Psychiatry of intellectual disability (PID)
Psychiatrists of lntellectual disability (PID) are specialist psychiatrists who offer psychiatric treatment for those with intellectual disabilities. They also treat other conditions including autistic spectrum disorders, other neuro-developmental disorders and epilepsy.
This page provides useful information on the nature of the work, the common procedures/interventions, sub-specialties and other roles that may interest you.
Nature of the work
People with intellectual disability have higher rates of mental health problems than the general population. Their biological and psychosocial risk factors are often greater and they may also have fewer internal resources to cope with mental distress, making them vulnerable. Minor disorders can sometimes have a severe effect for those with an intellectual disability, resulting in more psychiatric referrals.
Most intellectual disability psychiatrists see patients from the age of 18 upwards. Younger patients may be seen by child and adolescent psychiatrists or sometimes intellectual disability psychiatrists who specialise in work with children.
Psychiatrists working in this field need a wide range of clinical skills. The work is often made more complex and interesting by associated physical problems such as epilepsy and cerebral palsy, along with sensory and communication problems and challenges in accessing services.
Patients may present non-specifically (for example with withdrawal or change in behaviours) and finding out the cause is a fascinating diagnostic challenge. Anxiety disorders and obsessive compulsive disorders are common, as well as behaviours that challenge. Other psychiatric conditions including depression, bipolar disorder and schizophrenia are also diagnosed more frequently than in the general population.
Intellectual disability psychiatrists work as part of multidisciplinary teams providing mutual support. It is also important to work closely with family members and carers to help understand clinical problems and deliver effective interventions. The psychiatrist will often lead the team and provide support and advice.
Psychiatry of intellectual disability is an interesting academic discipline, whether you are interested in the biological basis of mental health problems (e.g. dementia in people with Down’s syndrome, behavioural phenotypes of genetic disorders), or the development of innovative service models.
Much work has been done in recent years in applying psychotherapeutic and systemic approaches to working with people with intellectual disability. There are also several high profile academic centres around the country offering research opportunities.
Supported living and person-centred planning are key to intellectual disability psychiatry and have brought substantial improvements to people’s quality of life.
Most specialist mental healthcare for people with intellectual disability is delivered in community settings. Mainstream beds are routinely used for those with mild intellectual disability and mental health problems who are able to access and in need of inpatient admission. Specialist inpatient facilities are provided for people with forensic needs, and those with a significant intellectual disability and challenging behaviour.
A wide variety of tailored treatments are available, as in mainstream psychiatry, including pharmacological intervention, psychological interventions (including behavioural therapy) social and educational interventions.
Within the specialty there are further subspecialties including child and adolescent and forensic.
Want to learn more?
Find out more about:
- the working life of someone in psychiatry of intellectual disability
- the entry requirements and training and development
- Pay and conditions Expand / Collapse
This section provides useful information about the pay for junior doctors (doctors in training), specialty doctors, consultants and general practitioners.
NHS employers provides useful advice and guidance on all NHS pay, contracts terms and conditions.
Medical staff working in private sector hospitals, the armed services or abroad will be paid on different scales.
- Where the role can lead Expand / Collapse
Read about consultant and non-consultant roles in learning disability psychiatry, flexible working and about wider opportunities.
Managerial opportunities for consultants include:
- clinical lead - lead NHS consultant for the team
- clinical director - lead NHS consultant for the department
- medical director - lead NHS consultant for the Trust
Most NHS consultants will be involved with clinical and educational supervision of junior doctors.
Here are some examples of education and training opportunities:
- director of medical education - the NHS consultant appointed to the hospital board who is responsible for the postgraduate medical training in a hospital. They work with the postgraduate dean to make sure training meets GMC standards.
- training programme director - the NHS consultant overseeing the education of the local cohort of trainee doctors eg foundation training programme director. This role will be working within the LETB/deanery
- associate dean - the NHS consultant responsible for management of the entirety of a training programme. This role will be also be working within the LETB/deanery
SAS doctor roles
SAS doctors (Staff, Associate Specialists and Specialty Doctors) work as career grade specialty doctors who are not in training or in consultant posts. You will need at least four postgraduate years training (two of those being in a relevant specialty) before you can apply for SAS roles.
