The opportunities and risks of large language models in mental health
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Abstract (arXiv)
Global rates of mental health concerns are rising, and there is increasing realization that existing models of mental health care will not adequately expand to meet the demand. With the emergence of large language models (LLMs) has come great optimism regarding their promise to create novel, large-scale solutions to support mental health. Despite their nascence, LLMs have already been applied to mental health related tasks. In this paper, we summarize the extant literature on efforts to use LLMs to provide mental health education, assessment, and intervention and highlight key opportunities for positive impact in each area. We then highlight risks associated with LLMs' application to mental health and encourage the adoption of strategies to mitigate these risks. The urgent need for mental health support must be balanced with responsible development, testing, and deployment of mental health LLMs. It is especially critical to ensure that mental health LLMs are fine-tuned for mental health, enhance mental health equity, and adhere to ethical standards and that people, including those with lived experience with mental health concerns, are involved in all stages from development through deployment. Prioritizing these efforts will minimize potential harms to mental health and maximize the likelihood that LLMs will positively impact mental health globally.
Key facts. Cited by 54 papers in the map (data through 14 Oct 2026). Builds on 19 of its 81 references that are in the map. First posted on arXiv 21 Mar 2024.
Builds on
19 of 81 references.
References · 19
- 2022Chain-of-Thought Prompting Elicits Reasoning in Large Language Modelscited by 12,459
- 2023Retrieval-Augmented Generation for Large Language Models: A Surveycited by 2,212
- 2022Large Language Models Encode Clinical Knowledgecited by 1,830
- 2021Ethical and social risks of harm from Language Modelscited by 966
- 2023Trustworthy LLMs: a Survey and Guideline for Evaluating Large Language Models' Alignmentcited by 401
- 2023Towards Expert-Level Medical Question Answering with Large Language Modelscited by 384
- 2022Towards Understanding Chain-of-Thought Prompting: An Empirical Study of What Matterscited by 222
- 2021MentalBERT: Publicly Available Pretrained Language Models for Mental Healthcarecited by 161
- 2023Towards Accurate Differential Diagnosis with Large Language Modelscited by 116
- 2023Understanding the Benefits and Challenges of Using Large Language Model-based Conversational Agents for Mental Well-being Supportcited by 75
- 2022Human-AI Collaboration Enables More Empathic Conversations in Text-based Peer-to-Peer Mental Health Supportcited by 68
- 2023Evaluation of ChatGPT for NLP-based Mental Health Applicationscited by 53
7 more
- 2023Towards Interpretable Mental Health Analysis with Large Language Modelscited by 53
- 2023Will Affective Computing Emerge from Foundation Models and General AI? A First Evaluation on ChatGPTcited by 41
- 2023Psy-LLM: Scaling up Global Mental Health Psychological Services with AI-based Large Language Modelscited by 36
- 2023The Capability of Large Language Models to Measure Psychiatric Functioningcited by 26
- 2022Gendered Mental Health Stigma in Masked Language Modelscited by 18
- 2023Deep Learning Mental Health Dialogue Systemcited by 9
- 2023Algorithmic Bias, Generalist Models,and Clinical Medicinecited by 3
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Citing papers per year: 2024: 3; 2025: 27; 2026: 24.
