Wayne Lonstein, CEO, VFT Solutions, Inc. Anti-Piracy, Social Media and Cybersecurity law and practice.getty​The use of chatbots as gatekeepers for access to reimbursable mental health care bears a striking resemblance to the dawn of health maintenance organizations (HMOs), when costs were the focus, not necessarily patient care. The future of mental healthcare may be defined less by whether AI can replace therapists than whether human care remains affordable. AI is being promoted as a solution to America's mental health crisis, but the more urgent question is whether economic pressures will make human care increasingly unsustainable. If that happens, AI will not just supplement care; it will reshape who receives it and what kind of care they receive.Technology certainly has a role to play here. But before celebrating AI as the answer, consider a more fundamental question: What happens when economic incentives make mental health care for humans increasingly difficult to sustain? Across the country, therapists report pressure from reimbursement rates that often fail to keep pace with rising costs and administrative demands. Many clinicians limit insurance participation, move to private-pay models or leave certain markets altogether. The result is a growing access problem, especially in underserved communities where finding an in-network provider can already be extraordinarily difficult. At the same time, insurers, employers and health care organizations are investing heavily in AI-powered mental health platforms. Advocates maintain that AI is better than no care at all, and in many situations, that may be true. But the deeper issue is whether lower-income patients will be routed toward automated alternatives, while patients with financial means continue to receive human-centered care. If so, we are not simply expanding access. We are deciding who gets human care.Recently, I was discussing these issues with my wife, a mental health professional serving a community where behavioral health resources are already limited and many families have little disposable income. Her greatest concern was not AI itself, but overwork in a profession already under financial hardship. Clinicians are being asked to absorb stagnant reimbursement, rising administrative demands, delayed payments and increasingly automated review processes. At the same time, some organizations are moving toward digital-first screening, triage tools and app-based pathways before patients ever reach a human therapist.Where AI Struggles In Mental HealthcareWhile AI tools may improve efficiency, they can also create additional layers between patients and clinicians. In communities already struggling to attract and retain providers, these pressures can compound existing workforce shortages. The concern is that economic pressures may gradually make human therapists less available, leaving AI as the default alternative.The accountability questions surrounding AI further complicate the discussion. When a licensed therapist makes a mistake, there are ethical standards, licensing boards and established systems of recourse. When an AI system causes a harmful outcome, responsibility becomes far less clear. Is it the insurer, the software vendor, the model developer or the health care organization that deployed the technology? Privacy also deserves attention in this discussion. Mental health treatment depends on trust. Patients routinely disclose trauma, addiction, relationship struggles and very personal experiences. As AI is increasingly integrated into mental health services, patients will reasonably ask how their information is stored, who has access to it and whether those conversations could become part of an insurer or government mental health dossier.There is also a longer-term workforce concern that receives surprisingly little attention. Becoming a therapist requires years of education, supervised practice, licensing examinations and often substantial student debt.Although there is currently no empirical evidence I've found that shows AI is directly discouraging students from entering the mental health profession, these converging trends raise concerns that prospective trainees could perceive the profession as offering diminished long-term financial returns, potentially worsening existing workforce shortages.Society could create a self-perpetuating cycle in which reimbursement pressures reduce provider participation, AI is introduced to address shortages, economic uncertainty discourages new entrants and shortages worsen.​Where Legislation Can Help​A potential policy solution already exists elsewhere in health care. For decades, the Critical Access Hospital program has recognized that market forces alone cannot sustain essential health care services in many rural and underserved communities. Enhanced reimbursement helps keep these providers financially viable and preserves access to care.Mental health care may require a similar approach. Therapists practicing in mental health shortage areas or underserved communities could receive enhanced reimbursement rates that reflect the unique economics of delivering human care where it is needed most. The policy goal is simple: Ensure clinician-led mental health care remains financially viable so patients continue to have access to qualified professionals.Questions To ConsiderWith these trends in mind, it is important to consider a few factors when vetting or embracing AI tools. Before investing in a new solution, consider the following:​1. Will this solution augment clinicians or replace billable clinical interactions?If the primary economic value of an AI platform comes from substituting for human care rather than extending clinicians' capacity, organizations should consider the long-term consequences. Students invest years of training and often accumulate substantial educational debt to become psychologists, counselors and psychiatrists.2. How will this technology affect the financial viability of clinician-led mental health practices?Responsible AI should reduce administrative burden, improve efficiency and allow clinicians to spend more time caring for patients. It should not erode the reimbursement or revenue needed to sustain professional practices. Organizations should evaluate whether an AI investment strengthens the economics of human-delivered care or gradually shifts financial value away from the clinicians on whom the mental health care system depends.3. Will adopting this tool improve employee trust or undermine it?Mental health care depends on trust. Employers should ask whether introducing AI will make employees feel more supported—or more vulnerable. Will employees worry that AI is replacing access to qualified professionals? Will they hesitate to use an AI mental health service because they fear their conversations are not truly private or could somehow be accessed by their employer? Even when those concerns are unfounded, a lack of confidence in privacy or confidentiality can reduce utilization and diminish the value of the benefit.​​Forbes Technology Council is an invitation-only community for world-class CIOs, CTOs and technology executives. Do I qualify?