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In Spain, three parallel processes have taken place during the last 20 years: decentralisation, a health reform and a mental health reform. These processes have produced an extremely complex situation in support and care for people with mental retardation. The decentralisation process was not accompanied by a clear definition of the co‐ordination mechanisms among local authorities, and as a result many different health and social care systems have emerged at different times. This makes the description of the current care organisation difficult. An important characteristic of the Spanish system is the major role of NGOs in care and policy‐making and planning in this area. A shift from institutional to community care has begun for both psychiatric patients and people with mental retardation, but compared with neighbouring countries and published standards, the provision of intermediate services and non‐hospital residential care is very low, and the situation is worst for people with mental retardation and psychiatric problems.

Many people with learning disabilities experience mental health problems, and the outcome is likely to be better if they have a good mental health service. Opinions vary about what form a good mental health service for people with learning disabilities would take. Great changes have occurred in services, but research about the effect of these changes is sparse. This paper explores the nature of mental health problems which require services and compares two models for providing a specialist mental health service for people with learning disabilities.

While the right to life, ‘personhood’, and the educability of people with profound and multiple learning disabilities are still under‐debated, service providers and research workers continue to extend the boundaries of expectation with respect to what such people can achieve. In this paper the messages of recent research are summarised and key references for fuller information suggested. The need to bring together such specialised knowledge in the framework of an ordinary life aimed at enhancing competence and quality of life is urged.

This paper offers readers a review of the literature on alcohol and illicit drug misuse in people with learning disabilities, focusing on six key areas. First, clarity is provided on the definition of ‘misuse’. Second, prevalence rates are examined along with the methodological difficulties involved in such studies, the authors arguing that prevalence rates are higher than current estimates. Third, the authors explore the relationship between the intra‐ and inter‐personal risk factors. Fourth, the nature of the substance misuse is explored, with a focus on offending behaviour. Fifth, a range of treatment modalities are described with a series of recommendations for more robust evidence‐based interventions. Last, the authors explore the gaps in policy that lead to a dearth in service provision as well the barriers which people with learning disabilities face on entering treatment services. The paper cites four innovative projects that address this population's needs in England, and illustrates how Northern Ireland has positioned the needs of this hidden population within the Department of Health, Social Services and Public Safety (Northern Ireland).

This article explores the nature of the classifications of learning disabilities as promulgated in the diagnostic manuals. By leaving aside all doubts and controversies that surround the concept and measurement of intellectual functioning, weaknesses are exposed from within those manuals' own frames of reference. The difficulties arising from using the international sub‐classifications of learning disabilities when the national classifications should apply are discussed.

It has been suggested that the emotional needs of people with intellectual disabilities have been neglected (Kroese, 1998). More recently there has been evidence of increased clinical and research activity in this area (Beail, 2003; Bouras & Holt, 2007; Foundation for People with Learning Disabilities, 2004). Currently much of the focus in this area is on mental ill‐health. This article will consider briefly the literature on mental ill‐health, with particular emphasis on the development of individual treatment approaches. From this discussion it will be evident that much of the research and theory in this area focuses on deficits and disadvantage. I will go on to suggest that a clinical and research focus that explores strengths and resilience will offer a more positive agenda for developing understanding of emotional well‐being and mental ill‐health in people with intellectual disabilities.

People with learning disabilities are typically over‐represented in Western criminal justice systems. They are vulnerable during police questioning, and may not comprehend their right to silence; they may confess, or acquiesce to the police version of events. They may have a long history of challenging behaviour which has never been appropriately addressed until the behaviour brings them into contact with the criminal justice system. It is important for service providers to have a working knowledge of the criminal justice system, and a clear idea of their role in relation to the client, especially during police interviews.

This paper introduces service changes impacting on adults with learning disabilities, defines the concepts of learning disability, needs and need assessments, dual diagnosis and mental health needs and considers their service implications. Between 25% and 50% of adults with learning disabilities have mental health needs, and the main clinical types are outlined. The findings from a national multi‐professional survey of services for adults with learning disabilities and mental health needs are summarised and the difficulties of meeting the complex needs of these adults are demonstrated. Recent developments in clinical diagnostic assessment, needs assessment, care planning, outcome monitoring, staff training and service evaluation are discussed, including the possible advantages of the care programme approach (CPA). Recommendations are given for services for adults with learning disabilities and mental health needs and points for discussion with service users and carers are suggested.

The number of parents with a learning disability is growing rapidly, as the closure of institutions and the rise of community living encourage this population to take on roles that were previously denied to them (DoH, 2001). People with a learning disability are seen as people first, with the right to be a parent and raise a child, a valued role in society. The rise in the number of parents with a learning disability can also be attributed to the discontinuation of enforced sterilisation and increasing opportunities to form relationships in which consensual sex is accepted and supported (Martin & Ticktum, 1987). Accordingly, the research on the ability of parents with learning disability to provide adequate parenting is expanding. However, research on the effect on the child of having a parent with a learning disability is still limited. This article will first look at the literature on factors affecting the ability of parents with a learning disability to care for their children adequately. The effects of having a parent with a learning disability will then be considered, and finally the implications for clinical practice will be outlined.

The dementias are important disorders of ageing which result in cognitive and functional decline, behaviour change, increasing dependency and premature death. Alzheimer's disease and other dementias are at least as prevalent in older people with learning disabilities as in the general population. In addition, people with Down's syndrome have high rates of early onset Alzheimer's disease. Assessment of dementia in people with learning disabilities is confounded by pre‐existing cognitive and functional impairments and high rates of comorbid disorders. This paper discusses assessment of dementia in people with learning disabilities from a clinical perspective, with reference to the current evidence base.