Christopher K. Rhea

Eranga Bandara, Asanga Gunaratna, Ross Gore et al.

Privacy represents one of the most critical yet underaddressed barriers to AI adoption in mental healthcare -- particularly in high-sensitivity operational environments such as military, correctional, and remote healthcare settings, where the risk of patient data exposure can deter help-seeking behavior entirely. Existing AI-enabled psychiatric decision support systems predominantly rely on cloud-based inference pipelines, requiring sensitive patient data to leave the device and traverse external servers, creating unacceptable privacy and security risks in these contexts. In this paper, we propose a zero-egress, on-device AI platform for privacy-preserving psychiatric decision support, deployed as a cross-platform mobile application. The proposed system extends our prior work on fine-tuned LLM consortiums for psychiatric diagnosis standardization by fundamentally re-architecting the inference pipeline for fully local execution -- ensuring that no patient data is transmitted to, processed by, or stored on any external server at any stage. The platform integrates a consortium of three lightweight, fine-tuned, and quantized open-source LLMs -- Gemma, Phi-3.5-mini, and Qwen2 -- selected for their compact architectures and proven efficiency on resource-constrained mobile hardware. An on-device orchestration layer coordinates ensemble inference and consensus-based diagnostic reasoning, producing DSM-5-aligned assessments for conditions. The platform is designed to assist clinicians with differential diagnosis and evidence-linked symptom mapping, as well as to support patient-facing self-screening with appropriate clinical safeguards. Initial evaluation demonstrates that the proposed zero-egress deployment achieves diagnostic accuracy comparable to its server-side predecessor while sustaining real-time inference latency on commodity mobile hardware.

Eranga Bandara, Ross Gore, Asanga Gunaratna et al.

Post-Traumatic Stress Disorder (PTSD) is fundamentally a neuroplastic problem traumatic contact events encode over-reactive neural pathways through Hebbian long-term potentiation, producing hair-triggered amygdala-HPA stress cascades that fire before conscious awareness can intercept them. Existing therapeutic approaches, prolonged exposure, EMDR, cognitive behavioural therapy, operate predominantly downstream of the reactive cascade, teaching patients to tolerate or reframe distress after it has arisen. While clinically valuable, these suppression-based approaches do not produce the upstream pathway dissolution that constitutes lasting structural neural reorganisation. This paper proposes MindGap, a privacy-preserving on-device conversational AI framework that delivers structured neuroplastic rehabilitation for PTSD through the practice of dependent origination, a Buddhist psychological framework that identifies the precise moment between the pre-cognitive affective signal and the reactive elaboration that follows as the site of therapeutic intervention. MindGap guides patients through three progressive layers of observation at this feeling tone gap: noticing the bare affective signal before reactive elaboration, recognising it as self-arising rather than caused by the stimulus, and recognising the conditioned implicit belief beneath the feeling. Each layer corresponds to progressively deeper prefrontal regulatory engagement and progressively deeper long-term depression-mediated weakening of the reactive pathway, producing genuine upstream dissolution rather than downstream suppression. Running entirely on-device with no data egress, MindGap delivers daily calibrated exposure sessions through a fine-tuned lightweight large language model, making it deployable in sensitive clinical and military contexts where cloud-based solutions are not permitted.

Eranga Bandara, Ross Gore, Asanga Gunaratna et al.

