Generation Z and millennials are tech-savvy and they learn more from videos compared to books. On average young people from the digital age spend more than five hours on digital gadgets. Innovative use of social media technology will improve the access to health information amongst this group of users. This article aims to share the project of using short video clips in social media, combined with poetry to improve mental and physical health literacy.

Short video clips (ranging from one to three minutes) were produced out of passion by the first author using the elements of poetry, rhyming, humour, artistic expressions, simulated play of clinical scenarios and news reporting style which depends on the creativity and suitability of the content. The production process includes initial conceptualisation, script drafting and editing, video-recording using a smartphone, and subsequent editing using phone and Canva software. Subtitles and captions were added to increase accessibility. The videos were uploaded in Instagram, Twitter, and TikTok under the name of “dr_lokai”. There is no external funding involved. The cost involved included subscription of editing software and the purchase of recording equipment.

The project was first conceptualised in 2014. Total videos produced so far is 70. The topics of mental health included both normal psychological topics (mental health, self-reflective practice, self-motivation, self-compassions, and self-actualisation) and disorder-related topics (delirium, generalised anxiety disorder, emotionally-unstable personality disorder, attention-deficit hyperactivity disorder); while the physical health topics included cardiology, dermatology, infectious diseases, etc.). There were also videos on stigma, interesting contemporary topics around public health and healthcare education. One of the videos was a collaborative work with The Royal College of Physicians, elaborating on the personal and non-clinical facet of journey in medical school. As of the day of submission, the number of followers was 1710. Qualitative feedback from the audiences was generally positive. There were frequent requests from audiences for videos on specific medical topics.

A creative generation requires a creative approach in outreach. The strength of this initiative is the low-cost production nature and it is freely accessible by anyone with internet access. In the future, more videos which involve debunking medical myths and history of medicine can be added. The main challenge is finding time to write the script, rehearse and record. Although the effectiveness and efficiency of this innovative initiative requires a systematic evaluation, passions in sharing medical knowledge using social media have kept this initiative alive.

Functional cognitive disorders (FCDs) refer to conditions where patients present with persistent problematic subjective memory complaints that are not consistent with their observed level of cognitive functioning. The demonstrated symptoms are also not in keeping with a recognized psychiatric or neurodegenerative process. FCD is likely to be underdiagnosed in clinical practice with the place-holder label of mild cognitive impairment being used in some cases due to lack of clarity about its symptomatology. In this paper, we describe two cases whose presentations were suggestive of FCDs.

Mrs X, 53 years old female not previously known to mental health services referred for increasing difficulties with her memory over 2 years which she believed was impacting her activities of daily living. She has a history of ischaemic heart disease, fibromyalgia, Insulin-dependent diabetes mellitus, depression, and polycystic ovarian syndrome. On assessment MOCA = 15/30, and MMSE = 25/30.

Mr Y, 57 years old male not known to mental health services. Although, has been treated for anxiety and depression by GP. He presented with a 3-year history of struggling with his memory. He reported being forgetful of appointments and he has to paste sticky papers on the fridge for reminders. Similarly, he has a diagnosis of Fibromyalgia and essential hypertension. On Assessment MOCA – 19/30 and MMSE – 25/30.

FCDs can be quite challenging because the clinical picture overlaps with other neurodegenerative conditions. Typically, patients report issues around memory function in the absence of relevant neuropathology and with evidence of inconsistency between symptoms reported and observations at assessment. Regarding our cases, the primary presenting issues were increasing difficulties with memory, and forgetfulness. Other noteworthy observations were a mismatch between their scores in the MOCA, MMSE, their level of functioning, and reported memory problems. Neurological examinations and neuroimaging were not suggestive of any neurodegenerative disorders. A differential diagnosis of functional cognitive disorder was considered due to the discrepancies between symptoms reported, the level of their functioning, observations at assessments as well as absence of relevant neuropathology on imaging.

