Guidelines for the ethical review of mental health research protocols from a culturally-sensitive perspective

In most of Africa, mental illness is considered a silent epidemic due to structural and systemic barriers such as inadequate health care infrastructure, insufficient number of mental health specialists, stigma and discrimination related to mental illness, and lack of access to all levels of care. The continued suffering and disability due to mental illness calls for newer treatments and continued research into the field of mental health treatment and therapy. Research ethics committees are cognizant of the importance of this aspect yet, the road to this innovative future is fraught with ethical dilemmas as well as ethical, legal, and social implications. There is an urgent need to have guidelines that give guidance to research ethics involving mental health participants. Guidelines were developed for the ethical review of mental health research protocols with the aim of increasing health equity and access in Africa and other low-income countries. We systematically analyzed 13 programme, research, and policy evaluation tools in light of mental health and cultural attributes. A 54-item assessment tool was created to guide the process of mental health research protocol evaluation taking into account ethical, gender, and sociocultural factors in Africa. The emerging themes i.e. research governance, background and justification, methodology and ethical impact of the research forming the basis of the assessment tool are interlinked with the bioethical principles of respect for autonomy, beneficence, non-maleficence and justice. When they are applied to the evaluation of a study they will not only underscore these principles, they enhance their application and increase access to equitable health in Africa and other low-resource settings regardless of the varied contexts.