Ethical challenges in contemporary psychiatry: an overview and an appraisal of possible strategies and research needs.
Ethics of psychiatry
coercive practices
conflicts of interests
digital psychiatry
early intervention
end‐of‐life decisions
experts by experience
family supporters
human rights
mental health legislation
shared decision‐making
Journal
World psychiatry : official journal of the World Psychiatric Association (WPA)
ISSN: 1723-8617
Titre abrégé: World Psychiatry
Pays: Italy
ID NLM: 101189643
Informations de publication
Date de publication:
Oct 2024
Oct 2024
Historique:
medline:
16
9
2024
pubmed:
16
9
2024
entrez:
16
9
2024
Statut:
ppublish
Résumé
Psychiatry shares most ethical issues with other branches of medicine, but also faces special challenges. The Code of Ethics of the World Psychiatric Association offers guidance, but many mental health care professionals are unaware of it and the principles it supports. Furthermore, following codes of ethics is not always sufficient to address ethical dilemmas arising from possible clashes among their principles, and from continuing changes in knowledge, culture, attitudes, and socio-economic context. In this paper, we identify topics that pose difficult ethical challenges in contemporary psychiatry; that may have a significant impact on clinical practice, education and research activities; and that may require revision of the profession's codes of ethics. These include: the relationships between human rights and mental health care, research and training; human rights and mental health legislation; digital psychiatry; early intervention in psychiatry; end-of-life decisions by people with mental health conditions; conflicts of interests in clinical practice, training and research; and the role of people with lived experience and family/informal supporters in shaping the agenda of mental health care, policy, research and training. For each topic, we highlight the ethical concerns, suggest strategies to address them, call attention to the risks that these strategies entail, and highlight the gaps to be narrowed by further research. We conclude that, in order to effectively address current ethical challenges in psychiatry, we need to rethink policies, services, training, attitudes, research methods and codes of ethics, with the concurrent input of a range of stakeholders, open minded discussions, new models of care, and an adequate organizational capacity to roll-out the implementation across routine clinical care contexts, training and research.
Types de publication
Journal Article
Langues
eng
Pagination
364-386Informations de copyright
© 2024 World Psychiatric Association.
Références
Lopez‐Munoz F, Alamo C, Dudley M et al. Psychiatry and political‐institutional abuse from the historical perspective: the ethical lessons of the Nuremberg Trial on their 60th anniversary. Prog Neuropsychopharmacol Biol Psychiatry 2007;31:791‐806.
Buoli M, Giannuli AS. The political use of psychiatry: a comparison between totalitarian regimes. Int J Soc Psychiatry 2017;63:169‐74.
van Voren R. Political abuse of psychiatry – an historical overview. Schizophr Bull 2010;36:33‐5.
World Psychiatric Association. Code of Ethics for Psychiatry. www.wpanet.org/policies.
World Psychiatric Association. Declaration of Hawaii. J Med Ethics 1978;4:71‐3.
Drew N, Funk M, Tang S et al. Human rights violations of people with mental and psychosocial disabilities: an unresolved global crisis. Lancet 2011;378:1664‐75.
Drolet MJ, Rose‐Derouin E, Leblanc JC et al. Ethical issues in research: perceptions of researchers, research ethics board members and research ethics experts. J Acad Ethics 2023;21:269‐92.
Wisgalla A, Hasford J. Four reasons why too many informed consents to clinical research are invalid: a critical analysis of current practices. BMJ Open 2022;12:e050543.
Taljaard M, McRae AD, Weijer C et al. Inadequate reporting of research ethics review and informed consent in cluster randomised trials: review of random sample of published trials. BMJ 2011;342:d2496.
United Nations. Convention on the Rights of Persons with Disabilities. New York: United Nations, 2007.
Maj M. Financial and non‐financial conflicts of interests in psychiatry. Eur Arch Psychiatry Clin Neurosci 2010;260(Suppl. 2):S147‐51.
Maj M. Non‐financial conflicts of interests in psychiatric research and practice. Br J Psychiatry 2008;193:91‐2.
Thornicroft G, Sunkel C, Aliev AA et al. The Lancet Commission on ending stigma and discrimination in mental health. Lancet 2022;400:1438‐80.
Donnelly J. Universal human rights in theory and practice. Ithaca and London: Cornell University Press, 2013.
United Nations. The Universal Declaration of Human Rights. New York: United Nations, 1948.
United Nations. International Covenant on Civil and Political Rights. New York: United Nations, 1966.
United Nations. International Covenant on Economic, Social and Cultural Rights. New York: United Nations, 1966.
Dudley M, Silove D, Gale F. Mental health, human rights, and their relationship: an introduction. In: Dudley M, Silove D, Gale F (eds). Mental health and human rights: vision, praxis, and courage. Oxford: Oxford University Press, 2012:1‐49.
United Nations. Vienna Declaration and program of action. Vienna: United Nations, 1993.
Mann J, Gostin L, Gruskin S et al. Health and human rights. Health Hum Rights 1994;1:6‐23.
Gostin LO, Gable L. The human rights of persons with mental disabilities: a global perspective on the application of human rights principles to mental health. Georgetown Law Faculty Publications and Other Works 2004;63:20‐121.
United Nations. Principles for protection of persons with mental illness and for the improvement of mental health care. New York: United Nations, 1991.
Perlin ML, Szeli E. Mental health law and human rights – evolution and contemporary challenges. In: Dudley M, Silove D, Gale F (eds). Mental health and human rights: vision, praxis, and courage. Oxford: Oxford University Press, 2012:80‐94.
Callard F, Sartorius N, Arboleda‐Flórez J et al. Mental illness, discrimination and the law: fighting for social justice. Hoboken: Wiley, 2012.
Harding T. Human rights law in the field of mental health: a critical review. Acta Psychiatr Scand 2000;101:24‐30.
Weller PJ. Lost in translation: human rights and mental health law. In: McSherry B, Weller P (eds). Rethinking rights‐based mental health laws. Oxford: Hart Publishing, 2010:51‐72.
Bartlett P. Implementing a paradigm shift: implementing the Convention on the Rights of Persons with Disabilities in the context of mental disability law. In: Centre for Human Rights and Humanitarian Law, American University Washington College of Law (ed). Torture in healthcare settings: reflections on the Special Rapporteur on Torture's 2013 Thematic Report. Washington: Centre for Human Rights and Humanitarian Law, American University Washington College of Law, 2014:169‐80.
McSherry B. Mental health laws: where to from here. Monash University Law Review 2014;40:175‐97.
United Nations Committee on the Rights of Persons with Disabilities. General Comment No. 1 ‐ Article 12: Equal recognition before the law. https://www.ohchr.org.
Minkowitz T. Abolishing mental health laws to comply with the Convention on the Rights of Persons with Disabilities. In: McSherry B, Weller P (eds). Rethinking rights‐based mental health laws. Oxford: Hart Publishing, 2010:151‐77.
Callaghan SM, Ryan C. Is there a future for involuntary treatment in rights‐based mental health law? Psychiatry Psychol Law 2014;21:747‐66.
Dawson J. A realistic approach to assessing mental health laws' compliance with the UNCRPD. Int J Law Psychiatry 2015;40:70‐9.
Freeman MC, Kolappa K, de Almeida JMC et al. Reversing hard won victories in the name of human rights: a critique of the General Comment on Article 12 of the UN Convention on the Rights of Persons with Disabilities. Lancet Psychiatry 2015;2:844‐50.
