2.8.1 Automation, Undermining Face-to-Face Care, and the Risk of Depersonalisation

One uniformly acknowledged risk is that digitising crisis support may reduce the type of human interaction and compassion that is indispensable to providing and experiencing care, support and healing. In 2018, Christopher Hollis and colleagues conducted what appears to be the largest participatory study in the world concerned with charting a research agenda about digital technologies in mental healthcare.⁴¹⁵ 664 ‘people with lived experience of mental health problems and use of mental health services, their carers, and health-care practitioners’ in the UK were consulted. The number one research priority for participants was determining ‘the benefits and risks of delivering mental health care through technology instead of face-to-face’ and considering the impact of removing ‘face-to-face human interaction’.⁴¹⁶ Participants’ concluded that – above all – technologies that emphasised connection should be prioritised. They warned against technologies, including well-intentioned ones, that would exacerbate isolation, loneliness and alienation.

The impact of new technologies on dynamics of care will be a key discussion in coming decades, both in terms of care in health care facilities and residential homes, but also home-based care. One common aim of new technology, such as AI, is to break down tasks into individual components which can be repetitively undertaken. Yet, care is not just tasks, it is also emotion; it is a fundamental part of human relationships and it is a highly complex social interaction.⁴¹⁷> Some have claimed that technology will supersede human care. For example, a major suicide hotline in Australia claimed that a ‘virtual or robotic counsellor’ could ‘speak to lots of people and provide support to people immediately’ whereas ‘phone counselors can only speak to one person at a time.’⁴¹⁸ Others have derided the benefit of human interaction in healthcare encounters, because it is not strictly clinical in nature and wasteful of healthcare resources. Nick Weston, the chief commercial officer at Lilli, a UK company behind biometric monitoring technology that was installed in the homes of older social care recipients, rejected claims that the monitoring could exacerbate the loneliness of older people who would have otherwise received care visits.⁴¹⁹ He stated that ‘We shouldn’t be relying on home care agency staff to provide the social interaction for somebody’.⁴²⁰ Such claims rest on the narrowest conceptions of human care, flattening its complexity in the extreme.

Care has been persistently devalued in many societies. This devaluation is often based on the sexist premise that care is ‘women’s work’, given that care for older persons, persons with disabilities and children has largely been performed by women, paid and unpaid.⁴²¹ Simplistic efforts to automate care can perpetuate this devaluation. To paraphrase Fiona Jenkins, relations of care are neither adequately recognised in many paradigms of digitised mental health care, and the language of market value, nor in our inherited traditions of contemplating the values and virtues that make for a truly human life.⁴²² Such concerns highlight the potential rise of cheap (if limited) software to replace more expensive, expert, and empathetic professionals, and the disruption of care service provision and public assistance for the provision of private mental health care.⁴²³

The potential for care technologies to dehumanise and objectify care-recipients was raised by the UN Independent Expert on the enjoyment of all human rights by older persons, Rosa Kornfeld-Matte.⁴²⁴ The risk of ‘automating care’, she wrote, includes ‘losing one’s sense of identity, self-esteem and control over one’s life’.⁴²⁵ Kornfeld-Matte argued that human dignity must be ‘integrated from the conception to the application of assistive devices and robotics’.426 Even on a purely practical level, new technologies may also mean increased pressure on mental health and other service providers to increase multi-tasking and workloads in generating, inputting, organising, and constantly updating data records. Paradoxically, this extra work may reduce care workers’ time for face-to-face engagement and collaborative work with care recipients and other care workers