AI aversion? Effects of author disclosure on young people’s perceptions of mental health advice

Lesbian, gay, bisexual, trans, queer/questioning, plus young people have a higher risk of poor mental health in comparison to cisgendered heterosexual young people, and they underutilise mental health services and support. In addition, there is a paucity of research conducted in United Kingdom examining mental health early intervention provision for lesbian, gay, bisexual, trans, queer/questioning, plus young people. To produce a model of what works for early intervention mental health support for lesbian, gay, bisexual, trans, queer/questioning, plus young people and increase understanding of lesbian, gay, bisexual, trans, queer/questioning, plus young people's access to, navigation of, and engagement with mental health support. This was a multi-methods theory-led case study evaluation with three distinct stages: (1) a meta-narrative review of existing literature to develop a theoretical framework to explain effective mental health support for lesbian, gay, bisexual, trans, queer/questioning, plus young people; (2) an online and offline service mapping exercise to locate current mental health early intervention support for lesbian, gay, bisexual, trans, queer/questioning, plus young people in the United Kingdom in order to produce a service typology; and (3) a theory-led case study evaluation of 12 case study sites selected from the service typology produced in stage 2, to establish the components of appropriate quality, early intervention mental health support for lesbian, gay, bisexual, trans, queer/questioning, plus young people. Stage 1 produced an interdisciplinary theoretical framework indicating that early intervention mental health support for lesbian, gay, bisexual, trans, queer/questioning, plus youth must prioritise addressing normative environments that marginalise youth, lesbian, gay, bisexual, trans, queer/questioning, plus identities and mental health problems. Stage 2 mapping found 111 services, the majority in urban settings in England. There was an absence of mainstream National Health Service support that specifically addressed the needs of lesbian, gay, bisexual, trans, queer/questioning, plus young people. The majority of lesbian, gay, bisexual, trans, queer/questioning, plus youth mental health support was provided by voluntary/community organisations. Stage 3 case study evaluation found that an intersectional, youth-rights approach is the most appropriate way to deliver early intervention mental health support for lesbian, gay, bisexual, trans, queer/questioning, plus young people. Youth rights should underpin mental health support to address the multiple marginalisation, isolation and stigmatisation that lesbian, gay, bisexual, trans, queer/questioning, plus young people may experience and to enable them to make informed independent decisions about their own bodies and lives, and for the right to freedom of safe self-expression to be upheld. The model that we have produced contains 13 principles that are necessary to the provision of mental health support, and to improve access to, engagement with, and navigation of mental health services. In the United Kingdom, a rights-based approach to mental health service provision is not prominent. In addition, at the time of writing, lesbian, gay, bisexual, trans, queer/questioning, plus young people are facing active legislative and policy attacks on their human rights. This study provides the first large-scale theory-led evaluation of early intervention mental health support for lesbian, gay, bisexual, trans, queer/questioning, plus young people with common mental health problems. The resulting intersectional, youth-rights approach provides evidence on ways of improving lesbian, gay, bisexual, trans, queer/questioning, plus young people's mental health. Further research on the implementation of an intersectional, youth-rights approach to early intervention mental health support for lesbian, gay, bisexual, trans, queer/questioning, plus young people with mental health problems is required. This study is registered as PROSPERO CRD42019135722. This award was funded by the National Institute for Health and Care Research (NIHR) Health and Social Care Delivery Research programme (NIHR award ref: 17/09/04) and is published in full in Health and Social Care Delivery Research; Vol. 12, No. 47. See the NIHR Funding and Awards website for further award information.

Objective Mental health problems are increasing. Nonetheless, the uptake of professional mental health support remains very low in Nigeria and other African countries, especially among men. This study explored the potential of digital mental health support in eliminating barriers to professional mental health services amongst men in Nigeria. Method Qualitative data were collected between July-August 2022 using an In-depth Interview (IDI) Guide with 24 men aged 18–38. NVivo 12 was employed to assist with the analysis. Results Digital mental health support has the potential to improve acceptance and uptake of professional mental health support services, reduce deterrent factors such as stigma, issues with confidentiality and trust, cost and availability. The use of digital support may also mitigate the nature of masculinity which deters some men from asking for help. Regulations around providing mental health support may improve men’s confidence in seeking professional mental health support. Conclusion Findings highlight the acceptability of digital mental health support for men, and the need for clinical practice regulations.

