Ethical issues when planning mental health services after the COVID-19 outbreak

Recently, a paper written by Ransing et al. (2020) adressed a conceptual framework aiming to guide the development, implementation and evaluation of mental health interventions during the COVID-19 outbreak. The proposed model includes the following main topics coordination and preparation, monitoring and assessment, reduction of the mental distress due to misinformation and “myths”, sustainability of mental health services and communication. In addition to this, ethical considerations should be incorporated when planning novel mental health programs during and after the COVID-19 pandemic.

It is widely known that COVID-19 pandemic has changed people’s lives. As a consequence, a new social dynamic has been established where people need to engage in healthy preventive behaviors by adopting social distance measures. In this respect, uncertainty on the duration of confinement actions, the unavailability of treatments/vaccines for COVID-19 and the increase of the number of people infected might increase worry, fear, confusion and anxiety, making adaptation process difficult to these new circumstances during the public global emergency.

In this context, the increase of mental health problems among socially distanced and self-isolated people is one of the major concerns encompassed by mental health professionals. Ransing et al. (2020) have described that mental health problems are common during a pandemic, but they need to be well identified by proper epidemiological studies. As a consequence, people have opted the use of digital technologies like telemedicine or hotlines to cope with mental health issues during and after the confinement actions taken by governments to stop the spread of the virus. Eventually, mental health interventions should include a comprehensive response from mental health professionals to preserve humanity, maintain sanity and promote health (Tandon, 2020a).

With that being said, these alternative approaches that represent a non-traditional way of mental health services delivery, might facilitate access to health services but at the same time, they rise new ethical challenges. For instance, protection of personal data is a major concern of mental health users that might lead people to feel unsteady when talking about intimate issues through digital tools. On the other hand, informed consent provided over digital platforms could make health professionals to feel doubtful about its validity if there is lack of agreed ethical norms (Wykes et al., 2019). This context challenges bioethicists, ethicists, psychiatrists, psychologists, jurists and other health professionals to examine and redefine norms and codes of conduct when psychotherapy and other types of mental health services are delivered through Internet based programs during the context of the pandemic.

For instance, The American Psychological Association’s (APA) Ethical Principles of Psychologists and Code of Conduct (American Psychological Association, 2017) is a wide known ethical guideline followed and implemented by many mental health professionals all over the world. Nevertheless, this code lack of details regarding ethics issues, like identity confirmation, when psychotherapy is delivered through digital platforms. According to this, the development of new ethical codes and amendments to The Ethical Principles of Psychologists and Code of Conduct are needed.

Ethical principles like justice, integrity, beneficence, nonmaleficence and autonomy must be incorporated in a new ethical framework to regulate the use of digital technologies related to health services. Culture practices are been transformed after the COVID-19 and new ethical controversies on mental health digital services are yet to be identified (Bauer et al., 2017).

To accomplish this challenge, professionals need to discuss, and review topics related to informed consent, data protection, patient privacy, identity confirmation or digital medical prescription in order to incorporate these subjects when developing contemporary mental health programs. As a psychologist, I think there is an opportunity to adapt to a new social digital complexity related to the COVID-19 pandemic by developing new codes of conduct aimed at psychologist, psychiatrist and other mental health professionals.

Things are changing. APA’s Ethical Principles of Psychologists and Code of Conduct and other ethical codes for psychologists and psychiatrists need to habituate to this current humanity’s challenge. We are facing a paradigm shift in psychological and psychiatric services provided through digital platforms that need a comprehensive and contemporary ethical analysis during and after the COVID-19 pandemic. In this regard, emerging works discussing the ethical implications of digital interventions will contribute to confront this challenge (Tandon, 2020b).

Funding

The Consejo Nacional de Ciencia y Tecnología (CONACyT) through a doctoral scolarship (CVU: 715915).