Alex and Rhiannon had a fantastic time listening to and meeting so many speakers. However, they were also there to give a talk! Rhiannon was invited to present “Seeking Schizophrenia in the shadows: cognitive biases that obscure negative symptoms”, a joint conference submission from our behavioural science and neuroscience centres of excellence.

Drawing on an anonymised meta-analysis of 14 different research projects HRW have conducted in schizophrenia using behavioural science analysis, Rhiannon highlighted some of the hidden cognitive factors that lead to negative and cognitive symptoms being obscured from notice, and therefore passing undetected by mental health professionals in consultation rooms around the globe.

When one thinks about schizophrenia, the symptoms and behaviours that tend to spring to mind usually fit under the ‘positive symptoms’ category – hallucinations, delusions, paranoia, which are of course highly distressing for both patients and people around them, and highly attention grabbing… But there are other types of symptoms too, symptoms that are less easily noticed by our brains which, over millennia, have evolved to be a threat detector. These symptoms are nonetheless crippling for the patients experiencing them. For example, avolition (lack of motivation) anhedonia (lack of pleasure), and social withdrawal – all types of ‘negative symptoms’ can be really disabling for patients, as can ‘cognitive symptoms’, which include impaired verbal and visual learning, problems with memory, as well as reasoning and problem solving. However, due to the ‘internal’ nature of these symptoms, their identification relies on our ability to detect the absence of something, and intuitively we all know it’s much harder to identify something we can’t tangibly ‘see’, something that isn’t there – unless we’re actively looking for it. Our paper covered three broad categories of psychological biases and mental shortcuts (‘heuristics’) underlying why these negative and cognitive symptoms so often fly under the radar and can go untreated often for extended periods of time, sometimes years.

The paper invited delegates to recognise these three categories of reasons why negative and cognitive symptoms can be overlooked, all underpinned by key psychological biases: attention-grabbing, distinctiveness, and exhaustion and burnout. The first category of Attention-Grabbing identified three key biases that work to ensure the positive symptoms control the spotlight and our attention, with these more urgent symptoms taking precedence over longer term, subtler symptoms. ‘Distinctiveness’ revealed two key biases that contribute to making negative and cognitive symptoms harder to recognise in their own right, and not simply because positive symptoms dominate so powerfully. The final category will resonate with those who know the area well, and that is one of Exhaustion and Burnout. With years spent struggling to improve a patient’s quality of life, all involved can experience mental and emotional exhaustion. Two key biases were found to be directly impacting healthcare professionals, and the patients and caregivers themselves. The brilliant thing about this, however, is that in identifying the biases unconsciously shaping this landscape the presentation was able to recommend strategies for healthcare professionals to tackle them. If this sounds like something of interest to you do get in touch, the paper is available for re-presentation to interested internal audiences.

Moving on, we would like to invite you to brew a cup of tea or grab a snack and read on as we talk through the highlights of ECMH.

The developing role of digital tech in mental health
Just like last year, this year’s conference also had a dedicated stream of talks on the role of digital tech in mental health. In her talk, Špela Selak from Slovenia put the spotlight on the lack of standardised benchmarks for measuring the effect and success of different digital tech on mental health. In her work, she found out that research on the effects of social media was inconsistent, mainly because the effects are measured in different ways. Her study compared the contribution of 9 measures of how digital tech use impacted mental health in university students during the Covid-19 pandemic, and the digital technology investigated was separated into internet, social media, and video games. She found that although social media use correlated with depressive symptoms, the use of social media alone was not enough to predict depressive symptoms. Rather, attributes such as duration and frequency of use were more reliable predictors.

Indeed, the use of technology in young people was a popular theme, accentuated even more by the background of the Covid-19 pandemic. Maurice D Mulvenna from Northern Ireland worked on the co-design of an app called “Our generation”, aimed at fostering resilience and self-awareness in children and young people.

Furthering this, Heidi Tranter and colleagues drew attention to the lack of a uniform or universal digital referral system for mental health therapy for children and adolescents, and the problems this presents. They reported that the number of children being referred to therapy has skyrocketed but a quarter of the referrals are unsuccessful with the services not recognising them as being in sufficient need. In the non-standardised forms completed by the GP information can often be incomplete, missing, or inaccurate, which makes identifying those groups who are consistently falling through the net much more challenging, compromising the support they receive.

The role of personal experience in shaping mental health services
Personal experience also paid a significant role in the conference, as some with first-hand experience bravely took to the stage to share their stories. Amongst some of the most moving of these was Alviina Alametsä who, galvanised by her experience, has become the youngest serving Finnish MEP, and one of the youngest MEPs in the European Parliament.

Alametsä presented a very personal case study on how the lack of timely therapy and support can be detrimental both for an individual and their community. In her adolescence, Alametsä survived a high school shooting. After the experience, seeking to understand how that could have happened, she discovered that prior to the shooting, the shooter had tried to get help but had been told that they didn’t qualify for mental health therapy, his symptoms weren’t considered severe enough. After the shooting, struggling with depression and post-traumatic stress disorder (PTSD) herself, Alametsä also found it difficult to access help for her mental health needs. Moreover, the help that was available was not always suitable or appropriate for the individual’s needs; some of the survivors for example, were struggling to leave their house and so to attend appointments, but no other alternative was provided.

The lack of adequate provision is particularly staggering when we consider that 1 in 6 people in Europe is diagnosed with mental ill health and that between 33% and 70% of people with severe mental health disorders in the European Union do not have access to adequate mental healthcare. Yet our collective failure to provide adequate and timely mental health services costs the EU at least €600 billion per year, so it beggars the question of: why are we not fixing it?

Driven by her experience, Alametsä set up several free walk-in psychotherapy clinics in Finland where people can receive 5-10 sessions. This has been very impactful, as some said it had made a  difference to them, and for some it has saved their lives. Supporting the fact that even a short course of psychotherapy can, in some cases, decrease depression symptoms by 50%, half of those who accessed the walk-in clinics said they had had enough help from the 5 sessions, without requiring further services. Here, it is also important to mention that the timing of the intervention is important- the later it is offered, the more sessions are needed.

Key challenges in mental health
Elsewhere, casting our look at mental health professionals, some of the talks focused on the topic of hierarchy between HCPs who work in the mental health space. In her talk, Brenda Happell from Australia talked about those HCPs who are “experts by experience” s, and who sometimes may not recognise the impact of their own power on the relationships with other HCPs and within that hierarchy in mental health. The take-home messages from her talk were that we must always discuss power differentials on HCP teams, engage in ongoing conversation focusing on adopting a trauma-informed approach to communication with the aim to reduce reactionary responses and breakdown in relationships.

Stigma in mental health
And finally, no discussion on mental health would be complete without touching on the topic of stigma. It is widely known that stigma shrouds the discussions surrounding mental health, therefore lacking the scope to do it justice, so on this occasion we’ve not given voice to it. We would instead, like to highlight how ECMH speakers’ lived experiences of ill mental health only made their input more valuable and reinforced how rich their lives (and ours) can be if they are embraced by society.

“Stigma’s power lies in silence. The silence that persists when discussion and action should be taking place”. M.B. Dallocchio


By Rhiannon Phillips and Alexandra Petrache


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