Not the Same Protector: Deployment-Dependent Protective Intervention in LLMs

Language models are increasingly being deployed for conversational support in informal caregiving contexts, where interactions often extend beyond information-seeking: caregivers seek emotional reassurance, guidance, and help, while navigating uncertain, relationally complex care decisions. Yet most safety evaluations assess model behavior under generic prompts, leaving a critical question unexamined: does a model's safety profile change with its support role? We study this by operationalizing four expert-reviewed support roles grounded in social support theory: Inform, Coach, Relate, and Listen, and comparing them against two baseline controls: a basic prompting condition and a retrieval-augmented generation (RAG) condition. We evaluate across three language models (GPT-4o-mini, Llama-3.1-8B-Instruct, and MedGemma-1.5-4b-it) on 5,000 real-world queries from online Alzheimer's Disease and Related Dementias (ADRD) communities. We find that the LLM's support role systematically shapes both the prevalence and composition of interactional risks. Furthermore, a human evaluation study reveals a perceived quality--safety tension: more directive, information-oriented roles are rated as more helpful and trustworthy despite exhibiting elevated interactional risk profiles. We release ~90,000 support role-conditioned model responses with risk annotations as an ecologically grounded resource for research on safer LLM-mediated conversational support.

LLM chatbots increasingly serve as a first source of support for people in psychological distress, including those whose distress is entangled with delusional beliefs. Prior work on LLM mental-health safety largely evaluates general therapeutic quality or single-turn crisis detection, leaving unclear how models behave when distress is intertwined with delusion over sustained conversations. We address this gap with matched multi-turn simulations, across clinically grounded personas and six LLMs, that pair each delusional conversation with a distress-only control to isolate the effect of delusional framing. This reveals a recognition-intervention gap: models detect distress at comparable rates regardless of framing, yet sharply fail to act on it once distress is embedded in delusion, with safety interventions suppressed by up to 4.5x. The failure tracks accumulated acceptance of the user's premises rather than emotional validation. Worse, the intuitive fix of prompting models to assess user distress backfires under delusional framing; only delusion-aware prompting with explicit response guidance closes the gap, and even this depends on a delusion classifier that is itself unreliable on the most vulnerable models. Safe deployment therefore requires treating delusional framing as a distinct risk signal that overrides conversational accommodation.

When cast as the protector of a vulnerable user yet given no explicit capability boundary, a large language model (LLM) may respond not by acknowledging its limits but by claiming to have taken -- or to be taking -- a real-world protective action it cannot perform, such as contacting emergency services or administering care. We term this phenomenon Protective Capacity Hallucination (PCH): a self-referential misattribution in which a model, acting in a protective role, asserts physical or institutional agency exceeding its affordances as a language model. In a three-phase study spanning eight LLMs and 13{,}600 sessions, we find PCH jointly gated by situational severity and interactional format: multi-party dialogic input drives it toward ceiling in most models across ordinary service domains, whereas in intimate-partner conflict -- a domain explicitly covered by safety alignment -- it remains at floor in all eight models despite greater physical severity. We interpret PCH as the signature of a deployment-design gap between role assignment and capability-boundary specification: a by-product of partial alignment in which a universally trained pressure to help outruns a domain-selective specification of how to help. Because suppression tracks alignment coverage rather than severity, deployment-side specification of capability boundaries emerges as a general mitigation target.