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