In today's column, I examine on a macroscopic scale the upbeat impact that widespread low-cost use of generative AI and large language models (LLMs) can have on society-wide mental health. My attention is toward an incredible up-and-coming return on investment (ROI) that is sitting right in front of how to cope with the existing worrisome and sadly worsening national mental health condition.
Here's the deal. Most existing ROI approaches for assessing the costs and benefits of governmental or privately funded mental health initiatives are based on conventional approaches to improving mental health. An initiative might involve psychoeducational efforts to increase awareness of mental health conditions and how to tap into clinical resources accordingly. Or there might be initiatives to train non-therapists in the keystones of therapy so they can spread throughout their community to provide limited levels of mental health guidance. And so on.
There is a new and humongous means of improving mental health that changes dramatically the ROI calculations. Yes, I'm referring to the advent of modern-era generative AI. This contemporary AI interacts with people on mental health and well-being facets that can markedly improve mental health on a massive scale, doing so at an amazingly low-cost. All told, it is now time to include the role of AI in the ROI analyses for how to deal with societal mental health issues.
Let's talk about it.
This analysis of AI breakthroughs is part of my ongoing Forbes column coverage on the latest in AI, including identifying and explaining various impactful AI complexities (see the link here).
AI And Mental Health
As a quick background, I've been extensively covering and analyzing a myriad of facets regarding the advent of modern-era AI that produces mental health advice and performs AI-driven therapy. This rising use of AI has principally been spurred by the evolving advances and widespread adoption of generative AI. For an extensive listing of my well over one hundred analyses and postings, see the link here and the link here.
There is little doubt that this is a rapidly developing field and that there are tremendous upsides to be had, but at the same time, regrettably, hidden risks and outright gotchas come into these endeavors, too. I frequently speak up about these pressing matters, including in an appearance on an episode of CBS's 60 Minutes, see the link here.
Background On AI For Mental Health
I'd like to set the stage on how generative AI and large language models (LLMs) are typically used in an ad hoc way for mental health guidance. Millions upon millions of people are using generative AI as their ongoing advisor on mental health considerations (note that ChatGPT alone has over 900 million weekly active users, a notable proportion of which dip into mental health aspects, see my analysis at the link here). The top-ranked use of contemporary generative AI and LLMs is to consult with the AI on mental health facets; see my coverage at the link here.
This popular usage makes abundant sense. You can access most of the major generative AI systems for nearly free or at a super low cost, doing so anywhere and at any time. Thus, if you have any mental health qualms that you want to chat about, all you need to do is log in to AI and proceed forthwith on a 24/7 bas
There are significant worries that AI can readily go off the rails or otherwise dispense unsuitable or even egregiously inappropriate mental health advice. Banner headlines in August of this year accompanied the lawsuit filed against OpenAI for their lack of AI safeguards when it came to providing cognitive advisement.
Despite claims by AI makers that they are gradually instituting AI safeguards, there are still a lot of downside risks of the AI doing untoward acts, such as insidiously helping users in co-creating delusions that can lead to self-harm. For my follow-on analysis of details about the OpenAI lawsuit and how AI can foster delusional thinking in humans, see my analysis at the link here. As noted, I have been earnestly predicting that eventually all of the major AI makers will be taken to the woodshed for their paucity of robust AI safeguards.
Today's generic LLMs, such as ChatGPT, Claude, Gemini, Grok, and others, are not at all akin to the robust capabilities of human therapists. Meanwhile, specialized LLMs are being built to presumably attain similar qualities, but they are still primarily in the development and testing stages. See my coverage at the link here.
ROI On Mental Health Initiatives
Shifting gears, let's discuss the potential return on investment (ROI) associated with the adoption of various mental health initiatives. Calculating an ROI requires laying out essential factors.
The way that mental health initiatives are usually designed consists of identifying a population that is the aim of the effort. An initiative might be focused on a narrow population based on particular demographics. The number of people could be relatively modest in the sense that the initiative covers part of a town or city. Think of this as a local-level initiative.
