PAIR-SAFE: A Paired-Agent Approach for Runtime Auditing and Refining AI-Mediated Mental Health Support

Abstract

LLMs are increasingly used for mental health support, yet they can produce responses that are overly directive, inconsistent, or clinically misaligned. Most risk mitigation approaches rely on implicit alignment through training or prompting, offering limited runtime accountability. We introduce PAIR-SAFE, a paired-agent framework that integrates a Responder agent with a Judge agent grounded in the clinically validated Motivational Interviewing Treatment Integrity (MITI-4). The Judge audits each response and issues \allow{} or \revise{} decisions to guide real-time refinement. We evaluate interactions using a support-seeker simulator derived from human-annotated data. The Judge-supervised interactions show significant improvements in key MITI dimensions, including Partnership, Seek Collaboration, and overall Relational quality. Our quantitative findings are corroborated by expert evaluation, highlighting nuances of runtime supervision. Our study reveals that paired-agent auditing can provide clinically grounded, transparent oversight for AI-assisted mental health support.