International Conference on Urban Mental Health
- 2022 -
On Friday October 7th, an international crowd of scientists, practitioners, students and experience experts gathered in Amsterdam for the first International Conference of the Centre for Urban Mental Health.
In their opening lecture co-directors Reinout Wiers, professor of Developmental Psychopathology (UvA), and Claudi Bockting, professor of Clinical Psychology in Psychiatry (Amsterdam UMC) made the urgent need for novel answers to the current mental health challenges very clear. Before the covid-19 pandemic, it was estimated that no less than 970 million people worldwide suffered from a mental health disorder. In the first year of the pandemic, a 25 percent rise in the prevalence of these disorders was recorded. Current treatment options are costly, only available to a small part of the population, and only effective for about half of the patients. Add to that the ongoing urbanization and the relationship between urban living and mental health problems and the need for new interventions becomes clearThese interventions might not only be aimed at, aiming not just at the individual, but also at neighborhoods and communities as well as on societal level.
Emotional Support
The Centre for Urban Mental health uses the potential of complexity science to unravel meaningful pathways for this in a city context. For example, this complexity approach sheds light on the feedback mechanisms that could make the mental health effects of the pandemic and its lockdowns more persistent than we might hope for, Bockting pointed out. Also, it helped identify risk- and protective factors when it comes to mental well-being of students during the pandemic, Wiers explained. Physical activity, emotional support, and adaptive coping mechanisms proved to contribute to students' well-being despite their lives being turned upside down.
To add to the identified urgency for better mental health measures, professor of Public Health Sandro Galea (Boston University) took a deep dive into the mental health research undertaken in the course of the pandemic. Among the many lessons to learn from this worldwide disaster – he identified seven – the undeniable importance of one’s financial and social situation might be the most prominent. Assets – be they financial, social, or physical – protect people from mental health problems even when facing life-disrupting events. 'This is a well-documented reality we don’t recognize enough in the mental health debate.’ Meanwhile, the pandemic has intersected with pre-existing mechanisms of inequality to further widen the gap between the haves and the have-nots. Galea questioned the emphasis on and funding flowing into genetic research in trying to unravel how to improve mental health, given that it is a phenomenon that is determined by both genes and the environment. So ultimately, it is the environment within which populations live that defines whether a genetic predisposition materializes, which demands us to face the social determinants of mental health, Galea argued.
The healing powers of nature
In a dazzling whirlwind, the Ph.D. candidates of the Centre for Urban Mental Health presented their research projects in Pecha Kucha style. Spanning the influence of the gut microbiome on depressions in urban settings to the asymmetry between transitioning from social drinking to alcohol use disorder and vice versa, they touch upon a range of urban mental health topics and explain how they use the tools of complexity science to gain new insights. [M1] [AK(2] [AK(3] [M4]
Searching for interventions that might alleviate the stress of urban living, Andreas Meyer-Lindenberg, professor ofPsychiatry and Psychotherapy (Central Institute Mental Health, Mannheim), combines neuroscientific measurements with ecological momentary assessment. This leads to the identification of three factors that boost mental resilience. First, social interactions, then movement, and finally nature. Different people have different sensitivity to the protective powers these three factors bear. For example, nature seems to block rumination, and those people who have difficulties regulating negative emotions benefit most from green spaces.
Looking ahead, the urbanization and migration climate change will bring about leads to a question of distribution. How to divide access to green space? ‘Since the healing effect of nature seems to be mediated by visual experience, If I were to distribute funding, I would do it in such a way that as many people as possible have visual access to nature. Planting trees in streets, rather than clustering all of it in big parks. And ideally, you would combine the potential of green space with that of social interaction. So plant a few trees with a bench underneath, that seduces people to interact.’
When mattering really matters
Professor of Human Development and Family Studies, Andrea Wittenborn (Michigan State University), emphasized that many factors play a role in depression. These factors act on different time scales, influence the onset of depression, the stress response system, immune function, social relationships, and financial resources, for example. In trying to unravel which patient might benefit from a specific treatment, Wittenborn opts for a system dynamics approach, mapping the feedback loops involved in depression. She takes into account cognitive, social, physical, and hormonal influences, amongst other factors. Mapping these feedback mechanisms offers the potential to identify new target points for interventions.
Ron Dahl, developmental scientist and professor of Public Health (UC Berkeley), stated that while puberty may be perceived as a period of vulnerability where kids are at risk to develop destructive behaviors like self-harm, it could also be seen as a unique inflection point for positive change. It is a period with increased sensitivity to social feedback, where reinforcement learning happens through trial and error. Looking at it from an evolutionary perspective, it is the moment when kids go from taking from the group to learning how to contribute to the group. Pointing at this inflection point, Dahl wondered: 'This is the age of opportunity for mastery. But what happens if, at this moment, kids are not motivated to master something of value to the group?' To develop this motivation, it is important for kids to feel that they matter. Dahl: ‘The adolescent brain is not inferior; it is remarkably well-adapted to the roles of adolescents. It is sensitive to gaining social value, often by contributing in meaningful ways.' Moving from the ancestral planes to the bustling contemporary cities, it is crucial to use this moment and alter the prestige criteria where necessary. For example, through school-based approaches or programs tackling problems with both sleep and rumination, by nurturing habits of savoring.
Resilient communities
In a shift from scientific knowledge to the insights and understanding brought about by lived experience, spoken word artist Daniëlle Zawadi shares how she experiences being young in hectic times in a mesmerizing performance. Then, Hannah Hollestelle and Jolien van Sleen of ExpEx share their insider perspective on mental health and mental illness. In fostering exchange between experience experts, they try to shape communities that can be each other’s keepers, as they believe we are only as resilient as the communities around us. Aiming to ‘bring the lessons they have had to learn the hard way to a table where anyone can have a seat.’ Juul van Hoof, director of Thrive, dives into mental health problems amongst the Amsterdam population. Thrive works to destigmatize and normalize mental health problems, especially among the younger generation. In a panel discussion, these experts discuss the mental health benefits and challenges of urban living and emphasize the value of involving experience experts in scientific research.
Emergence
Finally, Peter Sloot, professor of Complex Adaptive Systems (UvA), elaborates on the value of complexity science when it comes to understanding urban mental health. Mental well-being and illness are emergent phenomena. Like wetness being lost when you reduce water to its molecular parts, these emergent properties are lost, the moment you try to take them apart. Mental disorder arises from a network of interactions among its constituent elements. As a consequence, it is scale-free, non-linear, and irreducible, among other things. Data can help understand these networks, but come with their own challenges, so larger datasets don't necessarily help. Better data and especially longitudinal data would help. Data need models that describe the mechanistic processes underlying different patterns. ‘We are far removed from fully understanding mental health and disorder and being able to predict the best interventions, but we are not lost,’ Sloot says before referencing physicist Richard Feynman in concluding that we need to ‘stop and think about the complexity, the inconceivable nature of Nature.’
Thank you to all of our Speakers and Attendees that were apart of our first International Conference on Urban Mental Health. Special thanks to Andre Tomlin for live tweeting and hosting the conversation during the event. #ICoUMH
Video footage from the conference will be avaiable shortly. Please contact us if you would like a copy of speaker presentations.
All photos were taken by Monique Kooijmans