Global Mental Health Ethics

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