FCD is a condition that is common in clinical practice but underdiagnosed. Hence, it is imperative that clinicians keep this diagnosis in mind when patients present with memory difficulties that do not meet the diagnostic criteria for dementia and is not due to a recognized medical or psychiatric condition. Correctly identifying and diagnosing FCD can positively impact patient outcomes.

To examine the relationship between depression, anxiety and wellbeing in doctors.

The relationship between doctor wellbeing and mental health diagnoses is not well evidenced in the literature. There is a lack of comparable measurement of wellbeing in doctors within the National Health Service, meaning the effectiveness of wellbeing interventions is unknown.

A cross-sectional survey containing the PHQ9, GAD7 and WEMWBS questionnaires to measure depression, anxiety and wellbeing respectively, was advertised online nationally. The relationships between the total scores were explored using Spearman's rho correlation coefficients and Chi square tests. Thematic analysis of semi-structured interviews offered further insights.

Sixty-seven doctors returned completed questionnaires. 29.9% had PHQ9 scores >5 and 41.8% had GAD7 scores >5. Therefore, over a quarter of the participants had a score that would suggest a management plan was needed for depression, and a third for anxiety. Moderate negative correlation between the total WEMWBS scores and the total PHQ , rs= –0.775, p = 0.00, N = 67 and GAD7 scores rs= –0.724, , p = 0.00, N = 67 was seen. Statistically significant differences between those with low wellbeing scores (WEMWBS < 40) and normal wellbeing scores (WEMWBS ≥ 40) in relation to the need for a management plan for depression (PHQ9 > 10) X2 (1, N = 67) = 12.395, p = 0.00 and anxiety (GAD7>10) X2 (1, N = 67) = 5.611, p = 0.018 were seen. The main themes identified from the interviews (n = 10) were the importance of social support outside of work, cynicism about an NHS plan check-in and a tendancy to neglect wellbeing until it has dipped.

There is a moderate negative correlation between anxiety, depression and wellbeing, but they are not opposites and separate measures for wellbeing should be used. It is clinically useful to note that only those with a WEMWBS score of <45 had a PHQ9 score suggesting the need for treatment of depression.

To highlight the importance of appropriate diagnosis and management of severe mental illness in children. Awareness of rare diagnoses such as this will reduce the delay to treatment. A challenge in Ireland is accessing psychiatric inpatient treatment for very young children, with specialist units in Ireland designed to better cater for young people aged 12+.

Michael (not his real name), age 10, was always described as a happy, calm child. He enjoyed school and loved playing outdoors. He had been progressing well with his life and neither his parents nor school had any concerns for him. Following the COVID-19 pandemic and school closures, Michael began to became more conscious of daily hygiene safety advice. However, things escalated to a very difficult level. Initially, he manifested extreme levels of anxiety with heightened levels of distress. He ran away from open doors or windows for fear he would catch the virus, insisted on changing his clothes several times per day, would become distressed if anyone touched him accidentally while he was outside and could spend hours afterwards crying and screaming.

In June 2020 he showed profound refusal to engage in basic care tasks and a dramatic social withdrawal, and ultimately required admission to hospital. He refused to eat and drink, stopped washing and toileting himself, lay in bed with the covers over this head, became non-verbal and refused to engage with any conversation or games. He showed prolonged periods of screaming. Ultimately this reached a level requiring TPN and PEG feeding and a low stimulation environment. Diagnosis of pervasive refusal disorder, secondary to severe COVID-19 related anxiety was made.

Pervasive refusal disorder is a rare and potentially life threatening condition in children. It is described as a profound psychological response to uncontrollable events such as grief, abuse, parental conflict and migration. In this case, it was the threat of the global pandemic. Through treatment in low stimulation environments, with consistent communication and rehabilitation and medication, followed by individual and family therapies when patients are more able, patients show a slow, but generally complete recovery. Happily for Michael, he has now recovered and returned home to his family, where he has returned to all his previous activities.

