TY - JOUR
T1 - Ethical standards for mental health and psychosocial support research in emergencies
T2 - Review of literature and current debates
AU - Chiumento, Anna
AU - Rahman, Atif
AU - Frith, Lucy
AU - Snider, Leslie
AU - Tol, Wietse A.
N1 - Funding Information:
The Hastings Centre [36] trace the fair benefits principle to the “reasonable availability” principle in the Council for International Organisation of Medical Sciences International Guidelines for Biomedical Research involving Human Subjects, charging that it fails to distinguish considerations including: what amounts to fair benefits - continued access to services, capacity or infrastructure building? To whom should benefits extend - participants, communities, an entire country? And who is responsible for funding benefits? Based upon these considerations, they conclude that the reasonable availability principle guarantees benefits but not necessarily fair benefits, and as such fails to protect against exploitation [36]. To remedy this a number of authors argue that researchers have a moral duty to clearly define research benefits, allowing participants to make an assessment of their fairness relative to burdens specific to the context and research topic [36–38], avoiding paternalism and ensuring respect for those in whose interest the research is conducted [40]. This approach accounts for each emergency having its own background structural and situational context including: the strength of existing MHPSS services; population exposure to experiences that may impact upon mental health; limited resources; and community identification of benefits of value to them.
Publisher Copyright:
© 2017 The Author(s).
PY - 2017/2/8
Y1 - 2017/2/8
N2 - Background: Research in emergencies is needed to understand the prevalence of mental health and psychosocial problems and strengthen the evidence base for interventions. All research - including operational needs assessments, programme monitoring and evaluation, and formal academic research - must be conducted ethically. While there is broad consensus on fundamental principles codified in research ethics guidelines, these do not address the ethical specificities of conducting mental health and psychosocial support (MHPSS) research with adults in emergencies. To address this gap, this paper presents a review of multidisciplinary literature to identify specific ethical principles applicable to MHPSS research in emergencies. Discussion: Fifty-nine sources meeting the literature review inclusion criteria were analysed following a thematic synthesis approach. There was consensus on the relevance of universal ethical research principles to MHPSS research in emergencies, including norms of participant informed consent and protection; ensuring benefit arises from research participation; researcher neutrality, accountability, and safety; and the duty to ensure research is well designed and accounts for contextual factors in emergency settings. We go onto discuss unresolved issues by highlighting six current debates relating to the application of ethics in emergency settings: (1) what constitutes fair benefits?; (2) how should informed consent be operationalised?; (3) is there a role for decision making capacity assessments?; (4) how do risk management approaches impact upon the construction of ethical research?; (5) how can ethical reflection best be achieved?, and (6) are ethical review boards sufficiently representative and equipped to judge the ethical and scientific merit of emergency MHPSS research? Underlying these debates is a systemic tension between procedural ethics and ethics in practice. Summary and recommendations: In summary, underpinning the literature is a desire to ensure the protection of participants exposed to emergencies and in need of evidence-based MHPSS. However, there is a lack of agreement on how to contextualise guidelines and procedures to effectively maximise the perspectives of researchers, participants and ethical review boards. This is a tension that the field must address to strengthen ethical MHPSS research in emergencies.
AB - Background: Research in emergencies is needed to understand the prevalence of mental health and psychosocial problems and strengthen the evidence base for interventions. All research - including operational needs assessments, programme monitoring and evaluation, and formal academic research - must be conducted ethically. While there is broad consensus on fundamental principles codified in research ethics guidelines, these do not address the ethical specificities of conducting mental health and psychosocial support (MHPSS) research with adults in emergencies. To address this gap, this paper presents a review of multidisciplinary literature to identify specific ethical principles applicable to MHPSS research in emergencies. Discussion: Fifty-nine sources meeting the literature review inclusion criteria were analysed following a thematic synthesis approach. There was consensus on the relevance of universal ethical research principles to MHPSS research in emergencies, including norms of participant informed consent and protection; ensuring benefit arises from research participation; researcher neutrality, accountability, and safety; and the duty to ensure research is well designed and accounts for contextual factors in emergency settings. We go onto discuss unresolved issues by highlighting six current debates relating to the application of ethics in emergency settings: (1) what constitutes fair benefits?; (2) how should informed consent be operationalised?; (3) is there a role for decision making capacity assessments?; (4) how do risk management approaches impact upon the construction of ethical research?; (5) how can ethical reflection best be achieved?, and (6) are ethical review boards sufficiently representative and equipped to judge the ethical and scientific merit of emergency MHPSS research? Underlying these debates is a systemic tension between procedural ethics and ethics in practice. Summary and recommendations: In summary, underpinning the literature is a desire to ensure the protection of participants exposed to emergencies and in need of evidence-based MHPSS. However, there is a lack of agreement on how to contextualise guidelines and procedures to effectively maximise the perspectives of researchers, participants and ethical review boards. This is a tension that the field must address to strengthen ethical MHPSS research in emergencies.
KW - Conflict
KW - Disaster
KW - Emergencies
KW - Ethical practice
KW - Mental health and psychosocial support (MHPSS)
KW - Monitoring and evaluation
KW - Multidisciplinary literature review
KW - Research ethics
KW - Research guidelines
UR - http://www.scopus.com/inward/record.url?scp=85012096210&partnerID=8YFLogxK
U2 - 10.1186/s12992-017-0231-y
DO - 10.1186/s12992-017-0231-y
M3 - Article
C2 - 28178981
AN - SCOPUS:85012096210
SN - 1744-8603
VL - 13
JO - Globalization and Health
JF - Globalization and Health
IS - 1
M1 - 8
ER -