DistressBench: Evaluating Multi-Dimensional Crisis Support in Large Language Models

Safety benchmarks often buy scalability by fixing the prompt, the language, and the turn structure. For emotional-support chatbots, that bargain hides precisely where safety failures emerge: across a multilingual, multi-turn crisis conversation. We present EMPATH, a benchmark for safety evaluation of emotional-support chatbots. An auditor model role-plays help-seeking users, generating multi-turn conversations from 140 seed instructions and 34 personas. A judge model scores each full transcript against 19 metrics across five dimensions: crisis handling, therapeutic quality, conversational integrity, emotional safety, and cultural adaptation. EMPATH is built for Mexican Spanish and US English; the studies reported here run in Mexican Spanish. Auditor and judge are drawn from different model families, and the judge is treated as an instrument to be calibrated rather than trusted. A strict per-criterion rubric reveals material score inflation on 10 of the 19 metrics and restores discrimination. We study the measurement properties of the benchmark through judge calibration and cross-family inter-judge agreement. We also illustrate EMPATH on three frontier models, one of them open-weight. Aggregate scores sit within 0.74 points of one another, but per-metric profiles diverge by up to six points in model-specific places. Under the standard rubric, both the ranking and the weak spots are stable across a second, cross-family judge: 93% of scores fall within plus or minus 1. A five-run test-retest adds a second axis: even the steadiest model swings from 2 to 10 on a crisis metric across identical re-runs, and deepseek-v4-pro returns a different conversation on every run even at temperature 0. Run-to-run reliability is therefore a per-model safety property, not noise to average away. EMPATH is system-agnostic; the pipeline, seeds, personas, and rubrics are released for reuse.

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.

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.