Q&A with Dr. Alison Stansfield, Learning Disability Psychiatrist

Alison Stansfield, MBChB, MRCPsych, MD is the clinical lead and consultant psychiatrist for the Leeds Autism Diagnostic Service (LADS). This is an adult all-IQ autism diagnostic service which also provides consultancy and training.
She is a regular lecturer for the Andrew Sims Centre on topics such as autism, learning disabilities, Mental Capacity Act, deprivation of liberty safeguards and the Mental Capacity Act/Mental Health Act Interface. She is also currently involved in a filming project with NHS employers to produce short accessible films for GPs and other professionals on autism.
She did her undergraduate medical degree at Leicester University (MBChB 1989), and received her medical doctorate from Leeds University in 2007. She completed her house jobs in Leicester in various specialties, SHO paediatric job in Harlow, followed by her basic psychiatry training in Cambridge in the 90s. She moved to Yorkshire in 1999 to complete her specialist registrar training in learning disability psychiatry. Before her role as clinical lead for LADS, she was the Associate Medical Director for Learning Disabilities from 2010 to 2013.
She has been published in medical journals, including Schizophrenia Bulletin, Journal of Intellectual Disability Research (JIDR), Advances in Autism, Early Intervention in Psychiatry and Trials. She also co-authored “A Clinician’s Brief Guide to the Mental Capacity Act,” published June 2013 (2nd edition 2015) and has provided expert reports regarding issues of capacity for the Court of Protection/Official Solicitor. She is currently writing chapters for a new BMJ book on autism.
When did you first decide to become a physician? Why?
I initially wanted to be a veterinarian. When I didn’t get into veterinary school, I decided to apply for medicine, because I had volunteered with a play scheme for learning disabled children in Bradford. This was while I was in sixth form.
How/why did you choose the medical school you attended?
As I’d originally applied to veterinary school, and there were 29 medical schools in the country, I naively thought that if I didn’t apply to the same university for medicine, they wouldn’t know that I really wanted to be a vet! At the time, you needed 2 A’s and a B for veterinary school, and 3 B’s for medicine. This was largely down to the comparatively limited number of veterinary schools (about 7 at the time). When I applied for medical school the following year, they pulled out my old veterinary school application during my interview! In any case, I got unconditional offers from St Mary’s Hospital Medical School, London, Dundee School of Medicine and Leicester Medical School, which is the one I chose. As it turned out, most of my med school peers also originally wanted to become vets!
What surprised you the most about your medical studies?
On my first day in medical school, I found out that medical school would take five years, followed by one year in house jobs, then another ten to become a surgeon, or another six to become a GP. At that point, I briefly thought of how much quicker the veterinarian pathway was. I didn’t really know about the structure of a medical career.
What information/advice do you wish you had known when you were beginning your medical studies?
Nothing, really. I think not knowing all the things I would come across was probably good. In the old system of house jobs, you got to follow a patient from start to finish, and you learned so much because you were there all the time. I might have told myself “keep the patient at the centre of everything you do.”
Why did you decide to specialize in psychiatry?
I actually decided to become a learning disability psychiatrist while volunteering with the Bradford play scheme run by carers. In my senior house job, I did paediatrics for a year, which allowed me to work with children with special needs. I then entered the psychiatry training pathway. My medical school elective was on music therapy for adults with learning disabilities.
If you had it to do all over again, would you still specialize in psychiatry? Why or why not?
Yes, definitely. Your patients really let you understand what’s going on, and they put their trust in you. You get to know the person really well over a fairly long time period. When it comes to learning disability patients in particular, you’re not going to cure them, but you are going to improve their quality of life. I now mainly diagnose people with autism, where my role is to help them understand what’s going on.
Has being a psychiatrist met your expectations? Why?
When I was a medical student, people with learning disabilities lived in hospital, essentially in asylum-like settings. So I’ve spent my career moving patients from hospital to the community, seeing the transformation of the specialty all the way through.
What do you like most about being a psychiatrist? Explain.
You get to know someone really well. You get to share people’s entire lives with them; you visit them at home as well as at the workplace. You still get to continue to see all other interesting aspects of medicine,which aren’t necessarily your responsibility, but you can be the patient’s advocate. You might see interesting genetic syndromes, or unusual medical symptoms, but you’re specialising in your area. However, you’re also a good liaison between patients and the rest of their care team. You also have an ability to do so many other things. I love teaching and writing. I’m currently contributing to a book. I do lots of research.
What do you like least about being a psychiatrist? Explain.
