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Women have been discriminated against throughout history. Despite international efforts, there remain significant inequalities between men and women. In some countries women are still deprived of fundamental human rights. This article looks at the published literature on gender as it affects individual vulnerability and risk, and planning, organisation and delivery of health care, with specific focus on the mental health and learning disabilities literature. It acknowledges the important differences between the life experiences and social realities of men and women with learning disabilities, and discusses them in the context of recent government policy and guidance. It calls for urgent gender‐specific research to understand the key issues facing men and women with learning disabilities, and a rights‐based approach to access to education, health care and a competent and informed workforce.

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.

Mental health assessment in people with learning disability can be a challenging process for clinicians. The more severe the cognitive impairment and level of learning disability, the less likely it is that the clinician can reliably confirm the diagnosis of a psychiatric disorder. Coordinated, multi‐modal interdisciplinary team assessment is the way forward, as it draws together the bio‐psychosocial model of interviewing and mental health care planning. In this article we go through the psychiatric assessment structure and highlight the differences in assessing people with learning disability compared with their peers in the general population. We give special consideration to mental health assessments in emergency settings, and to people with challenging behaviour.