The psychiatry of intellectual disability, commonly known as learning disability, is a branch of neurodevelopmental psychiatry (The psychiatry of disorders occurring during or related to the development and maturation of the nervous system).
Intellectual disability is very common; most of us have friends and relatives who face such problems within their families. About 2% of the population (1.4 million) suffer from some degree of learning disability. About 1.2 million people suffer from what is judged as a mild to moderate learning disability, and some 200,000 suffer from severe or profound intellectual disability. Thus formally recognised intellectual disability covers a vast range from people having very mild degrees of impairment who live independently to those individuals whose disability is so profound that they require almost constant care and support in every aspect of their life.
People with intellectual disability experience a much higher prevalence of all types of mental illness, higher rates of neurological disease such as epilepsy and dementia, and higher rates of social problems such as isolation, joblessness and criminal conviction. Disorders of emotional regulation and behavioural problems are also much more common in people with learning disabilities. They may have poor affective regulation as a result of the arrested or incomplete development of their nervous system. They will, by definition, suffer from reduced intellectual capacity to cope with life’s stresses. Behavioural problems can include, for example, withdrawal, elective mutism, aggression or behaviours described as protest or challenging behaviour depending on their nature.
Intellectual disability psychiatrists treat mental illness in this disability group. They use a slightly different set of diagnostic criteria to other psychiatrists as illness can present in an atypical manner. They often have particular clinical expertise in providing treatment and care for epilepsy and psychiatric disorders related to epilepsy and dementia. They also have to frequently deal with legal and judicial issues and liaise closely with other branches of medicine.
In recent decades intellectual disability psychiatrists have been working at the forefront of delivering integrated models of community care. They are experienced in multidisciplinary working with a range of other professionals including speech and language therapists, non verbal psychotherapists, social care professionals and community care workers.
They have particular knowledge of The Mental Capacity Act, Deprivation of Liberty Safeguards (DOLS), the workings of the Court of Protection and case law in regard to the care of people with intellectual disability. Learning disability psychiatrists often have expertise in the medico-legal role of assessing capacity and consent. Many learning disability psychiatrists will be trained Mental Capacity Assessors, recognised and listed by the responsible authority.
As you will see if you browse through the partners in Psychiatry-UK LLP, we have a great deal of experience of working in this area of psychiatry. If you are concerned about the mental state of someone who has a learning disability, or if you need advice about one of the clinical problems or issues described above please contact us and we will arrange a private consultation with a suitably experienced and qualified consultant.
If you would like to explore this subject further, some key online resources include:
The Royal College of Psychiatrists publishes a lot of useful information for both Psychiatrists, Public including those with intellectual disability and their carer’s.
The General Medical Council also has a section on their website devoted to helping doctors improve the care they provide for people with a Learning Disability
Mencap and The British Institute of Learning Disabilities are also useful sources of information