The Ethical Challenges of AI-based Mental Health Interventions: Toward a Layered Accountability Framework
Research Article
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The Ethical Challenges of AI-based Mental Health Interventions: Toward a Layered Accountability Framework

Xinnuo Lei 1*
1 The University of Hong Kong, Shenzhen
*Corresponding author: 122o3oo26@link.cuhk.edu.cn
Published on 27 August 2025
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LNEP Vol.115
ISSN (Print): 2753-7056
ISSN (Online): 2753-7048
ISBN (Print): 978-1-80590-329-1
ISBN (Online): 978-1-80590-330-7
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Abstract

Artificial intelligence (AI) is increasingly prevalent in mental health services, enhancing accessibility by providing immediate support through chatbots and remote platforms, and improving efficiency through automated diagnostics and personalized treatment recommendations. However, this rapid integration also brings numerous ethical controversies, including concerns over data privacy, algorithmic bias, and the potential erosion of human empathy in therapeutic relationships. This paper focuses on seven core ethical issues in AI mental interventions, including privacy protection, informed transparency, fairness and bias, responsibility attribution, autonomy and agency, emotional dependency, and simulated empathy. Existing studies mostly address single dimensions and fail to respond to the multi-stakeholder collaborative ethical challenges. To address this, the paper proposes a “Layered Responsibility Framework” that systematically analyzes the division of responsibilities and ethical constraints across three levels: developers, platform operators, and users. The study highlights that only by promoting clear accountability, transparent design, and institutional coordination can society ensure the sustainable application of AI technology in mental health and safeguard users’ psychological safety.

Keywords:

Artificial Intelligence, Mental Health, Ethical Challenge, Responsibility Framework

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Lei,X. (2025). The Ethical Challenges of AI-based Mental Health Interventions: Toward a Layered Accountability Framework. Lecture Notes in Education Psychology and Public Media,115,15-23.

References

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[2]. Wüller, C. A.: Ethical and Practical Implications of Artificial Emotional Intelligence Approached from a Philosophical-Psychological Perspective: The Use Case of Psychiatry, University of Twente. Enschede (2023)

[3]. Pozzi, G., & De Proost, M.: Keeping an AI on the mental health of vulnerable populations: Reflections on the potential for participatory injustice. AI and Ethics, 1–11 (2024)

[4]. Zidaru, T., Morrow, E. M., & Stockley, R.: Ensuring patient and public involvement in the transition to AI‐assisted mental health care: A systematic scoping review and agenda for design justice. Health Expectations 24(4), 1072–1124 (2021)

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[6]. Graham, S., Depp, C., Lee, E. E., Nebeker, C., Tu, X., Kim, H. C., & Jeste, D. V.: Artificial intelligence for mental health and mental illnesses: An overview. Current Psychiatry Reports 21, 1–18 (2019)

[7]. Artificial Intelligence in Modern Psychology: A 2025 Guide to Diagnosis, Therapy, and Ethical Innovation, https: //osf.io/preprints/psyarxiv/724qe_v1, last accessed 2005/07/15

[8]. Bandawe, S., Roodt, S., & Ruhwanya, Z.: Ethical Limitations of Using AI to Predict and Diagnose Mental Health Disorders Based on Individuals’ Social Media Activity. African Conference on Information Systems and Technology 26, (2024)

[9]. Falade, O.: Serving Whom? Ethical and Practical Limits of AI Mental Health Chatbots for Marginalized Communities. GRACE: Global Review of AI Community Ethics 3(1) (2025)

[10]. Yu, L., & Zhai, X.: Use of artificial intelligence to address health disparities in low- and middle-income countries: A thematic analysis of ethical issues. Public Health 234, 77–83 (2024)

[11]. Rahsepar Meadi, M., Sillekens, T., Metselaar, S., van Balkom, A., Bernstein, J., & Batelaan, N.: Exploring the ethical challenges of conversational AI in mental health care: Scoping review. JMIR Mental Health 12, e60432 (2025)

[12]. Luxton, D. D.: Recommendations for the ethical use and design of artificial intelligent care providers. Artificial Intelligence in Medicine 62(1), 1–10 (2014)

[13]. Hoose, S., & Králiková, K.: Artificial Intelligence in Mental Health Care: Management Implications, Ethical Challenges, and Policy Considerations. Administrative Sciences 14(9), 227 (2024)

[14]. Vale, M. D.: Moral Entrepreneurship and the Ethics of Artificial Intelligence in Digital Psychiatry. Socius 10, 23780231241259641 (2024)

