1. The UCL IoMH International Conference (supported by the Grand Challenge of Mental Health & Wellbeing and the charity, MHRUK) is the only UK conference dedicated to the whole spectrum of mental health research – from nerve cells to social policy; from Alzheimer’s to Autism; from data to dialogue.
2. It is not run by a professional organisation; it is not sponsored by the pharmaceutical industry. There is no exam at the end. It is not about a particular condition or treatment modality but tries to take the best of all of these.
3. It’s live! Not one of those online insomnia cures that you have on in the background with your camera off, hoping somehow that new ideas and knowledge will somehow passively seep into you mind. No, this is a proper meeting where other engaged, impressive (sometimes infuriating) human beings will discuss, argue (and hopefully tell a few jokes) while imparting some of the most up-to-date and exciting research and ideas on mental health and illness.
4. This year, as before, we will be taking on some of the most pressing and sometimes controversial issues of the day. You’ll get to hear a plenary lecture from the new Director of the Dementia Research Institute Siddarthan Chandran, the first since he joined UCL, on new treatments based on translational research. This will be followed by a more sceptical view of the new Alzheimer drugs from Rob Howard. And coving the entire biopsychosocial spectrum we are also welcoming Ian James from Northumberland who is an expert in non-pharmacological interventions. We will also be discussing autism and neurodiversity. Flying in from the New York State Psychiatric Institute will be Jeremy Veentra-WanderWeele who is head of the Centre for Autism and the Developing Brain – which gives you a flavour of what he will be talking about. Antonia Hamilton will give us the latest on social cognition while Ginny Russell from Exeter will be broadening out the discourse into what autistic people make of such research and how those with lived experience and those who in some circumstances may need to care for them, differ in their outlook. The congress will finish with a lecture from Sir Mike Owen one of the world’s leading psychiatric geneticists who will take us beyond nature vs nurture to how our inheritance interacts with the environment in conditions like schizophrenia and bipolar disorder, and can point us in the direction of new treatments and biomarkers. https://www.ucl.ac.uk/mental-health/iomh-conference/conference-programme. We are also taking on a topic which is not automatically included in mental health discussions but which is among the greatest challenges of our age: climate change. Elizabeth Marks from Bath will introduce us to the problem of climate anxiety and Kris de Meyer, from UCL will give us a neuroscience perspective.
5. Built into each conference theme there will be plenty of time for discussion, led by other experts from UCL but with ample scope for audience participation.
6. There will be posters as well as oral presentations, so that early career researcher will get a chance to show what they are up to and get feedback from an interested and informed audience.
7. The cost of attending is incredibly reasonable given that it includes lunch, coffee and tea – and there are concessions for students and those eager (and well-organised) early birds. If you want to hob-nob with the presenters and other delegates, you can sign up for the wine reception afterwards. https://www.ucl.ac.uk/event-ticketing/app/?ev=24077
8. The majority of the audience comprises of both researchers and clinicians although people with lived-experience or carers or the merely curious are all welcome.
9. Mid-September is before the start of the new University term, you’ll be back from your holidays, so you will have some time on your hands. The weather is probably going to be a bit meh so what better way is there to get up to speed on mental health topics if you are a student or academic?
10. It’s just one day!

We look forward to seeing our research community come together on 18th September. We are offering a special rate for “early birds” who book before 1 July: www.ucl.ac.uk/mental-health/iomh-conference/conference-registration

Written by Shruti Menon, MSc Student, UCL Division of Psychiatry

I recently attended a webinar held on 22 May 2024 by a team of mental health researchers at the UCL Institute of Mental Health (IoMH) and Generating Research Insights for Development (GRID) Council, India. This was to facilitate a discussion about the quantitative investigation of suicide risk in patients with cancer using routine data in which there was also the opportunity to access Stata/R/Python code and analysis plans from previous analyses. The webinar was supported by the UCL Global Engagement Fund and attended by clinicians and researchers working with data in India, Sri Lanka, Bangladesh, Pakistan, Bhutan, Nepal, Afghanistan and the Maldives. I enrolled as a student in the UCL MSc course in Clinical Mental Health Sciences as I was interested in learning more about how to access and analyse cancer registry data in order to investigate mental health outcomes.

The webinar began with a warm introduction to the event from Dr Neethu Mohan, executive at the State Health Agency of Kerala. Dr Mohan briefly elucidated the aim of the webinar to promote the analysis of cancer registry data linked to mortality data as it would help answer key questions in suicide research. 