World Psychiatric Association. Implementing alternatives to coercion: a key component of improving mental health care. Position Statement. www.wpanet.org.
Herrman H, Allan J, Galderisi S et al. Alternatives to coercion in mental health care: WPA Position Statement and Call to Action. World Psychiatry 2022;21:159‐60.
Mezzina R, Rosen A, Amering M et al. The practice of freedom: human rights and the global mental health agenda. In: Mezzina R, Rosen A, Amering M et al (eds). Advances in psychiatry. Cham: Springer, 2019:483‐515.
Savage MK, Lepping P, Newton‐Howes G et al. Comparison of coercive practices in worldwide mental healthcare: overcoming difficulties resulting from variations in monitoring strategies. BJPsych Open 2024;10:e26.
World Psychiatric Association. QualityRights Gujarat: a case study of alternatives to coercion in mental health care. Geneva: World Psychiatric Association, 2020.
Sartorius N, Gill N, Virani S. Fighting for human rights and social justice and the promotion of mental health: complementary efforts. World Soc Psychiatry 2023;5:97‐100.
Maker Y, McSherry B. Human rights and the social determinants of mental health: fostering interdisciplinary research collaboration. Psychiatry Psychol Law 2023; doi: 10.1080/13218719.2023.2243297.
Sen A. Development as freedom. New York: Oxford University Press, 1999.
Nussbaum MC. Creating capabilities – The human development approach. Cambridge: Harvard University Press, 2011.
Marmot M. Social determinants of health inequalities. Lancet 2005;365:1099‐104.
Marmot M. Boyer lectures – Fair Australia: social justice and the health gap. www.abc.net.au.
Gill NS. Human rights framework: an ethical imperative for psychiatry. Aust N Z J Psychiatry 2019;53:8‐10.
Kestel D. Transforming mental health for all: a critical role for specialists. World Psychiatry 2022;21:333‐4.
Moeti M, Gao GF, Herrman H. Global pandemic perspectives: public health, mental health, and lessons for the future. Lancet 2022;400:e3‐7.
Rosen A, Gill NS, Salvador‐Carulla L. The future of community psychiatry and community mental health services. Curr Opin Psychiatry 2020;33:375‐90.
Campbell T, Heginbotham C. Mental illness: prejudice, discrimination and the law. London: Dartmouth, 1991.
Dawson J, Szmukler G. Fusion of mental health and incapacity legislation. Br J Psychiatry 2006;188:504‐9.
Szmukler G. Men in white coats: treatment under coercion. Oxford: Oxford University Press, 2018.
Funk M, Bold ND. WHO's QualityRights initiative: transforming services and promoting rights in mental health. Health and Human Rights 2020;22:69‐76.
Grisso T, Appelbaum PS. Assessing competence to consent to treatment: a guide for physicians and other health professionals. Oxford: Oxford University Press, 1998.
Flynn S, Rodway C, Appleby L et al. Serious violence by people with mental illness: national clinical survey. J Interpers Violence 2014;29:1438‐58.
Fusar‐Poli P, Sunkel C, Larrauri CA et al. Violence and schizophrenia: the role of social determinants of health and the need for early intervention. World Psychiatry 2023;22:230‐1.
Szmukler G, Daw R, Dawson J. A model law fusing incapacity and mental health legislation. J Ment Health Law 2010;20:1‐140.
Harper C, Davidson G, McClelland R. No longer ‘anomalous, confusing and unjust': the Mental Capacity Act (Northern Ireland). Int J Ment Health Capacit Law 2016;22:57‐70.
Northern Ireland Assembly. Mental Capacity Act (Northern Ireland) 2016. www.legislation.gov.uk.
Series L, Nilsson A. Article 12 CRPD: equal recognition before the law. In: Bantekas I, Stein MA, Anastasiou D (eds). The UN Convention on the Rights of Persons with Disabilities: a commentary. Oxford: Oxford University Press, 2018:339‐82.
Szmukler G. “Capacity”, “best interests”, “will and preferences” and the UN Convention on the Rights of Persons with Disabilities. World Psychiatry 2019;18:34‐41.
Scholten M, Gieselmann A, Gather J et al. Psychiatric advance directives under the Convention on the Rights of Persons with Disabilities: why advance instructions should be able to override current preferences. Front Psychiatry 2019;10:631.
Szmukler G. The UN Convention on the Rights of Persons with Disabilities: ‘rights, will and preferences’ in relation to mental health disabilities. Int J Law Psychiatry 2017;54:90‐7.
Ward A. A major step forward in CRPD compliance by the German Federal Constitutional Court? www.lexology.com.
Australian Law Reform Commission. Equality, capacity and disability in Commonwealth laws. www.alrc.gov.au.
Duffy J. Mental capacity, dignity and the power of international human rights. Cambridge: Cambridge University Press, 2023.
Stein DJ, Shoptaw SJ, Vigo DV et al. Psychiatric diagnosis and treatment in the 21st century: paradigm shifts versus incremental integration. World Psychiatry 2022;21:393‐414.
Zeavin H. The distance cure: a history of teletherapy. Cambridge: MIT Press, 2021.
Wilcock AD, Huskamp HA, Busch AB et al. Use of telemedicine and quality of care among Medicare enrollees with serious mental illness. JAMA Health Forum 2023;4:e233648.
Pendse SR, Nkemelu D, Bidwell NJ et al. From treatment to healing: envisioning a decolonial digital mental health. Presented at the CHI Conference on Human Factors in Computing Systems, New Orleans, April‐May, 2022.
Caliskan A, Bryson JJ, Narayanan A. Semantics derived automatically from language corpora contain human‐like biases. Science 2017;356:183‐6.
Oswald FL, Mitchell G, Blanton H et al. Predicting ethnic and racial discrimination: a meta‐analysis of IAT criterion studies. J Personal Soc Psychol 2013;105:171‐92.
Obermeyer Z, Powers B, Vogeli C et al. Dissecting racial bias in an algorithm used to manage the health of populations. Science 2019;366:447‐53.
Kim J. Data brokers and the sale of Americans’ mental health data. Durham: Duke Sanford School of Public Policy, 2023.
US Federal Trade Commission. FTC to ban BetterHelp from revealing consumers’ data, including sensitive mental health information, to Facebook and others for targeted advertising. www.ftc.gov.
YLE News. Hacked therapy centre's ex‐CEO gets 3‐month suspended sentence. YLE News, April 18, 2023. https://yle.fi/a/74‐20027665.
Ralston W. They told their therapists everything. Hackers leaked it all. Wired, May 4, 2021. www.wired.com.
Kirp D. The cyber attack that rocked the nation. Helsinki Times, December 22, 2020. www.helsinkitimes.fi.
Picchi A. Eating disorder helpline shuts down AI chatbot that gave bad advice. CBS News, June 1, 2023. www.cbsnews.com.
Jargon J. A chatbot was designed to help prevent eating disorders. Then it gave dieting tips. Wall Street Journal, June 1, 2023. www.wsj.com.
Xiang C. “Horribly unethical”: startup experimented on suicidal teens on social media with chatbot. Vice, March 7, 2023. www.vice.com.
World Health Organization. The ongoing journey to commitment and transformation: digital health in the WHO European Region. Copenhagen: WHO Regional Office for Europe, 2023.
