Psychiatry of intellectual disability (PID)

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 (25-40%) than the general population. Predisposing biological and psychosocial risk factors and maintaining factors are often greater, and they may also have fewer internal resources to cope with mental distress, making them particularly vulnerable. Even seemingly mild-moderate psychiatric disorders can sometimes have a profound effect on people with intellectual disability, impair their day-to-day functioning and quality of life, resulting in more referrals to intellectual disability services.

Most psychiatrists see patients from the age of 18 onwards. Younger patients are seen by child and adolescent (CAMHS) psychiatrists or ID psychiatrists who specialise in working with children alone, should they be available.

The clinical 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. The model of working is multidisciplinary, providing holistic [2] care. 

Patients may present non-specifically, for example with withdrawal or change in behaviours. Investigating and establishing 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 relative to the general population.

Psychiatrists work as part of multidisciplinary teams (MDTs) providing multi-professional support. It is also important to work closely with family members and carers to foster mutual understanding of clinical problems, sharing of information and enable delivery of effective interventions. The ID Psychiatrist will frequently lead the MDT and provide support and advice.

Psychiatry 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 or forensic aspects of intellectual disability.

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.

Common procedures and interventions

Most specialist mental healthcare for people with intellectual disability is delivered in community settings. Person-centred planning is key to ID psychiatry and helps provide substantial improvements to many people’s quality of life.

Mainstream beds are routinely used for those with mental health problems who are in need of inpatient admission. Specialist inpatient facilities are provided for people with forensic needs, and those with more complex conditions.

Much like in mainstream psychiatry, a wide variety of individualised treatments tailored to specific patients’ needs are available, including pharmacological intervention, psychological interventions (including behavioural therapies and positive behavioural support), as well as social and educational interventions.

Sub-specialties

Within the specialty there are further sub-specialties, including child and adolescent psychiatry, forensic psychiatry and strong links with neuropsychiatry.

Want to learn more?

Find out more about:

• the working life [3] of someone in psychiatry of intellectual disability
• the entry requirements [4] and training and development [5]

• Pay and conditions

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  This section provides useful information about the pay for junior doctors (doctors in training), specialty doctors, consultants and general practitioners.

  Find out more about the current pay scales for doctors [6], and there's more information on the BMA website [7].  

  NHS employers [8] 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

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  Read about consultant and non-consultant roles in learning disability psychiatry, flexible working and about wider opportunities.

  Consultant roles

  You can apply for consultant roles six months prior to achieving your Certificate of Completion of Training [9] (CCT [10]). You will receive your CCT [10] at the end of your psychiatry training.

  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 [11] 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 [12]is on this site.

  Other non-training grade roles

  These roles include:

  • trust grade
  • clinical fellows

  Academic pathways

  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 [13].

  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). [14]

  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. [15]

  The Clinical Research Network [16] [16](CRN) actively encourages all doctors to take part in clinical research.

  Other opportunities

  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

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  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. 

  NHS Digital regularly publish workforce statistics which show the number of full time equivalent consultants and doctors in training for each specialty: NHS Digital workforce statistics [17]. 

  Competition ratios for medical specialty training places are published on Health Education England's specialty training webpage [18]. 

  In 2014 there was an in-depth review of the whole psychiatric workforce [19] by the Centre for Workforce Intelligence (CfWI), which is published on gov.uk.

  For information regarding Scotland, Wales and Northern Ireland please click on the links below.

  NHS Scotland medical and dental workforce data [20]
  NHS Wales medical and dental workforce data [21]
  Department of Health, Social Services and Public Safety workforce information for Northern Ireland [22]

  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 [23]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 [24].

  Registration and applications for psychiatry core and higher specialist training is online via Oriel [25].

  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 [26] website.

• Further information

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  British Medical Association [27]

  BMJ Careers [28]

  General Medical Council [29]

  Royal College of Psychiatrists [30]