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Psychiatry of Learning Disability

nhs learning disabilty

Nature of the work

People with learning disability have higher rates of mental health problems than the general population, because they experience more biological and psychosocial risk factors.  Specialist psychiatrists working with this population not only offer treatment for severe mental illness, but also for a wide range of other mental and physical health problems such as autistic spectrum / other neurodevelopmental disorders  and epilepsy.  People with learning disability may have fewer internal resources to cope with mental distress.  As a consequence more minor disorders can have a severe effect, so services usually have a much lower threshold for referral than mainstream mental health services.

Working in psychiatry of learning disabilities

Psychiatrists working with people who have a 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 and cerebral palsy; along with 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.

Common procedure / interventions

Services for people with learning disability have been in the vanguard of delivering integrated community care, and models such as supported living and person centred planning have brought substantial improvements to people’s quality of life.  Most specialist mental healthcare for people with learning disability is delivered in community settings, but for those in need of inpatient admission people with mild learning disability and mental illness usually use mainstream inpatient beds, with specialist inpatient facilities provided for people with forensic needs, and people with more severe learning disability and challenging behaviour.  A wide variety of treatments are available, as in mainstream psychiatry, including pharmacology, psychological (including psychotherapy) social and educational interventions.

Associated subspecialties

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.  Within the specialty there are further subspecialties including Child and Adolescent and Forensic.  Much work has been done in recent years in applying psychotherapeutic and systemic approaches to working with people with learning disability.  There are a several high profile academic centres around the country.

 

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