This collection presents six case studies on the ethics of mental health research, written by scientific researchers and ethicists from around the world. We publish them here as a resource for teachers of research ethics and as a contribution to several ongoing ethical debates. Each consists of a description of a research study that was proposed or carried out and an in-depth analysis of the ethics of the study.

This article identifies and examines a tension in mental health researchers’ growing enthusiasm for the use of computational tools powered by advances in artificial intelligence and machine learning (AI/ML). Although there is increasing recognition of the value of participatory methods in science generally and in mental health research specifically, many AI/ML approaches, fueled by an ever-growing number of sensors collecting multimodal data, risk further distancing participants from research processes and rendering them as mere vectors or collections (...) of data points. The imperatives of the “participatory turn” in mental health research may be at odds with the (often unquestioned) assumptions and data collection methods of AI/ML approaches. This article aims to show why this is a problem and how it might be addressed. (shrink)

The extended mind thesis maintains that the functional contributions of tools and artefacts can become so essential for our cognition that they can be constitutive parts of our minds. In other words, our tools can be on a par with our brains: our minds and cognitive processes can literally ‘extend’ into the tools. Several extended mind theorists have argued that this ‘extended’ view of the mind offers unique insights into how we understand, assess, and treat certain cognitive conditions. In this (...) chapter we suggest that using AI extenders, i.e., tightly coupled cognitive extenders that are imbued with machine learning and other ‘artificially intelligent’ tools, presents both new ethical challenges and opportunities for mental health. We focus on several mental health conditions that can develop differently by the use of AI extenders for people with cognitive disorders and then discuss some of the related opportunities and challenges. (shrink)

I discuss Young’s “asymmetrical reciprocity” and apply it to an ethics of mental health care. Due to its emphasis on engaging with others through respectful dialogue in an inclusive manner, asymmetrical reciprocity serves as an appropriate framework for guiding caregivers to interact with their patients and to understand them in a morally responsible and appropriate manner. In Section 1, I define empathy and explain its benefits in the context of mental health care. In Section 2, (...) I discuss two potential problems surrounding empathy: the difficulty of perspectivetaking and “compassion fatigue.” In Section 3, I argue that these issues can be resolved if examined through the lens of an ethics of care. Reciprocal relationships between patients and caregivers are an important element in the development of an ethics of care. In Section 4, I introduce two models of reciprocity that can be applied to a health care context: Benhabib’s symmetrical reciprocity and Young’s asymmetrical reciprocity. In Section 5, I demonstrate how asymmetrical reciprocity cultivates empathy and, in Section 6 and Section 7, I show how it overcomes the objections of empathy and improves therapeutic relationships. (shrink)

Well before the COVID-19 pandemic, proponents of digital psychiatry were touting the promise of various digital tools and techniques to revolutionize mental healthcare. As social distancing and its knock-on effects have strained existing mental health infrastructures, calls have grown louder for implementing various digital mental health solutions at scale. Decisions made today will shape the future of mental healthcare for the foreseeable future. We argue that bioethicists are uniquely positioned to cut through the hype (...) surrounding digital mental health, which can obscure crucial ethical and epistemic gaps that ought to be considered by policymakers before committing to a digital psychiatric future. Here, we describe four such gaps: The evidence gap, the inequality gap, the prediction-intervention gap, and the safety gap. (shrink)

A recent systematic review of Machine Learning (ML) approaches to health data, containing over 100 studies, found that the most investigated problem was mental health (Yin et al., 2019). Relatedly, recent estimates suggest that between 165,000 and 325,000 health and wellness apps are now commercially available, with over 10,000 of those designed specifically for mental health (Carlo et al., 2019). In light of these trends, the present chapter has three aims: (1) provide an informative (...) overview of some of the recent work taking place at the intersection of text mining and mental health so that we can (2) highlight and analyze several pressing ethical issues that are arising in this rapidly growing field and (3) suggest productive directions for how these issues might be better addressed within future interdisciplinary work to ensure the responsible development of text mining approaches in psychology generally, and in mental health fields, specifically. In Section 1, we review some of the recent literature on text-mining and mental health in the contexts of traditional experimental settings, social media, and research involving electronic health records. Then, in Section 2, we introduce and discuss ethical concerns that arise before, during, and after research is conducted. Finally, in Section 3, we offer several suggestions about how ethical oversight of text-mining research might be improved to be more responsive to the concerns mapped out in Section 2. (shrink)

As COVID-19 spread, clinicians warned of mental illness epidemics within the coronavirus pandemic. Funding for digital mental health is surging and researchers are calling for widespread adoption to address the mental health sequalae of COVID-19. -/- We consider whether these technologies improve mental health outcomes and whether they exacerbate existing health inequalities laid bare by the pandemic. We argue the evidence for efficacy is weak and the likelihood of increasing inequalities is high. (...) -/- First, we review recent trends in digital mental health. Next, we turn to the clinical literature to show that many technologies proposed as a response to COVID-19 are unlikely to improve outcomes. Then, we argue that even evidence-based technologies run the risk of increasing health disparities. We conclude by suggesting that policymakers should not allocate limited resources to the development of many digital mental health tools and should focus instead on evidence-based solutions to address mental health inequalities. (shrink)

Existing ethical guidelines that aim to guide the development of mental health apps tend to overemphasize the role of Western conceptual frameworks. While such frameworks have proved to be a useful first step in introducing ethics to a previously unregulated industry, the rapid global uptake of mental health apps requires thinking more deeply about the diverse populations these apps seek to serve. One way to do this is to introduce more intercultural ethical perspectives into app (...) design and the guidelines that aim to encourage best practices. In addition to this, existing ethical guidelines can also benefit from the ethical scholarship from the feminist and disability traditions, both of which highlight specific ethical considerations for vulnerable users. Rethinking the ethical responsibilities of mental health app designers through the prisms of feminism, disability studies, and intercultural philosophy leads us to a more global and inclusive set of ethical considerations in app design. This white paper explores what existing guidelines for the regulation of mental health apps are missing. It also explores how these guidelines could be improved for users who inhabit an increasingly diverse and globalized world. (shrink)

