Addressing everyday ethical tensions in global mental health task-sharing

Global Mental Health task-sharing (GMH-TS) involves redistributing tasks from mental health specialists to community-based health workers, or to lay “helpers”. It is heralded globally as a flagship innovation that increases access to effective and contextually appropriate mental healthcare. In everyday practice GMH-TS generates ethical tensions embedded in the epistemic, relational, and moral demands of delivering mental healthcare in local communities. These ethical tensions both motivate the unique strengths of GMH-TS, whilst raising potential distress and harms for those engaging with this form of care. Currently, GMH-TS lacks robust empirical and conceptual understandings, and practice-based approaches, to recognise and respond to such ethical tensions. I will address this through empirical bioethics research co-developed with collaborators in Pakistan and Ethiopia. Ethnographic and qualitative research will explore the ethical tensions arising in three diverse GMH-TS case studies: (1) individual manualised psychosocial support intervention, (2) expert-by-experience peer-support groups, and (3) religious and traditional healer collaborative care with specialists. Research will examine the ethical values GMH-TS embodies and invokes, the ‘goods’ it offers, and the suffering it provokes. This study will transform our understanding and practice of GMH-TS by generating significant theoretical advances, and developing practice-based resources for responding to the ethical tensions GMH-TS creates.