Few books have been published on the psychiatry of intellectual disabilities. This book is more succinct, better presented and more consistent in the quality of writing and information than the corresponding title in the College Seminars series.

Despite this overall recommendation, the book has several flaws. It is presumably aimed primarily at trainees in the subspecialty. Clearly not a reference book, it should have been a more practical manual. Luty & Cooper's chapter on older people with intellectual disabilities gives useful guidelines for assessment and management but other chapters are much less practice-orientated. Although certainly better than many previous texts in limiting the content regarding general ‘handicap’, there are still too many references to the primary healthcare of people with intellectual disabilities. The era is long gone where psychiatrists in intellectual disability act as pseudo-general practitioners. It was also unnecessary to have paragraphs on such obscure conditions as Coffin-Siris syndrome. The reality is that most referrals to psychiatrists in intellectual disabilities are for problem behaviours. The trainee must learn that it is not their responsibility to solve these problems with medication alone but they should act as the only professional who has the training and expertise to take the holistic overview of the patient in biopsychosocial terms. There is also uncritical acceptance of the vague, catch-all term of ‘challenging behaviour’, which hampers rather than helps approaches to problem behaviours. It was a mistake therefore to include a chapter on medication without one on basic psychological assessments and interventions that a trainee needs to understand and implement.

Roy's chapter on multidisciplinary working gives an unjustifiably rosy view of the current state of (dis)organisation of services. There are undoubtedly good working relationships between hard-working and committed professionals in learning disability services but good intentions do not compensate for lack of focused working. It is scandalous that, 15 years after its introduction, the care programme approach (CPA) has not been implemented nationwide for people with intellectual disability and mental health problems. For those who seek to improve the rights of people with intellectual disability one powerful starting point would be to demand that such people with mental health problems should have their care coordinated through the recognised national standard of the CPA. It is not good enough therefore that CPA is described in this book as ‘useful’ rather than ‘mandatory’. Community learning disability teams, which vary in focus and make-up throughout the UK, are also blithely described as ‘useful’ without any recourse to evidence of service delivery models.

In summary, although this is perhaps the best introductory short text available in this sub-specialty, it will be unlikely to improve mental healthcare services and service delivery for people with intellectual disability.