Adversarial Training for Failure-Sensitive User Simulation in Mental Health Dialogue Optimization

Realistic user simulation is crucial for training and evaluating task-oriented dialogue (TOD) systems, yet creating simulators that accurately replicate human behavior remains challenging. A key property of effective simulators is their ability to expose failure modes of the systems they evaluate. We present an adversarial training framework that iteratively improves user simulator realism through a competitive dynamic between a generator (user simulator) and a discriminator. Applied to mental health support chatbots, our approach demonstrates that fine-tuned simulators dramatically outperform zero-shot base models at surfacing system issues, and adversarial training further enhances diversity, distributional alignment, and predictive validity. The resulting simulator achieves a strong correlation between simulated and real failure occurrence rates across diverse chatbot configurations while maintaining low distributional divergence of failure modes. Discriminator accuracy decreases drastically after three adversarial iterations, suggesting improved realism. These results provide evidence that adversarial training is a promising approach for creating realistic user simulators in mental health support TOD domains, enabling rapid, reliable, and cost-effective system evaluation before deployment.

Can AI Relate: Testing Large Language Model Response for Mental Health Support

Large language models (LLMs) are already being piloted for clinical use in hospital systems like NYU Langone, Dana-Farber and the NHS. A proposed deployment use case is psychotherapy, where a LLM-powered chatbot can treat a patient undergoing a mental health crisis. Deployment of LLMs for mental health response could hypothetically broaden access to psychotherapy and provide new possibilities for personalizing care. However, recent high-profile failures, like damaging dieting advice offered by the Tessa chatbot to patients with eating disorders, have led to doubt about their reliability in high-stakes and safety-critical settings. In this work, we develop an evaluation framework for determining whether LLM response is a viable and ethical path forward for the automation of mental health treatment. Using human evaluation with trained clinicians and automatic quality-of-care metrics grounded in psychology research, we compare the responses provided by peer-to-peer responders to those provided by a state-of-the-art LLM. We show that LLMs like GPT-4 use implicit and explicit cues to infer patient demographics like race. We then show that there are statistically significant discrepancies between patient subgroups: Responses to Black posters consistently have lower empathy than for any other demographic group (2%-13% lower than the control group). Promisingly, we do find that the manner in which responses are generated significantly impacts the quality of the response. We conclude by proposing safety guidelines for the potential deployment of LLMs for mental health response.

The Capability of Large Language Models to Measure Psychiatric Functioning

The current work investigates the capability of Large language models (LLMs) that are explicitly trained on large corpuses of medical knowledge (Med-PaLM 2) to predict psychiatric functioning from patient interviews and clinical descriptions without being trained to do so. To assess this, n = 145 depression and n =115 PTSD assessments and n = 46 clinical case studies across high prevalence/high comorbidity disorders (Depressive, Anxiety, Psychotic, trauma and stress, Addictive disorders) were analyzed using prompts to extract estimated clinical scores and diagnoses. Results demonstrate that Med-PaLM 2 is capable of assessing psychiatric functioning across a range of psychiatric conditions with the strongest performance being the prediction of depression scores based on standardized assessments (Accuracy range= 0.80 - 0.84) which were statistically indistinguishable from human clinical raters t(1,144) = 1.20; p = 0.23. Results show the potential for general clinical language models to flexibly predict psychiatric risk based on free descriptions of functioning from both patients and clinicians.