CALM-IT: Generating Realistic Long-Form Motivational Interviewing Dialogues with Dual-Actor Conversational Dynamics Tracking

Large Language Models (LLMs) are increasingly used in mental health-related settings, yet they struggle to sustain realistic, goal-directed dialogue over extended interactions. While LLMs generate fluent responses, they optimize locally for the next turn rather than maintaining a coherent model of therapeutic progress, leading to brittleness and long-horizon drift. We introduce CALM-IT, a framework for generating and evaluating long-form Motivational Interviewing (MI) dialogues that explicitly models dual-actor conversational dynamics. CALM-IT represents therapist-client interaction as a bidirectional state-space process, in which both agents continuously update inferred alignment, mental states, and short-term goals to guide strategy selection and utterance generation. Across large-scale evaluations, CALM-IT consistently outperforms strong baselines in Effectiveness and Goal Alignment and remains substantially more stable as conversation length increases. Although CALM-IT initiates fewer therapist redirections, it achieves the highest client acceptance rate (64.3%), indicating more precise and therapeutically aligned intervention timing. Overall, CALM-IT provides evidence for modeling evolving conversational state being essential for generating high-quality long-form synthetic conversations.

Do Large Language Models Align with Core Mental Health Counseling Competencies?

The rapid evolution of Large Language Models (LLMs) offers promising potential to alleviate the global scarcity of mental health professionals. However, LLMs' alignment with essential mental health counseling competencies remains understudied. We introduce CounselingBench, a novel NCMHCE-based benchmark evaluating LLMs across five key mental health counseling competencies. Testing 22 general-purpose and medical-finetuned LLMs, we find frontier models exceed minimum thresholds but fall short of expert-level performance, with significant variations: they excel in Intake, Assessment & Diagnosis yet struggle with Core Counseling Attributes and Professional Practice & Ethics. Medical LLMs surprisingly underperform generalist models accuracy-wise, while at the same time producing slightly higher-quality justifications but making more context-related errors. Our findings highlight the complexities of developing AI systems for mental health counseling, particularly for competencies requiring empathy and contextual understanding. We found that frontier LLMs perform at a level exceeding the minimal required level of aptitude for all key mental health counseling competencies, but fall short of expert-level performance, and that current medical LLMs do not significantly improve upon generalist models in mental health counseling competencies. This underscores the critical need for specialized, mental health counseling-specific fine-tuned LLMs that rigorously aligns with core competencies combined with appropriate human supervision before any responsible real-world deployment can be considered.

Supporters and Skeptics: LLM-based Analysis of Engagement with Mental Health (Mis)Information Content on Video-sharing Platforms

Over one in five adults in the US lives with a mental illness. In the face of a shortage of mental health professionals and offline resources, online short-form video content has grown to serve as a crucial conduit for disseminating mental health help and resources. However, the ease of content creation and access also contributes to the spread of misinformation, posing risks to accurate diagnosis and treatment. Detecting and understanding engagement with such content is crucial to mitigating their harmful effects on public health. We perform the first quantitative study of the phenomenon using YouTube Shorts and Bitchute as the sites of study. We contribute MentalMisinfo, a novel labeled mental health misinformation (MHMisinfo) dataset of 739 videos (639 from Youtube and 100 from Bitchute) and 135372 comments in total, using an expert-driven annotation schema. We first found that few-shot in-context learning with large language models (LLMs) are effective in detecting MHMisinfo videos. Next, we discover distinct and potentially alarming linguistic patterns in how audiences engage with MHMisinfo videos through commentary on both video-sharing platforms. Across the two platforms, comments could exacerbate prevailing stigma with some groups showing heightened susceptibility to and alignment with MHMisinfo. We discuss technical and public health-driven adaptive solutions to tackling the "epidemic" of mental health misinformation online.