Oh KJ, Lee D, Ko B et al. A chatbot for psychiatric counseling in mental healthcare service based on emotional dialogue analysis and sentence generation. Presented at the 18th IEEE International Conference on Mobile Data Management, Daejeon, May‐June, 2017.
Corsico P. The risks of risk. Regulating the use of machine learning for psychosis prediction. Int J Law Psychiatry 2019;66:101479.
Marks M. Artificial intelligence based suicide prediction. Yale Journal of Law and Technology 2019;21:98.
Flore J. Ingestible sensors, data, and pharmaceuticals: subjectivity in the era of digital mental health. New Media Soc 2020;23:2034‐51.
Miller S. The use of monitoring conditions (GPS tracking devices)Re CMX [2014] QMHC 4. Psychiatry Psychol Law 2015;22:321‐6.
Bossewitch J, Brown LXZ, Gooding P et al. Digital futures in mind: reflecting on technological experiments in mental health and crisis support. Melbourne: University of Melbourne, 2022.
Torous J, Roberts LW. Needed innovation in digital health and smartphone applications for mental health: transparency and trust. JAMA Psychiatry 2017;74:437‐8.
Taylor NP. Digital health funding jumps to new high as investors bet big on mental health startups: report. MedTech Dive, January 21, 2022. www.medtechdive.com.
DeAngelis T. As funding cools, venture capitalists shift investments in mental health. American Psychological Association, January 1, 2023. www.apa.org.
Kumar A, Ross JS, Patel NA et al. Studies of prescription digital therapeutics often lack rigor and inclusivity: study examines prescription digital therapeutics standards. Health Aff 2023;42:1559‐67.
Day S, Shah V, Kaganoff S et al. Assessing the clinical robustness of digital health startups: cross‐sectional observational analysis. J Med Internet Res 2022;24:e37677.
Gooding P, Kariotis T. Ethics and law in research on algorithmic and data‐driven technology in mental health care: scoping review. JMIR Ment Health 2021;8:e24668.
Steindl E. Safeguarding privacy and efficacy in e‐mental health: policy options in the EU and Australia. Int Data Priv Law 2023;13:207‐24.
Gooding P, Wee R. eMHIC position statement on the ethics and law of e‐mental health (& call to action). https://emhicglobal.com.
Burr C, Morley J, Taddeo M et al. Digital psychiatry: risks and opportunities for public health and wellbeing. IEEE Trans Technol Soc 2020;1:21‐33.
Burr C, Morley J. Empowerment or engagement? Digital health technologies for mental healthcare. In: Burr C, Milano S (eds). The 2019 yearbook of the digital ethics lab. Cham: Springer, 2020:67‐88.
Fiske A, Henningsen P, Buyx A. Your robot therapist will see you now: ethical implications of embodied artificial intelligence in psychiatry, psychology, and psychotherapy. J Med Internet Res 2019;21:e13216.
Coghlan S, D'Alfonso S. Digital phenotyping: an epistemic and methodological analysis. Philos Technol 2021;34:1905‐28.
Martinez‐Martin N, Greely HT, Cho MK. Ethical development of digital phenotyping tools for mental health applications: Delphi study. JMIR Mhealth Uhealth 2021;9:e27343.
Martinez‐Martin N, Insel TR, Dagum P et al. Data mining for health: staking out the ethical territory of digital phenotyping. NPJ Digit Med 2018;1:68.
Slack SK, Barclay L. First‐person disavowals of digital phenotyping and epistemic injustice in psychiatry. Med Health Care Philos 2023;26:605‐14.
Kariotis TC, Prictor M, Chang S et al. Impact of electronic health records on information practices in mental health contexts: scoping review. J Med Internet Res 2022;24:e30405.
Bondre A, Pathare S, Naslund JA. Protecting mental health data privacy in India: the case of data linkage with Aadhaar. Glob Health Sci Pract 2021;9:467‐80.
Torous J, Andersson G, Bertagnoli A et al. Towards a consensus around standards for smartphone apps and digital mental health. World Psychiatry 2019;18:97‐8.
Goldberg SB, Sun S, Carlbring P et al. Selecting and describing control conditions in mobile health randomized controlled trials: a proposed typology. NPJ Digit Med 2023;6:181.
Torous J, Myrick K, Aguilera A. The need for a new generation of digital mental health tools to support more accessible, effective and equitable care. World Psychiatry 2023;22:1‐2.
Robotham D, Satkunanathan S, Doughty L et al. Do we still have a digital divide in mental health? A five‐year survey follow‐up. J Med Internet Res 2016;18:e309.
Ennis L, Rose D, Denis M et al. Can't surf, won't surf: the digital divide in mental health. J Ment Health 2012;21:395‐403.
Spanakis P, Wadman R, Walker L et al. Measuring the digital divide among people with severe mental ill health using the essential digital skills framework. Perspect Public Health 2024;144:21‐30.
Zhao X, Schueller SM, Kim J et al. Real‐world adoption of mental health support among adolescents: cross‐sectional analysis of the California Health Interview Survey. J Pediatr Psychol 2023; doi: 10.1093/jpepsy/jsad082.
Ghafur S, Van Dael J, Leis M et al. Public perceptions on data sharing: key insights from the UK and the USA. Lancet Digit Health 2020;2:e444‐6.
Singh S, Sagar R. Time to have effective regulation of the mental health apps market: maximize gains and minimize harms. Indian J Psychol Med 2022;44:399‐404.
Cohen ZD, Schueller SM. Expanding, improving, and understanding behaviour research and therapy through digital mental health. Behav Res Ther 2023;167:104358.
Perret S, Alon N, Carpenter‐Song E et al. Standardising the role of a digital navigator in behavioural health: a systematic review. Lancet Digit Health 2023;5:e925‐32.
Torous J. A path towards progress: lessons from the hard things about digital mental health. World Psychiatry 2022;21:419‐20.
Australian Commission on Safety and Quality in Health Care. National safety and quality digital mental health standards – Guide for service providers. www.safetyandquality.gov.au.
European Commission. Regulatory framework proposal on artificial intelligence. https://digital‐strategy.ec.europa.eu.
Kelly B. New technology, psychiatry, and the law: navigating panic, prudence, and possibility. Presented at the 1st International Conference on Decision Making in Medicine and Law: Opportunities and Pitfalls of Information Technologies, Rome, December 2023.
Campion J, Bhui K, Bhugra D. European Psychiatric Association (EPA) guidance on prevention of mental disorders. Eur Psychiatry 2012;27:68‐80.
Howes OD, Whitehurst T, Shatalina E et al. The clinical significance of duration of untreated psychosis: an umbrella review and random‐effects meta‐analysis. World Psychiatry 2021;20:75‐95.
Menculini G, Verdolini N, Gobbicchi C et al. Clinical and psychopathological correlates of duration of untreated illness (DUI) in affective spectrum disorders. Eur Neuropsychopharmacol 2022;61:60‐70.
GBD 2019 Mental Disorders Collaborators. Global, regional, and national burden of 12 mental disorders in 204 countries and territories, 1990‐2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet Psychiatry 2022;9:137‐50.
Vigo D, Thornicroft G, Atun R. Estimating the true global burden of mental illness. Lancet Psychiatry 2016;3:171‐8.
Fusar‐Poli P, Correll CU, Arango C et al. Preventive psychiatry: a blueprint for improving the mental health of young people. World Psychiatry 2021;20:200‐21.
Fusar‐Poli P, Salazar de Pablo G, Correll CU et al. Prevention of psychosis: advances in detection, prognosis, and intervention. JAMA Psychiatry 2020;77:755‐65.
