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According to the definition provided by Oxford Languages via Google, ‘proactively’ means taking action to control a situation rather than just responding to it after it has happened, and ‘take up’ means to become interested or engaged in something. Quality of care also lies with the nature of the clinical relationship, with communication and with truly informed decision-making. The human evaluation framework used included factuality, comprehension, reasoning, possible harm, and bias.2 Additionally remarkable to this absolute performance improvement is the rate at which these models are improving against established benchmarks. General use cases such as writing assistance both generally and in academia are becoming widespread.8 Organisations including New Zealand universities and Te Whatu Ora (TWO) have now relaxed their initial blanket ‘don’t use’ policies – which were understandably reactionary/scrambling when ChatGPT went live – and are now exploring and even encouraging the selective use of generative AI.9 TWO is planning to pilot the use of AI for clinical coding of hospital admissions.10 The public will increasingly use these tools (bypassing the ‘not a medical expert’ warnings) and ‘Dr Google’-based information that patients present is going to become harder to navigate and dismiss.

The number of young people in New Zealand (Aotearoa) who experience mental health challenges is increasing. As those in Aotearoa went into the initial COVID-19 lockdown, an ongoing digital mental health project was adapted and underwent rapid content authoring to create the Aroha chatbot. This dynamic digital support was designed with and for young people to help manage pandemic-related worry. Aroha was developed to provide practical evidence-based tools for anxiety management using cognitive behavioral therapy and positive psychology. The chatbot included practical ideas to maintain social and cultural connection, and to stay active and well. Stay-at-home orders under Aotearoa’s lockdown commenced on March 20, 2020. By leveraging previously developed chatbot technology and broader existing online trial infrastructure, the Aroha chatbot was launched promptly on April 7, 2020. Dissemination of the chatbot for an open trial was via a URL, and feedback on the experience of the lockdown and the experience of Aroha was gathered via online questionnaires and a focus group, and from community members. In the 2 weeks following the launch of the chatbot, there were 393 registrations, and 238 users logged into the chatbot, of whom 127 were in the target age range (13-24 years). Feedback guided iterative and responsive content authoring to suit the dynamic situation and motivated engineering to dynamically detect and react to a range of conversational intents. The experience of the implementation of the Aroha chatbot highlights the feasibility of providing timely event-specific digital mental health support and the technology requirements for a flexible and enabling chatbot architectural framework.

There has been a lot of interest in digital mental health interventions but adherence to online programmes has been less than optimal. Chatbots that mimic brief conversations may be a more engaging and acceptable mode of delivery. We developed a chatbot, called 21-Day Stress Detox, to deliver stress management techniques for young adults. The purpose of the study was to explore the feasibility, acceptability, and potential efficacy of this low-intensity digital mental health intervention in a non-clinical population of young adults. The content was derived from cognitive behavioural therapy (CBT) and included evidence-informed elements such as mindfulness and gratitude journaling. It was delivered over 21 daily sessions using the Facebook Messenger platform. Each session was intended to last about 5–7 min and included text, animated GIFs, relaxation tracks and reflective exercises. We conducted an open single-arm trial collecting app usage through passive data collection as well as self-rated satisfaction and qualitative (open-ended) feedback. Efficacy was assessed via outcome measures of well-being (World Health Organisation (Five) Well-being Index; WHO-5; and Personal Well-being Measure; ONS4); stress (Perceived Stress Scale–10 item version; PSS-10); and anxiety (Generalized Anxiety Disorder 7-item scale; GAD-7). One hundred and ten of the 124 participants who completed baseline commenced the chatbot and 64 returned the post-intervention assessment. Eighty-one percent were female and 51% were first year students. Forty-five percent were NZ European and 41% were Asian. Mean engagement was 11 days out 21 days (SD = 7.8). Most (81%) found the chatbot easy to use. Sixty-three percent rated their satisfaction as 7 out of 10 or higher. Qualitative feedback revealed that convenience and relatable content were the most valued features. There was a statistically significant improvement on the WHO-5 of 7.38 (SD = 15.07; p < 0.001) and a mean reduction on the PSS-10 of 1.77 (SD = 4.69; p = 0.004) equating to effect sizes of 0.49 and 0.38, respectively. Those who were clinically anxious at baseline (n = 25) experienced a greater reduction of GAD-7 symptoms than those (n = 39) who started the study without clinical anxiety (−1.56, SD = 3.31 vs. 0.67, SD = 3.30; p = 0.011). Using a chatbot to deliver universal psychological support appears to be feasible, acceptable, have good levels of engagement, and lead to significant improvements in well-being and stress. Future iterations of the chatbot should involve a more personalised content.