Michael and his parents have kindly agreed to allow us to tell his story, in the hope of teaching current and future psychiatrists about this rare condition. We send them our thanks and appreciation.

Although patient and carer involvement in research is well-developed in many countries, this area has been largely overlooked in South-East European countries.

To explore experiences of patients participating in newly set up lived experience advisory panels (LEAPs) within a European Commission funded, large-scale, multi-country mental health research project that focused on improving treatment of individuals with psychosis.

Twenty-one mental health patients were individually interviewed across five countries: Bosnia and Herzegovina, Kosovo, Montenegro, North Macedonia and Serbia. Topic guides covered the experience of participating in LEAPs and their sustainability. Data were analysed by framework analysis.

Seven themes were identified about participating in LEAPs: predominantly positive evaluation, high levels of participant motivation, therapeutic benefits for participants, few challenges, various future perspectives, positive appraisal of the research project and mixed reflections on mental healthcare. Overall, patients’ experiences were positive and enabled them to feel empowered. Patients expressed interest in remaining involved in advisory panels. Additionally, they felt that they could potentially contribute to the work of non-government organisations.

This study is among the few studies exploring patient participation in research projects, and the first such study conducted in South-East European countries. Patients are highly motivated for this engagement, which has the potential to empower them to take on new social roles. Significant efforts at the national level are needed in each country, to make patient involvement in research standard practice.

This poster describes Child Parent Psychotherapy (CPP) in the treatment of severe trauma in a 4-year-old child with co-occurring Autism Spectrum Disorder (ASD).

The London Infant and Family Team (LIFT) implements the New Orleans Intervention Model. It targets the mental health needs of under 5 year olds, providing evidence based assessments and interventions for infants, their parents and foster carers within the framework of the Family Court in England. The majority of children seen by LIFT have suffered severe trauma. LIFT delivers a range of interventions including CPP - a relational treatment for young children who have experienced trauma.

CPP seeks to intervene in a number of ways: provides developmental guidance, demonstrates that the child's behaviour has meaning and can be linked to past traumas, enables the child to have space to play and talk about what has happened, helps to name and contain emotions - supporting emotional regulation, and helps the dyad to understand each other. The dyadic relationship is key to the intervention - helping to establish safety for the child and strengthen the caregiver-child relationship, enabling the child to make sense of past experiences and learn new ways to express feelings. Exploration of trauma takes place through a combination of play and interpretations made by the clinician, who supports and holds in mind the experiences and history of both child and carer. There is evidence that CPP helps young traumatised children to become less anxious, more secure in their attachment relationships and more able to cue their needs. There is less evidence of the efficacy of CPP in the context of young children with a co-occurring diagnosis of ASD.

The poster describes the assessment of a 4-year-old child of normal intelligence with a two year history of severe neglect, and physical and emotional abuse, who presented significant behavioural and emotional disturbance. Tools used to assess the child's behaviour, trauma symptoms and ASD are outlined. The process of CPP with the child and foster carer dyad is described. Outcome measures and symptom resolution are reported.

Co-occurrence of ASD did not prevent this child accessing trauma therapy. He engaged in symbolic play, made use of CPP interpretations, and achieved significant improvement in his symptoms. The differential diagnoses of trauma symptoms and ASD presenting in young children are discussed, alongside the importance of understanding and treating trauma in this context.

Although most people do not develop mental health disorders after exposure to traumatic events, they may experience subtle changes in cognitive functioning. We previously reported that 2–3 years after the Canterbury earthquake sequence, a group of trauma-exposed people, who identified as resilient, performed less well on tests of spatial memory, had increased accuracy identifying facial emotions and misclassified neutral facial expressions to threat-related emotions, compared with non-exposed controls.

The current study aimed to examine the long-term cognitive effects of exposure to the earthquakes in this resilient group, compared with a matched non-exposed control group.