The rapid deployment of autonomous AI agents across enterprise, healthcare, and safety-critical environments has created a fundamental governance gap. Existing approaches, runtime guardrails, training-time alignment, and post-hoc auditing treat governance as an external constraint rather than an internalized behavioral principle, leaving agents vulnerable to unsafe and irreversible actions. We address this gap by drawing on how humans self-govern naturally: before acting, humans engage deliberate cognitive processes grounded in executive function, inhibitory control, and internalized organizational rules to evaluate whether an intended action is permissible, requires modification, or demands escalation. This paper proposes a neurocognitive governance framework that formally maps this human self-governance process to LLM-driven agent reasoning, establishing a structural parallel between the human brain and the large language model as the cognitive core of an agent. We formalize a Pre-Action Governance Reasoning Loop (PAGRL) in which agents consult a four-layer governance rule set: global, workflow-specific, agent-specific, and situational before every consequential action, mirroring how human organizations structure compliance hierarchies across enterprise, department, and role levels. Implemented on a production-grade retail supply chain workflow, the framework achieves 95% compliance accuracy and zero false escalations to human oversight, demonstrating that embedding governance into agent reasoning produces more consistent, explainable, and auditable compliance than external enforcement. This work offers a principled foundation for autonomous AI agents that govern themselves the way humans do: not because rules are imposed upon them, but because deliberation is embedded in how they think.

Atmaram Yarlagadda, Eranga Bandara, Ross Gore et al.

Modern military operations expose soldiers to sustained psychological stress, leading to acute reactions, post-traumatic stress symptoms, and other mental health issues. Although the U.S. Department of Defense offers evidence-based therapies, access to trained professionals in forward-deployed and contested environments is limited. As a result, soldiers with early-stage distress are often evacuated to rear medical facilities, delaying care, reducing readiness, and increasing long-term risks. This paper proposes a Train-the-Trainers framework in which soldiers who have completed therapy and returned to duty are trained as peer facilitators to provide first-line psychological support in operational settings. To scale and standardize this model under severe resource and connectivity constraints, we introduce an agentic AI-enabled platform that augments these recovered soldiers with specialized AI agents. The recovered soldier acts as a human supervisor, coordinating agents for symptom triage, guided peer-support interventions, operational constraint reasoning, training and simulation, and structured documentation for clinical escalation when needed. The AI agents use consensus-driven decision support in high-stakes environments. The architecture functions in air-gapped and low-connectivity settings, maintaining human oversight and ethical safeguards. A functional prototype was developed with the McDonald U.S. Army Health Center, Newport News, VA, USA. By combining peer-based intervention with consensus-driven agentic AI decision support, the framework seeks to cut response times, prevent symptom escalation, reduce unnecessary evacuations, and improve continuity of care. This work shows how agentic AI can serve as a force multiplier for mental health support in austere environments and identifies pathways for broader evaluation and deployment across defense and humanitarian operations.

Eranga Bandara, Ross Gore, Atmaram Yarlagadda et al.

The diagnosis of most mental disorders, including psychiatric evaluations, primarily depends on dialogues between psychiatrists and patients. This subjective process can lead to variability in diagnoses across clinicians and patients, resulting in inconsistencies and challenges in achieving reliable outcomes. To address these issues and standardize psychiatric diagnoses, we propose a Fine-Tuned Large Language Model (LLM) Consortium and OpenAI-gpt-oss Reasoning LLM-enabled Decision Support System for the clinical diagnosis of mental disorders. Our approach leverages fine-tuned LLMs trained on conversational datasets involving psychiatrist-patient interactions focused on mental health conditions (e.g., depression). The diagnostic predictions from individual models are aggregated through a consensus-based decision-making process, refined by the OpenAI-gpt-oss reasoning LLM. We propose a novel method for deploying LLM agents that orchestrate communication between the LLM consortium and the reasoning LLM, ensuring transparency, reliability, and responsible AI across the entire diagnostic workflow. Experimental results demonstrate the transformative potential of combining fine-tuned LLMs with a reasoning model to create a robust and highly accurate diagnostic system for mental health assessment. A prototype of the proposed platform, integrating three fine-tuned LLMs with the OpenAI-gpt-oss reasoning LLM, was developed in collaboration with the U.S. Army Medical Research Team in Norfolk, Virginia, USA. To the best of our knowledge, this work represents the first application of a fine-tuned LLM consortium integrated with a reasoning LLM for clinical mental health diagnosis paving the way for next-generation AI-powered eHealth systems aimed at standardizing psychiatric diagnoses.