Psychiatry in Special Education Schools

Dr Ann Collins, Consultant in the Child and Adolescent Learning Disability Service (CALDS) in Aneurin Bevan University Health Board, writes about her experience of working as a psychiatrist in Special Education Schools.

Following my CCT in 2021, I have had the pleasure of working as a Child and Adolescent Intellectual Disability Psychiatrist in South Wales. Like many other new Consultants, this is the longest I have stayed in one post, and I hope it will be much longer! It has been the first opportunity to really consider how I want to deliver my service on a big scale. Many factors came into play; the need for an efficient and equitable service, supporting families, building multi-agency relationships and above all, doing what’s best for my patients.

My service provides mental health support to children and young people under the age of 18 with evidence of a moderate to severe learning disability. The Aneurin Bevan University Health Board covers five different county boroughs. There are five special education schools and additional resource based units. With the slow return to normality post COVID, I made it a priority for school based clinics to return.

A day in the school starts with me going round my pupils’ classrooms. I often join in activities such as circle time or, most recently, a drum lesson! Seeing the children in an environment they are comfortable in, and with adults they are used to communicating with, gives me a much better insight into how that child is doing. My patients are more confident and more likely to engage with me here, than when they visit my clinical room. Teachers can also report any changes they have noticed, such as improvement in mood or decrease in appetite. Their insights are always so helpful and can be missed in a traditional clinic. The parents then arrive for a more traditional clinic set up, each being allocated a time. Teachers, school nurses, social workers and family support workers can also join these clinics and support the families as needed, without worrying about overstimulating the child or young person.

Covering all five special education schools allows for me to spread my time equitably across the patch. Extra clinics, based in local Children’s Centres, ensure the patients based outside these schools are not missing out. For many families, school is their main source of respite. And their annual leave is often consumed by childcare. Being able to arrange a clinic in their local area, where they can just arrive for their slot, saves them valuable time. Coming to a hospital clinic often removes their child from their routine that day, increasing everyone’s stress and the whole day can be a challenge.

My own enjoyment of my job was also an important factor when developing these clinics. While I like community medicine, much can be confined to sitting behind a desk or steering wheel. It was important that I develop a service that allows me to feel as integrated into the community as possible. For those still in training, or considering a career change, I would recommend exploring all the corners of the wonderful world of psychiatry.