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Beyond the Single Turn: Reframing Refusals as Dynamic Experiences Embedded in the Context of Mental Health Support Interactions with LLMs

Argues that a refusal is not a single response to be scored for policy compliance but an experience that unfolds around the moment of refusal, and builds a five-phase framework from surveys and interviews with users and mental-health professionals. The phases run from what the user expected before asking to what happened after the refusal, with resource referral as a distinct phase in its own right.

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Publisher

ACM Conference on Fairness, Accountability, and Transparency (FAccT 2026); Carnegie Mellon University; Microsoft Research; University of Washington; Massachusetts General Hospital

Published

25 Jun 2026

Added

today

Key Findings

  • Surveys with N = 53 and interviews with N = 16, spanning users of LLMs for mental-health support and mental-health professionals.
  • The contribution is a five-phase refusal framework: pre-refusal expectation formation, triggering and encounter, message framing, resource referral provision, and post-refusal outcomes.
  • It is proposed explicitly as an alternative to evaluating refusals by binary policy-compliance accuracy.
  • Resource referral is treated as a separate evaluable phase rather than as part of the refusal message.
  • Post-refusal outcomes are included because what the user does next is part of whether the refusal worked.

Methodology Notes

Qualitative and survey evidence from 69 participants in total; the framework is derived rather than validated, and no product is scored against it in the paper. FAccT 2026 pp. 816-839, DOI 10.1145/3805689.3806723, published 2026-06-25; arXiv preprint 2602.01694. Metadata verified through Crossref (dl.acm.org unreachable from this box).

Topics

Crisis detectionGuardrails & moderationDigital mental healthhuman ai interaction safetyEval methodologyVulnerable users

Authors

Ningjing Tang, Alice Qian, Qiaosi Wang, Esther Howe, Blake Bullwinkel, Paola Pedrelli, Jina Suh, Hoda Heidari, Hong Shen

Tags

facct-2026refusalsresource-referralcmumicrosoft-researchframework

Cite This

APA

Ningjing Tang et al. (2026). Beyond the Single Turn: Reframing Refusals as Dynamic Experiences Embedded in the Context of Mental Health Support Interactions with LLMs. ACM Conference on Fairness, Accountability, and Transparency (FAccT 2026); Carnegie Mellon University; Microsoft Research; University of Washington; Massachusetts General Hospital. https://doi.org/10.1145/3805689.3806723