Personality disorders (PDs) involve persistent deviations from societal norms causing distress, particularly in older UK adults. ICD–11 distinguishes general personality dysfunction from traits. Despite a low reported prevalence among the elderly, underdiagnosis and undertreatment are concerns, suggesting higher actual prevalence. PD presentations in older adults differ, with increasing prevalence noted. Existing research lacks large-scale, population-based studies, longitudinal perspectives, and diagnostic tools sensitive to age-related changes. Overlapping symptoms and delayed diagnosis challenge accurate assessment, while misdiagnosis can lead to repeat hospitalisations.

A UK mental health organisation observed such issues, prompting a diagnostic pathway review and a service evaluation study to identify healthcare professionals' challenges in diagnosing personality disorders in older adults.

An online survey, conducted from January to March 2023, targeted healthcare professionals in the Trust. It gathered demographic data and focused on professionals' knowledge, and confidence in diagnosing personality disorders, along with limitations and suggestions for improvement. Responses were qualitative, involving community mental health team managers, doctors, healthcare assistants, mental health nurses, occupational therapists, and psychologists. Results, collected in March 2023, aimed to provide detailed insights into professionals' experiences with PDs when treating older adults.

Among 35 surveyed professionals (15 Consultant Psychiatrists, 2 community team managers, 6 nurses, 1 occupational therapist, 2 psychologists, and 9 junior doctors), 75% routinely conducted personality disorder assessments. They lacked specific diagnostic tools, relying on history and ICD–10/DSM–5 criteria. Confidence levels varied, with only 1 reporting high confidence and 37% not confident at all, citing a need for training and structured tools. Challenges in diagnosing older adults were acknowledged by 34 responders, attributing difficulties to comorbidities and ageing. All emphasised the importance of accurate diagnosis for tailored therapy, care, service workload, and healthcare financial implications.

Underdiagnosis and undertreatment of personality disorders in older adults impact their quality of life, posing challenges to healthcare services with financial implications. This local survey and service evaluation study revealed healthcare professionals' lower confidence in diagnosing PDs in older adults, attributed to the complexity of presentation and lack of diagnostic tools. Professionals may underestimate PD prevalence, emphasizing the need for improved education and training. The review calls for validated diagnostic tools tailored to older adults and suggests a need for larger-scale, mixed-methods research to explore factors affecting diagnosis accuracy. It underscores gaps in knowledge and emphasises the importance of understanding and addressing PDs in this population through research, education of professionals, and improved screening.

Dysregulated behaviours are prevalent amongst young people worldwide. Emotional dysregulation plays a key role in these behaviours. Several psychiatric disorders have significant elements of emotional dysregulation, making it a potentially effective transdiagnostic therapeutic target. Dialectical behaviour therapy (DBT), mentalisation-based therapy (MBT), and schema therapy (ST) can effectively manage emotional dysregulation, however access may be limited in clinical practice.

We aimed to explore whether young people with emotional dysregulation engaging in dysregulated behaviours receive support for emotion regulation. We hypothesised that those with emotionally unstable personality disorder (EUPD) will have a higher prevalence of self-harm, disordered eating, and/or substance misuse and more referrals for DBT, MBT, or ST than those with bipolar disorder, autism, attention deficit/hyperactivity disorder (ADHD), schizophrenia, or schizoaffective disorder.

De-identified clinical records from the West London NHS Trust on 2,413 16- to 25-year-olds with an ICD–10 diagnosis of EUPD, bipolar disorder, autism, ADHD, schizophrenia, and/or schizoaffective disorder were obtained through Akrivia. Chi-squared tests were performed.

Young people with bipolar disorder had the highest prevalence of self-harm, disordered eating, and substance misuse (88.35%, n = 182), χ2 (4, N = 3138) = 39.14, p < 0.001, but the lowest number of references to DBT, MBT, or ST. Those with EUPD had the highest number of references to DBT, χ2 (4, N = 2585) = 886.75, p < 0.001, MBT, χ2 (4, N = 2585) = 81.63, p < 0.001, or ST, LR (4, N = 2585) = 21.03, p < 0.001.

There could be an unmet need for psychological interventions for young people with bipolar disorder. A more transdiagnostic approach to offering psychotherapies that target emotional dysregulation should be applied in clinical practice.

This service evaluation had four aims:

1. 1. Breakdown the sources of referrals to one Perinatal Specialist Mental Health Service.

