Single-turn emergency psychiatric triage across 15 frontier AI chatbots

Abstract

People increasingly turn to general-purpose AI chatbots for advice about emotional and mental health problems, but the ability of these systems to recognize and appropriately triage psychiatric emergencies remains under-characterized. We evaluated psychiatric triage performance in 15 frontier AI chatbots using 112 clinical vignettes spanning four urgency levels, from routine care to immediate emergency assessment. In each trial (1680 total), a chatbot received a single user message conveying all triage-relevant information from one vignette and recommended a timeframe for care. The primary outcome was emergency under-triage; secondary outcomes included triage accuracy and the direction of errors. Vignettes and user messages were generated using a clinician-verified LLM pipeline. Across 415 emergency trials, 23 were under-triaged (5.5%; 95% CI 1.8-15.9). Overall accuracy, averaged across urgency levels, ranged from 42.0% to 71.8% across chatbots and was lowest for intermediate cases (19.6%; 95% CI 11.7-28.1). Every chatbot showed a net over-triage bias; overall, 763 of 786 incorrect assignments (97.1%) were more urgent than the prespecified triage level. The error pattern was similar when predictions were assessed against clinician ratings: 35 of 430 trials involving vignettes rated as emergencies by at least 75% of clinicians were under-triaged (8.1%). AI chatbots recognized most psychiatric emergencies but still missed clinically important cases and frequently over-triaged less urgent presentations. Further evaluations should examine how triage performance changes when clinically relevant information must be elicited through conversation.