At 8–9 years after the Canterbury earthquake sequence, 57 earthquake-exposed resilient (69% female, mean age 56.8 years) and 60 non-exposed individuals (63% female, mean age 55.7 years) completed a cognitive testing battery that assessed verbal and visuospatial learning and memory, executive functioning, psychomotor speed, sustained attention and social cognition.

With the exception of a measure of working memory (Digit Span Forward), no significant differences were found in performance between the earthquake-exposed resilient and non-exposed groups on the cognitive tasks. Examination of changes in cognitive functioning over time in a subset (55%) of the original earthquake-exposed resilient group found improvement in visuospatial performance and slowing of reaction times to negative emotions.

These findings offer preliminary evidence to suggest that changes in cognitive functioning and emotion processing in earthquake-exposed resilient people may be state-dependent and related to exposure to continued threat in the environment, which improves when the threat resolves.

Prompt follow-up at emergency department discharge is a key indicator of healthcare quality and patient recovery. To improve services, better knowledge of predictors for out-patient physician follow-up within 30 days after discharge is needed.

We investigated clinical and sociodemographic characteristics and service use to predict patients with mental disorders with or without physician follow-up after emergency department use.

This study used data extracted from clinical administrative databases for 9514 patients who attended an emergency department in Quebec (Canada) in 2014–2015 (index visit) for mental health reasons. Patient clinical and sociodemographic characteristics from 2012–2013 to 2014–2015, and service use 12 months before the index visit, were investigated as predictors for patients with or without prompt follow-up, using hierarchical logistic regression.

Two-thirds of patients did not receive prompt physician follow-up. Patients with level 1–2 illness acuity at emergency department triage (needing immediate or urgent care); those with adjustment or bipolar disorders, but without alcohol-related disorders (clinical characteristics); and patients with higher continuity of physician care, more psychosocial interventions in community healthcare centres and prior hospital admission (service use characteristics) were more likely to receive prompt out-patient follow-up.

Access to medical care was poor, considering the high needs of this population. The role of the emergency department as a gateway for accessing out-patient care may be strengthened by strategies like screening, brief intervention including motivational treatments, brief case management offered by emergency department staff, timely referral to services and better post-discharge planning. Collaborative care for patients attending emergency departments should also be improved.

Cognitive therapy and behavioural activation are both widely applied and effective psychotherapies for depression, but it is unclear which works best for whom. Individual participant data (IPD) meta-analysis allows for examining moderators at the participant level and can provide more precise effect estimates than conventional meta-analysis, which is based on study-level data.

This article describes the protocol for a systematic review and IPD meta-analysis that aims to compare the efficacy of cognitive therapy and behavioural activation for adults with depression, and to explore moderators of treatment effect. (PROSPERO: CRD42022341602)

Systematic literature searches will be conducted in PubMed, PsycINFO, EMBASE and the Cochrane Library, to identify randomised clinical trials comparing cognitive therapy and behavioural activation for adult acute-phase depression. Investigators of these trials will be invited to share their participant-level data. One-stage IPD meta-analyses will be conducted with mixed-effects models to assess treatment effects and to examine various available demographic, clinical and psychological participant characteristics as potential moderators. The primary outcome measure will be depressive symptom level at treatment completion. Secondary outcomes will include post-treatment anxiety, interpersonal functioning and quality of life, as well as follow-up outcomes.

To the best of our knowledge, this will be the first IPD meta-analysis concerning cognitive therapy versus behavioural activation for adult depression. This study has the potential to enhance our knowledge of depression treatment by using state-of-the-art statistical techniques to compare the efficacy of two widely used psychotherapies, and by shedding more light on which of these treatments might work best for whom.

The Advancing Mental Health Equality Collaborative is an innovative 3-year quality improvement programme led by the Royal College of Psychiatrists’ National Collaborating Centre for Mental Health (NCCMH). The collaborative was launched in July 2021 and involves 18 organisations across the UK who, with quality improvement support from the NCCMH, are working to understand the needs of their population and identify communities at risk of experiencing inequality to improve access, experience and outcomes of mental health care, support, and treatment for those populations.