2. 2. Calculate the average waiting time from referral to an initial assessment.

3. 3. Analyse the Did Not Attend (DNA) rate for initial assessments.

4. 4. Suggest possible service improvements to reduce waiting times and DNA rates.

Referrals made in the period May−July 2023 to the Cumbria, Northumberland, Tyne and Wear (CNTW) Perinatal Specialist Mental Health Service were collated. Data regarding the source of referral, demographic details of the patient, whether they were accepted for assessment and whether they did or did not attend their assessment and the outcome of the case was analysed.

Midwives and GPs made the greatest number of referrals (37% and 26% respectively). Out of 263 referrals, 47 did not meet the criteria for an initial assessment – the largest single contributor to this number being referrals from GPs. Just under 16% of referrals made by GPs were found more suited to primary care services after initial assessment compared with 11% amongst referrals from midwives.

The average waiting time from an accepted referral to assessment was 29.85 days. This is higher than the CNTW two-week wait target.

Of the 203 patients offered assessments, there were 20 occasions on which patients DNA. Those who DNA were more likely to have history of domestic abuse (55% compared with 48% amongst those who attended their assessment first-time). Of the patients who DNA their first appointment, 1/3 attended future appointments.

Text reminders about appointments proved extremely popular; where there was information available, 98% of patients were agreeable to text reminders about their appointments.

Waiting times could be reduced by implementing tighter guidelines for referrals and further educating referrers on the specific role of the perinatal service in contrast to primary psychological services, thus reducing unnecessary assessments.

Text reminders should continue to be used in addition to offering assessments at home where suitable. In several cases, patients who had forgotten about their appointment were still agreeable to assessment when met at home.

Future research could be carried out in collaboration with patients who DNA to better understand the barriers they face to attendance.

To measure the proportion of Attention Deficit Hyperactivity Disorder (ADHD) referrals that result in a positive diagnosis and medication prescription at a community mental health team (CMHT) in Cardiff.

To compare patient journeys from referral to diagnosis – documenting the use of GP mental health liaison, private psychiatrists, questionnaires and CMHT appointments.

To measure the proportion of patients with a pre-existing private diagnosis of ADHD that subsequently received a positive diagnosis by the CMHT.

230 referrals were made to Pendine CMHT in 2022 for consideration of ADHD. Patient e-records were manually reviewed over a 12-month period following initial referral.

We recorded whether a patient had a pre-existing private diagnosis and whether they were subsequently diagnosed with ADHD by the CMHT. It was also recorded if medication was prescribed or if an alternative diagnosis was suggested.

We recorded whether the patient was asked to see GP mental health liaison team, fulfil an ADHD questionnaire, or attend a doctor appointment before a diagnosis of ADHD was made or refuted.

For positive diagnoses, patient records were reviewed to record whether this diagnosis was later changed on subsequent appointments.

Of 230 referrals, 32 received a CMHT diagnosis of ADHD (14%) and 25 were prescribed medication for ADHD (11%).

Of the 25 patients who received a positive diagnosis and medication, 4 had the diagnosis changed on a subsequent appointment and medication stopped.

21 patients had a pre-existing private sector diagnosis of ADHD, of which 9 (43%) were given a positive diagnosis by CMHT and 8 (38%) were prescribed medication.

Of 230 total referrals, 33 were asked to see their GP mental health liaison team for information gathering before re-referral to the CMHT. 112 were asked to complete a questionnaire before an appointment would be considered. 87 were given a consultant psychiatrist appointment at CMHT.

When ADHD was not diagnosed, the most common alternative diagnoses suggested by the CMHT were anxiety, substance misuse or emotional dysregulation (36, 23 and 9 patients respectively).

Referrals to the CMHT for ADHD assessment result in a low rate of positive diagnosis and even lower rates of medication prescription, even for those with an existing private diagnosis.

Patient journeys vary markedly, which we propose reflects the variable quality of referrals and pressure on the CMHT to protect clinic time.

Future work to create ADHD referral guidance is needed to ensure better patient experience and proper utilisation of secondary mental health resource.

Community mental health transformation relies on the integration of NHS, local authority, and voluntary agencies to deliver mental health care and support where and when people need it. There is a concern that resources may be diverted to services focused on those with less severe problems and without robust outcome data. We plan to develop a network of self-sustaining mindfulness support groups in a disadvantaged locality with very limited community resources. We provided a pilot mindfulness programme to a group of mothers of primary school age children in East Cleveland.

