Adults with borderline intelligence are more likely to suffer from treatable mental disorders and an excess of substance misuse. Services should be aware of hidden morbidity in this group.

BackgroundStaff training in positive behaviour support (PBS) is a widespread treatment approach for challenging behaviour in adults with intellectual disability.AimsTo evaluate whether such training is clinically effective in reducing challenging behaviour during routine care (trial registration: NCT01680276).MethodWe carried out a multicentre, cluster randomised controlled trial involving 23 community intellectual disability services in England, randomly allocated to manual-assisted staff training in PBS (n = 11) or treatment as usual (TAU, n = 12). Data were collected from 246 adult participants.ResultsNo treatment effects were found for the primary outcome (challenging behaviour over 12 months, adjusted mean difference = −2.14, 95% CI: −8.79, 4.51) or secondary outcomes.ConclusionsStaff training in PBS, as applied in this study, did not reduce challenging behaviour. Further research should tackle implementation issues and endeavour to identify other interventions that can reduce challenging behaviour.Declaration of interestNone.

Working with mainstream mental health services and across health and social service boundaries delivers effective mental health care for people with intellectual disabilities.

Learning disability is strongly associated with risk of affective disorder, persisting well into midlife.

The Strathcona Theatre Company is made up of professional actors with a learning disability and two directors. As part of the teaching course in the Department of Psychiatry of Disability at St George's Hospital Medical School, the medical students participate in a workshop given by the Company, near the beginning of their attachment in psychiatry. During the two-hour workshop the students are taught a variety of ‘ice breaking’ games and mimes by members of the Company. This means that early on in the course, students have face to face contact with adults with a learning disability, and furthermore see them in a socially valued role as teachers and leaders. The students usually find the workshop enjoyable, and give positive feedback although they were unsure how successful the workshop was in changing medical students' attitudes towards people with learning disability. We report an evaluation of students' attitudes before and after the workshop, and show statistically significant changes in attitudes towards people with a learning disability.