Cansu Canca

Annika Marie Schoene, Cansu Canca, Gautham Vijay Kumar et al.

General-purpose large language models (LLMs) are increasingly used for mental health-related conversations, yet safety safeguards remain inadequate and inconsistent across clinical conditions. This study evaluates six proprietary LLMs across 16 DSM-5 conditions using four adversarial attack variants, introducing an eight-dimension harm taxonomy and a multi-dimensional evaluation framework. Results show that safeguards hold reliably only for suicide and self-harm, while conditions such as eating disorders, substance use disorder, and major depressive disorder exhibit failure rates of up to 100%. We argue that ethical design and deployment of these LLMs demand clearly defined harm categories across clinical conditions and implementation of safeguards accordingly. Until such safeguards are in place, these models pose significant risks to vulnerable populations, making their growing integration into educational settings a particularly concerning.

Annika M Schoene, Cansu Canca

Recent advances in large language models (LLMs) have led to increasingly sophisticated safety protocols and features designed to prevent harmful, unethical, or unauthorized outputs. However, these guardrails remain susceptible to novel and creative forms of adversarial prompting, including manually generated test cases. In this work, we present two new test cases in mental health for (i) suicide and (ii) self-harm, using multi-step, prompt-level jailbreaking and bypass built-in content and safety filters. We show that user intent is disregarded, leading to the generation of detailed harmful content and instructions that could cause real-world harm. We conduct an empirical evaluation across six widely available LLMs, demonstrating the generalizability and reliability of the bypass. We assess these findings and the multilayered ethical tensions that they present for their implications on prompt-response filtering and context- and task-specific model development. We recommend a more comprehensive and systematic approach to AI safety and ethics while emphasizing the need for continuous adversarial testing in safety-critical AI deployments. We also argue that while certain clearly defined safety measures and guardrails can and must be implemented in LLMs, ensuring robust and comprehensive safety across all use cases and domains remains extremely challenging given the current technical maturity of general-purpose LLMs.