Despite the growing use of artificial intelligence in youth mental health support, little is known about how either young people or health professionals perceive answers to mental health-related inquiries generated by large language models (LLMs). Therefore, we draw on Media Richness Theory to examine how these two user groups perceive the "richness" of text-based communication in this context and whether young people and health professionals differ in their assessment. A total of 123 young people and 31 health professionals evaluated answers to youth mental health inquiries. Each inquiry had two blinded answers: one generated by ChatGPT (GPT-4) and one written by a health professional. Participants rated the answers for validation, relevance, clarity, and utility and were asked to recommend one or both answers. Open-ended responses elaborating participant choices were also collected. The quantitative findings show that young people and health professionals rated answers from both sources similarly on validation, clarity, and utility. However, young people rated ChatGPT's answers higher for relevance and utility, finding them "richer." This was supported by qualitative data, where youth preferred ChatGPT's clear and actionable answers. Health professionals showed no strong preference and were more critical, often finding the answers too detailed or lacking empathy. This study is the first to compare youth and professional perspectives on ChatGPT's role in youth mental health advice within a blind evaluation design. We conclude by proposing a hybrid advisory model that combines professional expertise with LLMs to enhance the efficiency, scale, and accessibility of youth mental health advisory services.

BackgroundAustralian rural and regional communities are marked by geographic isolation and increasingly frequent and severe natural disasters such as drought, bushfires and floods. These circumstances strain the mental health of their inhabitants and jeopardise the healthy mental and emotional development of their adolescent populations. Professional mental health care in these communities is often inconsistent and un-coordinated. While substantial research has examined the barriers of young people’s mental health and help-seeking behaviours in these communities, there is a lack of research exploring what adolescents in rural and regional areas view as facilitators to their mental health and to seeking help when it is needed. This study aims to establish an in-depth understanding of those young people’s experiences and needs regarding mental health, what facilitates their help-seeking, and what kind of mental health education and support they want and find useful.MethodWe conducted a qualitative study in 11 drought-affected rural and regional communities of New South Wales, Australia. Seventeen semi-structured (14 group; 3 individual) interviews were held with 42 year 9 and 10 high school students, 14 high school staff, and 2 parents, exploring participants’ experiences of how geographical isolation and natural disasters impacted their mental health. We further examined participants’ understandings and needs regarding locally available mental health support resources and their views and experiences regarding mental illness, stigma and help-seeking.ResultsThematic analysis highlighted that, through the lens of participants, young people’s mental health and help-seeking needs would best be enabled by a well-coordinated multi-pronged community approach consisting of mental health education and support services that are locally available, free of charge, engaging, and empowering. Participants also highlighted the need to integrate young people’s existing mental health supporters such as teachers, parents and school counselling services into such a community approach, recognising their strengths, limitations and own education and support needs.ConclusionsWe propose a three-dimensional Engagement, Empowerment, Integration model to strengthen young people’s mental health development which comprises: 1) maximising young people’s emotional investment (engagement); 2) developing young people’s mental health self-management skills (empowerment); and, 3) integrating mental health education and support programs into existing community and school structures and resources (integration).

