From Algorithm to Alliance: A Blueprint for Responsible and Explainable AI in Mental Health Screening

AI holds promise for mental health care but raises concerns due to sensitive data, opaque models, and cultural variability. While explainable AI (XAI) tools like SHAP and LIME increase interpretability, they often lack clinical relevance. This work highlights recent advances, case-based reasoning, Chain-of-Thought prompting, and retrieval-augmented generation that align AI reasoning with clinician practice. We propose a blueprint centered on participatory co-design, human-centered metrics, and a living benchmark to ensure fairness and robustness. Our contribution reframes AI alignment for mental health toward systems that are empathetic, accountable, and supportive of trust in clinical decision-making. Background: Explainable AI (XAI) shows promise in mental health, from language-based depression detection to clinical diagnostics. Yet XAI tools like LIME [5] and SHAP [4] remain poorly aligned with clinical realities as they lack cultural sensitivity and actionable deployment frameworks [1]. Critical gaps persist in trust, inclusion, and real-world evaluation, with benchmarks failing to assess fairness and adaptability in high-stakes mental health applications [2,3,6]. This work bridges technical XAI tools with mental healthcare needs through: (a) systematic synthesis of tailored methods (case-based reasoning, Chain-Of-Thought (CoT) prompting, Retrieval Augmented Generation (RAG)), (b) responsible deployment blueprint featuring participatory co-design and "living benchmarks," and (c) reframing AI alignment from helpful/honest/harmless to empathetic, culturally aware, and accountable systems. Key Findings and Proposed Framework: We trace XAI evolution from keyword detection (e.g., words like “hopeless") to LLM-powered systems generating clinically coherent explanations that build trust by aligning with clinician reasoning and patient understanding. Our four-part approach includes: (1) participatory co-design with clinicians, patients, and marginalized communities, (2) human-centered metrics prioritizing comprehensibility over accuracy, (3) inclusive benchmarking with representative datasets, and (4) dynamic "living benchmarks" integrating fairness and real-world adaptation. Open Questions: How can trust be socially constructed? How do explanations support user agency? How do we mitigate algorithmic bias and over-medicalization while adapting to cultural pluralism? Conclusion: Mental health AI must earn trust, respect complexity, and amplify human judgment. This work establishes foundations for technically robust, ethically sound systems aligned with humanistic mental healthcare principles. [1] Nori, H., King, N., McKinney, S. M., Carignan, D., & Horvitz, E. (2023). Capabilities of GPT-4 on medical challenge problems. arXiv. https://doi.org/10.48550/arXiv.2303.13375 [2] Mittelstadt, B. D., Allo, P., Taddeo, M., Wachter, S., & Floridi, L. (2016). The ethics of algorithms: Mapping the debate. Big Data & Society, 3(2). https://doi.org/10.1177/2053951716679679 [3] Jobin, A., Ienca, M., & Vayena, E. (2019). The global landscape of AI ethics guidelines. Nature Machine Intelligence, 1(9), 389–399. https://doi.org/10.1038/s42256-019-0088-2 [4] Lundberg, S. M., & Lee, S.-I. (2017). A unified approach to interpreting model predictions. In Advances in Neural Information Processing Systems (Vol. 30). Curran Associates. [5] Ribeiro, M. T., Singh, S., & Guestrin, C. (2016). “Why should I trust you?”: Explaining the predictions of any classifier. In Proceedings of the 22nd ACM SIGKDD International Conference on Knowledge Discovery and Data Mining (pp. 1135–1144). ACM. https://doi.org/10.1145/2939672.2939778 [6] Khan, M. M., Shah, N., Shaikh, N., Thabet, A., Alrabayah, T., & Belkhair, S. (2025). Towards secure and trusted AI in healthcare: A systematic review of emerging innovations and ethical challenges. International Journal of Medical Informatics, 195, 105780. https://doi.org/10.1016/j.ijmedinf.2024.105780