IoMH International Conference 2022 – Reflecting the complex, nuanced and multifaceted nature of mental health research

This blog was written by Freya Robb, Senior Press Officer for Science Media Centre

The third Institute of Mental Health International Conference took place on the 21^st September 2022. This was the first time the conference had been held in person and was a sell-out event.

Led by its Director, Professor Anthony David, the UCL Institute of Mental Health was created to bring together the best interdisciplinary research to help tackle mental illness. This year’s conference aimed to reflect this broad and diverse approach, covering some key topics of interest that are at the forefront of public discussion and interest.

Session 1:

It therefore felt apt that the first session focused on COVID and what the latest research was telling us about the impact on the brain and mental health, introduced by Alan Thompson, Dean of the Faculty of Brain Sciences. First up, Dr Gwenaelle Douaud (Associate Professor and MRC Career Development Fellow at the University of Oxford) covered work looking at the impact of SARS-CoV-2 infection on the brain, taking advantage of the Biobank dataset which provided Gwanaelle and her team with brain scans before COVID infection to help provide a key insight into any structural changes. The results of this work were concerning as there were significant though small differences in brain regions connected with smell and perception, the majority of whom had had mild disease. Further study is needed to assess whether these changes are transient and also what the clinical symptoms and implications of these changes are.

Next up Dr Maxime Taquet (Oxford Health BRC Senior Research Fellow, University of Oxford) talked the audience through his team’s work on investigating the risk of neurological and psychiatric diagnoses up to 2 years after SARS-CoV-2 infection, with the use of electronic health records. While there was good news to be heard in regards to the increased risk of anxiety or depression since they seem to  subsided after a couple of months, the risks of some neurological and psychiatric sequelae (including brain fog, dementia, psychotic disorder and epilepsy) continued to be diagnosed at a higher rate 2 years after infection when compared to other respiratory infections. Children, had a lower risk profile overall showing the same levelling off in risk of anxiety and depression risk, and positively brain fog appeared to be a transient symptom, but there remained a heightened risk of epilepsy and seizures, although still in low absolute numbers.

Despite the good news that risk of anxiety and depression from infection itself was not elevated after infection, the next session by Dr Daisy Fancourt (Associate Professor of Psychobiology & Epidemiology and Head of the Social Biobehavioural Research Group at UCL) focused on the psychological impact of the pandemic as a whole. The COVID-19 Social Study was set up with a large cross section of volunteers throughout the UK, and running before the first lockdown in the UK, helping real time weekly insights into the mental health of the population. In sharing some of their key findings from the pandemic, Daisy discussed which groups were most significantly affected, highlighting both the importance of protective factors such as social support networks and risk factors such as poverty and belonging to a marginalised group to help to disentangle the complexities and nuances of the psychological responses to the twists and turns of the last few years.

Session 2:

The second session, introduced by Dr Gemma Lewis (Sir Henry Dale Fellow, UCL), covered an issue that has been the subject of debate and discussion for a much longer period of time – how best to treat depression.

It began with a talk from Prof Glyn Lewis (Director of the UCL Division of Psychiatry), about the evidence on antidepressants and how that has been reflected in public debate and in the media. He discussed that while there are problems in the existing literature and an overreliance on data produced by pharma for regulatory purposes, more recent data such as those from the UK NIHR-funded PANDA and ANTLER trials, do demonstrate that antidepressants are valuable tools in treatment of depression as they are used today. Despite this, much of the media focus and debate remains rooted against the use of antidepressants. Glyn finished his talk urging a greater focus on developing new and better treatments for these individuals rather than arguing about the existing ones where there is good evidence they work.

Prof Steven Pilling (Director of Clinical, Educational and Health Psychology at UCL) then discussed his  work in creating clinical guidelines that have culminated from decades’ worth of psychological research, looking at both the efficacy of different treatments but also the practical realities of engaging patients, such as with group therapies. He spoke of the positive results that has been seen with the IAPT programme and how patient preference must be a key part of clinical decision making. The key remaining issues were summarised as not knowing how will respond best to which treatments and the role of early intervention and picking up on risk factors in early life.