Rather than eliminate the terms "mental health and illness" because of the grave moral consequences of psychiatric labeling, conservative definitions are proposed and defended. Mental health is rational autonomy, and mental illness is the sustained loss of such. Key terms are explained, advantages are explored, and alternative concepts are criticized. The value and descriptive components of all such definitions are consciously acknowledged. Where rational autonomy is intact, mental hospitals and psychotherapists should not think of (...) themselves as treating an illness. Instead, they are functioning as applied axiologists, moral educators, spiritual mentors, etc. They deal with what Szasz has called "personal, social, and ethical problems in living." But mental illness is real. (shrink)

Climate change, pollution, and deforestation have a negative impact on global mental health. There is an environmental justice dimension to this challenge as wealthy people and high-income countries are major contributors to climate change and pollution, while poor people and low-income countries are heavily affected by the consequences. Using state-of-the art data mining, we analyzed and visualized the global research landscape on mental health, climate change, pollution and deforestation over a 15-year period. Metadata of papers were (...) exported from PubMed®, and both relevance and relatedness of terms in different time frames were computed using VOSviewer. Co-occurrence graphs were used to visualize results. The development of exemplary terms over time was plotted separately. The number of research papers on mental health and environmental challenges is growing in a linear fashion. Major topics are climate change, chemical pollution, including psychiatric medication in wastewater, and neurobiological effects. Research on specific psychiatric syndromes and diseases, particularly on their ethical and social aspects is less prominent. There is a growing body of research literature on links between mental health, climate change, pollution, and deforestation. This research provides a graphic overview to mental healthcare professionals and political stakeholders. Social and ethical aspects of the climate change-mental health link have been neglected, and more research is needed. (shrink)

A book chapter exploring the potential consquences and ethical ramifications of using coercive measures within community mental healthcare. We argue that, althogh the move towards 'care in the community' may have had liberalising motivations, the subsequent reduction in inpatient or other supported residential provision, means that there has been an increasing move towards coercive measures outside of formal inpatient detention. We consider measures such as Community Treatment Orders, inducements, and other forms of leverage, explaining the underlying concepts, aims, and (...) exploring adverse consequences and ethical difficulties. (shrink)

This article addresses the general ethical issues of accessing online personal data for research purposes. The authors discuss the practical aspects of online research with a specific case study that illustrates the ethical challenges encountered when accessing data from Kooth, an online youth web-counselling service. This paper firstly highlights the relevance of a process-based approach to ethics when accessing highly sensitive data and then discusses the ethical considerations and potential challenges regarding the accessing of public data from Digital (...) class='Hi'>Mental Health services. It presents solutions that aim to protect young DMH service users as well as the DMH providers and researchers mining such data. Special consideration is given to service users’ expectations of what their data might be used for, as well as their perceptions of whether the data they post is public, private or open. We provide recommendations for planning and designing online research in an ethical manner that includes vulnerable young people as research participants. We emphasise the distinction between public, private and open data, which is crucial to comprehend the ethical challenges in accessing DMH data. Among our key recommendations, we foreground the need to consider a collaborative approach with the DMH providers while respecting service users’ control over personal data, and we propose the implementation of digital solutions embedded within the platform for explicit opt-out/opt-in recruitment strategies and ‘read more’ options. (shrink)

Memory modification technologies (MMTs)—interventions within the memory affecting its functions and contents in specific ways—raise great therapeutic hopes but also great fears. Ethicists have expressed concerns that developing and using MMTs may endanger the very fabric of who we are—our personal identity. This threat has been mainly considered in relation to two interrelated concerns: truthfulness and narrative self‐constitution. In this article, we propose that although this perspective brings up important matters concerning the potential aftermaths of MMT utilization, it fails to (...) tell the whole story. We suggest that capturing more tangible potential consequences of MMT use, namely, its psychological ramifications is crucial both in ethical considerations and in making decisions regarding the permissibility of such interventions. To this end, we first examine what current MMTs are capable of and what are the prospects of emerging MMTs. Subsequently, we outline the relationship between memory and personal identity; specifically, we indicate that concepts of self‐defining memories and narrative identity are crucial to considering how MMTs may influence one's psychological functioning. On this basis, we analyze potential consequences of narrative disruption that may be the result of the use of MMTs; more precisely, we consider its potential effects on mental health, well‐being, and personal agency, and outline the ethical dilemmas that decision‐makers face in this context. We conclude by considering the broader cultural context that may have influence on policymaking regarding permissibility of memory modification interventions. (shrink)

Health care providers (HCPs) are routinely placed into morally challenging situations that have the potential to cause moral distress. This is especially true for HCPs working in the military, whether they are on deployment outside their typical contexts of practice such as in disaster relief (e.g., Haiti and the Ebola missions in West Africa), or in more typically military settings such as peace keeping or armed conflicts (e.g., Afghanistan, Syria). Moral distress refers to “painful feelings and/or psychological disequilibrium” (Nilsson, (...) Sjöberg, Kallenberg, & Larsson, 2011, p. 50) that occur when an individual is aware of a morally appropriate action in a moral dilemma but obstruction prevents them from carrying it out, or when in a situation where they must choose between upholding equally treasured but conflicting moral values. Similarly, moral distress can occur when faced with a ‘tragic choice’ where all available courses of action require something of moral significance to be given up, such as surgical triage in a mass casualty event (Hunt, Sinding, & Schwartz, 2012). In the literature, moral distress has been connected to negative psychological effects and even stress related mental health issues including compassion fatigue, burnout, and post-traumatic stress disorder (Owen & Wanzer, 2014; Gustafsson, Eriksson, Strandberg, & Norberg, 2010; Litz, et al., 2009). (shrink)