There are larger initiatives at the state level, perhaps encompassing hundreds of thousands or millions of people. The effort might cut across all sorts of municipalities and range widely in terms of demographics. We can zoom further out and have initiatives on a federal or nationwide basis.
The gist is that a mental health initiative is typically shaped around an intended population target. Of that population, the odds are that not everyone is going to participate or be touched by the initiative. It is useful to estimate what portion or percentage is likely to encounter the initiative.
Impacts Of An Initiative
The idea is to gauge what impact the mental health initiative has on the population that is covered by the initiative. Hopefully, the overarching mental health of the targeted population will be improved because of the initiative. We need to be able to measure the benefits or positive outcomes that arise. This can then be paired against the costs of undertaking the initiative.
Voila, we can then determine an ROI.
You normally come up with an anticipated or hoped-for ROI. This helps in justifying the initiative. Whatever source of funding there is, whether a governmental agency or privately funded, will usually want to know whether the investment is justifiable. If the estimated costs far exceed the expected outcomes, this will seem a somewhat sketchy way to use limited funds and constrained resources. There might be other alternatives that would be a better gamble.
Different mental health initiatives can be pitted against each other to weigh their respective value. Each one will have its own ROI. Each will have risks and other possible downsides. Likewise, each will have its potential upsides. Most mental health initiatives are complex and trying to decide which is more deserving than the other is quite a challenging affair. The complexity is not only based on dollars and cents, but it also entails socio-political elements and doesn't neatly get entirely captured in numbers per se.
Role Of Physical Health
Attempting to measure changes in mental health is a dicey proposition. How can we reasonably know that mental health went from some tangible amount to some higher amount due to the implementation of a mental health initiative? It's a hard aspect to readily measure.
You might try using surveys and ask people whether they feel that their mental health has improved. Another angle would be to administer mental health tests and do a before-and-after test. We could send out evaluators who are trained on gauging the impacts of mental health initiatives. They could fan out and assess whether mental health has improved. Numerous paths can be pursued.
One perhaps surprising way to measure the mental health impacts is by including physical health as a measure. I realize that at first glance this might seem askance. Why would someone's physical health have any pertinence to their mental health? It seems like we are veering away from the mental health focus.
Research has shown that there is a close bond between mental health and physical health. There is a reciprocal relationship at play. Your mental health can impact your physical health. And your physical health can impact your mental health.
In a research study entitled "The Projected Costs And Economic Impact Of Mental Health Inequities In The United States" by Meharry Medical College School of Global Health and Deloitte Health Equity Institute, 2024, these salient points were made (excerpts):
* "Twenty-five years ago, when Dr. David Satcher released the first surgeon general's report on mental health, he observed that there can be no health without mental health."
* "Mental health is the invisible counterpart to physical health."
* "It is important to understand that both physical health and mental health are linked, and that the soaring cost of health care in the United States due to chronic physical conditions will continue to rise until society tackles the mental health needs that exacerbate those issues."
* "About 90% of American adults believe that the country is experiencing a mental health crisis, and their opinions appear to be justified as prescriptions for antidepressants rose 15% between 2015 and 2019 for adults and 38% for adolescents."
* "Poor mental health outcomes include a broad range of negative consequences resulting from undertreated or untreated mental health conditions, such as social isolation, impaired cognitive function, development of or worsening physical health conditions, and increased susceptibility to substance use."
I assume you would reasonably agree that incorporating physical health into seeking to measure mental health is a sensible avenue.
Handiness Of The Relationship
The beauty of incorporating physical health is that we have a multitude of tangible ways in our society of measuring physical health. Perhaps we can astutely use physical health as a means of going after the somewhat less tangible aspects of mental health.
