Christine O'Farrelly, Shu-Tsen Liu & Beth Barker

Last week I was really pleased to have the opportunity to meet Mark Williams, a long-standing campaigner on mental health, particularly on fathers mental health. He set up Fathers Reaching Out and also established the International Fathers Mental Health Day, held each year on the Monday after Fathers Day.

Mark was in London taking part in the filming of a documentary, and this gave us the chance to meet in person for the first time.  I’d followed and admired his campaigning work for many years, and had narrowly missed meeting him on a couple of occasions, but this was the first time we had managed to actually meet face to face.  There was a lot of filming to do, so we only had limited time to talk off-camera, but it was great to have the chance to meet him at last.

Mark brought along a copy of his new book, Daddy Blues. I read it this weekend. It is an autobiographical account of his experience. In it he writes about the birth of his son and his struggles with that experience. He also writes about his wife, Michelle’s, experience of postnatal depression and Mark’s own experience of mental health problems, including depression.

It’s an open-hearted and challenging account of trying to understand what is happening when you don’t have much information. This relates both to the experience of childbirth and also seeing someone you love experience depression.  It is so important for all of us to hear this kind of first-hand experience. The experience of mental health problems is so very personal, and people are often reluctant to talk to others (indeed Mark writes about this in the book).  Consequently, when others have the same experience they may never have heard or read anything to give them a clue that many others go through similar things.

As well as writing movingly about his own experience, Mark’s book also highlights how complex the experience of mental health problems can be.  For example, his own experience could be described as depression (and he uses this term), but it also overlaps with experiences of anxiety, heavy use of alcohol and the re-experiencing of traumatic images and memories of his son’s birth. It’s important to be reminded of how these experiences so often overlap and also how important it is for a partner to be supported when someone develops depression (whether that’s a mother or a father).
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I’m grateful that Mark Williams has shared his story in a book. It’s a moving and important read. I now have a copy, if you want to borrow it. Better still, buy your own copy and support the important work that Mark and his colleagues and family are doing.
 
Author: Paul Ramchandani

This week we were extremely grateful to attend the first CNWL Research Conference held at the Wellcome Collection in London. The purpose of the day was to showcase current research activities across CNWL and link clinicians with research groups.

Professor Sir Simon Wessely – King’s College London
The talks began with a lively presentation by Professor Sir Simon Wessely highlighting the importance of research in understanding individuals’ reactions to adversity. Touching upon the London 2005 bombings, the Litvinenko Affair, and the Blitz he highlighted the resilience of mankind and launched into a spirited discussion on the use of psychological debriefing at the time of tragedy. Previous expertise has favoured the use of psychological debriefing at the time of a terror attack, however his Cochrane Review found that people preferred to talk to family and friends rather than a medical professional. He outlined that, for those with a typical emotional reaction to an attack, debriefing by a clinician is unnecessary and in some cases can do more harm than good! 
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​Professor Dame Anne Johnson – University College London
Second to the stage was Professor Dame Anne Johnson who spoke passionately about growing concerns regarding public health. The ever growing number of chronic conditions and increasing levels of obesity in the population have heightened the need for more research into preventative medicine. She presented the COPD value pyramid displaying the cost of the most common interventions in COPD. Flu vaccinations and stop smoking interventions were the cheapest and Triple Therapy was amongst the highest. Following on from this, Prof. Johnson presented the most common treatments used in clinics and showed that, frequently, the most favoured treatments were the more expensive options. Only 11% of patients received stop smoking interventions, one of the more cost-effective interventions, versus 37% being offered Triple Therapy. Patients need to be reached earlier to prevent these illnesses getting out of hand and thought needs to be placed on population based change to be more receptive to preventative measures. Prof. Johnson spoke of the importance in embracing the digital revolution to better inform researchers and the population in health preventative measures.

​Workshops
An array of workshops were on offer; Professor Paul Ramchandani on the needs of children and adolescents with mental and/or physical health problems, Dr Richard Gilson on promoting sexual health and well-being, Professor Anne Lingford-Hughes & Professor Andrew Hayward on tackling health inequalities and inclusion, and Professor Mike Crawford on interventions and treatments for adults with mental health problems.
I was lucky enough to attend Prof. Paul Ramchandani’s workshop which included four presentations on current research taking place. First to present was our own Dr Christine O’Farrelly who introduced the Healthy Start, Happy Start study, using clips of VIPP in action, and outlined the important role CNWL played in getting HSHS to its recruitment target of 300 families in the summer of this year, with an impressive 105 families coming from the trust.

Second was Dr Georgina Corbet Burcher who presented her findings of a link between PTSD in infants after discharge and levels of inflammation in the brain during their stay in the PICU. Dr Tami Kramer was next discussing the prevalence of adolescent sexual assault and the extreme need for extra specialised clinicians in this service. She reported that, due to the findings of her research, she has recently gained funding for a Clinical Psychologist specialising in adolescent sexual assault in CAMHS. This talk in particular highlighted the real change that can come from research. Lastly, Dr Matthew Hodes spoke of his project investigating the use of brief CBT for maternal anxiety associated with children with food allergy.
Discussion followed surrounding the steps that can be taken to increase the range and opportunities for staff in research within CNWL. Many ideas were put forth, such as including research into the NHS induction, opening up research to other specialities such as Occupational Therapists and Physiotherapists, and compiling a list of current research occurring within the trust so others are aware and can contact to become involved.

