@inproceedings{krishnan-etal-2026-beyond,
title = "Beyond the Flag: Clinical Framing Closes the Moderation Gap in Suicide Risk Measurement",
author = "Krishnan, Shreyas and
Ahn, Gun and
Kim, Jungjin",
editor = "Atwell, Katherine and
Borah, Angana and
Dementieva, Daryna and
Kreiss, Elisa and
Kotonya, Neema and
Liu, Jiarui and
Olson, Liz and
Wan, Ruyuan and
Zhao, Jieyu",
booktitle = "Proceedings of the Fifth Workshop on {NLP} for Positive Impact ({NLP}4{PI})",
month = oct,
year = "2026",
address = "Budapest, Hungary",
publisher = "Association for Computational Linguistics",
url = "https://aclanthology.org/2026.nlp4pi-1.9/",
pages = "83--102",
ISBN = "979-8-89176-495-8",
abstract = "Moderation APIs are built to flag policy-violating content, not to measure graded clinical risk. But a platform{'}s duty does not end at detection: the response owed to passive distress differs sharply from the response owed to active planning with means access, and emerging regulation (e.g., California Senate Bill 243) is turning that distinction into a compliance requirement. We therefore ask how well deployed safety signals recover clinically meaningful severity. We release a benchmark of 516 r/SuicideWatch posts rated by a licensed psychiatrist on a four-level ordinal schema (Indicator, Ideation, Behavior, Attempt) grounded in the Columbia Suicide Severity Rating Scale, and evaluate moderation APIs, prompted LLMs, and supervised baselines under seven ordinal-aware metrics. Three findings. Vendor moderation APIs separate low- from high-severity posts well (0.860 high-risk F1) but measure severity poorly (0.395 macro F1), systematically over-predicting the most severe category. Clinically grounded zero-shot prompting recovers much of that gap (0.562 macro F1), and expert-authored framing (not fine-tuning, added reasoning, or naive multi-agent aggregation) is the effective lever. The value of reasoning depends on register: it hurts on long, noisy Reddit posts and helps on short, clinician-authored statements. We argue graded severity, not a binary flag, is what a proportionate duty of care requires, and release our evaluation framework to support that measurement."
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<abstract>Moderation APIs are built to flag policy-violating content, not to measure graded clinical risk. But a platform’s duty does not end at detection: the response owed to passive distress differs sharply from the response owed to active planning with means access, and emerging regulation (e.g., California Senate Bill 243) is turning that distinction into a compliance requirement. We therefore ask how well deployed safety signals recover clinically meaningful severity. We release a benchmark of 516 r/SuicideWatch posts rated by a licensed psychiatrist on a four-level ordinal schema (Indicator, Ideation, Behavior, Attempt) grounded in the Columbia Suicide Severity Rating Scale, and evaluate moderation APIs, prompted LLMs, and supervised baselines under seven ordinal-aware metrics. Three findings. Vendor moderation APIs separate low- from high-severity posts well (0.860 high-risk F1) but measure severity poorly (0.395 macro F1), systematically over-predicting the most severe category. Clinically grounded zero-shot prompting recovers much of that gap (0.562 macro F1), and expert-authored framing (not fine-tuning, added reasoning, or naive multi-agent aggregation) is the effective lever. The value of reasoning depends on register: it hurts on long, noisy Reddit posts and helps on short, clinician-authored statements. We argue graded severity, not a binary flag, is what a proportionate duty of care requires, and release our evaluation framework to support that measurement.</abstract>
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%0 Conference Proceedings
%T Beyond the Flag: Clinical Framing Closes the Moderation Gap in Suicide Risk Measurement
%A Krishnan, Shreyas
%A Ahn, Gun
%A Kim, Jungjin
%Y Atwell, Katherine
%Y Borah, Angana
%Y Dementieva, Daryna
%Y Kreiss, Elisa
%Y Kotonya, Neema
%Y Liu, Jiarui
%Y Olson, Liz
%Y Wan, Ruyuan
%Y Zhao, Jieyu
%S Proceedings of the Fifth Workshop on NLP for Positive Impact (NLP4PI)
%D 2026
%8 October
%I Association for Computational Linguistics
%C Budapest, Hungary
%@ 979-8-89176-495-8
%F krishnan-etal-2026-beyond
%X Moderation APIs are built to flag policy-violating content, not to measure graded clinical risk. But a platform’s duty does not end at detection: the response owed to passive distress differs sharply from the response owed to active planning with means access, and emerging regulation (e.g., California Senate Bill 243) is turning that distinction into a compliance requirement. We therefore ask how well deployed safety signals recover clinically meaningful severity. We release a benchmark of 516 r/SuicideWatch posts rated by a licensed psychiatrist on a four-level ordinal schema (Indicator, Ideation, Behavior, Attempt) grounded in the Columbia Suicide Severity Rating Scale, and evaluate moderation APIs, prompted LLMs, and supervised baselines under seven ordinal-aware metrics. Three findings. Vendor moderation APIs separate low- from high-severity posts well (0.860 high-risk F1) but measure severity poorly (0.395 macro F1), systematically over-predicting the most severe category. Clinically grounded zero-shot prompting recovers much of that gap (0.562 macro F1), and expert-authored framing (not fine-tuning, added reasoning, or naive multi-agent aggregation) is the effective lever. The value of reasoning depends on register: it hurts on long, noisy Reddit posts and helps on short, clinician-authored statements. We argue graded severity, not a binary flag, is what a proportionate duty of care requires, and release our evaluation framework to support that measurement.
%U https://aclanthology.org/2026.nlp4pi-1.9/
%P 83-102
Markdown (Informal)
[Beyond the Flag: Clinical Framing Closes the Moderation Gap in Suicide Risk Measurement](https://aclanthology.org/2026.nlp4pi-1.9/) (Krishnan et al., NLP4PI 2026)
ACL