An overarching driver diagram for the Collaborative was developed in collaboration with a wide range of stakeholders through steering group meetings, design workshops and remote consultation. This overarching driver diagram informs the development of population-specific driver diagrams, based on the population segments organisations selected to focus on. Each organisation was allocated an experienced quality improvement coach who supports them to apply a quality improvement approach to plan and deliver their projects, including support to generate insights based on data, staff and community engagement, carry out assets mapping, develop the project's aim and key drivers organisations need to work towards, identify measures, generate change ideas to be tested, and sustain successful changes.

Members of organisations taking part also attend quarterly learning sets where they come together to network, share challenges and ideas, and learn from each other.

Populations identified by organisations include children and young people; Black, Asian and Ethnic minority men aged 18+ years; carer population; neurodivergent individuals with comorbid mental health diagnoses; Muslim women/Black women; refugees and forced migrants; women military veterans in Greater Manchester and Lancashire; Bangladeshi and Pakistani men and women in Oldham; Traveller community in Somerset. A number of initiatives are being tested by teams to improve access, experience and outcomes of mental health care, support, and treatment for these populations, such as offering mental health awareness sessions for refugees in a range of languages.

Addressing inequality in mental health care is a long and complex process. The AMHE collaborative is supporting teams to take an innovative approach to tackle this issue, by ensuring their projects are fully co-produced with those affected by inequality. This includes engaging representatives from the communities they are trying to improve access, experience and outcomes for in all aspects of their quality improvement projects; from design to generating ideas to test, and ensuring they measure what is important to these communities to determine whether improvements have been made.

To describe the main characteristics of adolescent and adult patients with Borderline Personality Disorder (BPD) treated in Emergency and Hospitalization services of Villa El Salvador Emergency Hospital during the first wave of the COVID-19 pandemic in Lima, Peru.

An analysis of 17 cases of patients with BPD according to DSM 5 criteria was carried out in SISGALEN PLUS software database that have been evaluated in the Emergency and Hospitalization areas during the first wave of the COVID-19 pandemic. Sociodemographic, clinical and personal variables were taken into account. A descriptive analysis of frequencies and proportions was carried out in SPSS 24.0 software.

Regarding sociodemographic variables, the average age was 27.47 (SD = 11.242), 82.4% single, 88.2% female, 52.9% from Villa El Salvador, 82.4% catholics, 76.5% have completed secondary school and 47.1% were housewives. For clinical variables, 64.7% located in the Emergency Service, 58.8% had no current diagnosis of COVID-19, 64.7% without medical comorbidity, 35.3% without psychiatric comorbidity, 52.9% with suicide attempt as the main reason for consultation, 52.9% without regular use of medications, 88.2% with psychopharmacological treatment; 70.6% received a psychiatric interview intervention; Regarding symptoms, all presented interpersonal problems, impulsivity, emotional instability and inappropriate anger, while 58.8% had alteration of identity and 94.1% had suicidality. For personal variables, 82.4% had no family history, 88.2% had no history of abuse or trauma, 52.9% had a history of substance use, and 88.2% had no previous hospitalizations.

The most of patients with BPD were young adults, women, single, from Villa El Salvador, catholics, completed secondary school, housewives, from Emergency, no diagnosis of COVID-19, without medical or psychiatric comorbidity, consulted for suicide attempt, without habitual use of medications, with indicated psychopharmacological treatment, a psychiatric interview was conducted, they had active symptoms, history of substance use and no family history, abuse or hospitalizations.

This study explores the different attitudes among fourth year medical students in Queen's University Belfast to Electroconvulsive Therapy (ECT) and investigates whether these are influenced by teaching and exposure to ECT during their undergraduate psychiatry placement. In particular we sought to determine firstly, correlates of baseline attitudes to ECT and secondly, whether specific forms of ECT teaching improved attitudes to ECT during their placement.