Participants were recruited through poster adverts at a primary school. The programme was delivered through 12 weekly hour-long sessions at the school. The group facilitators had basic training in mindfulness. The aim was to teach basic mindfulness practices that could be used in everyday life, including breath work, meditation, and journalling. Mental health status at baseline, mid-point (week 6) and end point (week 12) was measured using the GHQ-12 (score 0–36 and a threshold for likely psychiatric disorder). Data was analysed using t test for continuous scores and χ2 test for caseness.

14 women responded to the invitation and 9 completed the programme attending a mean of 11.2 sessions. The mean age of participants was 37.4 years and 8 reported previous mental health treatment with medication or psychological therapy, with 4 currently taking medication, but none were known to secondary mental health care services. GHQ-12 scores at baseline indicated significant levels of mental health distress (mean score = 24.1, caseness = 100%). At the midpoint there was a 56.2% reduction in GHQ-12 scores, and this increased to 62.0% at the endpoint. 2 participants remained GHQ cases at both follow-up assessments. The improvement was highly significant (baseline mean score (SD) = 24.1 (2.71); final mean score (SD) = 9.11 (6.15); paired t test: t = 7.23, df = 8, P = 0.0001).

This was a novel programme where participants gained access through being parents of primary school aged children. Despite being an unselected community sample, the participants reported significant levels of psychological distress. This highlights both that most people with mental health problems have no contact with psychiatric services and that there remains a high level of unmet need in the community. In this sample, a remarkable level of improvement was demonstrated from a relatively simple and straightforward intervention. Clearly, this will benefit from replication in greater numbers in more diverse samples and settings and with follow-up to see if the benefits persist beyond the intervention phase.

The NHS Southern Gambling Service (SGS) is a service providing evidence-based assessment and treatment for people affected by Gambling Disorder (GD) across the South-East of England. This service evaluation aimed to ascertain whether SGS was offering equality of access to treatment and suitable provision of treatment to ethnic minority communities, and whether there were barriers making it difficult for people from ethnic minority communities to access and engage in treatment for gambling harms.

Quantitative ethnic origin demographic data was obtained from 120 referrals to SGS between September 2022 and October 2023. These were statistically compared with the ethnic origin demographics of the general population in the same geographical area, as identified by Office of National Statistics (ONS) Census 2021 data. Qualitative data was collected through interviews with three participants from ethnic minority populations who were engaged in treatment with the service. Relevant themes in the qualitative data were identified using thematic analysis.

Quantitative data results indicated no significant statistical differences in most ethnic origin categories between the proportion of referrals to SGS from the ethnic origin and the recorded proportion of this ethnic origin in the general population. There was a greater difference for the “other ethnic group” category (chi square p,0.05, uncorrected), which was likely due to a difference in categorisation of ethnicity between SGS and ONS in 2021 Census.

The qualitative review identified themes of value of money, stigmatisation, different cultural attitudes towards gambling, and experiences of healthcare. GPs were identified as the first step towards seeking help for gambling.

These results suggested that SGS was offering equality of access to treatment for people from ethnic minority populations and that there were not significant barriers preventing people from ethnic minority populations accessing treatment. The reported positive experiences of participants' referral to and treatment with SGS indicates that for these participants suitable provision of treatment had been offered by our service.

With the thematic analysis identifying GPs as the first step towards seeking help for their gambling, this study indicates the importance of the gambling service working closely with primary care for the equitable access to treatment from gambling harms on a regional level.

These preliminary findings are based on a limited, small sample. Further research using a larger, more diverse sample to gain a deeper knowledge would be advised to further shape the service offer to ensure equity of access.

We aim to systematically document our reflections regarding the establishment of a perinatal-focused Compassion Focused Therapy (CFT) group within an expanding service. It aims to highlight specific outcomes and client experiences resulting from group completion.

