Meet Psychiatrist Prof. Craig Melville

“A comprehensive assessment of mental health and discussing possible diagnoses can be an important first step in a client understanding what’s going on. Clients have often said that the assessment process is the first time they have ever felt listened to.”

Prof. Craig Melville has been a consultant psychiatrist for twenty-two years, with decades of experience working in the NHS. He is also Professor of Neurodevelopmental Psychiatry at the University of Glasgow and has been working at The Dawn Practice for the past three years.

Here, he sheds light on the discipline of psychiatry, his experience in the field, and changes in the mental health landscape over the last couple of decades.

Tell us about your background.

I’m a consultant psychiatrist trained in general adult psychiatry and learning disabilities psychiatry. My clinical work at The Dawn Practice includes general psychiatry, ADHD, and autism spectrum conditions.

At the University of Glasgow, I’m very fortunate to work with an excellent group, in partnership with people with lived experience, NHS colleagues, and third sector organisations. The broad focus of our work is around addressing health inequalities in physical and mental health. Some of the work we’ve done has led to the introduction of new therapies in the NHS or a change in policy or practice, and the development of new services.

What inspired you to go into psychiatry?

After graduating from medicine, I had originally planned to follow a career in oncology and I worked at the Beatson Oncology Centre. I realised that I liked working within a holistic approach to medicine and Dr Marie Fallon, who is now Professor of Palliative Medicine at the University of Edinburgh, recommended I try psychiatry. Here we are 30 years later!

What are the main changes you have seen in mental health over the years?

The rates of neurodevelopmental conditions like autism and ADHD have grown exponentially. In 2003, I wrote a book chapter on autism spectrum conditions, and at that time, research suggested that 0.2% of the population met the criteria for a diagnosis of autism. Now studies are reporting a prevalence rate of autism spectrum conditions around 5%.

There’s a lot of debate about what the reasons are for these changes, is it increased awareness, better services, or reduced stigma? Probably all of those things. But one big challenge for society is how to provide effective and accessible services.

Do services by private clinics like The Dawn Practice help address these issues?

I think The Dawn Practice is a good example where collaborations between the NHS and private providers can help to reduce waiting times.

I work in adult services so I have not been part of these collaborations. However, I have heard from colleagues working in neurodevelopmental services and NHS Child and Adolescent Mental Health Service (CAMHS) that the work done by The Dawn Practice to tackle waiting times has been cost-effective and has delivered very high-quality assessments.

Describe the services you provide at The Dawn Practice.

About 20% of my workload is psychiatry assessments around mental health problems, 70% is ADHD assessments, and the other 10% is around managing medication for ADHD.

The key thing I like at The Dawn Practice is that I get the time and space to do gold-standard assessments. For example, health boards and other organisations have been very clear that private clinics offering ADHD assessments need to include a full mental health assessment, a physical health assessment, and the use of structured questionnaires and diagnostic interviews. The model we use at The Dawn Practice is very comprehensive and meets all the guidelines.

Depending on what people want, we are then able to talk to them about the potential role for medication, psychological therapies, or supporting them to implement workplace or lifestyle behaviour changes. This approach works best when we can support people as part of a shared care agreement with an individual’s GP.

Is there any advice that you would give people going to their GPs to seek an assessment for ADHD?

A useful starting point is the adult ADHD Symptom Rating Scale (ASRS-V1.1). This was developed by the World Health Organisation and is used worldwide as the initial screening tool. People can access that online, print it out, and take it to their GP.

We now have a better understanding that many adults have had problems for years before coming for an ADHD assessment. Often, people have been seeing their GP for a long time because of anxiety, depression, or stress. Many people have been struggling with alcohol or drug problems. GPs are really experienced in talking to people about whether ADHD might be contributing to their difficulties. Your GP is the one person who has all your health information, and they’re an excellent resource for the initial discussion around whether an ADHD assessment is something to consider.

What is the most rewarding part of your work at The Dawn Practice?

The primary role of a diagnosis is to help with communication and understanding. I think getting a comprehensive assessment of mental health or ADHD and talking about a possible diagnosis gives clients some understanding of what’s going on and a focus to go and do some self-directed research and make sense of things that have happened in the past.

Quite often, clients say that the process is the first time they have ever felt listened to. Meeting with a clinician to work through the assessment process should be positive and the first step towards finding ways to improve quality of life.

Another really important aspect of any job for me is working as part of a team. All the staff at The Dawn Practice have been great; Michelle, Tomas and the rest of the management team have been incredibly supportive of me, and the Admin Team are legends.

Any unexpected developments?

Since working at The Dawn Practice, I have been struck at how effective ADHD medication can be for some people and the positive effect it has on their general mental health. Medication isn’t right for everyone, and there is a lot of monitoring involved, but the research suggests 70-80% of adults diagnosed with ADHD who start medication experience a significant clinical benefit. It’s the same for psychological therapies too; the research shows that they can be very effective for mental health and ADHD.

The other thing that I have found interesting is how different ADHD can be in females and males. Many of the women I have worked report a developmental history where they have struggled with anxiety and depression for many years and longstanding difficulties with ADHD type symptoms are only recognised much later or never at all. However, research has provided us with a much clearer understanding of different presentations of ADHD, so comprehensive approaches to assessment and diagnosis can make a big difference to someone’s life.

Does social media play a role in mental health conversations?

I don’t use social media, so I can only comment on what clients and people I know have told me. Clients often say they saw somebody on social media talking about mental health or neurodiversity, and it helped them understand their own situation. Celebrities certainly have a much bigger influence now than they did in the 70’s when I was growing up, and there were only three TV channels!

Obviously, there are some negative influences in the social media space, but maybe it balances out. Footballers, rugby players, movie stars: everybody’s got a story now, and it helps when people talk openly about their struggles.

Different things work for different people, but there seems to be enough diversity in the social media space that people can find someone they can chime with. That really helps people break down any stigma or fears they have about seeking help.

Are there any misconceptions about psychiatry?

I think there’s a lot of stigma about seeing a psychiatrist and mental health more broadly. The See Me campaign in Scotland and similar approaches to tackling stigma have made a big difference.

Part of the stigma seems to be that people worry that if they are diagnosed with a mental health problem, ADHD, or autism, they have a much poorer prognosis than if they had a physical health problem. However, the evidence suggests that if someone is assessed by a qualified professional and gets appropriate support, the prognosis can be very positive.

The Dawn Practice Psychiatry Services

The Dawn Practice offers gold-standard psychiatric support, from assessment and psychological therapies through to medication. If you would like to receive deeper insight into your mental health or potential neurodiversity, we can provide a supportive environment for this. All our clinicians are highly qualified with decades of experience and are committed to compassionate care for your mental health.