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Clinical Social Work Journal

, Volume 40, Issue 4, pp 438–449 | Cite as

Ethical Standards for Transnational Mental Health and Psychosocial Support (MHPSS): Do No Harm, Preventing Cross-Cultural Errors and Inviting Pushback

  • Siddharth Ashvin ShahEmail author
Original Paper

Abstract

Important components of bioethics are routinely underappreciated in cross-cultural and transnational mental health and psychosocial support (MHPSS) efforts. This article provides case examples of cultural errors and/or harm by outsiders delivering MHPSS on different continents. The errors illustrate violations of informed consent (principle of autonomy) and avoiding harm (nonmaleficence). Ethical cultural adaptation standards are presented in order to avert such errors. Given the real risk of outsiders applying culturally erroneous and/or harmful practices in the process of delivering aid, the ability to discern pushback (resistance and redirection by intended beneficiaries) can yield ethically significant data. Actively inviting pushback is proposed as an additional methodology for ethical cultural adaptation with the purpose of at least gaining informed consent and, at best, shaping the most beneficent MHPSS.

Keywords

Global health Complex emergencies Disaster mental health Cultural competence Cross-cultural trauma Cultural adaptation Bioethics Medical errors International social work Transcultural psychology Humanitarian aid First responders 

Notes

Acknowledgments

The best practices of cultural adaptation and recommendations for further research in this paper are predicated on work done by the author while commissioned by Psychology Beyond Borders to establish organizational guidelines for cultural adaptation.

