Global Mental Health Ethics

✍ Scribed by Allen R. Dyer (editor), Brandon A. Kohrt (editor), Philip J. Candilis (editor)

• Publisher: Springer
• Year: 2021
• Tongue: English
• Leaves: 399
• Edition: 1st ed. 2021
• Category: Library

✦ Synopsis

This volume addresses gaps in the existing literature of global mental health by focusing on the ethical considerations that are implicit in discussions of health policy. In line with trends in clinical education around the world today, this text is explicitly designed to draw out the principles and values by which programs can be designed and policy decisions enacted. It presents an ethical lens for understanding right and wrong in conditions of scarcity and crisis, and the common controversies that lead to conflict. Additionally, a focus on the mental health response in “post-conflict” settings, provides guidance for real-world matters facing clinicians and humanitarian workers today.

Global Mental Health Ethics fills a crucial gap for students in psychiatry, psychology, addictions, public health, geriatric medicine, social work, nursing, humanitarian response, and other disciplines.

 

✦ Table of Contents

Preface
Contents
Contributors
Part I: Background
1: Global Mental Health Through the Lens of Ethics
Cast in Stone
IASC Guidelines
Globalization and the Humanitarian Imperative
Human Rights, the Rights That Accompany Being Human
Global Health, Public Health, Global Psychiatry, and Mental Health: A Complex Inter-relationship
Conclusion
References
2: Historical Origins of Global Mental Health
References
3: Global Mental Health Law and the Interface with Ethics
Introduction
The WHO as a Source of Global Health Law
The WHO’s Soft Law Functions
The WHO and the Right to Health
The WHO and Mental Health
Binding Hard Law
Limits to a Framework Convention Approach
Lack of a Normative Framework for Global Health Law
Critiques of a Human Rights Approach
Areas for Future Ethical Inquiry
Conclusions
References
4: Ethical Considerations in Global Mental Health Research
Background
Governing Principles
Respect for Persons
Beneficence and Nonmaleficence
Justice
Vulnerability
The International Ethics Framework for Conducting Research with Human Participants
The Nuremberg Code
The Declaration of Helsinki
The International Covenant on Civil and Political Rights
Guidelines of the Council for International Organizations of Medical Sciences
Additional Guidance
Launching the Study
Informed Consent Processes
Ethical Considerations in Study Design and Procedures
Research Monitoring and Compliance
The US Regulatory Framework and Compliance
Monitoring Mechanisms
Publication and Dissemination
Concluding Thoughts
References
Part II: History, Culture, and Diagnosis
5: Ethics and Humanitarianism in Global Mental Health
Introduction and Background
Definitions
Discussion and Conclusion
References
6: Counting What Counts: Epidemiologic Measurement and Generating Meaningful Findings
Introduction
What Matters to Measure?
What Matters About How We Measure?
Case Studies
Designing Screening Tools in Nigeria: Translating in Two Languages Simultaneously
Decision-Making [12]
Addressing Mental Health Needs in Haiti: Research Prior to Development of Formal Mental Healthcare
Decision-Making
Conclusion
References
7: Where Ethics and Culture Collide: Ethical Dilemmas in Grief Work Following the Easter Sunday Attacks in Sri Lanka
Counselling in Sri Lanka: Development Through the Decades
The Easter Bombing in Sri Lanka
Ethno-religious Tensions
An Invitation to Support Grieving Families
The Work of Grief Accompaniment: The Stage is Set
An Interruption: “A Play Within a Play”
The Dilemma Discussed: “Whose Fault Was It?”
Need for Standardized Training and Supervision
Peer Supervision as a Way Forward
Cultural Beliefs: “You Can Deal with Any Problem Because You Are a Counsellor”
Counsellor Training
Lessons Learned
References
8: Public Mental Health in Low-Resourced Systems in Uganda: Lay Community Health Workers, Context and Culture
Introduction
Pre-conditions: Culture, Context, and Syndemics
