CAMHS spotlight interviews: #1 – Dr Jessica Scott interviews Dr Dasha Nicholls

As part of a new series of blog posts, leading child and adolescent psychiatrists conduct interviews between themselves to shine a light on their speciality. To begin this series, Dr Jessica Scott interviews Dr Dasha Nicholls.

About Dr Dasha Nicholls

Dr Nicholls is a Clinical Reader in child and adolescent psychiatry at Imperial College London. She started her child psychiatry training at Great Ormond Street where she completed an MD on the endocrinology of eating disorders.

She was president of the Academy of Eating Disorders and instigated the development of the British Eating Disorders Society. While at Great Ormand Street Dr Nicholls set up the Child and Adolescent psychiatric surveillance system and developed the Junior Marzipan Guidelines and the National Whole Team training for young people with eating disorders.

She spoke with me about why she became a child psychiatrist, her current job at Imperial College London and her passions.

The interview

What drew you into child and adolescent psychiatry?

I was working on a CBT adult inpatient ward where two young women sparked my interest in child psychiatry.  Firstly, we were treating a 21-year-old with a complex somatization presentation. She had a family that would come and visit but we were treating her individually. It’s the first time I remember realising the need to treat ‘systemically’. Another patient on the ward had a history of sexual abuse and I remember thinking that she would have benefited from support much earlier in life.

How did the research part of your career start?

I am someone who takes opportunities. I was working in Great Ormond Street with Professor Brian Lask, on the Mildred Creak Unit. There was a strong research ethos in the clinical team and regular research meetings with the endocrinology and radiology teams. At one meeting a comment about there not being a paediatrician interested in the physical manifestations of early eating disorders led to me doing my MD on the endocrinology of eating disorders and growth development.

What drew you to work with eating disorders?

As a specialty it required me to combine my medical and psychiatric skills. It also has the feminist angle, so it aligns with my socio-political thinking.

What are you most proud of achieving in work?

The development of the Junior Marzipan Guidelines and Whole Team Training for eating disorders.

I remember being in a training event in Manchester with around 300 people in a Church thinking all these people have come together to learn about eating disorders and that the same event was happening in four other venues across the country. It was an amazing experience.

What does a normal week look like for you?

I work as an academic for Imperial College London, three days a week. I run two research groups, the Child and Adolescent Mental Health Research Group and the Multi Morbidity and Mental Health across the ages group in the ARC for Northwest London.

I work for the trust one and half days a week clinically, in a community eating disorders service. In this time, I run the training academy and do teaching and training, mainly in eating disorders.

I am on secondment one day a week as the Clinical and Strategic Director for National Audits and Research at the Royal College of Psychiatrists. I also work an 11^th PA as the national specialist advisor to NHS England on eating disorders.

What is the most rewarding part of your job?

I have a long relationship with the RCPsych and I love that part of my job. The national audit and research team are such an effective unit and I love being able to be a part of it without feeling as though without me it would grind to a halt. I can attend meetings, get feedback on the interesting projects happening and offer ideas and suggestions. I think it is this part of my job that I find the most immediately rewarding.

What do you feel is the future of children’s mental health?

I think we need to think about how mental health has become an identity for some young people and how we can change the language around it. Mental health competence thinks instead of how we can help young people identify the areas in which they are skilled. I think that we need to talk about how young people access their social and emotional learning in the world where they are interacting more online with their peers and less with their families.

I have realised there is no modern developmental theory based in cognitive neuroscience. I think someone needs to devise a theory with a more nuanced understanding what the tasks of adolescence are today. This can help identify the challenges that particular groups have and look at whether we can support them to learn certain skills when they still have neuro-plasticity.

What is your passion within child psychiatry?

I am passionate about how to benefit developing brains in pre-pubertal adolescence to become more resilient to mental health problems. I think having a developmental view of brain development and where the vulnerabilities are for mental illness enables thinking about how to provide support during those moments of crisis and how to help people back onto their developmental trajectory.

What are the key attributes of a child psychiatrist?

A combination of reflective function and analytical thinking. What I mean by that is being able to see both the big picture and bring everything in the complex scenario together but also being able to analyse the scenario with absolute precision so that you get to the root of something. We have probably the broadest and most complex training of any medical professional and our ability to bring all the different theoretical perspectives together to a specific problem has to be priceless.

What do you do outside of work?

I am a singer and used to sing in a very good choir that came second in the choir of the year competition. The pandemic put a stop to that and I still don’t have a choir but a good night at our house ends up with singing around the piano. I am also highly social and would almost fly around the world to go to a party and visit my friends.