Crisis Responders (CRs) rapidly assess thousands of youth SMS conversations each year to identify mental health concerns and guide support. Yet youth distress is increasingly expressed through evolving and context-specific language that often does not fit fixed-label taxonomies. This work analyzed 703,975 de-identified Kids Help Phone conversations (2018-2023) and expanded KHP's 19-label issue taxonomy into a 39-label hierarchical schema. We then introduce Keyphrase Generative Representation (KGR), a constrained LLM generating concise, conversation-specific keyphrases, evaluated across 129 conversations and 387 expert annotations. The expanded taxonomy achieved expert consensus reliability, with an accuracy of 0.96, and expert review found that 81% of keyphrases accurately reflected content and 74% improved clarity. KGR surfaced identity-linked themes absent from the fixed taxonomy, including immigration problems and caregiver burden, and supported a topic-retrieval workflow that increased accuracy from 0.25 to 0.70 (+0.45) over the manual analyst process. KGR marks a shift toward hybrid, interpretable generative representations that extend crisis response beyond static taxonomies to surface emerging and culturally grounded patterns of youth distress.
Psychological support hotlines provide critical support for individuals experiencing mental health emergencies, yet current assessments largely rely on human operators whose judgments may vary with professional experience and are constrained by limited staffing resources. This paper proposes a large language model (LLM)-based framework for automated crisis level classification, a key indicator that supports many downstream tasks and improves the overall quality of hotline services. To better capture emotional signals in spoken conversations, we introduce a paralinguistic injection method that inserts identified non-verbal emotional cues into speech transcripts, enabling LLM-based reasoning to incorporate critical acoustic nuances. In addition, we propose a reasoning-enhanced training strategy that trains the model to generate diagnostic reasoning chains as an auxiliary task, which serves as a regulariser to improve classification performance. Combined with data augmentation, our final system achieves a macro F1-score of 0.802 and an accuracy of 0.805 on the three-class classification task under 5-fold cross-validation.
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.
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.