Imagine that a mental health initiative is launched. Suppose the physical health of the targeted population is increased. For example, there are fewer visits to hospitals than would otherwise have occurred. Maybe people were less likely to take days off from work. All sorts of readily calculable aspects can serve as a proxy for claiming that the mental health initiative is paying off.
You could prepare a spreadsheet that has a listing of the factors and use that spreadsheet to calculate the anticipated ROI. And you could calculate the actual ROI once the initiative is underway or completed. There are mental health initiative spreadsheets online that you can tap into. Nowadays, it is relatively easy to make such a spreadsheet, and you can download a template or simply prepare one from scratch.
Some of the primary factors could include:
* Avoidable physical health conditions driven by mental health conditions.
* Cost of emergency room (ER) expenditures due to mental health conditions.
* Work productivity losses due to workforce mental health conditions.
* Economic cost from premature deaths due to mental health conditions.
You can look at chronic physical health conditions such as cardiovascular disease, diabetes, hypertension, etc., and estimate the reduction in those costs for whatever impact improved mental health might provide.
Another convenient route is to look at productivity losses in the workplace due to absenteeism (workers taking sick days due to mental health conditions), presenteeism (workers showing up to work but not fully functioning due to mental health conditions), and unemployment (becoming unemployed due to mental health conditions).
We must be cautious in making a willing leap that those "benefits" were truly a result of mental health improvements. The world is a messy place. There could be other reasons that those upsides arose. Always give scrutiny to any claims about incredible ROIs since the underlying factors might be explainable by elements outside of mental health, and the mental health initiative is "unfairly" riding on the coattails of other phenomena (I'll hit you with one surprising example, momentarily).
Online ROI Calculators For Mental Health Initiatives
A new website that provides an online ROI calculator for gauging mental health initiatives was recently made available and provides a handy, ready-to-use capability. Titled as the "Evidence-based Mental Health Return On Investment Calculator" and provided by Meharry Medical College School of Global Health, The Mental Health Innovation Network, 2026, here are some key aspects (excerpts):
* "We introduce the Mental Health Return on Investment (ROI) Calculator."
* "This tool helps policymakers, organizational leaders, benefit managers, and others assess the effectiveness of mental health interventions and programs."
* "By quantifying the economic value of mental health strategies, the calculator enables users to model potential savings, forecast long-term impact, and strengthen the business case for investing in data-driven solutions."
* "The tool shows how investments in mental health translate into stronger workforce wellbeing, economic stability, and healthier communities."
It is a straightforward model, and the website nicely articulates what the parameters consist of. I mention this since some models are not very transparent. They hide or obfuscate the factors. You have little awareness of what is being asked for and how the internal calculations are magically producing the presented ROIs.
Some of the factors of this online ROI calculator include:
* Total population size
* Mental health prevalence
* Expected participation
* Employment rate
* One-time setup cost per person
* Annual operating cost per person
* Program duration
* Annual medical cost per person
* Cost per ER visit
* Medical cost reduction
* Sick days per employee per year
* Expected absenteeism reduction
* Etc.
The formulas that are embedded into the model are explained in narrative form, such as "Population at Risk = floor (Total Population Size × Mental Health Prevalence / 100)" and "Total Setup Costs = Total Participants × One-Time Setup Cost Per Person".
The New Role Of Widespread AI
I have dragged you through that foundational backstory on ROIs of mental health initiatives to bring you to something that is a bit of a surprise and revelation. Here it is. The advent of modern-era generative AI is a new hidden factor that needs to be given due attention when talking about mental health initiatives and ROIs.
Why so?
First, a claim can be made that on a widespread basis, the use of generative AI is uplifting mental health across various populations. Millions upon millions of people are routinely dipping into AI to get mental health advice. This is happening not due to a particular mental health initiative. It is a separate activity, yet if it is indeed raising mental health, an initiative might unfairly assert that improvements arose even though the improvements were spurred by AI and had nothing to do with the initiative itself.
All boats are raised by the rising tide.
