This chapter summarises current knowledge on the development of services for adults with intellectual disability (ID) with forensic and/or complex needs over the past 25 years. It also details the challenges of new commissioning and policy initiatives. These are examined along with pathways and forensic service development within the NHS and the independent sector.

Following the closure of long-stay NHS hospitals for people with ID in the 1980s, there was an increase in demand for a range of local residential and other service provision. Gaps in service provision were seen from the beginning, especially for people with complex needs associated with risk of offending.