Latest / The Mental Health Evolution / Ep 40: When States Step Up for Safety with Delegate Lily Qi

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Ep 40: When States Step Up for Safety with Delegate Lily Qi · The Mental Health Evolution

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(Transcribed by TurboScribe. Go Unlimited to remove this message.) This podcast is part of the Frederick Podcast
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Network.
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Learn more at listenfrederick.com.
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Welcome to Mental Health Evolution, a podcast about
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what's changing in mental health and why it
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matters.
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I'm your host, Rachel Harrison, inviting you into
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honest conversations with people from all perspectives in
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the field, clinicians, tech founders, investors, insurance companies,
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and all the folks in between.
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Let's explore what's working, what's not, and what's
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next.
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All right, everyone, welcome back to the Mental
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Health Evolution podcast, where we are talking about
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how the landscape is quickly evolving in the
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mental health industry.
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As you probably know, we are coming to
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you from the state of Maryland, and today
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we are really excited to speak with Maryland
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State Delegate Lily Chee, who represents District 15,
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just south of us here in Montgomery County.
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Delegate Chee is currently seeking another term as
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a Maryland delegate.
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She works at the intersection of economic policy,
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consumer protection, and state systems design.
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In recent legislative sessions, she has focused on
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how Maryland responds to emerging technologies, including artificial
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intelligence, and how those technologies intersect with behavioral
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health systems and consumer safety.
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Her work sits within a broader national trend
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where states are increasingly stepping into mental health
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regulation, workforce challenges, and technology oversight in the
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absence of consistent federal standards.
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And as always, before we talk to our
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guest, we'd like to bring up a few
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relevant articles related to the topic today.
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These may be helpful for you if you
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know that there's some legislation out there, but
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you don't know exactly what we're talking about,
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and we'll definitely link all of these in
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the show notes for you so that you
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can have a great point of reference to
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go back to if you'd like to as
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well.
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The first article is a link to Maryland
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House Bill 883, which focused on the use
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of artificial intelligence in behavioral health care contexts.
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This was the bill that we were working
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to promote from our end in Maryland and
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what initially got us interested in talking to
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Delegate Chee today.
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Unfortunately, it did not make it through the
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full legislative process this session, but it's still
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an interesting example to look at in the
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context of how states are approaching AI regulation.
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Similar legislation has been passed in other states,
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and in this episode, we'll talk to Delegate
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Chee about plans to potentially reintroduce this or
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similar legislation in the upcoming session.
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And then the next article we have is
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talking about how states across the country are
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continuing to increase investments in mental health systems,
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including workforce development, school-based services, crisis response,
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and behavioral health infrastructure.
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This reflects a broader recognition that mental health
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challenges are not only clinical issues, but system
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-level issues that require sustained public investment at
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the state level, especially as federal funding priorities
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continue to shift.
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And this article is from NGA.org.
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And lastly, we have a growing article number
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three is from AI2, and this is a
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growing number of states are beginning to pass
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legislation addressing the use of artificial intelligence in
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mental health contexts, including concerns about safety, accuracy,
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and whether AI tools should be allowed to
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simulate therapy or behavioral health services.
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Tennessee, for example, has moved to ban certain
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AI therapy chatbots, signaling a broader wave of
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state-level regulation aimed at protecting consumers in
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the absence of federal standards.
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So you kind of see the framework of
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what we're talking about here.
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States are really trying to figure out the
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best way to balance the idea of what
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this technology can do to help us and
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also protect consumers in the process.
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So that is a lot of what Delegate
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Xi is all about.
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And I'm excited that she's here to talk
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with us.
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So welcome, Delegate Xi.
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Thank you very much, Rachel.
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It's a pleasure to join you today.
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Thank you.
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So to start off, I'd love to just
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ground this for our listeners.
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You've worked on a wide range of issues
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in the Maryland General Assembly.
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What first got you interested in the intersection
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of artificial intelligence, consumer protection, and behavioral health?
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Great question.
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I have served on the Economic Matters Committee
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for my entire two terms, and that means
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much of my work is at the intersection
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between consumer protection, business regulation, and advancing Maryland's
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competitive industries of the future.
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As someone with an economic development background, I
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certainly will continue to champion our innovation industries,
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including AI and other related industries.
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So this is not about not wanting AI
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to develop in the state of Maryland or
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serve consumers.
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I personally also use chatbots for research, for
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verification, for ideas sometimes.
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So definitely AI has a very important and
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increasingly important role to play in our everyday
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lives, has an enormous amount of benefits that
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we can all enjoy.
