Many of your teen patients are likely using artificial intelligence (AI) chatbots for mental health support. Teens are turning to AI chatbots for “therapy” and companionship at an alarming rate, making it primed to become the next public health crisis.
Teens are already navigating the well-documented risks of social media use and addiction while facing growing barriers to mental health care. As provider shortages limit access to support, many are turning to AI chatbots not only for schoolwork and social connection, but also for guidance on their mental health.
Clinicians have a responsibility to understand the risks posed by AI chatbots and to inform teen patients, their parents and caregivers about them. When used properly and ethically, AI is a powerful tool. In a clinical setting, advancements in AI technology (such as in radiology and early cancer detection) are already providing benefits to patients and the medical community. With respect to mental health, AI can help practitioners reimagine how to deliver established treatments, accelerating their effectiveness and efficiency while also personalizing them to meet each patient’s unique needs.
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Clinical shortage exacerbates the issue, increasing teen reliance on AI
All medical fields are experiencing a historic clinical shortage in the U.S., but the shortage of pediatric mental health providers is particularly troubling. Seventy percent of U.S. counties do not have a single child psychiatrist, and accessing mental health support through insurance is often difficult. Many patients are left paying out of pocket, widening the mental health access gap.
This access chasm means that teens seeking mental health support may turn to AI chatbots powered by large language models (LLMs) like OpenAI’s ChatGPT or Anthropic’s Claude. Teens are getting something they wouldn’t otherwise have, and they’re getting it immediately, in just a few clicks and keystrokes.
A new study published in JAMA Pediatrics found that one in five adolescents and young adults use AI chatbots for mental health advice. Of the more than 1,000 young people included in the study, whose responses were weighted to represent an estimated 42.8 million youths, more than 63% of those who are using AI for mental health support are not disclosing it to family and friends. The frequency with which teens and youths are using AI for support is also concerning. More than two in five (42.8%) are using them monthly, 10.8% weekly, and 5.8% almost daily. More than 91% of survey respondents found the guidance somewhat or very helpful, underscoring a larger problem: AI chatbots’ relationship with their users is often sycophantic rather than therapeutic.
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AI chatbot sycophancy
AI products are businesses, and they’re designed to collect data and turn a profit. This is one of the many reasons why they are not a replacement for a therapeutic relationship. A therapeutic relationship balances validating feelings with pushing our patients to consider healthier, more responsible alternatives. An effective therapeutic relationship challenges unhelpful thoughts, actions or beliefs in order to promote change. An AI chatbot designed to sustain engagement with a teen is most likely to validate their unhealthy impulses and beliefs rather than challenge them like a good therapist would. The sycophancy of the AI “yes man” may encourage a teen to continue to harbor toxic beliefs or in some cases recommend or validate unsafe decisions.
For a young person who lacks validation at home or school, the sycophantic response can feel like drinking water to quench one’s thirst. But it’s like salt water, not fresh drinking water, and it’s unsustainable, unhealthy and dangerous because it cannot address the underlying problem effectively. AI chatbots cannot replace the clinical judgment or human interaction provided by a trained clinician like a therapist or psychiatrist.
Real-world consequences of AI’s design
Heavy AI chatbot use has been associated with behaviors that clinicians recognize, such as increased emotional dependency, reduced real-world socialization and compulsive engagement that users themselves describe as difficult to control. A controlled trial conducted by the MIT Media Lab found that heavier daily use of chatbots correlated with greater loneliness and diminished social connection with real people. Whether this can be called addiction in a clinical sense remains open to interpretation, but the research is emerging.
In an August 2025 JMIR Mental Health study, a simulation demonstrated that chatbots endorsed harmful behaviors in teens, such as dropping out of school or pursuing a relationship with a teacher, in nearly one-third (32%) of opportunities. A November 2025 risk assessment conducted by Common Sense Media in collaboration with the Stanford Medicine Brainstorm Lab found that leading AI platforms, including ChatGPT, Claude, Gemini, and Meta AI, were fundamentally unsafe for teen mental health support, failing systematically to recognize adolescent psychiatric conditions and consistently prioritizing continued engagement over appropriate referral to care.
In addition to emerging research in the field, the real-world risks of teens using AI chatbots have been well documented. According to a lawsuit filed against OpenAI, 16-year-old Adam Raine used ChatGPT as a confidant in the months before his death by suicide in April 2025. As reported by the New York Times, the chatbot not only failed to redirect him toward care, but also allegedly deepened his isolation, discouraged him from involving his parents and offered to write his suicide note.
These are allegations in active litigation, and OpenAI disputes aspects of the account. But the pattern they describe — a system optimized for engagement and validating a teen’s darkest thoughts rather than challenging them — is precisely what makes AI chatbots poorly suited for the therapeutic role many adolescents are assigning them.
AI technology will continue to evolve much faster than regulation can follow, but what will remain constant is the obligation to patients. Mental health professionals are trained to meet teens and young people where they are. As the case may be right now, for many teens, that is the middle of the night, alone, and engaging with a chatbot. The challenge is ensuring teens and their parents understand the difference between a tool that feels like help and the effective, clinically sound therapies and supports that actually deliver it.
Photo: Vertigo3d, Getty Images
Nikhil Nadkarni, MD, is Chief Medical Officer at Brightline, a therapy and psychiatry practice that delivers pediatric, teen, and parental mental health care. He is an experienced double board certified child and adolescent and adult psychiatrist, and has prior experience building innovative tech-enable care delivery at Willow Health, and Little Otter. Prior to adventuring into the startup world, he was Chief Fellow for his program at UCLA (where he was also Chief Resident). Dr. Nadkarni is an avid traveler and foodie. He also has a tremendous passion for rural medicine and underserved communities and was involved at the early age of 19 in setting up clinical mission work for a leprosy colony in India.
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