ORCID

Abstract

In this century, psychiatry for people with intellectual disability in the United Kingdom has undergone profound shifts, shaped by deinstitutionalization, legislative reform, a focus on psychotropic reduction, an increasing recognition of the premature mortality, and a growing recognition of rights-based, person-centred approaches. Despite progress, entrenched challenges remain, including fragmented services, inconsistent outcome measures, inappropriate psychotropic prescribing, and health inequalities. The coming decades promise transformative opportunities through genomics, digital health, and personalized interventions, through integrated management of co-occurring conditions, but risk deepening inequities if inclusion is not intentional. This paper synthesizes past developments, including the impact of abuse scandals, legal reforms, medication optimization initiatives, recognition of premature mortality, outcome measurement advances, and evolving care models. It explores future trajectories, focusing on genomic medicine, technology, holistic care, and patient and carer co-production, emphasizing the role of shared genetic vulnerabilities and digital phenotyping in early detection and integrated care. By reflecting on past shortcomings and future potential, we propose an agenda that centres rights, equity, and evidence, ensuring that people with intellectual disability are not left behind in the next era of psychiatric innovation and equally that psychiatry remains integral to the welfare of people with intellectual disability.

Publication Date

2025-09-29

Publication Title

International Review of Psychiatry

ISSN

0954-0261

Acceptance Date

2025-09-17

Deposit Date

2025-09-29

Funding

There is no direct conflict of interest to declare for this paper for any of the authors. RS, IS, KC, and AR are or past office bearers in the Royal College of Psychiatrists Faculty of psychiatry of intellectual disability. This paper is the person views of the authors and is not representative of any organization to which they may be affiliated. RS has received institutional research, travel support, and/or honorarium for talks and expert advisory boards from LivaNova, UCB, Eisai, Veriton Pharma, Bial, Angelini, UnEEG, and Jazz/GW Pharma outside the submitted work. He holds or has held competitive grants from various national grant bodies, including Innovate, Economic and Social Research Council (ESRC), Engineering and Physical Sciences Research Council (ESPRC), National Institute of Health Research (NIHR), NHS Small Business Research Initiative (SBRI), and other funding bodies, including charities all outside this work. SJT holds competitive grants from the NIHR, and Baily Thomas Charitable Fund for projects related to intellectual disability and is also editor of the textbook Psychiatry of Intellectual Disability Across Cultures (Oxford University Press). RL has been Chief Investigator in studies for Janssen and Boehringer Ingelheim. RA holds or has held competitive grants from the National Institute of Health Research (NIHR), outside this work. No other author has any conflict of interest.

Keywords

Developmental disabilities, co-morbidity, future policy, mental illness, outcomes

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