CAMHS spotlight interviews #5 – Dr Jenny Price interviews Dr Susan Howson

Our series of blog posts sees leading child and adolescent psychiatrists conduct interviews between themselves to shine a light on their speciality. In this interview, Dr Jenny Price interviews Dr Susan Howson.

About Dr Susan Howson

Dr Susan Howson is a consultant in child and adolescent psychiatry in Devon with the Assertive Outreach Team, which provides additional community-based support to young people and their families who need a more intensive level of support than can be provided by local community CAMHS.

Susan is passionate about keeping young people with mental health difficulties rooted in their communities and drawing upon the resources of the family and community to help them recover.

She spoke with me about why she became a child psychiatrist, and her passions.

The interview

What drew you into Child and Adolescent psychiatry?

I started core psychiatry training in the Southwest in 2012 and was fully expecting to pursue general adult psychiatry. However, I began to notice that for many people presenting to mental health services, their problems began early in life as children and adolescents. I wondered if their lives would have been different if interventions had been available earlier on; would they have been saved from years of pain and suffering? I opted to do a CAMHS job during my core training which took place in a general community team. I highly valued this opportunity to work with children and young people with a wide range of psychiatric presentations, particularly where I saw them presenting to services for the first time rather than further down the line in highly specialised services.

How did you get into medical education?

It was from my CAMHS core training post that I decided to apply for an Academic Clinical Fellowship in Child and Adolescent Psychiatry which included higher specialist training. Currently, I supervise students from the MSc in Data Science for Healthcare at the University of Exeter with projects for better managing clinical data; I hope to work with another student in identifying optimal sites for a Devon-based day-programme. I also organise the MRCPsych regional teaching programme to which I introduced simulation based teaching as a core theme in the programme and run one of the Balint groups for Core Trainees.

What drew you to work with the Assertive Outreach Team?

Long before studying medicine, I worked part time in an old-fashioned ‘asylum’ which had hundreds of inpatients at its height. In the 1990’s, when there was a national trend to close these large asylums, this one remained open for several years as they struggled to find appropriate homes for elderly patients who had lived in the asylum since admission, in adolescence. This experience reminds me of the importance of keeping young people at home to provide treatment whenever possible, a concept with a growing evidence base. I also believe that services should support young people in developing their autonomy so that transitions to adult services are as smooth as possible. As young people approach 18 years of age, there is often a change in focus to recognise this.

What does a normal week look like for you?

My current post as Consultant Psychiatrist with the Devon Child and Adolescent Assertive Outreach Team may seem like a highly specialised role, but it’s actually incredibly varied and far from specialised. There is no ‘average day’ as they are so unpredictable. The team holds a caseload of up to 30 young people; I conduct psychiatric assessments and reviews, takes part in team discussions, aiding with the formulation and supporting their longer term, allocated Psychiatrists in outpatient CAMHS. I see patients in their homes, on paediatric wards, in general adolescent psychiatric units and in secure children’s homes. I also see young people in a variety of other contexts when I cover for other CAMHS consultants on leave. Furthermore, a significant part of my time is also in consultation with other teams and agencies, advocating for young people, providing advice and building on formulations. I also had the opportunity as a consultant to train in DBT, which I draw upon in my clinical work.

I also enjoy a role in service development in my Trust. One recent project involved rethinking referral criteria to the Assertive Outreach Team, as its remit evolves. For example, “at risk of hospital admission” used to be a criterion, but as hospital admission rates have dropped with an increased focus on care in the community, this has become less helpful as a criteria. I have also been looking at measuring case complexity at referral and considering instruments that can standardise its assessment. Furthermore, the service has secured funding to train in the model of Therapeutic Assessment, which may lead to taking part in a multi-site Randomised Controlled Trial.

What is the most rewarding part of your job?

I think the best thing about my job is working within a brilliant team; people who share my passion for working with young people with complex needs in a community setting. On referral to the Assertive Outreach team, young people and their families can often feel bleak, hopeless and stuck. Through working with the team, they can really turn their lives around and it has been highly rewarding to see some of the thank-you letters from such families. It is especially rewarding where the input of the team has meant they have been able to avoid hospital admission and sending young people far away from their home.

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

In terms of the future of children’s mental health care, I think there will be a shift away from Tier 4 inpatient admissions and focus on care at home will remain, perhaps mirroring developments in physical health care with the idea of ‘hospital at home’ services and I would very much like to see this explored further. There is also a widespread aim to create ‘youth services’ for young people up to the age of 25 years which she thinks could work well for a group of people. I would particularly like to see better integration with social care. I think there are increasingly complex systems of organisations involved in children’s welfare, with services less focused entirely in a single, CAMHS service; I would like to see better co-ordination in the planning of this. Perhaps the development of integrated care boards may help to achieve this.

Would you advise upcoming doctors to pursue a career in CAMHS?

Definitely! I feel that child and adolescent psychiatry offers space and scope for a wide variety of people with different attributes, as it is such a broad specialty. However, it does help to be flexible and open minded so that one doesn’t become too flustered when things don’t go according to plan or difficult decisions need to be made.