A career in Psychiatry of Intellectual Disability is like no other
Psychiatrists in intellectual disability specialise in the recognition, diagnosis and management of mental health problems in people with intellectual disabilities. But that is really just the start!
Although precise estimates vary, people with an intellectual disability have higher rates of many types of mental illness compared to the general population. However, mental illness (as well as physical) can present very differently in those with an intellectual disability. Therefore, as a psychiatrist you may be less likely to see “typical symptoms of depression”, “overt psychotic symptoms” or “well-formed delusions” etc. Often, an illness may present only with a change in behaviour and the patient may have limited communication to express their needs. It takes holistic thinking and creative assessment techniques to establish rapport and determine whether there is a mental illness or other reason for this change from a person’s baseline. For many this specialty is detective-work!
Sadly, “science” has not always served people with intellectual disabilities well. From being subjects of cruel experimentation, derogatory language and locked away in institutions, often they were prescribed high doses of sedating medication. Since the 1980s there has been a significant shift in the attitudes towards people with learning disabilities and a huge drive to support people to live fulfilled lives in the community. Nowadays, we acknowledge the risks of overprescribing medications in both the short-term and long-term, particularly when there is no clear indication for them. As psychiatrists in intellectual disability we are advocates for this group and support Stopping Over Medication of People with Intellectual Disability and/or Autism (NHS England, 2019).
In moving away from a purely medical model of working, this specialty has formed a strong culture of multi-disciplinary team working with professionals such as Psychologists, Speech and Language Therapists, Nurses, Occupational Therapists all working towards the same goal. You also work with external agencies including schools, social care and residential homes. This collaboration ensures that all patients and their families receive the best possible care.
The patient group is so diverse, with higher rates of other neurodevelopmental conditions such as attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD); higher rates of physical conditions such as epilepsy; and higher rates of rare genetic conditions. You will continue to see older adults and require an up-to-date knowledge of relevant law. The complexity keeps every day interesting, and you may find yourself becoming an expert in more areas than one.
It goes without saying, working in this field requires patience, empathy and dedication. It is therefore not surprising that you meet the most inspiring patients, carers, family members and staff. People with an intellectual disability are amongst the most vulnerable groups in society and those who work in this field are passionate about improving their quality of lives and health outcomes. Every day is a chance to make a real difference!
For those who are interested in research, opportunities in this field are vast. There has been a dearth of high-quality early research for reasons including ethical dilemmas, poor access, dependence on staff, a difficult informed consent procedure, the lack of validated tools and the burden of behaviours that challenge. As we move forward, research is both required and encouraged. There is an international network of enthusiastic intellectual disability psychiatrists keen to promote and support academics in this field. As well as research, opportunities for involvement in leadership roles, service development and teaching are plentiful.
The jobs in this specialty vary from inpatient, community-based, forensic-settings, liaison and LD-CAMHS (with other dual training posts and jobs to come). Even within these roles your days will always be varied. So, if you are looking for a fascinating, rewarding and truly patient-centred career, then ID psychiatry could be for you.
Link to Dr Sonya Rudra’s talk at Royal College of Psychiatrists London Divisions Discover Psychiatry Event 2022: “A career in Intellectual Disability Psychiatry”: https://youtu.be/JdC1OOj9Vm4 or https://www.youtube.com/watch?v=JdC1OOj9Vm4
NHS England. (2019). Stopping over medication of people with a learning disability, autism or both (STOMP). NHS. Retrieved 23 November from https://www.england.nhs.uk/learning-disabilities/improving-health/stomp/