[15]. Carvalho, C. A. S.: Ethical challenges of AI-based psychotherapy: The case of explainability. Scenarios: Biannual Journal of Contemporary Philosophy 17(2), 177–199 (2022)

[16]. Pandey, H. M.: Harnessing Large Language Models for Mental Health: Opportunities, Challenges, and Ethical Considerations. arXiv preprint arXiv: 2501 (2024)

[17]. Balcombe, L.: AI chatbots in digital mental health. Informatics 10(4), 82 (2023)

[18]. Fiske, A., Henningsen, P., & Buyx, A.: Your robot therapist will see you now: Ethical implications of embodied artificial intelligence in psychiatry, psychology, and psychotherapy. Journal of Medical Internet Research 21(5), e13216 (2019)

[19]. El-Mashharawi, H. Q., Alshawwa, I. A., Salman, F. M., Al-Qumboz, M. N., Abu-Nasser, B. S., & Abu-Naser, S. S.: AI in Mental Health: Innovations, Applications, and Ethical Considerations. International Journal of Academic Engineering Research 8(10), 53-58 (2024)

[20]. Vaidyam, A. N., Wisniewski, H., Halamka, J. D., Kashavan, M. S., & Torous, J. B.: Chatbots and conversational agents in mental health: A review of the psychiatric landscape. The Canadian Journal of Psychiatry 64(7), 456–464 (2019)

[21]. Morley, J., Floridi, L., Kinsey, L., & Elhalal, A.: From what to how: An initial review of publicly available AI ethics tools, methods and research to translate principles into practices. Science and Engineering Ethics 26(4), 2141–2168 (2020)

[22]. Fjeld, J., Achten, N., Hilligoss, H., Nagy, A., & Srikumar, M.: Principled artificial intelligence: Mapping consensus in ethical and rights-based approaches to principles for AI. Berkman Klein Center Research Publication, Cambridge (2020)

[23]. Luxton, D. D., June, J. D., & Kinn, J. T.: Technology-based suicide prevention: Current applications and future directions. Telemedicine and e-Health 17(1), 50–54 (2011)

[24]. McCradden, M. D., Baba, A., Saha, A., Ahmad, S., Boparai, K., Fadaiefard, P., & Cusimano, M. D.: Ethical concerns around use of artificial intelligence in health care research from the perspective of patients with meningioma, caregivers and health care providers: A qualitative study. Canadian Medical Association Open Access Journal 8(1), E90–E95 (2020)

[25]. Floridi, L., & Cowls, J.: A unified framework of five principles for AI in society. Machine Learning and the City: Applications in Architecture and Urban Design, 535–545 (2022)

References

[1]. Face-to-Faceless: Exploring the Benefits, Risks, and Ethical Considerations of Using Artificial Intelligence in Therapeutic Contexts, https: //www.diva-portal.org/smash/record.jsf?pid=diva2: 1881801, last accessed 2005/07/15

[2]. Wüller, C. A.: Ethical and Practical Implications of Artificial Emotional Intelligence Approached from a Philosophical-Psychological Perspective: The Use Case of Psychiatry, University of Twente. Enschede (2023)

[3]. Pozzi, G., & De Proost, M.: Keeping an AI on the mental health of vulnerable populations: Reflections on the potential for participatory injustice. AI and Ethics, 1–11 (2024)

[4]. Zidaru, T., Morrow, E. M., & Stockley, R.: Ensuring patient and public involvement in the transition to AI‐assisted mental health care: A systematic scoping review and agenda for design justice. Health Expectations 24(4), 1072–1124 (2021)

[5]. Artificial Intelligence Ethics in Psychological Support Services: A Scoping Review with Systematic Literature Search, https: //files.osf.io/v1/resources/sztdn_v1/providers/osfstorage/67a01a56cbb9fe3b57445c7c?action=download& direct& version=1, last accessed 2005/07/15

[6]. Graham, S., Depp, C., Lee, E. E., Nebeker, C., Tu, X., Kim, H. C., & Jeste, D. V.: Artificial intelligence for mental health and mental illnesses: An overview. Current Psychiatry Reports 21, 1–18 (2019)

[7]. Artificial Intelligence in Modern Psychology: A 2025 Guide to Diagnosis, Therapy, and Ethical Innovation, https: //osf.io/preprints/psyarxiv/724qe_v1, last accessed 2005/07/15

[8]. Bandawe, S., Roodt, S., & Ruhwanya, Z.: Ethical Limitations of Using AI to Predict and Diagnose Mental Health Disorders Based on Individuals’ Social Media Activity. African Conference on Information Systems and Technology 26, (2024)

