Plenary Speakers

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Professor Philippe Conus
Lausanne University


Professor Jacques Dubochet
Lausanne University
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Climate change: An important target for early intervention in mental health

While there is often mention of the effect of climate change on physical health, its major impact on mental health has not yet received the attention it deserves. In this plenary session, two speakers will intervene. Firstly, Philippe Conus will discuss the current literature on the consequences of climate change for mental health and he will argue that these elements define it as an important target for early intervention. In the second part of the plenary lecture, 2017 Nobel Prize winner Jacques Dubochet will discuss the role scientists need to take in this regard.

  • ABSTRACT

  • BIO

Climate change: An important target for early intervention in mental health

While there is often mention of the effect of climate change on physical health, its major impact on mental health has not yet received the attention it deserves. In this plenary session, two speakers will intervene. Firstly, Philippe Conus will discuss the current literature on the consequences of climate change for mental health and he will argue that these elements define it as an important target for early intervention. In the second part of the plenary lecture, 2017 Nobel Prize winner Jacques Dubochet will discuss the role scientists need to take in this regard.

Professor Stephani  Hatch
Kings College London
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Why utilising anti-racist practice and tackling discrimination are crucial for addressing inequities in mental health and mental health services

Professor Hatch will focus on the Tackling Inequalities and Discrimination Experiences in Health Services (TIDES) study funded by Wellcome. Since 2017, the TIDES team has focused on the role of discrimination in generating and perpetuating health inequalities and the structural changes needed to address identified inequities in health services. The study was expanded in 2020 with funding from the Economic and Social Research Council (ESRC) as part of UK Research and Innovation’s rapid response to COVID-19, to utilise a participatory framework to identify processes through which racial and ethnic inequalities in mental health and occupational outcomes are produced, maintained and resisted in the context of Covid-19. The team uses innovative quantitative and qualitative methods, including linked survey and health record data as well as virtual reality (VR) methods to examine how biases and discrimination impact clinical interactions; to improve understanding of lived experience; and to influence policies that have potential for sustainable change.  Professor Hatch will also touch on the work she co-leads within the ESRC Centre for Society and Mental Health, Marginalised Communities and Mental Health programme focused on advancing research with communities that have often been ignored, to examine and disrupt structures maintaining inequities in mental health access, experience and outcomes.

Sir Michael Marmot 
University College London
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Social determinants of health and health inequalities

Using examples from psychiatric epidemiology and social neuroscience, in this talk I will explore how the roles of place - and feeling out of place - may be causally related to our chances of experiencing psychosis. In particular, I will focus on two major inequalities of our time that shape this risk – ethnic minority position and exposure to more neighbourhood social adversity. I will highlight the importance of incorporating multiple levels of causation and spatial dimensions into epidemiological models of risk, and explore how we can use this data to strengthen both causal inference and effective delivery of psychosis treatment programs. By integrating perspectives from epidemiology, psychiatric genetics and social neuroscience I will show how we can develop causal models to identify and remove social disparities which give rise to an inequitable risk of psychosis by person and place.

Professor Patrick McGorry
Orygen
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The next stage for early intervention: Transdiagnostic, personalised, universal 

Early intervention in mental health has made great progress over the past 25 years through the prototype of early psychosis.  Yet real world reform remains relatively piecemeal and comprehensive upscaling has not yet occurred to enable every person with psychotic illness to receive timely, personalised and sustained clinical care and reach their full potential.  Nevertheless, the beachhead and evidence base established by the EI paradigm in psychosis creates the conditions for this principle to be extended to the full diagnostic spectrum.  EI has universal value in health care and the fluidity of our syndromal approach to diagnosis both cross-sectionally and longitudinally means that we cannot focus too narrowly.  The clinical staging model may provide the framework for us to translate the principles of early intervention to a wide range of mental disorders.

