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The purpose of this paper is to describe the current situation in relation to restrictive interventions, and some actions that could be taken to reduce them. The quality of care provided by inpatient services for people with intellectual disabilities has come under increasing scrutiny in recent years – from Winterbourne View in 2011 to Whorlton Hall in 2019, there has been increasing concern that admission to hospital does not always result in a good outcome for the patients. For some people, it has resulted in further deterioration in their physical and mental health, separation from families and supports and reduced probability of living as part of their community. This is in spite of knowledge and evidence of what good practice looks like.

This paper examines the extent to which inpatient services deliver good practice in treatment and care and, where this is not happening, the extent to which they are subject to effective governance.

People admitted to inpatient services can be at risk of poor-quality care and the overuse of restrictive interventions. There is guidance available that addresses what should be in place for them to receive high-quality care and treatment, and this clearly is available to many people. However, others can find themselves placed in increasingly restrictive environments and in circumstances where their human rights are at risk of being breached. There is increasing evidence that these services do not follow good practice guidance in terms of staff skills, development and implementation of effective care plans and governance arrangements that address these issues. Regulators, commissioners and managers could, and should, focus on these issues to ensure that the most vulnerable receive the care and treatment they need while in hospital.

Service providers are aware of the difficulties in developing alternative community services. This places even more importance on the need to ensure that care and treatment in hospital is of a good standard, and that the use of restrictive interventions is minimised. McGill et al. (this issue) describe the features of a capable environment and it may be that hospitals consider that the requirements are unlikely to be implemented effectively in a ward/unit setting. However, a shift of focus in doing this could result in a reduction in restrictive interventions and a better experience – potentially for both the staff and the patients. And families could have some reassurance that their relative was receiving the best quality care and treatment, and that their human rights were being upheld.

Changes have occurred in the pattern of services for people with learning disabilities and mental illness and/or challenging behaviour over recent years, with the development of a variety of service models across the UK. In SE London, residential services are based predominantly on a supported housing model and the strong philosophical premise that people should not be excluded from a community residential service because they have complex physical, behavioural or mental health needs. Local services, therefore, are supporting individuals with a wide range of need. This paper describes the development of specialist mental health and challenging needs services in support of this model. The issues raised are outlined, together with a list for action and priorities to overcome the difficulties encountered, including the maintenance of an effective infrastructure.

It is essential that the quality of residential services is monitored, both to identify service deterioration and to improve service quality. Current models of community services have produced fragmentation among service providers, and a separation of purchasers and providers. These different groups need to work together to share a vision and a model of good practice. Participation in the auditing of each other's services, and a focus from commissioners on being supportive rather than punitive, assist in this. Audit also enables a view of the strategic challenges which face services to be developed. These challenges include ensuring that staff are skilled in supporting clients to live as ordinary a life as possible, as well as meeting any additional complex needs they may have.

People with intellectual disabilities commonly come into contact with the criminal justice system as victims, witnesses or suspects. Their intellectual disabilities may make them disadvantaged in relation to all components of the criminal justice system, including police interviews, fitness to plead and stand trial, capacity to give evidence in court, and issues to do with criminal responsibility and sentencing. The focus in this paper is on police interviews and the capacity of adults with intellectual disabilities to give evidence in Court. Research into the types of vulnerability seen by people interviewed by police have focused on interviewees' understanding of the Oath and their legal rights, suggestibility, acquiescence, compliance and perceptions of the consequences of making self‐incriminating admissions. The essential components of any interview and testifying in court require that the person can communicate effectively and give reliable answers and accounts of events. Research into police interviews has highlighted the importance of taking into account the interviewee's vulnerabilities and providing appropriate support, and suggests a more humane approach to interviews and when vulnerable people testify in Court.

This paper explores some of the issues and barriers to service user involvement for people with learning disability in mental health settings. In particular the paper focuses on barriers to involvement including staff attitudes and the involvement of service users in their own assessment and treatment. The issue of getting people involved in their own care is addressed and is highlighted using examples of good practice.

The Mental Capacity Act (2005) is now in full operation in England and Wales. In this article, some of the common questions that professionals face on a day‐to‐day basis are discussed, including how to assess capacity and decide whether or not someone has capacity, what to do if someone lacks capacity and what could happen if someone does not follow the Mental Capacity Act.

The Improving Access to Psychological Therapies (IAPT) programme was established to treat people with mild to moderate depression and anxiety and bring them to recovery. Although the Positive Practice Guide for people with intellectual disabilities was published in 2009, no geographical areas are listed as having a special interest in specifically rolling out IAPT to people with intellectual disabilities. Issues related to whether current IAPT services can meet the needs of people with intellectual disabilities are considered, along with adaptations that would be needed to ensure the service is accessible and meets the needs of people with intellectual disabilities.