Areas of expertise
Liaison Psychiatry
I have extensive clinical and research experience working at the interface between physical and mental health, integrating mind and body. This is known as liaison psychiatry. My main expertise is working with people who have ongoing physical symptoms, or long-term medical conditions, and who have difficulties with how those illnesses impact their mental health. I have worked in liaison psychiatry across various NHS hospitals as well as in the community.
To understand liaison psychiatry better, I like to use examples. We can look at the human mind like a fusebox. Difficult thoughts and feelings are sometimes too overwhelming for us, and so the mind tries to protect itself by switching off, a bit like tripping a switch. These difficult thoughts, along with present and past experiences are then processed down the wrong pathways in the brain which turns into physical symptoms, rather than emotions and feelings. It is part of normal human experience for us to experience feelings in a physical way, so much so that it is part of our everyday language. We talk in English about having 'butterflies' when we feel anxious, which is that fluttery feeling in our stomach. We talk about feeling 'gutted' when something doesn't go our way, which often feels like a heavy rock at the pit of your stomach. This is an absolutely normal part of our lives. As you can see, what is going on in your life can greatly affect how you experience physical symptoms.
Often when you are living with long-term physical symptoms or illnesses, it can wear you down. You might not realise it at first, but as time goes by, perhaps you find it more difficult to manage the day-to-day. Maybe you spent time fighting to have your symptoms recognised and became overwhelmed, or you found yourself with nobody to talk to about the struggles you are facing or have faced on your journey. Perhaps you were told that ‘it is all in your head’. Our bodies tell us first in a very physical way when we are stressed or overwhelmed, and it can be difficult to know how and where to seek help when that happens.
It is also normal to experience some psychological symptoms when you have physical health issues. Long-term physical illnesses such as diabetes, cancer, Parkinson's disease, respiratory conditions, post-covid syndrome, stroke, or chronic heart or lung disease are difficult to manage for anyone, so it is understandable that you might feel unwell and experience depression or anxiety alongside your physical illness. At this point, you may have seen many different doctors and other health professionals and I see myself as part of the medical team that looks after you and helps you navigate through it all.
Neurological Conditions
I see patients with many long-term medical conditions including what doctors term a 'neurological' illness. This is any sort of illness where something is functioning abnormally in your brain. Sometimes people can experience psychiatric symptoms as part of their neurological illness. For example, low mood, anxiety, hallucinations, delusional beliefs, or cognitive impairment like brain fog or memory loss. Perhaps you are taking medications for an illness which have psychiatric side effects. I understand that this can be incredibly challenging and overwhelming and you might not know what to do about it.
Fertility and Maternal Mental Health
Maternal mental health is extremely important to me and I have experience supporting women through some of the most difficult times in their lives. I was previously involved with the setting up of the Maternity Trauma and Loss Care (M-TLC) service as well as the expansion of the Perinatal Psychiatry services in North West London.
If you have experienced foetal loss, are having recurrent miscarriages, have ongoing fertility difficulties, or have experienced ectopic pregnancies or birth trauma I may be able to help talk through things. I also work with women who are planning a pregnancy, or going through IVF, as well as with those who are pregnant. Though I am a psychiatrist first and foremost, I also know from personal experience that trying to have a baby, and then pregnancy and childbirth are times in your life that are extremely challenging for many of us. This period of time comes with the highest highs and the lowest lows, often swinging between these states for seemingly no good reason.
Pregnancy and childbirth are challenging both physically and emotionally. It is completely normal for hormonal fluctuations and changes in your body shape to impact how you feel about yourself. You might even feel like your body no longer belongs to you. Perhaps you have an existing mental health diagnosis and you are wondering how your medication may impact your fertility or pregnancy. Maybe you have questions about the risks of relapse and the impact on you and your baby. Overall, it can feel like a rollercoaster ride and having someone to listen to you can be extremely helpful. Reaching out for help early is extremely important for you, your relationships and of course, your baby’s development.
My Approach to Treatment
I believe that the relationship we have is extremely important. People often have a picture of what a psychiatrist, and the clinic setting, will be like from films or TV, and in my experience, there are very few films or TV programmes that get that right. Though you might have seen many doctors before, perhaps this is the first time you are seeing a psychiatrist. It is normal to feel a little nervous or scared but there is no need to be. If you are unsure about taking the first step, feel free to look me up on social media to get a sense of who I am and see if you think we will fit @draliceashby.
