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Three separate focus groups were conducted to compare the views of service users, carers and specialist health professionals on community services for adults with psychosis and learning disabilities. Participants were asked which staff, treatments or interventions and methods of working or style of service organisation make a significant contribution to helping people with psychosis and learning disabilities. Although there were few direct contradictions or conflicts between the three groups, the priorities of service users, carers and professionals often differed. Development of community services for adults with psychosis and learning disabilities should incorporate the views of service users and their carers as well as clinicians.

Service systems for people with learning disabilities in Scotland have developed in the context of the Scottish legal system and devolved policy for health. Scottish organisations are responding to the spectrum of mental health needs by working in partnership to improve quality. This article describes this system and the key organisations, and presents some findings of the National Overview Report of services undertaken by NHS Quality Improvement Scotland.

The effects of privatisation, public work force downsizing and schemes to re‐invent government have eroded the middle management capacity that is crucial to the success of many community development programmes and complex public and private partnerships for learning disability services in the US. The impact of these factors has been accelerated by reform proposals from within the learning disability field that associate government and management with the perceived ills of traditional specialised service agencies and assume that market and other approaches to providing services will be superior. In addition, the consolidation of learning disability within broader health and human services, at state and local levels, along with large losses in the number of managers in learning disability services, has added to the problems of managing community services. Managing community services is therefore an important challenge in the US, and attention needs to be paid to the unique problems in this environment, with the roles middle managers play in the large and complex organisational environment of community services crucial to their stability and success. Managers more than management frameworks are especially important in the US, as comprehensive administrative arrangements at local level are unlikely to emerge. Disappointment about traditional approaches in specialised provision should not lead to uncritical assumptions about the superiority of alternative arrangements for managing learning disability services.

There are high rates of emotional, behavioural and psychiatric problems (Cooper et al, 2007) in the learning disability population. This paper describes the Mental Health in Learning Disabilities (MHiLD) service for adults with learning disabilities in four South London boroughs. This service has been in operation in two South East London boroughs from 1982, and was extended to a third in 1999 and a fourth in 2006.

Knowledge of what makes for quality in adult learning disabilities services does not cascade directly down into grassroots practice. It is instead severely filtered and variously diluted through layers of national policy, local strategy and administrative complexity. In the current difficult climate, quality is not obtained without exposure to the strains and stresses inherent in the dynamics of the health and welfare bureaucracies and their attempts at partnership. Following a largely chronological and descriptive account of attempts to change and develop services in the Greater Glasgow area in the mid‐1990s, consideration is given to the effect of these ‘filters’ in the context of the Greater Glasgow Joint Learning Disability Project.

There is an ongoing debate about how specialist psychiatric services for people with learning disabilities and mental health problems should be developed. Nursing personnel are the largest professional group involved with care provision, yet to date there has been little research addressing the knowledge and experiences of learning disability and mental health nurses co‐working with this population. This aim of this study was to explore the perceptions of these nurses, using qualitative methods. The findings are discussed in relation to A Vision for Change (DoHC, 2006) and in comparison with the innovative collaborative working that has occurred with the UK.

This paper reports some preliminary lessons from a qualitative study of services that have cared for a person with learning disabilities during a terminal illness. It reflects current concern about access to health care as well as the national priority being placed on improvements in cancer services for all patients. The study documents how the service learned of the person's illness, how they mobilised services and made decisions, how agencies worked together (or not!) and what support staff needed in the person's last months and weeks. It also considers the way staff, as individuals and as teams, made sense of their experiences and evaluated the input of other professionals.

The care programme approach (CPA) is an important part of supporting people with mental health problems in the community and has been applied with variable success in services for people with learning disabilities. Investigation into service users' understanding of the CPA has been limited. We employed multiple methodologies to explore what service users with learning disabilities and additional mental health problems thought about the CPA process, and what their understanding of it was. We used the findings to work with other professionals to adapt the meetings in a way that was accessible and inclusive. We included this work in the service communication plan and produced guidance for care co‐ordinators and materials to be used at the meetings. The guidance and materials can be used by any service and will be available online.

In the last decade we have witnessed much debate and activity around the provision of mental health services for people with learning disabilities in England. This article looks not only at current initiatives to improve mental health care from around England, but also places them within a policy context. Unfortunately there are areas that still fail to provide a basic care standard, some of which has been reported throughout the media from recent investigations. Where this is the case, we outline the responses and actions that have been put in place to address these issues.To maintain a momentum for positive change for the mental health care of people with learning disabilities, there now needs to be cooperation between services that traditionally have not worked together for the benefit of this client group. Before an equality of mental health service provision, in line with national standards, can be realised the traditional views and values of service providers and commissioners will need to be challenged and tuned to the needs of this group of people.