Engagement-Optimized Care: When LLMs become Mental Health Infrastructure
arXiv:2605.23787v1 Announce Type: cross Abstract: General-purpose LLMs are increasingly functioning as mental health infrastructure due to gaps in care left by provider shortages, inadequate insurance coverage, social isolation, and stigma around formal help-seeking. This shift poses a distinct problem for AI ethics: systems neither designed nor governed as care technologies are being used as such, while their dominant design incentives optimize for engagement rather than user well-being. We present findings from a qualitative, longitudinal study with 18 US-based participants who use general-purpose LLMs for socioemotional support and participated in one or more of our study phases, including initial interviews, a four-week diary study, focus groups, and exit interviews. Participants turned to LLMs because other forms of support were unavailable, unaffordable, socially costly, or inadequate. As they continued to use these systems, design features such as anthropomorphic cues, default v