New cultures of care appropriate to early intervention are needed and emerging.  Through more refined prediction strategies and definition of underlying mechanisms we can also move towards the holy grail of a more personalised approach to treatment.  Transdiagnostic research can be enabled if systems of care guarantee "soft entry" to new cultures youth-oriented culture of care, at the sub threshold stage, making stepwise expertise progressively available with functional recovery as the goal.  We need to combine the power of the evidence-based paradigm with greater confidence, tenacity and much more intensive and professional advocacy in partnership with the general public.

Professor David Mohr
NorthWestern University
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Making digital mental health work in the real world

Digital mental health services (DMHS), which use commonly available technologies such as smartphone apps and websites to support the treatment and management of mental health conditions, have the potential to extend cost-effective mental health care to those who cannot access traditional forms treatment.  A large number of randomized controlled trials have demonstrated the effectiveness of DMHSs for the treatment of common mental health problems such as depression and anxiety, particularly when they are provided with low intensity support from a coach. A number of countries have begun to integrate DMHSs into their healthcare systems.  However, despite the remarkable advances over the past two decades, a number of challenges remain.  Sustained engagement by app and website users is often substantially lower in real-world deployment, compared to engagement in clinical trials.  Successful integration and implementation in healthcare environments has also frequently been challenging.  This talk will review the present state of the research, with a particular focus on app and web-based DMHSs, and will consider the current challenges for research.

Dr Valeria Mondelli
Kings College London
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Targeting inflammation: a way forward for adolescent depression and early intervention?

Extensive research suggests a role for inflammation and the innate immune system in the pathogenesis of depression. However, the majority of studies have been conducted in adult populations and it remains still unclear whether inflammation is relevant biological mechanism for onset of depression in adolescence and whether it could be considered as a viable target for early intervention (prevention and treatment). Dr Mondelli will first present evidence from systematic review of the literature on role of inflammation in development of depression in adolescence. She will discuss findings suggesting a role for the interaction between environmental risk factors, such as exposure to childhood trauma, and increased inflammation in leading to depression onset. Dr Mondelli will then present novel findings from the Identifying Depression Early in Adolescence (IDEA) study investigating inflammatory markers in a cohort of adolescents stratified for increased risk or presence of depression. In the second part of the talk, she will discuss the use of anti-inflammatory treatment and strategies, including the data from her clinical trial using add-on minocycline treatment in adult patients with depression and discuss potential ways forward for early intervention.

Professor Barnaby Nelson
Orygen
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The prediction and treatment of early stage psychosis: Sharpening the tools, broadening the target, and innovating the interventions

The field of early intervention for psychosis faces several challenges: a) how to more accurately predict clinical outcomes in high risk individuals, b) to better understand how and why subthreshold mental ill-health evolves into threshold-level (diagnosable) syndromes, c) the need to match treatment with individual patient and develop new, more effective treatments. In order to address these challenges, we need to sharpen our prediction tools using dynamic and multimodal approaches, draw on cross disciplinary models of complex system change, widen the prediction and mechanism lens beyond psychosis to encompass transdiagnostic targets, clarify effective ingredients of existing treatments and for whom they work, and develop ‘outside the box’ treatment options. This talk will outline current work guided by these aims, including the Accelerating Medicines Partnership (AMP®) Schizophrenia (AMP SCZ), the Self, Neuroscience and Psychosis (SNAP) study, the Staged Treatment in Early Psychosis (STEP) study, and an integrated Virtual Reality-Neurofeedback-CBT study (Hybrid). Preliminary data from these studies will be presented. 

Vanessa Pinfold 
McPin Foundation
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Lived experience expertise in early intervention research: looking back and forwards to pioneer models of involvement in a changing world

This presentation will draw on our work at the McPin Foundation over the last 10 years, centring the expertise of people with lived experience in the design and delivery of mental health research. This includes research on early intervention. It is work conducted mainly in the UK but learnings will be relevant to everyone in the sector.  Peer research methods, lived experience advisory groups and co-production approaches are all known strategies for lived experience involvement in research. Involvement roles are increasingly varied including lived experience co-applicants, young people co-researchers, peer researchers, lay reviewers and lived experience advisory group members. Lived experience research leadership within the mental health community is also expanding. We will first look at the principles underpinning lived experience involvement in mental health and early intervention research as well as practice models. We will then take learning from our Young People’s involvement programme to provide examples from a range of studies adopting different methodologies and reflect on the experiences these generate in an expert by experience research workforce. These cover intervention studies such as use of virtual reality technology and working in schools to address mental health needs of LGBTQ+ young people, public mental health awareness and stigma busting programmes, as well as experience-based studies, research prioritisation and conceptual work.  Finally, we will look forwards on how these principles and models can be improved to reduce remaining barriers to lived experience involvement in a changing world.