Schmidt SJ, Schultze‐Lutter F, Schimmelmann BG et al. EPA guidance on the early intervention in clinical high risk states of psychoses. Eur Psychiatry 2015;30:388‐404.
Schultze‐Lutter F, Michel C, Schmidt SJ et al. EPA guidance on the early detection of clinical high risk states of psychoses. Eur Psychiatry 2015;30:405‐16.
Ratheesh A, Cotton SM, Davey CG et al. Ethical considerations in preventive interventions for bipolar disorder. Early Interv Psychiatry 2017;11:104‐12.
Fusar‐Poli P, Bonoldi I, Yung AR et al. Predicting psychosis: meta‐analysis of transition outcomes in individuals at high clinical risk. Arch Gen Psychiatry 2012;69:220‐9.
Oliver D, Arribas M, Radua J et al. Prognostic accuracy and clinical utility of psychometric instruments for individuals at clinical high‐risk of psychosis: a systematic review and meta‐analysis. Mol Psychiatry 2022;27:3670‐8.
Fusar‐Poli P, Radua J, Jauhar S. Lack of robust meta‐analytic evidence to favour cognitive behavioural therapy for prevention of psychosis. World Psychiatry 2021;20:443‐44.
Davies C, Cipriani A, Ioannidis JPA et al. Lack of evidence to favor specific preventive interventions in psychosis: a network meta‐analysis. World Psychiatry 2018;17:196‐209.
Fusar‐Poli P, Schultze‐Lutter F, Cappucciati M et al. The dark side of the moon: meta‐analytical impact of recruitment strategies on risk enrichment in the clinical high risk state for psychosis. Schizophr Bull 2016;42:732‐43.
Ajnakina O, David AS, Murray RM. ‘At risk mental state’ clinics for psychosis – an idea whose time has come – and gone! Psychol Med 2019;49:529‐34.
McCrone P. Does early intervention for psychosis services make economic sense? Ment Health Today 2012;Jan‐Feb:30‐3.
Amos A. Unsystematic review shows neither that early intervention in psychosis is cost‐effective nor cost‐minimising. Br J Psychiatry 2019;215:744.
Rosenheck R. The challenge of cost‐effectiveness research on first‐episode psychosis. Br J Psychiatry 2019;215:386‐7.
Cuijpers P, Smit F, Furukawa TA. Most at‐risk individuals will not develop a mental disorder: the limited predictive strength of risk factors. World Psychiatry 2021;20:224‐5.
van Os J, Guloksuz S. A critique of the “ultra‐high risk” and “transition” paradigm. World Psychiatry 2017;16:200‐6.
Carpenter WT, van Os J. Should attenuated psychosis syndrome be a DSM‐5 diagnosis? Am J Psychiatry 2011;168:460‐3.
Shrivastava A, McGorry PD, Tsuang M et al. “Attenuated psychotic symptoms syndrome” as a risk syndrome of psychosis, diagnosis in DSM‐V: the debate. Indian J Psychiatry 2011;53:57‐65.
Yang LH, Wonpat‐Borja AJ, Opler MG et al. Potential stigma associated with inclusion of the psychosis risk syndrome in the DSM‐V: an empirical question. Schizophr Res 2010;120:42‐8.
Koren D. Early detection and intervention in psychiatry in the post‐DSM‐5 publication era: is it time to rethink the trees we bark up? Early Interv Psychiatry 2013;7:235‐7.
Tsuang MT, van Os J, Tandon R et al. Attenuated psychosis syndrome in DSM‐5. Schizophr Res 2013;150:31‐5.
Corcoran C, Malaspina D, Hercher L. Prodromal interventions for schizophrenia vulnerability: the risks of being “at risk”. Schizophr Res 2005;73:173‐84.
Colizzi M, Ruggeri M, Lasalvia A. Should we be concerned about stigma and discrimination in people at risk for psychosis? A systematic review. Psychol Med 2020;50:705‐26.
DeLuca JS, Yang LH, Lucksted AA et al. Reducing stigma among youth at risk for psychosis: a call to action. Schizophr Bull 2021;47:1512‐4.
Rüsch N, Heekeren K, Theodoridou A et al. Stigma as a stressor and transition to schizophrenia after one year among young people at risk of psychosis. Schizophr Res 2015;166:43‐8.
Yang LH, Link BG, Ben‐David S et al. Stigma related to labels and symptoms in individuals at clinical high‐risk for psychosis. Schizophr Res 2015;168:9‐15.
Anglin DM, Greenspoon MI, Lighty Q et al. Spontaneous labelling and stigma associated with clinical characteristics of peers ‘at‐risk' for psychosis. Early Interv Psychiatry 2014;8:247‐52.
Corcoran CM. Ethical and epidemiological dimensions of labeling psychosis risk. AMA J Ethics 2016;18:633‐42.
Yung AR, Wood SJ, Malla A et al. The reality of at risk mental state services: a response to recent criticisms. Psychol Med 2021;51:212‐8.
Mittal VA, Dean DJ, Mittal J et al. Ethical, legal, and clinical considerations when disclosing a high‐risk syndrome for psychosis. Bioethics 2015;29:543‐56.
Firth J, Solmi M, Wootton RE et al. A meta‐review of “lifestyle psychiatry”: the role of exercise, smoking, diet and sleep in the prevention and treatment of mental disorders. World Psychiatry 2020;19:360‐80.
Reeve S, Nickless A, Sheaves B et al. Sleep duration and psychotic experiences in patients at risk of psychosis: a secondary analysis of the EDIE‐2 trial. Schizophr Res 2019;204:326‐33.
Wang J, Eccles H, Nannarone M et al. Does providing personalized depression risk information lead to increased psychological distress and functional impairment? Results from a mixed‐methods randomized controlled trial. Psychol Med 2020;52:2071‐9.
Meiser B, Mitchell PB, McGirr H et al. Implications of genetic risk information in families with a high density of bipolar disorder: an exploratory study. Soc Sci Med 2005;60:109‐18.
Alder RG, Young JL, Russell EI et al. The impact and desirability of news of risk for schizophrenia. PLoS One 2013;8:e62904.
Ruiz B, Ceccolini CJ, Shah BB et al. Stigma and coping experiences in Latinx individuals at clinical high‐risk for psychosis. Early Interv Psychiatry 2022;16:34‐41.
Bortolotti L, Widdows H. The right not to know: the case of psychiatric disorders. J Med Ethics 2011;37:673‐6.
Duttge G. The right to know and not to know: predictive genetic diagnosis and non‐diagnosis. Recent Results Cancer Res 2021;218:67‐83.
Andorno R. The right not to know: an autonomy based approach. J Med Ethics 2004;30:435‐40.
Carpiniello B, Wasserman D. European Psychiatric Association policy paper on ethical aspects in communication with patients and their families. Eur Psychiatry 2020;63:e36.
Woodberry KA, Powers KS, Bryant C et al. Emotional and stigma‐related experiences relative to being told one is at risk for psychosis. Schizophr Res 2021;238:44‐51.
Schiffman J, Horton LE, Landa Y et al. Considerations for providing feedback to patients and families regarding clinical high‐risk for psychosis status. Schizophr Res 2022;244:55‐7.
Appelbaum PS. Ethical challenges in the primary prevention of schizophrenia. Schizophr Bull 2015;41:773‐5.