The observation that a crisis of confidence regarding Psychiatry exists is a notion shared even among psychiatrists themselves. Psychiatry has a checkered history and its alliance with the pharmaceutical industry, aka Big-Pharma, continues to reinforce a need for healthy skepticism. Why? Mainly, an over-reliance on the questionable expertise and authority afforded psychiatry as the specialists of mental health. I contend that the authority of psychiatry is misplaced and too often harmful. Since the criteria required to justify and satisfy (...) psychiatric expertise is not fully established as can be substantiated by compelling reasons to rethink its authority as a reliable profession in its current form. Psychiatric expertise is not particularly scientific and this is especially dangerous in a sector that prescribes mind-altering drugs. There are a number of identified criteria that would otherwise substantiate psychiatric expertise and whilst partially existent, are nonetheless deficient. These major yet deficient aspects of psychiatric practice concern diagnostic problems – reliability and verification of diagnoses and accurate testable validity of diagnoses - mainly due to an absence of identifiable underlying biomarkers ordinarily related to disease or biological conditions. Psychiatrists often fail to distinguish between reactive-depression (reaction to external event or circumstance) and endogenous-depression (biological) resulting, in part, from incorrectly distinguishing between conditions constitutive of ‘trait’ (endogenous) and of those of ‘state’ (e.g. reactive depression; adverse effects from medication, etc.). (shrink)

I offer a preliminary examination on the importance of narrative for helping to overcome the issue of stigma surrounding mental illness, specifically schizophrenia. I maintain that engaging with first-person accounts of schizophrenia allows caregivers, and the broader general public, to better understand the phenomenological lived experiences of persons living with this mental health challenge and to better understand the experience of dealing with stigma. In doing so, I maintain that both caregivers and the public can begin developing (...) more accepting views of schizophrenia and begin to support those who need it the most. (shrink)

Abstract: In this article, we explore what are ethical forms of holding service users responsible in mental health care contexts. Hanna Pickard has provided an account of how service users should be held responsible for morally wrong or seriously harmful conduct within contexts of mental health care, called the clinical stance. From a clinical stance one holds a person responsible for harm, but refrains from emotionally blaming the person and only considers the person responsible for this (...) conduct in a detached sense. Her account is based on what are considered best practices in the treatment of people with borderline personality disorder and addiction. We ask if this account generalizes across different diagnostic criteria and different clinical contexts. To begin to answer this question, we compare the clinical stance to an account of what are considered best practices in the treatment of service users at a specialized clinic for people with autism spectrum disorder in the Netherlands. We refer to this alternative account as the nurturing stance and highlight relevant similarities and differences between the clinical stance and the nurturing stance. We conclude with suggestions for further research and theorizing. (shrink)

Common mental health disorders are rising globally, creating a strain on public healthcare systems. This has led to a renewed interest in the role that digital technologies may have for improving mental health outcomes. One result of this interest is the development and use of artificial intelligence for assessing, diagnosing, and treating mental health issues, which we refer to as ‘digital psychiatry’. This article focuses on the increasing use of digital psychiatry outside of clinical (...) settings, in the following sectors: education, employment, financial services, social media, and the digital well-being industry. We analyse the ethical risks of deploying digital psychiatry in these sectors, emphasising key problems and opportunities for public health, and offer recommendations for protecting and promoting public health and well-being in information societies. (shrink)

Mental health challenges can be described via the application of multiple lenses, from clinical-medical perspectives, to social and community-based, to further understandings in the context of public health. While these challenges can represent multiple issues to the scientific community at-large, especially because of the translational issues attached to the application of research and practice to the sphere of community services, it is useful to understand that the triad ethics, evidence, and experience can be instrumental in navigating (...) the complexity of the issue-at-hand. Furthermore, the work of researchers and practitioners is rooted in a solid understanding of the specific needs of psychiatric patients, particularly from the perspective of possible misunderstandings, ostracization, and stigmatization of psychiatric issues and related presentation, affect, and behaviours. Years of research have indicated how a proper interaction between resources at the level of scientific research and the community is a fundamental cornerstone for a practice rooted in both science and true care for individuals affected by mental health disorders. In this presentation we will discuss the case of the Centro Salute Mentale (Mental Health Centre, CSM) of Verona. (shrink)

This thesis under the title “Public Health Policy in Resource Allocation: the Role of Ubuntu Ethics in Redressing Resource Disparity between Public and Private Healthcare in South Africa” explores health care disparities pertaining to resource allocation between public and private sector. It is of relevance and importance in South Africa where 54% of the population live on less than US$3 per day. Although the government has instituted certain changes aimed at transforming the public health care system, (...) the resource allocation gap between the two persists and remains wide. The research gives special attention to the role that Ubuntu ethics can play in redressing the resource allocation disparities between public and private health care sectors in South Africa, pointing out the existing gap in financing, as well as human resource between public and private health care sectors, which leads to poor health outcomes in public sector. Therefore, the problem is the prevalent inequality of resource allocation between private and public health care sectors. The analysis of policy gaps, as well as evaluating the cause of disparities in the health system is the goal of this research. The study endeavours to redress the disparities within the context of Ubuntu ethical principles and proposes a change in public policy so as to enhance healthcare for the benefit of the people. The study is philosophical and ethical, so the methodology used is discursive in nature, majorly focusing on critically reviewing existing literature, that is, the philosophical resources on Ubuntu ethics and justice theories as well as a range of government resources inclusive of public health policy documents. Social determinants of health and their impact in a South African context are discussed with the implication that health is not merely freedom from disease and or incapacity, but rather being well mentally, physically and socially. The attainment of a healthy status goes beyond ability to access healthcare services, and incorporates social determinants including but not limited to conditions in which people have been born into, stay, establish career and grow old in. It also includes the arrangements put in place to deal with illness and determine health. Issues of revenue, literacy, communal safety networks, vocation and conditions under-which vocation is undertaken, lack of work and vocation insecurity, early stages of human development, gender, cultural group, dietary insecurity, housing communal exclusion and disability all come into the picture as factors that determine health. But there is also discussion of the socio-economic status as contributors to health inequity wherein alcohol abuse, sugar intake, and smoking are identified as behavioural factors that complicate public health. One outstanding feature of this research is that it establishes a link between Ubuntu and public health policy. The researcher establishes that Ubuntu ethics is appropriate for not only discussing public morality, but also for formulating public policy that is morally tenable for South Africa, especially for the public health sector. This thesis calls for an application of Ubuntu in a proper context in order to enhance societal well-being for the benefit of many, if not all. The research proposes the fundamental principle of Ubuntu ethics in which the good of the community is as important as the good of every member of the community. Since Ubuntu ethics does not merely seek to fulfil what benefits the majority, as would be the case in a utilitarian society, the researcher advocates for the building of consensus on the common good, which should be understood to imply not just what is good for everyone in the community, but also what is good for the continued well-being of the community as a single unit. In this regard, the research finds it important that deliberate effort be made to integrate Ubuntu ethics into policies, citing the example of the National Health Insurance (NHI). The good health of all the members of a community is an assurance of the well-being and continuity of the whole national community. The research concludes that public health policy should integrate Ubuntu ethical values such as community, sharing, care, solidarity, identity, harmony, respect, and dignity into policy documents and legislation. (shrink)