This study was conducted in Queen's University Belfast and agreed with their ethics committee. Participants completed a questionnaire at the beginning of their psychiatry placement and another questionnaire in the second half of their placement. The first questionnaire captured background information and baseline attitudes. The second questionnaire recorded the educational and clinical experience gained on ECT during placement (for example lectures, tutorials, informal teaching, observing ECT and interacting with ECT patients), in addition to attitudes to ECT at this timepoint. Attitudes to ECT were assessed on a 5-point Likert scale. A positive attitude to ECT was defined as scoring agree/strongly agree on a 5-point Likert scale to the statement “I would recommend ECT for a patient if clinically indicated”.

187 students were interviewed at both time points. At the outset of the psychiatry placement 66% of students reported a positive attitude to ECT. Positive attitude was associated with age: 72% of students under 24 had a positive attitude to ECT vs 58% of students over 24 (χ2 = 3.5; P < 0.05). Of students who had previously attended a lecture on ECT (n = 117) 83% had a positive attitude to ECT vs 42% of those who had not previously attended a lecture (χ2 = 33.5; P < 0.001).

Attitudes to ECT significantly improved during the placement (66% vs 94% positive; t = 7.97; P < 0.001). Students who attended a lecture on ECT during the psychiatry placement were more likely to have a positive shift in attitude (67% vs 49%; F = 6.0; P = 0.01). No other specific teaching modality was associated with a positive shift in attitude.

We conclude that undertaking a Psychiatry placement and particularly having a lecture on ECT significantly improves attitudes of medical students to ECT. It is therefore important that lectures on ECT are included in the medical undergraduate curriculum to allow students to be accurately informed about this essential treatment for a number of psychiatric disorders.

• • High Dose Antipsychotic Treatment defined as 100% of the maximum recommended dose in British National Formulary, either as single agent or in combination.

• • HDAT and poly-pharmacy may be linked to heightened mortality for psychiatric patients. The Committee on Safety of Medicines, Medicines and Healthcare Products Regulatory Agency recommended ECGs, electrolyte monitoring after each dose escalation, and 6 monthly intervals.

• • The Royal College of Psychiatrists in 2006 suggested some justifiable cases of temporary poly-pharmacy with careful monitoring.

• • This audit has been done in past to improve standards, especially in High Secure Setting where prescribing HDAT is a common practice

• • To audit adherence to “HDAT monitoring guidelines” including regular monitoring of bloods, physical observations and ECG , done after every dose escalation plus at every 6 months.

• • To monitor compliance with consent to treatment documentation including reasons of being on HDAT, documentation of physical health monitoring results

• • All patients prescribed high dose antipsychotic (regular and as required) were identified by treating Consultants and also going through drug cards.

• • One year retrospective review of haematological, ECG and physical observations were identified through Electronic notes

• • 6 % of patients received HDAT within Rampton Hospital in 2018(12 males’ vs 6 females).

• • All patients on Regular HDAT had yearly TFT done whereas only 71% had prolactin monitoring done.

• • Approximately 50-60% of patients had quarterly blood monitoring including glucose, electrolytes, lipids, liver function test and full blood count.

• • About 40% of patients had quarterly ECG monitoring recorded.

• • 100% patients on regular HDAT had quarterly physical observation monitoring compared to 81% patients on HDAT (including PRN).

• • Consent forms were completed for all patients on HDAT. 85% patients on regular HDAT has the reasons for treatment documented in the notes compared to 100% patients on HDAT (including PRN).

• • Improvement in monitoring of blood parameters and cardiac function (ECG) 40-60% as compared to 2014 audit (8% to 23%).

• • Yearly monitoring of TFTs and Prolactin also appeared better (100% and 71%) which was (88% and 72% in 2014).

