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"We're on the brink of something very exciting": a psychiatrist on the potential for research

Professor David Osborn is a psychiatrist and researcher – putting him in the unique position to both treat people experiencing mental illness and discover new ways to improve those treatments. We talked to him about what led him to build a career in mental health, the research he’s working on and the challenges facing psychiatrists today.

It was whilst David was at University College London (UCL) training to be a doctor that he first experienced working with people with mental health problems – having been invited onto the student psychotherapy scheme. This “fascinating and really rewarding” experience, led him to train to become a psychiatrist, and later a researcher looking into the interplay between physical and mental health. 

What was it about psychiatry that you found particularly fascinating?

I enjoyed medicine but found that it didn’t have the same challenges as mental health – you’re told here’s a protocol for a heart attack, here’s a protocol for an asthma attack… Psychiatry is less driven by things like blood tests – it’s a more complex presentation where you also need to think about all the social factors and psychological factors, family factors, relationship factors, plus things like genes and substance misuse and physical health. It’s really complex, challenging and stimulating. 

Tell me more about how you spend your days working as a psychiatrist.

 I work in something called a Crisis and Emergency Team – with nurses, junior doctors, social workers and psychologists, doing mainly home visits. 

I work across lots of different types of mental health problems; from students who have depression and have taken an overdose, to someone who’s got their first episode of a paranoid illness like psychosis, to someone who has long recurrent depression for many years and has had another episode.

We might start people on treatment and get them in the right service – or get their treatment optimised and see what social factors need to be addressed – then continue visits and make sure that they’re back on track.

What questions would you like research to answer in order to better help your patients?

What’s frustrating to me at the moment is that we don’t have good protocols of who’s going to do well on ‘treatment A’ or ‘treatment B’ and so it’s just kind of trial and error, which I think is really hard for the service user. Say they are really depressed and they want to try an antidepressant, it’s hard to say which one will work for them. 

So, I’d like to be able to target the right treatments, whether that’s psychological therapies or medication, at the right people. I’d like to personalise treatments in a much more sophisticated way – and understand who is most at risk of needing more intensive care.

I’d also like to decrease the mortality gap – so that less people with psychosis die of cardiovascular disease. It appears that there’s this mortality gap which is getting wider between the general population and those with schizophrenia and bipolar.

And how could research help us answer these questions?

Data is really important – and I am fascinated by collecting it. People working in this field have lots of ideas for improvements, but unless we have evidence we don’t know about how common problems are, what it is like to experience these problems and how to help people get better.

We should use this data in helpful way, with things like machine-learning – which enables us to look at big sets of data over a long period of time and come up with models to identify who is more likely to respond well to a treatment and who isn’t.

Focussing specifically on your research – you’re looking at the interface between mental health and physical health –what was it about this area that peaked your interest?

I was a bit worried that psychiatry was seen as a different field, that’s completely separate to physical medicine and that people therefore stopped thinking about physical health when they were thinking about mental health.

The cliché was always that people hang up their stethoscope when they get into psychiatry and stop looking at the fact that many of the people that use mental health services also have poor physical health conditions like lung disease and heart disease. I started doing some simple studies looking at the kind of physical health care that people got when they were on some of the mental health wards. I then looked at the other side – and was interested in how people in stressful medical situations don’t get their mental health looked at. 

Unsurprisingly, in a way, people just have this mind/body divide thing where they can’t see that problems occur simultaneously – or they see mental health as separate to physical health. 

Can you tell me about the specifics of some of your studies and their findings?

I’m particularly interested in severe mental illness – conditions like schizophrenia and bipolar disorder – where people have things like delusions and hallucinations. My PhD showed that people in General Practice with those conditions were twice as likely to have diabetes, they were three times more likely to smoke, they were at far greater risk of having abnormal cholesterol levels, they have poorer diet and do less exercise – all of that came together to show that they were at a much greater risk of developing heart disease. 

My PhD was the first work that was looking at that in a controlled way – but there’s been lots of work since then using different methods confirming all that. 

And that’s what I worked on for the last 15 years – looking in more detail about cardiovascular disease and thinking, what can we do about it. 

So, what can we do about it?

The big question people often ask is: what role did medication play? People worry about anti-psychotic drugs for schizophrenia increasing weight-gain and leading to abnormalities in glucose which can increase the risk of heart disease.

But it’s pretty complex because if you don’t treat people with anti-psychotic drugs that puts them at risk for poor outcomes mentally and physically. We need to understand how much of it the risk is increased by smoking, being poor and medication. How much of it is bad health care – with people not getting the proper screening they should get.

We’ve done lots of work trying to improve screening for people – and improving international and national guidelines to make sure people get screened for all these risk factors. We’re trying to make sure GPs are screening for these problems – being a bit more holistic – rather than, if you’ve got a mental health problem, let’s just talk about voices.

You mentioned data science playing a crucial part if we’re to provide breakthroughs in how we treat and understand mental illness. Are there any other areas you think are important in driving forward change?

There’s lots of exciting stuff around digital healthcare, and being able to monitor people and predict and prevent relapse. I think the future’s massively bright in terms of the development of neuroscience and its computational power. 

And there’s also social factors – we need to decrease the stigma, which will ensure more people get access to treatment earlier and enable people to talk about their suffering. This means not having videos like Kasabian’s ‘You’re In Love With A Psycho’ that make people not want to be seen by mental health services. Seriously, the damage could be really big with something like that.

Funding is a big thing if we are to provide the breakthroughs – but it feels like we’re on the brink of something very, very exciting – so we’ve got to keep that excitement going. 

Last updated: 26 July 2017

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