Online therapy sessions and other forms of digital mental health services (DMH) have seen a sharp spike in new users since the start of the COVID-19 pandemic. Having little access to their social networks and support systems, people have had to turn to digital tools and spaces to cope with their experiences of anxiety and loss. With no clear end to the pandemic in sight, many of us are likely to remain reliant upon DMH for the foreseeable future. (...) As such, it is important to articulate some of the specific ways in which the pandemic is affecting our self and world-relation, such that we can identify how DMH services are best able to accommodate some of the newly emerging needs of their users. In this paper I will identify a specific type of loss brought about by the COVID-19 pandemic and present it as an important concept for DMH. I refer to this loss as loss of perceptual world-familiarity. Loss of perceptual world-familiarity entails a breakdown in the ongoing effortless responsiveness to our perceptual environment that characterizes much of our everyday lives. To cash this out I will turn to insights from the phenomenological tradition. Initially, my project is descriptive. I aim to bring out how loss of perceptual world-familiarity is a distinctive form of loss that is deeply pervasive yet easily overlooked-hence the relevance of explicating it for DMH purposes. But I will also venture into the space of the normative, offering some reasons for seeing perceptual world-familiarity as a component of well-being. I conclude the paper with a discussion of how loss of perceptual world-familiarity affects the therapeutic setting now that most if not all therapeutic interactions have transitioned to online spaces and I explore the potential to augment these spaces with social interaction technologies. Throughout, my discussion aims to do justice to the reality that perceptual world-familiarity is not an evenly distributed phenomenon, that factors like disability, gender and race affect its robustness, and that this ought to be reckoned with when seeking to incorporate the phenomenon into or mitigate it through DMH services. (shrink)

We argue that while digital health technologies (e.g. artificial intelligence, smartphones, and virtual reality) present significant opportunities for improving the delivery of healthcare, key concepts that are used to evaluate and understand their impact can obscure significant ethical issues related to patient engagement and experience. Specifically, we focus on the concept of empowerment and ask whether it is adequate for addressing some significant ethical concerns that relate to digital health technologies for mental healthcare. We frame these concerns (...) using five key ethical principles for AI ethics (i.e. autonomy, beneficence, non-maleficence, justice, and explicability), which have their roots in the bioethical literature, in order to critically evaluate the role that digital health technologies will have in the future of digital healthcare. (shrink)

In Two Minds is a practical casebook of problem solving in psychiatric ethics. Written in a lively and accessible style, it builds on a series of detailed case histories to illustrate the central place of ethical reasoning as a key competency for clinical work and research in psychiatry. Topics include risk, dangerousness and confidentiality; judgements of responsibility; involuntary treatment and mental health legislation; consent to genetic screening; dual role issues in child and adolescent psychiatry; needs assessment; cross-cultural (...) and gender issues; rational and irrational suicide; shared decision making in multi-agency teams, and the growing role of the user's voice in psychiatry. Key ethical concepts are carefully introduced and explained. The text is richly supported by detailed guides for further reading. There are separate chapters on teaching psychiatric ethics, including a sample seminar, and on writing a research ethics application. Each case history and discussion is followed by a critical commentary from a practitioner with relevant experience. Jim Birley adds a comparative international perspective on psychiatric ethics. Cartoons by Johnny Cowee provide punchy counterpoint! In Two Minds is the sister volume to the third edition of Sidney, Paul Chodoff and Steven Green's highly successful Psychiatric Ethics. In providing a bridge between theory and practice, it will be essential reading for everyone concerned with improving standards in mental health care. (shrink)

The mental health crisis and loneliness epidemic have sparked a growing interest in leveraging artificial intelligence (AI) and chatbots as a potential solution. This report examines the benefits and risks of incorporating chatbots in mental health treatment. AI is used for mental health diagnosis and treatment decision-making and to train therapists on virtual patients. Chatbots are employed as always-available intermediaries with therapists, flagging symptoms for human intervention. But chatbots are also sold as stand-alone virtual (...) therapists or as friends and lovers. There is evidence that these uses of AI and chatbots can provide better quality service, improve accessibility, and lower costs. The systems can reduce the stigma and shame of sharing their problems and leverage a mass of biometric and behavioral data to supplement self-reports. As the systems' intelligence rapidly improves, they will need to be rigorously tested for the accuracy and precision of their diagnoses and the quality of their interactions with patients. As chatbots become indistinguishable from humans and leverage their superhuman capacity to detect affect and draw on knowledge of a patient’s life, patients will be drawn to attribute personality to and relationship with the chatbot. Consequently, it will be essential to study what the “therapeutic alliance” with an actual human counselor provides and the risks of patients attributing such a relationship to a one-sided or “parasocial” relationship. (shrink)

