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Mental Health and Psychosocial Support in Crisis and Conflict: Report of the Mental Health Working Group

Published online by Cambridge University Press:  28 June 2012

K. Allden ,
L. Jones ,
I. Weissbecker ,
M. Wessells ,
P. Bolton ,
T.S. Betancourt ,
Z. Hijazi ,
A. Galappatti ,
R. Yamout  and
P. Patel
...Show all authors
K. Allden*
Affiliation:
Department of Psychiatry, Dartmouth Medical School, Hanover, New Hampshire USA
L. Jones
Affiliation:
International Medical Corps and Developmental Psychiatry Section, Cambridge University, UK
I. Weissbecker
Affiliation:
Harvard School of Public Health, Boston, Massachusetts USA
M. Wessells
Affiliation:
Columbia University, New York, New York USA
P. Bolton
Affiliation:
Center for Refugee and Disaster Response, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland USA
T.S. Betancourt
Affiliation:
Harvard School of Public Health, Boston, Massachusetts USA
Z. Hijazi
Affiliation:
International Medical Corps, Middle East Programs
A. Galappatti
Affiliation:
Department of Social Anthropology, University of Edinburgh and the Institute for International Health and Development, Queen Margaret University, Edinburgh, UK
R. Yamout
Affiliation:
Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
P. Patel
Affiliation:
Northeastern University School of Law/Tufts University School of Medicine, Boston, Massachusetts USA
A. Sumathipala
Affiliation:
Institute of Psychiatry Kings College, University of London, London, UK
*
Health Care and Rehabilitation Services49 School StreetHartford, Vermont 05049 USA E-mail: [email protected]
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Abstract

Introduction:

The Working Group on Mental Health and Psychosocial Support was convened as part of the 2009 Harvard Humanitarian Action Summit. The Working Group chose to focus on ethical issues in mental health and psychosocial research and programming in humanitarian settings. The Working Group built on previous work and recommendations, such as the Inter-Agency Standing Committee's Guidelines on Mental Health and Psychosocial Support in Emergency Settings.

Objectives:

The objective of this working group was to address one of the factors contributing to the deficiency of research and the need to develop the evidence base on mental health and psychosocial support interventions during complex emergencies by proposing ethical research guidelines. Outcomes research is vital for effective program development in emergency settings, but to date, no comprehensive ethical guidelines exist for guiding such research efforts.

Methods:

Working Group members conducted literature reviews which included peer-reviewed publications, agency reports, and relevant guidelines on the following topics: general ethical principles in research, cross-cultural issues, research in resource-poor countries, and specific populations such as trauma and torture survivors, refugees, minorities, children and youth, and the mentally ill. Working Group members also shared key points regarding ethical issues encountered in their own research and fieldwork.

Results:

The group adapted a broad definition of the term “research”, which encompasses needs assessments and data gathering, as well as monitoring and evaluation. The guidelines are conceptualized as applying to formal and informal processes of assessment and evaluation in which researchers as well as most service providers engage. The group reached consensus that it would be unethical not to conduct research and evaluate outcomes of mental health and psychosocial interventions in emergency settings, given that there currently is very little good evidence base for such interventions. Overarching themes and issues generated by the group for further study and articulation included: purpose and benefits of research, issues of validity, neutrality, risk, subject selection and participation, confidentiality, consent, and dissemination of results.

Conclusions:

The group outlined several key topics and recommendations that address ethical issues in conducting mental health and psychosocial research in humanitarian settings. The group views this set of recommendations as a living document to be further developed and refined based on input from colleagues representing different regions of the globe with an emphasis on input from colleagues from low-resource countries.

Keywords

conflictcross-culturalemergencyhumanitarianinternally displaced personmental healthpsychosocialrefugeeresearch ethics
Type
Working Group 6
Information
Prehospital and Disaster Medicine , Volume 24 , supplement S2: 2009 Humanitarian Action Summit , August 2009 , pp. s217 - s227
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2009

