# The opportunities and risks of large language models in mental health

arXiv: https://arxiv.org/abs/2403.14814 · HTML: https://mlsanity.com/paper/2403.14814/

## 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 (most cited first, 19 of 19)

- [Chain-of-Thought Prompting Elicits Reasoning in Large Language Models](https://mlsanity.com/paper/2201.11903/) (2022)
- [Retrieval-Augmented Generation for Large Language Models: A Survey](https://mlsanity.com/paper/2312.10997/) (2023)
- [Large Language Models Encode Clinical Knowledge](https://mlsanity.com/paper/2212.13138/) (2022)
- [Ethical and social risks of harm from Language Models](https://mlsanity.com/paper/2112.04359/) (2021)
- [Trustworthy LLMs: a Survey and Guideline for Evaluating Large Language Models' Alignment](https://mlsanity.com/paper/2308.05374/) (2023)
- [Towards Expert-Level Medical Question Answering with Large Language Models](https://mlsanity.com/paper/2305.09617/) (2023)
- [Towards Understanding Chain-of-Thought Prompting: An Empirical Study of What Matters](https://mlsanity.com/paper/2212.10001/) (2022)
- [MentalBERT: Publicly Available Pretrained Language Models for Mental Healthcare](https://mlsanity.com/paper/2110.15621/) (2021)
- [Towards Accurate Differential Diagnosis with Large Language Models](https://mlsanity.com/paper/2312.00164/) (2023)
- [Understanding the Benefits and Challenges of Using Large Language Model-based Conversational Agents for Mental Well-being Support](https://mlsanity.com/paper/2307.15810/) (2023)
- [Human-AI Collaboration Enables More Empathic Conversations in Text-based Peer-to-Peer Mental Health Support](https://mlsanity.com/paper/2203.15144/) (2022)
- [Evaluation of ChatGPT for NLP-based Mental Health Applications](https://mlsanity.com/paper/2303.15727/) (2023)
- [Towards Interpretable Mental Health Analysis with Large Language Models](https://mlsanity.com/paper/2304.03347/) (2023)
- [Will Affective Computing Emerge from Foundation Models and General AI? A First Evaluation on ChatGPT](https://mlsanity.com/paper/2303.03186/) (2023)
- [Psy-LLM: Scaling up Global Mental Health Psychological Services with AI-based Large Language Models](https://mlsanity.com/paper/2307.11991/) (2023)
- [The Capability of Large Language Models to Measure Psychiatric Functioning](https://mlsanity.com/paper/2308.01834/) (2023)
- [Gendered Mental Health Stigma in Masked Language Models](https://mlsanity.com/paper/2210.15144/) (2022)
- [Deep Learning Mental Health Dialogue System](https://mlsanity.com/paper/2301.09412/) (2023)
- [Algorithmic Bias, Generalist Models,and Clinical Medicine](https://mlsanity.com/paper/2305.04008/) (2023)