The final presentation of this session was from Dr Tania Gergel (Wellcome Trust Senior Research Fellow, IoPPN, King’s College London) who picked up on aspects of Glyn’s talk and tackled the media discussion around mental health citing two recent examples, on ECT and depression. In both, she explained there were similarities in that misrepresentation of the evidence around these treatments are often led by ideology and emotive language, and how harmful this can be for both the general public but particularly patients in understanding the evidence.

Gemma summarised the session pulling out key themes, including the need for good public health messaging around treatments and medications while continuing to work towards new and improved interventions, especially those targeting primary prevention of mental illness in young people.

Session 3:

The last group session was best characterized as a challenging of assumptions often held by those outside of the research field of mental health in conflict, war and trauma.

Dr Tayla Greene (Associate Professor at the University of Haifa) began with discussing the impact of conflict and war on civilians, starting by citing the 938 million people who are currently living in fragile or conflict situations, challenging the idea that it not simply the most recent conflict that makes the news where this is occurring. She discussed the stronger evidence base we have on supporting refugees once they have fled the danger but that it is much harder to both help in and research best practice for those who are unable to leave areas of conflict. She described the principles needed to guide work conflict, including an acknowledgement that some interventions may cause harm, working in partnership with those already on the ground, being aware of cultural sensitivities, and having the sustainability and scalability at the forefront of the work in large and ongoing crises.

Next up we heard from Dr Tejendra Pherali (Associate Professor in Education and International Development at UCL) who gave fascinating insights from the education perspective, demonstrating how important interdisciplinary discussion can be in this area – from the more recognised impact that conflict can really harm education but also that education is seen and can be a source of violence and harm as well.

The final talk was from Prof Sir Simon Wessely (Interim Executive Dean at IoPPN, King’s College London) who’s focus was on the mental health of military personnel. He asked the audience to pick out the facts and fictions in some common tropes about the mental health of those who serve in the armed forces, revealing that veterans are no more likely to be ‘mad, bad, or sad’ than the general population, in fact often demonstrating higher levels of mental health and resilience. He concluded that war and military service absolutely does change a person, but it’s important to be able to distinguish those who have horrible experiences during their service and those who are left with psychiatric disorders which require medical intervention.

Dr Aseel Hamid (Clinical Research Fellow in the Department of Clinical, Educational and Health Psychology, UCL) summed up the session in highlighting the unique psychological profile and risks to military personnel, those who remain in places conflict compared to those who have left, and those providing support in these place, and the need for better research on best practices on longer term interventions for those in long standing areas of instability and conflict.

Keynote:

For the final talk of the day, we heard from Dr Tom Insel who led the National Institute of Mental Health (MIMH) from 2002 to 2015 and is now MD of Vanna Health – a start-up helping people with serious mental illness engage in psychosocial and supportive care. He began by asking the audience to think about why, as we’ve appeared to have seen real improvement in terms of effective interventions and increased access to these treatments, outcomes appear to be getting worse at a population level? Citing data from the US, he suggested that deaths of despair in those under 30 will way surpass those caused by COVID-19.

He summed this up as a care crisis and that more research, that can take decades to enter clinical practice, was not necessarily an immediate solution – “My house is on fire and you’re discussing the chemical composition of paint” – but instead, a focus on investment in capacity, engagement with patients, higher quality training, accountability and recovery based care. He also highlighted the important role of that digital platforms can play in accessing proven interventions. He concluded that while serious mental illness is indeed a medical issue, solutions in social, environmental and political efforts are key in achieving improvements in morbidity and mortality.

Conclusions:

The conference wrapped up with speakers and attendees discussing the day’s sessions over a glass of wine. From the very new issue of studying the impact of COVID, to the treatment of depression which has challenged mental health researchers for centuries. And from well-studied interventions such as SSRIs, to the unknown potential of new digital platforms and technologies. This conference brought together a real mix of disciplines and perspectives, reflecting the complex, nuanced and multifaceted nature of what drives good and poor mental health.

Some of the speakers also took part in podcasts to discuss the themes of their talks, which you can listen to here: https://shows.acast.com/iomhconf2022/episodes