Panel Discussions
Global Mental Health
Natalie Johnson, M.P.H.
Researach Manager
Shamiri Institute
Nairobi, Nairobi Area, Kenya
Daniel Coppersmith, M.A.
PhD Candidate
Harvard University
CAMBRIDGE, Massachusetts
Katherine E. Venturo-Conerly, PhD
PhD Candidate
Harvard University
CAMBRIDGE, Massachusetts
Christine Wasanga, M.A., Ph.D., Other
Senior Lecturer, Counseling Psychologist
Kenyatta University
Nairobi, Nairobi Area, Kenya
Eve S. Puffer, Ph.D.
Assistant Professor
Duke University
Durham, North Carolina
Tom Osborn, PhD
Co-Founder and CEO
Shamiri Institute
Nairobi, Kentucky
David Ndetei, Ph.D.
Professor, Psychiatry
University of Nairobi
Nairobi, Nairobi Area, Kenya
The primary goal of this panel is to discuss considerations when designing and implementing risk protocols for treatment research with youth in low-and middle-income countries (LMICs). Many LMICs face a shortage of trained mental health providers, with 0.5 psychologists, and 0.3 social workers per million people (WHO, 2019). This shortage limits prospects for addressing risk via referral to local mental health providers. Although research is limited, mental illness stigma appears more prevalent in LMICs than high-income countries. This generates fear and magnifies shame for those suffering from mental health problems, and discourages help-seeking. Elevated stigma also means that revealing participant risk to others, including guardians or authorities who would typically be informed about youth risk, carries considerable risk to participant wellbeing and social standing. In some countries, such as Kenya, suicide is criminalized, and those who attempt suicide can be fined or jailed for up to 2 years (Government of Kenya, 2009). Initial discussions will turn to these and other examples from LMICs of why risk management needs to be contextualized to consider the local culture and context. Next, our multicultural panel of experts in youth risk assessment and management and youth treatment research in LMICs will discuss current best practices for planning how to manage the clinical risks that arise during youth treatment research. These will include consultation with local mental health professionals, training of a tiered network of lay-providers and supervisors, and balancing disclosure to others such as guardians with risk-level. Our experience with adaptation of risk protocols to the local context when conducting treatment research in LMICs will be shared. An example of an adaptation that will be presented is the management of clinical emergencies when testing the Shamiri intervention with youth in Kenya (Venturo-Conerly et al., 2022). We will also discuss the importance of understanding how mental illness stigma manifests locally, and integrating this knowledge into the risk protocol. Finally, we will discuss future directions for research and practice related to addressing risks that arise when conducting treatment research in LMICs.