CAMHS spotlight interviews #3 – Dr John Ward interviews Dr Kate Stein
12 September, 2023
Our series of blog posts sees leading child and adolescent psychiatrists conduct interviews between themselves to shine a light on their speciality. Our third interview in this series has Dr John Ward interviewing Dr Kate Stein.
CAMHS spotlight interviews
About Dr Kate Stein
Dr Kate Stein is a Community Child and Adolescent Consultant Psychiatrist based at the University of Oxford.
She spoke with me about her journey in child and adolescent psychiatry, the current state of CAMHS, and the importance her clinical and research work plays in her life.
The interview
What have been the key moments in your training as a psychiatrist?
I spent four months working as a psychiatrist in Uganda after my FY2 year and got interested in CAMHS over there because I saw lots of conversion disorders and functional disorders in the kids. I became interested in mind-body disorders. When I came back to the UK, I started on the psychiatry training scheme in Oxford and began conversations with the academics here. The most common functional disorders in kids are functional abdominal pain disorders. 20% of children suffer from recurrent abdominal pain conditions that do not have an underlying ‘organic’ disease process.
How did the research part of your career start?
I applied for an academic clinical fellowship (ACF) in Oxford that ran alongside my training. This allowed me to focus on research and I was able to write three first author publications in functional abdominal pain disorders over the course of that time. I also secured a travelling fellowship from the Royal College to work in America with a professor at Duke University who is an expert on childhood functional abdominal disorders. We have since written three papers together.
Have you always intended on becoming a researcher?
Not really; my dad is an academic so I guess I have been brought up with that kind of appreciation of the process and respect for disciplined thinking. But I really like being with patients, communicating ideas, trying to problem solve and working in a team I wanted to take a bit of that academic thinking to my clinical work and hopefully that makes me a better clinician.
What do you enjoy about research?
For me the joy was in writing up my findings and communicating ideas. I ended up on Radio 4’s All in the Mind talking about one of my papers. It was a bit nerve wracking at the beginning, but I enjoyed trying to think about how to communicate complex ideas in a way that’s palatable to the general public.
Research reminds me of the principles you’re trying to underpin in clinical practice; for example recently I found a paper all about the “Golden Half Hour” of talking to families about chronic pain. These papers are really helpful, and they’re written by frontline clinicians. I feel clinicians need to be creating research because that’s what’s actually going to drive changes in practice.
Functional disorders are challenging disorders for clinicians in all specialities. How do you approach them?
I start with a thorough history and holistic approach as they are truly biopsychosocial conditions. I need to understand the young person and their family, what's happening at school, what's happening at home. Often families want to find an answer—a cause and a cure—for the abdominal pain, but the focus of treatment is less about finding a cure, but helping them manage their pain better, to learn to distract themselves and live with it. Once they learn to connect with their body a bit better, and feel less alarmed by their bodily sensations, their symptoms improve.
Sometimes, young people misinterpret normal gut sensations and they’re amplified; this leads to anxiety and a vicious cycle is set up. For example, they become hyper-vigilant about their diet and start avoiding various foods. What I showed with my research is that there’s a correlation between those kids with tummy pains when they’re little, and whether they’re going to have disordered eating and anxiety/depression when they are teenagers. It’s worth tackling it when they’re little because it might help with some of these problems down the line.
I imagine that having these conversations with patients and their families must be challenging?
I've come to the conclusion that gaining the trust of the families is crucial; you need their buy-in. One of the ways you can do that is by keeping the medical team involved. The families feel reassured that if there are new red flag symptoms (e.g. sudden weight loss), they can be investigated. It is also important to bring in the Functional diagnosis early—it’s a positive diagnosis, not a diagnosis of exclusion. That way, every negative test doesn’t come with a shock and a feeling that they are not getting anywhere.
Would you advise upcoming doctors to go into CAMHS?
The NHS is a tough place to work right now, there’s no doubt about it, but I don’t regret it. I love my job and working with young people and their families. I feel like you can make significant changes and help many kids to achieve a full recovery. A lot of them won’t go on to have chronic psychiatric illness. Of course, some of them will remain severely unwell and these young people and their families need a lot of support. I also like the holistic approach; you have to work with schools, with social care, often with the police and of course very closely with the whole family.
I feel like the medications that I prescribe a lot really do work. ADHD meds can be magical and it's so rewarding for the instant gratification. There are families that need other kinds of help such as social care input - but again, they can be helped if everyone works together.
What are the current challenges in CAMHS?
I see so many autistic girls with emotional dysregulation at the moment and I feel like the traditional psychological treatments need to be adapted to suit them better; the classic CBT model doesn't work for these young people. They need more body focused psychological treatments and that’s an area I’m particularly interested in developing (e.g. psychological treatments using interoceptive exposure). We’re getting to grips with understanding more about autism and girls and in my generic CAMHS team at the moment, there is just so much undiagnosed neurodiversity.
What have you learnt since working as a senior clinician?
Something I’m realising as a consultant is the value in seeing the same doctor and providing containment to patients so they don’t have to repeat the same story again and again. People need consistency for the relationship to be therapeutic.
How have you found balancing clinical work, research and life outside of work?
It is very busy, certainly! The dream would be for me to do some clinical work and then have some space to reflect and maybe do teaching/research. It’s hard - especially when you’ve got a family of your own. Research does also give you a lot of autonomy in some ways and you can manage your life. You know you can go to the Christmas play and no one’s going to give you a hard time about it, but you can’t just cancel a clinic. I try and reassess every few months to find the right balance.