General-purpose chatbots are increasingly used for emotional and mental health support. They can be useful, but issues such as sycophancy, reinforcement of delusional beliefs, and poor crisis response create risks that are difficult for researchers to study and evaluate. In this paper, we review the most critical open problems for researchers and policymakers in the use of general-purpose chatbots and their effects on mental health. First, there are tractable problems in the controlled evaluation of chatbots: establishing the construct and ecological validity of evaluations, evaluating multi-turn interactions, and connecting evaluations to improvements in chatbot behavior. For example, conventional benchmarks that primarily rely on static datasets cannot establish chatbot safety, and novel simulation methods need validation. Second, researchers must connect their studies of chatbots and mental health to real-world evidence. This includes analyzing the chatbot products that AI companies and mental health practitioners have deployed, including their user interfaces and human review and escalation practices for user welfare concerns. However, clinical analysis opportunities afforded by real chat log data sharing are complicated by significant privacy concerns. Finally, we argue that researchers should take an active role in the construction and refinement of evidence-based policy through corporate and governmental decisions such as user protections, standards of care, protected access to user chat logs, data sharing between institutions, incident reporting, and post-deployment monitoring. Such behavioral evaluations, studies of real-world outcomes, and data governance depend on each other and must be addressed in tandem. We believe a coordinated research effort would have substantial real-world impact.

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