Ilina Singh

• Professor at University of Oxford

Hybrid Green Spaces in psychiatric intensive care units offer a transformative approach to mental healthcare environments, addressing tensions between therapeutic intent and institutional control. Drawing on our CAMHS PICU case, we demonstrate how (co)produced biodiverse outdoor spaces can actively mediate challenges across risk management, spatial...

How we should design and interact with social artificial intelligence depends on the socio-relational role the AI is meant to emulate or occupy. In human society, relationships such as teacher-student, parent-child, neighbors, siblings, or employer-employee are governed by specific norms that prescribe or proscribe cooperative functions including h...

Background Adolescent mental health is vital for public health, yet many interventions fail to recognise adolescents as proactive community contributors. This paper discusses the co‐design and acceptability testing of a chat‐story intervention to enhance Brazilian adolescents' participation in the promotion of mental health in their peer communitie...

Objectives This study investigated how Brazilian young people perceive their role in promoting and supporting their peer community’s mental health and well-being, and the conditions and contexts influencing their engagement. Design Co-produced qualitative study using in-depth interviews and focus groups with adolescents. The sessions were audio-re...

A growing body of research is connecting global environmental degradation to negative impacts on mental health and human flourishing. Meanwhile, international research and policy agendas are targeting the sustainable development of human health and flourishing. Here we argue that these research and policy approaches are too narrow, because they lar...

Background Urbanisation is taking place worldwide and rates of mental illness are rising. There has been increasing interest in ‘nature’ and how it may benefit mental health and well-being. Aims To understand how the literature defines nature; what the characteristics of the nature intervention are; what mental health and well-being outcomes are b...

The rapidly advancing field of brain-computer (BCI) and brain-to-brain interfaces (BBI) is stimulating interest across various sectors including medicine, entertainment, research, and military. The developers of large-scale brain-computer networks, sometimes dubbed ‘Mindplexes’ or ‘Cloudminds’, aim to enhance cognitive functions by distributing the...

Background Use of personal sensing to predict mental health risk has sparked interest in adolescent psychiatry, offering a potential tool for targeted early intervention. Objectives We investigated the preferences and values of UK adolescents with regard to use of digital sensing information, including social media and internet searching behaviour...

Background The COVID-19 pandemic and associated lockdown measures have posed a major risk to young people’s wellbeing, which might be ameliorated by peer-led programmes. Using a randomised controlled trial (ISRCTN registry, number ISRCTN77941736 https://doi.org/10.1186/ISRCTN77941736), we tested the short-term efficacy of an online peer-led interve...

Digital Mental Health Technologies (DMHTs) have the potential to close treatment gaps in settings where mental healthcare is scarce or even inaccessible. For this, DMHTs need to be affordable, evidence-based, justice-oriented, user-friendly, and embedded in a functioning digital infrastructure. This viewpoint discusses areas crucial for future deve...

Many research institutions and funders have recently stated their commitment to actively support and promote ‘Equality, Diversity and Inclusion’ (EDI) in various aspects of health research including Patient and Public Involvement (PPI). However, translating this commitment into specific research projects presents significant challenges that existin...

This paper explores the dilemma faced by mental healthcare professionals in balancing treatment of mental disorders with promoting patient well-being and flourishing. With growing calls for a more explicit focus on patient flourishing in mental healthcare, we address two inter-related challenges: the lack of consensus on defining positive mental he...

LANGUAGE NOTE | Document text in English; abstract also in Chinese. 腦機介面 (BCIs) 是大腦和電腦無需人工交互即可直接交流的一系列技術。隨著人工智能 (AI) 時代的到來，我們需要更多地關注腦機介面和人工智能的融合所帶來的倫理問題。那麼，與機器一起思考會帶來什麼樣的倫理問題？在本文中，圍繞這一主題，我們將重點關注以下問題：自主性、完整性、身分認同、隱私，以及作為一種增強的方式，該技術在兒科領域的應用會帶來怎樣的風險和潛在收益。我們的結論是，雖然該技術存在多種令人擔憂的問題，同時也有可能帶來好處，但仍存在很大的不確定性。如果生命倫理學家想在這一領域有所建樹，他們就應該做好準備來迎接我們對醫學和醫療保健領域中一些我們視為核...

The concept of mental integrity is currently a significant topic in discussions concerning the regulation of neurotechnologies. Technologies such as deep brain stimulation and brain-computer interfaces are believed to pose a unique threat to mental integrity, and some authors have advocated for a legal right to protect it. Despite this, there remai...