BackgroundHealth systems are investing in mental health and well-being support tools and resources for health care workers (HCW). Considering the mental health strain facing HCWs, there is a need to optimize the current mental health delivery model.ObjectiveThis study aimed to evaluate the usability and acceptability of a proactive digital mental health approach (Cobalt+;Penn Medicine), which included services proactively sent to HCWs via text messaging, including (1) monthly automated text messaging reminders and links to Cobalt, and (2) bimonthly text-message–based measures of depression and anxiety.MethodsThis study used the System Usability Scale (SUS), Net Promoter Score (NPS), and open-ended questions to capture Cobalt+ participants who received proactive digital mental health tools and resources. Descriptive summary statistics were used for SUS and NPS outcome measures, and a chi-square test was used to detect group differences. Open-ended questions were analyzed using a qualitative open coding process by 2 coders. Research team members calculated interrater agreement (Cohen κ above 0.80).ResultsA total of 162 of 642 HCWs randomized to Cobalt+ (25.2%) visited Cobalt due to a proactive text message and completed usability and acceptability measures. The mean age was 38.9 years, most were female (90.7%), 56.8% White, 53.1% married or partnered, and 34.6% engaged in shift work. The mean SUS score was 74.43 (median score 72.5). Participants said they mostly “browsed” the online mental health platform. Cobalt+ received an NPS of 13.7. When asked to elaborate on their experience, 2 categories (eg, positive and negative experiences) with 13 subcategories were identified. Most participants noted the brief process that helped prioritize mental health: “Forget otherwise. Puts in forefront of my mind,” and “Your texts do remind me to take stock of my current feelings.”ConclusionsA proactive digital mental health approach may help overcome barriers in the uptake of services that are otherwise passively available to HCWs. This study demonstrated that the proactive approach is generally usable, modestly acceptable, and further supplemented by HCW feedback. These findings suggest the approach’s viability and the need for additional research toward improvement and broader implementation.Trial RegistrationClinicalTrials.gov NCT05028075; https://clinicaltrials.gov/study/NCT05028075

Background and aims While some digital supports aid in improving young people’s mental health, there is a dearth of information regarding the most effective ways to involve young people in the co-production of digital technologies. User input is essential, particularly for marginalised young people who are often excluded. The aim of this scoping review was to examine recent literature on the most common co-production processes of digital mental health supports with marginalised young people. Method A scoping review was conducted to identify literature published since 2021, written in English, focusing on co-production processes of digital mental health supports with marginalised young people aged 16–25. Basic information, data relating to the research question and key findings were extracted. A combination of Excel and Covidence management software was used to collate the charted data and manage the screening process. Studies were included if they used innovative youth-led approaches in the design, development, implementation or evaluation of digital mental health supports ranging from mental health promotion to targeted interventions. Results Out of 2341 studies initially screened, 21 studies published between 2021 and 2023 with a range of study designs and evidence were included. The studies reported on engagement with marginalised young people in the design, implementation, and/or evaluation of digital mental health technologies. The review examined qualitative and mixed methods studies from eleven countries, with most co-produced digital supports relating to mental health promotion and prevention. Most common were supports targeting general mental health and mental wellbeing. More than half of the studies included representation from LGBTQ+ young people, followed by ethnic minorities and migrants, but few included other marginalised groups. Only 6 of 21 studies used innovative approaches and many typically involved young people in only one of the co-production processes with design identified as most common. Finally, passive rather than active participation of young people was found to be pronounced. This limits young people’s opportunities to shape the outcome to the data collection process only. Conclusion Given the extent to which marginalised groups are actually involved in co-production, the review suggests the need for young people to be more actively involved in all co-production processes of digital mental health technologies. Offering a diverse range of methods through innovative, participatory approaches can facilitate more effective engagement from young people and provide an environment that is inclusive to a range of voices and perspectives. Lastly, the lack of inclusion of marginalised groups such as young people with a disability, or youth living in rural areas is an important issue to consider for future research.

