Nearly 1 in 5 adolescents and young adults in the U.S. — an estimated 8.2 million people — used an AI chatbot for mental health advice in 2025, according to a study published June 1 in JAMA Pediatrics. The findings are stark: 91.7% rated the guidance as somewhat or very helpful, and 42.8% came back at least monthly. But 63.3% never told a parent, friend or other trusted adult they were doing it.
For John Constantino, MD, chief of behavioral and mental health and the Liz and Frank Blake chair for children’s behavioral and mental health at Children’s Healthcare of Atlanta, the trend points back to adults, not kids.
He called the turn toward AI-based “surrogate therapy” understandable, given how many barriers stand between youth and a qualified provider — but he was unequivocal that no unguided chatbot has been shown fit for the role. Smartphone data, he said, shows many young people drifting into conversations with AI that mirror what they might otherwise bring to a caregiver or therapist, often without realizing that’s what they’re doing.
“AI can be seductive in pulling, especially vulnerable youth, into that kind of a role or position or mindset,” he said.
Rather than treating AI as the solution, Dr. Constantino argued the more urgent work is giving young people a real, human alternative before they open a chatbot. That means basic steps: guidance on screen time, plain-language explanations of what an AI agent is and isn’t, and an open door to talk about emotional conflict. Above all, he said, every young person needs to know who they can turn to in distress.
He pointed to Hall County, a rural Georgia school district where every student’s ID badge lists the name of a specific adult in the building who serves as that student’s go-to person. It’s a small, literal detail, he said, that stands in for a much bigger obligation.
“It’s an actual representation for those kids, but it’s a metaphorical representation of the necessity of the grown-ups to make sure that children have pathways” to deal with a youth mental health crisis, he said.
Because a device is the only way AI reaches a young person, Dr. Constantino said the more scalable safeguard has to live on the device itself. Children’s Healthcare of Atlanta is working with Atlanta-based Georgia Tech on research aimed at detecting when a smartphone interaction — AI-driven or otherwise — turns harmful. Then, he said, intervene at different levels: privately redirecting the youth in the moment, or, at higher-risk levels, alerting the caregiver who provided the phone or, in an emergency, the authorities. He described the technology as achievable, not speculative.
“It’s all knowable. It’s all devisable,” he said. “There’s a lot of good minds that have developed all this capability. Now we have to use those same minds to protect children who have access to it.”
Dr. Constantino pointed to maternal and infant health as the first point of contact, arguing that many of the stressors shaping youth mental health take hold long before a child reaches a classroom. Schools remain an important front line, he said, pointing to the University of Oregon’s Ballmer Institute for Children’s Behavioral Health in Portland as a model for building school-based services that insurance can actually reimburse.
But he drew a firm line around what schools should be asked to carry. Too often, Dr. Constantino said, health systems look to schools and community partners to take on work that properly belongs to healthcare, pushing higher-acuity cases onto a workforce that was never meant to handle them. Health systems, in his view, need to back up school-based care when a case gets too complex, and direct their own resources to wherever treatment is actually happening.
“I have a huge problem with clinicians in health systems, who are in a good-hearted way lamenting how difficult mental health care is, and saying, ‘Let’s try to get the community to do this. Let’s try to get the schools to do this.’ Let’s try to do anything but own what is a healthcare issue. Mental health is health,” Dr. Constantino said. “The health system has to be right there to back that school up.”
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