There are a number of important links and similarities between public health and safety. In this extended essay, Gregg D. Caruso defends and expands his public health-quarantine model, which is a non-retributive alternative for addressing criminal behavior that draws on the public health framework and prioritizes prevention and social justice. In developing his account, he explores the relationship between public health and safety, focusing on how social inequalities and systemic injustices affect health outcomes and crime (...) rates, how poverty affects brain development, how offenders often have pre-existing medical conditions (especially mental health issues), how involvement in the criminal justice system itself can lead to or worsen health and cognitive problems, how treatment and rehabilitation methods can best be employed to reduce recidivism and reintegrate offenders back into society, and how a public health approach could be successfully applied within the criminal justice system. Caruso's approach draws on research from the health sciences, social sciences, public policy, law, psychiatry, medical ethics, neuroscience, and philosophy, and he delivers a set of ethically defensible and practically workable proposals for implementing the public health-quarantine model. The essay begins by discussing recent empirical findings in psychology, neuroscience, and the social sciences that provide us with an increased understanding of the social and neurological determinants of health and criminal behavior. It then turns to Caruso's public health-quarantine model and argues that the model provides the most justified, humane, and effective approach for addressing criminal behavior. Caruso concludes by proposing a capability approach to social justice grounded in six key features of human well-being. He argues that we cannot successfully address concerns over public health and safety without simultaneously addressing issues of social justice—including the social determinants of health (SDH) and the social determinants of criminal behavior (SDCB)—and he recommends eight general policy proposals consistent with his model. (shrink)

Background Genomic research on neurodevelopmental disorders (NDDs), particularly involving minors, combines and amplifies existing research ethics issues for biomedical research. We performed a review of the literature on the ethical issues associated with genomic research involving children affected by NDDs as an aid to researchers to better anticipate and address ethical concerns. Results Qualitative thematic analysis of the included articles revealed themes in three main areas: research design and ethics review, inclusion of research participants, and communication of research (...) results. Ethical issues known to be associated with genomic research in general, such as privacy risks and informed consent/assent, seem especially pressing for NDD participants because of their potentially decreased cognitive abilities, increased vulnerability, and stigma associated with mental health problems. Additionally, there are informational risks: learning genetic information about NDD may have psychological and social impact, not only for the research participant but also for family members. However, there are potential benefits associated with research participation, too: by enrolling in research, the participants may access genetic testing and thus increase their chances of receiving a (genetic) diagnosis for their neurodevelopmental symptoms, prognostic or predictive information about disease progression or the risk of concurrent future disorders. Based on the results of our review, we developed an ethics checklist for genomic research involving children affected by NDDs. Conclusions In setting up and designing genomic research efforts in NDD, researchers should partner with communities of persons with NDDs. Particular attention should be paid to preventing disproportional burdens of research participation of children with NDDs and their siblings, parents and other family members. Researchers should carefully tailor the information and informed consent procedures to avoid therapeutic and diagnostic misconception in NDD research. To better anticipate and address ethical issues in specific NDD studies, we suggest researchers to use the ethics checklist for genomic research involving children affected by NDDs presented in this paper. (shrink)

Two general ethical problems in psychiatry are thrown into sharp relief by long term care. This article discusses each in turn, in the context of two anonymised case studies from actual clinical practice. First, previous mental health legislation soothed doubts about patients' refusal of consent by incorporating time limits on involuntary treatment. When these are absent, as in the provisions for long term care which have recently come into force, the justification for compulsory treatment and supervision becomes more (...) obviously problematic. Second, Anglo-American law does not normally allow the preventive detention of someone who may be dangerous but has not actually committed any crime. The justification for detaining a possibly dangerous user of mental health services without his or her consent can only be based on risk assessment, but this raises issues of moral luck. Is the psychiatrist who decides not to take out a supervision order for a possibly dangerous patient with an initial psychotic diagnosis morally at fault if that person harms someone in the community, or himself? Or is the psychiatrist merely unlucky? (shrink)

This study, by using 142 groups of data from 1990 to 2007 and the method of cross-temporal meta-analysis, researched the changing trend of status of mental health of 108736 members of the Chinese Army along with the change of years. All the data came from 94 related research reports, and all the research reports used SCL-90 (the Symptom Checklist 90) as the testing tool of mental health. The study found that: (1) mental health of (...) members of the Chinese Army steadily improved between 1990 and 2007; (2) during those 18 years, the Interpersonal Sensitivity factor of SCL-90 of Chinese Army members changed most significantly, and the least significantly changed factor was Somatization; (3) Chinese Army members showed evidence of fewest problems on the Photic Anxiety factor, in contrast to the consistent problems indicated by scores on the Obsessive-Compulsive and Interpersonal Sensitivity scales; (4) Chinese Army members from single-child families (N =1,944) showed significant lower evidence of positive mental health than soldiers from multiple child families (N =2,649); (5) The mental health of soldiers from non-agricultural backgrounds (N =7,808) was less positive than that of soldiers from agricultural households(N =11,459); (6) Chinese Army members with senior high school education level (N = 10,189) had less positive mental health than those with junior high school (N = 8,407) or university education (N = 863). (shrink)

The professional application of ethics often lacks the necessary conceptual tools to construct adequate theoretical foundations that can be used for practical enterprise. This book focuses on an anthropological approach to mental illness, describing how schizophrenia can distort one's experience of empathy and of the presence in the world through pathological indifference. It describes factual and phenomenological perspectives on a case of schizophrenia, based on the method of Eugène Minkowski.

Religion constitutes an important element in every society as regards coping with the demands as well as vicissitudes of life. Mental health issues are becoming a recurrent decimal in societies overwhelmed by stress and other social factors. This paper examines how the presence of religious beliefs affects how some Christians respond to cases that have to do mental health. At the same time, it surveys how a near absence of religious attitude, that is, clinical medicine approach (...) to mental health issues betters the state of those suffering from these psychopathologies. This work sees participatory partnership approach as an effective means of correcting unhealthy biases that prevent a better understanding of mental health care. Sociological theory of structural functionalism will be used in assessing how religion can reinvent itself in areas that are associated with mental health. Ethnographic methodology through quantitative analysis of administered questionnaire is used as a research tool for this research. Three persons were also interviewed. The research findings show that religion is a crucial agent of socialization that can change how religious beliefs impact on mental health and there is need for medical professionals to collaborate with pastoral agents. (shrink)

Editorial introduction to series of papers resulting from a European Commission Project on mental capacity.