This was followed by insights into the findings of a systematic review by Heinrich et al (2022) from Dr Alexandra Pitman at UCL Division of Psychiatry. Through her work as a psychiatrist in a cancer team, she described her experience of having observed the impact of cancer on the mental health of people with cancer including their risk of suicidal thoughts. She summarised the findings which indicated that the risk of suicide was significantly higher in patients with cancer compared to the general population. It highlighted how the mental health needs of cancer patients are often overlooked and how factors including time since diagnosis and stage of cancer are linked to the risk of suicide. Dr Pitman emphasised the need to not only monitor the psychological health of people with cancer but to inquire carefully about any suicidal thoughts and screen for untreated depression and anxiety to improve outcomes and well-being. Finally, the Heinrich et al systematic review also brought attention to the geographical gaps in research literature on this topic as the review was limited to studies conducted in high-income countries.

The webinar then provided participants with an opportunity for discussion in which participants were invited to share their clinical experiences and research priorities. Participants described issues such as medical staff not being trained to screen for mental health problems and suicidal thoughts. Such training could be crucial in vulnerable periods such as immediately after a cancer diagnosis when evidence demonstrates that the risk of suicide is heightened. Important research questions were also raised such as the role of psychiatric conditions in increasing suicide risk in patients with cancer and whether treatment expenditure or lack of social support could potentially heighten the risk of suicide. Participants pointed out the importance of acknowledging to patients how distressing a cancer diagnosis can be so that patients might find it acceptable to disclose any struggles with suicidal thoughts.

Dr Katherine Thackray (née Henson), a data analyst in the National Disease Registration Service (NDRS) at NHS England discussed the methods used in her population-based analysis of English cancer registry data investigating the risk of suicide after cancer diagnosis (Henson et al, 2019). She provided a detailed overview of the analysis, including the statistical techniques used, and sub-groups evaluated. She also outlined the methodological considerations when replicating the analysis such as considering biases in data ascertainment. She highlighted a key limitation of the study which was that due to challenges with linking cancer registry datasets with mental health datasets, the influence of psychiatric disorders on suicide risk in people with cancer could not be explored. She summarised the results of the study which indicated that the risk of suicide was 20% higher in individuals with cancer than in the matched general population, and the increased risk was particularly marked in the first six months post-diagnosis. She also noted that the risk of suicide may have been underestimated as suicide tends to be underreported as a cause of death. Dr Thackray emphasised the implication of these findings namely the potential to prevent these deaths through additional support.

Dr Justin Yang, Research Fellow in the UCL Division of Psychiatry provided a summary of the code used in the study by Henson et al (2019) including details about the variables and confounders to be considered. He also elaborated on various aspects of the analyses such as how to calculate the Standardised Mortality Rate (SMR). This talk illustrated how to conduct the analyses by providing examples of code in different statistical software packages such as Stata, R and Python. Dr Yang discussed the advantages and disadvantages of each of these software packages. While Stata is commonly taught in universities and has supportive online forums, cost can be a limiting factor. R is a free software package with useful statistical functions, however, less formal support tends to be available to researchers using it. While Python has a good capacity to handle large datasets and offers useful statistical functions, it might be the most challenging software to learn. Dr Yang emphasised that the best software to use would be that which one is most familiar with.

A second discussion ensued in which participants identified critical barriers in low and middle-income countries to investigating this research question such as paper records recording deaths, or administrative issues while linking cancer registry data to mortality data. Other important research questions were identified such as exploring the role of acquired capability for suicide in the context of cancer (as patients with cancer may have a reduced fear of death, a reduced pain threshold and/or access to lethal medications) and the need to explore more proximal outcomes than suicide. In particular, risk-taking or self-destructive behaviour such as alcohol use was identified as important to study in people with cancer. The inclusion of participants/researchers with lived experiences in primary research was recognised as beneficial. The participants brainstormed ways to navigate these practical issues, for example by collaborating with data guardians within organisations that collect registry data or using probabilistic data linkage methods to link datasets.

A wide range of resources were provided on the project website after the session, including annotated data analysis code (with Stata/R/Python versions), a list of 321 cancer registries across South Asia and access to a Slack channel for networking with potential collaborators. Through these resources, the project aimed to create a community of researchers and facilitate collaboration so that future analyses might identify any patient groups at risk who might need increased support. The longer-term goal was therefore to help reduce psychiatric co-morbidity in people with cancer.