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But at the same time, because of our
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increasing relationship and dependency sometimes on AI usage
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for our everyday work and life, there's also
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a risk that is not talked about enough
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or people are aware of, especially for the
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most vulnerable population, whether they are seniors or
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people who speak English as a second language
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or our youth.
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So we all know, you know, since the
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pandemic, there was a huge surge of youth
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mental health crisis, and that surge coincided with
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the rapid evolution of AI.
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So we all knew something needed to be
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done.
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And as someone who pays attention to something
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like that, I was aware that the Trump
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administration just does not like the idea of
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the states regulating AI.
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In fact, there was an executive order specifically
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written to punish states that dare to regulate
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AI.
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So short of federal action, which I wish
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was the case, states have to be the
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backstop to protect our consumers and to have
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some baseline regulation and clarity about what is
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and is not acceptable behavior.
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So when this bill idea was brought to
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me, I thought it was perfect.
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This is a great timing for us to
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zoom in on this issue.
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Plus, I happen to serve on the right
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committee to advance that bill.
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Yeah, all the all the things kind of
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aligned, it sounds like.
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Right.
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Yeah.
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Yeah.
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And so I would love to hear your
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sort of story of how the bill got
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started, what happened, and maybe a little bit
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about what's next.
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I know that's kind of broad, but.
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Yeah, so when the advocates brought this bill
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to my attention, I discussed it with my
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chief of staff and I said, you know,
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I'll be more than happy to do that.
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Of course, we have Zoom calls, multiple Zoom
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calls with different advocacy groups and bipartisan support
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to sign out as co-sponsors, because I
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don't know if you're aware, but this session,
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the House Minority Leader himself also introduced a
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similar bill because so this is a bipartisan
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issue that affects everyone.
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Right.
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So I was very encouraged.
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The colleagues, my Republican colleagues, offered to co
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-sponsor my bill.
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He said, hey, we heard you are introducing
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a chatbot bill.
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Can we sign on to that?
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I said, perfect.
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So I was very encouraged and got a
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long list of people to sign up to
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testify at the bill hearing.
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You could see that online.
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And I was very encouraged that the bill,
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you know, got advanced all the way across
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the House with overwhelming bipartisan support.
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And I even presented it on the Senate
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side.
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Unfortunately, that got stalled.
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And I don't know if it was because
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there was confusion about the scope of it
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or was because big tech's aggressive lobbying.
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Right.
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Because at the end of the day, as
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much as the tech companies say, you know,
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we don't want a 50 state patchwork.
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And I understand the bottom line is, you
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know, this is not the first industry that
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has to go through 50 state regulation.
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You know, banking, for example, is regulated at
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a federal level, but every state also has
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their own banking laws.
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Right.
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Insurance, you know, another major industry that affects
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everyday people's lives is not heavily regulated at
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the federal level.
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So every insurance company will have property and
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casualty insurance, for example.
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Right.
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We'll have to go through 50 different states'
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rule books.
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So this is not new, a new territory
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for businesses to adapt to.
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Right.
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And so we all can leverage each other's
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examples and model policies to see what is
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working and whatever to make it work for
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tech companies.
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And frankly, at the end of the day,
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if the big techs were doing their jobs,
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self regulating, we wouldn't be here talking about
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this.
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Right.
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I mean, at my hearing, there was a
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parent who came with this framed photo of
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his 12-year-old boy who took his
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own life because of chatbot manipulation.
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Right.
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So that's the kind of example we wanted
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to stop.
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There's nothing right now in Maryland that stops
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this kind of self-harm or harming other
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people because of chatbot influence.
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So something has to be done.
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And because it got stalled, the next step
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is we'll continue to build alliances, you know,
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continue to educate other legislators.
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And this year, I think I would have
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the advantage of starting early, earlier.
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Right.
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Now that we have gone through this round
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and made some progress on the House side,
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I think we can be more focused in
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our efforts.
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Yeah, yeah.
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And I think you're right.
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I, too, am not against AI in any
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capacity.
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Right.
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But as a as a person in the
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mental health industry and being trained as a
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clinician, it is so alarming to think that
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there's this access out there for anyone.
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And and there are lots of AI chatbots
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being marketed as a counselor until you look
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at the fine print and they say, no,
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we're not a therapist.
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Right.
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And so that's very confusing because all the
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marketing says, yes, we're here to support you.
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And then it's like, but if you tell
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me something that's challenging or difficult, don't blame
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me.
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I'm not a therapist.
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It's very, it's just risky.
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And when it's free, also, there's just no
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no guardrails.
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Right.
11:25
Right.
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I don't know if in my response to
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your earlier question, I made it clear what
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the bill actually does is very simple.
