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Purpose -- This article aims to bring readers up to date with policy developments in England and Northern Ireland in the last two years since the journal first reported on these issues. Design/methodology/approach -- As well as looking at changes to policy and legislation, the paper highlights not only the differences but also the shared concerns for people with intellectual disability living in the two countries, e.g. equal access to healthcare as experienced by the general population. Findings -- In spite of shared visions of inclusion and equality in mental health care, there are major differences in how both countries approach these issues. Recently this has been highlighted by significant shifts in policy. In Northern Ireland strategies designed to inform the delivery of evidence based services for the future have been witnessed. Whilst in England there has also been a move towards public protection within mental health legislation and the reaffirmation of the need to move towards more individual services. Whilst policy initiatives in both countries have been encouraging; they need to be implemented so issues such as access to healthcare and geographical disparity are addressed by local providers. Social implications -- Although there is a desire for change, the reality is that the policies and legislation introduced to address issues such as accessing mental health care and service standards have still to make a significant impact to people's daily lives. Originality/value -- This paper offers an update of current practice and policy relating to mental health for people with intellectual disabilities in England and Northern Ireland. [ABSTRACT FROM AUTHOR]