The significance of critical phenomenology for psychiatric praxis has yet to be expounded. In this paper, I argue that the adoption of a critical phenomenological stance can remedy localised instances of hermeneutical injustice, which may arise in the encounter between clinicians and patients with psychosis. In this context, what is communicated is often deemed to lack meaning or to be difficult to understand. While a degree of un-shareability is inherent to subjective life, I argue that issues of unintelligibility can be (...) addressed by shifting from individualistic conceptions of understanding to an interactionist view. This takes into account the contextual, historical and relational background within which meaning is co-constituted. I conclude by providing a corrective for hermeneutical injustice, which entails a specific attentiveness towards the person’s subjectivity, a careful sensitivity to contingent meaning-generating structures, and a degree of hermeneutical flexibility as an attitude of openness towards alternative horizons of possibility. (shrink)

Mental health generally refers to an individual’s thoughts, feelings and actions, particularly when he faced with life challenges and stresses. A good mental health isn’t just the absence of mental health problems. It is the achievement and the maintenance of psychological well-being. Mental Health is the state of one’s peace of mind, happiness and harmony brought out by one’s level of adjustment with himself and his environment. In describing mental health, (...) Anwar said, “…mental health is the health of one’s mind which can prove a potent determinant of one’s integrated personality and balanced behavour identified on the basis of the level of his adjustment to himself, others and with the environment. A mentally healthy individual possesses a number of characteristics which influence his life positively and help him in achieving his goals of life effectively. He has adequate ability to make adjustments in the changed circumstances and situations. His intellectual powers are adequately developed. He is able to think independently and take proper decision at the proper time. He tries to accomplish his work as effectively as possible but he does not prove to be an extremist by becoming a perfectionist. Though these characteristics are expected from a mentally healthy individual, but these should be taken as essential and necessary conditions for the maintenance of proper mental health and thus absence of one or the other characteristic does not necessarily mean negation of mental health. Good mental health is not just the absence of mental problems. Being mentally healthy is much more than free of depression, anxiety or other psychological issues.”1 In this paper an attempt is made to discuss about the mental health policies and issues in India. (shrink)

Summary Background Self-binding directives instruct clinicians to overrule treatment refusal during future severe episodes of illness. These directives are promoted as having potential to increase autonomy for individuals with severe episodic mental illness. Although lived experience is central to their creation, service users’ views on self-binding directives have not been investigated substantially. This study aimed to explore whether reasons for endorsement, ambivalence, or rejection given by service users with bipolar disorder can address concerns regarding self-binding directives, decision-making capacity, and (...) human rights. Methods This study used qualitative data from an internet-based survey distributed to the mailing list of the UK charity Bipolar UK, which contained multiple closed and open questions on advance decision-making in bipolar disorder. Quantitative analysis of a closed question about self-binding directives had already demonstrated endorsement amongst a very high proportion of participants with bipolar disorder who completed the survey. We conducted thematic analysis of responses from those participants who answered a subsequent open question about reasons for their view. Research was co-produced within a multi-disciplinary team, with clinical, legal, and ethical expertise, and lived experience of bipolar disorder. Ideas and methodologies associated with all these areas of expertise were used in the analysis of these reasons and to gain insight into the thoughts of individuals with bipolar disorder about self-binding directives and associated issues. Findings Between Oct 23 and Dec 5, 2017, 932 individuals with a self-reported clinical diagnosis of bipolar disorder completed the internet survey, with 565 (154 men; 400 women; 11 transgender or other) providing free text answers to the open question. A large majority of respondents endorsed self-binding directives, nearly all describing a determinate shift to types of distorted thinking and decision-making when unwell as their key justification. Responses indicating ambivalence were dominated by logistical concerns about the drafting and implementation of self-binding directives, while those who rejected self-binding directives also cited logistical concerns, validity of their thinking when unwell, and potential contravention of human rights. Interpretation This study is, to our knowledge, the first large study of reasons why mental health service users might endorse or reject the use of self-binding directives. The findings provide empirical support for introducing self-binding directives into mental health advance decision-making practice and policy and may help to address enduring ethical concerns surrounding possible implementation of the directive while a person retains decision-making capacity. The opinions expressed here in responses given by multiple service users with bipolar disorder challenge a prominent view within international disability rights debates that involuntary treatment and recognition of impaired mental capacity constitute inherent human rights violations. Funding The Wellcome Trust . (shrink)

Approaching mental health on a global scale with particular reference to low- and mid-income countries raises issues concerning the disregard of the local context and values and the imposition of values characteristic of the Global North. Seeking a philosophical viewpoint to surmount these problems, the present paper argues for a value-laden framework for psychiatry with the specific incorporation of value pluralism, particularly in relation to the Global South context, while also emphasizing personal values such as the choice of (...) treatment. In sketching out this framework, the paper aims to overcome the clash between universalism and relativism about psychiatric categories by focusing on how overlaps between cultures can contribute to ontology-building. A case study analyzing ethnopsychiatric research in the context of South India will illustrate the proposed view, while also pointing out avenues for further research on the causal efficacy of local shared beliefs about mental disorder. If approaches across different traditions and theoretical frames are shown to work in treating similar ailments, causal connections appear to cut across the different ontologies. Ethnopsychiatry would play a central role in such research, namely in disclosing the variables and mechanisms at work within the local approaches. (shrink)

Most mental health research largely ignores or minimises gender and age differences in depression. In ‘Don't mind the gap: Why do we not care about the gender gap in mental health?’, Patalay and Demkowicz identify a dearth of research on the causal factors of depression in young women. They attribute this to an over-reliance on biological accounts of gender differences in depression. Patalay and Demkowicz conclude that a person-centred approach that meaningfully engages with the reports of (...) young women with depression is more likely to expose the social drivers of depression that impact this group. This commentary focuses on Patalay and Demkowicz's call to examine the patient's lived experience. We argue that there is an urgent need to reflect upon the methodologies involved in examining lived experience and how they can be best utilised. Ultimately, we advocate for an approach known as ‘phenomenological psychopathology’, through a phenomenological investigation of depression in young women, we can go some way towards closing the gender gap. (shrink)