I learned a lot about how to evaluate suicide risk in cancer patients using routine data in this webinar and was grateful to all the speakers, the participants for their key insights and the IoMH and GRID council for organising this webinar. I hope that this will foster collaboration among researchers interested in suicide prevention in people with cancer.

Links:

• Investigating risk of suicide in patients with cancer globally
• UCL Special Interest Group in Self-harm and Suicide

The fourth UCL Institute of Mental Health Conference explored a diverse range of topics including health economics, suicide prevention and cognitive neuroscience. UCL Wellcome PhD student Jennifer Fielder shares some of her highlights of the day.

As a PhD student in Mental Health Science, I was excited to hear some of the latest mental health research showcased by leading experts at the Institute of Mental Health (IoMH) Conference.

The first session on mind and body interactions followed warm welcomes from Professor Anthony David, director of UCL IoMH, and Professor Alan Thompson, Dean of the UCL Faculty of Brain Sciences. UCL’s Professor Sarah Garfinkel focused on how our ability to sense internal contexts and signals, known as interoception, shapes mental health. This covered her work on interoceptive training, where people learn to detect their heartbeats more accurately, which decreased anxiety in autistic adults for up to one year after the training. The talk finished with the exciting prospect that effective psychiatric treatments may work via interoceptive pathways. For example, one dose of the antidepressant Citalopram was found to increase interoceptive accuracy.

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Entries are invited for the 2023 Michael King Prize, which is awarded to the UCL PhD awardee with the best thesis on a subject relating to mental health. In this blog, last year’s winner Aaron Kandola, shares his experiences of the award and reveals what he’s been doing since then.

Last year I was awarded the Michael King Prize for my PhD thesis on the relationship between physical activity, fitness, and sedentary behaviour with depression and anxiety symptoms in the population.

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A project to bring South Asian music and dance to people with dementia will be showcased next month at Bloomsbury Theatre. Dr Naaheed Mukadam, the researcher behind the project, shares her experiences of this project.

I have been a dementia researcher for more than 15 years and have always focused on ethnic inequalities, initially in the diagnostic pathway and more recently in genetic risk, prevention and post diagnostic support.

My research has highlighted the stigma that can exist around memory loss and dementia and I have tried to counteract this during my career so far. I am used to the scientific method – hypothesis testing and use of both qualitative and quantitative methods to answer specific questions. However, after attending public engagement workshops at UCL and reflecting on the power of personal stories in connecting with others, I started to think about how else I could go about capturing the experiences of those with dementia and those who care for them. Music was one way of connecting that I thought would be quite universal.

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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.

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This blog was written by UCL Division of Psychiatry PhD Student, Ava Mason.

The Institute of Mental Health (IoMH) Special Interest Group in Psychological Trauma is an interdisciplinary group of UCL researchers and clinicians from our partner NHS trusts. The meetings within this group aim to provide opportunities for collaboration between academics and clinicians, raise the visibility of trauma research at UCL and develop a UCL-wide ‘trauma strategy’. The first meeting included a range of hot topic talks, whereby each of the members discussed their research or clinical focus to the 150 attendees.

Dr Michael Bloomfield who chaired the event explained how one third of individuals who experience psychosis have also experienced previous childhood trauma. Reporting recent results from a large multi-site international study, he stated that 69.9% of participants who had experienced childhood trauma and had an at-risk mental state also had undiagnosed PTSD or complex PTSD. Relating to trauma experienced by children in care, Dr Rachel Hiller discussed key work currently being conducted investigating transdiagnostic predictors of mental health outcomes.  This work could help to develop feasible and effective interventions and inform future service decision making for those in care.

The next hot topic was presented by Shirley McNicholas, who discussed multiple ways in which trauma informed care could be implemented, specifically referring to the women-only Drayton Park crisis house.  She discussed how the environment can be used as a therapeutic tool to help people feel safe, while environment seen as punishing and criminalising negatively impacts women who require support. Trauma informed care also involves helping people connect the past to the present to intervene appropriately, reducing misdiagnosis, inappropriate care planning and compounding self-isolation and shame.  A trauma informed organisational approach within Camden and Islington was then emphasised by Dr Philippa Greenfield.

She discussed the need to increase trauma informed culture embedded within all services and wider communities.  This involves challenging inequality and addressing secondary trauma in the workforce and with patients and acknowledging the impact of adversity and inequality on physical and mental health. Currently, trauma informed collaborative and Hubs have been established to help manage change from within organisations and monthly trauma informed training is being run for staff, service users and carers.

