Higher Training In Psychiatry Of Intellectual Disability

Over two decades ago, the UK underwent a significant shift in terminology regarding individuals with cognitive challenges, replacing the outdated term "mental retardation" with the more inclusive language of "learning disability" or "intellectual disability." This transformation was prompted by evolving international perspectives and a growing recognition of the need for sensitive language in describing individuals with intellectual disabilities. Collaborating with the Learning Disabilities Observatory, recommendations were made to the WHO for an update, leading to the removal of the term in the latest classification system, ICD-11, launched in 2022. Advocates for individuals with intellectual disabilities assert that such changes are vital, as terms like "mental retardation" carry negative connotations, are offensive, and contribute to misunderstandings about the nature of the disorder and the value of those affected. The global move towards adopting inclusive language reflects a commitment to respecting the dignity and worth of all individuals.

Choosing Psychiatry of Intellectual Disability (ID) is a compelling decision driven by the field's captivating, intricate, and highly rewarding nature. This specialty offers a holistic perspective, allowing practitioners to delve into the intricate interplay between mental and physical health, behaviour, and development.

As a lifespan specialty, it presents a unique opportunity to cultivate skills and experiences in addressing the diverse needs of patients from childhood to old age. Psychiatry of ID/Learning Disability is intricately connected to other pivotal branches, including Neurodevelopmental Psychiatry and Forensic Psychiatry, providing a comprehensive understanding of related disciplines. The field promises a highly fulfilling career, and the East of England stands out as an excellent training ground for developing essential skills and confidence that will prove invaluable throughout one's professional journey. 

Higher Training in Psychiatry of Intellectual Disability takes between three and five years depending on whether a single Certificate of Completion of Training (CCT) is sought or a dual. The Higher Trainee builds on their Core Training to manage with an increasing level of sophistication and assurance the full range of Psychiatric presentations seen within Psychiatry of Intellectual Disability.  Development of leadership and management skills are of increasing importance alongside developing the skills that will enable the Trainee to be seen as an essential component of teams within which they will work as a Consultant. Supervision from experienced Consultant Trainers is an essential part of the process.

On joining the Psychiatry programmes, doctors immediately register with the College. The College holds predicted Certificate of Completion of Training (CCT) dates, and gives more information at: http://www.rcpsych.ac.uk/studypsychiatry.aspx

The Royal College of Psychiatrists also provides personal trainee reflections, and more on the background, on the three years in a higher training programme (ST4-ST6). 

• Assessment and management (under supervision) of people with learning disabilities referred to the service with additional mental health difficulties, including mental illness, multiple and complex disabilities, challenging behaviour, autism, epilepsy, personality disorders and offending behaviours. This includes exposure to a diverse range of experiences, seeing patients across the spectrum of learning disabilities and mental disorders, across various settings including inpatient, outpatient, community, and emergency contexts.
• To develop leadership and management skills through learning about the operational aspects of the learning disability service, including participation in service-wide meetings such as clinical governance sessions.
• Gaining an appreciation of the strata of secure services.
• Participation in training opportunities to other sectors e.g. the Tribunal Service, Police Service, Probation and residential and supported tenancy staff (particularly during patient transitions.
• Development of skills in understanding Part 3 of the Mental Health Act and support in preparing evidence for tribunals and potentially Court proceedings.
• Support in presenting evidence in tribunals, Care Programme Approach (CPA) meetings, and case presentations.
• Regular participation in supervision sessions with the clinical supervisor (minimum one hour weekly) to identify competency areas for development, opportunities for learning, progress monitoring (including regular appraisals throughout the placement), and a forum for addressing any other relevant issues as needed.

(By Dr Alexandra GABRIELSSON, Higher trainee in psychiatry of Intellectual Disability)

Research into the specific needs of people with intellectual disabilities has historically been an underfunded and understudied area, and the evidence base used in daily practice is largely based on data extrapolated from randomized controlled trials conducted in the general population.

Fortunately, this is changing, and research is becoming more inclusive to generate findings that are representative of this specific patient population. Co-production which actively involves people with intellectual disabilities and/or autistic people in research is also an area which is receiving more attention!

There is still a lot of work to be done, and so there are endless opportunities to get involved with exciting research projects in epilepsy management, autism spectrum disorders and ADHD to name a few. I have personally found the intellectual disability research community to be very supportive to trainees who wish to take part, and I have been able to tailor projects to my specific interests. It feels extremely rewarding to see the work invested contribute to our growing understanding of the specific needs of this patient cohort, and ultimately help us provide better care and support.

 (By Dr Saher Binnat Rafiq, ST5 Specialty Registrar in Psychiatry of Intellectual Disabilities and LD Higher Trainee Rep)

 The EOE school of psychiatry also offers special interest session which you can find as attached.

Hertfordshire 

Norfolk 

More opportunities for Special Interest:

Generic Special Interest Database 

Special Interest Database 

(By Dr Anu Sharma, Consultant Psychiatrist in Learning Disabilities)

At East of England region, we are dedicated to pioneering innovative learning and development opportunities, particularly through our Simulation Hub. Our Simulation Training Facility, developed by Hertfordshire Partnership University Foundation Trust, is a groundbreaking initiative within the Trust, designed to provide innovative simulation training in mental health, physical health and learning disabilities.

Simulation is a fantastic experiential learning modality offering participants the chance both to engage in high fidelity scenarios and reflect as a group on the challenges and issues raised. People learn most effectively when training is interactive, immersive and replicates real life. Simulation replicates a real-life scenario, but in a psychologically safe and controlled environment.

Our approach to simulation-based learning (SBL) focuses on structured activities that represent real-life situations in education and practice. This learner-centred method involves small group learning through problem-based learning, case-based learning, and role plays with a guide on the side.

Each training session involves simulated characters such as patients, carers, or assessors, along with facilitators and observers (learners). We specialise in scenario-based simulation, which is proven to enhance team working, communication skills, risk assessment, and managing challenging behaviours.

In designing each scenario, we follow a comprehensive process including preparation, briefing, simulation activity, debriefing and feedback, reflection, and evaluation. During debriefing, we guide participants through three key stages: reactions, understanding, and summarisation. This ensures that lessons learned are effectively applied to real-life situations and future events.

Simulation training offers numerous advantages, including improving patient safety by allowing practice in simulation rather than on actual patients, enhancing healthcare provider performance in crisis events, promoting reflection and critical thinking, refining psychomotor skills, and fostering communication skills and interprofessional collaboration.