Following the workshops we had a lovely lunch provided and settled in to chat about our morning. We then settled in to the comfy Henry Wellcome auditorium to begin the afternoon session.

Professor Mike Crawford – Imperial College London
To begin the afternoon Professor Mike Crawford delivered a speech regarding the prevalence of sexual health problems amongst those with mental health conditions. His work has shown that sexual health problems are most prevalent in individuals with a diagnosis of Personality Disorder. However, many clinicians in mental health clinics aren’t asking about sexual health during appointments, which is concerning as these can be common side effects with medication. He also spoke of the Respect study run by Professor Liz Hughes which promotes sexual health for people with serious mental illness. 
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Workshops
Another great variety of workshops were on offer for the afternoon. From responsibilities of a principal investigator by Dr Sarah Yardley & Lynis Lewis, to involving patients and public in research by Dr Rose Thompson. I was fortunate to attend Dr Tim Weaver’s workshop about qualitative interviewing. Dr Weaver presented the different methods of analysis and practical advice for helping a participant open up to questions. A lively discussion followed, with calls for more opportunities for qualitative interview training and uses within NHS research.
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Plenary
After a quick break and browse of the posters we then attended a plenary session to hear the feedback from the various workshops to best raise the level of research within the trust. Four common themes emerged from the discussion; time, funding, training opportunities, and awareness. Ideas were discussed surrounding ways in which these factors can be built upon and increased throughout the trust.  One really interesting idea was for the creation of a clear and widely-used website where research groups can update information of their current projects and clinicians can update their personal profiles to include research interests.

Closing Remarks
Professor Richard Watt concluded the day with closing remarks and summarised the feedback. He highlighted the importance of a regular R&D conference to inform staff within the trust of the range of research underway and in linking clinicians and research groups and promoting collaborations.
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The day was an exciting whirlwind of presentations and workshops and it was a great opportunity to see the current research taking place. It was wonderful to see and hear everyone’s enthusiasm for research and the ideas for different projects going forward!

Author: Holly Mattock

​We were extremely fortunate to attend part of this brilliant conference in Geneva. The overarching theme was transition in a world of change and the content more than met our expectations. 
 
The keynote speakers included Professor Tony Charman from King's College, London and Professor Johannes Hebebrand from Germany.
 
Professor Tony Charman's talk was on tracking the emergence of early autism symptoms in at-risk infants, looking at possibilities for prodromal intervention.  Until recently, most of what we knew about the emergence of autism in infancy relied on retrospective accounts. A new approach, the study of infants at familial risk (younger siblings of autistic children), aims to identify the earliest “pure” manifestations of autism, before subsequent years of atypical development exacerbate, or compensate for, initial atypical development. He explained that there are some studies suggesting that in children from 12 months old, it is possible to detect signs (measured with EEG, ERP, visual fixation and attention) which could be related to ASD development.

He presented data from a prospective longitudinal study (J. Green et al, J Child Psychol Psychiatry 2017) based on using VIPP as a pre-emptive intervention in the prodrome of autism. Specifically, it is a RCT comparing a 12-session parent-mediated social communication intervention delivered in infants at familial risk of autism but not otherwise selected for developmental atypicality, between 9 and 14 months of age (Intervention in the British Autism Study of Infant Siblings-Video Interaction for Promoting Positive Parenting), against no intervention. The results were that very early VIPP for infants at familial risk of developing autism has shown a treatment effect, to reduce the overall severity of autism prodromal symptoms and enhance parent-child dyadic social communication over this period.   

More information about the European project based on siblings of ASD children can be found here www.eurosibs.eu
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Professor Johannes Hebebrand presented on pre- and post- natal screening in the context of CAP.  Should we proactively be screening pre and postnatally for mental disorders? He covered the WHO criteria for a screen, the potential biases, the ethical issues around non-invasive prenatal screening, the modified checklist for autism risk in toddlers (M-CHAT-R/F) and highlighted the demand for better integration of CAP services with increased focus on evidence based screening with improved interdisciplinary collaboration with Paediatricians GPs and Gynaecologists.

Other keynote speakers included:
 
* Jörg Fegert (Germany) discussing the Care of traumatized children in youth welfare systems.
* Patrick McGorry (Australia) talking about Transitioning to 21st century mental health care: early intervention for young people with emerging mental disorders.
* Paul Hoff (Switzerland) on Conceptual transitions: what will happen to the concept of mental disorders in the 21st century?
* Patrick Luyten (Belgium/UK) on A radical shift in the treatment of child and adolescent depression: Perhaps the time is ripe?​​* Maria Melchior (France) on Social inequalities in children's mental health – from observation to prevention.
* Dieter Wolke (UK) on Peers and siblings matter for mental health: long term consequences of bullying.

