Evidence-Based Ethics and Mental Health Research with Prisoners

关于人类受试者保护的伦理和联邦法律已经演变成保护研究参与者 特别是一般和弱势群体。根据联邦法律，弱势群体包括孕妇； 胎儿、新生儿和儿童；以及囚犯。根据伦理学家的说法，弱势群体还包括 因精神疾病、耻辱的医疗疾病和其他使人衰弱的疾病而遭受损害的个人 精神错乱。根据这些定义，患有精神疾病的囚犯更容易受到伤害。使用的数量 患有严重精神障碍的囚犯超过精神病院、监狱和 监狱已经成为“美国新的精神病院”(Torrey，1995)，对许多精神病患者来说 由于患病，现在监狱和监狱中提供住院精神病护理(Lamb&Weinberger，2005)。研究 对待囚犯，特别是那些精神疾病易感性增加的人，构成了道德挑战和 责任，但还没有关于道德的解释和应用的实证研究 参与精神健康研究的研究人员和IRBs的原则和监管保障 囚犯。本建议的重点是1)研究人员和IRB成员如何解释和应用伦理 囚犯心理健康研究中的自主、公正和仁慈原则；2)研究人员如何 以及IRB成员对囚犯心理健康研究的监管保障措施的解释和应用；3)方式 惩教系统(包括监狱和监狱)的政策和结构环境创造道德 必须由精神健康研究人员和IRBs解决的挑战；以及4)在伦理上 保障措施和监督影响对囚犯的心理健康研究。该项目将使用顺序 定性和定量阶段，以检查有关以下方面的道德挑战、责任和解决方案 开展和监督囚犯心理健康研究。第一阶段包括与关键线人面谈 曾与囚犯一起进行心理健康研究的个人；IRB主席和成员；IRB囚犯 代表、监狱管理人员和研究伦理学家。使用这些数据，阶段2侧重于 构建关于道德挑战和解决方案的量化调查。在第三阶段，这项调查是 对全国心理健康研究人员、IRB主席和成员以及IRB囚犯进行抽样调查 各位代表。在第四阶段，之前阶段的调查结果将被带给监狱管理人员、安全官员、 和医疗官员以及监狱倡导团体成员，收集他们对意义和监狱倡导团体成员的看法 这些发现的含义。阶段5侧重于通过传播以下信息来启动数据驱动的对话 向重要的利益相关者群体提供研究成果，包括研究人员、IRB主席、成员和监狱 代表；以及监狱管理人员、医务人员和安保人员，以加强 道德和监管保障措施在囚犯心理健康研究中的应用，目的是 减少流行病学障碍和干预研究的重点是囚犯中的精神疾病。

Ethics and federal laws about human subject protections have evolved to protect research participants in general and vulnerable groups in particular. Under federal law, vulnerable groups include pregnant women; fetuses, neonates, and children; and prisoners. According to ethicists, vulnerable groups also include individuals who suffer from impairment due to mental illness, stigmatized medical illness, and other debilitating disorders. Given these definitions, prisoners with mental illnesses are multiply vulnerable. With the number of prisoners with serious psychiatric disorders exceeding the number of patients in psychiatric hospitals, jails and prisons have become "America's new mental hospitals" (Torrey, 1995) and for many individuals with mental illness, inpatient psychiatric care is now provided in jails and prisons (Lamb & Weinberger, 2005). Research with prisoners, especially those with the added vulnerability of mental illness, poses ethical challenges and responsibilities, yet there have been no empirical studies of the interpretation and application of ethical principles and regulatory safeguards by researchers and IRBs involved in mental health research with prisoners. This proposal focuses on 1) how researchers and IRB members interpret and apply ethical principles of autonomy, justice, and beneficence in mental health research with prisoners; 2) how researchers and IRB members interpret and apply regulatory safeguards for mental health research with prisoners; 3) ways in which policies and structural environments of correctional systems (including prisons and jails) create ethical challenges that must be addressed by mental health researchers and IRBs; and 4) ways in which ethical safeguards and oversight affect mental health research with prisoners. This project will use sequential qualitative and quantitative phases to examine ethical challenges, responsibilities, and solutions regarding the conduct and oversight of mental health research with prisoners. Phase 1 involves key informant interviews with individuals who have conducted mental health research with prisoners; IRB Chairs and members; IRB prisoner representatives; prison administrators; and research ethicists. Using these data, Phase 2 focuses on construction of a quantitative survey about ethical challenges and solutions. In Phase 3, this survey is administered to a national sample of mental health researchers, IRB chairs and members, and IRB prisoner representatives. In Phase 4, findings from prior phases are taken to prison administrators, security officials, and medical officials, and prison advocacy group members, to gather their perspectives on the meaning and implications of these findings. Phase 5 focuses on initiating a data-driven dialogue through dissemination of research findings to important stakeholder groups, including researchers; IRB chairs, members, and prison representatives; and prison administrators, medical staff, and security personnel to result in enhanced application of ethics and regulatory safeguards to mental health research with prisoners, with the goal of reducing barriers to epidemiologic and intervention research focused on mental illness among prisoners.