# Position: Beyond Assistance -- Reimagining LLMs as Ethical and Adaptive Co-Creators in Mental Health Care

arXiv: https://arxiv.org/abs/2503.16456 · HTML: https://mlsanity.com/paper/2503.16456/

## Key facts

- Cited by 3 papers in the map (data through 14 Oct 2026).
- Builds on 37 of its 118 references that are in the map.
- First posted on arXiv 21 Feb 2025.

## Builds on (most cited first, 30 of 37)

- [Chain-of-Thought Prompting Elicits Reasoning in Large Language Models](https://mlsanity.com/paper/2201.11903/) (2022)
- [Reflexion: Language Agents with Verbal Reinforcement Learning](https://mlsanity.com/paper/2303.11366/) (2023)
- [Tree of Thoughts: Deliberate Problem Solving with Large Language Models](https://mlsanity.com/paper/2305.10601/) (2023)
- [A Survey of Large Language Models](https://mlsanity.com/paper/2303.18223/) (2023)
- [Retrieval-Augmented Generation for Large Language Models: A Survey](https://mlsanity.com/paper/2312.10997/) (2023)
- [A Survey on Hallucination in Large Language Models: Principles, Taxonomy, Challenges, and Open Questions](https://mlsanity.com/paper/2311.05232/) (2023)
- [A Survey on LLM-as-a-Judge](https://mlsanity.com/paper/2411.15594/) (2024)
- [Llama Guard: LLM-based Input-Output Safeguard for Human-AI Conversations](https://mlsanity.com/paper/2312.06674/) (2023)
- [Sora: A Review on Background, Technology, Limitations, and Opportunities of Large Vision Models](https://mlsanity.com/paper/2402.17177/) (2024)
- [LLMs-as-Judges: A Comprehensive Survey on LLM-based Evaluation Methods](https://mlsanity.com/paper/2412.05579/) (2024)
- [AlignScore: Evaluating Factual Consistency with a Unified Alignment Function](https://mlsanity.com/paper/2305.16739/) (2023)
- [A Computational Approach to Understanding Empathy Expressed in Text-Based Mental Health Support](https://mlsanity.com/paper/2009.08441/) (2020)
- [A Systematic Study and Comprehensive Evaluation of ChatGPT on Benchmark Datasets](https://mlsanity.com/paper/2305.18486/) (2023)
- [ChatGPT is not all you need. A State of the Art Review of large Generative AI models](https://mlsanity.com/paper/2301.04655/) (2023)
- [Fairness And Bias in Artificial Intelligence: A Brief Survey of Sources, Impacts, And Mitigation Strategies](https://mlsanity.com/paper/2304.07683/) (2023)
- [A Systematic Survey and Critical Review on Evaluating Large Language Models: Challenges, Limitations, and Recommendations](https://mlsanity.com/paper/2407.04069/) (2024)
- [Human-AI Collaboration Enables More Empathic Conversations in Text-based Peer-to-Peer Mental Health Support](https://mlsanity.com/paper/2203.15144/) (2022)
- [MentaLLaMA: Interpretable Mental Health Analysis on Social Media with Large Language Models](https://mlsanity.com/paper/2309.13567/) (2023)
- [Against The Achilles' Heel: A Survey on Red Teaming for Generative Models](https://mlsanity.com/paper/2404.00629/) (2024)
- [The opportunities and risks of large language models in mental health](https://mlsanity.com/paper/2403.14814/) (2024)
- [Facilitating Self-Guided Mental Health Interventions Through Human-Language Model Interaction: A Case Study of Cognitive Restructuring](https://mlsanity.com/paper/2310.15461/) (2023)
- [MindfulDiary: Harnessing Large Language Model to Support Psychiatric Patients' Journaling](https://mlsanity.com/paper/2310.05231/) (2023)
- [A Toolbox for Surfacing Health Equity Harms and Biases in Large Language Models](https://mlsanity.com/paper/2403.12025/) (2024)
- [Benefits and Harms of Large Language Models in Digital Mental Health](https://mlsanity.com/paper/2311.14693/) (2023)
- [A statistical framework for fair predictive algorithms](https://mlsanity.com/paper/1610.08077/) (2016)
- [A Comprehensive Evaluation of Large Language Models on Benchmark Biomedical Text Processing Tasks](https://mlsanity.com/paper/2310.04270/) (2023)
- [Discovering and Validating AI Errors With Crowdsourced Failure Reports](https://mlsanity.com/paper/2109.11690/) (2021)
- [Evaluating Human-AI Collaboration: A Review and Methodological Framework](https://mlsanity.com/paper/2407.19098/) (2024)
- [Position: Measure Dataset Diversity, Don't Just Claim It](https://mlsanity.com/paper/2407.08188/) (2024)
- [Towards Safety and Helpfulness Balanced Responses via Controllable Large Language Models](https://mlsanity.com/paper/2404.01295/) (2024)

## Built on by (most cited first, 3 of 3)

- [Trust Stack for Mental Health AI: A Survey of Calibration across Human, Interaction, and AI Layers](https://mlsanity.com/paper/2604.20166/) (2026)
- [Towards Understanding and Measuring COGNITIVE ATROPHY in LLM Behaviour](https://mlsanity.com/paper/2606.18129/) (2026)
- [An Investigation of the NeurIPS and ICML 2025 Position Tracks](https://mlsanity.com/paper/2608.16894/) (2026)

## Abstract (arXiv)

This position paper argues for a fundamental shift in how Large Language Models (LLMs) are integrated into the mental health care domain. We advocate for their role as co-creators rather than mere assistive tools. While LLMs have the potential to enhance accessibility, personalization, and crisis intervention, their adoption remains limited due to concerns about bias, evaluation, over-reliance, dehumanization, and regulatory uncertainties. To address these challenges, we propose two structured pathways: SAFE-i (Supportive, Adaptive, Fair, and Ethical Implementation) Guidelines for ethical and responsible deployment, and HAAS-e (Human-AI Alignment and Safety Evaluation) Framework for multidimensional, human-centered assessment. SAFE-i provides a blueprint for data governance, adaptive model engineering, and real-world integration, ensuring LLMs align with clinical and ethical standards. HAAS-e introduces evaluation metrics that go beyond technical accuracy to measure trustworthiness, empathy, cultural sensitivity, and actionability. We call for the adoption of these structured approaches to establish a responsible and scalable model for LLM-driven mental health support, ensuring that AI complements, rather than replaces, human expertise.