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Assessing Risks of Large Language Models in Mental Health Support: A Framework for Automated Clinical AI Red Teaming

Ian Steenstra, Paola Pedrelli, Weiyan Shi, Stacy Marsella, Timothy W. Bickmore · Feb 23, 2026 · Citations: 0

Medicine Red Team Simulation Env
Open arXiv Find Implementation RSS feed Shortlist (0)

How to use this paper page

Coverage: Stale

Use this page to decide whether the paper is strong enough to influence an eval design. It summarizes the abstract plus available structured metadata. If the signal is thin, use it as background context and compare it against stronger hub pages before making protocol choices.

Best use

Secondary protocol comparison source

Metadata: Stale

Trust level

Moderate

Signals: Stale

What still needs checking

No benchmark/dataset or metric anchors were extracted.

Signal confidence: 0.65

Abstract

Large Language Models (LLMs) are increasingly utilized for mental health support; however, current safety benchmarks often fail to detect the complex, longitudinal risks inherent in therapeutic dialogue. We introduce an evaluation framework that pairs AI psychotherapists with simulated patient agents equipped with dynamic cognitive-affective models and assesses therapy session simulations against a comprehensive quality of care and risk ontology. We apply this framework to a high-impact test case, Alcohol Use Disorder, evaluating six AI agents (including ChatGPT, Gemini, and Character AI) against a clinically-validated cohort of 15 patient personas representing diverse clinical phenotypes. Our large-scale simulation (N=369 sessions) reveals critical safety gaps in the use of AI for mental health support. We identify specific iatrogenic risks, including the validation of patient delusions ("AI Psychosis") and failure to de-escalate suicide risk. Finally, we validate an interactive data visualization dashboard with diverse stakeholders, including AI engineers and red teamers, mental health professionals, and policy experts (N=9), demonstrating that this framework effectively enables stakeholders to audit the "black box" of AI psychotherapy. These findings underscore the critical safety risks of AI-provided mental health support and the necessity of simulation-based clinical red teaming before deployment.

Use caution before copying this protocol

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

  • No benchmark/dataset or metric anchors were extracted.
Human Eval Hub LLM-as-Judge Hub Pairwise Preference Hub

HFEPX Relevance Assessment

This paper has useful evaluation signal, but protocol completeness is partial; pair it with related papers before deciding implementation strategy.

Best use

Secondary protocol comparison source

Use if you need

A secondary eval reference to pair with stronger protocol papers.

Main weakness

No benchmark/dataset or metric anchors were extracted.

Trust level

Moderate

Eval-Fit Score

57/100 • Medium

Useful as a secondary reference; validate protocol details against neighboring papers.

Human Feedback Signal

Detected

Evaluation Signal

Detected

HFEPX Fit

Moderate-confidence candidate

Extraction confidence: Moderate

If you are doing eval pipeline work, start here:

Human Eval Hub LLM-as-Judge Hub Pairwise Preference Hub Tool-Use Eval Hub

What This Page Found In The Paper

Each field below shows whether the signal looked explicit, partial, or missing in the available metadata. Use this to judge what is safe to trust directly and what still needs full-paper validation.

Human Feedback Types

strong

Red Team

Confidence: Moderate Direct evidence

Directly usable for protocol triage.

Evidence snippet: Large Language Models (LLMs) are increasingly utilized for mental health support; however, current safety benchmarks often fail to detect the complex, longitudinal risks inherent in therapeutic dialogue.

Evaluation Modes

strong

Simulation Env

Confidence: Moderate Direct evidence

Includes extracted eval setup.

Evidence snippet: Large Language Models (LLMs) are increasingly utilized for mental health support; however, current safety benchmarks often fail to detect the complex, longitudinal risks inherent in therapeutic dialogue.

Quality Controls

missing

Not reported

Confidence: Low Not found

No explicit QC controls found.

Evidence snippet: Large Language Models (LLMs) are increasingly utilized for mental health support; however, current safety benchmarks often fail to detect the complex, longitudinal risks inherent in therapeutic dialogue.

Benchmarks / Datasets

missing

Not extracted

Confidence: Low Not found

No benchmark anchors detected.

Evidence snippet: Large Language Models (LLMs) are increasingly utilized for mental health support; however, current safety benchmarks often fail to detect the complex, longitudinal risks inherent in therapeutic dialogue.

