Ethical Standards for Transnational Mental Health and Psychosocial Support (MHPSS): Do No Harm, Preventing Cross-Cultural Errors and Inviting Pushback

Important components of bioethics are routinely underappreciated in cross-cultural and transnational mental health and psychosocial
support (MHPSS) efforts. This article provides case examples of cultural errors and/or harm by outsiders delivering MHPSS
on different continents. The errors illustrate violations of informed consent (principle of autonomy) and avoiding harm (nonmaleficence).
Ethical cultural adaptation standards are presented in order to avert such errors. Given the real risk of outsiders applying
culturally erroneous and/or harmful practices in the process of delivering aid, the ability to discern pushback (resistance
and redirection by intended beneficiaries) can yield ethically significant data. Actively inviting pushback is proposed as
an additional methodology for ethical cultural adaptation with the purpose of at least gaining informed consent and, at best,
shaping the most beneficent MHPSS.