Publications

A potential role for psilocybin in the treatment of obsessive-compulsive disorder

July 17, 2020. Posted in

Authors: Eddie Jacobs

The recent revivification of interest in the therapeutic use of psychedelics has had a particular focus on mood disorders and addiction, although there is reason to think these drugs may be effective more widely. After outlining pertinent aspects of psilocybin and obsessive-compulsive disorder (OCD), the current review summarizes the evidence indicating that there may be a role for psilocybin in the treatment of OCD, as well as highlighting a range of potential therapeutic mechanisms that reflect the action of psilocybin on brain function. Although the current evidence is limited, that multiple signals point in directions consistent with treatment potential, alongside the psychological and physiological safety of clinically administered psilocybin, support the expansion of research, both in animal models and in further randomized controlled trials, to properly investigate this potential.

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What do we owe to Novel Synthetic Beings and how can we be sure?

June 10, 2020. Posted in

Authors: Alex McKeown

Embodiment is typically given insufficient weight in debates concerning the moral status of Novel Synthetic Beings (NSBs) such as sentient or sapient Artificial Intelligences (AIs). Discussion usually turns on whether AIs are conscious or self-aware, but this does not exhaust what is morally relevant. Since moral agency encompasses what a being wants to do, the means by which it enacts choices in the world is a feature of such agency. In determining the moral status of NSBs and our obligations to them, therefore, we must consider how their corporeality shapes their options, preferences, values, and is constitutive of their moral universe. Analysing AI embodiment and the coupling between cognition and world, the paper shows why determination of moral status is only sensible in terms of the whole being, rather than mental sophistication alone, and why failure to do this leads to an impoverished account of our obligations to such NSBs.

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The voices of children in the global health debate

June 10, 2020. Posted in

Authors: Gabriela Pavarini

In the face of imminent threats arising from climate change, commercial marketing of harmful products, and pervasive inequities, the new WHO–UNICEF–Lancet Commission makes a compelling ethical and economic case for investing in the world’s children. The Commission advocates for children to be at the centre of the Sustainable Development Goals (SDGs) and for the protection of their health and rights. This agenda is essential and urgent to avoid mistakes that could cost a generation the chance to grow up safely, happily, and with abundant resources.

Crucially, the Commission recognises children and adolescents as active agents with rights to freedom of expression, dignity, and citizenship: decision makers in their own lives and in society at large. Integrating young people into decision making contributes to a more cohesive and egalitarian society, catalysing our ability to create a sustainable and healthy future

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Ethical implications of poor comparative effectiveness evidence: obligations in industry-research partnerships.

March 19, 2020. Posted in

Authors: Ilina Singh

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Developing sustainable capacity-building in mental health research: implementation outcomes of training of trainers in systematic reviewing

February 10, 2020. Posted in

Authors: Rosemary Musesengwa

Less than 1% of biomedical research papers originate in Africa. Locally relevant mental health research, including synthesis of existing evidence, is essential for developing interventions and strengthening health systems, but institutions may lack the capacity to deliver training on systematic reviewing for publication in international journals. This paper describes the development and implementation of a training-of-trainers (ToT) course on systematic reviewing.

The ToT prepared junior faculty (‘trainers’) from universities in Ethiopia, Malawi, and Zimbabwe to lead a five-day systematic reviewing workshop. Using an evaluation framework based on implementation science outcomes, the feasibility of the ToT was assessed by tracking the number of workshops the trainers subsequently conducted and the number of trainers and trainees who participated; acceptability was assessed through post-workshop surveys on trainee perspectives; impact was evaluated through trainee scores on a 15-item multiple choice test on systematic reviewing concepts; and sustainability was assessed based on whether the workshop was integrated into university curricula. Twelve trainers (86% of those trained) facilitated a total of seven workshops in their home countries (total 103 trainees). The first workshop run in each country was evaluated, and there was a significant improvement in mean knowledge scores between pre- and post-tests among trainees (MD= 3.07, t= 5.90, 95% CI 2.02–4.11).

In two of the three countries, there are efforts to integrate the systematic review workshop into university curricula. The cost of the workshop led by the international trainer was $1480 per participant, whereas the trainer-led workshops cost approximately $240 per participant. Overall, ToT is relatively new to research capacity building, although it has been used widely in clinical settings. Our findings suggest ToT is a promising, low-cost way to develop both technical skills of individuals and the pedagogical capacity of universities, and to promote sustainability of research capacity building programs that often have time-limited grant funding.

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Investigating assumptions of vulnerability: A case study of the exclusion of psychiatric inpatients as participants in genetic research in low- and middle-income contexts.

January 14, 2020. Posted in

Authors: Ilina Singh

Psychiatric genetic research investigates the genetic basis of psychiatric disorders with the aim of more effectively understanding, treating, or, ultimately, preventing such disorders. Given the challenges of recruiting research participants into such studies, the potential for long‐term benefits of such research, and seemingly minimal risk, a strong claim could be made that all non‐acute psychiatric inpatients, including forensic and involuntary patients, should be included in such research, provided they have capacity to consent. There are tensions, however, regarding the ethics of recruiting psychiatric inpatients into such studies. In this paper our intention is to elucidate the source of these tensions from the perspective of research ethics committee interests and decision‐making. We begin by defining inpatient status and outline some of the assumptions surrounding the structures of inpatient care. We then introduce contemporary conceptions of vulnerability, including Florencia Luna’s account of vulnerability which we use as a framework for our analysis. While psychiatric inpatients could be subject to consent‐related vulnerabilities, we suggest that a particular kind of exploitation‐related vulnerability comes to the fore in the context of our case study. Moreover, a subset of these ethical concerns takes on particular weight in the context of genetic research in low‐ and middle‐income countries. At the same time, the automatic exclusion of inpatients from research elicits justice‐related vulnerabilities.

