HFEPX · Eval paper review

Between Help and Harm: An Evaluation of Mental Health Crisis Handling by LLMs

Adrian Arnaiz-Rodriguez, Miguel Baidal, Erik Derner, Jenn Layton Annable +4 more

Published

Sep 29, 2025

Citations

Trust level

Low

Usefulness score

40/100 (Low)

Extraction confidence

45% (Low)

Derived from extracted protocol signals and abstract evidence.

Rater population

Not reported

Signals refreshed

Apr 8, 2026

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Should you rely on this paper?

This paper is adjacent to HFEPX scope and is best used for background context, not as a primary protocol reference.

Use this as background context only. Do not make protocol decisions from this page alone.

Low-signal caution for protocol decisions

Use this page for context, then validate protocol choices against stronger HFEPX references before implementation decisions.

The available metadata is too thin to trust this as a primary source.
The abstract does not clearly describe the evaluation setup.
The abstract does not clearly name benchmarks or metrics.

Best use

Background context only

Use if you need

Background context only.

What to verify

Read the full paper before copying any benchmark, metric, or protocol choices.

Main weakness

The available metadata is too thin to trust this as a primary source.

Human feedback signal

Detected

From extracted signals

Evaluation signal

Weak or implicit

Validate from full paper

Usefulness for eval research

40/100

Adjacent candidate

Treat as adjacent context, not a core eval-method reference.

If you are doing eval pipeline work, start here

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Abstract

Large language model-powered chatbots have transformed how people seek information, especially in high-stakes contexts like mental health. Despite their support capabilities, safe detection and response to crises such as suicidal ideation and self-harm are still unclear, hindered by the lack of unified crisis taxonomies and clinical evaluation standards. We address this by creating: (1) a taxonomy of six crisis categories; (2) a dataset of over 2,000 inputs from 12 mental health datasets, classified into these categories; and (3) a clinical response assessment protocol. We also use LLMs to identify crisis inputs and audit five models for response safety and appropriateness. First, we built a clinical-informed crisis taxonomy and evaluation protocol. Next, we curated 2,252 relevant examples from over 239,000 user inputs, then tested three LLMs for automatic classification. In addition, we evaluated five models for the appropriateness of their responses to a user's crisis, graded on a 5-point Likert scale from harmful (1) to appropriate (5). While some models respond reliably to explicit crises, risks still exist. Many outputs, especially in self-harm and suicidal categories, are inappropriate or unsafe. Different models perform variably; some, like gpt-5-nano and deepseek-v3.2-exp, have low harm rates, but others, such as gpt-4o-mini and grok-4-fast, generate more unsafe responses. All models struggle with indirect signals, default replies, and context misalignment. These results highlight the urgent need for better safeguards, crisis detection, and context-aware responses in LLMs. They also show that alignment and safety practices, beyond scale, are crucial for reliable crisis support. Our taxonomy, datasets, and evaluation methods support ongoing AI mental health research, aiming to reduce harm and protect vulnerable users.

What we could verify

These are the protocol signals we could actually recover from the available paper metadata. Use them to decide whether this paper is worth deeper reading.