Moritz S, Gawe˛da Ł, Heinz A et al. Four reasons why early detection centers for psychosis should be renamed and their treatment targets reconsidered: we should not catastrophize a future we can neither reliably predict nor change. Psychol Med 2019;49:2134‐40.
Falkenberg I, Valmaggia L, Byrnes M et al. Why are help‐seeking subjects at ultra‐high risk for psychosis help‐seeking? Psychiatry Res 2015;228:808‐15.
Addington J, Cornblatt BA, Cadenhead KS et al. At clinical high risk for psychosis: outcome for nonconverters. Am J Psychiatry 2011;168:800‐5.
Olvet DM, Carrión RE, Auther AM et al. Self‐awareness of functional impairment in individuals at clinical high‐risk for psychosis. Early Interv Psychiatry 2015;9:100‐7.
Beck K, Andreou C, Studerus E et al. Clinical and functional long‐term outcome of patients at clinical high risk (CHR) for psychosis without transition to psychosis: a systematic review. Schizophr Res 2019;210:39‐47.
Salazar de Pablo G, Soardo L, Cabras A et al. Clinical outcomes in individuals at clinical high risk of psychosis who do not transition to psychosis: a meta‐analysis. Epidemiol Psychiatr Sci 2022;31:e9.
Herrera SN, Sarac C, Phili A et al. Psychoeducation for individuals at clinical high risk for psychosis: a scoping review. Schizophr Res 2023;252:148‐58.
World Psychiatric Association. Social justice for the mentally ill. Int J Soc Psychiatry 2015;61:213‐4.
Fusar‐Poli P. Why ultra high risk criteria for psychosis prediction do not work well outside clinical samples and what to do about it. World Psychiatry 2017;16:212‐3.
Ajnakina O, Morgan C, Gayer‐Anderson C et al. Only a small proportion of patients with first episode psychosis come via prodromal services: a retrospective survey of a large UK mental health programme. BMC Psychiatry 2017;17:1‐9.
Morgan C, Knowles G, Hutchinson G. Migration, ethnicity and psychoses: evidence, models and future directions. World Psychiatry 2019;18:247‐58.
Hagler MA, Ferrara M, Yoviene Sykes LA et al. Sampling from different populations: sociodemographic, clinical, and functional differences between samples of first episode psychosis individuals and clinical high‐risk individuals who progressed to psychosis. Schizophr Res 2023;255:239‐45.
Fridgen GJ, Aston J, Gschwandtner U et al. Help‐seeking and pathways to care in the early stages of psychosis. Soc Psychiatry Psychiatr Epidemiol 2013;48:1033‐43.
Allan SM, Hodgekins J, Beazley P et al. Pathways to care in at‐risk mental states: a systematic review. 2021;15:1092‐103.
Satinsky E, Fuhr DC, Woodward A et al. Mental health care utilisation and access among refugees and asylum seekers in Europe: a systematic review. Health Policy 2019;123:851‐63.
Carson N, Lê Cook B, Alegria M. Social determinants of mental health treatment among Haitian, African American, and White youth in community health centers. J Health Care Poor Underserved 2010;21(Suppl. 2):32‐48.
Burke T, Thompson A, Mifsud N et al. Proportion and characteristics of young people in a first‐episode psychosis clinic who first attended an at‐risk mental state service or other specialist youth mental health service. Schizophr Res 2022;241:94‐101.
Geros H, Sizer H, Mifsud N et al. Migrant status and identification as ultra‐high risk for psychosis and transitioning to a psychotic disorder. Acta Psychiatr Scand 2020;141:52‐9.
Valmaggia LR, Byrne M, Day F et al. Duration of untreated psychosis and need for admission in patients who engage with mental health services in the prodromal phase. Br J Psychiatry 2015;207:130‐4.
Lu W, Todhunter‐Reid A, Mitsdarffer ML et al. Barriers and facilitators for mental health service use among racial/ethnic minority adolescents: a systematic review of literature. Front Public Health 2021;9:641605.
McGorry PD, Tanti C, Stokes R et al. headspace: Australia's national youth mental health foundation – where young minds come first. Med J Aust 2007;187(Suppl. 7):S68‐70.
McGorry P, Trethowan J, Rickwood D. Creating headspace for integrated youth mental health care. World Psychiatry 2019;18:140‐1.
Rickwood D, Paraskakis M, Quin D et al. Australia's innovation in youth mental health care: the headspace centre model. Early Interv Psychiatry 2019;13:159‐66.
Buckley R, Illback R, O'Brien G et al. Description and outcome evaluation of Jigsaw: an emergent Irish mental health early intervention programme for young people. Ir J Psychol Med 2015;32:71‐7.
O'Reilly A, O'Brien G, Moore J et al. Evolution of Jigsaw ‐ a national youth mental health service. Early Interv Psychiatry 2022;16:561‐7.
Iyer SN, Boksa P, Lal S et al. Transforming youth mental health: a Canadian perspective. Ir J Psychol Med 2015;32:51‐60.
Malla A, Iyer S, Shah J et al. Canadian response to need for transformation of youth mental health services: ACCESS Open Minds (Esprits ouverts). Early Interv Psychiatry 2019;13:697‐706.
Read H, Kohrt BA. The history of coordinated specialty care for early intervention in psychosis in the United States: a review of effectiveness, implementation, and fidelity. Community Ment Health J 2022;58:835‐46.
Hughes F, Hebel L, Badcock P et al. Ten guiding principles for youth mental health services. Early Interv Psychiatry 2018;12:513‐9.
van Amelsvoort T, Leijdesdorff S. Peer involvement and accessibility as key ingredients for 21st century youth mental health care services. World Psychiatry 2022;21:82‐3.
McGorry PD, Goldstone SD, Parker AG et al. Cultures for mental health care of young people: an Australian blueprint for reform. Lancet Psychiatry 2014;1:559‐68.
McGorry PD, Mei C, Chanen A et al. Designing and scaling up integrated youth mental health care. World Psychiatry 2022;21:61‐76.
Rickwood D, McEachran J, Saw A et al. Sixteen years of innovation in youth mental healthcare: outcomes for young people attending Australia's headspace centre services. PLoS One 2023;18:e0282040.
Kisely SR, Bastiampillai T, Allison S et al. More smoke and mirrors: fifteen further reasons to doubt the effectiveness of headspace. Australas Psychiatry 2023;31:282‐91.
Kisely S, Looi JC. Latest evidence casts further doubt on the effectiveness of headspace. Med J Aust 2022;217:388‐90.
Goldney RD. Early intervention services. Australas Psychiatry 2020;28:599.
Iorfino F, Carpenter JS, Cross SP et al. Social and occupational outcomes for young people who attend early intervention mental health services: a longitudinal study. Med J Aust 2022;216:87‐93.
Iorfino F, McHugh C, Richards M et al. Patterns of emergency department presentations for a youth mental health cohort: data‐linkage cohort study. BJPsych Open 2023;9:e170.
Looi JC, Allison S, Bastiampillai T. Leviathans: headspace‐like behemoths swallow resources. Aust N Z J Psychiatry 2019;53:1050‐1.
Looi JC, Kisely SR, Bastiampillai T et al. Commentary: Is Australian headspace socioculturally westernised, educated, industrialised, rich and democratic in conceptualisation and accessibility? Australas Psychiatry 2023;31:255‐7.
