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 ST1-3  6x 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 ST4-6  Usually 3x one year posts  National Curriculum  Obtain competencies in 13 areas of learning  Assessed using WPBAs  Monitored 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?