When Markets Shape AI Mental Health Self-Management Tools: Consequences for Serious Mental Illness.

AI-enabled self-management health tools are increasingly promoted within health care policy as part of digital self-management models for mental health care. However, development is concentrated on scalable, low-intensity interventions for common conditions, such as anxiety and depression, rather than on populations with the greatest clinical need, such as those with serious mental illness (SMI). This includes schizophrenia-spectrum and bipolar disorders, which remain comparatively underserved, despite experiencing a disproportionate burden of morbidity and service use. However, the clinical features of SMI-comprising fluctuating symptoms, multimorbidity, and elevated risk-may limit the suitability of low-intensity AI-driven self-management tools designed for mild-to-moderate conditions. In this Viewpoint, we argue that the scarcity of AI-enabled self-management tools for SMI reflects a structural feature of current innovation systems rather than one of technical infeasibility alone. Market incentives, regulatory pathways, and fragmented research pipelines favor low-risk, high-volume populations, thereby limiting development for clinically complex groups. Addressing this unevenness is essential and will require upstream intervention, including targeted public funding, improved data infrastructure, and administrative frameworks that support safe innovation in high-risk populations. Embedding equity for SMI as a primary design requirement will be necessary to ensure that AI-driven mental health tools do not reinforce current inequalities.