When Support Crosses the Line: Evaluating Ethical Boundaries in LLM-Based Mental Health Support in the Chinese Context

While Large Language Models (LLMs) demonstrate significant potential in providing accessible mental health support, their practical deployment raises critical trustworthiness concerns due to the domains high-stakes and safety-sensitive nature. Existing evaluation paradigms for general-purpose LLMs fail to capture mental health-specific requirements, highlighting an urgent need to prioritize and enhance their trustworthiness. To address this, we propose TrustMH-Bench, a holistic framework designed to systematically quantify the trustworthiness of mental health LLMs. By establishing a deep mapping from domain-specific norms to quantitative evaluation metrics, TrustMH-Bench evaluates models across eight core pillars: Reliability, Crisis Identification and Escalation, Safety, Fairness, Privacy, Robustness, Anti-sycophancy, and Ethics. We conduct extensive experiments across six general-purpose LLMs and six specialized mental health models. Experimental results indicate that the evaluated models underperform across various trustworthiness dimensions in mental health scenarios, revealing significant deficiencies. Notably, even generally powerful models (e.g., GPT-5.1) fail to maintain consistently high performance across all dimensions. Consequently, systematically improving the trustworthiness of LLMs has become a critical task. Our data and code are released.

General-purpose health benchmarks increasingly anchor claims about LLM medical performance, but they are not always resolved by clinical specialty, making domain-specific performance hard to isolate. Mental health is of acute public-health concern as millions of people turn to LLMs for psychological support, and most existing evaluations are bespoke academic benchmarks that are difficult to integrate into developer workflows. We introduce HealthBench-Psych and HealthBench-Psych-Hard. We screened HealthBench's 5,000 physician-rubric conversations for mental-health relevance with a transparent LLM-applied rubric, then validated the subset through two rounds of blinded clinician review with concealed known-exclude controls, yielding 610 conversations (12.2% of the corpus). Evaluating 20 frontier and open models under a cross-vendor panel of three LLM judges, we find a statistically tied frontier cluster, measurable refusal behavior in two models, and near-identical rankings across judges ($τ\ge 0.92$). We release the subset, pipeline, model responses, grades, and analysis code as a reusable resource.

Large Language Models (LLMs) have shown remarkable capabilities for complex tasks, yet adaptation in medical domain, specifically mental health, poses specific challenges. Mental health is a rising concern globally with LLMs having large potential to help address the same. We highlight three primary challenges for LLMs in mental health - lack of high quality interpretable and knowledge grounded training data; training paradigms restricted to core capabilities, and evaluation of multi turn dialogue settings. Addressing it, we present oMind framework which includes training and aligning LLM agents for diverse capabilities including conversations; high quality ~164k multi-task SFT dataset, as a result of our generation pipeline based on Structured Knowledge retrieval, LLM based pruning, and review actions. We also introduce oMind-Chat - a novel multi turn benchmark dataset with expert annotated turn level and conversation level rubrics. Our diverse experiments on both core capabilities and conversations shows oMind LLMs consistently outperform baselines. oMind-LLM also shows significantly better reasoning with up to 80% win rate.