People with an intellectual disability (ID) are more likely to experience mental health difficulties than others. The United Nations (UN) Convention on the Rights of Persons with Disabilities (CRPD) states that health services should be provided close to people's own communities. This article examines differences in access to psychiatry services for those with an ID according to geography, in the context of a small European country (Republic of Ireland). The sample consisted of 753 individuals aged 40 and over with ID in the Republic of Ireland, with data collected from the Intellectual Disability Supplement of the Irish Longitudinal Study on Aging (IDS‐TILDA). The primary outcome of interest was attendance with any psychiatrist and the primary independent variables were area of residence (health service region and degree of county urbanicity). Logistic regression was used to analyze associations, unadjusted and then controlling for age group, gender and level of ID. Secondary analysis examined factors associated with anti‐psychotic prescription without psychiatrist supervision. Treatment by a psychiatrist was associated with both health region (p = 0.029) and degree of urbanicity (p = 0.015) before controlling for group differences but only the health region was significantly associated after controlling for age, gender and level of ID. Antipsychotic use without a psychiatrist was associated with degree of urbanicity (p = 0.036) but not with health service region (p = 0.989). Geographic factors are associated with access to mental health services among those with ID in the Republic of Ireland. This may be partly due to movement of people with ID away from their area of origin, highlighting the need for locally tailored specialist ID mental health teams and for further research into barriers to treatment. Additional work in other countries will further understanding of similar roles of geographic factors in mediating mental health services access.