Objectives We assess different approaches to seeking consent in research in secondary schools. Design We review evidence on seeking active versus passive parent/carer consent on participant response rates and profiles. We explore the legal and regulatory requirements governing student and parent/carer consent in the UK. Results Evidence demonstra...

Background: Young people have the potential to be effective agents within their communities, and can play a critical role in promoting their peers’ mental health and well-being. But do young people feel a sense of agency and responsibility towards promoting their peers’ mental health and well-being? This co-produced study mapped how Brazilian young...

The Autism Voices study draws on novel inclusive methods to obtain the first-person experiences of autistic youth with a range of cognitive and verbal abilities. Thirty-one autistic youth were interviewed with a strength-based protocol, enabling them to provide responses in the modality of their choice. Dynamics between youth and their environments...

A growing number of technologies are currently being developed to improve and distribute thinking and decision-making. Rapid progress in brain-to-brain interfacing and swarming technologies promises to transform how we think about collective and collaborative cognitive tasks across domains, ranging from research to entertainment, and from therapeut...

Context: The use of biological materials raises diverse ethical concerns and there is insufficient research into the views of stakeholders on these concerns. Aims: This study investigated healthcare providers’ (HCPs) and clients’ perspectives on giving feedback about biological samples that are used in research and sharing of subsequent benefits. S...

The Bloomsbury Handbook of Theories in Childhood Studies showcases the cutting-edge theoretical work that has been produced within the field of childhood studies. It speaks to both scholars and students in the field by addressing basic questions such as what childhood is, how childhoods are diversely constructed and how children’s experiences can b...

Objective This study aimed to assess US/UK adults’ attitudes towards COVID-19 ventilator and vaccine allocation. Design Online survey including US and UK adults, sampled to be representative for sex, age, race, household income and employment. A total of 2580 participated (women=1289, age range=18 to 85 years, Black American=114, BAME=138). Inter...

Background Involving young people (YP) as co‐researchers (YCoR) in mental health research is important for ethical and epistemological reasons. However, approaches to involve and evaluate ‘meaningful involvement’ in complex qualitative mental health research, and how to evaluate impacts (or change) for the co‐researcher and the research is less wel...

Background Over the last decades, the neurosciences, behavioral sciences, and the social sciences have all seen a rapid development of innovative research methods. The field of bioethics, however, has trailed behind in methodological innovation. Despite the so-called “empirical turn” in bioethics, research methodology for project development, data...

Background: Involving young people (YP) as co-researchers (YCoR) in mental health research is important for both ethical and epistemological reasons. However, approaches to involve and evaluate ‘meaningful involvement’ in complex qualitative mental health research, and how to evaluate impacts (or change) for both the co-researcher and the research...

Opportunities to communicate first-person perspectives are essential for self-determination. However, many autistic youth are excluded from sharing their perspectives, specifically those who are minimally verbal or with lower intellectual functioning. Current challenges to capturing their voices include a lack of appropriate inclusive methodologies...

Calls for diversity in genomics have motivated new global research collaborations across institutions with highly imbalanced resources. We describe practical lessons we have learned so far from designing multidisciplinary international research and capacity-building programs that prioritize equity in two intertwined programs — the NeuroGAP-Psychosi...

Utilising science and technology to maximize human performance is often an essential feature of military activity. This can often be focused on mission success rather than just the welfare of the individuals involved. This tension has the potential to threaten the autonomy of soldiers and military physicians around the taking or administering of en...

Background Advances in genetics and digital phenotyping in psychiatry have given rise to testing services targeting young people, which claim to predict psychiatric outcomes before difficulties emerge. These services raise several ethical challenges surrounding data sharing and information privacy. Objectives This study aimed to investigate young...

Purpose Effective intervention, policy, and research in mental health and well-being (MHWB) requires young people to be understood not only as beneficiaries, but also as active agents in codesigning and implementing initiatives. To identify pathways for young people’s participation in promoting MHWB in low- and middle-income countries (LMICs), this...

Adolescents often look to their peers for emotional support, so it is critical that they are prepared to take on a supportive role, especially during a health crisis. Using a randomised controlled trial (ISRCTN99248812, 28/05/2020), we tested the short-term efficacy of an online training programme to equip young people with skills to support to the...

Introduction Clinical depression is usually treated in primary care with psychological therapies and antidepressant medication. However, when patients do not respond to at least two or more antidepressants within a depressive episode, they are considered to have treatment resistant depression (TRD). Previous small randomised controlled trials sugge...

