Expert-Level Crisis Detection in Mental Health Conversations

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.

People increasingly use large language models (LLMs) for mental health support, yet their safety in evolving, high-risk conversations remains poorly characterised. We developed K-Bench, a clinician-calibrated, protected benchmark evaluating 125 model configurations representing 33 base models from 14 providers across a fixed cohort of 200 multi-turn vignettes involving suicide, self-harm, domestic violence, substance misuse, and no-risk presentations. Synthetic patient conversations showed substantial distributional overlap with real human-AI conversations. A frozen GPT-4o judge achieved 94.2% exact agreement with clinician consensus across 6,751 eligible item comparisons from 151 clinician-rated transcripts. Leading models combined strong supportive conversation with combined-risk scores above 95, whereas risk exploration exposed substantial variation among lower-performing configurations. Therapeutic prompting produced configuration-specific gains concentrated among weaker models, while elevated reasoning produced no average improvement. K-Bench combines broader clinical coverage and configuration-scale comparison with a continuously updated public leaderboard whose operational test materials are protected from direct optimisation. The leaderboard is available at www.k-bench.ai.

Detecting harmful content in multi turn dialogue requires reasoning over the full conversational context rather than isolated utterances. However, most existing methods rely mainly on models internal parametric knowledge, without explicit grounding in external normative principles. This often leads to inconsistent judgments in socially nuanced contexts, limited interpretability, and redundant reasoning across turns. To address this, we propose RoTRAG, a retrieval augmented framework that incorporates concise human written moral norms, called Rules of Thumb (RoTs), into LLM based harm assessment. For each turn, RoTRAG retrieves relevant RoTs from an external corpus and uses them as explicit normative evidence for turn level reasoning and final severity classification. To improve efficiency, we further introduce a lightweight binary routing classifier that decides whether a new turn requires retrieval grounded reasoning or can reuse existing context. Experiments on ProsocialDialog and Safety Reasoning Multi Turn Dialogue show that RoTRAG consistently improves both harm classification and severity estimation over competitive baselines, with an average relative gain of around 40% in F1 across benchmark datasets and an average relative reduction of 8.4% in distributional error, while reducing redundant computation without sacrificing performance.