Position: Beyond Assistance – Reimagining LLMs as Ethical and Adaptive Co-Creators in Mental Health Care

Abstract

This position paper argues for a fundamental shift in how Large Language Models (LLMs) are integrated into the mental health care domain. We advocate for their role as co-creators rather than mere assistive tools. While LLMs have the potential to enhance accessibility, personalization, and crisis intervention, their adoption remains limited due to concerns about bias, evaluation, over-reliance, dehumanization, and regulatory uncertainties. To address these challenges, we propose two structured pathways: SAFE-i (Supportive, Adaptive, Fair, and Ethical Implementation) Guidelines for ethical and responsible deployment, and HAAS-e (Human-AI Alignment and Safety Evaluation) Framework for multidimensional, human-centered assessment. SAFE-i provides a blueprint for data governance, adaptive model engineering, and real-world integration, ensuring LLMs align with clinical and ethical standards. HAAS-e introduces evaluation metrics that go beyond technical accuracy to measure trustworthiness, empathy, cultural sensitivity, and actionability. We call for the adoption of these structured approaches to establish a responsible and scalable model for LLM-driven mental health support, ensuring that AI complements—rather than replaces—human expertise.