It is becoming increasingly clear that the field of empirical bioethics requires methodological innovations that can keep up with the scale and pace of contemporary research in health and medicine. With that in mind, we have recently argued for Design Bioethics—the use of purpose‐built, engineered research tools that allow researchers to investigat...

"Across the globe the phenomenon of digital phenotyping – the collection and analysis of digital data for mental health – is growing increasingly popular within the education sector. Schools enter collaborations with health care providers, often with the aim to support young people and to reduce the risk for severe mental health challenges, self-ha...

Background Advances in genetics and digital phenotyping in psychiatry have given rise to testing services targeting young people, which claim to predict psychiatric outcomes before difficulties emerge. These services raise several ethical challenges surrounding data sharing and information privacy. Objectives This study aimed to investigate young...

Background Since the 1990s, increasing research has been devoted to the identification of biomarkers for autism to help attain more objective diagnosis; enable early prediction of prognosis; and guide individualized intervention options. Early studies focused on the identification of genetic variants associated with autism, but more recently, resea...

Background: Adolescents often look to their peers for emotional support, so it is critical that they are prepared to take on a supportive role, especially during a health crisis. Using a pilot randomised controlled trial (ISCRN registry, number ISRCTN99248812), we tested the efficacy of an online training programme designed to equip young people wi...

The Africa Ethics Working Group (AEWG) is a South-South-North collaboration of bioethics and mental health researchers from sub-Saharan Africa, working to tackle emerging ethical challenges in global mental health research. Initially formed to provide ethical guidance for a neuro-psychiatric genomics research project, AEWG has evolved to address cr...

Alzheimer’s disease (AD) research, treatment, and prevention focus increasingly on developing personalized interventions based on personal genetic, biological, phenotypic data, for early intervention (EI) to limit harm. This approach has much to recommend it, but important ethical and philosophical challenges follow that should be considered, which...

Purpose Since the U.S. Food and Drug Administration approved sales of genetic tests for late-onset Alzheimer’s disease (LOAD) risk, a heated debate has arisen over whether these tests should indeed be offered online and direct-to-consumer (DTC). As this debate progresses, it is important to understand the ethical perspectives and motivations of you...

Background : Several social and policy developments have led to research partnerships in mental health research, which depart from traditional research models. One form of such partnerships is among Research institutions, Industry (pharmaceutical and biotech) and People with lived experience of mental illness (RIPs) in the NIHR services. There are...

Data platforms represent a new paradigm for carrying out health research. In the platform model, datasets are pooled for remote access and analysis, so novel insights for developing better stratified and/or personalised medicine approaches can be derived from their integration. If the integration of diverse datasets enables development of more accu...

Empirical research in bioethics has developed rapidly over the past decade, but has largely eschewed the use of technology-driven methodologies. We propose “design bioethics” as an area of conjoined theoretical and methodological innovation in the field, working across bioethics, health sciences and human-centred technological design. We demonstrat...

Data platforms represent a new paradigm for carrying out health research. In the platform model, datasets are pooled for remote access and analysis, so novel insights for developing better stratified and / or personalised medicine approaches can be derived from their integration. If the integration of diverse datasets enables development of more ac...

Our author-Professor of Neuroscience & Society at the University of Oxford and co-director of the Wellcome Trust Center for Ethics and Humanities-reflects on efforts to grow recognition of neuroscience in low- and middle-income countries.

Background: Several social and policy developments have led to research partnerships in mental health research, which depart from traditional research models. One form of such partnerships is among research institutions, industry (pharmaceutical and biotech) and people with lived experience of mental illness (RIPs). There are several benefits but a...

Advancements in mental health research, social changes and policy developments have led to the emergence of new forms of research partnerships, which bring together research institutions, public companies and lay people as partners in the same research project. In this paper, we argue that partnerships comprised of industry, academia and people wit...

The COVID‐19 pandemic is having a pervasive effect on young people's mental health and well‐being, giving rise to feelings of deep uncertainty and lack of control. Inspired by Amartya Sen's capabilities framework, we argue that building capacity and creating opportunities for community and civic engagement during this time will help young people ga...

Background Dementia has been described as the greatest global health challenge in the 21st Century on account of longevity gains increasing its incidence, escalating health and social care pressures. These pressures highlight ethical, social, and political challenges about healthcare resource allocation, what health improvements matter to patients,...