Dr Padmavati Ramachandran
Schizophrenia Research Foundation, India
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Catch them Early - SCARF Youth Mental Health Program

With the population of young persons increasing globally, it is critical to enable young people to grow up, develop resilience, and lead productive lives through mainstreaming mental health across sectors. Mental illness is a chronic disease of the young, with over 75% of mental illnesses having their onset between the age group of 15- 24, a period defined as Youth, by the World Health Organisation. While there has been focus on child psychiatry and adult psychiatry as independent departments, in mental health services, the age group, 15-24,  falls in a  transition period when the population  receives  least attention when needed the most. The Schizophrenia Research Foundation (SCARF India) in Chennai, India , is one of the very few institutions in the country to run a Youth mental health program, aiming to address this treatment gap in the youth in the community. Focusing on the urgent need for initiatives that bring innovative mental health education, prevention, early identification  treatment and recovery support to young people, SCARF has brought together a plethora of programs targeting young people across various settings.

While Catch them early has been the principal philosophy, the approach has been to start from the basics of improving the understanding, requirements and participation of young people in each phase of developing the program targeted towards them, to enhance compliance and acceptance among them.

This presentation describes the various programs that have adopted evidence-based strategies for tackling the most pressing problems in mental health and wellbeing — stigma, the incidence of suicide and mental health problems faced by young people in general with special focus on vulnerable groups, shortcomings in support for young people and means to enhance existing care, to suit requirements of the youth.

Professor Ulrike Schmidt 
Kings College London
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Early Intervention for Eating Disorders 

Eating disorders are common, disabling and deadly disorders, affecting one in every six young females and one in 20 males. Anorexia nervosa has the highest mortality of any mental disorder. One in every 2-3 people with bulimic disorders are obese or will become obese, with potential metabolic complications. Peak onset of eating disorders is in adolescence or emerging adulthood i.e. a developmentally sensitive time. Thus, eating disorders have the potential to derail young people’s cognitive, socio-emotional and educational development. Average duration of untreated illness is between 2.9 (anorexia nervosa) and 6.5 years (bulimic disorders). Longer illness duration is associated with cognitive, behavioural and neurobiological changes that adversely affect illness progression and with poorer treatment outcomes. Yet despite this strong rationale for early intervention, efforts at prevention/early intervention for eating disorders are piecemeal and have lagged behind other disorders. In my talk I will summarise our work on early intervention for eating disorders, describing our model for first episode rapid early intervention for eating disorders (FREED), the data supporting FREED’s effectiveness and our national implementation of FREED in England.  I will also talk about ongoing research designed to make early intervention for eating disorders ‘earlier’ and ‘brainier’.

Associate Professor Jai Shah
McGill University
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What should be the structure and function of multi-level transdiagnostic early intervention services? Translating lessons from the psychosis at-risk state to youth mental health

For some time, early intervention services have considered both first episode psychosis and its at-risk mental state to be along the same diagnostic ‘track’ of services.  However, this siloed approach to operationalizing services for the at-risk mental state for psychosis has encountered challenges, including declining transition rates to psychosis and the frequent development of non-psychotic disorders.  Recent epidemiological and clinical evidence also suggests that not all threshold-level psychoses occur homotypically: early-stage non-psychotic syndromes may undergo heterotypic shifts to a first episode of psychosis, without an identifiable at-risk state. This talk will review and present these findings, their relevance for youth-onset mental health problems and trajectories, as well as their implications for care settings – including the need to embrace pluripotentiality, convergence, and non-traditional outcomes in next-generation multi-level early intervention service systems.