Boonstra A, van Mastrigt G, Evers S et al. @ease peer‐to‐peer youth walk‐in centres in The Netherlands: a protocol for evaluating longitudinal outcomes, follow‐up results and cost‐of‐illness. Early Interv Psychiatry 2023;17:929‐38.
Shah JL, Moinfar Z, Anderson KK et al. Return on investment from service transformation for young people experiencing mental health problems: approach to economic evaluations in ACCESS Open Minds (Esprits ouverts), a multi‐site pan‐Canadian youth mental health project. Front Psychiatry 2023;14:1030407.
Iyer SN, Shah J, Boksa P et al. A minimum evaluation protocol and stepped‐wedge cluster randomized trial of ACCESS Open Minds, a large Canadian youth mental health services transformation project. BMC Psychiatry 2019;19:273.
Looi JCL, Allison S, Bastiampillai T et al. Headspace, an Australian youth mental health network: lessons for Canadian mental healthcare. J Can Acad Child Adolesc Psychiatry 2021;30:116‐22.
McMahon J, Ryan F, Cannon M et al. Where next for youth mental health services in Ireland? Ir J Psychol Med 2019;36:163‐7.
Brannan C, Foulkes AL, Lázaro‐Muñoz G. Preventing discrimination based on psychiatric risk biomarkers. Am J Med Genet B Neuropsychiatr Genet 2019;180:159‐71.
Smith WR, Appelbaum PS, Lebowitz MS et al. The ethics of risk prediction for psychosis and suicide attempt in youth mental health. J Pediatr 2023;263:113583.
Beauchamp TL. The right to die as the triumph of autonomy. J Med Philos 2006;31:643‐54.
Meisel A. The legal consensus about foregoing life‐sustaining treatment: its status and its prospects. Kennedy Inst Ethics J 1992;2:309‐45.
Emanuel LL. Advance directives. Annu Rev Med 2008;59:187‐98.
Calati R, Olié E, Dassa D et al. Euthanasia and assisted suicide in psychiatric patients: a systematic review of the literature. J Psychiatr Res 2021;135:153‐73.
Emanuel EJ. Euthanasia. Historical, ethical, and empiric perspectives. Arch Intern Med 1994;154:1890‐901.
Gunderson M, Mayo DJ. Altruism and physician assisted death. J Med Philos 1993;18:281‐95.
Mroz S, Dierickx S, Deliens L et al. Assisted dying around the world: a status quaestionis. Ann Palliat Med 2021;10:3540‐53.
Nicolini ME, Kim SYH, Churchill ME et al. Should euthanasia and assisted suicide for psychiatric disorders be permitted? A systematic review of reasons. Psychol Med 2020;50:1241‐56.
Coelho R, Maher J, Gaind KS et al. The realities of medical assistance in dying in Canada. Palliat Support Care 2023;21:871‐8.
Nicolini ME, Gastmans C, Kim SYH. Psychiatric euthanasia, suicide and the role of gender. Br J Psychiatry 2022;220:10‐3.
Appelbaum PS. Physician‐assisted death in psychiatry. World Psychiatry 2018;17:145‐6.
Liu RT, Kleiman EM, Nestor BA et al. The hopelessness theory of depression: a quarter century in review. Clin Psychol 2015;22:345‐65.
Lemmens T. When death becomes therapy: Canada's troubling normalization of health care provider ending of life. Am J Bioeth 2023;23:79‐84.
Gamage M. She sought help in crisis and was suggested MAID instead. The Tyee, August 9, 2023. https://thetyee.ca.
Appelbaum PS. Assessment of patients' competence to consent to treatment. N Engl J Med 2007;357:1834‐40.
Doernberg SN, Peteet JR, Kim SY. Capacity evaluations of psychiatric patients requesting assisted death in the Netherlands. Psychosomatics 2016;57:556‐65.
American Medical Association. AMA Code of Medical Ethics. https://code‐medical‐ethics.ama‐assn.org.
American Psychiatric Association. Position statement on medical euthanasia. Washington: American Psychiatric Association, 2016.
Carpenter T, Vivas L. Ethical arguments against coercing provider participation in MAiD (medical assistance in dying) in Ontario, Canada. BMC Med Ethics 2020;21:46.
Kim SYH. Canadian medical assistance in dying and the hegemony of privilege. Am J Bioeth 2023;23:1‐6.
Appelbaum PS. Physician‐assisted death for psychiatric disorders: ongoing reasons for concern. World Psychiatry 2024;23:56‐7.
Lo B, Field MJ (eds). Conflict of interest in medical research, education, and practice. Washington: National Academies Press, 2009.
McCoy MS, Emanuel EJ. Why there are no “potential” conflicts of interest. JAMA 2017;317:1721‐2.
Dana J, Loewenstein G. A social science perspective on gifts to physicians from industry. JAMA 2003;290:252‐5.
Feldman AM, Mann DL. Restoring public trust in scientific research by reducing conflicts of interest. J Clin Invest 2019;129:3971‐3.
United Nations. Report of the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health. New York: United Nations, 2020.
Stuart H, Sartorius N, Liinamaa T. Images of psychiatry and psychiatrists. Acta Psychiatr Scand 2015;131:21‐8.
Sartorius N. Guidance on how to combat stigmatization of psychiatry and psychiatrists. World Psychiatry 2012;11:61‐2.
Bhugra D, Sartorius N, Fiorillo A et al. EPA guidance on how to improve the image of psychiatry and of the psychiatrist. Eur Psychiatry 2015;30:423‐30.
Angermeyer MC, Van der Auwera S, Carta MG et al. Public attitudes towards psychiatry and psychiatric treatment at the beginning of the 21st century: a systematic review and meta‐analysis of population surveys. World Psychiatry 2017;16:50‐61.
Gaebel W, Zäske H, Zielasek J et al. Stigmatization of psychiatrists and general practitioners: results of an international survey. Eur Arch Psychiatry Clin Neurosci 2015;265:189‐97.
Fadlallah R, Alkhaled L, Brax H et al. Extent of physician‐pharmaceutical industry interactions in low‐ and middle‐income countries: a systematic review. Eur J Public Health 2018;28:224‐30.
Katz D, Caplan AL, Merz JF. All gifts large and small: toward an understanding of the ethics of pharmaceutical industry gift‐giving. Am J Bioeth 2003;3:39‐46.
King M, Bearman PS. Gifts and influence: conflict of interest policies and prescribing of psychotropic medications in the United States. Soc Sci Med 2017;172:153‐62.
Mitchell AP, Trivedi NU, Gennarelli RL et al. Are financial payments from the pharmaceutical industry associated with physician prescribing? A systematic review. Ann Intern Med 2021;174:353‐61.
Brax H, Fadlallah R, Al‐Khaled L et al. Association between physicians' interaction with pharmaceutical companies and their clinical practices: a systematic review and meta‐analysis. PLoS One 2017;12:e0175493.
Ansari B. Industry payments and physicians prescriptions: effect of a payment restriction policy. Soc Sci Med 2021;278:113942.
Mitchell A, Sarpatwari A, Bach PB. Industry payments to physicians are kickbacks. how should stakeholders respond? J Health Polit Policy Law 2022;47:815‐33.
Alkhaled L, Kahale L, Nass H et al. Legislative, educational, policy and other interventions targeting physicians' interaction with pharmaceutical companies: a systematic review. BMJ Open 2014;4:e004880.
Grundy Q, Habibi R, Shnier A et al. Decoding disclosure: comparing conflict of interest policy among the United States, France, and Australia. Health Policy 2018;122:509‐18.