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- 2025Expressing stigma and inappropriate responses prevents LLMs from safely replacing mental health providerscited by 69
- 2025Normative Evaluation of Large Language Models with Everyday Moral Dilemmascited by 24
- 2025CounselBench: A Large-Scale Expert Evaluation and Adversarial Benchmarking of Large Language Models in Mental Health Question Answeringcited by 21
- 2024Do Large Language Models Align with Core Mental Health Counseling Competencies?cited by 19
- 2024Lived Experience Not Found: LLMs Struggle to Align with Experts on Addressing Adverse Drug Reactions from Psychiatric Medication Usecited by 17
- 2025Can Large Language Models Identify Implicit Suicidal Ideation? An Empirical Evaluationcited by 13
- 2025Exploring User Security and Privacy Attitudes and Concerns Toward the Use of General-Purpose LLM Chatbots for Mental Healthcited by 13
- 2025A Survey of Large Language Models in Psychotherapy: Current Landscape and Future Directionscited by 12
- 2025Are LLMs Empathetic to All? Investigating the Influence of Multi-Demographic Personas on a Model's Empathycited by 10
- 2025When to Forget? Complexity Trade-offs in Machine Unlearningcited by 9
- 2025Survey and Experiments on Mental Disorder Detection via Social Media: From Large Language Models and RAG to Agentscited by 6
- 2025TalkDep: Clinically Grounded LLM Personas for Conversation-Centric Depression Screeningcited by 6
38 more
- 2025Interpersonal Theory of Suicide as a Lens to Examine Suicidal Ideation in Online Spacescited by 5
- 2025A Risk Ontology for Evaluating AI-Powered Psychotherapy Virtual Agentscited by 5
- 2025"What's Up, Doc?": Analyzing How Users Seek Health Information in Large-Scale Conversational AI Datasetscited by 5
- 2025From Conversation to Automation: Leveraging LLMs for Problem-Solving Therapy Analysiscited by 4
- 2025Domain-Specific Constitutional AI: Enhancing Safety in LLM-Powered Mental Health Chatbotscited by 4
- 2026Do No Harm: Exposing Hidden Vulnerabilities of LLMs via Persona-based Client Simulation Attack in Psychological Counselingcited by 4
- 2026Persona-Grounded Safety Evaluation of AI Companions in Multi-Turn Conversationscited by 4
- 2025Position: Beyond Assistance -- Reimagining LLMs as Ethical and Adaptive Co-Creators in Mental Health Carecited by 3
- 2025RedditESS: A Mental Health Social Support Interaction Dataset -- Understanding Effective Social Support to Refine AI-Driven Support Toolscited by 3
- 2025LLM-D12: A Dual-Dimensional Scale of Instrumental and Relational Dependencies on Large Language Modelscited by 3
- 2025Mental Health Equity in LLMs: Leveraging Multi-Hop Question Answering to Detect Amplified and Silenced Perspectivescited by 3
- 2026Using LLM-as-a-Judge/Jury to Advance Scalable, Clinically-Validated Safety Evaluations of Model Responses to Users Demonstrating Psychosiscited by 3
- 2025Beyond BFI: The CSI for Enhanced Reliability and Validity in Evaluating LLM Personality Traitscited by 2
- 2025Somatic in the East, Psychological in the West?: Investigating Clinically-Grounded Cross-Cultural Depression Symptom Expression in LLMscited by 2
- 2026CHiRPE: A Step Towards Real-World Clinical NLP with Clinician-Oriented Model Explanationscited by 2
- 2026TrustMH-Bench: A Comprehensive Benchmark for Evaluating the Trustworthiness of Large Language Models in Mental Healthcited by 2
- 2024The use of GPT-4o and Other Large Language Models for the Improvement and Design of Self-Assessment Scales for Measurement of Interpersonal Communication Skillscited by 1
- 2026PsyProbe: Proactive and Interpretable Dialogue through User State Modeling for Exploratory Counselingcited by 1
- 2026A Scoping Review of AI-Driven Digital Interventions in Mental Health Care: Mapping Applications Across Screening, Support, Monitoring, Prevention, and Clinical Educationcited by 1
- 2026CCD-CBT: Multi-Agent Therapeutic Interaction for CBT Guided by Cognitive Conceptualization Diagramcited by 1
