Psychiatry of intellectual disability in the UK: looking back, moving forward
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Authors
Shankar, Rohit
Tromans, Samuel
Laugharne, Richard
Courtenay, Ken
Sawhney, Indermeet
Roy, Ashok
Alexander, Regi
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Issue Date
29/09/2025
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Journal article
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Mental Health
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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.
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Citation
International Review of Psychiatry, 1–12. https://doi.org/10.1080/09540261.2025.2564166
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International Review of Psychiatry