BACKGROUND Barriers to accessing mental health support are common experiences reported by university students. Digital tools can improve equitable access to the indicated level of support and provide actionable insight and recommendations. OBJECTIVE This study aimed to evaluate the acceptability and effectiveness of a web-based self-guided mental health and well-being support platform (U-Flourish Platform) that was tailored specifically for university students. METHODS The i-spero® platform was adapted in partnership with students to provide evidence-based well-being plans, mental health symptom tracking, and automated alerts and recommendations based on self-report data from students. After providing informed consent, students registered to access the platform and completed baseline demographic information and weekly validated screening measures of anxiety (GAD), depression (PHQ), and well-being (SWEMWEBS) over 8 weeks. At 6 weeks, students completed a user-experience survey. Paired t-tests were used to compared symptom scores and chi-squared tests assessed changes in symptom screening status over the 8-week period. Unadjusted logistic regression was used to assess whether baseline demographic factors and symptom screening status were associated with user-experience outcomes. RESULTS The analyses included data from 404 consenting students. At 6-weeks, most students (75%) expressed satisfaction with the platform, felt it was easy to use and understand (85%), and found the platform helpful for supporting their mental health (58%). Adherence was relatively high (76%) and attrition was relatively low (26%) after 6 weeks but reduced substantively thereafter; associated with timing of the end of incentivized use and end of term examinations and assignments. Mean anxiety (1.55 vs. 2.19, p<.0001; Cohen’s d=0.36), depression (0.94 vs. 1.36, P=.0001; Cohen’s d=0.33), and well-being (24.87 vs. 22.28, P<.0001, Cohen’s d=0.34) scores were improved at 8-Weeks vs baseline, with the greatest positive effects for students who screened positive for anxiety (Cohen’s d=1.16) and depression (Cohen’s d=2.22) at baseline. There was no evidence of differences in user-experience across demographic factors (i.e. gender, international student status, and lifetime history of a mental disorder) or baseline screening status, except for males who had lower odds (OR=0.40, 95% CI: 0.18-0.90) of finding the platform easy to use compared to female students. Of the 404 student-users, 142 created at least one well-being plan, with 75% and 57% of them being endorsed as helpful and being satisfactory in the support they provided, respectively. Most students reported satisfaction with the Platform (75%), it being easy to use (85%), and it having a positive impact on their mental health (58%). CONCLUSIONS Evidence supports that a self-guided digital well-being and mental health support platform is an acceptable and useful resource for university students. Therefore, student-tailored digital tools should be considered as part of an integrated and comprehensive whole-university approach for student well-being and mental health support.

Australian providers of mental health services and support for young people include private and public allied health providers, government initiatives (eg, headspace), nongovernment organizations (eg, Kids Helpline), general practitioners (GPs), and the hospital system. Over 20 years of research has established that many young people prefer to seek mental health support online; however, clear client pathways within and between online and offline mental health services are currently lacking. The authors propose a Digital Mental Health Practice model of care for youth to assist with digital mental health service mapping. The proposed model offers accessible pathways for a client to engage with digital mental health services, provides clear navigation to access support for individual needs, and facilitates a seamless connection with offline mental health services using a transferable electronic health records system. This future-looking model also includes emerging technologies, such as artificial intelligence and the metaverse, which must be accounted for as potential tools to be leveraged for digital therapies and support systems. The urgent need for a user-centered Digital Mental Health Practice model of care for youth in Australia is discussed, highlighting the shortcomings of traditional and existing online triage models evident during the COVID-19 pandemic, and the complex challenges that must be overcome, such as the integration of diverse mental health care providers and establishment of a robust electronic health records system. Potential benefits of such a model include reduced pressure on emergency rooms, improved identification of immediate needs, enhanced referral practices, and the establishment of a cost-efficient national digital mental health care model with global applicability. The authors conclude by stressing the consequences of inaction, warning that delays may lead to more complex challenges as new technologies emerge and exacerbate the long-term negative consequences of poor mental health management on the economic and biopsychosocial well-being of young Australians.

