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Live streaming is a form of media that allows streamers to directly interact with their audience. Previous research has explored mental health, Twitch.tv and live streaming platforms, and users' social motivations behind watching live streams separately. However, few have explored how these all intertwine in conversations involving intimate, self-disclosing topics, such as mental health. Live streams are unique in that they are largely masspersonal in nature; streamers broadcast themselves to mostly unknown viewers, but may choose to interact with them in a personal way. This study aims to understand users' motivations, preferences, and habits behind participating in mental health discussions on live streams. We interviewed 25 Twitch viewers about the streamers they watch, how they interact in mental health discussions, and how they believe streamers should discuss mental health on live streams. Our findings are contextualized in the dynamics in which these discussions occur. Overall, we found that the innate design of the Twitch platform promotes a user-hierarchy in the ecosystem of streamers and their communities, which may affect how mental health is discussed.