Pre-implementation: Moving Away from “Efficacy-Thinking” in Global Health
Implementation: Pluripotent Interventions
Maintenance and Evolution Phase: Key Considerations for Public Mental Health in LMICs
Policy Implications for LCHW-Led Public Mental Health in LMICs
References
9: Suicide Outside the Frame of Mental Illness: Exploring Suicidal Behaviors in Global and Cultural Contexts
Introduction
Genetics and Neurobiology of Suicide: A Brief Overview
Suicidal Behaviors and Motivations: Cross-Cultural Analysis
Roles and Groups
Honor and Shame
Preservation of Dignity
Political Protest
Conclusion
References
Part III: Social Determinants and Global Mental Health
10: Rethinking Idioms of Distress and Resilience in Anthropology and Global Mental Health
Introduction
Idiom of Distress: The Case of Thinking Too Much
Theorizing Idioms of Resilience
The Idiom of Acceptance as Process of Resilience
Thinking Forward
References
11: Epidemiologic Linkages Between Childhood Trauma, Health, and Health Care
Introduction
Social Epidemiology and Epigenetics: Factors Influencing Childhood Trauma
Social Determinants of Health
Intergenerational and Historical Trauma
Epigenetics
Life Course Epidemiology, Trauma, and Health
Mind Body Connections of Trauma and Health
Costs of Trauma
Economic Costs
Disability Adjusted Life Years (DALYs)
Case Examples and Personal Experience
Munsieville, South Africa, ACE and Trauma-Informed Care Project
Langtang Valley, Nepal, and the 2015 Earthquake
Understanding ACEs and Building a Trauma-Informed System of Care in Appalachia
Analysis in an Ethical Framework
Conclusions
References
Part IV: Interventions and Public Health Programs
12: Coping With Addictive Opioid Markets
Introduction
Population Health and the Opiate Drug Market
Economic/Social/Legal Impacts
Global Burden of Opioid Use
Associated Medical Comorbidities
Addiction in Humanitarian Settings
Impact on National Security and Stability
Case Examples
The Portuguese Case
Background
Model Intervention
Results
The Iranian Case
Background
Model Intervention
Results
Analysis
Primary Prevention: Education/Public Health Campaigns
Secondary Prevention: Focusing on at Risk Populations
Tertiary Prevention: Interventions
Widespread Naloxone Distribution
Needle and Syringe Programs
Medication-Assisted Treatment (MAT)
Monitoring and Evaluation Frameworks for MAT for Opioid Dependence
Ethical Considerations
Conclusion
References
13: Resilience and Ethics in Post-conflict Settings: Kwihangana, Living After Genocide Rape, and Intergenerational Resilience in Post-genocide Rwanda
Resilience and Gender-Based Violence in Humanitarian Settings
Brief Ethnohistory of Rwanda
Post-genocide Rwandan Context
Western Conceptions of Resilience vs. Local Variation in Accounts of Resilience
Collective Resilience in Politically Sensitive Environments: Narrating Suffering vs. Unspeakability
Strengthening Resilience in Practice: Singular Focus on Humanitarian Mental Health and Well-Being vs. Simultaneously Addressing Peace-Building and Post-conflict Development
Ethical Frameworks for Interpreting Resilience in Post-conflict Contexts
Recommendations
References
14: Ethical Challenges of Nonmaleficence in Mental Health Care for Forcibly Displaced Children and Adolescents
The Changing Ecology of Conflict and Displacement
Nonmaleficence in Providing Mental Health Care for Forcibly Displaced Youth
The Intersection of Humanitarian Principles and Ethical Obligations
Clinical and Public Health Ethics
Contextually Inappropriate Interventions
Sidelining of Existing Evidence on Mental Health Interventions
A Narrow Focus on Symptom Checklists
Cultural Illiteracy
Dismissing Children’s Agency and Resilience
The Dual Loyalty Conflict
Conclusion
References
Part V: Global Mental Health and Human Rights
15: Human Rights and Global Mental Health: Reducing the Use of Coercive Measures
Introduction
Global Health Law and Policy
Debate Over the CRPD
WHO QualityRights and Mental Health Action Plan
UN Sustainable Development Goals
Domestic Legislation
