Aligning with Lived Experience: Heterogeneous Benefits of Fine Tuning in Mental Health Support Generation

Large language models (LLMs) show promise in generating supportive responses for mental health queries, but improving their usefulness, empathy, and safety often requires substantial compute, expert input, and labeled data. At the same time, deploying proprietary, cloud-based models for mental health-related interactions raises important privacy and data-governance concerns, given the sensitivities. To address this challenge, we introduce LLUMI setup that can be hosted in-house within protected environments. LLUMI consists of two complementary components: a generation model (GM), which drafts supportive responses to mental health queries, and an improvement model (IM), which revises an initial human-crafted response. We leverage feedback signals from Reddit mental health communities, using community endorsement patterns such as upvotes and downvotes to construct chosen-rejected response pairs for Supervised Fine Tuning (SFT) and Direct Preference Optimization (DPO). We further align LLUMI using human evaluation across five dimensions: readability, empathy, connection, actionability, and safety. Our results show that, despite relying on smaller open-source models rather than proprietary cloud-based GPT models, LLUMI achieves comparable performance across linguistic analyses and human evaluations. These findings suggest that open-source models, when trained with community-derived preference signals, can support high-quality mental health support assistance while offering a more privacy-preserving alternative for sensitive support contexts.

Mental health is a growing global concern, prompting interest in AI-driven solutions to expand access to psychosocial support. Peer support, grounded in lived experience, offers a valuable complement to professional care. However, variability in training, effectiveness, and definitions raises concerns about quality, consistency, and safety. Large Language Models (LLMs) present new opportunities to enhance peer support interactions, particularly in real-time, text-based interactions. We present and evaluate an AI-supported system with an LLM-simulated distressed client (SimClient), context-sensitive LLM-generated suggestions (Suggestions), and real-time emotion visualisations. 2 mixed-methods studies with 12 peer supporters and 6 mental health professionals (i.e., experts) examined the system's effectiveness and implications for practice. Both groups recognised its potential to enhance training and improve interaction quality. However, we found a key tension emerged: while peer supporters engaged meaningfully, experts consistently flagged critical issues in peer supporter responses, such as missed distress cues and premature advice-giving. This misalignment highlights potential limitations in current peer support training, especially in emotionally charged contexts where safety and fidelity to best practices are essential. Our findings underscore the need for standardised, psychologically grounded training, especially as peer support scales globally. They also demonstrate how LLM-supported systems can scaffold this development--if designed with care and guided by expert oversight. This work contributes to emerging conversations on responsible AI integration in mental health and the evolving role of LLMs in augmenting peer-delivered care.

When users seek social support from chatbots, they disclose their situation gradually, yet most evaluations of supportive LLMs rely on single-turn, fully specified prompts. We introduce a multi-turn simulation framework that closes this gap. Support-seeking narratives from five Reddit communities are decomposed into ordered fragments and revealed turn by turn to a language model. Each response is coded with the Social Support Behavior Code (SSBC), an established multi-label taxonomy that captures the composition of support, rather than a single quality score. To ask whether support choices track the model's own construal of user distress, we use linear probes on hidden representations to estimate this internal signal without altering the generation context. Across two mid-scale models (Llama-3.1-8B, OLMo-3-7B) and more than 6,200 turns, support composition shifts systematically with estimated distress: teaching declines as estimated distress rises, a finding that replicates across architectures, while increases in affective and esteem-oriented strategies (such as validation) are suggestive but model-specific and rest on noisier annotations. Community context independently shapes behavior, tracking topic and discourse norms rather than demographic categories. These trajectory-level dynamics, invisible to single-turn evaluation, motivate multi-turn auditing frameworks for socially sensitive applications.