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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\u2014comprising fluctuating symptoms, multimorbidity, and elevated risk\u2014may 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.<\/jats:p>","DOI":"10.2196\/99143","type":"journal-article","created":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T13:05:27Z","timestamp":1783429527000},"page":"e99143-e99143","source":"Crossref","is-referenced-by-count":2,"title":["When Markets Shape AI Mental Health Self-Management Tools: Consequences for Serious Mental Illness"],"prefix":"10.2196","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-7658-5522","authenticated-orcid":false,"given":"Lucy","family":"Smith","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-1288-6207","authenticated-orcid":false,"given":"Yousef","family":"Yousef","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Piotr","family":"Wasilewski","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-5306-9154","authenticated-orcid":false,"given":"Hajira","family":"Dambha-Miller","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1010","published-online":{"date-parts":[[2026,8,25]]},"reference":[{"issue":"6","key":"R1","doi-asserted-by":"publisher","first-page":"539","DOI":"10.1001\/jamapsychiatry.2024.0532","article-title":"Digital mental health\u2019s unstable dichotomy-wellness and health","volume":"81","author":"Torous","journal-title":"JAMA Psychiatry"},{"issue":"3","key":"R2","doi-asserted-by":"publisher","first-page":"175","DOI":"10.1192\/bjp.bp.117.202606","article-title":"Mortality gap for people with bipolar disorder and schizophrenia: UK-based cohort study 2000-2014","volume":"211","author":"Hayes","journal-title":"Br J Psychiatry"},{"issue":"5","key":"R3","doi-asserted-by":"publisher","first-page":"444","DOI":"10.1001\/jamapsychiatry.2022.0347","article-title":"Mortality associated with mental disorders and comorbid general medical conditions","volume":"79","author":"Momen","journal-title":"JAMA Psychiatry"},{"key":"R4","unstructured":"Gilburt H Mallorie S . 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