I am a neurodevelopmental psychiatrist trained in Intellectual Disability (ID) in South London, UK. I was attracted to the profession for three main reasons. First, I love the patient group. People with intellectual disability are the kindest, funniest and most engaging patients I have ever met. Even on difficult days, they generate in me a big smile. Unfortunately, they are also the least heard group in society. The second reason comes naturally then: I want to do my bit. The needs of people with intellectual disability are not adequately met, and health and social care professionals outside intellectual disability circles do not understand them. I look at the powerful voice of the LGBT population and the changes they have effected in so short a time, within government, within the Law, within society, and I wonder how we can achieve something similar for people with intellectual disability, or whether it is possible. There are so many initiatives, but still so much to do. The NHS is under strain. I am under strain. There is not enough money made available to bridge the gap. However, going back to reason no.1, I still smile.
My third reason for choosing a career in intellectual disability psychiatry is academic. The complex interaction of neurological and developmental disorders, genetics, general health and the environment makes medical assessments intellectually rewarding. It is a time consuming detective work, going right back to the person's conception, to try and understand the presentation, and treat it to the best of my ability. Within the Bromley intellectual disability medical team, epilepsy receives a close attention. Optimising epilepsy control has led to improvements in functioning, alertness, mood and behaviour. There is a dementia pathway, especially aimed at people with Down syndrome, so medical treatment can be initiated early to benefit quality of life. Of course, some people present with functional psychiatric disorders also, such as depression, anxiety and psychotic disorders. Many people with intellectual disability are on the autism spectrum, and I try and raise awareness about environmental adjustments that can be made to meet the patient's needs, and reduce his/her distress. Often, treatment is not medical but environmental. I then refer on to my precious multidisciplinary team (MDT). It has been humbling to learn from them about the changes that I can make to my communication to provide better consultations for people with intellectual disability.
I strongly believe that there should be a new medical speciality, a sort of paediatrician for adults with intellectual disability. It is my opinion, and my opinion only, that the current adult model is widening the health gap for people with intellectual disability, who need a specialised service with a specialised MDT. Interestingly, the only medical speciality represented within intellectual disability services in the UK is psychiatry. Does this make us specialists or generalists? The topic is widely debated.
Dr Lilly Lines