Zarei E, Ghaffari A, Nikoobar A et al. Interaction between physicians and the pharmaceutical industry: a scoping review for developing a policy brief. Front Public Health 2022;10:1072708.
Appelbaum P, Arboleda‐Florez J, Javed A et al. WPA recommendations for relationships of psychiatrists, health care organizations working in the psychiatric field and psychiatric associations with the pharmaceutical industry. World Psychiatry 2011;10:155‐9.
Höschl C, Fialová L. European Psychiatric Association guidance on the conflicts of interest. Eur Psychiatry 2012;27:142‐6.
Fadlallah R, Nas H, Naamani D et al. Knowledge, beliefs and attitudes of patients and the general public towards the interactions of physicians with the pharmaceutical and the device industry: a systematic review. PLoS One 2016;11:e0160540.
American Medical Association. Physician financial transparency reports (Sunshine Act). ama‐assn.org/go/sunshine.
European Federation of Pharmaceutical Industries and Associations (EFPIA). EFPIA code on disclosure of transfers of value from pharmaceutical companies to healthcare professionals and healthcare organisations. www.efpia.eu.
Loewenstein G, Sunstein CR, Golman R. Disclosure: psychology changes everything. Annu Rev Econom 2014;6:391‐419.
Stoll M, Hubenschmid L, Koch C et al. Physicians' attitudes towards disclosure of payments from pharmaceutical companies in a nationwide voluntary transparency database: a cross‐sectional survey. BMJ Open 2022;12:e055963.
Tringale KR, Hattangadi‐Gluth JA. Truth, trust, and transparency – the highly complex nature of patients' perceptions of conflicts of interest in medicine. JAMA Netw Open 2019;2:e191929.
Kanter GP, Carpenter D, Lehmann LS et al. US nationwide disclosure of industry payments and public trust in physicians. JAMA Netw Open 2019;2:e191947.
Taylor J, Denegri S. Industry links with patient organisations. BMJ 2017;356:j1251.
Rose SL. Patient advocacy organizations: institutional conflicts of interest, trust, and trustworthiness. J Law Med Ethics 2013;41:680‐7.
Rose SL, Highland J, Karafa MT et al. Patient advocacy organizations, industry funding, and conflicts of interest. JAMA Intern Med 2017;177:344‐50.
Khabsa J, Semaan A, El‐Harakeh A et al. Financial relationships between patient and consumer representatives and the health industry: a systematic review. Health Expect 2020;23:483‐95.
Chimonas S, Mamoor M, Zimbalist SA et al. Mapping conflict of interests: scoping review. BMJ 2021;375:e066576.
King M, Essick C, Bearman P et al. Medical school gift restriction policies and physician prescribing of newly marketed psychotropic medications: difference‐in‐differences analysis. BMJ 2013;346:f264.
Epstein AJ, Busch SH, Busch AB et al. Does exposure to conflict of interest policies in psychiatry residency affect antidepressant prescribing? Med Care 2013;51:199‐203.
Fabbri A, Hone KR, Hrõbjartsson A et al. Conflict of interest policies at medical schools and teaching hospitals: a systematic review of cross‐sectional studies. Int J Health Pol 2021;11:1274‐85.
Guy‐Coichard C, Perraud G, Chailleu A et al. Inadequate conflict of interest policies at most French teaching hospitals: a survey and website analysis. PLoS One 2019;14:e0224193.
Scognamiglio P, Morena D, Di Fazio N et al. Vox clamantis in deserto: a survey among Italian psychiatrists on defensive medicine and professional liability. Front Psychiatry 2023;14:1244101.
Jena AB, Seabury S, Lakdawalla D et al. Malpractice risk according to physician specialty. N Engl J Med 2011;365:629‐36.
Passmore K, Leung WC. Defensive practice among psychiatrists: a questionnaire survey. Postgrad Med J 2002;78:671‐3.
Reuveni I, Pelov I, Reuveni H et al. Cross‐sectional survey on defensive practices and defensive behaviours among Israeli psychiatrists. BMJ Open 2017;7:e014153.
Lundh A, Lexchin J, Mintzes B et al. Industry sponsorship and research outcome. Cochrane Database Syst Rev 2017;2:MR000033.
Waqas A, Baig AA, Khalid MA et al. Conflicts of interest and outcomes of clinical trials of antidepressants: an 18‐year retrospective study. J Psychiatr Res 2019;116:83‐7.
Nejstgaard CH, Bero L, Hróbjartsson A et al. Association between conflicts of interest and favourable recommendations in clinical guidelines, advisory committee reports, opinion pieces, and narrative reviews: systematic review. BMJ 2020;371:m4234.
Tibau A, Bedard PL, Srikanthan A et al. Author financial conflicts of interest, industry funding, and clinical practice guidelines for anticancer drugs. J Clin Oncol 2015;33:100‐6.
International Committee of Medical Journal Editors. Disclosure of financial and non‐financial relationships and activities, and conflicts of interest. International Committee of Medical Journal Editors, 2022.
Schünemann HJ, Al‐Ansary LA, Forland F et al. Guidelines International Network: principles for disclosure of interests and management of conflicts in guidelines. Ann Intern Med 2015;163:548‐53.
Institute of Medicine Committee on Standards for Developing Trustworthy Clinical Practice Guidelines. Clinical practice guidelines we can trust. Washington: National Academies Press, 2011.
National Health Medical Research Council. NHMRC guidelines for guidelines: identifying and managing conflicts of interest. Canberra: National Health Medical Research Council, 2018.
Resnik DB, Ariansen JL, Jamal J et al. Institutional conflict of interest policies at U.S. academic research institutions. Acad Med 2016;91:242‐6.
Resnik DB. Institutional conflicts of interest in academic research. Sci Eng Ethics 2019;25:1661‐9.
Kahr B, Hollingsworth M. Massive faculty donations and institutional conflicts of interest. J Sci Pract Integr 2019;1:1‐33.
Nichols‐Casebolt A, Macrina FL. Current perspectives regarding institutional conflict of interest: commentary on “Institutional conflicts of interest in academic research”. Sci Eng Ethics 2019;25:1671‐7.
Graham SS, Karnes MS, Jensen JT et al. Evidence for stratified conflicts of interest policies in research contexts: a methodological review. BMJ Open 2022;12:e063501.
Cappola AR, FitzGerald GA. Confluence, not conflict of interest: name change necessary. JAMA 2015;314:1791‐2.
Wiersma M, Kerridge I, Lipworth W et al. Should we try to manage non‐financial interests? BMJ 2018;361:k1240.
Lieb K, von der Osten‐Sacken J, Stoffers‐Winterling J et al. Conflicts of interest and spin in reviews of psychological therapies: a systematic review. BMJ Open 2016;6:e010606.
Munder T, Brütsch O, Leonhart R et al. Researcher allegiance in psychotherapy outcome research: an overview of reviews. Clin Psychol Rev 2013;33:501‐11.
Miller S, Wampold B, Varhely K. Direct comparisons of treatment modalities for youth disorders: a meta‐analysis. Psychother Res 2008;18:5‐14.
Cuijpers P, Driessen E, Hollon SD et al. The efficacy of non‐directive supportive therapy for adult depression: a meta‐analysis. Clin Psychol Rev 2012;32:280‐91.