References

  1. American Psychological Association (2002). Ethical principles of psychologists and code of conduct. American Psychologist, 57, 1060–1073. Also available from http://www.apa.org/ethics/code2002.html.
  2. Baron, N., Jensen, S. B., & de Jong, J. T. V. M. (2003). Refugees and internally displaced people. In B. Green, M. Friedman, J. de Jong, S. Solomon, T. Keane, J. Fairbank, et al. (Eds.), Trauma interventions in war and peace: Prevention, practice, and policy (pp. 243–270). New York: Kluwer Academic/Plenum.CrossRefGoogle Scholar
  3. Beauchamp, T. L., & Childress, J. F. (2001). Principles of biomedical ethics. Oxford University Press.Google Scholar
  4. Betancourt, T. (2005). Stressors, supports and the social ecology of displacement: Psychosocial dimensions of an emergency education program for Chechen adolescents displaced in Ingushetia, Russia. Culture, Medicine and Psychiatry, 29(3), 309–340.PubMedCrossRefGoogle Scholar
  5. Billow, R. M. (2010). Modes of therapeutic engagement part I: diplomacy and integrity. International Journal of Group Psychotherapy, 60(1), 1–28.PubMedCrossRefGoogle Scholar
  6. Bolton, P., & Tang, A. M. (2004). Using ethnographic methods in the selection of post-disaster mental health interventions. Prehospital and Disaster Medicine, 19, 97–101.PubMedGoogle Scholar
  7. Brenner, G. H. (2009). Fundamentals of collaboration. In G. H. Brenner, D. H. Bush, & J. Moses (Eds.), Creating spiritual and psychological resilience: Integrating care in disaster relief work (pp. 3–18). New York: Routledge.Google Scholar
  8. de Jong, J. T. V. M. (2007). Nongovernmental organizations and the role of the mental health professional. In R. J. Ursano, C. S. Fullerton, L. Weisaeth, & B. Raphael (Eds.), Textbook of disaster psychiatry (pp. 206–224). Cambridge, UK: Cambridge University Press.CrossRefGoogle Scholar
  9. de Jong, J. T. V. M., & van Ommeren, M. (2002). Toward a culture-informed epidemiology: Combining qualitative and quantitative research in transcultural contexts. Transcultural Psychiatry, 39, 422–433.CrossRefGoogle Scholar
  10. Debiak, D. (2007). Attending to diversity in group psychotherapy: An ethical imperative. International Journal of Group Psychotherapy, 57(1), 1–12.PubMedCrossRefGoogle Scholar
  11. Eisenman, D., Weine, S., Green, B., de Jong, J., Rayburn, N., Ventevogel, P., et al. (2006). The ISTSS/rand guidelines on mental health training of primary healthcare providers for trauma-exposed populations in conflict-affected countries. Journal of Traumatic Stress, 19, 5–17.PubMedCrossRefGoogle Scholar
  12. Engelhardt, H. T., Jr. (1986). The foundations of bioethics. New York: Oxford University Press.Google Scholar
  13. Fallon, A. (2006). Informed consent in the practice of group psychotherapy. International Journal of Group Psychotherapy, 56, 431–454.PubMedCrossRefGoogle Scholar
  14. Gans, J. S. (1989). Hostility in group psychotherapy. International Journal of Group Psychotherapy, 39, 499–516.PubMedGoogle Scholar
  15. Green, Z., & Stiers, M. J. (2002). Multiculturalism and group therapy in the United States: A social constructionist perspective. Group, 26(3), 233–246.CrossRefGoogle Scholar
  16. Hinton, D. E. (2006). Special Issue culturally sensitive CBT: Introduction. Cognitive and Behavioral Practice, 13, 246–248.CrossRefGoogle Scholar
  17. Hinton, D. E., Chhean, D., Pich, V., Safren, S. A., Hofmann, S. G., & Pollack, M. H. (2005). A randomized controlled trial of CBT for Cambodian refugees with treatment-resistant PTSD and panic attacks: A cross-over design. Journal of Traumatic Stress, 18, 617–629.PubMedCrossRefGoogle Scholar
  18. Honwana, A. M. (1997). Healing for peace: Traditional healers and post-war reconstruction in Southern Mozambique. Peace and Conflict: Journal of Peace Psychology, 3, 293–306.CrossRefGoogle Scholar
  19. Inter-Agency Standing Committee (IASC) (2007). IASC guidelines on mental health and psychosocial support in emergency settings. Geneva: IASC. Also available from http://www.who.int/mental_health/emergencies/guidelines_iasc_mental_health_psychosocial_june_2007.pdf.
  20. Kayser, K., Wind, L., & Shankar, R. A. (2008). Disaster relief with in a collectivistic context. Journal of Social Service Research, 34, 87–98.CrossRefGoogle Scholar
  21. Kleinman, A. (1995). Writing at the margin: Discourse between anthropology and medicine. Berkeley, CA: University of California.Google Scholar
  22. Marsella, A. J., Johnson, J. L., Watson, P., & Gryczynski, J. (2008). Essential concepts and foundations. In A. J. Marsella, J. L. Johnson, P. Watson, & J. Gryczynski (Eds.), Ethnocultural perspectives on disaster and trauma (pp. 3–13). New York, NY: Springer Science.CrossRefGoogle Scholar
  23. Midgley, J. (1990). International social work: Learning from the third world. Social Work, 35, 295–301.Google Scholar
  24. Norris, F. H., & Alegría, M. (2006). Promoting disaster recovery in ethnic-minority individuals and communities. In E. C. Richie, P. J. Watson, & M. J. Friedman (Eds.), Interventions following mass violence and disasters: Strategies for mental health practice (pp. 319–342). New York: Guilford Press.Google Scholar
