Richard Miller, MD, staff psychiatrist at Elwyn Adult Behavioral Health in Cranston, Rhode Island.

Richard Miller, MD

Patients are increasingly bringing AI-generated 

 advice into clinical encounters, raising new challenges for psychiatrists caring for individuals with severe mental illness. In this Q&A, Richard Miller, MD, staff psychiatrist at Elwyn Adult Behavioral Health in Cranston, Rhode Island, discusses how tools such as ChatGPT are shaping conversations in outpatient psychiatry.

 present AI-derived recommendations, sometimes with limited context or accuracy. He explains how clinicians can validate patient curiosity while clarifying misinformation, protect the therapeutic alliance, and assess when AI use may reinforce maladaptive thinking. Miller also outlines potential roles for AI in documentation and education, emphasizing the need to maintain comprehensive, clinician-guided care.

Watch the dynamic feature on using AI as your therapist or psychiatrist, featuring Miller, 

 In your practice, are you already seeing patients use tools like ChatGPT for mental health advice, and what does that look like in real clinical encounters?

 I've seen it a lot, and it's not always good, and there needs to be some asterisks next to the information that they attain in the context.

Just for reference, I do outpatient psychiatry…serving the most sick folks in the community, [with] severe, persistent mental illness. A lot of patients [with] schizophrenia, bipolar disorder. I say that because those are the folks that are primarily coming to me with…statements [such as], “Hey, I plugged this into ChatGPT” or “I looked this up on AI, and this is what I've been told I need to talk to you about.”

These are individuals that at their baseline struggle with paranoia, sometimes with human validation…and they're putting stuff into an algorithm and getting an answer and maybe having a preconceived notion of what they want the answer to be. They're just coming to me with information which [are] not always accurate, largely inaccurate at times, and it's thrown together.

 How are patients interpreting the guidance that they get? Are they treating it as supplemental or as a substitute for clinical care?

 It's kind of both. There's some folks that I would say that are [a] bit higher functioning that might come to me and say, “Hey, I was looking this up because I know we've chatted about this, and this is what the ChatGPT has told me.” It might be based on a discussion we've had earlier…and it might supplement. Maybe it's something that is brand new and quite useful to both of us.

More often, it's actually deleterious where information is kind of cherry-picked, and the context is not always understood. Patients are kind of going on an extended trip and excursion to get the information that they're looking for…maybe [a] particular answer. I would say the higher the degree of functionality, in large part, I find it to be more deleterious than useful.

 When a patient brings in an AI-generated device, how do you approach that conversation without undermining the trust or therapeutic alliance?

 I always ask them where they're coming from and how they got the information. I always validate them and say, “Hey, thanks for bringing this to my attention. Thank you for sharing this with me. However, let's talk, or let's see what the entirety of the picture is.”

 Do you think clinicians should be proactively asking about AI use as a part of a routine history taking?

 Proactively, I'm not sure, but it should be part [of] the background to make sure they understand that a lot of people are looking into this. That's not something that has to be [at] the forefront of the discussion, but something that needs to be kept on the burner.

What concerns you most about patients with mental illness using AI as a therapist or psychiatrist?

 There's a reason I went to medical school…we need to put together the entire clinical picture.

My biggest concern is that patients are getting information piecemeal and [poorly] putting together to create a recipe or a puzzle… Pieces are not appropriate. They're not getting the entire clinical picture.

 Are there specific red flags that suggest AI use is becoming clinically problematic or reinforcing maladaptive thinking?

 It really depends. I don't want you to think I'm in a clinic where people are coming in every session with AI information. It comes up [about] 3 times a week.

It's caught me off guard sometimes; sometimes people you wouldn't expect [use AI]. It's becoming more prominent. It's kind of forcing us, in a good way, to stand our toes, to make sure that we are aware that these technologies are out there, and sometimes they are sources of misinformation.

 Where do you see the most practical appropriate role for AI in psychiatric care, whether in documentation screening or decision support?

 There is a lot of AI-generated software that's helping with documentation. I don't use it, not because I am against it, because we don't support it in my…place of employment.

It’s good to encourage patients to think more and learn more about their illness, but [it] really depends on the patient. Somebody who's paranoid…is going to maybe be more susceptible to misinformation… whereas somebody who did not suffer from psychosis might be able to see through it a little bit and [understand] some of [the information] may not be accurate.

Articles

In this interview, Miller discusses patients using ChatGPT for mental health advice, risks in severe mental illness, and how clinicians respond.

Patients Bring ChatGPT to Psychiatry Visits, With Richard Miller, MD

Your Patient's New Therapist Is an AI. Now What?

Watch the full expert dynamic feature above.

In your clinic, you may hear patients say, “Chat told me this” or “Chat told me that.” Numerous individuals use ChatGPT, colloquially referred to as “Chat,” to get quick, convenient 

advice. This can be dangerous, depending on what the chatbot says, potentially providing patients with advice you would never, in a million years, give.

“More often, it's actually deleterious where information is cherry-picked, and the context is not always understood,” said Richard Miller, MD, a staff psychiatrist at Elwyn Adult Behavioral Health in Cranston, RI. “Patients are kind of going on an extended trip…to get the information that they're looking for…. maybe [a] particular answer. It's not always accurate.”

