From Explainability to Action: A Generative Operational Framework for Integrating XAI in Clinical Mental Health Screening

Abstract

Explainable Artificial Intelligence (XAI) has been presented as the critical component for unlocking the potential of machine learning in mental health screening (MHS). However, a persistent lab-to-clinic gap remains. Current XAI techniques, such as SHAP and LIME, excel at producing technically faithful outputs such as feature importance scores, but fail to deliver clinically relevant, actionable insights that can be used by clinicians or understood by patients. This disconnect between technical transparency and human utility is the primary barrier to real-world adoption. This paper argues that this gap is a translation problem and proposes the Generative Operational Framework, a novel system architecture that leverages Large Language Models (LLMs) as a central translation engine. This framework is designed to ingest the raw, technical outputs from diverse XAI tools and synthesize them with clinical guidelines (via RAG) to automatically generate human-readable, evidence-backed clinical narratives. To justify our solution, we provide a systematic analysis of the components it integrates, tracing the evolution from intrinsic models to generative XAI. We demonstrate how this framework directly addresses key operational barriers, including workflow integration, bias mitigation, and stakeholder-specific communication. This paper also provides a strategic roadmap for moving the field beyond the generation of isolated data points toward the delivery of integrated, actionable, and trustworthy AI in clinical practice.