{ "source": "Cooked Index — occupational AI risk register", "page": "https://cookedindex.com/jobs/psychiatric-aides/", "methodology": "https://cookedindex.com/methodology", "notice": "Verdicts are re-examined as evidence accumulates. Re-fetch before relying on this; the page above always carries the current score.", "scored_at": "2026-08-11", "model": "claude-opus-5", "occupation": { "title": "Psychiatric Aides", "soc_code": "31-1133", "category": "Healthcare Support", "us_employment": 35520, "median_annual_wage": 44910 }, "verdict": "EXPOSED", "risk_resistance": 64, "contested": false, "near_boundary": false, "dimensions": { "task_resistance": 17, "embodiment": 20, "liability_shield": 4, "trust_premium": 12, "judgment_accountability": 11 }, "reasoning": { "task_resistance": "Fifteen-minute safety checks, one-to-one observation of a suicidal patient, hands-on assistance with toileting and showering, and de-escalating or holding a patient during a takedown are tasks no software performs; the 3 points off reflect that shift notes, behavior logs and incident documentation are already being templated and voice-dictated.", "embodiment": "You are on a locked unit in physical contact with unpredictable bodies — blocking a swing, sitting on a mattress on the floor with someone in seclusion, walking a group to the courtyard, cleaning up after incontinence — and the environment is defined by the fact that it cannot be controlled.", "liability_shield": "Most states require only a high school diploma plus employer-run CPI/crisis-intervention and CPR training; the RN or attending physician signs the orders for restraint and medication, so when something goes wrong the investigation lands on the nurse's judgment and your employer's staffing plan, not a license you hold and could lose.", "trust_premium": "Patients who will not talk to the psychiatrist will talk to the aide who sat with them all night, and continuity on a unit genuinely reduces incidents — but you are assigned by shift rotation, not chosen by the patient, and the therapeutic relationship is formally owned by the clinical team, which caps this below the 13+ band.", "judgment_accountability": "You decide in real time whether pacing is escalating and needs a nurse now, whether to close observation distance, whether contraband is worth a search — real calls with real consequences, made inside written unit protocols and a chain of command you are expected to escalate to rather than substitute for." }, "rationale": "The work is almost entirely physical and interpersonal: monitoring patients on a psychiatric unit, assisting with bathing, dressing and meals, escorting patients between activities, and physically intervening during agitation or restraint situations. None of that is text-on-a-screen work, and current robotics cannot manage an unpredictable human body in crisis. The real exposure is not AI substitution but the thin paper trail around the role — no license protects it, documentation and shift-report writing will be AI-assisted, and staffing decisions are driven by budgets and monitoring tech rather than by capability.", "outlook": "Demand holds or grows with behavioral health caseloads, and AI will mostly eat your paperwork rather than your shift — but wages stay low and camera-based monitoring will be used to justify thinner staffing, so the credentialed and high-acuity end of the job is where the security is.", "what_would_raise_it": { "levers": [ { "dimension": "liability_shield", "change": "Extension of California-style Psychiatric Technician licensure (BVNPT, Business & Professions Code) to other states, or a state scope-of-practice rule making a certified psych tech the person who must be physically present and personally attest to restraint/seclusion monitoring checks under CMS Conditions of Participation §482.13(e) — turning an aide's initials into a licensed, individually accountable signature", "plausibility": "plausible", "would_add": 6 }, { "dimension": "liability_shield", "change": "State minimum-staffing-ratio statutes for behavioral health inpatient units that count direct-care aides by name (following Oregon HB 2697, 2023, which set enforceable ratios including CNAs/techs on behavioral health units) — making the headcount legally mandated rather than budget-discretionary", "plausibility": "already happening", "would_add": 4 }, { "dimension": "judgment_accountability", "change": "Deployment of AI patient-monitoring (e.g., Oxehealth, Care.ai vision systems on psych units) where the aide is designated the human who must clear or escalate each algorithmic alert, and that disposition is logged against their credential in incident review — ownership of the false-negative shifts explicitly onto the aide", "plausibility": "already happening", "would_add": 4 }, { "dimension": "judgment_accountability", "change": "Joint Commission or state survey findings that make the aide's real-time decision to initiate hands-on intervention versus continue verbal de-escalation a documented, reviewable clinical call rather than an undocumented reflex", "plausibility": "plausible", "would_add": 3 }, { "dimension": "task_resistance", "change": "Task-mix shift as shift reports, rounding logs and observation charting move to ambient AI documentation: the residual role concentrates in crisis response, restraint-alternative de-escalation and bodily assistance — genuine two-tier structure here, with the clerical tier being the automatable one", "plausibility": "already happening", "would_add": 2 }, { "dimension": "trust_premium", "change": "Private psychiatric and residential treatment facilities marketing guaranteed human 1:1 observation coverage (rather than camera-based watch) as a purchased differentiator for suicide-risk patients and their families", "plausibility": "plausible", "would_add": 2 } ], "ceiling_note": "Embodiment is already maxed at 20 and cannot rise. The score gap is almost entirely institutional: without licensure or a named-signature requirement, this role stays a budget line, and the main real-world threat is headcount reduction justified by monitoring tech, not AI doing the work. Trust premium is structurally capped because the buyer is a hospital administrator, not the patient." }, "adjudication": null, "employment_history": { "points": [ { "y": 2019, "emp": 55020, "wage": 31110 }, { "y": 2020, "emp": 51550, "wage": 31570 }, { "y": 2021, "emp": 39140, "wage": 30260 }, { "y": 2022, "emp": 30590, "wage": 37160 }, { "y": 2023, "emp": 32310, "wage": 39160 }, { "y": 2024, "emp": 34900, "wage": 41590 }, { "y": 2025, "emp": 35520, "wage": 44910 } ], "from": 2019, "to": 2025, "change_pct": -35.4, "comparable_from": 2019, "spans_soc_revision": false }, "pivots": [ { "slug": "massage-therapists", "title": "Massage Therapists", "verdict": "SAFE", "risk_resistance": 76, "median_wage": 58450, "overlap": 59, "skills_to_close": [] } ], "license": "https://cookedindex.com/terms" }