Covid-19: Mental health research and the pandemic response

by Rory O’Connor

On Friday 13^th March I was meant to fly to Australia.  But on advice from the University (not that I am superstitious) a couple of days beforehand, I had made the difficult decision to cancel my trip.  This was fortuitous for a couple of reasons; first, obviously, if I had flown I probably would have been quarantined on arrival. Second though, was that the following week, as concern about Covid-19 was growing, I got an email from Helen Munn, the CEO of MQ: Transforming Mental Health, the mental health research charity.  She had been consulting with MRC, Wellcome, ESRC and other organisations and she invited me to co-chair a group to rapidly pull together a Position Paper on the Covid-19 mental health science research priorities (in partnership with the Academy of Medical Sciences). She was responding to concern from within the research community that, without a coordinated effort, the mental health science response to Covid-19 may become fragmented.

As I was unexpectedly still in the UK, I agreed but didn’t quite know what I had let myself in for!  However, less than a month later, after daily author meetings, an intense period of writing, editing, consulting, and rapidly surveying 3,000 people with lived experience, the Position Paper was published on 15^th April in Lancet Psychiatry.  The long days and late nights and the tight turnaround were worth it, though. The Paper garnered global media coverage, it highlighted the importance of mitigating mental health risks and it has already started to inform the Covid-19 mental health and neuroscience research agenda in the UK.  Around the same time, I also became part of the Covid-19 International Suicide Research Collaboration. This initiative, led by David Gunnell (University of Bristol), is important because we know from other public health and economic crises that risk of suicide can increase in their aftermath. So we worked quickly to issue another Call for Action, also published in Lancet Psychiatry, to ensure that suicide prevention is given the urgent attention that it warrants.

Jack Melson and I, alongside Karen Wetherall, Seonaid Cleare and Cara Richardson have also been busy tailoring the Distress Brief Intervention (DBI), the Scottish Government’s flagship multi-agency response for people in distress, to be Covid-ready. In anticipation of the likely impact of Covid-19 on our mental health, First Minister Nicola Sturgeon made new funding available to extend this crisis-response service and roll it out nationally. We were charged with developing new training and intervention materials in light of Covid-19 which we had to turn around in record-quick-time. We are delighted to be able to play our part in the government’s mental health response; indeed the first referrals by this new DBI-Covid 19 service were made on the 13^th May – with plans for the service to go nationwide in June.

Finally, as part of the Scottish Government’s Academic Advisory Group on suicide prevention, Tiago Zortea is leading on a systematic review to explore the impact of public health emergencies on suicidal behaviour, suicidal thoughts and self-harm.  This is another collaborative effort; Tiago, Heather McClelland and I are working with Steve Platt (University of Edinburgh) and colleagues in Ireland and Canada to see what we can learn from previous emergencies. It is our hope that if we act now, we can mitigate suicide risk in the longer term.

A final reflection.  It is incredibly humbling and rewarding to work with such a dedicated group of people, both here at the University and well beyond. Everyone has a shared goal of trying to do whatever we can to help and protect the most vulnerable during this global COVID-19 pandemic, as we all navigate an uncertain future ahead together. 

22/05/20

Distress Brief Intervention programme wins prestigious Scottish Health Award

The national Distress Brief Intervention programme which is a partnership between a range of statutory and 3^rd sector organisations including the University of Glasgow received the Care for Mental Health award at the Scottish Health Awards event held in Edinburgh on the 14^th of November.

 

The Suicidal Behaviour Research Lab have the pleasure of hosting Associate Professor Matthew Spittal from the University of Melbourne, who will be talking on 3.30pm on Wednesday 25^th September, in Lecture room 2 at Lilybank Gardens (University of Glasgow). 

Identifying patients at high-risk of suicide: the problems and pitfalls of using predictive instruments to make treatment decisions

Tools for assessing suicide risk are widely used in the emergency department and other settings to identify people at high risk of suicide. This classification then often informs treatment decisions, such as whether to admit a person as a psychiatric inpatient. In this talk I (1) describe a program of research that has examined the clinical utility of these risk prediction instruments; (2) explain why these tools don’t work, and why in the era of big data and machine learning, better tools are unlikely to be developed; and (3) offer suggestions for how we can do better.

Biography

Matthew Spittal is an Associate Professor and Australian Research Council Future Fellow at the University of Melbourne. He is a biostatistician by training. His research program crosses several areas of public health. His main area of research is on the role of individual practitioner performance on patient safety and quality of care. He also studies the epidemiology of suicide and self-harm and is developing a new area of research on traffic safety.

UPDATE:  The Son is now showing in the West End's Duke of York's Theatre (London). For more info click here.

I spent the weekend in London catching up with a close friend from my university days.  The highlight, without doubt, was seeing The Son, the final part of a trilogy from French playwright Florian Zeller, on Friday night.

Perhaps highlight is the wrong word, I left the Kiln Theatre emotionally drained; The Son is immersive, uncompromising, raw and visceral.   I am still reflecting on it. 

The audience is taken on an emotional tsunami of teenage depression, self-harm and suicidality.  It focuses on one family’s attempt to deal with the unravelling of their son, Nicolas (Laurie Kynaston), against the backdrop of divorce and new family relationships.

We first see Nicolas before the play ‘begins’, pacing the stage furiously and scribbling on the walls as the audience are taking their seats.  Pain etched on his face. We then meet Anne (the mother, Amanda Abbington), Pierre (her work-focused ex-husband, John Light) and Sofia (his new partner, Amaka Okafor) and their baby.  Nicolas hasn’t been to school for three months,  Anne is struggling; she’s at a loss and thinks he would be better off living with his father, Sofia and his little half-brother. Sadly, this solution doesn’t have the desired effect and over the next 1 hour and 45 minutes, we track Nicolas’ angst, his hoped for recovery, his relationship with Sofia and his mother’s forlorn efforts to keep hold of her cherished son. 

Alongside exploring the relationships among the family, old and new, there are brief moments of light; when egged on by Sofia, Nicolas mocks Pierre’s dad-dancing with his father responding by throwing amusingly impressive shapes. This juxtaposition serves only to illuminate their struggle more profoundly; providing a glimpse of happier times. 

You really feel each family member’s angst and pain; right down to the pit of the stomach. It took my breath away in parts: in a not-able-to-breathe-sort-of-way. Incredible performances all round: Amanda Abbington and John Light are brilliant,  you get a sense of what bound them together in marriage, their helplessness to keep their son safe and Abbington’s thwarted desire to have her family back together. Both are utterly captivating.   Laurie Kynaston’s take on Nicolas is equally powerful.  It is vulnerable and nuanced, conveying the nothingness as well as overwhelmingness of depression and suicidal pain. Amaka Okafor’s Sofia is excellent also, as the new partner who is struggling to connect with Nicolas and understand his emotional pain.

The staging is exquisite; the clean, sharp lines and white walls of the Parisian apartment help to illuminate the emotional turmoil of this teenage life which is metaphorically strewn across the stage.

After the play, fortuitiously we banged into the cast and I asked Amanda Abbington how the cast deal with the emotional intensity every night, and as she also repeated in a tweet later, they are aware of the sensitivity of its content and make a real point of looking after each other.