# Trust Stack for Mental Health AI: A Survey of Calibration across Human, Interaction, and AI Layers

arXiv: https://arxiv.org/abs/2604.20166 · HTML: https://mlsanity.com/paper/2604.20166/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 27 of its 82 references that are in the map.
- First posted on arXiv 22 Apr 2026.

## Builds on (most cited first, 27 of 27)

- [DecodingTrust: A Comprehensive Assessment of Trustworthiness in GPT Models](https://mlsanity.com/paper/2306.11698/) (2023)
- [Trustworthy LLMs: a Survey and Guideline for Evaluating Large Language Models' Alignment](https://mlsanity.com/paper/2308.05374/) (2023)
- [Formalizing Trust in Artificial Intelligence: Prerequisites, Causes and Goals of Human Trust in AI](https://mlsanity.com/paper/2010.07487/) (2020)
- [SoulChat: Improving LLMs' Empathy, Listening, and Comfort Abilities through Fine-tuning with Multi-turn Empathy Conversations](https://mlsanity.com/paper/2311.00273/) (2023)
- [PsySafe: A Comprehensive Framework for Psychological-based Attack, Defense, and Evaluation of Multi-agent System Safety](https://mlsanity.com/paper/2401.11880/) (2024)
- [TrustAgent: Towards Safe and Trustworthy LLM-based Agents](https://mlsanity.com/paper/2402.01586/) (2024)
- [Designing for Responsible Trust in AI Systems: A Communication Perspective](https://mlsanity.com/paper/2204.13828/) (2022)
- [Customizing Emotional Support: How Do Individuals Construct and Interact With LLM-Powered Chatbots](https://mlsanity.com/paper/2504.12943/) (2025)
- [EmoAgent: Assessing and Safeguarding Human-AI Interaction for Mental Health Safety](https://mlsanity.com/paper/2504.09689/) (2025)
- [AnnaAgent: Dynamic Evolution Agent System with Multi-Session Memory for Realistic Seeker Simulation](https://mlsanity.com/paper/2506.00551/) (2025)
- [The Colorful Future of LLMs: Evaluating and Improving LLMs as Emotional Supporters for Queer Youth](https://mlsanity.com/paper/2402.11886/) (2024)
- [Understanding the Therapeutic Relationship between Counselors and Clients in Online Text-based Counseling using LLMs](https://mlsanity.com/paper/2402.11958/) (2024)
- [An Integrative Survey on Mental Health Conversational Agents to Bridge Computer Science and Medical Perspectives](https://mlsanity.com/paper/2310.17017/) (2023)
- [Writing Style Matters: An Examination of Bias and Fairness in Information Retrieval Systems](https://mlsanity.com/paper/2411.13173/) (2024)
- [MAGI: Multi-Agent Guided Interview for Psychiatric Assessment](https://mlsanity.com/paper/2504.18260/) (2025)
- [KokoroChat: A Japanese Psychological Counseling Dialogue Dataset Collected via Role-Playing by Trained Counselors](https://mlsanity.com/paper/2506.01357/) (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)
- [Knowledge Planning in Large Language Models for Domain-Aligned Counseling Summarization](https://mlsanity.com/paper/2409.14907/) (2024)
- [FedTherapist: Mental Health Monitoring with User-Generated Linguistic Expressions on Smartphones via Federated Learning](https://mlsanity.com/paper/2310.16538/) (2023)
- [Private Yet Social: How LLM Chatbots Support and Challenge Eating Disorder Recovery](https://mlsanity.com/paper/2412.11656/) (2024)
- [Trustworthy AI Psychotherapy: Multi-Agent LLM Workflow for Counseling and Explainable Mental Disorder Diagnosis](https://mlsanity.com/paper/2508.11398/) (2025)
- [Assessment and manipulation of latent constructs in pre-trained language models using psychometric scales](https://mlsanity.com/paper/2409.19655/) (2024)
- [Script-Strategy Aligned Generation: Aligning LLMs with Expert-Crafted Dialogue Scripts and Therapeutic Strategies for Psychotherapy](https://mlsanity.com/paper/2411.06723/) (2024)
- [Understanding Attitudes and Trust of Generative AI Chatbots for Social Anxiety Support](https://mlsanity.com/paper/2501.15628/) (2025)
- [Position: Beyond Assistance -- Reimagining LLMs as Ethical and Adaptive Co-Creators in Mental Health Care](https://mlsanity.com/paper/2503.16456/) (2025)
- [The Impact of Explanations on Layperson Trust in Artificial Intelligence-Driven Symptom Checker Apps: Experimental Study](https://mlsanity.com/paper/2202.13444/) (2022)
- [Understanding Adolescents' Perceptions of Benefits and Risks in Health AI Technologies through Design Fiction](https://mlsanity.com/paper/2504.13389/) (2025)

## Abstract (arXiv)

Language-based AI is increasingly deployed for mental health support, yet trust is evaluated in interdisciplinary but operationally misaligned ways: NLP and AI work measures robustness, safety, privacy, and explanations, while psychotherapy, HCI, and regulatory work emphasize therapeutic fidelity, lived experience, empathy, and reliance. Empathetic chatbots can elicit strong user trust without commensurate safety, while safer systems are under-trusted when their boundaries are opaque, a calibration gap no single community owns. Through a structured scoping synthesis of 61 papers, we survey this landscape into a three-layer framework separating (L1) human-oriented trust, (L2) interaction-oriented trustworthiness, and (L3) AI-oriented trustworthiness, and map five stakeholder perspectives onto these layers. We outline a research agenda for building socio-technically aligned trustworthy AI for mental health support, highlighting that the central objective should shift from maximizing perceived trust to calibrating human trust to demonstrated interaction- and AI-level trustworthiness.