The developed countries of the Australasian region have legislative and healthcare systems similar to the UK, consistent with their relatively recent colonial history. Australia and Aotearoa New Zealand both demonstrate varying approaches to provision of healthcare, disability support services and legislative frameworks for people with neurodevelopmental disabilities who commit offences. Particular areas of need are described, including the impact of the lack of capacity in neurodevelopmental disability healthcare and also the additional skills and understanding required to develop cultural competence to better support and work with the Indigenous people of both countries facing additional disadvantage. The challenges of service delivery across vast geographic areas of low population density are also discussed. Common features of both countries are discussed initially, then unique aspects in Australia andAotearoa New Zealand. Significant improvements have been made in recent years, but both countries still suffer from a lack of capacity in the workforce and sufficient funding to deliver high-quality services to people with neurodevelopmental disabilities who commit offences.