Background Dementia has been described as the greatest global health challenge in the 21st century on account of longevity gains increasing its incidence, escalating health and social care pressures. These pressures highlight ethical, social, political challenges about healthcare resource allocation, what health improvements matter to patients, and...

Research in bioethics largely relies on interviews and surveys, which engage participants with scenarios that are distal in time and place to an actual situation. However, context and embodiment are relevant to moral decision-making. Due to the potential to immerse participants in a simulated environment, purpose-built games and scenarios might pro...

New ethics are needed for twenty-first-century psychiatry. This chapter considers innovations in psychiatry that either raise new ethical questions for psychiatry or require a revision of prior understanding of what constitutes ethical behaviour in a psychiatric context. The chapter begins by examining two novel neurointerventions at opposite poles...

In the UK, medical cannabis was approved in November 2018, leading many patients to believe that the medicine would now be available on the NHS. Yet to date, there have been only 12 NHS prescriptions and less than 60 prescriptions in total. In marked contrast a recent patient survey found 1.4 million people are using illicit cannabis for medical pr...

Psychiatric genetic research investigates the genetic basis of psychiatric disorders with the aim of more effectively understanding, treating, or, ultimately, preventing such disorders. Given the challenges of recruiting research participants into such studies, the potential for long‐term benefits of such research, and seemingly minimal risk, a str...

The attempt to identify individuals at the very early stages of psychotic illness, before they suffer from a psychotic episode, has clinical, ethical, and social implications. In this chapter, we provide an overview of the ethical issues that arise from the attempt to identify and treat psychosis risk. We organize such concerns around four question...

Context Both within politics and practice, the field of psychiatry is undergoing a significant transformation, as increasing emphasis is placed on the importance of involving those with lived experience in research. In response to this participatory turn, a push towards measuring the impact of patient involvement is also growing, seeking to identif...

Most research regarding youth with autism spectrum disorder has not focused on their first-person perspectives providing limited insight into methodologies best suited to eliciting their voices. We conducted a synthesis of methods previously used to obtain the first-person perspectives of youth with various disabilities, which may be applicable to...

Introduction Matching treatment to specific patients is too often a matter of trial and error, while treatment efficacy should be optimised by limiting risks and costs and by incorporating patients’ preferences. Factors influencing an individual’s drug response in major depressive disorder may include a number of clinical variables (such as previou...

Context The 1989 UN Convention on the Rights of the Child states that children have the right to be heard in all matters affecting them. The Convention inspired a surge in research that investigates young people's perspectives on health and wellness‐related concerns and that involves children as ‘co‐researchers'. Young people's advisory groups (YPA...

Over the last decade, there has been an explosion of digital interventions that aim to either supplement or replace face-to-face mental health services. More recently, a number of automated conversational agents have also been made available, which respond to users in ways that mirror a real-life interaction. What are the social and ethical concern...

There is substantial interest in the possibility that cognitive skills can be improved by dedicated behavioral training. Yet despite the large amount of work being conducted in this domain, there is not an explicit and widely agreed upon consensus around the best methodological practices. This document seeks to fill this gap. We start from the pers...

The NeuroDev study will deeply phenotype cognition, behavior, dysmorphias, and neuromedical traits on an expected cohort of 5,600 Africans (1,800 child cases, 1,800 child controls, and 1,900 parents) and will collect whole blood for exome sequencing and biobanking.

There is substantial interest in the possibility that cognitive skills can be improved by dedicated behavioral training. Yet despite the large amount of work being conducted in this domain, there is not an explicit and widely agreed upon consensus around the best methodological practices. This document seeks to fill this gap. We start from the pers...

Psychiatric genomics has the potential to radically improve the prevention and early intervention of serious mental and neurodevelopmental disorders worldwide. However, little work has been done on the ethics of psychiatric genomics—an oversight that could result in poor local uptake, reduced practical/clinical application, and ethical violations i...

Early intervention (EI) aims to identify children or families at risk of poor health, and take preventative measures at an early stage, when intervention is more likely to succeed. EI is concerned with the just distribution of “life chances,” so that all children are given fair opportunity to realize their potential and lead a good life; EI policy...

The debate about the desirability of using drugs to enhance human skills encompasses cognitive abilities such as memory and attention, and moral capacities such as emotional empathy and a sense of fairness. These two strands of literature in bioethics have grown relatively independent from each other, and an implicit framing assumption has emerged...