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Which is simple disclosure.
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Right.
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You say, you know, this AI system that
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you are interacting with is an AI system.
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It's not certified or licensed human professional at
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the back end giving you proper professional advice
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for mental health.
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Right.
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That's a simple disclosure.
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People need to know before they fall into
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the traps, you know, because the chatbots are
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designed to kind of coach your ego, make
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you feel good about the decisions and ideas
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you have.
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They keep encouraging you, even if you're on
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the wrong path and say, oh, that's a
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great idea.
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Yeah.
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You know, you should do that.
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Right.
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Why not?
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You know, and it's designed to be so
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encouraging and stroke your ego and make you
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feel good about whatever ideas you have.
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So I think this is really a very
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high risk proposition we're looking at.
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Yeah.
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I mean, yeah.
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And I think that, too, that's not you're
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not asking too much.
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You're not.
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I think it's the state of Illinois that
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has said there can't be any AI therapists
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or chatbot therapists like there are definitely stronger
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lines being drawn in different states.
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So simply disclosing and then allowing people to
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have the information to make the decision then
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on their own, what they choose to do
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with that seems like a pretty reasonable step.
12:53
Yeah.
12:53
We found it very reasonable.
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Mm hmm.
12:56
Yeah.
12:58
What are your thoughts on some of the
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other state rulings?
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Not that I expect you to be an
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expert on all of those, but I'm curious
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if any of those informed or inspired your
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decision for what you put forward in the
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House bill.
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Well, I am confident after this session, between
13:15
now and the next session, there will be
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more states that are stepping up and introduce
13:20
or maybe this session they have already passed
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while Maryland stalled.
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Right.
13:25
AI chatbot bill.
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And by the way, the minority leaders also
13:28
did not advance on the Senate side.
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So I think we need to focus on
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the Senate.
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Yes, it sounds that way.
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Yeah.
13:35
I was encouraged that not only did Maryland
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House passed with overwhelming bipartisan support, but states,
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other red and blue states, including those very
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tech driven states like California and New York,
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right, are leading the way.
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You know, and other states like Utah, Nevada,
13:55
Illinois and all that have all stepped in.
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And you mentioned Tennessee.
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So this is going to sweep across the
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country as more and more Americans are waking
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up to the downside of unregulated AI and
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how invasive these systems can be in our
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lives.
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So I think I'm very optimistic and hopeful.
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It's just a matter of technically how to
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do it right and how not to let
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the tech lobbyists come back and say, you're
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being too broad.
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I don't know if you saw my pushback
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against their pushback, so to speak, and say,
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you know, this is too broad and blah,
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blah.
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I said, well, they come up with some
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solutions.
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Right.
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If you know the status quo is not
14:36
perfect, then work with us.
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You know, make it work.
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Don't just come say categorically oppose any regulation.
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As I said, you know, if you were
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good at self-regulating, we wouldn't be here
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talking about this, you know, so work with
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us.
14:51
Give us ideas.
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If it's neat, if it needs to be
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narrowed and tailored, then show us what works
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in other states.
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Yeah.
14:58
And I think especially in the mental and
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behavioral health space, it's just not a tool
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that can be broadly applied without some thought
15:08
processes and guardrails and things like that.
15:11
So I think it's been.
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Yeah, maybe a little accidental, maybe a little
15:15
short sighted, maybe all those things.
15:18
But I have talked on this podcast with
15:20
some people who are developing different AI systems
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and a lot of them do acknowledge some
15:25
of the errors, some of the hallucinations, the
15:29
mistakes, the risks, you know, so that information
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is out there, right?
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It's not.
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How can it be?
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It's pretty new.
15:36
Yeah, that's right.
15:38
Yeah.
15:38
There's human bias, too, in training the AI
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to make decisions.
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Yeah, absolutely.
15:44
Absolutely.
15:46
Yeah.
15:46
So when when you and other legislators coordinate
15:49
these approaches, when it comes to build like
15:51
this, when technology is moving faster than any
15:54
one state can keep up with, how does
15:57
that coordination and collaboration work?
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And is there anything that listeners can do
16:03
to help support this?
16:05
Yeah.
16:05
Great questions.
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I'm looking forward to joining this year's national
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conference in Chicago, which is the National Conference
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for State Legislators.
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And with AI being so pervasive and important
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as an area of regulation, I'm really looking
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forward to joining these workshops and seminars to
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learn what other states are doing and how
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to perfect my bill to make it work,
16:29
remove the impediments to passage, hopefully, to a
16:33
better path and how they build coalitions across
16:37
different consumer groups and user groups and all
16:40
of that.