Further information on the SAS doctor role is on this site.
Other non-training grade roles
These roles include:
- trust grade
- clinical fellows
If you have trained on an academic psychiatry pathway or are interested in research there are opportunities in academic medicine. However, opportunities with psychiatry are fairly limited. Academic psychiatrists make up 7.6% of the total medical academic workforce. There has been a 33% decrease in the number of academic psychiatrists between 2000 and 2013. 11% of the total medical workforce are academics, meaning that psychiatry is under-represented. (CfWI 2014).
For those with a particular interest in research, you may wish to consider an academic career in psychiatry. Whilst not essential, some doctors start their career with an academic foundation post. Entry is highly competitive. This enables them to develop skills in research and teaching alongside the basic competences in the foundation curriculum.
Entry into an academic career would usually start with an Academic Clinical Fellowship (ACF) at ST1-2 and may progress to a Clinical Lectureship (CL) at ST3 and beyond. Alternatively some trainees that begin with an ACF post then continue as an ST trainee on the clinical programme post-ST4.
After completion of the academic foundation trainees can then apply for academic core training posts (instead of normal core training). A PhD is often taken, either during core or specialty training.
Applications for entry into Academic Clinical Fellow posts are coordinated by the National Institute for Health Research Trainees Coordinating Centre (NIHRTCC).
There are also numerous opportunities for trainees to undertake research outside of the ACF/CL route, as part of planned time out of their training programme. Find out more about academic medicine.
The Clinical Research Network (CRN) actively encourages all doctors to take part in clinical research.
Psychiatrists often undertake research, which includes collaborating with colleagues in the UK and overseas, writing papers and presenting work at conferences. Research within this specialty, as is often the case, is subject to financial constraints. There is not always sufficient money to carry out all the necessary work.
There may also be opportunities to work overseas. Opportunities for private work are limited.
- Job market and vacancies Expand / Collapse
This section provides useful information about the availability of jobs, how to find vacancies and sources of further information.
Job market information
Psychiatry is the fifth largest medical specialty in the UK. Consultant psychiatrists comprise 4.5% of the mental health workforce and 10.5% of the total NHS consultant workforce (Health and Social Care Information Centre, HSCIC 2014). Most areas of psychiatry have seen considerable growth in the consultant workforce in the last ten years, and intellectual disability psychiatry is no exception. In 2003 there were 186 intellectual disability psychiatrists in post and by 2013 this had risen to 249, showing a 34% growth. (CfWI analysis based on HSCIC, 2014).
At present there are 266 consultants and 133 medical registrars in England (2015, HSCIC).
The competition ratio (CR) for core psychiatry training (CT1), the first stage in the training (post-foundation), in 2015 was 1.42 (NHS Specialty Training, 2015). The competition ratio (CR) to Psychiatry of Intellectual Disability Training in 2015 was 0.84 (NWPGMD).
52% of entrants to core psychiatry training in 2013 were women (HEE 2013). At present 41% of psychiatrists are women (HSCIC 2013).
6% of consultant psychiatrists specialise in intellectual disability psychiatry.
In 2014 there was an in-depth review of the whole psychiatric workforce by the Centre for Workforce Intelligence (CfWI).
For information regarding Scotland, Wales and Northern Ireland please click on the links below.
Where to look for vacancies
Specialist intellectual disability psychiatry training is open to those who may want to train flexibly on a less than full-time basis (LTFT). You can request and apply for this after you have been offered the job. Restrictions apply.
Recruitment into specialist psychiatry training (excluding Northern Ireland) is coordinated by the North Western Deanery, Health Education North West.
Registration and applications for psychiatry core and higher specialist training is online via Oriel.
Northern Ireland has its own recruitment process for psychiatry. Find out more about the recruitment process on the Northern Ireland Medical and Dental Training Agency website.
- Further information Expand / Collapse