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

By iomh, on 26 October 2022

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 21st 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

Reflections from the first meeting of IoMH Special Interest Group in Psychological Trauma

By iomh, on 6 July 2022

nurse on bed head in hands

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.

model for trauma informed organisational change

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 

The academic conference: a Total Perspective Vortex with cappuccinos

By tonydavid, on 1 September 2020

In anticipation of the UCL Institute of Mental Health’s first international Conference on 9th 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 9th). 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?”