The symposiums included tracks covering an incredibly broad range of subjects. From presentations on early findings from Professor David Coghill's ADDUCE project to transgenerational effects of childhood adversity, including early detection of personality disorders to the treatment of eating disorders, to the use of neuroimaging and treatment of psychosis to more highly emotionally charged topics relating to the world's response to political crisis in relation to refugees with examples from Syria, Iraq, Serbia & Croatia and a presentation on the child psychiatric care in Nice following the terrorist attack in July 2016. 
There was something in there for absolutely everyone to engage with. We have all learnt a huge amount and come away feeling inspired to collaborate with our colleagues from across the world in future research and clinical practice. 

We are very much looking forward to the next meeting in Vienna in July 2019.
 


Author: Marina Fabrega Ribera and Rebecca Lancaster

Written by Beth Barker

Following the close of the first day of IAC 2017, I found my head buzzing with fresh ideas for future research, collaborations and papers. Part of me wondered how Day 2 could come even come close to the bar set so high by Day 1 but wonderfully the second day just pushed that bar even higher. The day was kicked off by three insightful and thought-provoking talks from the key notes, and rounded off by a fantastic fifteen symposia.  

Prof. Marian Bakermans-Kranenburg - Leiden University 
To begin, Prof. Marian Bakermans-Kranenburg provided a captivating insight into the world of infant crying. We already know that crying plays a really important role in how infants develop attachments with their caregivers, but key to this attachment forming is the response that their crying is met with. Crying often evokes a sensitive and positive response from parents to ensure that the needs of the infant are met. However, infant crying can also result in anger, fear, or aversion from the parent, particularly if the baby is crying for 5+ hours a day. Prof. Bakermans-Kranenburg’s group have been working to examine why some parents are able to respond in a sensitive way to their crying infants, whilst others respond in an abusive manner. The fact that incidences of Shaken Baby Syndrome peak around eight weeks of age, around the same time that rates of infant crying peaks, really drove home why research of this kind is so important. 

A range of biological and psychological factors appear to play a part in individual responses to infant crying, including maternal oxytocin levels and attachment representations. Findings from Marian’s work indicate that intranasal oxytocin administration can not only increase overt sensitive maternal behaviours when exposed to infant crying, but also result in a decrease in amygdala reactivity and handgrip force, from those with insecure attachment representations. Prof. Bakermans-Kranenburg stressed that, despite the encouraging results of these findings, the answer isn’t quite as simple as administering oxytocin to all in an effort to induce solely positive responses to infant crying, as effectiveness differed between groups. Nonetheless, the findings were highly interesting and the papers from the research were quickly added to my growing to-read list! 

​Prof. Jonathan Hill – University of Reading
Next up was Jonathan Hill who was presenting findings looking at sex differences in adaptation and pathways to psychopathology. One set of interesting findings Prof. Hill presented outlined differences in the ways in which boys and girls are affected by low birth weight and prenatal maternal anxiety, and how this might influence later psychopathology, using a sample from the Wirral Child Health and Development Study. What they found was that low birth weight predicted higher vagal reactivity at 29 weeks only in girls, whilst prenatal maternal anxiety predicted lower vagal reactivity only in boys. Further studies have now followed these children up to 5 years of age and from these findings, it has been hypothesised that increases in vagal reactivity is associated with an increase in ODD symptoms in girls and a reduction of ODD symptoms in boys. From an early intervention stand-point, these findings are really interesting as it indicates that early markers of risk (such as low birth weight or prenatal maternal anxiety) may need to be considerate of slightly different processes in males and females. 

​Prof. Miriam Steele – The New School for Social Research
The final talk of the day came from Miriam Steele, presenting on the work of the Group Attachment-Based Intervention (GABI) which looks to prevent the intergenerational transmission of child maltreatment in families that have already experienced trauma. GABI, developed by Dr. Anne Murphy and inspired by the work of John Bowlby and Mary Ainsworth, is designed for families who have histories of adverse childhood experiences (ACEs) with the aim of enhancing parent coping and resilience, in turn promoting secure parent-child attachment and preventing disorganised attachment relationships. The intervention works under a framework called R.E.A.R.I.N.G and involves parents with 0-3 year olds attending GABI up to three times a week for two hours, where families can learn parenting skills, share experiences, and meet with a range of therapists. It seems that purely based on the frequency of contact provided by the intervention, GABI can act as a secure base for families in amongst what’s, frequently, an otherwise chaotic life. Building on Mary Dozier’s talk from yesterday, the power of video was displayed once again when Prof. Steele showed us a moving clip of a mother’s response to seeing videos for the first time of her and her infant daughter interacting. We saw that the mother didn’t look solely to the therapists during feedback but also to the other mums taking part, which really highlighted the unique forms of support offered by interventions which have a group-based element. 

​I appear to have got a little carried away again in trying to “summarise” each the captivating array of studies which came through in the three talks of Day 2 – it was all just a little too interesting and noteworthy if you ask me! Tomorrow I aim to get on to Day 3 and not only touch on the key notes but also the highlights from the many symposia we were lucky enough to attend too!