Online mental health communities (OMHCs) are tiered platforms that connect patients with licensed counselors through public Q&A forums and paid private consultations. Their two-tier structure creates a strategic dilemma for genAI integration. Conversational agents can provide scalable and timely responses to a broader set of patients, alleviating persistent supply shortages, but their large-scale presence may also reshape counselors' participation in providing nuanced expertise, emotionally sensitive support, and paid consultations, which are central to platform revenue and long-run sustainability. Leveraging a quasi-natural experiment from the integration of a genAI-based conversational agent in a leading OMHC, we examine how AI entry affects counselor participation. Using multiple identification strategies, we find that posting intensity increases significantly after AI integration, while average response length remains unchanged and per-post social recognition declines. Mechanism analyses show that AI improves responsiveness and expands patient engagement, enlarging counselors' opportunity sets, with activity partially reallocated from a nearby non-AI subforum. Counselors respond heterogeneously: intrinsically motivated counselors reduce participation, whereas economically motivated counselors intensify competitive effort. These dynamics generate cross-tier spillovers: inactive counselors experience declines in paid consultations, while those who increase public participation preserve or expand downstream demand. Overall, our findings show that in tiered professional platforms, demand expansion and competitive incentives can outweigh intrinsic crowding-out.
Rising global demand for mental health support creates significant service delivery challenges, with asynchronous email counselling serving as a crucial low-threshold channel for accessing care. This paper presents CAIA, a co-designed AI-based tool suite that demonstrates responsible AI integration into counselling practice through seven LLM-driven functions enhanced by retrieval-augmented generation. A field evaluation involved 34 professional counsellors conducting authentic sessions with trained student counsellees (36 threads, 321 messages, 1,257 AI outputs). User behaviour analysis confirms substantial adoption, revealing that professional autonomy and information accuracy are decisive for sustained acceptance, with counsellors particularly valuing interpretive functionalities that provide new perspectives and stimulate professional reflection.
Philipp Steigerwald, Nico Bienlein, Jennifer Burghardt +3
Faculty of Computer Science, Technische Hochschule Nürnberg Georg Simon Ohm, Nürnberg, Germany · Faculty of Social Sciences, Institute for E-Counselling, Technische Hochschule Nürnberg Georg Simon Ohm, Nürnberg, Germany
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.
As autonomous LLM-based agents increasingly populate social platforms, understanding the dynamics of AI-agent communities becomes essential for both communication research and platform governance. We present the first large-scale empirical comparison of AI-agent and human online communities, analyzing 73,899 Moltbook and 189,838 Reddit posts across five matched communities. Structurally, we find that Moltbook exhibits extreme participation inequality (Gini = 0.84 vs. 0.47) and high cross-community author overlap (33.8% vs. 0.5%). In terms of linguistic attributes, content generated by AI-agents is emotionally flattened, cognitively shifted toward assertion over exploration, and socially detached. These differences give rise to apparent community-level homogenization, but we show this is primarily a structural artifact of shared authorship. At the author level, individual agents are more identifiable than human users, driven by outlier stylistic profiles amplified by their extreme posting volume. As AI-mediated communication reshapes online discourse, our work offers an empirical foundation for understanding how multi-agent interaction gives rise to collective communication dynamics distinct from those of human communities.
Agam Goyal, Olivia Pal, Hari Sundaram +2
Siebel School of Computing and Data Science University of Illinois Urbana-Champaign, Urbana, IL, USA