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Ethical Challenges of Nonmaleficence in Mental Health Care for Forcibly Displaced Children and Adolescents

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Global Mental Health Ethics

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Abstract

Violent conflict and persecution have led to a record high of forcibly displaced children and adolescents. The disruptive impact of being uprooted from one’s culture and community due to traumatic events and prolonged exposure to conditions of precarity and insecurity can be devastating for children in the short and long term. Determining and meeting displaced children’s mental health needs that are shaped by a complex interaction of individual susceptibility, cultural norms, and structural forces remains a daunting challenge. The heterogeneity of children and adolescents on the move is evident. The term displaced children used for the purpose of this paper is a loosely defined umbrella term acknowledging that children’s motives for migration are complex composites and sometimes irrelevant to persecution (Bhabha, 2014). Forced displacement (due to conflict and trafficking) may intersect with distress migration (due to economic, environmental, or other hardships conditions) and include administrative reasons, such as statelessness. The intricacy of humanitarian settings gives rise to a myriad of ethical challenges. To not aggravate pre-existing complexities, the ethical principle of nonmaleficence—of avoiding unintentional harm—should be at the forefront of every clinician’s mind.

We provide an overview of the changing pattern of conflict and displacement and present challenges in adhering to humanitarian, clinical, and public health ethics frameworks. We discuss examples of nonmaleficence that play a role in delivering humanitarian assistance to displaced children: contextually inappropriate interventions, sidelining of existing evidence on mental health interventions, a narrow focus on symptom checklists, cultural illiteracy, dismissing children’s agency and resilience, and the dual loyalty conflict of clinicians torn between the organization’s mandate and their own humanitarian agenda.

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Notes

  1. 1.

    Clinical case of SJS adapted to protect the patient’s identity

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Authors and Affiliations

  1. Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA

    Edith Stein

  2. Department of Psychiatry and Behavioral Sciences, George Washington University, Washington, DC, USA

    Suzan J. Song

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  1. Edith Stein
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  2. Suzan J. Song
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Correspondence to Suzan J. Song .

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Editors and Affiliations

  1. Department of Psychiatry and Behavioral Sciences, The George Washington University, Washington, DC, USA

    Allen R. Dyer

  2. Division of Global Mental Health, George Washington University, Washington, DC, USA

    Brandon A. Kohrt

  3. Department of Behavioral Health, Saint Elizabeths Hospital, Washington, DC, USA

    Philip J. Candilis

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Stein, E., Song, S.J. (2021). Ethical Challenges of Nonmaleficence in Mental Health Care for Forcibly Displaced Children and Adolescents. In: Dyer, A.R., Kohrt, B.A., Candilis, P.J. (eds) Global Mental Health Ethics. Springer, Cham. https://doi.org/10.1007/978-3-030-66296-7_14

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