Mental illness has personal, professional, and economic impacts. Greenberg et al. 2014 reports that 6.8% of the work first is directly impacted by depression and $11,936 is lost annually on average per depressed employee due to absenteeism, disability and presenteeism. Barriers such as stigma and access issues prevent 60% of people with a mental health problem from seeking help (

Saint Elizabeth Health Care (Saint Elizabeth) is a Canadian, not-for-profit and charitable organization that has since 1908 been responding to client, family and health system needs, primarily in the home and community. X2AI Inc. (X2) partners with Saint Elizabeth to expand their IntelligentCareTM Platform with X2’s mental health chatbot, Tess, that delivers 24/7 and on-demand emotionally supportive conversations. Accessing support from Tess is convenient via existing communication channels such as SMS text messaging, Facebook Messenger, and can be integrated with Amazon Alexa / Google Home for voice-enabled services..

Phase I: Validate Program Success and Gather Feedback

A subset of Saint Elizabeth employee caregivers received on-demand access to support from Tess over a 30 day period. The purpose of caregiver interactions with Tess in this first phase were to help develop Tess’ ability to hold meaningful and relevant caregiver support conversations. Caregivers ranged from 20 to 59 years of age with the majority between 50 and 59. They identified themselves as parents, friends, grandparents, children and cousins of individuals they were providing care to.

Tess is designed using a combination of artificial intelligence and expert guidance from psychologists in order to deliver conversations in the same way a therapist or coach would. Tess walked each caregiver through a brief introduction to set expectations and offer the privacy policy. Thereafter, Tess asked simple questions to gain a better understanding of the person's unique experience such as "how are you feeling?" and "have you felt this way before?" Over time, Tess got to know the person better in order to deliver more specific support by incorporating check-ins to reinforce skills discussed in previous conversations, as well as offer options for the person to talk about the simple things in life such as a place that brings them joy, or what they like to do, in order to build rapport. 

The success of this initiative was reflected in the results, which displayed high engagement with more than 12,000 messages exchanged between the caregivers and Tess. Furthermore, conversations with Tess were rated as helpful 88% of the time; 70% participants have found value in having conversations with Tess; and 76% of participants found Tess provided relevant support and coping tips all or most of the time (Figure 1). 

Figure 1:

Phase II: Scale Support to Reach Total Caregiver Workforce

Delivering over 20,000 patient visits every day, Saint Elizabeth’s 9,000 staff are flag bearers for their hope and happiness movement, and through their engagement with those receiving care, maintain a pulse on their evolving needs and steer the organization’s research and innovation initiatives. 

Since the first Saint Elizabeth employee interacted with Tess, the system has been expanded to include 800 different supportive interventions, which enable over 3,000,000 unique conversations. Over 50 coaches and psychologists have written the conversations on Tess. Conversations are personalized to each employee's needs to deliver a range of interventions from cognitive behavioral therapy, to deeper levels of support like psychodynamic strategies. 

Today, Tess offers on-demand emotional support to reduce burnout and improve wellbeing to the 9,000 employees at Saint Elizabeth, as well as the 100,000+ caregivers that visit on a monthly basis.  With a deeper understanding of the issues faced by caregivers, Tess personalizes support to best meet each person’s unique needs.  Tess reinforces skills practiced in previous discussions with check-in’s and reminders to build resilience. You can read more about how Tess is providing a safe space for caregivers to get emotional support and encouraging self-care here:

Phase III: Innovate to Extend Support to Patients

Saint Elizabeth and X2 are preparing to take Tess to the next level in order to deliver more holistic support to caregivers and their patients. Through a grant awarded by the Baycrest Centre for Aging and Brain Health Innovation, Tess is being integrated with Amazon Alexa / Google Home to deliver voice-enabled emotional support to older adults with a focus on social isolation, loneliness, depression, and anxiety. 

For the aging population, declining mental health has profound implications on personal, economic and societal wellbeing. Social isolation and loneliness have been linked to increased risk of coronary heart disease and stroke, increased prevalence of dementia, and likelihood of death. Understanding that loneliness in older adults is often triggered by physical and/or social losses, Tess will help this population adjust to changes and make new connections. The rapidly improving natural language interface will offer a safe space for older adults to engage in conversation about their concerns via text messaging and/or a voice enabled interface for those with physical limitations. 

Approximately 20,000 older adults living independently will be granted unlimited access to Tess across Canada and the U.S., with support from AARP. This program aims to further demonstrate Tess’ efficacy in delivering emotional support for older adults in order to reduce feelings social isolation, and loneliness and strengthen the emerging body of knowledge outlining to the use of voice-enabled natural language interfaces to overcome many of the traditional barriers to care that older adults face.

X2’s mental health chatbot, Tess delivers affordable, on-demand, and quality support using artificial intelligence. Tess brings support to people whenever and wherever they need it most through commonly available communication channels such as smartphones, tablets, laptops and computers. This is particularly beneficial for demographics where access to mental health support is limited in scope and hours of service; where mental health is costly; and, when it poses other barriers to those seeking help. 

Posted on
April 6, 2018
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