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The Royal College of Psychiatrists Improving the lives of people with mental illness

Psychiatry of Learning Disability

Background to psychiatry of learning disability

People with learning disability are much more likely than the general population to experience mental health conditions, because they experience more biological and psychosocial risk factors.  Specialist psychiatrists who work with people with learning disability offer treatment for severe mental illness, but also for a wide range of other mental health conditions such as autistic spectrum disorders and anxiety disorders.  Because people with learning disability may have less internal resources to cope with mental distress, more minor disorders can have a severe effect, so services usually have a much lower threshold for referral than mainstream mental health services.

 

Psychiatrists who work with people with learning disability need to have a wide range of clinical skills.  The clinical work is often made more complex and interesting by concurrent physical problems such as epilepsy, communication problems and challenges in accessing services.  People often present non-specifically (for example with withdrawal or behaviour problems) and finding out the cause is a fascinating diagnostic challenge.  Working with other disciplines can really help with this process.  It is also essential to consider the system around the person (such as family, support staff) to understand clinical problems and deliver effective interventions. 

 

Services for people with learning disability have been in the vanguard of delivering well resourced community care, and models such as supported living and person centred planning have brought substantial improvements to peoples’ quality of life.  Most specialist mental healthcare for people with learning disabilities is delivered in community settings, and because of the social supports available, the need for inpatient admission can be less than in mainstream services.  If people do need admission, people with mild learning disabilities and mental illness often use mainstream inpatient beds.  Specialist inpatient facilities are provided for people with forensic needs, and people with very severe challenging behaviour.

 

Psychiatry of Learning Disability is a fascinating academic discipline, whether you are interested in the biological basis of mental health problems (e.g. dementia in people with Down’s syndrome, behavioural phenotypes of genetic disorders), or the development of innovative service models.  Much work has been done in recent years in applying psychotherapeutic and systemic approaches to working with people with learning disability. 

 

You must respect people with learning disabilities to work with them effectively, and value the contribution they make to society.  If you can do this, and enjoy helping people with complex clinical problems, then Psychiatry of Learning Disability might be the specialty for you.

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Personal perspective

As a senior house officer in the nineties, I really enjoyed my old age and working age adult psychiatry but I was unprepared for the enthusiasm I developed for learning disability psychiatry. At the time one of my peers commented “If you like learning disability psychiatry, you’re not the person I thought you were”. Many years on I still reflect on that curious comment with a smile. Psychiatry is not the most glamorous of medical specialties and indeed the psychiatry of learning disability is not the most high profile of psychiatry subspecialties, but it has a great deal to offer.

Having dual trained as a specialist registrar in both learning disability and working age adult psychiatry, I now work as one of five consultants in the learning disability directorate. Community psychiatry uses all of the skills that I learned throughout my training.

What inspires me about the job is the variety of mental health challenges that keeps the week so interesting. The nature of problems managed within our service is much broader than with other psychiatric subspecialties. My typical clinic includes organic and functional psychiatric disorders, autism, challenging behaviour, behavioural phenotypes, epilepsy and of course there’s always capacity to consider. Generally, community clinics allow us to see a spectrum of people of different ages, cognitive abilities, sensory impairment and risk. Not surprisingly, issues around adult protection and offending behaviour are not infrequent themes within our population.

As a result, you need a questioning approach for accurate diagnosis and risk assessment and to appropriately consider the full range of resources and treatment options that are available. Yes, biopsychosocial assessments started here!

I work within a truly multidisciplinary community learning disability team. This allows joint working to flourish and makes the job satisfying and productive. I actually feel we make a difference to both the service user and the carers’ quality of life.

I am glad I took up the challenge to embark upon this exciting and rewarding career.

Amanda Spencer

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Page updated on 9 December 2010

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