Friends in Europe: A mental health conference with a difference

A warm welcome awaited me when I arrived at the European Network for Mental Health Service Evaluation (more commonly referred to as ENMESH) recently. ENMESH develops and maintains a network of active researchers in mental health service research in Europe. I met service users and carers, junior researchers, professors and international policy experts. Not all conference events are friendly and welcoming to all! I first attended as a junior researcher back in 2000 and was petrified of presenting my work. But I survived and remember well the warm hospitality, including a recital in the world-renowned concert hall in Leipzig.

In Groningen, scientific progress was on display alongside a city of culture. People attend the conference from across Europe, Canada and Australia. Here are some of the highlights which I hope help to give a sense of what progress is being made in mental health research at the moment:

Virtual Reality

Progress is being made in applying virtual reality (VR) to mental health care – building on 20 years of development work. Dr Lucia Valmaggia showed us videos of how VR works, as well as feedback from service users who are helping her and the team develop realistic scenarios. The big gains here are in the clinic, as a therapist can see how a person is reacting to a situation, rather than relying on them explaining how it feels after the event. We also heard results from the AVATAR study, which has piloted a new way of working with voice hearers.

I came away feeling real progress is being made to develop new treatments using VR – and these are being piloted with people with a range of problems including anxiety, phobias, psychosis and eating disorders. They will not be in every clinic cross Europe just yet, but with technology progressing to produce cheaper and lighter VR headsets, and the scientist’s fine-tuning their therapies I am hopeful in the next 10 years this approach will be implemented.

The value of expertise from experience

I have found two PhD thesis’ to read both written by experts from experience from the Netherlands, with an emphasis on the contribution of experiential knowledge.  I recommend both to you: Planting a Tree – on recovery, empowerment and experiential expertise by Wilma Boevink and Inside-Outside, on stereotype awareness, childhood trauma and stigma on psychosis by Catherine van Zelst. There were quite a few presentations that focused on co-production, peer research and user-led work including a keynote talk from Catherine. She emphasised the need to address internalised stigma, and to look at strengths-based arguments for change in how mental health care is delivered alongside human rights. Catherine also challenged the recovery notion of a clinical and personal recovery distinction, emphasising the professionalization of recovery has created a third category – service defined recovery. A good conference makes you think, reflect, challenge your current assumptions and inspires you. This one certainly did.

Anti-psychotic medication

I attended a symposium on dose reduction and discontinuation of anti-psychotic medication.  Professor Lex Wunderink from the Netherlands, who has lead the way in this field of research presented data from their long-term follow up study. He spoke passionately about the detailed work they have done to support people to tailor doses, building confidence in clinicians and service users with sustained recovery achievements at 7-year follow-up. Functional improvements are the gains people report – the very things we all know are important to everyone: relationships, meaningful occupation, stable housing. We heard about ambitious new trials in Denmark, Netherlands and Australia: Ambitious because they seek to recruit many more people to participate and need to keep people engaged over long follow-up periods. All the other presenters acknowledged their studies would not have been possible without Lex’s groundbreaking work, not least because of bureaucratic and ethical barriers. There is potential for patient and public involvement to make a real difference in these studies, and we heard how young people are involved in Orygen work in Australia and how the Hamlett trial in the Netherlands has a service user advisory group. We are working on a similar study in the UK – RADAR, and it feels like there is strengthen in numbers. I would like to bring all the service user advisory groups supporting medication discontinuation studies together to share knowledge and expertise.

Experience sampling methodology (ESM)

Professor Marieke Wichers provided us with an overview of progress being made in ESM which basically asks service users to monitor in real time their reactions to things using handheld devises several times a day, giving moment to moment data. Marieke talked about how this work is leading to a better understanding of resilience, and how resilience changes over time. She also showed how clinicians in the Netherlands are starting to use this technology with service users as part of shared decision-making strategies. The feedback process is so important – with both clinicians and service users trying to make sense of the moment to moment data being produced together and consider data ownership and confidentiality concerns.

There are other topics I could highlight, but this gives a flavour of progress being made in mental health research. On a personal note two years ago we presented our wellbeing networks research: In the audience was a social worker from Copenhagen, Elsebet Schultz. She went away and with colleagues and developed a wellbeing networks mapping project back home. In Groningen, Elesbet gave me their manual and explained the difference it was making locally. We do research to make a difference; in a small way we have started to have an impact with wellbeing network mapping. We now must take this forward on a larger scale.