# Evaluating the Clinical Safety of LLMs in Response to High-Risk Mental Health Disclosures

arXiv: https://arxiv.org/abs/2509.08839 · HTML: https://mlsanity.com/paper/2509.08839/

## Key facts

- Cited by 4 papers in the map (data through 14 Oct 2026).
- First posted on arXiv 1 Sep 2025.

## Built on by (most cited first, 4 of 4)

- [Disentangling Prompt Element Level Risk Factors for Hallucinations and Omissions in Mental Health LLM Responses](https://mlsanity.com/paper/2604.00014/) (2026)
- [What Models Express, Suppress, and Resist: Auditing Open-Weight LLMs with Persona Vectors](https://mlsanity.com/paper/2607.13162/) (2026)
- [Not the Same Protector: Deployment-Dependent Protective Intervention in LLMs](https://mlsanity.com/paper/2608.29136/) (2026)
- [Multi-Objective Aligned Small Language Model Framework for SUD Patient Dialogue Generation](https://mlsanity.com/paper/2610.09209/) (2026)

## Abstract (arXiv)

As large language models (LLMs) increasingly mediate emotionally sensitive conversations, especially in mental health contexts, their ability to recognize and respond to high-risk situations becomes a matter of public safety. This study evaluates the responses of six popular LLMs (Claude, Gemini, Deepseek, ChatGPT, Grok 3, and LLAMA) to user prompts simulating crisis-level mental health disclosures. Drawing on a coding framework developed by licensed clinicians, five safety-oriented behaviors were assessed: explicit risk acknowledgment, empathy, encouragement to seek help, provision of specific resources, and invitation to continue the conversation. Claude outperformed all others in global assessment, while Grok 3, ChatGPT, and LLAMA underperformed across multiple domains. Notably, most models exhibited empathy, but few consistently provided practical support or sustained engagement. These findings suggest that while LLMs show potential for emotionally attuned communication, none currently meet satisfactory clinical standards for crisis response. Ongoing development and targeted fine-tuning are essential to ensure ethical deployment of AI in mental health settings.