Purpose – The “outcomes revolution” in healthcare has yet to impact strongly on secure intellectual disability (ID) services in the UK. The purpose of this paper is to review the service-level outcome studies that exist for this population, and to explore some of the challenges of conducting such research. It further describes some illustrative routine outcome data from the National High Secure Learning Disability Service. Design/methodology/approach – Routinely collected outcome measures (length of stay; violent incidents; Emotional Problem Scale (EPS) Behaviour Rating Scale and EPS Self-Report Inventory) were analysed for two overlapping cohorts of patients resident in the high-secure service between 2008 and 2013. Findings – The median length of stay of those discharged during the study period (n=27) was around 9.9 years (range one to 40 years). A significant proportion (25 per cent) of discharges resulted in an eventual return to high security. There did not appear to be a treatment effect over two to three years using staff-rated global clinical measures, but patient-rated clinical measures did reduce. Violent incidents also reduced significantly over a longer period of four years in treatment. Research limitations/implications – There are identified challenges to research design and outcome measurement which need to be addressed in any future cross-service studies. Originality/value – There are relatively few published outcome studies from forensic ID services. None of the studies have used clinical measures of changes or patient-rated outcome measures.

There are a growing number of studies concerning people with intellectually disabilities (ID) who offend, however few studies systematically record prevalence of mental health problems. This article will attempt to determine the prevalence mental health problems in people with ID who offend. Search terms were entered into the CINAHL, EM-BASE, Ovid MEDLINE(R) and PsycINFO databases. Studies were also selected through discussion with clinicians and references from relevant papers. Fourteen relevant articles were found that indicated the prevalence of mental health problems in people with an ID who offend. Mental health problems may be more prevalent in individuals with an ID who offend than those with an ID who do not offend with schizophrenia/psychotic difficulties occurring more frequently. The possible increased prevalence should be considered within treatment regimes in order to effectively rehabilitate individuals.

Purpose -This paper describes a service improvement project with two aims: to identify and screen all adults with Down's syndrome aged over 30 years in a defined locality using a standardised instrument to establish functional baselines; and to set up a database to facilitate early diagnosis of dementia in this population.Design/methodology/approach -An assistant psychologist used a standardised instrument to screen participants who were identified through contact with health, social, and third sector, and housing services.Findings -Eligible people were identified and screened using an informant-based measure. Three groups were identified: group 1 showed no significant change; group 2 showed significant change but no signs of dementia; and group 3 showed significant change plus signs of dementia. People with suspected dementia were referred on for further investigation/assessment and supportive services.Practical implications -Terminology is important in engaging families in a screening project, as is the opportunity to provide information. A proactive screening project can be established by employing working partnerships between intellectual disability and older adult services to aid diagnosis.Originality/value -Adults with Down's syndrome aged over 30 years in a defined locality can be identified through contact with health, social, and third sector, and housing services. Those identified can be screened using a standardised instrument and a database of screening results established in order to establish baselines against which future re-screening can be conducted. Partnership working between older adult mental health services and intellectual disability services can improve the diagnostic service to adults with Down's syndrome.