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This paper reports the results of a review of services for adults with profound intellectual and multiple disabilities carried out as part of the implementation of Valuing People Now. Examples of good practice were identified which could be used to illustrate both what is possible and what policy obstacles have to be overcome. Families supported to make the most of the opportunities presented by the Government's ‘personalisation’ agenda were in general getting what they and their disabled family member needed and wanted. A number of specific obstacles were identified to which national and local government need to attend in order to enable more families to take up the new opportunities available.

Since 1999, one of the Special Interest Research Groups within the International Association for the Scientific Study of Intellectual Disabilities (IASSID) has been on profound multiple disabilities (PMD). This group has stimulated a world‐wide discussion on education and support for such individuals. However, it is evident that there is some disagreement about who is included in this category. There has also been a debate about the applicability of various policy changes for people with PMD. A third topic of discussion has been the need for more research related to this target group and the related research priorities. This paper profiles and discusses these questions.

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.

The Netherlands is a country where much is regulated, and several departments have made rules, regulations, memoranda and even laws related to people with intellectual disabilities. Large organisations that offer different forms of support dominate the system of care and support. The policy on care for people with intellectual disabilities has, generally speaking, developed away from segregation and towards integration and inclusion. Changes have led to improvement for people with mild and moderate disabilities, although the process is slow. At the same time, the situation for people with profound and multiple disabilities has deteriorated. For a real change in the support system, client‐held budgets are believed to be of primary importance. However, this is still a slow development. This article describes the current organisation of care and support.

There are many definitions of profound and multiple learning disabilities. Most definitions include having a high degree of learning disability in conjunction with at least one other severe impairment, such as visual, auditory or physical impairments (Male, 1996; Ware, 1996; Lacey, 1998). Bunning (1997) adds that people with such disabilities are very reliant on others for support, including support in taking part in communicative events. Establishing reliable and consistent methods of communication may be exceptionally difficult (Florian et al, 2000). However, it is important to consider the individuality and extreme diversity of this population (Detheridge, 1997; Hogg, 1998), which includes variability in communication strengths and needs (Granlund & Olsson, 1999; McLean et al, 1996). Communication is often given little attention when services are planning ways of supporting individuals to participate, develop independence and make choices (McGill et al, 2000). While the individual's communication strengths and needs should remain central within any discussion, the significant others and the environment will also have an important influence. This article explores some of the communication issues experienced by people with profound and multiple learning disabilities and highlights the importance of the communication partnership within interventions.

The purpose of this paper is to provide a commentary on “An audit of an Intensive Interaction service”.

Drawing on the literature regarding other related person-centred approaches and clinical and research experience, an argument is made that people with profound intellectual and multiple disabilities are particularly at risk when service innovation does not account for their unique needs.

Practice and service models need to specifically account for the needs of people with profound intellectual and multiple disabilities.

The commentary draws attention to the importance of implementation and seeks to draw lessons from well established, service wide approaches for people with intellectual disabilities.

Widely varying rates for the prevalence of psychiatric disorder have been reported in the previous published literature. The aims of this study were to describe the prevalence of psychiatric disorders in a random sample of adults with moderate to profound learning disabilities living in the community, and to explore the socio‐clinical factors associated with psychiatric disorders.A process of active case finding was undertaken to identify adults with learning disabilities. A random sample of 240 was taken of whom 121 were found to have moderate to profound learning disabilities at interview. Information was collected on socio‐demographics, service use, physical health, medication use, and life events. Standardised instruments were used to assess psychiatric symptoms, problem behaviour, and severity of learning disabilities. Diagnoses were generated using four diagnostic systems: clinical, DC‐LD, DCR‐10 and DSM‐IV.Higher rates of psychiatric disorder are reported than in previous published studies in the general population and in studies with people with learning disabilities living in the community. Further investigation of the effect of diagnostic system on prevalence rates, and associations of psychiatric disorder are warranted.