The crucial yet ethically delicate conduct of mental health research in low-resource communities is the subject of the student paper awarded the 2012 Marcia G. Pines honor by Johns Hopkins Berman Institute of Bioethics. Sarah Murray, a PhD student in the department of Mental Health, is the author.
The paper, Murray’s final one for the course Research Ethics and Integrity, is titled The Ethics of Global Mental Health Prevalence Research in Low-Resource Contexts: A Survey of the Current Literature and an Exploration of Moral Dilemmas.
“Global mental health research has grown as a field in recent years, and there are ethical issues that are especially relevant to mental health research,” Murray says of her motivation in choosing the topic of her paper. “I feel the ethical literature particular to this field also must grow. I felt it was important to think through what dilemmas need further discussion while drawing on relevant literature.”
In the paper, Murray writes, “the impoverished, marginalized and displaced may exhibit the greatest need for mental health treatment and support given their exposure to numerous risk factors, yet they are the least able and likely to access quality services in low and middle income countries.”
Murray defines three primary moral dilemmas of global mental health research in these less privileged parts of the world: “whether an etic or emic approach should be taken in measurement, whether the results must be used to directly inform an intervention, and how cases of serious mental distress identified in the course of research should be handled.”
“Sarah’s paper takes on an issue that is woefully underaddressed in both the bioethics and public health literatures: ethical issues around global mental health research,” says Nancy Kass, ScD, the Berman Institute’s Deputy Director for Public Health. “The paper was well researched, and she outlined recommendations going forward. Global mental health is a young area of research, and papers like Sarah’s can help advance thinking in this area of work.”
Murray’s paper concludes by setting a high bar for justification of research that is not associated with medical care, including showing ample evidence of a gap in knowledge as well as implementing a consent process that includes a test of the research subject’s understanding. Murray also notes that planning in concert with the local community is essential, both in designing and implementing the research study and planning for any medical care that may be required.