Young people are experiencing worsening mental health and a growing reliance on online tools and services to address mental health difficulties. At the same time, next-generation large language models (LLMs) that are deployed through 'chatbot style interfaces', using deep learning artificial intelligence akin to interacting with a human appear to mark an opportunity for mental health therapeutics when designed specifically for clinical intervention. However, emergent evidence suggests the use of more generic LLM chatbots may pose a risk of providing misinformation, bias, or over reliance for some individuals when used outside of clinical contexts for mental health. This perspective paper examines the intersection of youth mental health and the rapid adoption of LLM chatbots. It first contextualises rising mental health challenges among young people alongside their increasing reliance on digital solutions. The paper then explores the potential benefits of LLM chatbot style interfaces in clinical mental health interventions. Following this, we discuss the evidence surrounding adverse mental health outcomes from the use of generic LLMs to support mental health at population level, describing complex system-level and human-level factors noted from the evidence. Finally, we outline considerations for public health and youth mental health discourse, purpose built LLM platform design, and a supporting research agenda. While current evidence on benefits and risks from generic LLMs is emergent and not youth-specific, this perspective highlights a need for research focused on young people to ensure safe and effective use of widely available LLMs for mental health support.

The rapid evolution of large language models (LLMs), such as Bidirectional Encoder Representations from Transformers (BERT; Google) and GPT (OpenAI), has introduced significant advancements in natural language processing. These models are increasingly integrated into various applications, including mental health support. However, the credibility of LLMs in providing reliable and explainable mental health information and support remains underexplored. This scoping review systematically maps the factors influencing the credibility of LLMs in mental health support, including reliability, explainability, and ethical considerations. The review is expected to offer critical insights for practitioners, researchers, and policy makers, guiding future research and policy development. These findings will contribute to the responsible integration of LLMs into mental health care, with a focus on maintaining ethical standards and user trust. This review follows PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines and the Joanna Briggs Institute (JBI) methodology. Eligibility criteria include studies that apply transformer-based generative language models in mental health support, such as BERT and GPT. Sources include PsycINFO, MEDLINE via PubMed, Web of Science, IEEE Xplore, and ACM Digital Library. A systematic search of studies from 2019 onward will be conducted and updated until October 2024. Data will be synthesized qualitatively. The Population, Concept, and Context framework will guide the inclusion criteria. Two independent reviewers will screen and extract data, resolving discrepancies through discussion. Data will be synthesized and presented descriptively. As of September 2024, this study is currently in progress, with the systematic search completed and the screening phase ongoing. We expect to complete data extraction by early November 2024 and synthesis by late November 2024. This scoping review will map the current evidence on the credibility of LLMs in mental health support. It will identify factors influencing the reliability, explainability, and ethical considerations of these models, providing insights for practitioners, researchers, policy makers, and users. These findings will fill a critical gap in the literature and inform future research, practice, and policy development, ensuring the responsible integration of LLMs in mental health services. DERR1-10.2196/62865.

Approximately 39% of young people (aged 16-24 y) experience mental ill health, but only 23% seek professional help. Early intervention is essential for reducing the impacts of mental illness, but young people, particularly those from culturally diverse communities, report experiencing shame and stigma, which can deter them from engaging with face-to-face services. Digital mental health (DMH) tools promise to increase access, but there is a lack of literature exploring the suitability of DMH tools for culturally diverse populations. The project was conducted in partnership with a large-scale national DMH organization that promotes evidence-based early intervention, treatment, and support of mental health in young people and their families. The organization wanted to develop a self-directed web-based platform for parents and young people that integrates psychological assessments and intervention pathways via a web-based "check-in" tool. Our project explored the views of culturally diverse parents and young people on the opportunities and barriers to engagement with a web-based DMH screening tool. We conducted a 2-phase qualitative study aiming to identify potential issues faced by culturally diverse communities when engaging with DMH tools designed for the Australian public. We worked with 18 culturally diverse participants (parents: n=8, 44%; young people: n=10, 56%) in a series of design-led workshops drawing on methods from speculative design and user experience to understand the opportunities and barriers that organizations might face when implementing population-level DMH tools with culturally diverse communities. NVivo was used to conduct thematic analyses of the audio-recorded and transcribed workshop data. Five themes were constructed from the workshops: (1) trust in the use and application of a DMH tool, (2) data management and sharing, (3) sociocultural influences on mental health, (4) generational differences in mental health and digital literacy, and (5) stigma and culturally based discrimination in mental health support. The emergent themes have important considerations for researchers wishing to develop more inclusive DMH tools. The study found that healthy parent-child relationships will increase engagement in mental health support for young persons from culturally diverse backgrounds. Barriers to engagement with DMH tools included culturally based discrimination, the influence of culture on mental health support, and the potential impact of a diagnostic label on help seeking. The study's findings suggest a need for culturally safe psychoeducation for culturally diverse end users that fosters self-determination with tailored resources. They also highlight important key challenges when working with culturally diverse populations.