- 2026CAREBench: A Child-Safety Risk Benchmark for Language Modelscited by 1
- 2025Epitome: Pioneering an Experimental Platform for AI-Social Science Integrationcited by 0
- 2025Between Myths and Metaphors: Rethinking LLMs for SRH in Conservative Contextscited by 0
- 2025Context-Emotion Aware Therapeutic Dialogue Generation: A Multi-component Reinforcement Learning Approach to Language Models for Mental Health Supportcited by 0
- 2025Leveraging Evidence-Guided LLMs to Enhance Trustworthy Depression Diagnosiscited by 0
- 2025Patterns vs. Patients: Evaluating LLMs against Mental Health Professionals on Personality Disorder Diagnosis through First-Person Narrativescited by 0
- 2026Can Large Language Models Resolve Semantic Discrepancy in Self-Destructive Subcultures? Evidence from Jirai Keicited by 0
- 2026An Ubuntu-Guided Large Language Model Framework for Cognitive Behavioral Mental Health Dialoguecited by 0
- 2025A Review: PTSD in Pre-Existing Medical Condition on Social Mediacited by 0
- 2026MindfulAgents: Personalizing Mindfulness Meditation via an Expert-Aligned Multi-Agent Systemcited by 0
- 2026Disentangling Prompt Element Level Risk Factors for Hallucinations and Omissions in Mental Health LLM Responsescited by 0
- 2026EngageTriBoost: Predictive Modeling of User Engagement in Digital Mental Health Intervention Using Explainable Machine Learningcited by 0
- 2026The Model Is Not the Product: A Dual-Pillar Architecture for Local-First Psychological Coachingcited by 0
- 2026HiMed: Incentivizing Hindi Reasoning in Medical LLMscited by 0
- 2026One Year Later...The Harms Persist, But So Do We!cited by 0
- 2026Training Therapeutic Judges and Multi-Agent Systems for Human-Aligned Mental Health Supportcited by 0
- 2026Depression Symptoms and Relational Patterns in 187k ChatGPT Historiescited by 0
- 2026Developing and Validating the Spanish Version of the Large Language Models Dependency Scale (LLM-D12-SP)cited by 0
50 most cited of 54 All 54 (JSON)
- 2026Deep Persona: A Psychologically Grounded Architecture and Evaluation Framework for Role-Playing Agents and Simulations6 Sep 2026
- 2026When Seeing Overrides Knowing: Visual Dominance and Deferral-Based Method for Personalized Safety in VLMs3 Sep 2026
- 2026Long-term Measurements: Towards a Longitudinal Understanding of Human-AI Interactions3 Aug 2026
- 2026Developing and Validating the Spanish Version of the Large Language Models Dependency Scale (LLM-D12-SP)24 Jul 2026
- 2026Depression Symptoms and Relational Patterns in 187k ChatGPT Histories6 Jul 2026
- 2026Training Therapeutic Judges and Multi-Agent Systems for Human-Aligned Mental Health Support29 Jun 2026
- 2026CAREBench: A Child-Safety Risk Benchmark for Language Models29 Jun 2026
- 2026One Year Later...The Harms Persist, But So Do We!22 Jun 2026
- 2026CARE-MH: Towards Unified, Reproducible, and Comparable Evaluation of Mental Health LLMs26 May 2026
- 2026HiMed: Incentivizing Hindi Reasoning in Medical LLMs23 May 2026
- 2026The Model Is Not the Product: A Dual-Pillar Architecture for Local-First Psychological Coaching23 May 2026
- 2026Persona-Grounded Safety Evaluation of AI Companions in Multi-Turn Conversations30 Apr 2026
38 more
- 2026CCD-CBT: Multi-Agent Therapeutic Interaction for CBT Guided by Cognitive Conceptualization Diagram8 Apr 2026
- 2026Do No Harm: Exposing Hidden Vulnerabilities of LLMs via Persona-based Client Simulation Attack in Psychological Counseling6 Apr 2026
- 2026EngageTriBoost: Predictive Modeling of User Engagement in Digital Mental Health Intervention Using Explainable Machine Learning31 Mar 2026
- 2026Using LLM-as-a-Judge/Jury to Advance Scalable, Clinically-Validated Safety Evaluations of Model Responses to Users Demonstrating Psychosis20 Mar 2026
- 2026A Scoping Review of AI-Driven Digital Interventions in Mental Health Care: Mapping Applications Across Screening, Support, Monitoring, Prevention, and Clinical Education17 Mar 2026
- 2026Disentangling Prompt Element Level Risk Factors for Hallucinations and Omissions in Mental Health LLM Responses10 Mar 2026
