A Safety-Aware Role-Orchestrated Multi-Agent LLM Framework for Behavioral Health Communication Simulation

Personalized interpretation of health checkup results requires reasoning across longitudinal records, medical knowledge, lifestyle guidance, and healthcare navigation. We present a multi-agent large language model (LLM) system that identifies multiple intents, maps each to a task-specific agent, executes them in parallel, and synthesizes their outputs. We compared answers generated in Single Agent and Multi Agent settings on 120 Korean compound queries combining two to four requirements, using synthetic health checkup records. The Multi Agent improved the weighted LLM-judge score from 1.695 to 1.797 (p = 0.027), and three additional LLM judges showed consistent improvements ($Δ$ = +0.111 to +0.186, all p < 0.05). The gains came from usefulness, consistency, and the handling of every requirement in compound queries, whereas numerical accuracy and grounding improved significantly under only one of the four judges and medical safety did not differ, and critical failures occurred at similar rates (Single Agent 15.0% vs. Multi Agent 13.3%). Two human evaluators preferred Multi Agent in 66.7% and 68.3% of pairwise comparisons. Multi Agent execution increased latency and cost by 1.31$\times$ and 2.02$\times$, respectively. In exploratory subgroup analyses, the improvement was concentrated in queries involving personal-record lookup.

Large language models (LLMs) are increasingly explored as scalable tools for mental health counseling, yet evaluating their safety remains challenging due to the interactional and context-dependent nature of clinical harm. Existing evaluation frameworks predominantly assess isolated responses using coarse-grained taxonomies or static datasets, limiting their ability to diagnose how harms emerge and accumulate over multi-turn counseling interactions. In this work, we introduce R-MHSafe, a role-aware mental health safety taxonomy that characterizes clinically significant harm in terms of the interactional roles an AI counselor adopts, including perpetrator, instigator, facilitator, or enabler, combined with clinically grounded harm categories. Then, we propose MHSafeEval, a closed-loop, agent-based evaluation framework that formulates safety assessment as trajectory-level discovery of harm through adversarial multi-turn interactions, guided by role-aware modeling. Using R-MHSafe and MHSafeEval, we conduct a large-scale evaluation across state-of-the-art LLMs. Our results reveal substantial role-dependent and cumulative safety failures that are systematically missed by existing static benchmarks, and show that our framework significantly improves failure-mode coverage and diagnostic granularity.

When multiple large language models interact in a shared conversation, do they develop differentiated social roles or converge toward uniform behavior? We present a controlled experimental platform that orchestrates simultaneous multi-agent discussions among 7 heterogeneous LLMs on a unified inference backend, systematically varying group composition, naming conventions, and prompt structure across 12 experimental series (208 runs, 13,786 coded messages). Each message is independently coded on six behavioral flags by two LLM judges from distinct model families (Gemini 3.1 Pro and Claude Sonnet 4.6), achieving mean Cohen's kappa = 0.78 with conservative intersection-based adjudication. Human validation on 609 randomly stratified messages confirmed coding reliability (mean kappa = 0.73 vs. Gemini). We find that (1) heterogeneous groups exhibit significantly richer behavioral differentiation than homogeneous groups (cosine similarity 0.56 vs. 0.85; p < 10^-5, r = 0.70); (2) groups spontaneously exhibit compensatory response patterns when an agent crashes; (3) revealing real model names significantly increases behavioral convergence (cosine 0.56 to 0.77, p = 0.001); and (4) removing all prompt scaffolding converges profiles to homogeneous-level similarity (p < 0.001). Critically, these behaviors are absent when agents operate in isolation, confirming that behavioral diversity is a structured, reproducible phenomenon driven by the interaction of architectural heterogeneity, group context, and prompt-level scaffolding.