Background:In March 2020, New Zealand was plunged into its first nationwide lockdown to halt the spread of COVID-19. Our team rapidly adapted our existing chatbot platform to create Aroha, a well-being chatbot intended to address the stress experienced by young people aged 13 to 24 years in the early phase of the pandemic. Aroha was made available nationally within 2 weeks of the lockdown and continued to be available throughout 2020.Objective:In this study, we aimed to evaluate the acceptability and relevance of the chatbot format and Aroha’s content in young adults and to identify areas for improvement.Methods:We conducted qualitative in-depth and semistructured interviews with young adults as well as in situ demonstrations of Aroha to elicit immediate feedback. Interviews were recorded, transcribed, and analyzed using thematic analysis assisted by NVivo (version 12; QSR International).Results:A total of 15 young adults (age in years: median 20; mean 20.07, SD 3.17; female students: n=13, 87%; male students: n=2, 13%; all tertiary students) were interviewed in person. Participants spoke of the challenges of living during the lockdown, including social isolation, loss of motivation, and the demands of remote work or study, although some were able to find silver linings. Aroha was well liked for sounding like a “real person” and peer with its friendly local “Kiwi” communication style, rather than an authoritative adult or counselor. The chatbot was praised for including content that went beyond traditional mental health advice. Participants particularly enjoyed the modules on gratitude, being active, anger management, job seeking, and how to deal with alcohol and drugs. Aroha was described as being more accessible than traditional mental health counseling and resources. It was an appealing option for those who did not want to talk to someone in person for fear of the stigma associated with mental health. However, participants disliked the software bugs. They also wanted a more sophisticated conversational interface where they could express themselves and “vent” in free text. There were several suggestions for making Aroha more relevant to a diverse range of users, including developing content on navigating relationships and diverse chatbot avatars.Conclusions:Chatbots are an acceptable format for scaling up the delivery of public mental health and well-being–enhancing strategies. We make the following recommendations for others interested in designing and rolling out mental health chatbots to better support young people: make the chatbot relatable to its target audience by working with them to develop an authentic and relevant communication style; consider including holistic health and lifestyle content beyond traditional “mental health” support; and focus on developing features that make users feel heard, understood, and empowered.

In March 2020, New Zealand was plunged into its first nationwide lockdown to halt the spread of COVID-19. Our team rapidly adapted our existing chatbot platform to create Aroha - a wellbeing chatbot intended to address the stress experienced by young people aged 13-24 in the early phase of the pandemic. Aroha was made available nationally within two weeks of the lockdown and continued to be available throughout 2020. To evaluate the acceptability and relevance of the chatbot format and Aroha's content in young adults and to identify areas for improvement. We conducted qualitative in-depth and semi-structured interviews with young adults, as well as in situ demonstrations of Aroha to elicit immediate feedback. Interviews were recorded transcribed and analyzed using thematic analysis assisted by NVivo. 15 young adults (median age 20 years, M = 20.07, SD = 3.17; 13 female, two male; all tertiary students) were interviewed in person. Participants spoke of the challenges of living through the lockdown, including social isolation, loss of motivation, and the demands of remote work/study - though some were able to find silver linings. Aroha was well liked for sounding like a 'real person' and peer with its friendly, local 'Kiwi' communication style, rather than an authoritative adult or counselor. The chatbot was praised for including content that went beyond traditional mental health advice. Participants particularly enjoyed the modules on gratitude, getting active, anger management, job-seeking, and how to deal with alcohol and drugs. Aroha was described as being more accessible than traditional mental health counselling and resources. It was an appealing option for those who did not want to talk to someone in person for fear of the stigma associated with mental health. On the other hand, participants dislike software bugs. They also wanted a more sophisticated conversational interface where they could express themselves and \"vent\" in free text. There were several suggestions for how to make Aroha more relevant to a diverse range of users, including developing content on navigating relationships and diverse chatbot avatars. Chatbots are an acceptable format to scale up the delivery of public mental health and wellbeing-enhancing strategies. We make the following recommendations for others interested in designing and rolling out mental health chatbots to better support young people: 1) Make the chatbot relatable to its target audience by working with them to develop an authentic and relevant communication style; 2) Consider including holistic health and lifestyle content beyond traditional \"mental health\"; 3) Focus on developing features that make users feel heard, understood, and empowered.

E-health technologies have the potential to provide scalable and accessible interventions for youth mental health. As part of a developing an ecosystem of e-screening and e-therapy tools for New Zealand young people, a dialog agent, Headstrong, has been designed to promote resilience with methods grounded in cognitive behavioral therapy and positive psychology. This paper describes the architecture underlying the chatbot. The architecture supports a range of over 20 activities delivered in a 4-week program by relatable personas. The architecture provides a visual authoring interface to its content management system. In addition to supporting the original adolescent resilience chatbot, the architecture has been reused to create a 3-week 'stress-detox' intervention for undergraduates, and subsequently for a chatbot to support young people with the impacts of the COVID-19 pandemic, with all three systems having been used in field trials. The Headstrong architecture illustrates the feasibility of creating a domain-focused authoring environment in the context of e-therapy that supports non-technical expert input and rapid deployment.