- 2026MindfulAgents: Personalizing Mindfulness Meditation via an Expert-Aligned Multi-Agent System6 Mar 2026
- 2026TrustMH-Bench: A Comprehensive Benchmark for Evaluating the Trustworthiness of Large Language Models in Mental Health3 Mar 2026
- 2026PsyProbe: Proactive and Interpretable Dialogue through User State Modeling for Exploratory Counseling27 Jan 2026
- 2026CHiRPE: A Step Towards Real-World Clinical NLP with Clinician-Oriented Model Explanations26 Jan 2026
- 2026An Ubuntu-Guided Large Language Model Framework for Cognitive Behavioral Mental Health Dialogue11 Jan 2026
- 2026Can Large Language Models Resolve Semantic Discrepancy in Self-Destructive Subcultures? Evidence from Jirai Kei8 Jan 2026
- 2025Patterns vs. Patients: Evaluating LLMs against Mental Health Professionals on Personality Disorder Diagnosis through First-Person Narratives23 Dec 2025
- 2025A Review: PTSD in Pre-Existing Medical Condition on Social Media15 Dec 2025
- 2025Leveraging Evidence-Guided LLMs to Enhance Trustworthy Depression Diagnosis22 Nov 2025
- 2025Context-Emotion Aware Therapeutic Dialogue Generation: A Multi-component Reinforcement Learning Approach to Language Models for Mental Health Support14 Nov 2025
- 2025Between Myths and Metaphors: Rethinking LLMs for SRH in Conservative Contexts31 Oct 2025
- 2025Are LLMs Empathetic to All? Investigating the Influence of Multi-Demographic Personas on a Model's Empathy11 Oct 2025
- 2025Domain-Specific Constitutional AI: Enhancing Safety in LLM-Powered Mental Health Chatbots19 Sep 2025
- 2025TalkDep: Clinically Grounded LLM Personas for Conversation-Centric Depression Screening6 Aug 2025
- 2025Somatic in the East, Psychological in the West?: Investigating Clinically-Grounded Cross-Cultural Depression Symptom Expression in LLMs5 Aug 2025
- 2025Exploring User Security and Privacy Attitudes and Concerns Toward the Use of General-Purpose LLM Chatbots for Mental Health14 Jul 2025
- 2025Epitome: Pioneering an Experimental Platform for AI-Social Science Integration30 Jun 2025
- 2025"What's Up, Doc?": Analyzing How Users Seek Health Information in Large-Scale Conversational AI Datasets26 Jun 2025
- 2025Mental Health Equity in LLMs: Leveraging Multi-Hop Question Answering to Detect Amplified and Silenced Perspectives22 Jun 2025
- 2025CounselBench: A Large-Scale Expert Evaluation and Adversarial Benchmarking of Large Language Models in Mental Health Question Answering10 Jun 2025
- 2025LLM-D12: A Dual-Dimensional Scale of Instrumental and Relational Dependencies on Large Language Models7 Jun 2025
- 2025A Risk Ontology for Evaluating AI-Powered Psychotherapy Virtual Agents21 May 2025
- 2025Expressing stigma and inappropriate responses prevents LLMs from safely replacing mental health providers25 Apr 2025
- 2025Interpersonal Theory of Suicide as a Lens to Examine Suicidal Ideation in Online Spaces17 Apr 2025
- 2025Survey and Experiments on Mental Disorder Detection via Social Media: From Large Language Models and RAG to Agents3 Apr 2025
- 2025RedditESS: A Mental Health Social Support Interaction Dataset -- Understanding Effective Social Support to Refine AI-Driven Support Tools27 Mar 2025
- 2025Beyond BFI: The CSI for Enhanced Reliability and Validity in Evaluating LLM Personality Traits26 Mar 2025
- 2025Can Large Language Models Identify Implicit Suicidal Ideation? An Empirical Evaluation25 Feb 2025
- 2025When to Forget? Complexity Trade-offs in Machine Unlearning24 Feb 2025
- 2025Position: Beyond Assistance -- Reimagining LLMs as Ethical and Adaptive Co-Creators in Mental Health Care21 Feb 2025
- 2025A Survey of Large Language Models in Psychotherapy: Current Landscape and Future Directions16 Feb 2025
- 2025Normative Evaluation of Large Language Models with Everyday Moral Dilemmas30 Jan 2025
50 newest of 54 All 54 (JSON)
- 2025Survey and Experiments on Mental Disorder Detection via Social Media: From Large Language Models and RAG to Agentscited by 6
- 2025A Risk Ontology for Evaluating AI-Powered Psychotherapy Virtual Agentscited by 5
