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Evaluating Generative AI Psychotherapy Chatbots Used by Youth: Cross-Sectional Study
Kunmi Sobowale1, Daniel Kevin Humphrey2, Sophia Yingruo Zhao3
1Department of Psychiatry and Biobehavioral Sciences, University of California, 760 Westwood Plaza, Suite 48-241, Los Angeles, CA, 90024, United States, 1 310-794-7035, 1 925-281-3270.
JMIR Mental Health
|December 10, 2025
Summary
Generative AI chatbots offer accessible mental health support but are unsafe for youth due to poor therapeutic quality and crisis handling. Standardized audits are crucial for protecting young users.
Area of Science:
- Digital Mental Health
- Artificial Intelligence in Healthcare
- Youth Mental Health
Background:
- Millions of youth utilize direct-to-consumer generative artificial intelligence (GenAI) chatbots for mental health support.
- The psychotherapeutic quality of these AI chatbots remains significantly understudied.
Purpose of the Study:
- To comprehensively evaluate and compare the psychotherapeutic quality of widely used GenAI chatbots.
- To assess chatbot performance using the Conversational Agent for Psychotherapy Evaluation II (CAPE-II) framework.
Main Methods:
- A cross-sectional study involving trained raters evaluating 5 GenAI chatbots.
- Raters adopted youth personas to simulate mental health support interactions.
- The Conversational Agent for Psychotherapy Evaluation II (CAPE-II) framework was employed for quality assessment.
Main Results:
- GenAI chatbots demonstrated high accessibility (86.7%) and avoided harmful content (89%).
- Significant weaknesses were identified in therapeutic approach (31%) and risk assessment (39%).
- Chatbots exhibited poor crisis handling, opaque privacy policies, and lack of model transparency, with statistically significant quality differences observed.
Conclusions:
- Direct-to-consumer GenAI chatbots pose unacceptable risks to youth mental health.
- Urgent reforms, including standardized quality audits like CAPE-II, are necessary.
- Findings offer targets for platforms, regulators, and policymakers to enhance youth safety in digital mental health support.
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