BACKGROUND Approximately 39% of young people (aged 16-24 y) experience mental ill health, but only 23% seek professional help. Early intervention is essential for reducing the impacts of mental illness, but young people, particularly those from culturally diverse communities, report experiencing shame and stigma, which can deter them from engaging with face-to-face services. Digital mental health (DMH) tools promise to increase access, but there is a lack of literature exploring the suitability of DMH tools for culturally diverse populations. OBJECTIVE The project was conducted in partnership with a large-scale national DMH organization that promotes evidence-based early intervention, treatment, and support of mental health in young people and their families. The organization wanted to develop a self-directed web-based platform for parents and young people that integrates psychological assessments and intervention pathways via a web-based “check-in” tool. Our project explored the views of culturally diverse parents and young people on the opportunities and barriers to engagement with a web-based DMH screening tool. METHODS We conducted a 2-phase qualitative study aiming to identify potential issues faced by culturally diverse communities when engaging with DMH tools designed for the Australian public. We worked with 18 culturally diverse participants (parents: n=8, 44%; young people: n=10, 56%) in a series of design-led workshops drawing on methods from speculative design and user experience to understand the opportunities and barriers that organizations might face when implementing population-level DMH tools with culturally diverse communities. NVivo was used to conduct thematic analyses of the audio-recorded and transcribed workshop data. RESULTS Five themes were constructed from the workshops: (1) trust in the use and application of a DMH tool, (2) data management and sharing, (3) sociocultural influences on mental health, (4) generational differences in mental health and digital literacy, and (5) stigma and culturally based discrimination in mental health support. CONCLUSIONS The emergent themes have important considerations for researchers wishing to develop more inclusive DMH tools. The study found that healthy parent-child relationships will increase engagement in mental health support for young persons from culturally diverse backgrounds. Barriers to engagement with DMH tools included culturally based discrimination, the influence of culture on mental health support, and the potential impact of a diagnostic label on help seeking. The study’s findings suggest a need for culturally safe psychoeducation for culturally diverse end users that fosters self-determination with tailored resources. They also highlight important key challenges when working with culturally diverse populations.

South Africa faces a critical shortage of mental health service professionals and support for young people with common mental health disorders is inadequate. Social relationships that provide support to adolescents in South African communities are increasingly declining due to socio‐economic pressures. Developing ethical digital mental health innovations has potential to address provide services particularly in rural communities where mental health facilities are scarce. The active involvement of young people is critical to maximising uptake and reducing apathy on the use of digital innovations for mental health. Using the nominal group technique this study engaged young people in identifying stakeholders for setting up a community‐based mental health intervention in a rural community. Use of nominal group technique for stakeholder analysis proved to a useful tool for engaging young people. The stakeholder identification and analysis provided a base for inclusivity in developing digital innovations for mental health through identifying multi‐sector community stakeholders. It revealed that young people in the community have varying perceptions about the level of power and interest which their peers, family members, local leaders, health workers and social development organisations have in developing digital mental health interventions. This research contributes to our understanding of the ways in which to leverage young people's participation in project planning and decision‐making and building strong teams and alliances for developing digital innovations for mental health in marginalised rural communities.

