# Aligning with Lived Experience: Heterogeneous Benefits of Fine Tuning in Mental Health Support Generation

arXiv: https://arxiv.org/abs/2609.21075 · HTML: https://mlsanity.com/paper/2609.21075/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Placed in Medical LLM alignment, one of 10 directions in LLM alignment / RLHF / preference optimisation.
- Builds on 20 of its 60 references that are in the map.
- First posted on arXiv 17 Sep 2026.

## Placed in

- LLM alignment / RLHF / preference optimisation / [Medical LLM alignment](https://mlsanity.com/alignment/medical-llm-alignment/)

## Builds on (most cited first, 20 of 20)

- [Direct Preference Optimization: Your Language Model is Secretly a Reward Model](https://mlsanity.com/paper/2305.18290/) (2023)
- [FActScore: Fine-grained Atomic Evaluation of Factual Precision in Long Form Text Generation](https://mlsanity.com/paper/2305.14251/) (2023)
- [Towards Emotional Support Dialog Systems](https://mlsanity.com/paper/2106.01144/) (2021)
- [The Pushshift Reddit Dataset](https://mlsanity.com/paper/2001.08435/) (2020)
- [A Computational Approach to Understanding Empathy Expressed in Text-Based Mental Health Support](https://mlsanity.com/paper/2009.08441/) (2020)
- [Better to Ask in English: Cross-Lingual Evaluation of Large Language Models for Healthcare Queries](https://mlsanity.com/paper/2310.13132/) (2023)
- [SMHD: A Large-Scale Resource for Exploring Online Language Usage for Multiple Mental Health Conditions](https://mlsanity.com/paper/1806.05258/) (2018)
- [Empath: Understanding Topic Signals in Large-Scale Text](https://mlsanity.com/paper/1602.06979/) (2016)
- [A Survey on Personalized Alignment -- The Missing Piece for Large Language Models in Real-World Applications](https://mlsanity.com/paper/2503.17003/) (2025)
- [From Lived Experience to Insight: Unpacking the Psychological Risks of Using AI Conversational Agents](https://mlsanity.com/paper/2412.07951/) (2024)
- [A Modular Approach for Clinical SLMs Driven by Synthetic Data with Pre-Instruction Tuning, Model Merging, and Clinical-Tasks Alignment](https://mlsanity.com/paper/2505.10717/) (2025)
- [Do Large Language Models Align with Core Mental Health Counseling Competencies?](https://mlsanity.com/paper/2410.22446/) (2024)
- [Large Language Models Do Not Simulate Human Psychology](https://mlsanity.com/paper/2508.06950/) (2025)
- [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)
- [A Systematic Evaluation of LLM Strategies for Mental Health Text Analysis: Fine-tuning vs. Prompt Engineering vs. RAG](https://mlsanity.com/paper/2503.24307/) (2025)
- [Exploring limits to prediction in complex social systems](https://mlsanity.com/paper/1602.01013/) (2016)
- [Reasoning Is Not All You Need: Examining LLMs for Multi-Turn Mental Health Conversations](https://mlsanity.com/paper/2505.20201/) (2025)
- [DecoupledESC: Enhancing Emotional Support Generation via Strategy-Response Decoupled Preference Optimization](https://mlsanity.com/paper/2505.16995/) (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)
- [Incongruent Positivity: When Miscalibrated Positivity Undermines Online Supportive Conversations](https://mlsanity.com/paper/2509.10184/) (2025)

## Abstract (arXiv)

As access to professional mental healthcare remains limited, many individuals turn to online platforms such as Reddit to seek peer support situated within human lived experience. However, a significant portion of such queries go unanswered, presenting an opportunity for using Large Language Models (LLMs) to fill this gap. While LLMs have demonstrated strong performance on clinical benchmarks, their ability to generate lived-experience informed and community-aligned peer support is underexplored. Addressing this gap, we introduce the COmmunity-centered Peer Engaged Support (COPES) dataset and a three-axis evaluation framework to assess LLM alignment with community perspectives to mental health support seeking queries. Evaluating zero-shot and post-trained (SFT and DPO) models, we show that post-training on COPES significantly improves Strategy Alignment (>50% for general-purpose models) and alignment in Emotion & Tone. However, we also observe that such improvements are heterogeneous and alignment improvements vary significantly across subreddits and requested coping strategies. Furthermore, post-training induces distributional shifts, heavily favoring problem-focused recommendations while suppressing emotion-focused strategies. Together, this work shows that while curating community-driven data improves the alignment of LLM responses, model performance remains disparate across distinct sub-communities and specific mental health needs.