Virtual Mental Health Assistants (VMHAs) are seeing continual advancements to support the overburdened global healthcare system that gets 60 million primary care visits, and 6 million Emergency Room (ER) visits annually. These systems are built by clinical psychologists, psychiatrists, and Artificial Intelligence (AI) researchers for Cognitive Behavioral Therapy (CBT). At present, the role of VMHAs is to provide emotional support through information, focusing less on developing a reflective conversation with the patient. A more comprehensive, safe and explainable approach is required to build responsible VMHAs to ask follow-up questions or provide a well-informed response. This survey offers a systematic critical review of the existing conversational agents in mental health, followed by new insights into the improvements of VMHAs with contextual knowledge, datasets, and their emerging role in clinical decision support. We also provide new directions toward enriching the user experience of VMHAs with explainability, safety, and wholesome trustworthiness. Finally, we provide evaluation metrics and practical considerations for VMHAs beyond the current literature to build trust between VMHAs and patients in active communications.

翻译：心理健康虚拟助手持续进步，以支持因全球每年6000万次初级诊疗和600万次急诊就诊而负担过重的医疗系统。这些系统由临床心理学家、精神病学家和人工智能研究人员基于认知行为疗法构建。目前，心理健康虚拟助手主要通过提供信息进行情感支持，较少注重与患者开展反思性对话。构建负责任的心理健康虚拟助手需要更全面、安全且可解释的方法，使其能够提出后续问题或提供充分知情的回应。本综述对现有心理健康对话代理进行系统性批判性回顾，进而提出基于情境知识、数据集改进心理健康虚拟助手的新见解及其在临床决策支持中的新兴作用。我们还提供了新方向，通过增强可解释性、安全性和整体可信度来丰富用户体验。最后，我们提出了超越现有文献的评估指标和实践考量，以在积极交流中建立心理健康虚拟助手与患者之间的信任。