This critique takes a look both back and forward at research, services, and training for people with intellectual disabilities (IDs) and cooccurring psychiatric disorders. Despite multiple National Institutes of Health (NIH)-sponsored conferences, Surgeon General Reports, editorials, reviews, books, and calls to action, we have yet to reach a tipping point that galvanizes the field into reducing mental health research and clinical care disparities in this population. Four overarching challenges are presented: (1) what to call this subspecialty; (2) an inadequately trained mental health workforce with little motivation to work in this population; (3) establishing meaningful psychiatric diagnoses and developing nuanced mental health outcome measures; and (4) the systematic exclusion of people with low IQs in psychiatric research programs and clinical trials. Looking forward, four bold recommendations, intended to stir debate, are provided: (1) designate IDs as a Medically Underserved Population and US Health Disparity Population; (2) add disability status to NIH's required human subject section in grant applications; (3) reform and improve training in specific mental health professions and train nonspecialists to deliver care; and (4) integrate primary heath care and mental health services. These are actionable goals that necessarily entail placing a higher value on the well-being and contributions of a persistently stigmatized group.