  25. Omar, M. (2009, July). Diversity in the Muslim worldHow NGOs can work more effectively with communities. Paper presented at the Interaction Forum 2009. Washington, DC.Google Scholar
  26. Ormont, L. R. (1994). Developing emotional insulation. International Journal of Group Psychotherapy, 44(3), 361–375.PubMedGoogle Scholar
  27. Patterson, G. T. (2009). An Examination of evidenced-based practice interventions for public emergencies. Journal of Evidence-Based Social Work, 6, 274–287.PubMedCrossRefGoogle Scholar
  28. Pedersen, D., Tremblay, J., Errazuriz, C., & Gamarra, J. (2008). The sequelae of political violence: Assessing trauma, suffering and dislocation in the Peruvian highlands. Social Science and Medicine, 67, 205–217.PubMedCrossRefGoogle Scholar
  29. Puig, M. E., & Glynn, J. B. (2004). Disaster responders: A cross-cultural approach to recovery and relief work. Journal of Social Service Research, 30, 55–66.CrossRefGoogle Scholar
  30. Sen, A. (1999). Development as freedom. New York: Knopf.Google Scholar
  31. Shah, S.A. (2006). Resistance to cross-cultural psychosocial efforts in disaster and trauma: Recommendations for ethnomedical competence. The Australasian Journal of Disaster and Trauma Studies. Retrieved June 30, 2010, from http://www.massey.ac.nz/~trauma/issues/2006-2/shah.htm.
  32. Shah, S. A. (2007). Ethnomedical best practices for international psychosocial efforts in disaster and trauma. In C. S. Tang & J. P. Wilson (Eds.), Cross-cultural assessment of psychological trauma and PTSD (pp. 51–64). New York: Springer Verlag.CrossRefGoogle Scholar
  33. Shah, S. A. (2009a). “To do no harm”, spiritual care and ethnomedical competence: Four cases of psychosocial trauma recovery for the 2004 tsunami and 2005 earthquake in South Asia. In G. H. Brenner, D. H. Bush, & J. Moses (Eds.), Creating spiritual and psychological resilience: Integrating care in disaster relief work (pp. 157–178). New York: Routledge.Google Scholar
  34. Shah, S.A. (2009, July). Diversity in the Muslim worldHow NGOs can work more effectively with communities. Paper presented at the Interaction Forum 2009. Washington, DC.Google Scholar
  35. Shah, S. A. (2010). Mental health emergencies and post-traumatic stress disorder. In G. B. Kapur & J. P. Smith (Eds.), Emergency public health: Preparedness and response (pp. 493–516). Boston: Jones and Bartlett Publishers.Google Scholar
  36. Shah, S.A., Seyle, C., Skiadas, T., & Naturale, A. (2009, September). Do no further harm: Guidelines for psychosocial work across cultures (Psychology Beyond Borders Working Paper). Available upon request from http://psychologybeyondborders.org.
  37. Shapiro, E. L., & Gans, J. S. (2008). The courage of the group therapist. International Journal of Group Psychotherapy, 58(3), 345–361.PubMedCrossRefGoogle Scholar
  38. Spivak, G. C. (1989). Who Claims Alterity? In B. Kruger & P. Mariani (Eds.), Remaking history: DIA Art foundation discussions in contemporary culture no. 4 (pp. 269–292). Seattle: Bay Press.Google Scholar
  39. Summerfield, D. (2008). How scientifically valid is the knowledge base of global mental health? British Medical Journal, 336, 992–994.PubMedCrossRefGoogle Scholar
  40. van Ommeren, M., & Wessells, M. (2007). Inter-agency agreement on mental health and psychosocial support in emergency settings. Bulletin of the World Health Organization, 85(11), 822–823.PubMedGoogle Scholar
  41. Watters, E. (2010). Crazy like us: The globalization of the American psyche. New York: Free Press.Google Scholar
  42. Weber, R. L., & Gans, J. S. (2003). The group therapist’s shame: A much undiscussed topic. International Journal of Group Psychotherapy, 53(4), 395–416.PubMedCrossRefGoogle Scholar
  43. Wehbi, S. (2009). Deconstructing motivations: Challenging international social work placements. International Social Work, 52, 48–59.CrossRefGoogle Scholar
  44. Wessells, M. G. (1999). Culture, power, and community: Intercultural approaches to psychosocial assistance and healing. In K. Nader, N. Dubrow, & B. Stamm (Eds.), Honoring differences: Cultural issues in the treatment of trauma and loss (pp. 267–282). New York: Taylor & Francis.Google Scholar
  45. Wessells, M. (2009). Do No Harm: Toward contextually appropriate psychosocial support in international emergencies. American Psychologist, 64(8), 842–854.PubMedCrossRefGoogle Scholar
  46. Wessells, M. G., & Monteiro, C. (2004). Healing the wounds following protracted conflict in Angola: A community-based approach to assisting war-affected children. In U. P. Gielen, J. Fish, & J. G. Draguns (Eds.), Handbook of culture, therapy, and healing (pp. 321–341). Mahwah, NJ: Erlbaum.Google Scholar
  47. Wilson, J. P. (2008). Culture, trauma, and the treatment of post-traumatic syndromes: A global perspective. In A. J. Marsella, J. L. Johnson, P. Watson, & J. Gryczynski (Eds.), Ethnocultural perspectives on disaster and trauma (pp. 351–375). New York, NY: Springer Science.CrossRefGoogle Scholar
  48. Xu, Q. (2006). Defining international social work: A social service agency perspective. International Social Work, 49, 679–692.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  1. 1.Greenleaf Integrative Strategies, LLC

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