Interview with Dr Alexandra Pitman
Dr Alexandra Pitman is an Associate Professor in Psychiatry, co-lead of the Loneliness and Social Isolation in Mental Health Network at UCL, and an Honorary Consultant Psychiatrist in the NHS. Her research focuses on suicide, self-harm, and the links between loneliness, social isolation, and mental health problems. Alexandra is a member of the UCL-Wellcome Mental Health Science PhD programme committee and has organised an extensive seminar programme for each cohort covering a huge variety of important aspects in mental health research. She is also my mentor throughout my four years on the programme, and has been an incredibly knowledgeable, supportive, and thoughtful person to rely on during the challenges of a PhD.
Q: What book would you recommend to anyone working or interested in mental health?
As an undergraduate I remember reading various books that described the authors’ experiences of mental illness. These included Breakdown by Stuart Sutherland, who was himself a psychologist, and An Unquiet Mind by Kay Redfield Jamison, also a psychologist. I remember at the time, untrained in medicine, it struck me just how debilitating mental illness was, and how hard it was to understand. I think books like these probably encouraged me to pursue a career in psychiatry, and in clinic today I am still struck by how debilitating mental illness is. Books like these are really important for anyone in society to read, not just people working or interested in mental health, because it is so hard for all of us to understand the reality of mental disorder and its myriad forms. This is partly why patients have such troubling experiences of feeling stigmatised due to their mental illness. On the tube I am always really pleased to see people reading Reasons to Stay Alive by Matt Haig because he too provides a vivid account of a terrifying state of being mentally unwell and how disabled he was by his illness. It puts paid to expectations that people with mental illness should “pull themselves together” and reminds mental health researchers and clinicians of the suffering inherent to the conditions we research and treat, and the importance of making progress in this work.
Q; What are you working on at the moment?
I am interested in self-harm and suicide epidemiology, and my research involves investigating risk factors such as loneliness, suicide bereavement, pain, access to the physical means of suicide, and the cognitive availability of suicide. I have collaborated with the UCL Institute of Cognitive Neuroscience recently to investigate social influences on self-harm, and this is part of a wider programme of work to understand the communicability of psychiatric symptoms such as mood and suicidality.
What I have really enjoyed about this Wellcome Trust PhD programme in mental health science has been the various projects I have been collaborating on with students from the programme. Last year I supervised Karel Kieslich in an epidemiological analysis of data on a cohort of US adolescents to investigate the association between problematic drinking and suicidality. Rosalind McAlpine and I have been collaborating with researchers at Imperial College on the co-production of an intervention for young people bereaved by suicide. I have also been working with you, Tom, on our systematic review of studies investigating the effectiveness of interventions that aim to reduce loneliness using psychological strategies. The second cohort of students have just started their first rotation project, and I am currently supervising Anna Hall who is planning to use quantitative and qualitative methods to investigate loneliness in relation to mental health.
Being a member of the programme committee for the Wellcome Trust PhD programme has also introduced me to many colleagues across the UCL Institute of Mental Health. This and the interdisciplinary ethos of the course has led to various new collaborations and projects, as I know it has for other supervisors on the programme.
Q: What do you think is the biggest challenge in your field of work?
The low proportion of funding allocated to mental health research relative to physical health problems, which communicates the stigma associated with mental illness, and does a disservice to patients.
Q: How do you incorporate different disciplines in your research? What have been the benefits and challenges when conducting transdisciplinary research?
Being involved in this PhD course has helped form various inter-disciplinary collaborations, as mentioned above, and so has being a member of the UKRI-funded Loneliness and Social Isolation in Mental Health network, which aims to promote cross-disciplinary research collaborations. However, incorporating different disciplines when trying to answer a research question can be challenging because of the different cultures inherent to different disciplines. For example I am working on a grant application at the moment with Laura Vaughan and Ashley Dhanani, who are both urban scientists in the UCL Bartlett School of Architecture, and Praveetha Patalay, an epidemiologist in the UCL Centre for Longitudinal Studies. We are all interested in socio-spatial influences on adolescent loneliness and mental health; essentially how the physical environments where young people grow up might influence their future social and emotional worlds. Melding epidemiology with spatial modelling requires us to read around each other’s subjects and discuss plans carefully to align methods, using language that will make sense to peer reviewers spanning a range of research councils. It is a huge learning curve, but getting to grips with new approaches and realising how these combined perspectives might bring new insights, is very motivating.
Q: You co-lead the Loneliness & Social Isolation in Mental Health network. Why is loneliness such an important issue in society, and are they any promising approaches to reduce it?
We are certainly more aware of the prevalence of loneliness in society, particularly amongst young people, although I am very wary of terms such as ‘epidemic’ of loneliness. What is striking about the Covid-19 pandemic is the degree to which it appears to have reduced the stigma of loneliness. Prior to the pandemic it was hugely stigmatising for young people to recognise that they might be feeling lonely. Reducing this stigma may have diminished the barriers to accessing interventions that might reduce loneliness. Unfortunately the evidence to support the effectiveness of interventions to address loneliness in young people is still weak, and there are relatively few studies. Generally, it has been suggested that interventions to address unhelpful cognitions around loneliness hold most promise. It also seems that universal interventions delivered to all young people in the population are more acceptable than those in groups deemed to be at risk and this may well relate to the stigma of singling people out in this way.
Q: You have organised a brilliant range of seminars on research methods, clinical aspects of mental health, diversity and more as part of the UCL Wellcome 4-year PhD in Mental Health Science programme. What have the highlights of the seminar series been?
Your cohort of students, as the first to pass through the programme, have made it a really enjoyable set of seminars. All the speakers have commented on how much they enjoyed engaging with you, and I think the small group format, the informality of the sessions, and the range of topics covered have also helped. Last year we invited Marcus Munafo from the University of Bristol to talk about questionable research practices and I think this was a really important foundation for the PhD programme ahead, for you as researchers and as future supervisors and research group leaders. We had a series of interactive training sessions with the UCL Co-Production Collective, which I know were really well received. We also had a series of dissemination seminars from speakers across UCL and beyond, including topics such as how to give engaging presentations, how to communicate research findings to diverse audiences, how to use social media effectively, and how to navigate conferences to get your work seen.
Q: What is the most important lesson you’ve learned in the past 10 years?
To keep on going, and not to feel disheartened by the inevitable rejections and setbacks. After the initial sting there will be lots to learn from the experience (and lots to recycle in the rejected grant application).
