Ethics in global mental health research: enhancing theory, policy, and practice.

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Following emergencies such as conflict or earthquakes, the number of people experiencing poor mental health including stress, depression, anxiety, and trauma reactions increases. However, in global settings mental health services are often limited or inaccessible to people experiencing such difficulties. To develop appropriate and accessible services, reliable research evidence is critical for guiding policy makers to invest limited resources in effective and culturally appropriate mental health services.Research ethics promotes research conduct that prioritises protecting participants from harm, and generating reliable evidence. However, my research has shown that procedural systems of ethical oversight, and researcher in-practice implementation of ethical principles, do not always result in the intended ethical research conduct. This may lead to poor quality research meaning people experiencing mental health difficulties are denied evidence-based services to support their recovery. Therefore, the aim of this fellowship is to improve approaches to the ethical conduct of global mental health research.In my PhD I spoke to researchers conducting mental health research in post-conflict settings in South Asia. This revealed a disconnection between what ethical research procedures aim to achieve, and how researchers actually apply ethical principles to global mental health research. This presents a significant problem that requires addressing, as when research is not conducted ethically the risks increase. Examples of risks identified in my PhD include: researchers witholding participant compensation promised for time or travel expenses; and falsifying data. Beyond these examples of unethical conduct, researchers described challenges when applying ethical principles, such as not being confident that participants made autonomous decisions about research participation when respected religious leaders or medical professionals recommended participation.Beyond these in-practice ethical issues, researchers described the procedural system of research ethics review as stifling ethical research. One reason this arose was because during the procedural ethical review process researchers simplified the ethical issues potentially raised by their research to speed up and secure approval, thereby ignoring the ethical challenges that could arise in practice. This suggests that the very procedures designed to promote ethical research may be having the opposite impact, leading researchers to plan research based on an ideal rather than real-world research setting.As these examples show, there is a need to examine the impact of the procedural ethics system on ethical research practice; and the support for researchers carrying out global mental health research. I will address these knowledge gaps by developing a conceptual framework to aid our understanding of the disconnect between ethical research procedures and researchers' in-practice implementation of ethics. I will also host a symposium to develop evidence briefings containing recommendations based on my research and the experiences of my research partners. These evidence briefings will be communicated to stakeholders with a role in supporting ethical research - such as policy makers, ethical review boards, research funders, and researchers themselves - to inform future research ethics policy, procedures, and practice.By the end of this fellowship I aim to have raised the awareness of stakeholders to the disconnect between ethical research procedures and the ethical experiences of researchers carrying out global mental health research. This sensitisation will provide opportunities for further understanding and promoting vital ethical global mental health research to underpin evidence-based mental health services that will support populations in their recovery.