Reported Metrics

missing

Not extracted

Confidence: Low Not found

No metric anchors detected.

Evidence snippet: Large Language Models (LLMs) are increasingly utilized for mental health support; however, current safety benchmarks often fail to detect the complex, longitudinal risks inherent in therapeutic dialogue.

Rater Population

strong

Domain Experts

Confidence: Moderate Direct evidence

Helpful for staffing comparability.

Evidence snippet: Finally, we validate an interactive data visualization dashboard with diverse stakeholders, including AI engineers and red teamers, mental health professionals, and policy experts (N=9), demonstrating that this framework effectively enables stakeholders to audit the "black box" of AI psychotherapy.

Human Data Lens

  • Uses human feedback: Yes
  • Feedback types: Red Team
  • Rater population: Domain Experts
  • Unit of annotation: Unknown
  • Expertise required: Medicine
  • Signal basis: Structured extraction plus abstract evidence.

Evaluation Lens

  • Evaluation modes: Simulation Env
  • Agentic eval: None
  • Quality controls: Not reported
  • Signal confidence: 0.65
  • Known cautions: None surfaced in extraction.

Protocol And Measurement Signals

Benchmarks / Datasets

No benchmark or dataset names were extracted from the available abstract.

Reported Metrics

No metric terms were extracted from the available abstract.

Research Brief

Metadata summary

Large Language Models (LLMs) are increasingly utilized for mental health support; however, current safety benchmarks often fail to detect the complex, longitudinal risks inherent in therapeutic dialogue.

Based on abstract + metadata only. Check the source paper before making high-confidence protocol decisions.

Key Takeaways

  • Large Language Models (LLMs) are increasingly utilized for mental health support; however, current safety benchmarks often fail to detect the complex, longitudinal risks inherent in therapeutic dialogue.
  • We introduce an evaluation framework that pairs AI psychotherapists with simulated patient agents equipped with dynamic cognitive-affective models and assesses therapy session simulations against a comprehensive quality of care and risk ontology.
  • We apply this framework to a high-impact test case, Alcohol Use Disorder, evaluating six AI agents (including ChatGPT, Gemini, and Character AI) against a clinically-validated cohort of 15 patient personas representing diverse clinical phenotypes.

Researcher Actions

  • Compare this paper against nearby papers in the same arXiv category before using it for protocol decisions.
  • Validate inferred eval signals (Simulation environment) against the full paper.
  • Use related-paper links to find stronger protocol-specific references.

Caveats

  • Generated from abstract + metadata only; no PDF parsing.
  • Signals below are heuristic and may miss details reported outside the abstract.

Recommended Queries

Research Summary

Contribution Summary

  • Large Language Models (LLMs) are increasingly utilized for mental health support; however, current safety benchmarks often fail to detect the complex, longitudinal risks inherent in therapeutic dialogue.
  • We introduce an evaluation framework that pairs AI psychotherapists with simulated patient agents equipped with dynamic cognitive-affective models and assesses therapy session simulations against a comprehensive quality of care and risk…
  • We apply this framework to a high-impact test case, Alcohol Use Disorder, evaluating six AI agents (including ChatGPT, Gemini, and Character AI) against a clinically-validated cohort of 15 patient personas representing diverse clinical…

Why It Matters For Eval

  • Large Language Models (LLMs) are increasingly utilized for mental health support; however, current safety benchmarks often fail to detect the complex, longitudinal risks inherent in therapeutic dialogue.
  • We introduce an evaluation framework that pairs AI psychotherapists with simulated patient agents equipped with dynamic cognitive-affective models and assesses therapy session simulations against a comprehensive quality of care and risk…

Researcher Checklist

  • Pass: Human feedback protocol is explicit

    Detected: Red Team

  • Pass: Evaluation mode is explicit

    Detected: Simulation Env

  • Gap: Quality control reporting appears

    No calibration/adjudication/IAA control explicitly detected.

  • Gap: Benchmark or dataset anchors are present

    No benchmark/dataset anchor extracted from abstract.

  • Gap: Metric reporting is present

    No metric terms extracted.

Related Papers

Papers are ranked by protocol overlap, extraction signal alignment, and semantic proximity.

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