Need for Reform
Unresolved Ethical Issues
Notable Examples
Coercive Measures
Prevalence and Correlates of Coercion
Reduction Strategies
Generalizing the Findings?
General Recommendations
Monitoring and Enforcement
Guidance for National Legislation
Health Systems Strengthening
Conclusion
References
16: Interrogations, Torture, and Mental Health: Conceptualizing Exceptionalism
Introduction: Making Moral Decisions
Nontraditional Treatment Roles
Treatment Professionals Working in Nontreatment Roles
Ethics of Working as a Forensic Expert Witness
Law Enforcement Interviews with Criminal Suspects
New Global Realities and the Creation of New Professional Roles
Mis-Applied Ethics and the Torture “Question”
“Enhanced Interrogation Techniques”
It Works, it’s the Only Way to Get the Info, and it’s Legal
It’s OK to Work Outside Treatment Roles
“Expertise” in Interrogating Suspects
It’s Not Really Torture
But What About the Ticking Time Bomb?
Is There a More Realistic “Ticking Time Bomb Scenario”?
Conclusions
References
17: Mental Health Under Occupation: The Dilemmas of “Normalcy” in Palestine
The Context of Palestine
Clinical Vignettes
Case One
Comment
Case Two
Comment
Case Three
Comment
Case Four
Comment
Case Five
Comment
Discussion
Recommendations
Clinical and Research Program Implementation
Solidarity
Justice
References
18: LGBTQ Global Mental Health: Ethical Challenges and Clinical Considerations
Part One: Background and Research
Part Two: Challenges and Ethical Dilemmas
Part Three: Considerations for Improvement
References
19: The Ethics of Migration: Aspiring to Just Mercy in Immigration Policies
Introduction
Contemporary Challenges of International Migration
The Extant Literature on the Ethics of Immigration
When Law and Policy Are both Just and Merciful
Conclusion
References
Part VI: New Horizons and Ethical Considerations
20: Restorative Justice: Principles, Practices, and Possibilities
Restorative Justice, Core Principles, and Community Mental Health
The Processes and Mechanics of Restorative Justice
The Processes and Mechanics of Restorative Justice
Key Sources for Implementing Restorative Justice
International Contexts
Promoting Responsibility: Correcting Memories of Violence in Northern Ireland and South Africa
Burundi: Reclaiming Restorative Practices Through Case-Based Learning
Case Studies of Restorative Justice in Korea
Case Studies of Restorative Practices in Israel and Palestine
Case Studies in Ukraine and Russia
Restorative Benefits of Forgiveness
Summary and Conclusion
References
21: Community Response to Disaster: Hurricanes in the Caribbean
Introduction: The Role of the Community in Disaster
Finding Solidarity in Community
Un buen correazo and Other Barriers Facing Puerto Rico
Vieques, a Small Island con un corazon grande
The Virgin Islands Hit by the Same Storm
Long Overdue
The GWU Resilience Workshops
The Resilience Workshops Focus
The Different Emotional Stages of Disaster
American Academy of Community Psychiatrists (AACP) Responds to Vieques
Ethical Considerations and Responses
After the Hurricanes Came a New Sense of Urgency: A Search for Opportunities
Survivors’ Shame and Guilt
Mobilizing Hope in a Community
Stories of Hope
A Storm on the Horizon
References
22: Global Mental Health, Planetary Health, and the Ethical Co-Benefit
Introduction
Our Dilemma
The Ethical Co-benefit and Climate Inequity
Mitigation and Adaptation/Resilience
First Person Narrative
Respect for Autonomy, in the Context of Disasters, Can Be Inappropriate
Waking up and Mobilizing Requires Varieties of Containment
Complex Systems and Wicked Problems
Reckoning with Reality Is an Ongoing Task, As Essential as Mitigation and Adaptation
Recommendations
The Importance of Focusing on Less Affected Areas for Education
Both/and Thinking
Remembering Containment
References
Part VII: Conclusion
23: Arriving at the Ethics of Global Mental Health
The Variety of Ethics Approaches
The Theoretical Level: Finding a Unifying Justification
The Practical Level: Operationalizing the Theory
Conclusion
References
Index