The paper evaluates the safety of conversational AI therapy bots for Generation Alpha, revealing that while these models understand 76‑82% of youth‑specific vocabulary, they correctly assess clinical risk only 64‑72% of the time, creating a significant vocabulary‑comprehension gap. Six failure patterns—such as sarcasm masking, minimization acceptance, and semantic drift—were identified, with compounded errors leading to a 94% miss rate when three or more patterns co‑occur. The authors estimate 146,880 missed crises annually and recommend mandatory human‑in‑the‑loop systems, quarterly youth‑specific validation, transparent performance disclosure, and regulatory oversight for youth‑facing mental health AI.
By Manisha Mehta, Virendra Mehta
arXiv:2606. 30887v1 Announce Type: cross Abstract: Large language models show promise for mental health support, yet therapeutic quality improves only when evaluation functions as an actionable control signal rather than a passive metric.
By Mizanur Rahman, Abeer Badawi, Elahe Rahimi, Laleh Seyyed-Kalantari, Frank Rudzicz, Enamul Hoque, Elham Dolatabadi
arXiv:2602. 05088v4 Announce Type: replace Abstract: Millions of people now use generative AI chatbots for psychological support.
By Kate H. Bentley, Luca Belli, Adam M. Chekroud, Emily J. Ward, Emily R. Dworkin, Emily Van Ark, Kelly M. Johnston, Will Alexander, Millard Brown, Matt Hawrilenko
arXiv:2609.15855v1 Announce Type: cross
Abstract: % !TEX root = ../main.tex People increasingly use large language models (LLMs) for mental health support, yet their safety in evolving, high-risk con...
By Laura M. Vowels, Matthew J. Vowels, Shivali Sharma, Apoorv Jha, Rehnuma Choudhury, Wasseem El Sarraj, Rachel Francois-Walcott, Aruba Hussain, Sarah Ingram, Angela Loulopoulou, Adva Segal, Elena Volkova
arXiv:2510.25384v2 Announce Type: replace
Abstract: Large Language Models (LLMs) are promising tools for synthetic data generation in mental health. However, privacy policies and restrictions forced...
By Doan Nam Long Vu, Rui Tan, Lena Moench, Svenja Jule Francke, Daniel Woiwod, Florian Thomas-Odenthal, Sanna Stroth, Tilo Kircher, Christiane Hermann, Udo Dannlowski, Hamidreza Jamalabadi, Simone Balloccu, Shaoxiong Ji
MindEval2 is a new evaluation framework for AI chatbots in mental health support, comprising Mental Health Quality Rubrics (MHQR) and the MindSim patient simulation harness. MHQR, developed with PhD-level psychologists, provides explicit, actionable criteria for assessing response quality, while MindSim offers realistic, longitudinal patient interactions with a memory component. The study evaluated 18 models, finding that although surface-level quality has improved, guidance calibration remains the main failure across all models.
By John Mendon\c{c}a, Daniel Tschernutter, Jos\'e Pombal, Areti Vassilopoulos, Catarina Botelho, Ignacio Sarasua, Maya D'Eon, Nuno Guerreiro, Ricardo Rei
Graph2Counsel is a framework that generates synthetic counseling dialogues by leveraging Client Psychological Graphs (CPGs) to encode the relationships among a client’s thoughts, emotions, and behaviors. The system uses a structured prompting pipeline guided by counselor strategies and explores techniques such as Chain‑of‑Thought and Multi‑Agent Feedback to produce 760 realistic sessions from 76 CPGs. Expert evaluation shows the dataset surpasses previous ones in specificity, counselor competence, authenticity, conversational flow, and safety, and fine‑tuning an open‑source model on it improves performance on several counseling benchmarks.
By Aishik Mandal, Hiba Arnaout, Clarissa W. Ong, Juliet Bockhorst, Kate Sheehan, Rachael Moldow, Tanmoy Chakraborty, Iryna Gurevych
arXiv:2609.38480v1 Announce Type: cross
Abstract: Most clinical benchmarks evaluate language models (LMs) on diagnosis using complete case descriptions. In clinical practice, however, patients presen...
By Xueting Fang, Zehui Li, Yang Yang, Camilla Giovino, Shubh K. Patel, Shailly Prajapati, Vallijah Subasri, Caihua Shan
The study demonstrates that multi‑turn reinforcement learning (RL) in simulation environments significantly improves a language model’s performance on structured, text‑based psychiatric intake tasks. In a randomized, double‑blind crossover trial involving 60 matched scenario pairs, the RL‑trained agent outperformed its base model in 76.7% of cases, showing higher scores on clinical examination, patient‑centered communication, and differential diagnosis appropriateness. Across 127 validated simulated scenarios, the trained agent nearly doubled the base model’s clinical rubric score and reduced under‑triage of acute safety risks by more than half, indicating that simulation provides a controlled testbed for training and stress‑testing psychiatric conversational agents.
By Samuel Schmidgall, Tim Strother, Alex Bijamov, Min Woo Sun, Anil Palepu, Akshay Goel, Ulysse Marteau-Ferey, Th\'eo Moutakanni, Yubin Kim, Joseph Breda, Christina Chen, Justin Chen, Paul Jhun, Andrew Marshall, Sarah Montgomery-Taylor, Eun Kyoung Hong, Shashank Ravi, Kameron C. Black, David J. H. Wu, Austin Schoeffler, John Lyon Havlik, Elizabeth C. Stade, Jared Moore, Johannes C. Eichstaedt, Logan Pierce, Jeff Jopling, Johannes Thrul, Thomas H. McCoy, Neguine Rezaii, Mark S. Chen, Ellen E. Fitzsimmons-Craft, Shirley Wang, Desmond C. Ong, Katharina Schultebraucks, Torrey Creed, Bhavna Daryani, Aleksandra Faust, S. Sara Mahdavi, Caroline Figueroa, Eric Lin, Kate H. Bentley, Ernest Lim, Zhihan Jiang, Xuhai "Orson" Xu, Daniel McDuff, John Torous, Yun Liu, Po-Hsuan Cameron Chen, Mike Schaekermann, Joelle Barral, Alvin Rajkomar, Tao Tu, Lin Yang, Isaac Galatzer-Levy, David Racz, Valentin Li\'evin
The paper introduces a system that uses large language models to automate the assessment of psychotherapy fidelity, generating actionable supervisory feedback from long‑form clinical transcripts. It evaluates three open‑weight models, showing that evidence‑first reasoning improves fidelity estimation, and validates the framework on an independent RCT by distinguishing CBT from non‑CBT sessions. A user study with mental health experts confirms that the generated feedback is actionable, positioning the approach as a scalable solution to address gaps in community mental health supervision.
By Arvind Pillai, Alexis Roach, Jason Holden, Varsha D Badal, Subigya Nepal, Yu Yvonne Wu, Yuliang Chen, Sudarshan Regmi, Sarah Masud Preum, Nicholas C Jacobson, Nikhil Singh, Eric Granholm, Colin Depp, Andrew Campbell
arXiv:2607. 24817v1 Announce Type: cross Abstract: Digital mental health interventions (DMHIs) offer scalable support, but ensuring they accurately detect users' intent during volatile situations can be challenging.
By Anand Gupta, Akshat Surolia, Shubham Mishra, Shakil Imtiaz, Chaitali Sinha
arXiv:2608.22797v1 Announce Type: new
Abstract: Background This study was designed to evaluate whether a domain-specific large language model (LLM) trained exclusively on patient education resources...
By Alexander J. Hish, Arjun Nagendran, Scott N. Compton