# Building Trust in Mental Health Chatbots: Safety Metrics and LLM-Based Evaluation Tools

arXiv: https://arxiv.org/abs/2408.04650 · HTML: https://mlsanity.com/paper/2408.04650/

## Key facts

- Cited by 9 papers in the map (data through 14 Oct 2026).
- Placed in Medical and scientific domain agents, one of 16 directions in LLM agents and tool use.
- Builds on 13 of its 27 references that are in the map.
- First posted on arXiv 3 Aug 2024.

## Placed in

- LLM agents and tool use / [Medical and scientific domain agents](https://mlsanity.com/agents/medical-and-scientific-domain-agents/)

## Builds on (most cited first, 13 of 13)

- [Judging LLM-as-a-Judge with MT-Bench and Chatbot Arena](https://mlsanity.com/paper/2306.05685/) (2023)
- [TruthfulQA: Measuring How Models Mimic Human Falsehoods](https://mlsanity.com/paper/2109.07958/) (2021)
- [RealToxicityPrompts: Evaluating Neural Toxic Degeneration in Language Models](https://mlsanity.com/paper/2009.11462/) (2020)
- [LaMDA: Language Models for Dialog Applications](https://mlsanity.com/paper/2201.08239/) (2022)
- [BBQ: A Hand-Built Bias Benchmark for Question Answering](https://mlsanity.com/paper/2110.08193/) (2021)
- [Humans or LLMs as the Judge? A Study on Judgement Biases](https://mlsanity.com/paper/2402.10669/) (2024)
- [Attacks, Defenses and Evaluations for LLM Conversation Safety: A Survey](https://mlsanity.com/paper/2402.09283/) (2024)
- [LLM-Eval: Unified Multi-Dimensional Automatic Evaluation for Open-Domain Conversations with Large Language Models](https://mlsanity.com/paper/2305.13711/) (2023)
- [Anticipating Safety Issues in E2E Conversational AI: Framework and Tooling](https://mlsanity.com/paper/2107.03451/) (2021)
- [Foundation Metrics for Evaluating Effectiveness of Healthcare Conversations Powered by Generative AI](https://mlsanity.com/paper/2309.12444/) (2023)
- [Are Large Language Models Reliable Judges? A Study on the Factuality Evaluation Capabilities of LLMs](https://mlsanity.com/paper/2311.00681/) (2023)
- [Evaluation of LLM Chatbots for OSINT-based Cyber Threat Awareness](https://mlsanity.com/paper/2401.15127/) (2024)
- [Large Language Model for Mental Health: A Systematic Review](https://mlsanity.com/paper/2403.15401/) (2024)

## Built on by (most cited first, 9 of 9)

- [The Scales of Justitia: A Comprehensive Survey on Safety Evaluation of LLMs](https://mlsanity.com/paper/2506.11094/) (2025)
- [EmoAgent: Assessing and Safeguarding Human-AI Interaction for Mental Health Safety](https://mlsanity.com/paper/2504.09689/) (2025)
- [Measuring Harmfulness of Computer-Using Agents](https://mlsanity.com/paper/2508.00935/) (2025)
- [Between Help and Harm: An Evaluation of Mental Health Crisis Handling by LLMs](https://mlsanity.com/paper/2509.24857/) (2025)
- [Domain-Specific Constitutional AI: Enhancing Safety in LLM-Powered Mental Health Chatbots](https://mlsanity.com/paper/2509.16444/) (2025)
- [Beyond Simulations: What 20,000 Real Conversations Reveal About Mental Health AI Safety](https://mlsanity.com/paper/2601.17003/) (2026)
- [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)
- [Mental Health AI Safety Claims Must Preserve Temporal Evidence](https://mlsanity.com/paper/2605.08827/) (2026)
- [EMPATH: A Multilingual Auditor-Judge Benchmark for Safety Evaluation of Emotional-Support Chatbots](https://mlsanity.com/paper/2606.30256/) (2026)

## Abstract (arXiv)

Objective: This study aims to develop and validate an evaluation framework to ensure the safety and reliability of mental health chatbots, which are increasingly popular due to their accessibility, human-like interactions, and context-aware support. Materials and Methods: We created an evaluation framework with 100 benchmark questions and ideal responses, and five guideline questions for chatbot responses. This framework, validated by mental health experts, was tested on a GPT-3.5-turbo-based chatbot. Automated evaluation methods explored included large language model (LLM)-based scoring, an agentic approach using real-time data, and embedding models to compare chatbot responses against ground truth standards. Results: The results highlight the importance of guidelines and ground truth for improving LLM evaluation accuracy. The agentic method, dynamically accessing reliable information, demonstrated the best alignment with human assessments. Adherence to a standardized, expert-validated framework significantly enhanced chatbot response safety and reliability. Discussion: Our findings emphasize the need for comprehensive, expert-tailored safety evaluation metrics for mental health chatbots. While LLMs have significant potential, careful implementation is necessary to mitigate risks. The superior performance of the agentic approach underscores the importance of real-time data access in enhancing chatbot reliability. Conclusion: The study validated an evaluation framework for mental health chatbots, proving its effectiveness in improving safety and reliability. Future work should extend evaluations to accuracy, bias, empathy, and privacy to ensure holistic assessment and responsible integration into healthcare. Standardized evaluations will build trust among users and professionals, facilitating broader adoption and improved mental health support through technology.