One Year Later...The Harms Persist, But So Do We!

Abstract

General-purpose large language models (LLMs) are increasingly used for mental health-related conversations, yet safety guardrails remain inadequate and inconsistent across clinical conditions. This study evaluates eight 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 publicly available settings (e.g., schools, search engines, and consumer chatbots) are particularly concerning.