

The stress caused by the pandemic increased the prevalence of mental health issues, specifically anxiety and depression, by 25 percent, and tragically, suicide is in the top ten leading causes of death for individuals ages 5 to 64.

    Yet the current workforce in the behavioral health field is insufficient to meet the needs, and staff shortages abound. According to the U.S. Bureau of Labor, in 2021, 181,600 jobs were posted for psychologists, with an increase to 192,900 projected by 2031. Finding qualified professionals to apply for those positions is challenging, as doctoral programs in health service psychology nationwide admit fewer students.

    From 2004 to 2021, the number of APA-accredited doctoral programs in health service psychology went from 354 to 409, representing a 15.5 percent increase. However, the overall number of students enrolled decreased by 8.2 percent during that same period, even while attrition rates declined.

    On average, programs graduated only 8.5 students in 2021. The mounting shortage of psychologists in the field stems from multiple points in the pipeline. Sufficient applicants for graduate programs in psychology will continue to be problematic soon due to a demographic cliff predicted through 2025, with the drastic drop in the number of youths coming of college age. The National Center for Health Statistics reported in 2021 that an almost 20 percent decline in birthrates since 2007 will likely persist.

    Moreover, the price tag for a college degree continues to increase and represents a deterrent for young adults who do not have the financial support to complete a college degree and fear the accumulation of student loan debt. 

    Once in college, the intense rigor of coursework may inhibit students from working at a job or lead to academic failure. The pressure to choose the “correct” college path may also compel students to select a higher-paying degree major within the STEM fields or a track into medicine rather than psychology.

    The grave concern about financial burden carries into graduate education. A student funding an undergraduate education through student loans may be unlikely to enroll in a five-year graduation program if they face further debt accumulation. Whereas some doctoral programs in psychology are fully funded, most are not, particularly those in health service psychology subfields, typically leading to enormous student debt burdens.

    A related systemic issue is the lack of diverse backgrounds represented in student populations, as those with higher socio-economic backgrounds are much more likely to pursue and enroll in graduate programs. Exacerbating the problem is the recent discontinuance of scholarships for students of color, such as the Andrew Mellon Foundation, which offered a critical funding source.

    Other challenges for higher education in health service psychology include the cost of obtaining an internship, barriers to licensing, and mediocre income following graduation. The internship process adds to a student’s financial load through the cost of applications for each site. The competitive nature of internship sites requires students to apply to many sites to receive a match.

    One positive change in the internship process is the move to virtual interviews instead of in-person meetings. In previous years, the travel expenses for interviews entailed costs into the thousands. Nonetheless, interns receive little pay for internships while continuing to be responsible for tuition in their graduate program, requiring some students to obtain further loan debt to cover living expenses.

    Following graduation, additional challenges to practice are faced. The Examination for Professional Practice in Psychology (EPPP) poses a daunting hurdle for graduates, entailing significant costs in registration and preparation. The exam is rigorous, and APA research of 1691 early career psychologists shows many test-takers do not pass on the first try – 92 percent of white respondents and 83 percent of those of color passed on their initial take.

    Furthermore, the Association of State and Provincial Psychology Boards issued

a decision recently to add the skills component of the exam (known as the EPPP-2)

as a part of licensing requirements by 2026. Many in the field, including psychology

trainers are deeply worried about the impact of the additional time and cost to

independent practice and the potential disparities in impact on those of color.

    Despite the likely rewarding career ahead, doctoral psychology graduates can expect

a lower earning potential than others in the healthcare profession, with implications

for their debt burden and overall wealth accumulation. U.S. Bureau of Labor Statistics

of 2021 salaries by occupation show that whereas psychologists make an average of $92,100, healthcare professionals with similarly lengthy graduate and clinical training can earn far more as a psychiatrist ($249,760) or a family medicine doctor ($235,930). Nurse practitioners with a master’s degree have an earning potential of $118,040.

    A comprehensive approach is needed to attract undergraduate students to psychology majors, nurture interest in health service psychology, and support graduate students to enter the field. A widespread, strategic public campaign is needed to communicate the role of psychology in meeting the needs of the mental health epidemic. Both high school and undergraduate college students need information about the benefits of a psychology major and the wide-ranging career options and job market.

    Fostering connections between undergraduate and graduate students, for example, through research labs and experiential learning, would offer first-hand exposure to the field. Shadowing practitioners in the field would also be a valuable opportunity. 

    In addition, a mentorship model with graduate students supporting undergraduate students in their pursuit of graduate school would increase accessibility and success.

    Academic counselors are also critical in preparing students for their next steps beyond their undergraduate degree and considering graduate education in psychology. Greater financial support is also required to help attract students to graduate training. It is incumbent upon undergraduate and graduate institutions and programs to ensure that students are aware of their options for funding and supported in finding ways to fund their education.

    Persistent advocacy is needed at all levels and sectors for scholarships, research, other funding opportunities, and loan forgiveness programs. This includes local opportunities such as advocating for scholarships by community organizations and negotiating for paid clinical training opportunities (e.g., crisis care consultation). Dedicating scholarship funds, particularly for students with significant financial need and those from historically marginalized populations, must be prioritized by graduate training programs. Partnerships with other organizations to create program-specific scholarships would also be fruitful.

    In summary, our nation’s mental health needs far outweigh the current behavioral healthcare workforce's capacity. Offering a critical and unique expertise within the healthcare professions, health service psychology is in high demand, yet the number of students enrolling in graduate training has declined in the past two decades. A comprehensive, long-term strategy is needed to recruit students into the field and provide the support and incentives needed to sustain them through graduate training.

    A past APA President, Frank Worrell, Ph.D., exhorts us as psychologists to answer the call because “…today, the world needs psychologists.” Let us carefully consider the role we all can play to expand our psychology workforce and better equip our field to meet our communities’ great needs.


References available from author.

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Amanda Riedel, M.A., is a doctoral candidate in the Graduate School of Clinical Psychology at George Fox University. Her current interests include working with active military personnel, ADHD assessments and treating depression/anxiety in a primary care setting.


Leihua Edstrom, Ph.D., ABSNP is a school neuropsychologist and professor in the Graduate School of Clinical Psychology at George Fox University. Her interests include culturally sensitive mentoring, religious/spiritual factors in treatment and school neuropsychological assessment and consultation with neuro-divergent, culturally and/or gender diverse children and their parents and educators. Her email address is:

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