Do LLMs genuinely incorporate external definitions, or do they primarily rely on their parametric knowledge? To address these questions, we conduct controlled experiments across multiple explanation benchmark datasets (general and domain-specific) and label definition conditions, including expert-curated, LLM-generated, perturbed, and swapped definitions. Our results reveal that while explicit label definitions can enhance accuracy and explainability, their integration into an LLM’s task-solving processes is neither guaranteed nor consistent, suggesting reliance on internalized representations in many cases. Models often default to their internal representations, particularly in general tasks, whereas domain-specific tasks benefit more from explicit definitions. These findings underscore the need for a deeper understanding of how LLMs process external knowledge alongside their pre-existing capabilities.

Language Models (LMs) are being proposed for mental health applications where the heightened risk of adverse outcomes means predictive performance may not be a sufficient litmus test of a model’s utility in clinical practice. A model that can be trusted for practice should have a correspondence between explanation and clinical determination, yet no prior research has examined the attention fidelity of these models and their effect on ground truth explanations. We introduce an evaluation design that focuses on the robustness and explainability of LMs in identifying Wellness Dimensions (WDs). We focus on two existing mental health and well-being datasets: (a) Multi-label Classification-based MultiWD, and (b) WellXplain for evaluating attention mechanism veracity against expert-labeled explanations. The labels are based on Halbert Dunn’s theory of wellness, which gives grounding to our evaluation. We reveal four surprising results about LMs/LLMs: (1) Despite their human-like capabilities, GPT-3.5/4 lag behind RoBERTa, and MedAlpaca, a fine-tuned LLM on WellXplain fails to deliver any remarkable improvements in performance or explanations. (2) Re-examining LMs’ predictions based on a confidence-oriented loss function reveals a significant performance drop. (3) Across all LMs/LLMs, the alignment between attention and explanations remains low, with LLMs scoring a dismal 0.0. (4) Most mental health-specific LMs/LLMs overlook domain-specific knowledge and undervalue explanations, causing these discrepancies. This study highlights the need for further research into their consistency and explanations in mental health and well-being.