Neuroenhancement involves the use of neurotechnologies to improve cognitive, affective or behavioural functioning, where these are not judged to be clinically impaired. Questions about enhancement have become one of the key topics of neuroethics over the past decade. The current study draws on in-depth public engagement activities in ten European c...

In this article, we present a pragmatic approach to neuroethics, referring back to John Dewey and his articulation of the “common good” and its discovery through systematic methods. Pragmatic neuroethics bridges philosophy and social sciences and, at a very basic level, considers that ethics is not dissociable from lived experiences and everyday mo...

Increasingly, national governments across the globe are prioritizing investments in neuroscience. Currently, seven active or in-development national-level brain research initiatives exist, spanning four continents. Engaging with the underlying values and ethical concerns that drive brain research across cultural and continental divides is critical...

In this response to Bortolotti and Jefferson (2018), we discuss the action‐guidance problem of moral attributes and the risk of superiority illusion in early intervention for psychosis. First, we suggest that guidance documents are not devoid of behavioural recommendations and goals for service provision, though these are not linked to the ethical...

Appendix S1 England clinical guidelines relevant to EIP services.

Appendix S3 Moral attributes of clinicians: Sample quotes.

Appendix S2 Ethical requirements of service delivery: Sample quotes.

Background In many countries, a young person who seeks medical care is not authorised to consent to their own assessment and treatment, yet the same child can be tried for a criminal offence. The absence of child and adolescent mental health legislation in most countries exacerbates the issues young people face in independently accessing mental hea...

Patients have received experimental pharmaceuticals outside of clinical trials for decades. There are no industry-wide best practices, and many companies that have granted compassionate use, or ‘preapproval’, access to their investigational products have done so without fanfare and without divulging the process or grounds on which decisions were ma...

Attention deficit−hyperactivity disorder (ADHD) has been a common psychiatric diagnosis in both children and adults since the 1980s and 1990s in the United States. But the diagnosis was much less common—even unknown—in other parts of the world. By the end of the twentieth century, this was no longer the case, and ADHD diagnosis and treatment became...

Background: Guidelines suggest the patient community should be consulted from the outset when designing and implementing basic biomedical research, but such patient communities may include conflicting views. We examined how engagement occurred in one such instance. Objective: Our objective was to scrutinize patient and public involvement (PPI) b...

This paper reports on an online contrastive vignette study investigating the public's views of gene editing for therapy and enhancement in adult and prenatal contexts. The study, comprising quota samples of 1000 respondents per country, involved 10 European countries and the United States. Vignettes featuring gene editing for therapy compared to en...

Few empirical studies in the UK have examined the complex social patterns and values behind quantitative estimates of the prevalence of pharmacological cognitive enhancement (PCE). We conducted a qualitative investigation of the social dynamics and moral attitudes that shape PCE practices among university students in two major metropolitan areas in...

Parental Responsibility in the Context of Neuroscience and Genetics, by Kristien Hens, Daniela Cutas, and Dorothee Horstkötter. Cham, Switzerland: Springer International Publishing; 2017. 246 pp. - Volume 26 Issue 4 - Arianna Manzini, Rose Mortimer, Ilina Singh

Scientific understanding of genetically driven, neurobiological pathways that contribute to diverse developmental outcomes in children has advanced considerably in the past decade. As knowledge accumulates, various aspects of a child’s health, wellbeing, and even character, are increasingly framed as amenable to external control, through pharmacolo...

Background Early Intervention in Psychosis (EIP) services have been implemented with the dual aims of preventing harmful outcomes associated with early‐onset psychosis and improving prognosis. However, concerns have been raised regarding the ethical implications of involving young people in EIP services. One way to ensure high ethical standards and...

Jonsson et al.'s excellent review of the literature on quality of life (QoL) and childhood mental and behavioural disorders (Jonsson et al., 2017) highlights the need for studies that utilise child self-reported QoL, in contrast to parent or proxy QoL measures, and further challenges the field to develop QoL measures that ‘put the child's own views...

We present a review and analysis of the ethical considerations in off-label ketamine use for severe, treatment-resistant depression. The analysis of ethical considerations is contextualised in an overview of the evidence for ketamine use in depression, and a review of the drug's safety profile. We find that, based on current evidence, ketamine use...

Neurosurgical interventions for psychiatric disorders have a long and troubled history (1, 2) but have become much more refined in the last few decades due to the rapid development of neuroimaging and robotic technologies (2). These advances have enabled the design of less invasive techniques, which are more focused, such as deep brain stimulation...