[9]. Falade, O.: Serving Whom? Ethical and Practical Limits of AI Mental Health Chatbots for Marginalized Communities. GRACE: Global Review of AI Community Ethics 3(1) (2025)

[10]. Yu, L., & Zhai, X.: Use of artificial intelligence to address health disparities in low- and middle-income countries: A thematic analysis of ethical issues. Public Health 234, 77–83 (2024)

[11]. Rahsepar Meadi, M., Sillekens, T., Metselaar, S., van Balkom, A., Bernstein, J., & Batelaan, N.: Exploring the ethical challenges of conversational AI in mental health care: Scoping review. JMIR Mental Health 12, e60432 (2025)

[12]. Luxton, D. D.: Recommendations for the ethical use and design of artificial intelligent care providers. Artificial Intelligence in Medicine 62(1), 1–10 (2014)

[13]. Hoose, S., & Králiková, K.: Artificial Intelligence in Mental Health Care: Management Implications, Ethical Challenges, and Policy Considerations. Administrative Sciences 14(9), 227 (2024)

[14]. Vale, M. D.: Moral Entrepreneurship and the Ethics of Artificial Intelligence in Digital Psychiatry. Socius 10, 23780231241259641 (2024)

[15]. Carvalho, C. A. S.: Ethical challenges of AI-based psychotherapy: The case of explainability. Scenarios: Biannual Journal of Contemporary Philosophy 17(2), 177–199 (2022)

[16]. Pandey, H. M.: Harnessing Large Language Models for Mental Health: Opportunities, Challenges, and Ethical Considerations. arXiv preprint arXiv: 2501 (2024)

[17]. Balcombe, L.: AI chatbots in digital mental health. Informatics 10(4), 82 (2023)

[18]. Fiske, A., Henningsen, P., & Buyx, A.: Your robot therapist will see you now: Ethical implications of embodied artificial intelligence in psychiatry, psychology, and psychotherapy. Journal of Medical Internet Research 21(5), e13216 (2019)

[19]. El-Mashharawi, H. Q., Alshawwa, I. A., Salman, F. M., Al-Qumboz, M. N., Abu-Nasser, B. S., & Abu-Naser, S. S.: AI in Mental Health: Innovations, Applications, and Ethical Considerations. International Journal of Academic Engineering Research 8(10), 53-58 (2024)

[20]. Vaidyam, A. N., Wisniewski, H., Halamka, J. D., Kashavan, M. S., & Torous, J. B.: Chatbots and conversational agents in mental health: A review of the psychiatric landscape. The Canadian Journal of Psychiatry 64(7), 456–464 (2019)

[21]. Morley, J., Floridi, L., Kinsey, L., & Elhalal, A.: From what to how: An initial review of publicly available AI ethics tools, methods and research to translate principles into practices. Science and Engineering Ethics 26(4), 2141–2168 (2020)

[22]. Fjeld, J., Achten, N., Hilligoss, H., Nagy, A., & Srikumar, M.: Principled artificial intelligence: Mapping consensus in ethical and rights-based approaches to principles for AI. Berkman Klein Center Research Publication, Cambridge (2020)

[23]. Luxton, D. D., June, J. D., & Kinn, J. T.: Technology-based suicide prevention: Current applications and future directions. Telemedicine and e-Health 17(1), 50–54 (2011)

[24]. McCradden, M. D., Baba, A., Saha, A., Ahmad, S., Boparai, K., Fadaiefard, P., & Cusimano, M. D.: Ethical concerns around use of artificial intelligence in health care research from the perspective of patients with meningioma, caregivers and health care providers: A qualitative study. Canadian Medical Association Open Access Journal 8(1), E90–E95 (2020)

[25]. Floridi, L., & Cowls, J.: A unified framework of five principles for AI in society. Machine Learning and the City: Applications in Architecture and Urban Design, 535–545 (2022)

Cite this article

Lei,X. (2025). The Ethical Challenges of AI-based Mental Health Interventions: Toward a Layered Accountability Framework. Lecture Notes in Education Psychology and Public Media,115,15-23.

Data availability

The datasets used and/or analyzed during the current study will be available from the authors upon reasonable request.

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Volume title: Proceeding of ICIHCS 2025 Symposium: The Dialogue Between Tradition and Innovation in Language Learning

ISBN: 978-1-80590-329-1(Print) / 978-1-80590-330-7(Online)
Editor: Heidi Gregory-Mina, Enrique Mallen
Conference website: https://2025.icihcs.org/Huntsville.html
Conference date: 17 November 2025
Series: Lecture Notes in Education Psychology and Public Media
Volume number: Vol.115
ISSN: 2753-7048(Print) / 2753-7056(Online)

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