Recent evidence shows significant potential for therapies involving psychedelic substances such as psilocybin and MDMA to improve clinical outcomes for patients experiencing various mental disorders. However, research to date focuses almost exclusively on adults. I argue that adolescents should be included in research into psychedelic therapies. First, I demonstrate the pressing need for novel interventions to address the growing mental health burden of adolescents, and I draw on empirical evidence to show that research into psychedelic therapies presents (...) an opportunity to address this shortfall. Secondly, I argue that psychedelics pose low risk to young patients, particularly relative to existing psychiatric medications. I then address two major concerns specific to adolescent contexts. First, I address the risks of using psychedelic substances at earlier stages of physiological and cognitive development. I note that the lack of understanding of the risks underscores the need for including adolescents in research. I then address the added complexity of consent in the adolescent context. I highlight some additional concerns that should be addressed in an “enhanced” informed consent process for adolescents and defend the view that capable adolescents should be able to consent to psychedelic interventions. I ultimately hold that including adolescents in emerging psychedelic research has the potential to substantiate innovative treatments that could improve their clinical outcomes, long-term mental health and quality of life. (shrink)

Post-Traumatic Stress Disorder is a mental health condition in which the experience of a traumatic event causes a series of psychiatric and behavioral symptoms such as hypervigilance, insomnia, irritability, aggression, constricted affect, and self-destructive behavior. This paper investigates two case studies to argue that the experience of PTSD is not restricted to humans alone; we have good epistemic reason to hold that some animals can experience genuine PTSD, given our current and best clinical understanding of the disorder in (...) humans. I will use this evidence to argue for two claims. First, because the causal structure of PTSD plausibly requires reference to a traumatic conscious experience in order to explain subsequent behaviors, the fact that animals can have PTSD provides new evidence for animal consciousness. Second, the discovery of PTSD in animals puts pressure on accounts which hold that animal behavior can be fully explained without reference to subjective experience. (shrink)

Physicians try hard to alleviate mental and physical ailments of their patients. Thus, they are heavily burdened by observing ethics and staying well-informed while improving health of their patients. A major ethical concern or dilemma in medication is that some physicians know their behavior is unethical, yet act against their moral compass. This study develops models of theory–practice gap, offering optimal solutions for the gap. These solutions would enhance self-motivation or remove external obstacles to stimulate ethical practices (...) in medicine. The Constructivist Grounded Theory Methodology is applied here where the participants and the main researcher mutually interacted with each other. Data collection was performed through qualitative methods including observation and semi-structured interviews with 21 physicians and medical students. Initial and focused coding was done, from which principal concepts were later extracted. MAXQDA software was used for analyzing data. Analysis of twelve major concepts in the study resulted in two factors and solution groups, from which four general notions influencing the ethical theory and practice gap in medicine were extracted: (1) providing effective education to change attitude and behavior; (2) considering motivational and emotional factors; (3) reconstructing regulations and processes to facilitate ethical practice; (4) conducting comprehensive and systematic studies. The existing medical educational system needs to be reconsidered to add to individual internal motivation, including optimizing persuasion strategies, maximizing participation of students, adhering to virtuous ethical theories, and fostering emotions. Additionally, regulations and processes can be reconstructed to remove practical obstacles and promote ethical practice with insignificant damages to individual self-motivation. (shrink)

Mindfulness exercises are presented as being compatible with almost any spiritual, religious or philosophical beliefs. In this paper, we argue that they in fact involve imagining and conceptualising rather striking and controversial claims about the self, and the self’s relationship to thoughts and feelings. For this reason, practising mindfulness exercises is likely to be in tension with many people’s core beliefs and values, a tension that should be treated as a downside of therapeutic interventions involving mindfulness exercises, not unlike a (...) side effect. Clients ought to be informed of these metaphysical aspects of the exercises, and mental health providers ought to take them into account in assessing which course of treatment to recommend. Given these concerns, the casual way in which mindfulness exercises are presently distributed by mental health providers to the general public is inappropriate. (shrink)

This article is about an intervention or approach in mental health care that has been developed from hermeneutics, more specifically the hermeneutics of Ricoeur. In this intervention photography is used as a means to assist patients in a process of meaning making from experiences in their life world. It aims at empowerment and strengthening the agency of patients. It does so by facilitating storytelling. Mimesis, as interpreted by Ricoeur, was found to be a central concept with which we (...) could explain the therapeutic working of the approach and legitimize its ethical claims of empowerment and recovery. Another aspect is the concordance between narrative and action, as described by Ricoeur, which has a pendant in the goal orientation of the photography intervention. At the same time demonstrations and experiences from professional practice (nurses applying the intervention) will give us feedback on the theory and enrich it with new insights, e.g. on ‘iconic representation’. (shrink)

This study investigates the relationship between mental health and emotional intelligence among senior high school students in a public school. Thus, the study employed a correlational design to measure the relationship between mental health and emotional intelligence among 152 Grade 12 senior high school students in a public school. Hence, to measure the study’s variables - Mental Health Inventory and Emotional Intelligence Scale (EIS) were utilized. Based on the inferential statistics, the r coefficient of (...) 0.32 indicates a low positive correlation between the variables and a p-value of 0.00, indicating a significant relationship between the respondents' mental health and emotional intelligence. Implications and recommendations were discussed in the study. (shrink)

Personal recovery entails the idea of learning to live a good life in the face of mental illness. It takes place in a continuous dynamic between change and acceptance and involves the existential dimension in the broadest sense. With cognitive self-regulation and empowerment as central elements, however, current models of recovery mostly have an individual focus instead of a relational one. Furthermore, there seems to be an emphasis on the component of change. Little attention is payed to the role (...) and integration of dealing with loss in personal recovery. In this paper, the role of loss in mental illness will be elaborated from an existential perspective. This will be done by relating existential changes to possibly disruptive experiences of loss in wider experience. With the help of several perspectives on dealing with loss it will be argued this can be integrated in processes of recovery. Then, it will be elaborated how reexperiencing a state of being surrounded, or being included, being held is a necessary part of recovery. The result consists of a refinement of the view on personal recovery. The aim of this paper is therefore twofold: (1) to arrive at a better understanding of what existential loss and loss in wider experience in the context of psychopathology entails, and (2) to further develop perspectives on recovery in mental health care. (shrink)

