The increasing use of large language models in mental health applications calls for principled evaluation frameworks that assess alignment with psychotherapeutic best practices beyond surface-level fluency. While recent systems exhibit conversational competence, they lack structured mechanisms to evaluate adherence to core therapeutic principles. In this paper, we study the problem of evaluating AI-generated therapist-like responses for clinically grounded appropriateness and effectiveness. We assess each therapists utterance along six therapeutic principles: non-judgmental acceptance, warmth, respect for autonomy, active listening, reflective understanding, and situational appropriateness using a fine-grained ordinal scale. We introduce FAITH-M, a benchmark annotated with expert-assigned ordinal ratings, and propose CARE, a multi-stage evaluation framework that integrates intra-dialogue context, contrastive exemplar retrieval, and knowledge-distilled chain-of-thought reasoning. Experiments show that CARE achieves an F-1 score of 63.34 versus the strong baseline Qwen3 F-1 score of 38.56 which is a 64.26% improvement, which also serves as its backbone, indicating that gains arise from structured reasoning and contextual modeling rather than backbone capacity alone. Expert assessment and external dataset evaluations further demonstrate robustness under domain shift, while highlighting challenges in modeling implicit clinical nuance. Overall, CARE provides a clinically grounded framework for evaluating therapeutic fidelity in AI mental health systems.

Online Mental Health Communities (OMHCs) provide crucial peer and expert support, yet many posts remain unanswered due to missing support attributes that signal the need for help. We present a novel framework that identifies these gaps and prompts users to enrich their posts, thereby improving engagement. To support this, we introduce REDDME, a new dataset of 4,760 posts from mental health subreddits annotated for the span and intensity of three key support attributes: event what happened?, effect what did the user experience?, and requirement what support they need?. Next, we devise a hierarchical taxonomy, CueTaxo, of support attributes for controlled question generation. Further, we propose MH-COPILOT, a reinforcement learning-based system that integrates (a) contextual attribute-span identification, (b) support attribute intensity classification, (c) controlled question generation via a hierarchical taxonomy, and (d) a verifier for reward modeling. Our model dynamically assesses posts for the presence/absence of support attributes, and generates targeted prompts to elicit missing information. Empirical results across four notable language models demonstrate significant improvements in attribute elicitation and user engagement. A human evaluation further validates the model’s effectiveness in real-world OMHC settings.

In mental health counseling, condensing dialogues into concise and relevant summaries (aka counseling notes) holds pivotal significance. Large Language Models (LLMs) exhibit remarkable capabilities in various generative tasks; however, their adaptation to domain-specific intricacies remains challenging, especially within mental health contexts. Unlike standard LLMs, mental health experts first plan to apply domain knowledge in writing summaries. Our work enhances LLMs’ ability by introducing a novel planning engine to orchestrate structuring knowledge alignment. To achieve high-order planning, we divide knowledge encapsulation into two major phases: (i) holding dialogue structure and (ii) incorporating domain-specific knowledge. We employ a planning engine on Llama-2, resulting in a novel framework, PIECE. Our proposed system employs knowledge filtering-cum-scaffolding to encapsulate domain knowledge. Additionally, PIECE leverages sheaf convolution learning to enhance its understanding of the dialogue’s structural nuances. We compare PIECE with 14 baseline methods and observe a significant improvement across ROUGE and Bleurt scores. Further, expert evaluation and analyses validate the generation quality to be effective, sometimes even surpassing the gold standard. We further benchmark PIECE with other LLMs and report improvement, including Llama-2 (+2.72%), Mistral (+2.04%), and Zephyr (+1.59%), to justify the generalizability of the planning engine.