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This survey describes the socio‐demographic, clinical and forensic variables of all patients referred to a medium secure unit in the psychiatry of learning disability. Of the sample, 67.5% were referred following an index offence and 76.6% had at least one previous conviction. Just over half (50.6%) came from either prisons, special hospitals or medium secure units and the remainder from mental health/learning disability hospitals or community resources. The majority (91.7%) had prior contact with a mental health or learning disability team. Most (81.5%) had a mild or ‘borderline’ learning disability, 46.8% had either a psychosis or major mood disorder, 58.4% had personality disorders and 56.6% had a history of illicit substance abuse. Of the 79 referrals 29.1% were accepted for admission. Arson as an index offence and a previous conviction for arson were significantly associated with being accepted for admission.

The Information for Health strategy for the NHS (Department of Health, 1998) announced the creation of a national electronic library for health (NeLH). This paper describes a project to develop a virtual branch library for learning disabilities that would reflect the multi‐disciplinary/ multi‐agency nature of these services. It explains the vision and explores some challenges and opportunities.

This case study describes how threats to stab people, in a client with learning disabilities, may have been inadvertently reinforced during detention in a medium secure unit by over‐looking borderline personality traits. Formulating the case from the biopsychosocial model of borderline personality disorder (Linehan, 1993), the article illustrates how an invalidating environment provided by learning disability services may have interacted with underlying difficulties in emotion regulation to reinforce challenging behaviour. Explaining threats to stab purely in terms of learning disability accidentally invalidated the client's emotional distress, so the only way he could convey how he was feeling was by escalating challenging behaviour. Risk management procedures also strengthened the client's belief that he was a dangerous person, and reinforced the challenging behaviour by gaining interpersonal attention. The need for learning disability services to be aware of how personality features contribute to learning disability presentations and to formulate from an interactive perspective is highlighted.