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Measuring the impact of participatory research in psychiatry: How the search for epistemic justifications obscures ethical considerations.

December 18, 2019. Posted in

Authors: Sapfo Lignou, Ilina Singh

CONTEXT: Both within politics and practice, the field of psychiatry is undergoing a significant transformation, as increasing emphasis is placed on the importance of involving those with lived experience in research. In response to this participatory turn, a push towards measuring the impact of patient involvement is also growing, seeking to identify how participation can improve research.

OBJECTIVE: This paper examines the recent push towards measuring impact in relation to justifications underlying the democratization of research in psychiatry, revealing a disconnect between the two, and harms that could result from a singular focus on measuring impact.

DISCUSSION: While those promoting and regulating participatory research tend to focus on the epistemic benefits of such research, many have pointed to both epistemic and ethical justifications underlying participatory research. The ethical reasons for involving service users loom especially large in psychiatry, given its unique history of abuse, the ways diagnoses can be utilized as tools for oppression, and the prevalence of coercion. The current focus on measuring the impact of involvement can be harmful, in that it obscures ethical reasons in favour of epistemic ones, potentially exacerbating issues common to participatory research, such as role confusion and ineffective, tokenistic participatory efforts.

CONCLUSIONS: We argue that to take the ethical reasons behind involvement in mental health research seriously will involve looking beyond impact and towards sharing power. We suggest three ways this can be done: measuring more than impact, building service user capacities and sharing power in realms outside of research.

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Why research ethics should add retrospective review

October 10, 2019. Posted in

Authors: Sapfo Lignou

Research ethics is an integral part of research, especially that involving human subjects. However, concerns have been expressed that research ethics has come to be seen as a procedural concern focused on a few well-established ethical issues that researchers need to address to obtain ethical approval to begin their research. While such prospective review of research is important, we argue that it is not sufficient to address all aspects of research ethics. We propose retrospective review as an important complement to prospective review. We offer two arguments to support our claim that prospective review is insufficient.

First, as currently practiced, research ethics has become for some a ‘tick box’ exercise to get over the ‘hurdle’ of ethics approval. This fails to capture much of what is important in ethics and does not promote careful reflection on the ethical issues involved. Second, the current approach tends to be rules-based and we argue that research ethics should go beyond this to develop people’s capacity to be sensitive to the relevant moral features of their research, their ethical decision-making skills and their integrity. Retrospective review of a project’s ethical issues, and how they were addressed, could help to achieve those aims better. We believe that a broad range of stakeholders should be involved in such retrospective review, including representatives of ethics committees, participating communities and those involved in the research.

All stakeholders could then learn from others’ perspectives and experiences. An open and transparent assessment of research could help to promote trust and understanding between stakeholders, as well as identifying areas of agreement and disagreement and how these can be built upon or addressed. Retrospective review also has the potential to promote critical reflection on ethics and help to develop ethical sensitivity and integrity within the research team. Demonstrating this would take empirical evidence and we suggest that any such initiatives should be accompanied by research into their effectiveness. Our article concludes with a discussion of some possible objections to our proposal, and an invitation to further debate and discussion.

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Co-Production: An Ethical Model for Mental Health Research?

July 10, 2019. Posted in

Authors: Sapfo Lignou, Ilina Singh

In this commentary we argue for the value of involving people with a diagnosis of mental health disorders and/or their caregivers as co-researchers in mental health research. We claim that co-production shares key ethical values with the citizen science approach, such as the acknowledgment of the right of citizens to manage their own care and the value of “expertise by experience.”

These values are especially important in a mental health context and should not be overlooked. Moreover, we argue that research collaborations involving people with a diagnosis of mental health disorders and/or their caregivers avoid certain important ethical challenges posed by some citizen science models, such as the need to develop a different model of ethical oversight

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Is coercion ever beneficent? Public health ethics in early intervention and prevention for mental health

July 10, 2019. Posted in

Authors: Alex McKeown, Arianna Manzini, Ilina Singh

Early intervention in mental health seeks to improve the wellbeing of as many people as possible, by intervening at an early stage in the onset of illness, or by taking preventative action in ‘at risk’ populations. The paradigm is rhetorically powerful, and it is easy to talk in terms of it helping to deliver rights to health and realise social justice.

However, in spite – or perhaps because – of the apparently unarguable desirability of such goals, it is harder to discuss rights to dissent. In this respect the risk of coercion is an issue that should be discussed, especially because of the stigmatizing effect that the labelling associated with early intervention may have in mental health contexts. Here we explore this issue, with a particular focus on its practical and ethical implications in relation to UK policy for treating Attention Deficit Hyperactivity Disorder and mild Conduct Disorder in young people.

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