• • Quarterly physical observations were recorded in 77% patients on regular HDAT in 2014 which improved to 100% in 2018.

• • There was slight difference for those who were on PRN (77% to 81%). All prescribers informed about results and reminded of recommended guidelines

• • Reaudit in 2021-22 to measure change in clinical practice in prescribing HDAT.

Our aim was to develop an easily accessible, relevant and deliverable resource to meet the training requirements of the new foundation curriculum for Foundation Trainees in the West Midlands. The virtual resource needed to provide information at the correct knowledge depth, whilst also being flexible enough to allow trainees to access the materials despite the challenges of remote working. The West Midlands currently holds approximately 1,300 places for foundation training with an increase in numbers planned for 2023 and 2024.

The United Kingdom Foundation Programme (FP) is a two-year structured, supervised training programme of learning in the workplace developed to prepare medical graduates for speciality training. The Foundation Curriculum is currently being updated in line with the GMC Standards for Post Graduate Curricula to reflect the developing and contemporaneous training needs of doctors and is expected to go live in August 2021.

Though the foundation curriculum is broad and does not usually include specific diseases, it is recognised that mental health disorders are common and are frequently missed. The new curriculum makes a specific statement regarding the importance of mental health and specifies a syllabus covering this important area of medical practice

Around 80% of doctors are expected to have exposure to a community medicine placement, with around 40% expected to have placement within a specific mental health setting. Though other community placements may provide some exposure to the acute challenges of mental health, this is not guaranteed.

To assist in meeting the FP requirement for training in mental health we developed an online resource for all West Midlands trainees, with lectures and information available that covers all of the core curriculum requirements for the FP. These resources can be accessed at any time of the day, at any point of foundation training, with each module certificated to show evidence of the attainment of foundation competencies ready for students ARCP (Annual Review of Competency Progression).

A programme of evaluation and effectiveness will be undertaken when the new curriculum goes live.

There is an expected expansion in the number of training Foundation doctors within the next 5 years; therefore the demand for this training is expected to increase over time. As the understanding and awareness of the interaction between physical health and mental health continues to develop, we expected the use of this resource grow into the future.

To establish Safety Huddles (SH) on an acute general adult psychiatric ward, exploring links to restrictive practice. Additionally, to obtain multidisciplinary staff feedback on SH's impact on their workload/wellbeing and on patient care, and to identify barriers in implementation.

Background: A SH is a multidisciplinary daily briefing focused on patients most at risk, held at a fixed time and place, lasting max 5-10 minutes. Effective SH involve agreed actions, are informed by multidisciplinary staff feedback of data and provide the opportunity to appreciate and celebrate success in reducing harm. SH are a valuable team building activity, promoting situational awareness and helping with prioritising daily tasks.

SH were introduced on September 2020. Templates were developed to prompt staff how to facilitate. Staff were encouraged to identify key goals and reflect on issues in the last and next 24 hours. Each participant was allocated a role, e.g. record keeping or dissemination of information. In December 2020, records of incidence of restrictive practice (numbers of restraints, seclusions and rapid tranquilisations) were obtained for the periods June-August 2020 and September-November 2020. Additionally, staff feedback was obtained through a short anonymous Survey Monkey questionnaire. It explored whether SH had an effect on patient care and staff's workload/wellbeing, and possible barriers to implementation.

Comparing the two 3-month periods before and after SH implementation, restraint episodes were reduced from 47 to 21, seclusion episodes from 19 to 2, and rapid tranquilisation episodes from 10 to 3. Nine staff members responded to the feedback questionnaire. All believed SH had a positive impact on patient care, or had the potential to do so. Staff reported SH gave them insight into incidents, made them feel safer and prepared for the day, played a part in reducing restrictive practice, and empowered staff from all professional backgrounds by giving them a voice. Low or late participation, cancellation of SH because of clinical activity, and vague questions in the meeting template were identified as barriers in implementation.