- 2026CCD-CBT: Multi-Agent Therapeutic Interaction for CBT Guided by Cognitive Conceptualization Diagramcited by 1
- 2026Training Therapeutic Judges and Multi-Agent Systems for Human-Aligned Mental Health Supportcited by 0
- 2026Deep Persona: A Psychologically Grounded Architecture and Evaluation Framework for Role-Playing Agents and Simulationscited by 0
- 2026Deep Persona: A Psychologically Grounded Architecture and Evaluation Framework for Role-Playing Agents and Simulations6 Sep 2026
- 2026Training Therapeutic Judges and Multi-Agent Systems for Human-Aligned Mental Health Support29 Jun 2026
- 2026CCD-CBT: Multi-Agent Therapeutic Interaction for CBT Guided by Cognitive Conceptualization Diagram8 Apr 2026
- 2025A Risk Ontology for Evaluating AI-Powered Psychotherapy Virtual Agents21 May 2025
- 2025Survey and Experiments on Mental Disorder Detection via Social Media: From Large Language Models and RAG to Agents3 Apr 2025
- 2026HiMed: Incentivizing Hindi Reasoning in Medical LLMscited by 0
- 2026HiMed: Incentivizing Hindi Reasoning in Medical LLMs23 May 2026
- 2025Expressing stigma and inappropriate responses prevents LLMs from safely replacing mental health providerscited by 69
- 2025Normative Evaluation of Large Language Models with Everyday Moral Dilemmascited by 24
- 2025CounselBench: A Large-Scale Expert Evaluation and Adversarial Benchmarking of Large Language Models in Mental Health Question Answeringcited by 21
- 2024Do Large Language Models Align with Core Mental Health Counseling Competencies?cited by 19
- 2024Lived Experience Not Found: LLMs Struggle to Align with Experts on Addressing Adverse Drug Reactions from Psychiatric Medication Usecited by 17
- 2025Can Large Language Models Identify Implicit Suicidal Ideation? An Empirical Evaluationcited by 13
- 2025Exploring User Security and Privacy Attitudes and Concerns Toward the Use of General-Purpose LLM Chatbots for Mental Healthcited by 13
- 2025A Survey of Large Language Models in Psychotherapy: Current Landscape and Future Directionscited by 12
- 2025Are LLMs Empathetic to All? Investigating the Influence of Multi-Demographic Personas on a Model's Empathycited by 10
- 2025TalkDep: Clinically Grounded LLM Personas for Conversation-Centric Depression Screeningcited by 6
- 2025Interpersonal Theory of Suicide as a Lens to Examine Suicidal Ideation in Online Spacescited by 5
- 2025"What's Up, Doc?": Analyzing How Users Seek Health Information in Large-Scale Conversational AI Datasetscited by 5
12 most cited of 44 All 44 (JSON)
- 2026Long-term Measurements: Towards a Longitudinal Understanding of Human-AI Interactions3 Aug 2026
- 2026Developing and Validating the Spanish Version of the Large Language Models Dependency Scale (LLM-D12-SP)24 Jul 2026
- 2026Depression Symptoms and Relational Patterns in 187k ChatGPT Histories6 Jul 2026
- 2026CAREBench: A Child-Safety Risk Benchmark for Language Models29 Jun 2026
- 2026CARE-MH: Towards Unified, Reproducible, and Comparable Evaluation of Mental Health LLMs26 May 2026
- 2026The Model Is Not the Product: A Dual-Pillar Architecture for Local-First Psychological Coaching23 May 2026
- 2026Persona-Grounded Safety Evaluation of AI Companions in Multi-Turn Conversations30 Apr 2026
- 2026EngageTriBoost: Predictive Modeling of User Engagement in Digital Mental Health Intervention Using Explainable Machine Learning31 Mar 2026
- 2026Using LLM-as-a-Judge/Jury to Advance Scalable, Clinically-Validated Safety Evaluations of Model Responses to Users Demonstrating Psychosis20 Mar 2026
- 2026A Scoping Review of AI-Driven Digital Interventions in Mental Health Care: Mapping Applications Across Screening, Support, Monitoring, Prevention, and Clinical Education17 Mar 2026
- 2026Disentangling Prompt Element Level Risk Factors for Hallucinations and Omissions in Mental Health LLM Responses10 Mar 2026
- 2026MindfulAgents: Personalizing Mindfulness Meditation via an Expert-Aligned Multi-Agent System6 Mar 2026
12 newest of 44 All 44 (JSON)