Why do we need Learning Disability psychiatrists in Learning Disability liaison teams?

So, what is the role of a Consultant Psychiatrist in this service? Initially, it was thought that most of the work would center around the mental health issues of patients with LD in acute hospitals much like the standard hospital liaison role in general psychiatry. However, after a period of nearly 2 years in this role it is apparent that the role of the LD psychiatrist in an Acute Liaison Team is much broader than this. I do see people where there is an identified or suspected mental health issue or where there is challenging behaviour (Neurology often review inpatients with epilepsy and so this is not a significant part of my role). 

LD doctors can provide an invaluable resource to our nursing colleagues in relation to treatment rationale, drug regimes, interpreting test results and options for surgical interventions. We have a medical-based view of palliative care and we have a broad understanding of pathology and prognostic indicators. These skills bring a balanced view to the work of the team and provide support and advice to the team when issues of support and care for a patient with LD is being discussed. We are also in a better position to identify and flag up poor medical care (in a similar way the Liaison nurses can identify poor standards in nursing care) 

As LD Consultants we have a detailed knowledge of MHA and MCA and are also skilled at assessment of capacity. We understand the need and mechanism for best interest decisions if someone lacks capacity and we often have good knowledge of policy such as DNACPR. This represents an important role in the Acute Liaison team, especially if there is conflict between acute care professionals and family or uncertainty about the provisions of MCA (sadly this is not uncommon). 

As an LD consultant, I also have a role in the team in “unsticking situations”. One of the major frustrations for our nurses is that although they can influence nursing practice on wards to some extent, their requests to doctors can sometimes be overlooked or even ignored. My role can sometimes simply be sending an email to a consultant colleague outlining the concerns of the liaison team, or requesting a best interests meeting. My direct contact to the Consultant is often successful more quickly than the nursing team attempting to escalate concerns via the nursing and medical hierarchy on the ward. 

I have a role in supporting teaching and education and expanding the groups that we train as LD Champions. I have supported the updating of the training packages, I am exploring with colleagues how we get training to colleagues early in their clinical training and I have trained cohorts of individuals as LD champions and supported induction for groups of doctors. 

Perhaps unique to me is the fact that I have worked for many years as a community LD Psychiatrist in ABUHB and so inevitably I have some previous knowledge of a proportion of our inpatients and their families and carers. It has been a real privilege to see patients I have known for years come into our acute hospitals, receive good care and go home again but it is equally a privilege and a sadness to see those I have worked with in the past come into the hospital and die.  

A good death can and often does happen for people with LD, but my role and that of the team I work with, is to highlight and pursue instances of poor care which has led to morbidity or mortality. We raise concerns through all the appropriate mechanisms in our organisation and provide support and training for clinicians involved in these incidents. 

As people with LD lead longer lives than in the past, the diseases of old age and acute illness become more of an issue for them and extended periods of hospitalisation appear to be becoming more common, there is therefore likely that LD doctors will be a useful adjunct to LD Liaison teams.