16:41
So I'm really looking forward to connecting with
16:43
other state legislators, learning different ways to tackle
16:47
this issue.
16:49
And is there any particular way that someone
16:52
listening, like maybe they're in Maryland and this
16:55
bill specifically, or maybe they're just in the
16:57
United States and they're just interested in advocating
16:59
for this?
17:00
What would you recommend as next steps for
17:04
that type of advocacy?
17:06
I think it's important to bring ideas to
17:10
legislators because we are no subject matter experts
17:13
in every aspect, in every area, right?
17:16
I came from a very different professional background
17:20
than AI regulation, for example.
17:23
It is such a new area that everyone
17:25
is learning and it's constantly evolving.
17:28
So please bring new ideas to us and
17:31
reach out to our offices.
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But also, if you feel passionate and strongly
17:35
about certain things, build a coalition and don't
17:38
just expect the hearing itself to deliver magic.
17:43
The real work is behind the scenes, right,
17:45
is reaching out to the committee members one
17:47
by one, committee chairs, make sure both the
17:52
House and Senate are on the same page,
17:54
work with us throughout the process.
17:56
Don't just expect to show up and speak
17:59
your two minutes or testimony and think people
18:02
will get the message.
18:03
With thousands of bills introduced each year and
18:07
only a 90-day session, my advice to
18:10
the advocates is start early, do your homework,
18:14
reach out, build a coalition, remove the potential
18:18
questions that legislators may have on their minds
18:22
about how this might work and all that.
18:24
I mean, the more we do the homework,
18:26
the more prepared we are to push for
18:29
the passage of a bill like this.
18:31
And when you say create coalitions, what exactly
18:35
do you mean by that?
18:36
I think a coalition could be built between
18:38
the tech community, which also at least, you
18:42
know, that's what they claim.
18:43
They care about users because that's what they
18:46
sell to, right?
18:47
They cater to users.
18:48
And I don't doubt that they are doing
18:50
a lot of work to stop the harm
18:53
and all of that, but it's just not
18:55
enough, right?
18:56
We have seen harm, we have seen real
18:58
danger on our community, especially the vulnerable populations.
19:02
So it needs regulation.
19:04
And we can never stop bad players from
19:07
entering the market until we have regulation in
19:10
place.
19:11
So I think community advocates, parent groups, anyone
19:17
who is concerned about the AI's harm, build
19:21
a coalition with other, you know, like consumer
19:24
advocacy groups, for example, as well as the
19:27
tech community, right?
19:29
And with the school systems, for example, or
19:32
with the senior community, whatever places where you
19:35
think people will get it.
19:37
And with the behavioral professionals or other licensed
19:40
professionals that people often, or the kind of
19:44
service providers where people often go to AI
19:47
to seek help for advice.
19:50
So I think that there are multiple ways
19:53
to do that.
19:53
And of course, to build bridges and relationships
19:56
with your own state representatives and legislators is
20:00
always a good idea.
20:02
I think that's a great invitation coming from
20:06
you, Delegate Chi, because I don't know that
20:08
in my industry, a lot of people talk
20:11
about that or think about that necessarily.
20:15
And it is such a changing industry and
20:18
there is so much happening right now.
20:20
And that is a great, yeah, just opening
20:22
up lines of communication, giving our perspective, expertise,
20:27
what's impacting us, all of those things.
20:29
So I really appreciate you saying that.
20:31
I don't think that that is often a
20:33
route.
20:33
In mental health, we can be so focused
20:35
on patient care that that's sort of all
20:39
we focus on.
20:41
Right, right.
20:42
You know, the immediate issue.
20:44
Yeah.
20:45
And then these things come and they impact
20:47
us and our clients and we suddenly get
20:50
worried.
20:50
But then it's like, OK, well, wait, what
20:52
do we do about this?
20:53
And that's really how this podcast was born
20:55
is like, what do we do about all
20:57
these changes?
20:57
I don't know.
20:58
So let's have the conversation.
21:00
Let's see what people are talking about.
21:02
Yeah, yeah.
21:03
Zooming out a little bit, when you think
21:06
about behavioral health more broadly, where do you
21:09
see the biggest gaps right now that state
21:11
policy is actually able to address in a
21:14
meaningful way?
21:15
That's a big question.
21:17
Yeah, I think in the stepping back, I
21:19
think when you look at holistically the space
21:23
of AI regulation, I think we are still
21:26
the whole world is still relatively new, right?
21:29
Yeah.
21:29
Understanding AI and how it can be so
21:32
sweeping in benefiting or harming, you know, our
21:37
lives and what what should the human relationship
21:40
be?
