Out of area treatments (OAT) are expensive and contribute to social isolation of individuals with intellectual disabilities and challenging behaviour.

To identify the needs of those service users who are in OATs with the view of developing a process of assessment and relocation of those service users locally where possible. Finally we aim to reinvest financial flow in each locality to develop high quality services.

We undertook a scoping project over one year in five London boroughs. We reviewed the existing literature, surveyed mental health and challenging behaviour needs of sample, reviewed current treatment and run focus groups with various stakeholders. We presented a business case

205 service users were identified costing over £1300 per week. 65.4% were in OATs costing an estimated £403,740 a week across the five boroughs. High expenditure was associated with increased perceived severity of mental illness, complex physical disabilities and presence of autism. Those detained under the Mental Health Act were also in more expensive placements. Private sector placements were used in the majority of cases.

Despite the lack of high level evidence for specialist services for challenging behaviour, a multi-stranded approach with both inpatient spot purchasing, rehabilitation facilities and high quality accommodation with flexible community with variable purchasing patterns and specialist community input could substantially reduce the financial burden.