ENTER

 On the 3rd of June 2016, St Andrews, Scotland, welcomed over 70 delegates from across Europe to discuss and debate emerging priorities in mental health. 

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The conference took place in the Medical and Biological Sciences building of the University of St Andrews. Conference convener Alex Baldacchino and co-director Thilo Kroll (SDHI, Scotland) opened the event. Tim Greacen (Paris, France) welcomed the delegates as ENTER chairperson. The morning session saw the plenary speakers set the scene by introducing the three main themes of the conference: Migration, Ageing and the Virtual World. Bojan Šošić (Academy of Sciences and Arts of Bosnia and Herzegovina), unable to attend in person due to UK visa restrictions, addressed the audience via an online link on issues such as the drivers of migration, the influence migration has had in shaping the global environment and how the decision to migrate can come down to personal values and not just direct pressure or finances. Then, Ilana Crome (Keele University, England) spoke of how we need to look more closely at the terminology that defines mental health and/or addictions when applied to issues specific to ageing populations. Finally, Wendy Moncur (SDHI, University of Dundee, Scotland) rounded up the plenary session by looking at how emerging practices using digital technology are providing new coping mechanisms for bereavement and how such technology raises issues around the boundaries between the natural and digital lifespan. Following the poster session over lunch, the afternoon saw breakout sessions on the three main conference pillars of virtual world, ageing, and migration. 

 

Virtual World 

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In the virtual world session, speakers from Scotland, England, Ireland and Spain presented work on new approaches to the prevention or treatment of mental health issues using tools from the virtual world. Silvia Rosado (Parc de Salut Mar, Barcelona, Spain) began by discussing the pros and cons of using virtual reality (VR) technology to help people overcome flight phobia. Alex Baldacchino, SDHI, Scotland, described the development of ORION, an online tool which provides opioid - dependent patients a means to self-assess their risk perception of overdose against seven risk factors. Ann-Marie Mann (University of St Andrews, Scotland) then presented an app which enables recovering addicts to track progress and access their local recovery network. Developed with end user input, the app does not retrieve personal information. 

Ana Salzberg (University of Dundee, Scotland) described a project which aims to examine the effectiveness of recreating the cinematic experience for care home communities in Scotland to help combat loneliness and cognitive decline. Agnes Higgins (Trinity College, Dublin, Ireland) spoke about how two independent studies in Ireland into the mental health and wellbeing of LGBT people raised issues around the information available to LGBTs on line. Where a number of young people reported finding inspiration to make decisions about their sexual orientation from stories on line, there was a lack of positive stories for transgender and bisexual people and a lack of information on strategies for coming out. Juan Ye (University of St Andrews, Scotland) is developing a mobile phone-based system which monitors real-time application usage to try and understand how people use their mobile devices in social situations and to determine how people can be discouraged from using the phone during social situations by intervening to divert attention back to their social partners. Chris O’Sullivan from the Mental Health Foundation in England, rounded up the session by taking the audience through the current trends and barriers to using personal technologies for self-management of mental and physical health. He described the potential benefits, risks and ethical issues associated with their use, such as the ethics of data ownership and sharing, and the psychological issues associated with quantifying health. Chris produced a picture of how to get past these obstacles and called for constructive engagement of people with experience of mental ill health to engage in the development of new self-management tools. 

 

Ageing 

 

In the session on Ageing, speakers from Ireland, Italy, England, Scotland and Poland talked about means of addressing and monitoring mental health in the elderly. Andrea Koenigstorfer (Dublin Simon Community Sure Steps Counselling Service, Republic of Ireland) opened this session by drawing on case examples to highlight the need for specialist services in identifying and dealing with mental health issues of elderly homeless individuals. Stephano Zanone (Rovigo, Italy) spoke of a study to bring multiple agencies together to increase understanding and to better train policy-makers and service providers in dealing with depression, self-harm and suicidal ideation in elderly people in rest homes. Trish Hafford-Letchfield followed looking at how lifelong learning can help address the unmet needs of elderly people and their carers to encourage engagement and promote mental and physical health to improve quality of life. Interventions using younger learning mentors can promote engagement through reciprocal learning experiences, while bringing a more person-centred perspective to living in care. Kirsty Miller (University of Dundee, Scotland) presented a review of work which suggests that moving from traditional risk-focused approaches to mental illness and addiction in elderly people towards one that also considers group identification and social identity can lead to healthier behaviour and greater psychological and physical well-being. The final speaker in the session, Katarzyna Prot-Klinger (Academy of Special Education, Warsaw, Poland) described how psychotherapy is a valuable route to empowering the elderly. She illustrated this through a therapeutic programme in Poland which aims to address the psychological legacy for children who survived the holocaust, with new initiatives enabling survivors to promote their stories in schools and through written media, thus allowing individuals to externalise their experiences. 

 

Migration 

 

In the migration breakout session, presenters from Scotland, Ireland, Slovenia, Spain and Greece highlighted emergent mental health challenges in different national contexts. Steve MacGillivray (University of Dundee, Scotland) reviewed the evidence base around the alcohol and substance abuse among migrants. He pointed to the conceptual challenges of ‘identifying’ migrants and concluded that, despite extensive 

searching through databases and grey literature, there are no reliable estimates of incidence and prevalence rates of alcohol and substance abuse in migrants in Europe. 

 

Rebecca Murphy (Trinity College Dublin, Ireland) discussed the mental health situation of African migrants in Ireland and the impact that ‘living in camps’ and feeling disconnected from the social, cultural and economic life in their new or temporary host country can have. She importantly distinguished between pre- and post-migration trauma: in many cases, the living circumstances in the new host country are responsible for mental health concerns and traumatisation or re-traumatisation. Mojca Urek (University of Ljubljana, Slovenia) then reported how she worked as a volunteer and observer when refugee waves over a few short weeks moved through Slovenia until the Austrian border to the North and the Hungarian border to the East were closed. An unprecedented number of refugees got stranded and threatened to overwhelm the resources of a small country. Using photographs, she painted a powerful and emotional picture of how the initially very welcoming and understanding atmosphere of the public turned into concern and weariness about those ‘others’. Enthusiastic support was replaced by providing basic hand-outs. In this situation, it was impossible to address the emotional and social needs of refugees. 

 

Then, Anna Mané (Hospital del Mar, Barcelona, Spain) highlighted the challenges of providing mental health services to the undocumented or ‘nameless’ migrants who do not easily fit into the health care system. In some instances, only mental health ‘first aid’ can be provided as the migration status is unclear and a long-term therapy may not be feasible or fundable. 

 

Finally, the session concluded with a very bleak scenario from Greece, which has accommodated most refugees in Europe while facing 45% reductions in public expenditures as a result of massive austerity measures imposed on the country. Panagiotis Chondros from the Greek organisation EPAPSY showed how the country has produced innovative ways of providing fast initial mental health responses to refugees. 

 

The conference served as a great opportunity to form or strengthen existing collaborations and academic-practice networks across Europe. 

 

Contact Fred Comerford at fac1@st-andrews.ac.uk for further information.