Second, since AI usage varies, it is vital to consider what population is targeted for an initiative and to what degree that segment might be using AI for mental health purposes. It could be that only certain demographics in that population are likely to have access to AI and/or use AI for mental health guidance. The goal would be to ferret out where AI usage is already juicing results and where it is not.
Third, astute mental health initiatives need to upfront acknowledge that the popular use of generative AI and its massive availability do play a role in measuring and gauging the initiative and its potential ROI. Do not pretend that the AI is not there. Keeping your head in the sand is not a good look. Be honest about the world we live in today.
Fourth, consider leveraging the aspect that generative AI is so widespread. How might the mental health initiative lean into the use of generic generative AI? This does complicate things since the initiative might have little if any control over the use of generic generative AI. It is a dual-edged sword, so be careful.
Fifth, an initiative should consider employing a customized AI mental health capability. Doing so allows for more control over what the AI does and ascertaining what happens when it is utilized. You would need to select the AI or devise the AI. That's a lot more work. You would need to ensure that the targeted population can access the AI and will, in fact, make use of it. That's a challenge. Anyway, the point is that keep in mind there is a difference between generic generative AI and AI that is customized for mental health advisement.
The Three Eras Of Generative AI ROI Impacts
Estimates suggest that around 1.5 billion people are routinely using generic generative AI. Some percentage of those people are opting to use the AI for mental health guidance, perhaps around 20% to 30% by various estimations (see my analysis at the link here).
Do those counts seem staggering?
Well, those numbers are going up; thus, be ready to be further astounded. The percentage of tapping into mental health guidance is expected to increase, aiming for 50% or higher. In addition, the 1.5 billion overall count is expected to increase, reaching soon 2-3 billion people (and higher later). The number of people is increasing, and the percentage of those using AI for mental health is increasing. It's a twofer. The use of AI is just now ramping up. No end in sight.
A bottom-line consideration is that the "hidden" impact of generic generative AI pervasively serving as a mental health impact is going to get even more pronounced. The impact can be positive. Regrettably, the impact can also be negative, in the sense that the chances of people stirred toward delusions and AI psychosis will rise too, see my discussion at the link here.
I predict that we will experience these three coming eras:
* (1) Near-term Era Of Erratic ROI (1-2 years from now). Generative AI mildly plays a role in raising population-level mental well-being, doing so on a relatively sporadic or random basis.
* (2) Medium-term Era Of Predictable ROI (3-5 years from now). Generative AI becomes a well-known and predictable population-level mental health impactor, including being carefully studied and tracked.
* (3) Long-term Era of Arranged ROI (5+ years from now). Generative AI is actively shaped to engage in the mental health of users, and regulatory frameworks make this a societal requirement for public health intervention.
Gradually, the hidden role of generic generative AI will become exposed. Policymakers and lawmakers will realize that regulatory approaches for the mental health consequences are going to be needed. See my analysis of AI mental health policies and laws at the link here and the link here.
The World Is Changing
The terrain of AI is the human psyche.
It is incontrovertible that we are now amid a grandiose worldwide experiment when it comes to societal mental health. The experiment is that AI is being made available nationally and globally, which is either overtly or insidiously acting to provide mental health guidance of one kind or another. Doing so either at no cost or at a minimal cost. It is available anywhere and at any time, 24/7. We are all the guinea pigs in this wanton experiment.
The reason this is especially tough to consider is that AI has a dual-use effect. Just as AI can be detrimental to mental health, it can also be a huge bolstering force for mental health. A delicate tradeoff must be mindfully managed. Prevent or mitigate the downsides, and meanwhile make the upsides as widely and readily available as possible.
A final thought for now.
Benjamin Franklin famously made this remark: "An investment in knowledge pays the best interest." By investing in the use of AI to serve as a societal mental health guidance tool, we are making a good investment that has substantive ROI. That goes along with Benjamin Franklin's other famous line that being well done is better than simply being well said.