Can’t think of anything!
Tell me more about being a clinical lead.
I’m a clinical lead because I came up with the idea for the service, and put the bid in to the commissioners to get money for the pilot. I then continued to bid for funding.
The clinical lead role is about developing the service and thinking about the future of the team and sustainability plans. We are working with the University of Southampton to develop digital applications for people with autism, and I’m currently working with NHS Employers making short films about autism to educate other professionals. So I’m not just a clinician and consultant within the team; I’m also thinking about what’s next.
In your position now, knowing what you do – what would you say to yourself when you were beginning your medical career?
Nothing in particular. The system was different then. You worked as part of a firm with doctors at all levels of training. I always had someone to look to, and felt part of a family.
Describe a typical day at work–walk me through a day in your shoes.
As clinical lead, I make complex clinical decisions based on developmental information. I also perform observational assessments with psychiatrists from other subspecialties. I also consult with those who already have a diagnosis; this is mainly about giving practical guidance on jobs, school, etc.
My other roles involve doing research and supervising psychiatry trainees. I give lectures on subjects like the Mental Capacity Act and train social workers and general practitioners.
Tell me more about developing a new service in the NHS.
Developing a service is hard work! You have to persuade people that there’s good reason for a new service, as people are creatures of habit. My case for the service was helped by the passing of The Autism Act close to that time; this act required the NHS to have autism diagnostic services for adults.
We did a pilot first, as we had to show that it’s a good, cost-effective service. I had to become more business-oriented and teach commissioners about the need for the service. I was advised to take on the role as associate medical director, which helped me meet relevant decision makers, and learned valuable lessons about management. As an associate medical director, I also had to learn to say no to colleagues, which I didn’t like.
On average: How many hours a week do you work? How many hours do you sleep per night? How many weeks of vacation do you take?
I work 4 days a week, and I often email before I get to work. I love sleeping so I try to get 8 hours every night. I always take the full quota of holiday – a good work/life balance helps me stay enthusiastic about my job.
From your perspective, what is the biggest problem in health care today?
Decision makers aren’t asking clinicians what needs to happen. They are typically non-clinical themselves, and are not asking the right questions about the clinical issues. Money is not being channeled to the right places, and there isn’t enough reflection on what the health service should be providing.
Where do you see your specialty in five years?
I think we’ll see further specialization within learning disabilities, including autism and dementia. We need to be focusing on things which other specialties can’t do and are essential for improving the lives of people with learning disabilities. Private psychiatry has taken over many of the complex cases that the NHS couldn’t deal with; this might become a bigger issue in time, but I’m not sure.
Where do you see medicine in five years?
We need to rethink who’s doing the jobs, and about what medical students need to know. With the advent of the working time directive came the loss of ‘firms’ and the change in training. As a result, there isn’t the same sense of sharing, belonging and learning that I benefited from among current junior doctors, so we need to rethink training. We also have a very disillusioned workforce, which is a real shame.
What types of outreach/volunteer work do you do, if any?
I train other healthcare professionals as part of my job. I’m also involved in a project making educational short films about living with autism; as part of this, I’m working with a professor of English from Leeds University (who has sons with autism) and a history lecturer from Leeds Beckett University (who has been diagnosed with autism).
How do you balance work and life outside of work?
I enjoy my job, but I enjoy being a mum, too. I’ve worked part-time since my son was born twenty-three years ago, and I’ve managed to be a doctor and do all the things I’m interested in too. My husband also works part-time, so we have a day off together every week. I’m currently learning Spanish, I do lots of walking, and I’m involved in the local community.
What is your final piece of advice for students interested in pursuing a career in your field?
Learning disability psychiatry is particularly great because you can be a psychiatrist and at the same time continue to see all the fascinating aspects of medicine. It’s also great if you want a good work-life balance, because there aren’t usually emergencies which involve the psychiatrist per se; there are carers involved. It’s an ever-expanding field, which is seeing the growth of services for neuro-developmental conditions like autism and ADHD, dyslexia and dyspraxia. I’ve also done a lot of forensic learning disability work, at regional and national levels. If you’re interested in working in this field, the patients are truly wonderful and can be the most rewarding group to serve.
About the Author
Gloria Onwuneme is a Danish-born Nigerian who’s studying medicine at the University of Nottingham, UK. She has a strong interest in neurology and psychiatry, and a growing interest in healthcare innovation and medical entrepreneurship. In her spare time, she reads a lot, she jogs sometimes, and she (thinks she) writes poems.