Since the start of the 1970s the pattern of care available to more severely ‘mentally handicapped’ people in Britain has undergone major changes. The passing of the 1971 Education Act and the publication of Better Services for the Mentally Handicapped (HMSO 1971) opened the way to a process of transition away from large institution based, medically orientated services towards a more disseminated, flexible and locally available system of educational and social provision.

A central objective of this paper, therefore, is to review the development and coordination of NHS and local authority residential, social and educational support for mentally handicapped individuals. It updates and extends earlier OHE publications on this topic (OHE 1973, 1978). The study relates mainly to the situation in England, although some reference is also made to the levels of provision in other parts of Britain. In addition, questions about the occurrence, causes and opportunities open for the prevention of intellectual impairment are discussed in the opening sections of the paper. The intention is to provide a general overview of the field.