What is it to be mentally healthy? In the ongoing movement to promote mental health, to reduce stigma, and to establish parity between mental and physical health, there is a clear enthusiasm about this concept and a recognition of its value in human life. However, it is often unclear what mental health means in all these efforts and whether there is a single concept underlying them. Sometimes, the initiatives for the sake of mental (...) health are aimed just at reducing mental illness, thus implicitly identifying mental health with the absence of diagnosable psychiatric disease. More ambitiously, there are high-profile proposals to adopt a positive definition, identifying mental health with psychic or even overall well-being. We argue against both: a definition of mental health as mere absence of mental illness is too thin, too undemanding, and too closely linked to psychiatric value judgments, while the definition in terms of well-being is too demanding and potentially oppressive. As a compromise, we sketch out a middle position. On this view, mental health is a primary good, that is, the psychological preconditions of pursuing any conception of the good life, including well-being, without being identical to well-being. (shrink)

This study evaluates the relationship between mental health and academic motivation among third-year college TES grantees. Thus, correlational design was employed to determine if there is a significant relationship between mental health and academic motivation among 150 third-year TES grantees. Statistical findings reveal that the r coefficient of 0.52 indicates a moderate positive correlation between the variables. The p-value of 0.00, which is less than 0.05, leads to rejecting the null hypothesis. Hence, a significant relationship exists (...) between mental health and academic motivation of third-year college TES grantees. Implications were discussed in the study. (shrink)

Police killings of individuals with mental illness have prompted calls for greater funding of mental health services to shift responsibilities away from the police. Such investments can reduce police interactions with vulnerable populations but are unlikely to eliminate them entirely, particularly in cases where individuals with mental illness have a weapon or are otherwise dangerous. It remains a pressing question, then, how police should respond to these and other vulnerable aggressors with diminished culpability (VADCs). This article (...) considers and ultimately rejects three potential approaches from the ethics of defensive force literature. It looks to improve on them by developing what I call the fusion account, which explains how vulnerability and diminished culpability fit together to provide moral grounds for extra protections from deadly force. The article’s final sections explore the policy implications of the fusion account for police administrators, officers, and the law. (shrink)

The tendency to draw mind-brain dichotomies and evaluate mental disorders dualistically arises in both laypeople and mental health professionals, leads to biased judgments, and contributes to mental health stigmatization. This paper offers a theory identifying an underlying source of these evaluations in social practice. According to this theory, dualistic evaluations are rooted in two mechanisms by which we represent and evaluate the beliefs of others in folk psychology and theory of mind: the doxastic conception of (...) mental disorders and doxastic voluntarism. Tracing these origins contributes to our understanding of mental state representation in cognitive science and philosophy of psychiatry, the concept of belief in philosophy of mind, and may help improve patient experience and treatment in light of social stigmatization and bias toward mental illness. (shrink)

Aim: Low professional help-seeking intention (PHSI) hinders effective treatment of mental illness. PHSI among Chinese students is still understudied and under-recognized. This study aimed to evaluate the status of PHSI and its associated risk factors among Chinese medical students. -/- Methods: A cross-sectional survey was conducted in Hainan province, South China, between January 1, 2021, and May 31, 2021. A total of 2182 medical students were recruited and surveyed via an anonymous structured questionnaire. Logistic regression analyses were performed to (...) identify the factors associated with PHSI. -/- Results: Among the 2182 medical students (mean age 21.0 years (SD = 3.70), 61.5% females), those with and without PHSI were 72.0% and 28.0%, and 16.4% with moderate to severe depression. Male students, those with a high level of depression stigma, serious family dysfunction, and heavy dependence on mobile phones were significantly less likely to seek professional mental health help, with odds ratios (ORs) of 1.5, 2.0, 2.1, and 1.7, respectively. -/- Conclusion: A significant proportion of Chinese medical students demonstrate low PHSI, influenced by factors such as gender, depression stigma, family dysfunction, and mobile phone dependence. Future interventions aimed at increasing medical students’ PHSI should prioritize reducing depression stigma, mitigating reliance on mobile phone use, and enhancing family function to address these key barriers to seeking professional mental health support. (shrink)

Not only the direct physical experiences of deployment can severely harm soldiers’ mental health. Witnessing violations of their moral principles by the enemy, or by their fellow soldiers and superiors, can also have a devastating impact. It can cause soldiers’ moral disorientation, increasing feelings of shame, guilt, or hate, and the need for general answers on questions of right and wrong. Various attempts have been made to keep soldiers mentally sane. One is to provide convincing causes for their (...) deployment, which risks an “end justifies the means” way of thinking. The good cause can provide a moral justification for horrible atrocities. Another method, introduced in the USA, Canada, and Australia, aims to strengthen military personnel’s resistance by promoting and maintaining a happy, optimistic state of mind through the use of positive psychology. Alongside making soldiers “morally fit” for all kinds of situations, the focus could also be on moral recovery and forgiveness. Such a care-based military ethics approach, aimed at mutual understanding and interdependence, could help soldiers handle the emotional impact of moral conflicts. This demands that military units reflect on their organizational culture and rethink oaths and codes of conduct that focus mainly on efficiency and readiness, as well as the soldierly self-image with its seemingly still deeply rooted warrior ethos. Today, resilience and positive psychology in the military is apparently mainly geared to assuring its soldiers’ readiness. An appropriate set of virtues and understanding of virtue ethics that are less centered on self-perfection and autonomy could point to a different form of character-building and lead to a better understanding of others. (shrink)

Mental health among students is one of the major concerns amidst the pandemic. Employing a correlational design, this study investigates the relationship between emotional intelligence and mental health among 152 senior high school students. Based on the statistical analysis, the r coefficient of 0.82 indicates a high positive correlation between the variables. The p-value of 0.00, which is less than 0.05, leads to the decision to reject the null hypothesis. Hence, a significant relationship exists between emotional (...) intelligence and mental health among senior high school. Implications were discussed in the study. (shrink)