The ethics of psychiatric care and research in resource-poor settings: The case of a research trial in a prayer camp in Ghana

A communication in the January 2018 issue of the British Journal of Psychiatry detailed a clinical trial on persons with mental illness (PWMI), some of whom were in chains in a prayer camp setting in Ghana. The camp's advertised mission statement was to "set free those held captive by Satan" through its "ministry of fasting and prayer". This article considers the potential ethical problems raised by the clinical trial on chained PWMI against the background of Ghanaian ethnoanthropological beliefs. It highlights two significant categories of ethical issues: first, those associated with standard psychiatric practice in the treatment of persons with severe mental illness (specifically, the issue of informed consent and the use of physical restraint and seclusion in psychiatric practice); and second, issues pertaining to the study under discussion (specifically, issues of study methodology and the principle of equipoise; biological determinism as against the multifactorial paradigm of mental illness/practice, implied or assumed; misalignment between the research methodology, results, and the underlying aim of the study, bordering on epistemology and pragmatism/values; and finally, the association of the trial researchers with the practice of chaining). This article, in highlighting the ethical issues raised by the clinical trial in question, attempts to suggest what Ghanaian healthcare professionals, policymakers, and the national government can do (and how) to institute workable, enforceable measures towards ending the practice of chaining PWMI in Ghana.