Dr Jo Billings highlighted the considerable impact of occupational trauma within the workplace.  Within the peak of the pandemic, this phenomenon had increased research focus, with studies finding 58% of workers meeting criteria for anxiety, depression, or PTSD.  Within global research on police workers, 25.7% drank hazardously and 14.2% met criteria for PTSD. Focusing on UK research on 253 mental health professionals, high rates of burnout and secondary traumatic stress have been reported.  Strategies that could mitigate this include increased reflective supervision, minimising work exposure where ethically possible and identifying individuals who may be at most risk.

Relating to plasticity enhanced psychotherapy, Dr Ravi Das discussed the importance of research aiming to improve synergy between drug and psychological treatments. Current medication for PTSD does not target causal mechanisms of PTSD, which may explain why many individuals with PTSD do not find medication effective. Drugs like Ketamine block NMDA receptors critical to memory formation and restores lost synaptic plasticity, preventing trauma memories from stabilising. This allows the memory and cognitions of the event to be altered during therapy. Future research should focus on specific medication that target mechanism of change itself to increase the effectiveness of PTSD treatments.

Dr Talya Greene discussed the impact of mass trauma, whereby the same event or a series of traumas affect many people at the same time. The current health system is not built to provide support to many individuals at once following an event, especially when the health workers themselves may be affected by the incident. Additionally, those that are affected by the event vary in many ways, from their cultural, mental health and trauma backgrounds to the way in which they were mentally or physically affected by the event itself. Focus is needed on the effects of early trauma responses on future health outcomes, and how to target groups that don’t normally access support due to physical difficulties or cultural background. Additionally, the current evidence base needs to be increased to see what may be effective specifically in the context of mass trauma settings.

Dr Mary Robertson and Dr Sue Farrier discussed various specialist services within Camden and Islington. One of these was the traumatic stress clinic, working with patients who have a history of complex trauma, including trafficking victims, war and conflict refugees, and individuals with a history of child abuse. The service helps to stabilise the individual before considering which trauma focused individual or group intervention to provide. Additionally, Operation Courage is the term used to describe several Veterans specialist mental health services. They offer comprehensive holistic assessment, referral to local services and in house social support, pharmacological and psychological treatment. These veteran services aim to offer quick support, working alongside statutory and non-statutory agencies where care is shaped by the service users. Alcohol and substance misuse is not seen as a barrier for treatment access, and services also provide peer support and consultation for carers and family.

The audience raised some relevant questions for the panel to discuss, such as how best to strengthen clinical and academic collaborations. Feedback suggested the need to quickly produce trauma informed digestible research that can be rapidly synthesised and relayed back to clinicians. The main barrier to this being a fundamental need for more funding to create a working relationship between academic and clinical services. Within under resourced clinical services, a network approach is required so clinicians can codevelop research questions with other colleagues and trainees to reduce research workload. The need to listen to the voice of marginalised groups within research was also discussed. This involves building a trusting relationship between researchers and BAME groups, to collaborate with service users and consider the impact of historical racism, family dynamics and cultural impact within trauma research. The panel also suggested ways to reduce occupational trauma through having a cohesive team where people can build resilience and support through integrating coping mechanism individually and as a team.

Lastly, Ana Antunes-Martins discussed the Institute of Mental Health Small Grants, providing funding for interdisciplinary teams of all mental health areas, prioritising applications focusing on mechanistic understanding of mental health.

The next meeting will focus more on some of the relevant points raised within this meeting, as well as potential collaboration opportunities. To find out more about this group (and future meeting dates) please visit: https://www.ucl.ac.uk/mental-health/special-interest-group-psychological-trauma 

In anticipation of the UCL Institute of Mental Health’s first international Conference on 9^th September, I posed a few questions to our speakers about their attitudes and experiences of scientific conferences. In this Covid-19 world we are having to rethink many aspects of life we previously took for granted – from the most profound to the trivial (I am not sure where conferences sit on this dimension).

The first question was:  What do you most miss/not miss about ‘conventional’ (pre-Covid) scientific conferences?

For Argyris Stringaris it is the sheer randomness of the encounters that academic conferences engender. For Emily Holmes it’s about sharing cups of coffee and informal chats around the symposia. “Getting to know the people behind the research” as much as hearing about the research alone is the key. Meeting people behind the scientific papers that you have read is a truly eye-opening experience, but not always positive. Some say you should never meet your heroes. I find that I am increasing left feeling that the person whose work I have admired invariably turns out to be much younger than I had imagined. Perhaps this is evidence of a bias to equate longevity with wisdom – a self-serving bias of course. Tamsin Ford agrees – except it’s “a good-sized mug of tea” that she yearns for rather than coffee, but certainly not the jet lag, the delays in immigration and the inevitable traveller’s fatigue.

