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Telephone interviews were conducted with 64 participants who attended an initial systemic consultation meeting within a community‐based psychology service for people with a learning disability. Most participants found the sessions helpful and liked the reflecting conversations, which they said broadened their views on the presenting problems and offered a positive approach to the meeting, as well as enabling as many views as possible to be heard. However, depending on whether they were carers, colleagues or client and family members, participants' views varied on how prepared and comfortable they felt about the format of the meetings. The authors felt that the results lend support to the overall helpfulness of using an initial systemic consultation meeting when working with this client group.

This paper describes how one specialist learning disability health service has attempted to increase its focus on meeting the complex needs of people with profound learning disability (PLD) both with and without additional physical, sensory and medical impairment. Through individual assessment and intervention, carer consultation, training and supervision, research, and audit and advice to management, a multi‐disciplinary group has influenced the development of more proactive community teams for people with learning disability. This is in the context of both the publication of Signposts for Success (NHSE, 1998) and of a changing organisational culture which has embraced essential lifestyle planning, person‐centred teams, supported living and direct payments. The challenge remains of ring‐fencing sufficient resources (of time, skill and equipment), given the high‐profile and competing demands of people with milder learning disabilities but with complex mental health needs and/or challenging behaviour.