Will Alexander

Kate H. Bentley, Luca Belli, Adam M. Chekroud et al.

Millions now use leading generative AI chatbots for psychological support. Despite the promise related to availability and scale, the single most pressing question in AI for mental health is whether these tools are safe. The Validation of Ethical and Responsible AI in Mental Health (VERA-MH) evaluation was recently proposed to meet the urgent need for an evidence-based automated safety benchmark. This study aimed to examine the clinical validity and reliability of the VERA-MH evaluation for AI safety in suicide risk detection and response. We first simulated a large set of conversations between large language model (LLM)-based users (user-agents) and general-purpose AI chatbots. Licensed mental health clinicians used a rubric (scoring guide) to independently rate the simulated conversations for safe and unsafe chatbot behaviors, as well as user-agent realism. An LLM-based judge used the same scoring rubric to evaluate the same set of simulated conversations. We then compared rating alignment across (a) individual clinicians and (b) clinician consensus and the LLM judge, and (c) examined clinicians' ratings of user-agent realism. Individual clinicians were generally consistent with one another in their safety ratings (chance-corrected inter-rater reliability [IRR]: 0.77), thus establishing a gold-standard clinical reference. The LLM judge was strongly aligned with this clinical consensus (IRR: 0.81) overall and within key conditions. Clinician raters generally perceived the user-agents to be realistic. For the potential mental health benefits of AI chatbots to be realized, attention to safety is paramount. Findings from this human evaluation study support the clinical validity and reliability of VERA-MH: an open-source, fully automated AI safety evaluation for mental health. Further research will address VERA-MH generalizability and robustness.

Luca Belli, Kate Bentley, Will Alexander et al.

We introduce VERA-MH (Validation of Ethical and Responsible AI in Mental Health), an automated evaluation of the safety of AI chatbots used in mental health contexts, with an initial focus on suicide risk. Practicing clinicians and academic experts developed a rubric informed by best practices for suicide risk management for the evaluation. To fully automate the process, we used two ancillary AI agents. A user-agent model simulates users engaging in a mental health-based conversation with the chatbot under evaluation. The user-agent role-plays specific personas with pre-defined risk levels and other features. Simulated conversations are then passed to a judge-agent who scores them based on the rubric. The final evaluation of the chatbot being tested is obtained by aggregating the scoring of each conversation. VERA-MH is actively under development and undergoing rigorous validation by mental health clinicians to ensure user-agents realistically act as patients and that the judge-agent accurately scores the AI chatbot. To date we have conducted preliminary evaluation of GPT-5, Claude Opus and Claude Sonnet using initial versions of the VERA-MH rubric and used the findings for further design development. Next steps will include more robust clinical validation and iteration, as well as refining actionable scoring. We are seeking feedback from the community on both the technical and clinical aspects of our evaluation.