Specialist Training in Psychiatry of Learning Disability in the UK

Dr Helen Sharrard, Consultant Psychiatrist

INTRODUCTION

In the UK the specialists who look after the needs of people with a learning disability are psychiatrists

Our professional body is the Royal College of Psychiatrists in London

Learning Disability has been a subspecialty of Psychiatry since 1980s and it has its own Faculty within the College

This is a large Faculty. In 2007 a census (excluding Scotland) showed 277 LD consultants. There are currently 74 advanced trainees in LD in England Scotland Wales and Northern Ireland.

Current structure of Learning Disability Training

Various types of training schemes in UK Bristol and Gloucestershire Rotation the only

advanced training scheme for Learning Disability in the South West of England

7 trainees can choose from a wide variety of posts (general LD, child/LD, neuropsychiatry)

Trainees and consultants based in community teams, few hospital beds

In 2008/9 the national PMETB survey of trainees placed our scheme first in the country

The LD consultant needs to know about:

Mental illness/Personality disorder/Autistic Spectrum Disorder/Attention Deficit Disorder

Complex epilepsy and neurological disorders Physical disease affecting mental state (liaison

with GP or hospital consultant) Syndrome behaviours Psychological and environmental processes Management in a wide range of settings Working in Community Teams

How does the trainee become an LD consultant?

Medical School

Then 2 years Foundation Training-medicine, surgery and other specialties (can do psychiatry)

Then choose the specialty of Psychiatry

How does the trainee become an LD consultant?

3 years Core Psychiatric Training:

Called Specialty Registrars ST1-36x six month posts in General Adult, Old Age, Child

and Adolescent, Learning Disability, Addiction, Rehabilitation

Follow national curriculum and gain competencies in 18 areas of learning

Continuous assessment by WPBAs (Work-place based assessments)

Also have to pass exams to gain Membership of Royal College of Psychiatrists

How does the trainee become an LD consultant?

Following core training, trainees have a choice of 6 subspecialties: General Adult Old Age Forensic Psychotherapy Child and Adolescent Learning Disability

Obtain CCT (Certificate of Completion of Training) in chosen subspecialty.

How does the trainee become an LD consultant?

3 years Advanced Specialty training in LD:

Called Specialty Registrars ST4-6Usually 3x one year postsNational CurriculumObtain competencies in 13 areas of learningAssessed using WPBAsMonitored by ARCP (Annual Review of

Competence Progression) panels

How does the trainee become an LD consultant?

Advanced Curriculum for LD

End of year 1 (ST4)-assess and manage routine LD cases of mental illness, challenging behaviour, ongoing epilepsy, autistic disorder

End of year 2 (ST5)-assess and manage more complex cases of people with a range of levels of LD

How does the trainee become an LD consultant?

Advanced Curriculum for LD (cont’d)

End of year 3 (ST6)-assess and manage complex cases across the ability range of LD including cases of mental illness, challenging behaviour, autistic spectrum disorder, dementia, transition to adulthood and those needing secure care; offer expertise and consultation to others.

Mental Health and Mental Capacity legislation

Audit, teaching, research, management, team-working

Issues for Training in UK

Dutch trainees on placement in Bristol over last 10 years-they are developing expertise in the medical problems of people with a learning disability. Perhaps our trainees should have more specific medical training- these issues can have a great impact on behaviour

Dual training is increasing:Child/LD; Forensic/LD; General Adult/LD.

What does the future hold?