I take a patient-led approach to treatment. This means that when we meet, I will be listening to you to make sure I understand your issues and concerns. This time is for you. When we meet, we'll both be in normal armchairs, it won't look like a hospital, and you won't be on a couch. If I see you online, I'll be wearing normal work clothes and sitting in my home office. It will be a relaxed, safe atmosphere for you to share your thoughts. It should feel like a fairly normal conversation. Perhaps you are anxious about the type of questions I will ask you, or maybe you think I might ask intrusive questions that you don’t want to answer. That is not the case at all. This first appointment is an opportunity to get to know me and whether my approach suits you as the fit between doctor and patient is really the most important factor for things to work. If you find it helpful, you can make a list before our appointment of things you think would be useful to tell me about, and questions you would like to ask.
Over the first few meetings, I will be focused on listening to you, and gaining an understanding of what you are going through, or have been through. I would want to know a bit more about you, what the difficulties are that led you to seek help, what you've tried already, as well as what is going well for you at the moment. My starting point will be to go through the symptoms that are most worrying you, rather than a list of questions I've got prepared beforehand. You will have the time and space to share all of your difficulties with me. This is something you may not have been able to do before with a doctor due to appointment time constraints. When we are together, you can share how these difficulties are affecting you, your mental health, and your relationships with others around you.
Personalised treatment plans
In order to personalise your treatment plan, my approach is to get to know you and understand what your personal goals are. These goals, or what 'recovery' means, are very different for each person. My goal is to tailor treatment specifically to you. I will use my extensive clinical experience along with evidence-based methods of treatment to create this personalised treatment plan.
The first step in any personalised treatment plan is to understand what is happening for you and what might help, so I will give you information on the different treatment options available to help you reach your goal. We will discuss these together so that you feel comfortable and empowered to make the best decision for your health. If there are other people, like family members or professionals that you believe will help you reach your goal, then I will work collaboratively with them to support you as best I can.
When we meet we will also talk about some basic psychological techniques that might help you. For example, many people find talking therapies helpful, which I can refer you to. Other lifestyle changes can also help, such as improving your sleep, eating healthily, getting outside into nature and finding a form of regular exercise that suits you. These are all vital parts of recovery and ways to achieve well-being.
Medication
The solutions to illness are complex, and will never just be about medication. Medication can be extremely effective, and in some cases life-saving, but it will never be 100% of the answer. If medication may be useful for you, I will let you know and we’ll discuss all of the options together. I will make sure that you understand the possible benefits, risks and side effects so that you can decide whether to include it as part of your recovery. I will always make recommendations to you based on national guidelines such as the Royal College of Psychiatrists, the British Association for Psychopharmacology, and the National Institute for Health and Care Excellence (NICE). Any medication you take should provide relief from symptoms without causing any additional problems. My goal for you would be to reduce medication as soon as it is safe to do so.
Education & Training
I’m registered as a General Adult and Liaison Psychiatry specialist by the General Medical Council (GMC, UK) and also hold a licence with the Saudi Commission for Health Specialties. I was recently awarded Fellowship of the Royal College of Psychiatrists. This is a mark of distinction and recognition of contributions to psychiatry in the UK. I completed my psychiatry training at St. George’s and have been a practicing consultant psychiatrist for 10 years.
In addition to seeing patients in private practice, I work as the Associate Medical Director for adult services at LPC. This means that part of my role is ensuring that things work for patients and for the clinic, especially for the purposes of our registration with the Care Quality Commission. I am part of the LPC senior leadership team responsible for ensuring patient safety, and staff well-being, and making sure we learn and improve when things don't go as well as we would hope.
For most of my career, I have worked in the National Health Service (NHS) in various large London teaching hospitals including St Thomas', Charing Cross and St George's. I've held many leadership roles throughout my time there. I was an Associate Medical Director at South London and the Maudsley NHS Foundation Trust, and a Clinical Director at West London NHS Trust. These roles included setting up new services or expanding existing provisions in liaison and perinatal psychiatry, and clinical health psychology, all of which I am extremely proud of.
As part of my non-clinical work, I am an active member of the Royal College of Psychiatrists. Over my career, I have published many research papers in areas of psychiatry and I will continue to contribute to the growing evidence base. Staying up to date with the latest research in my field means that I can always improve the care I provide my patients. I have a particular interest in medical ethics and law and hold a Masters degree in this from King’s College London.
Personal interests
I’m passionate about music and have been almost every year to Glastonbury festival since my twenties. In 2016 realised a lifetime ambition when I started voluntary work as a liaison psychiatrist at Glastonbury and Reading festivals for Festival Medical Services. Like most people, I love to travel and in January 2023 my family and I moved to Riyadh, Saudi Arabia. I also enjoy pilates, yoga and swimming, and these are really important things for me to keep maintain my mental well-being.