## Built on by (most cited first, 30 of 54)

- [Expressing stigma and inappropriate responses prevents LLMs from safely replacing mental health providers](https://mlsanity.com/paper/2504.18412/) (2025)
- [Normative Evaluation of Large Language Models with Everyday Moral Dilemmas](https://mlsanity.com/paper/2501.18081/) (2025)
- [CounselBench: A Large-Scale Expert Evaluation and Adversarial Benchmarking of Large Language Models in Mental Health Question Answering](https://mlsanity.com/paper/2506.08584/) (2025)
- [Do Large Language Models Align with Core Mental Health Counseling Competencies?](https://mlsanity.com/paper/2410.22446/) (2024)
- [Lived Experience Not Found: LLMs Struggle to Align with Experts on Addressing Adverse Drug Reactions from Psychiatric Medication Use](https://mlsanity.com/paper/2410.19155/) (2024)
- [Can Large Language Models Identify Implicit Suicidal Ideation? An Empirical Evaluation](https://mlsanity.com/paper/2502.17899/) (2025)
- [Exploring User Security and Privacy Attitudes and Concerns Toward the Use of General-Purpose LLM Chatbots for Mental Health](https://mlsanity.com/paper/2507.10695/) (2025)
- [A Survey of Large Language Models in Psychotherapy: Current Landscape and Future Directions](https://mlsanity.com/paper/2502.11095/) (2025)
- [Are LLMs Empathetic to All? Investigating the Influence of Multi-Demographic Personas on a Model's Empathy](https://mlsanity.com/paper/2510.10328/) (2025)
- [When to Forget? Complexity Trade-offs in Machine Unlearning](https://mlsanity.com/paper/2502.17323/) (2025)
- [Survey and Experiments on Mental Disorder Detection via Social Media: From Large Language Models and RAG to Agents](https://mlsanity.com/paper/2504.02800/) (2025)
- [TalkDep: Clinically Grounded LLM Personas for Conversation-Centric Depression Screening](https://mlsanity.com/paper/2508.04248/) (2025)
- [Interpersonal Theory of Suicide as a Lens to Examine Suicidal Ideation in Online Spaces](https://mlsanity.com/paper/2504.13277/) (2025)
- [A Risk Ontology for Evaluating AI-Powered Psychotherapy Virtual Agents](https://mlsanity.com/paper/2505.15108/) (2025)
- ["What's Up, Doc?": Analyzing How Users Seek Health Information in Large-Scale Conversational AI Datasets](https://mlsanity.com/paper/2506.21532/) (2025)
- [From Conversation to Automation: Leveraging LLMs for Problem-Solving Therapy Analysis](https://mlsanity.com/paper/2501.06101/) (2025)
- [Domain-Specific Constitutional AI: Enhancing Safety in LLM-Powered Mental Health Chatbots](https://mlsanity.com/paper/2509.16444/) (2025)
- [Do No Harm: Exposing Hidden Vulnerabilities of LLMs via Persona-based Client Simulation Attack in Psychological Counseling](https://mlsanity.com/paper/2604.04842/) (2026)
- [Persona-Grounded Safety Evaluation of AI Companions in Multi-Turn Conversations](https://mlsanity.com/paper/2605.00227/) (2026)
- [Position: Beyond Assistance -- Reimagining LLMs as Ethical and Adaptive Co-Creators in Mental Health Care](https://mlsanity.com/paper/2503.16456/) (2025)
- [RedditESS: A Mental Health Social Support Interaction Dataset -- Understanding Effective Social Support to Refine AI-Driven Support Tools](https://mlsanity.com/paper/2503.21888/) (2025)
- [LLM-D12: A Dual-Dimensional Scale of Instrumental and Relational Dependencies on Large Language Models](https://mlsanity.com/paper/2506.06874/) (2025)
- [Mental Health Equity in LLMs: Leveraging Multi-Hop Question Answering to Detect Amplified and Silenced Perspectives](https://mlsanity.com/paper/2506.18116/) (2025)
- [Using LLM-as-a-Judge/Jury to Advance Scalable, Clinically-Validated Safety Evaluations of Model Responses to Users Demonstrating Psychosis](https://mlsanity.com/paper/2604.02359/) (2026)
- [Beyond BFI: The CSI for Enhanced Reliability and Validity in Evaluating LLM Personality Traits](https://mlsanity.com/paper/2503.20182/) (2025)
- [Somatic in the East, Psychological in the West?: Investigating Clinically-Grounded Cross-Cultural Depression Symptom Expression in LLMs](https://mlsanity.com/paper/2508.03247/) (2025)
- [CHiRPE: A Step Towards Real-World Clinical NLP with Clinician-Oriented Model Explanations](https://mlsanity.com/paper/2601.18102/) (2026)
- [TrustMH-Bench: A Comprehensive Benchmark for Evaluating the Trustworthiness of Large Language Models in Mental Health](https://mlsanity.com/paper/2603.03047/) (2026)
- [The use of GPT-4o and Other Large Language Models for the Improvement and Design of Self-Assessment Scales for Measurement of Interpersonal Communication Skills](https://mlsanity.com/paper/2409.14050/) (2024)
- [PsyProbe: Proactive and Interpretable Dialogue through User State Modeling for Exploratory Counseling](https://mlsanity.com/paper/2601.19096/) (2026)

## 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.