Psychiatric research has increased remarkably over recent decades to help in understanding the current trends and better therapeutic options for illness. On the other hand, there is also a trend toward higher rates of retraction of published papers in the recent years. Ethics is required to maintain and increase the overall quality and morality of research. Psychiatric research faces several unique ethical challenges. Ethical guidelines are very important tool of research which safeguards participants; however, there is a dearth of such guidelines in India. Ethical Issues in Psychiatric Mental Health

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The present paper aims to review available ethical issues and guidelines pertaining to psychiatric research. A search was conducted on Pubmed using search terms (e.g., “ethics,” “psychiatry,” “research”). Relevant studies were selected for the review after manual screening of title/abstract. Additional sources were referred to using cross references and Google Scholar. Psychiatric research has several important ethical issues which are different from other medical disciplines. These issues are related to informed consent, confidentiality, conflict of interest, therapeutic misconception, placebo related, vulnerability, exploitation, operational challenges, among others. The current paper has made several recommendations to deal with ethical challenges commonly faced in psychiatric research. The ethical guidelines are utmost needed for Indian psychiatric research. Specific guidelines are lacking pertaining to psychiatric research. The issues and recommendations merit a further discussion and consideration.Ethical Issues in Psychiatric Mental Health Practice.

INTRODUCTION

The term “ethics” has been derived from the ancient Greek words “ethos,” which implies to understand right and wrong.[1] It refers moral standards and values that a person carries within himself.[2] Research is defined as “any systematic investigation designed to develop or contribute to generalizable knowledge.”Ethical Issues in Psychiatric Mental Health Practice.

The World Health Organization (WHO) estimates that 10% of world population is suffering from some psychiatric illness and 25% of person experience some psychiatric illness during their lifetime.[3,4] According to a review by Math and Srinivasaraju, at least 20% of population in India is suffering from some psychiatric illness.[5] Five out of ten leading cause of disability are due to mental illness, for example, depression, alcohol abuse, bipolar mood disorder, schizophrenia, and obsessive-compulsive disorder (OCD).[6] The continued suffering and disability due to mental illness calls for newer treatments and continued research into field of psychiatry.Ethical Issues in Psychiatric Mental Health Practice.

Psychiatric disorders itself carry significant stigma, myths, and biases. Causation of psychiatric disorders has varied beliefs as described by cultural psychiatrist as explanatory models of illness that includes moral model, religious model, magical or supernatural model, medical model, and psychosocial stress model.Ethical Issues in Psychiatric Mental Health Practice.

Considering various issues involved in psychiatric disorders and research, ethics plays crucial role in protecting rights of persons with mental illness and simultaneously safeguarding the interest of researchers. Ethical guidelines in research help maintain transparency and accountability during research. Therefore, various ethical guidelines have been put forward by national and international organizations for different groups of researchers.Ethical Issues in Psychiatric Mental Health Practice.

Historically, ethical abuse in human research was noticed in experiments conducted by Nazi doctors on convicts, following which the first international standard for ethical conduct of research was framed, the Nuremberg Code in 1947.[8,9] It was based on ten principles focusing on voluntary consent, right to withdraw from the study, and prohibited studies causing harm to patients. TEthical Issues in Psychiatric Mental Health Practice.he World Medical Association also adopted a set of guidelines known as the Declaration of Helsinki which consisted 32 principles, which focused on informed consent, confidentiality, vulnerable population, and requirement of a research protocol stating scientific rationale of the study which need to be reviewed by the Ethics Committee.[10] Later on, following infamous Syphilis study at Tuskegee in 1972, the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research was founded in 1974.[11] In 1979, the commission drafted the Belmont Report – Ethical Principles and Guidelines for the protection of human subjects of research. Due to increase in research conducted by pharmaceutical companies in underdeveloped and developing countries, “International Ethical Guidelines for Biomedical Research Involving Human Subjects” were developed in 1982 by the Council for International Organizations of Medical Sciences in association with WHO.[12] Strech et al. reported among 123 psychiatry journals mentioning International Committee of Medical Journal Editors (ICMJE) and COPE guidelines, about half of the journals’ editorial policy required ethical review (54%) and informed consent (58%) whereas 14% and 19% demanded the reporting of these issues in the manuscript, respectively.Ethical Issues in Psychiatric Mental Health Practice.

Ethical principles are values are morals that defend the conduct of practice. Medical ethics stresses principles such as professionalism, privacy and confidentiality, respect for human rights, and access to medical care. The unique nature of mental illness presents with stigma and socio-economic disadvantages. Therefore, there is a need for ethical standards in the management of psychiatric patients. Ethical Issues in Psychiatric Mental Health Practice.Psychiatrists should maintain the principles of confidentiality, beneficence, non-maleficence, autonomy, and justice. Privacy and confidentiality come in when the practitioner confines the information shared by the relatives and the workmates unless with permission from the patient (Hsiao, et al, 2019). Privacy and confidentiality prevent stigma. A mentally challenged patient cannot make medical decisions. The role of a psychiatric mental health nurse practitioner (PMHNP) is to promote the best interest of the patient and prevent harm. These are the principles of beneficence and non-maleficence. This helps to promote a good prognosis in mental health. The PMHNP should respect the patient’s interest, individual, and cultural sensitivity. Obtain informed consent from the patient for treatment. The patient has a right to knowledge about their treatment and their illness.Ethical Issues in Psychiatric Mental Health Practice.

Ethical Issue And Dilemma

Often, psychiatric patients especially those suffering from schizophrenia and depressive mood disorder, have poor decision-making skills. This causes poor health outcomes due to poor behavior. A PMHNP decides for the patient including the medication the patient should take and disclose the patient’s mental health status to his immediate family (Hsiao, et al, 2019). By doing this, the nurse is violating the principle of privacy and confidentiality, informed consent, and autonomy. Despite ethical violations for that patient, the nurses ensure the patient gets the best medical attention. In this situation, the nurse takes the best interest of the patient by giving medication to improve the mental status, the monitor for the progress, and drug adverse effects to ensure safety for the patient.Ethical Issues in Psychiatric Mental Health Practice.

States Health Law and Regulations

The government works together with the state to make decisions about their mental health systems. The state sets rules and regulations in protecting, funding, and researching mental health. The state sets rules and regulations for the treatment providers, schools, and companies (Hedman, et al, 2016). It sets a standard for privacy and prohibits disclosing patient’s personal information. It also protects their rights like access to medical attention, protection from harm, fighting abuse, eliminating barriers and discrimination, and promoting civil liberties and inclusion. These rules and regulations have to be followed to the latter.Ethical Issues in Psychiatric Mental Health Practice.

The Ethical Decision-Making Process in This Dilemma

An ethical dilemma is a situation in which a difficult choice has to be made between two courses of action. To make the right decision, the nurse needs to follow a few steps to develop a comprehensive lens of handling ethical disputes. The nurse should identify the ethical issue, consult the resources, and seek assistance. In this situation, he or she should involve the multidisciplinary team to make the decision. The nurse should evaluate the long-lasting effects of the ethical principle, note the ethical rules and regulations in other industries, decide on a make a decision, implement, and evaluate the decision (Heeler, et al, 2016). In this situation, the principles of beneficence, non-maleficence, and right to medical attention out-weights the violated principles of respect for autonomy, informed consent, and confidentiality.Ethical Issues in Psychiatric Mental Health Practice.

ETHICAL ISSUES IN PSYCHIATRIC RESEARCH