BackgroundHealth professionals are at risk of poor mental health outcomes due to the COVID-19 pandemic. The Essential Network (TEN) is a blended care mental health support service for Australian health professionals, funded by the Australian Federal Department of Health. TEN comprises both digital and face-to-face components. We examined completed digital mental health assessments (Digital Mental Health Check-Up) to understand usage of TEN and the demographics and mental health of users.MethodsA total of 9889 completed assessments from a community sample of help-seeking health professionals who engaged with the Digital Mental Health Check-Up between May 2020 and December 2021 were examined. Users had the option to complete the Distress Questionnaire (DQ-5), Patient Health Questionnaire (PHQ-9), Generalised Anxiety Disorder (GAD-7), Oldenburg Burnout Inventory (OLBI-16), Work and Social Adjustment Scale (WSAS), Post-traumatic Stress Disorder Checklist (PCL-5), as well as provide demographic information on their gender, age, and profession.ResultsUsers were mostly women (85.7%) aged between 25 and 54 (73.7%). Nursing was the most reported profession (32.6%), followed by allied health (27.5%) and doctors (21.9%). Notably, 8.1% of users reported being in medical administration roles. Mental health measures were poor across all measures and professions and worse than would be expected from the general population. Disengagement (92.5%) from burnout and impaired social and occupational functioning (75%) were also notably high. Use of the DQ-5 as a screening tool in the Digital Mental Health Check-Up was confirmed through correlation with clinically significance scoring on all other measures and increased likelihood of opting to complete other optional measures following clinically significant scoring on the DQ-5.ConclusionsThe present study indicates good usage of the TEN digital components among Australian health professionals, with use across all professional categories. While self-selection bias is inherent in the sample, mental health measures were notably poor – particularly for burnout. Such findings highlight the continued need to provide mental health support to health professionals both during and after the eventual resolution of the COVID-19 pandemic, as well as to develop better support for health professionals experiencing burnout.

Large language models (LLMs) are advanced artificial neural networks trained on extensive datasets to accurately understand and generate natural language. While they have received much attention and demonstrated potential in digital health, their application in mental health, particularly in clinical settings, has generated considerable debate. This systematic review aims to critically assess the use of LLMs in mental health, specifically focusing on their applicability and efficacy in early screening, digital interventions, and clinical settings. By systematically collating and assessing the evidence from current studies, our work analyzes models, methodologies, data sources, and outcomes, thereby highlighting the potential of LLMs in mental health, the challenges they present, and the prospects for their clinical use. Adhering to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, this review searched 5 open-access databases: MEDLINE (accessed by PubMed), IEEE Xplore, Scopus, JMIR, and ACM Digital Library. Keywords used were (mental health OR mental illness OR mental disorder OR psychiatry) AND (large language models). This study included articles published between January 1, 2017, and April 30, 2024, and excluded articles published in languages other than English. In total, 40 articles were evaluated, including 15 (38%) articles on mental health conditions and suicidal ideation detection through text analysis, 7 (18%) on the use of LLMs as mental health conversational agents, and 18 (45%) on other applications and evaluations of LLMs in mental health. LLMs show good effectiveness in detecting mental health issues and providing accessible, destigmatized eHealth services. However, assessments also indicate that the current risks associated with clinical use might surpass their benefits. These risks include inconsistencies in generated text; the production of hallucinations; and the absence of a comprehensive, benchmarked ethical framework. This systematic review examines the clinical applications of LLMs in mental health, highlighting their potential and inherent risks. The study identifies several issues: the lack of multilingual datasets annotated by experts, concerns regarding the accuracy and reliability of generated content, challenges in interpretability due to the "black box" nature of LLMs, and ongoing ethical dilemmas. These ethical concerns include the absence of a clear, benchmarked ethical framework; data privacy issues; and the potential for overreliance on LLMs by both physicians and patients, which could compromise traditional medical practices. As a result, LLMs should not be considered substitutes for professional mental health services. However, the rapid development of LLMs underscores their potential as valuable clinical aids, emphasizing the need for continued research and development in this area. PROSPERO CRD42024508617; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=508617.