Aim: To analyse trends in admissions to an intellectual disability unit over a ten year period. Method: We carried out a retrospective review of medical case notes over two time periods (1999-2001 and 2009-2011). Data collected included patient demographics, reasons for admission, length of stay, delay in discharge and reasons for delay in discharge.Results: During the initial review there were 60 admissions to the unit, compared to 41 admissions during the later time period. During both periods challenging behaviour followed by psychotic disorder were the most common reasons for admission. Over this ten year period, more than half of the admissions were considered delayed discharges, most commonly due to social reasons (i.e. funding, appropriate placement).Conclusions: Specialist inpatient assessment and treatment units are a costly necessity. Reducing the average length of stay where possible can reduce the cost of a patient admission. However, this single agenda can lead to problems of pressured early discharge to placements which are unable to sustain the patients. Collaborative approaches together with those involved in community care is crucial to getting the right care at the right financial cost for this relatively small but very complex and vulnerable group of individuals.