CAMHS spotlight interviews #2 – Dr Richard Hayes interviews Dr Rory Conn

Our series of blog posts sees leading child and adolescent psychiatrists conduct interviews between themselves to shine a light on their speciality. Our second interview in this series has Dr Richard Hayes interviewing Dr Rory Conn.

About Dr Rory Conn

Dr Rory Conn is a Consultant Child and Adolescent Psychiatrist and Honorary Senior Clinical Lecturer in Exeter. He started his child psychiatry training at the Tavistock, where he completed a Higher Degree in Systemic Therapy.

He then undertook a Darzi Fellowship at GOSH and a Postgraduate Certificate in Healthcare Leadership and Management. He started his first Consultant post in 2017 and became an elected member of the Royal College of Psychiatrists CAMHS faculty in 2020.

He spoke to me about why he became a child psychiatrist, his current job in Exeter and what he does outside of work.

The interview

What drew you to CAMHS in the first place?

As a Core Trainee I was very interested in neuropsychiatry. What really swung it toward CAMHS for me was the mesmerising experience of doing family therapy, not just of observing it but being integral to it in a core training post. For me it felt like there was a stage with players on, and in facilitating/directing these meetings I was helping a family to understand themselves and each other better. It was this introduction to systemic working that put CAMHS front and centre in my plans.

Neuropsychiatry (and in fact lots of psychiatry) can be a rather ‘slow burn’. I loved how in the dynamic of family therapy, and in crisis work, you could make a major shift in a network even in one intervention. A rapid turnover appeals to me and that also got me interested in working in liaison, being at the ‘coal face’ of paediatrics when there is a real need for change.

Could you describe your typical week at work for us?

It’s very varied, which I like. Within my liaison work probably a third of my time is spent on eating disorders. Lately we have seen a significant increase in the number of young people needing intensive support with eating disorders on paediatric wards. About another third is spent on risk-management with presentations like self-harm and overdoses. Then there are those patients who come with more subtle body/mind interface presentations. I am the Undergraduate Lead for Psychiatry at Exeter University Medical School. I work four days in the NHS and privately half a day a week. Otherwise on Fridays I spend a whole day working for Duchenne UK. I am the National Psychiatric Lead for this devastating and complex life-limiting illness.

Could you explain what you do with Duchenne UK?

Boys with Duchenne muscular dystrophy have very significant neuropsychiatric sequelae; about a third present with ADHD, the same number would meet the criteria for autism, others have specific learning needs which might be missed. On top of that, it is a life-limiting condition which can bring with it depression and anxiety. High dose steroids can also lead to psychiatric symptoms for some. The project with Duchenne UK involves seeing patients from around the country which I’m doing remotely, as well as helping the team define what the standards of care should be. For example ensuring that boys get access to cognitive assessments, or if they are presenting with suicidal ideation that they are able to get support with that. I really enjoy having a national role like this.

How do you see the future of children’s mental health services?

People are becoming more mindful of children’s mental health and conversation about this on a national level is encouraging. We know there has been an enormous increase in referrals and I do wonder sometimes if we are looking at normal childhood distress through a more pathological lens than we used to. There is an argument that some presentations we are seeing should be ‘solvable’ through other interventions that don’t put the mental health of the child front and centre. Generally, improved alignment with social care and education regarding non-medical approaches is the starting point. Overall the future is bright because there are more people interested in training and greater governmental and policy focus on children’s mental health.

What does a really good day at the office look like for you?

Some of the most rewarding bits (and the reason I chose to work in liaison) are the opportunities to bring a new perspective to an established problem. Particularly working with children who have an existing physical health diagnosis, for example those dealing with side effects from chemotherapy, or those refusing to take insulin for their diabetes. A good day looks like aligning the body and mind components of health. Alongside this, the opportunity to teach medical students and paediatric staff as well.

As psychiatrists, how can we bridge the gap between physical and mental health?

We ought to be thinking more about physical health within the CAMHS setting. Some teams are employing GPs and paediatricians now, working to blur those boundaries. For example, we would do well to realise that the task of improving a child’s HbA1c is not solely that of the paediatric team. We can empower ourselves by realising that an interaction with any mental health professional can have a massive impact on all aspects of a patient’s life. Another important thing to note is that the stigma that was once there regarding psychiatric careers is changing fast. Psychiatry is proper medicine; it has a strong evidence base and has become a much more ‘valid’ choice among medical students and foundation doctors.

What personal qualities do you think make a good child psychiatrist?

Patience is important, as change can take a long time. Child psychiatrists should have a broad world view and be able to embrace others’ positions whilst tolerating uncertainty. It goes without saying but also being good at talking to young people is key; I find that really the best way of thinking about this is remembering what it was like to be young ourselves. Other than that, being comfortable with a ‘flattened hierarchy’ is essential.

How do you ‘switch off’ from work, and what do you do with your free time?

Well, the pandemic was interesting from that point of view, I didn’t proactively try to find a new hobby but I managed to fall into restoring and collecting mid-century furniture. In fact I’m sitting here in my conservatory on a lovely Danish teak sofa! There’s something very therapeutic about sanding, perhaps it’s a bit like EMDR. To be honest now the pandemic is over I don’t have the long evenings to fill in quite the same way but I’ve got two kids who keep me busy.

Lastly, do you have one stand-out achievement from your career that you would like to share?

I am very interested in Public Education. In 2018 I did a One to One interview on Radio 4 about working in child psychiatry. It was part of a series about working in stressful environments. Because it was ‘Pick of the Week’ it had a really big reach and I felt like I was getting the word out there about child psychiatry. I then set up a website – Connected Child Health – which is all about the body mind interface, plus training in psychiatry.