Dragioti E, Dimoliatis I, Fountoulakis KN et al. A systematic appraisal of allegiance effect in randomized controlled trials of psychotherapy. Ann Gen Psychiatry 2015;14:25.
Bero L. Addressing bias and conflict of interest among biomedical researchers. JAMA 2017;317:1723‐4.
Sniderman AD, Furberg CD. Pluralism of viewpoints as the antidote to intellectual conflict of interest in guidelines. J Clin Epidemiol 2012;65:705‐7.
Viswanathan M, Carey TS, Belinson SE et al. A proposed approach may help systematic reviews retain needed expertise while minimizing bias from nonfinancial conflicts of interest. J Clin Epidemiol 2014;67:1229‐38.
Grundy Q. A politics of objectivity: biomedicine's attempts to grapple with “non‐financial” conflicts of interest. Sci Eng Ethics 2021;27:37.
Scheffer PJ, Guy‐Coichard C, Outh‐Gauer D et al. Conflict of interest policies at French medical schools: starting from the bottom. PLoS One 2017;12:e0168258.
Varley CK, Jibson MD, McCarthy M et al. A survey of the interactions between psychiatry residency programs and the pharmaceutical industry. Acad Psychiatry 2005;29:40‐6.
Accreditation Council for Continuing Medical Education. Standards for integrity and independence in accredited continuing education. Chicago: Accreditation Council for Continuing Medical Education, 2020.
Varetto T, Costa DC. Continuing Medical Education Committee and UEMS‐EACCME. Eur J Nucl Med Mol Imaging 2013;40:470‐4.
Union Européenne des Médecins Spécialiste/European Union of Medical Specialists. The Charter on CME of Medical Specialists in the European Union. www.uems.eu.
European Federation of Pharmaceutical Industries and Associations. The EFPIA Code of Practice. www.efpia.eu.
Union Européenne des Médecins Spécialiste/European Union of Medical Specialists. Criteria for international accreditation of CME. www.uems.eu.
Golestaneh L, Cowan E. Hidden conflicts of interest in continuing medical education. Lancet 2017; 390:2128‐30.
Barnes BE. Financial conflicts of interest in continuing medical education: implications and accountability. JAMA 2017;317:1741‐2.
Wallcraft J, Amering M, Freidin J et al. Partnerships for better mental health worldwide: WPA recommendations on best practices in working with service users and family carers. World Psychiatry 2011;10:229‐36.
WPA Working Group on Developing Partnerships with Service Users and Family Carers. WPA position paper on developing partnerships with persons with lived experience of mental health conditions and family and informal carers. www.wpanet.org.
World Health Organization. WHO framework for meaningful engagement of people living with noncommunicable diseases, and mental health and neurological conditions. Geneva: World Health Organization, 2023.
Laitila M, Nummelin J, Kortteisto T et al. Service users' views regarding user involvement in mental health services: a qualitative study. Arch Psychiatr Nurs 2018;32:695‐701.
Newman D, O'Reilly P, Lee SH et al. Mental health service users' experiences of mental health care: an integrative literature review. J Psychiatr Ment Health Nurs 2015;22:171‐82.
Stacey D, Légaré F, Lewis K et al. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev 2017;4:CD001431.
Davidson L, Guy K. Peer support among persons with severe mental illnesses: a review of evidence and experience. World Psychiatry 2012;11:123‐8.
Solomon P. Peer support/peer provided services underlying processes, benefits, and critical ingredients. Psychiatr Rehabil J 2004;27:392.
Reif S, Braude L, Lyman DR et al. Peer recovery support for individuals with substance use disorders: assessing the evidence. Psychiatr Serv 2014;65:853‐61.
Charbonneau DH, Akers KG. Information needs and sources for family members of individuals living with mental disorders. In: Dalmer NK, Barringe S (eds). Family matters: mapping information phenomena within the context of the family. Chicago: University of Illinois, 2022:133‐48.
Reinhard SC. Living with mental illness: effects of professional support and personal control on caregiver burden. Res Nurs Health 1994;17:79‐88.
Sin J, Gillard S, Spain D et al. Effectiveness of psychoeducational interventions for family carers of people with psychosis: a systematic review and meta‐analysis. Clin Psychol Rev 2017;56:13‐24.
Leff J, Kuipers L, Berkowitz R et al. A controlled trial of social intervention in the families of schizophrenic patients. Br J Psychiatry 1982;141:121‐34.
Grant C, Ballard ED, Olson‐Madden JH. An empowerment approach to family caregiver involvement in suicide prevention: implications for practice. Fam J 2015;23:295‐304.
Bradley E. Carers and co‐production: enabling expertise through experience? Ment Health Rev J 2015;20:232‐41.
Szmukler G. Ethics in community psychiatry. Aust N Z J Psychiatry 1999;33:328‐38.
Livingston G, Cooper C. User and carer involvement in mental health training. Adv Psychiatr Treat 2004;10:85‐92.
Kaiser BN, Varma S, Carpenter‐Song E et al. Eliciting recovery narratives in global mental health: benefits and potential harms in service user participation. Psychiatr Rehabil J 2020;43:111‐20.
Trivedi P. ‘Nothing about us, without us’ – A user/survivor perspective of global mental health. Int Rev Psychiatry 2014;26:544‐50.
Sunkel C. A lived experience perspective on the new World Mental Health Report. World Psychiatry 2022;21:390‐1.
Bell J, Lim A, Williams R et al. ‘Nothing about us without us': co‐production ingredients for working alongside stakeholders to develop mental health interventions. Adv Ment Health 2023;21:4‐16.
Isom J, Balasuriya L. Nothing about us without us in policy creation and implementation. Psychiatr Serv 2021;72:121.
Beames JR, Kikas K, O'Gradey‐Lee M et al. A new normal: integrating lived experience into scientific data syntheses. Front Psychiatry 2021;12:763005.
Fusar‐Poli P, Estradé A, Stanghellini G et al. The lived experience of psychosis: a bottom‐up review co‐written by experts by experience and academics. World Psychiatry 2022;21:168‐88.
Fusar‐Poli P, Estradé A, Stanghellini G et al. The lived experience of depression: a bottom‐up review co‐written by experts by experience and academics. World Psychiatry 2023;22:352‐65.
Happell B, Roper C. Consumer participation in mental health research: articulating a model to guide practice. Australas Psychiatry 2007;15:237‐41.
Van de Bovenkamp HM, Trappenburg MJ, Grit KJ. Patient participation in collective healthcare decision making: the Dutch model. Health Expect 2010;13:73‐85.
Ennis L, Wykes T. Impact of patient involvement in mental health research: longitudinal study. Br J Psychiatry 2013;203:381‐6.
Fortuna KL, Myers A, Brooks J et al. Co‐production of the quality of patient‐centered outcomes research partnerships instrument for people with mental health conditions. Patient Exp J 2021;8:148.
Bloch S, Kenn F, Lim I. Codes of ethics for psychiatrists: past, present and prospect. Psychol Med 2022;52:1201‐7.
Elwyn G, Frosch DL, Kobrin S. Implementing shared decision‐making: consider all the consequences. Implement Sci 2016;11:114.
Slade M. Implementing shared decision making in routine mental health care. World Psychiatry 2017;16:146‐53.
Davidson L, Tondora J. Person‐centred care planning as foundational to clinical practice. World Psychiatry 2022;21:1‐2.
World Health Organization. Peer support mental health services: promoting person‐centred and rights‐based approaches. www.who.int.