Despite the danger, AI can also be helpful in the psychiatry field. AI can provide a new perspective and can augment, not replace, treatment.

 Editorial Team put together a feature examining the benefits, dangers, and ethics surrounding AI use in psychiatry. Millions of Americans struggle to access mental health care, with waitlists sometimes lasting 3 to 6 months.

These individuals, desperate for mental health advice, turn to AI. As Darlene King, MD, from the University of Texas Southwest Medical Center, said, using AI as a therapist is like getting mental health advice from a friend, who can very well give bad advice.

Dominic Sisti, PhD, from Penn Medicine, discussed the ethical concerns of AI in psychiatry. Vulnerable populations may be susceptible to abusing AI and can even go as far as asking ChatGPT ways to self-harm. “How would these AI platforms [respond] to a patient who is indicating they have suicidal ideation or behavior?” he asked. “How might these platforms recognize elevated risk for self-harm or harm to others?

Sisti stressed the need for guardrails on age restrictions, redirection protocols, and HIPAA compliance standards. He also said there is a need for platforms to distinguish between an investigator asking about suicide methods versus someone in crisis.

Other than mental health advice, AI can assist in screening. In 2024, a study showed the promise of Sonde Health’s mental fitness vocal biomarker tool to 

identify depression from the sound of a voice

 Another study showed the potential of MoodCapture, a smartphone application using AI to 

detect the onset of depression based on facial cues 

More recently, a study showed AI can predict treatment response in major depressive disorder (MDD). In the 

phase 2b OLIVE trial assessing BH-200 (nelivaptan)

, a selective vasopressin V1b receptor antagonist, a proprietary genetic tool stratified patients by vasopressin-related biomarkers.

 Patients with lower peripheral but higher central vasopressin activity had a stronger antidepressant response, supporting biomarker-guided patient selection.

AI can also help with psychiatrists’ day-to-day responsibilities. For instance, Suki AI, Heidi, and DeepScribe, among others, are designed for clinician documentation.

As AI becomes more commonplace, experts recommend asking about its use non-judgmentally during routine history-taking. Although potentially dangerous, AI can be beneficial if used with a “human in the loop,” according to Sisti.

 Staff psychiatrist at Elwyn Adult Behavioral Health in Cranston, RI.

Associate professor of medical ethics & health policy, director of the scattergood program for applied ethics in behavioral health care, associate professor of psychiatry (secondary), associate professor of philosophy (secondary) at the University of Pennsylvania.

Assistant professor in the department of psychiatry at University of Texas Southwest Medical Center who specializes in general adult psychiatry, including women’s health, addiction, and trauma.

A psychiatrist and chief medical officer at HMNC Brain Health.

Relevant disclosures include Teva Pharmaceuticals USA, Inc., Alkermes Janssen Pharmaceuticals, Inc, and Otsuka America Pharmaceutical for MIller. King, Sisti and Eriksson have no reported disclosures.

Andrew. How Long Is the Wait to See a Psychiatrist? What to Expect and How to Shorten It. Brain Health USA. Published September 30, 2025. 

https://brainhealthusa.com/how-long-is-the-wait-to-see-a-psychiatrist/

Derman C. A Voice Detecting Depression? Lindsey Venesky, PhD, Discusses New Data. HCPLive. March 14, 2024. Accessed on March 30, 2026. 

https://www.hcplive.com/view/a-voice-detecting-depression-lindsey-venesky-phd-discusses-new-data

Derman, C. Smartphone App with AI Detects Depression Onset from Facial Expressions. HCPLive. February 28, 2024. Accessed March 30, 2026. 

https://www.hcplive.com/view/smartphone-app-ai-detects-depression-onset-facial-expressions

Eriksson H. New Genetic Tool Shows Promise for Targeted MDD Treatment, With Hans Eriksson, PhD, MD. HCPLive. Published December 5, 2026. Accessed March 30, 2026. 

https://www.hcplive.com/view/new-genetic-tool-shows-promise-targeted-mdd-treatment-hans-eriksson-md-phd

Palm E, Manikantan A, Mahal H, Belwadi SS, Pepin ME. Assessing the quality of AI-generated clinical notes: validated evaluation of a large language model ambient scribe. 

. 2025;8:1691499. Published 2025 Oct 22. 

Mess SA, Mackey AJ, Yarowsky DE. Artificial Intelligence Scribe and Large Language Model Technology in Healthcare Documentation: Advantages, Limitations, and Recommendations. 

. 2025;13(1):e6450. Published 2025 Jan 16. 

DeepScribe. DeepScribe Solidifies Ambient AI Leadership in Oncology with New Study and Accelerated Growth. Prnewswire.com. Published September 16, 2025. Accessed March 30, 2026. 

https://www.prnewswire.com/news-releases/deepscribe-solidifies-ambient-ai-leadership-in-oncology-with-new-study-and-accelerated-growth-302557045.html

Videos

As patients increasingly turn to ChatGPT for mental health support, psychiatrists and ethicists weigh the clinical risks, ethical concerns, and what clinicians should do next.