21:41
What is the what is a how do
21:43
we define healthy human relationship with an AI
21:46
system?
21:47
Right.
21:48
So that we can reap the benefits without
21:51
being harmed by the system, whether it's workforce
21:54
disruption, whether it's, you know, AI taking over
21:58
certain people's ability to think critically and do
22:01
their homework and all of that.
22:03
Right.
22:03
But on the other hand, there's tremendous potential
22:06
to to improve the quality of life and
22:09
the human experience in so many ways.
22:11
Right.
22:11
So I think this is still a new
22:13
frontier that when we take a step back,
22:16
we should just look holistically.
22:18
And then another issue is how Maryland wants
22:20
to position ourselves in this whole AI revolution.
22:24
Right.
22:24
How inviting do we want to be in
22:27
facilitating the development of AI companies and industries
22:31
in our state as a competitive advantage?
22:35
Right.
22:35
But at the same time, putting in proper
22:37
guardrails so our community is not harmed, you
22:41
know, or is aware of the potential harm
22:43
of AI.
22:44
And then another issue related to that is
22:47
workforce, workforce shortage related to certain areas.
22:52
Yeah.
22:52
In this case that we're talking about behavioral
22:55
health, you know, people turn to AI because
22:58
just not enough resources around to help them
23:01
with their mental and behavioral health.
23:03
They think this is anonymous tool that makes
23:05
them feel safe.
23:07
That's why they turn to AI.
23:08
Right.
23:08
How do we create that kind of human
23:10
environment where it's safe and accessible and hopefully
23:14
also culturally competent so that we can meet
23:17
people where they are and how we can
23:20
invest in such workforce that is, you know,
23:23
linguistically accessible, culturally competent and hopefully also age
23:27
appropriate and all of that.
23:29
So there are a lot of big questions
23:31
we have not answered.
23:32
We are still grappling with this is, you
23:35
know, the kind of issues policymakers at the
23:38
federal and the state level should be thinking
23:40
about.
23:40
Yeah, that that's pretty inspiring.
23:43
From my perspective, one of the things that
23:46
I feel passing a bill offers is just
23:51
that there is guidance out there for consumers.
23:54
It's a line in the sand that says,
23:58
be careful.
23:59
Right.
24:00
Some people may still choose to use it.
24:02
But from the end of providing behavioral health,
24:06
mental health services, you know, a lot of
24:08
our clients are utilizing it alongside human therapy.
24:13
So sometimes we're educating and talking about how
24:16
do we use that interactively and effectively, but
24:19
not dangerously.
24:21
And the legislation, to me, gives some guidance
24:26
to that, gives some support to that and
24:29
really helps the work that we are able
24:31
to do.
24:32
So, yeah, I appreciate all that you have
24:35
done in that vein.
24:36
Anything as we wrap up here today that
24:40
you would like to leave our listeners with
24:42
as a last tidbit or something for them
24:47
to be mindful of or encourage them or
24:50
inspire them in any way?
24:52
Well, I just want to be encouraging by
24:54
saying don't give up.
24:55
You know, this is an important field and
24:58
I will continue to be your partner.
25:00
Please reach out to our office if you
25:02
want to be involved in advocating and pushing
25:04
for the bill's passage, hopefully next year.
25:08
This is the time to have this kind
25:09
of conversation.
25:10
I welcome your ideas, your input, whatever.
25:13
Hope to see you in Annapolis and beyond.
25:16
It is a partnership, an ongoing partnership.
25:19
Awesome.
25:20
I appreciate that so much, Delegate Chi.
25:22
Thank you so much for being here, talking
25:25
through the process with us.
25:26
And yes, we look forward to next session
25:29
as well.
25:30
Great.
25:30
And maybe you want to share with your
25:32
listeners my contact information so that Absolutely.
25:35
We will include that in the show notes.
25:37
If anybody wants to reach out, that would
25:39
be great.
25:41
And we'll have all those articles in the
25:42
show notes.
25:43
And so people can also follow the progress
25:45
and see what happened last session as well.
25:48
Great.
25:49
And for our listeners, thank you for diving
25:51
in with us today.
25:53
We will be back next week to talk
25:55
more about the evolving landscape in the mental
25:58
health field.
25:59
Bye for now.
26:00
Thank you, Rachel.
26:01
Thanks for listening to the Mental Health Evolution
26:05
podcast.
26:06
Join the conversation.
26:07
Find us on socials, send us your thoughts
26:09
and tell us what you are seeing in
26:11
your corner of the mental health world.
26:13
Until next time, stay curious and keep evolving.