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References

1.Inter-Agency Standing Committee: IASC Guidelines on Mental Health and Psychosocial Support in Emergency Settings. Geneva, 2007.Google Scholar
2.Goodhand, J: Research in conflict zones: Ethics and accountability. Forced Migration 2000(8):12–15.Google Scholar
3.Rose, S, Bisson, J, Churchill, R, Wessely, S: Psychological debriefing for preventing post traumatic stress disorder (PTSD): Cochrane Database of Systematic Reviews. Issue 2. Art. No.: CD000560. DOI: 10.1002/14651858.CD000560; 2002.CrossRefGoogle Scholar
4.Yamout, R, Jabbour, S: Complexities of conducting research in wartime. Unpublished manuscript to be submitted for publication. 2009.Google Scholar
5.Bolton, P, Betancourt TS: Mental health in postwar Afghanistan. JAMA 2004;292(5):626–628.CrossRefGoogle ScholarPubMed
6.Schenk, K, Williamson, J: Ethical Approaches to Gathering Information from Children and Adolescents in International Settings: Guidelines and Resources. Washington, DC: Population Council; 2005.Google Scholar
7.Reed, H: Research Ethics in Complex Humanitarian Emergencies: Summary of a Workshop. Washington, DC: National Academy of Science; 2002.Google Scholar
8.Galappatti, A: Brief notes on post-emergency MHPSS research ethics in practice: Questions and problems from Sri Lanka. (unpublished manuscript); 2009.Google Scholar
9.Fisher, CB, Hoagwood, K, Boyce, C. et al. : Research ethics for mental health science involving ethnic minority children and youths. Am Psychol 2002;57(12):1024–1040.CrossRefGoogle ScholarPubMed
10.Leaning, J: Ethics of research in refugee populations. Lancet 2001;357:1432–1433.CrossRefGoogle ScholarPubMed
11.Edelstein, L. The Hippocratic Oath: Text, Translation, and Interpretation. Baltimore: Johns Hopkins Press; 1943.Google Scholar
12.United Nations General Assembly: Article 5. Universal Declaration of Human Rights. Geneva, Switzerland 1948.Google Scholar
13.World Medical Association General Assembly: The Helsinki Declaration. Helsinki, Finland 1964.Google Scholar
14.Pincus, H, Lieberman, J, Feris, S: Ethics in Psychiatric Research: A Resource Manual for Human Subjects Protection. Washington, D.C: American Psychiatric Association; 1999.Google Scholar
15.US Department of Health and Human Services: Research involving individuals with questionable capacity to consent: Points to consider. 1999. Available at http://grants.nih.gov/grants/policy/questionablecapacity.htm. Accessed 15 November 2008.Google Scholar
16.Council for International Organizations of Medical Sciences: International Ethical Guidelines for Biomedical Research Involving Human Subjects. Geneva, Switzerland; 2002.Google Scholar
17.Office for the Coordination of Humanitarian Affairs: OCHA Orientation Handbook on Complex Emergencies. OCHA; 1999.Google Scholar
18.Mackenzie, C., McDowell, C., Pittaway, E: Beyond ‘Do No Harm’: The challenge of constructing ethical relationships in refugee research. Journal of Refugee Studies 2007;20(2):299–310.CrossRefGoogle Scholar
19.Thomas, S, Byford, S: Research with unaccompanied children seeking asylum. BMJ 2003;327:1400–1402.CrossRefGoogle ScholarPubMed
20.Boyden, J: Anthropology under Fire: Ethics, Researchers and Children in War. In: Berry, JBJd, (ed): Children and Youth on the Front Line. New York: Berghahn; 2004:237–258.Google Scholar
21.Dyregrov, K, Dyregrov, A, Raundalen, M: Refugee families' experience of research participation. J Trauma Stress 2000;13(3):413–426.CrossRefGoogle ScholarPubMed
22.Ellis, BH, Kia-Keating, M, Yusuf, SA, Lincoln, A, Nur, A: Ethical research in refugee communities and the use of community participatory methods. Transcult Psychiatry 2007;44(3):459–481.CrossRefGoogle ScholarPubMed
23.Bolton, P, Bass, J, Betancourt, T et al. : Interventions for depression symptoms among adolescent survivors of war and displacement in northern Uganda: A randomized controlled trial. JAMA 2007;298(5):519–527.CrossRefGoogle ScholarPubMed
24.Jacobsen, K, Landau, L: The dual imperative in refugee research: Some methodological and ethical considerations in social science research on forced migration. Disasters 2003;27(3):295–316.CrossRefGoogle ScholarPubMed
25.Jones, L: The question of political neutrality when doing psychosocial work with survivors of organised violence. Int Rev Psychiatry 1998;10(3):239–247.CrossRefGoogle Scholar
26.Wessells, M: Do no harm: Challenges in organizing psychosocial support to displaced people in emergency settings. Refuge 2008;25(1):6–14.CrossRefGoogle Scholar
27.Hart, J, Tyrer, B: Research with children living in situations of armed conflict: Concepts, ethics and methods. Refugee Studies Centre Working Paper No. 30. Oxford University: Queen Elizabeth House, 2006.Google Scholar
28.Seedat, S, Pienaar, WP, Williams, D, Stein, DJ: Ethics of research on survivors of trauma. Curr Psychiatry Rep 2004;6(4):262–267.CrossRefGoogle ScholarPubMed
29.Jorm, AF, Kelly, CM, Morgan, AJ: Participant distress in psychiatric research: A systematic review. Psychol Med 2007;37(7):917–926.CrossRefGoogle ScholarPubMed
30.Dyregrov, K: Bereaved parents' experience of research participation. Soc Sci Med 2004;58(2):391–400.CrossRefGoogle ScholarPubMed
31.Straker, G: Ethical Issues in Working with Children in War Zones. In: Apfel, R, Simon, B, (eds): Minefields in their Hearts: The Mental Health of Children in War and Communal Violence. New Haven: Yale University Press; 1996:18–31.Google Scholar
32.Sumathipala, A. Research ethics must still apply in disaster zones. Available at http://www.scidev.net/en/agriculture-and-environment/tropical-cyclones-1/opinions/research-ethics-must-still-apply-in-disaster-zones.html. Accessed 16 April 2009.Google Scholar
33.Gibbs, M: Toward a strategy for undertaking cross-cultural collaborative research. Soc Nat Resour 2001;14(8):673–687.CrossRefGoogle Scholar
34.Jones, L, Rrustemi, A, Shahini, M, Uka, A: Mental health services for war-affected children: report of a survey in Kosovo. Br J Psychiatry 2003;183:540–546.Google ScholarPubMed
35.Zwi, A, Grove, N, MacKenzie, C. et al. : Placing ethics in the centre: Negotiating new spaces for ethical research in conflict situations. Global Public Health 2006;1(3):264–277.CrossRefGoogle ScholarPubMed
36.Fitzgerald, T: Cross-cultural research principles & partnerships: experiences from New Zealand and Australia. Management in Education 2005;19(1):17–20.CrossRefGoogle Scholar
37.Schulz, A, Israel, B, Lantz, P: Instrument for evaluating dimensions of group dynamics within community-based participatory research partnerships. Evaluation and Program Planning 2003;26(3):249–262.CrossRefGoogle Scholar
38.Wolff, T: A Practical Approach to Evaluating Coalitions. In: Backer, T, (ed). Evaluating Community Collaborations. New York: Springer Publishing; 2002.Google Scholar