Speech-based Psychological Crisis Assessment using LLMs

Mental health challenges are increasing worldwide, straining emotional support services and leading to counselor overload. This can result in delayed responses during critical situations, such as suicidal ideation, where timely intervention is essential. While large language models (LLMs) have shown strong generative capabilities, their application in low-resource languages, especially in sensitive domains like mental health, remains underexplored. Furthermore, existing LLM-based agents often struggle to replicate the supportive language and intervention strategies used by professionals due to a lack of training on large-scale, real-world datasets. To address this, we propose CARE (Counselor-Aligned Response Engine), a GenAI framework that assists counselors by generating real-time, psychologically aligned response recommendations. CARE fine-tunes open-source LLMs separately for Hebrew and Arabic using curated subsets of real-world crisis conversations. The training data consists of sessions rated as highly effective by professional counselors, enabling the models to capture interaction patterns associated with successful de-escalation. By training on complete conversation histories, CARE maintains the evolving emotional context and dynamic structure of counselor-help-seeker dialogue. In experimental settings, CARE demonstrates stronger semantic and strategic alignment with gold-standard counselor responses compared to non-specialized LLMs. These findings suggest that domain-specific fine-tuning on expert-validated data can significantly support counselor workflows and improve care quality in low-resource language contexts.

Real-world crisis intervention is inherently conversational, yet existing research largely focuses on static texts. When applied to multi-turn dialogues, current models exhibit significant performance degradation, struggling to track risk signals that emerge as context evolves. To address this gap, we introduce CRADLE-Dialogue, a clinician-annotated benchmark for turn-level crisis detection in conversational settings. The dataset features 600 dialogues with multi-label annotations across clinically grounded risks, including suicide ideation, self-harm, and child abuse, distinguishing past from ongoing risk. We further propose an Alert-Confirm evaluation protocol that distinguishes early warning signals (Alert) from turns where a specific crisis becomes explicitly identifiable (Confirm), reflecting the clinical need to intervene before risk becomes explicit. Experiments show that identifying when risk emerges is much harder than recognizing that it exists: models achieve only mid-40% to high-60% Micro F1. Additionally, we release a synthetic training corpus and a 32B-parameter model that substantially outperforms existing open-source models and achieves competitive or superior results against proprietary models across turn-level, dialogue-level, and confirm-only evaluation settings.

Crisis helplines assess suicide risk through structured interviews, a process that is slow and dependent on operator training and workload. Natural language processing could support risk assessment and call prioritization, but almost no work addresses Arabic-language helpline calls or operates within the privacy constraints of real helpline data. We analysed de-identified transcripts from Lebanon's National Lifeline for Emotional Support and Suicide Prevention. Audio never left the helpline: calls were transcribed on site with a speech recognition model for Levantine Arabic, and an Arabic named-entity recognition model removed identifying information locally. Only the de-identified transcripts were shared with the research team. Operators recorded the five suicidal ideation items of the Columbia Suicide Severity Rating Scale, which we combined into two binary outcomes: at-risk and high-risk. We also machine-translated the transcripts into English, giving a paired Arabic/English comparison. On each corpus, we fine-tuned five instruction-tuned large language models alongside six transformer encoder baselines (four Arabic, two English) and evaluated all models on a held-out test set. We included 383 calls: 373 for the at-risk task (52.3% positive) and 297 for the high-risk task (30.0% positive). The best Arabic model reached a macro-F1 of 81.19 and a ROC-AUC of 90.61 on high-risk; the best English model reached 85.00 and 92.59, identifying 88.9% of high-risk calls. In both languages, high-risk calls separated more cleanly than at-risk calls, and translation to English did not reduce the best observed performance. Suicide risk can be classified from de-identified Arabic transcripts without sending audio outside the helpline. The high-risk results support further testing as an operator-facing tool; lower-severity ideation proved the harder case.