Learning Disability is defined as:
- A significantly reduced ability to understand new or complex information, to learn new skills (impaired intelligence), combined with a reduced ability to cope independently (impaired social functioning) and which started before adulthood, with a lasting effect on development. (DH, 2001)
Psychiatry of Learning Disability
People with learning disability are much more likely than the general population to experience mental health problems, 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.
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.
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.
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, biological basis of autistic spectrum disorders, ADHD), 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. This specialty more than other adult specialties helps us understand the practical limitations of our current diagnostic approaches to mental illness which by nature has to rely mainly on subjective descriptions of complex internal mental phenomena and such descriptions are less available when assessing people with more severe learning disability
It is important to 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.
A typical clinic includes organic and functional psychiatric disorders, autism, challenging behaviour, behavioural phenotypes, epilepsy and of course there’s always mental 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.
Adult ADHD is another emerging and exciting subgroup that is more recognised and diagnosed.
One needs to work within a truly multidisciplinary community learning disability team. This allows joint working to flourish and makes the job satisfying and productive. We can make a difference to both the service user and the carers’ quality of life and receive genuine feedback when what we have done as a team has been helpful.
Learning Disability Health Services within LCFT
There are 7 multidisciplinary community learning disability teams (CTLD) within LCFT. These include Blackburn with Darwen; East Lancashire (Burnley, Pendle, Rossendale, Hyndbrun and Ribble Valley); Chorley and South Ribble; Greater Preston; West Lancashire (Ormskirk and Skelmersdale) Fylde and Wyre; and Lancaster. There are currently 3.6 WTE Consultant Psychiatrist posts and 2.6 WTE in post with one vacancy.
Multidisciplinary teams include clinical psychology, OT, speech and language therapy, physiotherapy and activity co-ordinators. There is close working with mainstream mental health services and out of hours support relies on crisis teams and general on-call for psychiatry.
There is opportunity for young enthusiastic psychiatrists to play a leading role in future exciting service developments within the community with the closure plan for Calderstones Hospital which is the last remaining long stay hospital for people with learning disability in this area. Local commissioners are increasingly recognising the complex nature of mental health difficulties and specialist support needs of this population which can occasionally require admission to a specialist learning disability unit out of area and there are currently good working relationships between health, social services and commissioners.
There is also a continuing need to improve the interface with other psychiatric specialties including transition from CAMHS to adult services, ensuring equitable access to mainstream services when appropriate. There is growing interest in development of integrated health and social care teams and providing services for the wider autism spectrum disorders and perhaps a need to look at lifespan service models for such complex lifelong developmental disorders.