Closure of institutions designed for adults with intellectual disability (ID) has meant that those with more complex psychiatric and/or medical conditions have been admitted to health care settings designed for the general population of non-disabled adults. This paper describes the characteristics and service utilization of persons with ID receiving inpatient psychiatric care in Ontario, and compares them to patients without ID in the same setting. Results reveal that significant discrepancy exists between the identified needs and services offered to patients with ID, with most interventions focused on behaviour management, including use of psychotropic medication, seclusion rooms, and confinement to unit.