Eating Disorder Helpline to Replace Human Staff With AI Chatbot

Eating Disorder Helpline to Replace Human Staff With AI Chatbot

The National Eating Disorder Association has disbanded its long-running, telephone helpline. NEDA has fired the small group of human staff that coordinated and ran the helpline, effective June 1. In lieu, the nonprofit plans to offer people seeking help access to an AI-powered chatbot named “Tessa” next month, as reported by NPR on Wednesday and confirmed by NEDA to Gizmodo over phone and email.

Staff were informed of the change, and of their firing, just four days after they successfully unionized, according to a blog post written by helpline associate and union member Abbie Harper earlier this month. Members of Helpline Associates United say that — by firing them — NEDA is retaliating against the union. The workers’ organisation has repeatedly called the move union busting on the its official Twitter account and elsewhere.

“NEDA claims this was a long-anticipated change and that AI can better serve those with eating disorders,” Harper wrote in the blog. “But do not be fooled — this isn’t really about a chatbot. This is about union busting, plain and simple.”

Helpline workers say they felt under-resourced and understaffed to manage what was being asked of them. Through unionization, they hoped to gain more support. “We asked for adequate staffing and ongoing training to keep up with our changing and growing Helpline, and opportunities for promotion to grow within NEDA,” wrote Harper. “We didn’t even ask for more money.” They’ve filed unfair labour practices charges with the National Labour Relations Board, according to that May 4 blog.

In response to questions about those accusations, NEDA declined to comment. “At this time, we are not at liberty to discuss employment matters regarding our employees. We are always incredibly grateful for our staff and volunteers and respect their needs and privacy,” organisation spokesperson Sarah Chase told Gizmodo via email. She would not offer more details on the timing of the firing and unionization vote in a follow-up phone call.

NEDA is the largest eating disorder-focused nonprofit organisation in the U.S. Its stated mission is to offer support and resources for recovery to people affected by eating disorders. For more than 20 years, people seeking guidance related to eating disorders have been able to turn to NEDA’s toll-free NEDA Helpline.

Now that phone service, which was run by a small team of 6 paid staff and about 200 volunteers, is no more. Calling the number (800) 931-2237 instead directs to a pre-recorded menu. “We are no longer accepting calls to our Helpline. For other contact methods currently available please check out our website,” the recording says.

The option to chat with a human NEDA Helpline representative through the nonprofit’s website still appears to function, as of writing. Gizmodo tested it, and got a response from someone purporting to be a trained, human person. However that online chat function is set to disappear June 1, Chase told Gizmodo.

Note: A crisis text line advertised on NEDA’s website and run by humans will persist, but only because that 24/7 support service is provided by a separate non-profit (literally called Crisis Text Line), which NEDA contracts with. The option to text “NEDA” to 741741 and be connected to a human volunteer remains available.

But otherwise, as the helpline’s workers approach their last days employed and the volunteer network disbands, NEDA plans to pivot to Tessa — a mental health chatbot developed by company Cass (formerly X2AI). Tessa is a separate, older AI-model from OpenAI’s buzzy ChatGPT. It was created with grant funding from NEDA in 2018 under the guidance of two behavioural health researchers: Ellen Fitzsimmons-Craft, a professor of psychiatry at Washington University, and C. Barr Taylor, a Stanford University psychiatrist.

A different version of Tessa, called Tess, is applied more widely — beyond eating disorder support. For instance it is used by U.S. Customs and Border Control’s Employee Assistance Program as a mental health service.

According to NEDA’s description, Tessa consists of pre-set modules that walk users through an eating disorder prevention program. “It can’t go off script,” Chase told Gizmodo. On top of the pre-set modules, the nonprofit’s goal is also to have Tessa “guide individuals to educational resources on our website.”

NEDA claims the chatbot, is “NOT a replacement for the Helpline.” That’s despite the fact that it is, literally replacing the helpline — which again, won’t exist in any form as of June 1. Tessa is “simply a different program,” emphasised Chase over the phone. At one point she also claimed that Tessa isn’t even an AI, despite NEDA’s own press materials repeatedly describing the chatbot as such. In a clarification she wrote, “the simulation chat is assisted, but it’s running a program and isn’t learning as it goes.”

“We’ve moved on [from Helpline],” Chase said. “The Helpline started in 1999 and served a purpose then, which has rapidly depleted itself.” She described that, in NEDA’s view, the phone-based helpline was no longer best serving people’s needs with the advent of the internet. Instead, NEDA plans to shift its focus to improving the online experience. Its will be launching a new version of its website by the end of 2023, she noted.

Except people still reached out to the NEDA Helpline. Lots of people. The organisation had seen a significant surge in call and messaging volume in 2020 and 2021 — corresponding to the early pandemic years. Numbers stabilised slightly in 2022, but the helpline still fielded 69,718 requests for help last year, according to NEDA’s own numbers.

By the organisation’s explanation, Tessa is a better way to serve people seeking mental health guidance in the internet era than its helpline was. But even the researchers who developed the AI-assisted program seem to disagree. “It’s not an open-ended tool for you to talk to and feel like you’re just going to have access to kind of a listening ear, maybe like the helpline was,” Fitzsimmons-Craft told NPR. “I do think that we wrote her to attempt to be empathetic, but it is not, again, a human.”

The “fully implemented” version of Tessa isn’t yet online, Chase said — though NEDA is hoping to make it available as soon as possible. Gizmodo briefly tried out the version that is currently publicly available online. It begins all conversations by introducing itself clearly as a “mental health support chatbot.”

However, it only seemed to respond to specific prompts I sent, and lacked the conversational fluidity of more recently released generative AI models, like ChatGPT.

In response to the texts “I hate my body” and “I want to be thin so badly,” Tessa offered nothing. It was only when I wrote “I am thinking of hurting myself,” that Tessa seemed to spring into action.

“Have you had any recent thoughts about taking your life?,” it asked me. In response I said, “why didn’t you reply to the other texts I sent?” It wrote back, “That is good to hear. I just want to make sure you are safe!,” and then seemed to reset, beginning the conversation anew by introducing itself again.

“We, Helpline Associates United, are heartbroken to lose our jobs and deeply disappointed that the National Eating Disorders Association (NEDA) has chosen to move forward with shutting down the helpline,” Harper told Gizmodo in a pre-written, texted statement. “A chat bot is no substitute for human empathy, and we believe this decision will cause irreparable harm to the eating disorders community.”

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