Acute psychiatric wards regularly face challenges of high clinical activity, low staffing levels, bed pressures, and high-risk patient cohorts. SH contributed to reducing restrictive practice and creating a safer and more positive work environment. It is important to ensure SH are taking place daily, using an appropriate template to guide staff who may be new to facilitating. Accordingly, the impact on restrictive practice, patient care and staff wellbeing can be sustained long-term.

Despite policy pressure and concerns regarding the use of antipsychotics and benzodiazepines, many care home residents with dementia are prescribed psychotropic medication, often off licence. This is the first large study to report psychotropic prescribing and ‘as required’ administration patterns in English care homes.

To explore the prevalence and associates of psychotropic prescription in care home residents with dementia and compare the results with national guidance.

We collected data in a longitudinal cohort study of residents with diagnosed or probable dementia in 86 care homes in England in 2014–2016. We reported the prevalence of psychotropic (antipsychotics, anxiolytics/hypnotics, antidepressants) prescriptions and drug receipt. We explored the associations between resident factors (sociodemographic, agitation [Cohen–Mansfield Agitation Inventory], dementia severity [Clinical Dementia Rating]) and care home factors (type, ownership, size, dementia registration/specialism, quality rating) in prescription and ‘as required’ administration, using multilevel regression models.

We analysed data from 1425 residents. At baseline, 822 residents (57.7%, 95% CI: 55.1–60.2) were prescribed a psychotropic drug, 310 residents (21.8% 95% CI: 19.7–24.0) were prescribed an anxiolytic/hypnotic, 232 (94.3%, 95% CI: 90.6–96.6) were prescribed one antipsychotic and 14 (5.7%, 95% CI: 3.4–9.4) were prescribed two antipsychotics. The median prescription duration during the study was 1 year. Residents with clinically significant agitation were prescribed more antipsychotics (odds ratio [OR] = 2.00, 95% CI: 1.64–2.45) and anxiolytics/hypnotics (OR = 2.81, 95% CI: 2.31–3.40).

Antipsychotics and anxiolytics/hypnotics are more commonly prescribed for people with dementia in care homes than in the community, and prescribing may not reflect guidelines. Policies which advocate reduced use of psychotropics should better support psychosocial interventions.

Frequent readmissions present a challenge to both community and inpatient mental health services and are frequently used as a quality indicator. Service users who are readmitted also tend to have a poorer prognosis and can be characterised as ‘revolving door’ patients. Determining modifiable factors that affect rates of readmission may allow mental health services to target interventions such as to improve outcomes and service users’ experiences

The caseload of an inner-city NHS community rehabilitation team was examined for psychiatric admissions over the period from January 2022 to January 2023. This was divided into an admission group and a readmission group. Readmission was defined as service users who were admitted within ninety days of the index admission. A variety of factors related to the index admission and subsequent discharge were examined and compared between the two groups to identify factors associated with readmission.

The community rehabilitation team caseload comprised of 122 care-coordinated service users. The readmission rate to an inpatient psychiatric ward between 1st January 2022 and 1st January 2023 was 37.5%. Factors that appeared to be protective against readmission were positive engagement with therapies during the index admission, such as dual diagnosis team, psychology, and occupational therapy. Additionally, service users who were discharged on a Community Treatment Order had significantly reduced rates of readmission. A shorter index admission was also associated with reduced rates of readmission. Involvement of the Home Treatment Team and medication changes in the week prior to discharge were not associated with reduced rates of readmission

The results of this study suggest that the provision of therapies by allied healthcare professionals should be prioritised in inpatient settings. Service users should be strongly encouraged to engage, and poor engagement may be considered an indication that the service user is not yet ready for discharge. Community Treatment Orders, where appropriate, should be considered to be protective against readmission. Longer inpatient stays may be associated with readmission since these service users are more likely to be severely unwell. Nevertheless, service users who require longer admissions are at high risk for readmission and interventions should be considered to mitigate this risk.