This is particularly salient for Ethel Mpungu who is based in Uganda. “At the moment, I do not miss ‘conventional’ (pre-COVID) scientific conferences outside my country” she says. “The fatigue from the long distance travel was just about to kill me!… For now I will enjoy the international conferences in the comfort of my office. Before Covid, in-country conferences were attended by very few individuals but with virtual conferences up to 300-500 may attend which I find absolutely amazing. I know that my work has reached so many more people in my country during the Covid pandemic than before.” And we anticipate reaching over 500 this time round.

But what of the actual ‘work’ of the conference format. Pasco Fearon laments the absence of live question and answer sessions from the floor. “I do rather miss formulating a polite answer to the inevitable left-field, really long and rambling question – posting questions online and having the chair choose them has killed that sport.” (We will try and keep this sport alive on September 9^th). But who misses those other staples: “This isn’t so much a question as a comment…” and the embittered, entitled question that barely conceals the admonishment: why didn’t you cite my work?

Finally there is the longing for international travel and cultural exchange. For Rick Adams it’s the glorious Italian food at the Schizophrenia International Research Society in Florence every other spring, and American music at Society of Biological Psychiatry.

The second question put to our guests was:  What scientific conferences do you most enjoy?  eg., small focussed symposia? Large scale extravaganzas?

Here I can report that the data were fairly consistent and convincing. The small symposia were considerably more appreciated – “small all the way” according to Rick Adams – but even here it is hard to separate the academic aspects from those more social. Pasco Fearon again: “I much prefer the smaller conferences where there’s a tighter focus on an area of interest; old friends and new stars get to meet, talk in-depth and socialise. I find the big conferences a bit like the Total Perspective Vortex in the Hitchhiker’s Guide to the Galaxy!”

Some like to have their cake and eat it. “I love small focussed symposia (which allow discussion and debate)”, says Emily Holmes, “…but within Large scale extravaganzas to catch up on the big picture.” The same story comes from Tamsin Ford, for whom it’s the American Academy of Child and Adolescent Psychiatry’s ‘research institutes’, “… where a whole day is devoted to a project – some of these have been excellent” – a kind of small-within-large format.

Clearly if it’s about getting your message out to the largest number of people, the large-scale events deliver on their promise and that is what swings it for Ethel Mpungu.  For Jim Gold it’s all about catching up with old friends – more likely in the big international events – although for him the real purpose seems to be seeing who has or has not aged well. It reminds me of a class reunion I went to – often the scene of repressed competitiveness – where the most coveted prize was, not for the most successful or wealthy but for the person who looked most “well preserved”.

The final question was as follows:  What is the single most important scientific/clinical question in our field right now?

Perhaps surprisingly given the scope of the question, there was something approaching a consensus. For Jim Gold and Ethel Mpungu – it’s simple. “When will clinical neuroscience actually impact clinical care at a large scale?” says Jim, while Ethel wants to know, “How interventions work and for whom”.  Argyris Stringaris is equally succinct: “What is mood and how to influence it?”

Pasco Fearon circles the question before homing in: “How can we make programmatic mental health prevention really work? It’s one of the holy grails of the field, but it’s fraught with difficulties.” But like all good research, attempting to answer one question always leads to many more: “How do we sustain intervention effects over long periods of time? In child psychology and psychiatry there are a good number of prevention and intervention strategies that seem to be helpful in the short-term, but their benefits often fade over time. Good strategies for maintaining treatment gains might sometimes be quite different to the strategies that affected change in the first place, but we rarely think about this thoroughly or study it.”

Emily Holmes also wants to take a run-up before jumping on the major questions.  She says: “To dream big and really help people with mental health difficulties, we are going to have to transform our culture … For example, how can we move from studies about ‘description’ (merely counting, describing, knowing if something works or not) to learn to best change what is troubling someone and derive novel interventions to transform mental health?”

But we cannot escape the challenge of the moment. For Tamsin Ford the biggest question for us to address right now is “The impact of Covid and the recession on the mental health and development of children and young people” but perhaps she would say that. Rick Adams is also acutely in tune with the times. When preparing for a scientific lecture, the question at the forefront of his mind is:

“Has someone forgotten to mute themselves?”