When Support Crosses the Line: Evaluating Ethical Boundaries in LLM-Based Mental Health Support in the Chinese Context

Abstract

Large language models (LLMs) are increasingly explored for mental health support, yet existing benchmarks primarily focus on supportive capabilities rather than whether models consistently adhere to professional ethical boundaries. This issue is particularly important in multi-turn interactions, where users may introduce new information or exert emotional pressure over time. We introduce MindEth-Bench, a benchmark for evaluating ethical boundary adherence in multi-turn mental health interactions. Grounded in professional ethical standards for mental health services in China, MindEth-Bench covers multiple dimensions of ethical conduct and uses Monte Carlo Tree Search (MCTS) to systematically explore interaction trajectories that stress-test model boundaries. Experiments across nine LLMs show that models that initially respond appropriately can shift toward ethical violations over extended interactions, with substantial variation across models and ethical dimensions. These results show that single-turn evaluations may overestimate the ethical reliability of LLM-based mental health support systems and highlight the need to evaluate ethical behavior throughout multi-turn interaction.