‘If you want a better outcome, you need a different solution’: developing a new specialist mental health service for people with learning disabilities and/or autism

People with a learning disability and/or autism frequently experience inequitable access to effective mental health care; many receive support in environments that are not designed to meet their needs, including psychiatric intensive care units (PICUs). We describe a new specialist mental health service established by Avon and Wiltshire Mental Health Partnership NHS Trust. The Kingfisher comprises an integrated care pathway, combining a community outreach offering with a dedicated inpatient facility designed specifically for adults with a learning disability and/or autism and co–occurring treatable mental health conditions. We outline the national and regional policy context underpinning the service, the identified need arising from high rates of out–of–area placements, and the programme requirements to reduce inpatient admissions and length of stay while improving patient experience and outcomes. Central to the development has been a commitment to co–production with people with lived experience, influencing service model design, workforce development, building architecture, and clinical practice. Trauma–informed and autism–friendly design principles, alongside a strong emphasis on nature connection, were embedded within both the physical environment and the clinical model. Key challenges encountered during delivery, including cost pressures, planning constraints, and the absence of specific design guidance for this type of unit, are discussed. The Kingfisher demonstrates how a whole–pathway, co–produced approach can support safer, more humane and effective mental health care for people with a learning disability and/or autism. This model offers transferable learning for other systems seeking to move away from inappropriate inpatient care, towards more personalised, inclusive and locally delivered services.