Synthesizing information from established CFT Group protocols across various National Health Service (NHS) contexts, scholarly investigations, and our CFT training, this study instituted a 10-week perinatal-CFT group intervention. Recruitment targeted individuals already engaged in our services, resulting in the referral and screening of eleven potential participants. Nine eligible individuals provided informed consent, with seven successfully completing the program. Assessments, including the Clinical Outcomes in Routine Evaluation (CORE-10), Postpartum Bonding Questionnaire (PBQ), The Forms of Self-criticizing/Attacking & Self-reassuring Scale (FSCRS), and Maternal Antenatal Attachment Scale (MAAS), were administered pre- and post-group. Quantitative findings were analysed and compared, supplemented by qualitative insights distilled from thematic analyses of feedback forms and post-group reviews with each participant.

Though we had a small number of participants (n = 4) who completed the pre and post measures and the post group review, we received overall positive feedback for the group intervention. During the post group review and from their feedback forms, participants expressed the value of the group experience and found the discussions and exploration of CFT concepts to be helpful in reflecting on their self-critical thoughts.

On the Core-10, there was a reliable and clinically significant change for 75% of participants. Two participants completed the PBQ, and both showed a reliable but not clinically significant change in scores. We had one antenatal client who showed a reliable but not clinically significant change on the MAAS.

The FSCRS comprises three scales: Inadequate Self (IS), Reassured Self (RS), and Hated Self (HS). On the IS subscale, a reliable and clinically significant change was observed for 75% of participants. The HS subscale showed a reliable change but lacked clinical significance for 50% of participants. No reliable change was observed in the RS scale for any participant.

While the study's results are not generalizable due to the small sample size, positive feedback suggests the well-received nature of online perinatal CFT groups. Despite a preliminary evidence base, this paper contributes reflections and experiences, highlighting the potential effectiveness of online CFT groups in the perinatal period. These findings underscore the need for further research and exploration in this promising therapeutic approach.

Repetitive Transcranial Magnetic Stimulation (rTMS) is a non-invasive brain stimulation recommended by NICE for treatment of depression. Our aim was to study the impact of real world rTMS treatment on service utilisation.

Data was collected for all patients who received rTMS treatment at the Centre for Neuromodulation Services (CNS) and followed up for 6 months. Sociodemographic data was collected for all patients. To understand service utilisation, data was collected to record involvement of mental health services including Community Mental Health Team, inpatient admission, Crisis and Home Treatment, Psychiatry Liaison and Talking Therapies.

Fifteen patients completed treatment in the year 2023 since inception of the service. All patients received 25 daily treatment sessions over a period of 5 weeks.

67% of the patients were female (N = 10). 93% of the patients were White-British (N = 14) with one patient with British-Indian ethnicity. The mean age of patients was 50.8 years.

One-third of the patients were involved with more than two services within the Trust in the 6 months before referral for rTMS. Historically, most patients were involved with Talking Therapies (N = 13; 86%), Crisis and Liaison Teams (N = 10; 67%) and inpatient services (N = 9; 60%). Two (13%) patients were not on any medications at the time of starting treatment. In the 6 months after completion of treatment, only 3 (20%) patients were involved with more than one service while 3 (20%) patients were discharged from services.

The referral pattern along with involvement of services revealed that complex patients requiring multiple services were referred for TMS treatment. The drop in number of services involved post completion of treatment suggests that TMS was effective in reducing service utilisation. The study sample was limited to a small group and the same would have to be repeated with a larger sample.

There are a shortage of specialist services available for Functional Neurological Disorders, especially within the paediatric population. Patients and families often find themselves falling within the borderland between medical and psychiatric services. Functional symptoms can cause significant morbidity and disruption to the lives of children and young people, impacting their access to education and social lives. Early diagnosis and explanation of FND is a mainstay of treatment, and is associated with positive outcomes. A Functional Neurological Disorder pilot MDT clinic was set up within Great Ormond Street Hospital, with the aim to provide a one-off therapeutic assessment and psychoeducation. We surveyed families who attended the clinic to assess their experiences and outcomes.

A pilot clinic was set up for patients referred within GOSH with a confirmed diagnosis of FND. The Multidisciplinary team consisted of a CAMHS psychiatrist, paediatric neurologist, physiotherapist and occupational therapist. Patients received a one-off outpatient consultation to discuss FND symptoms and background history. Clinicians provided psychoeducation for patients and families about the diagnosis and devised treatment plans including follow-up assessments, onward referral to local services and a consultation with teams where appropriate. A follow-up survey was conducted using semi-structured telephone interviews and patient satisfaction questionnaires. Questionnaires were scored using a Likert rating scale (1: very dissatisfied – 5: very satisfied). Parents were asked about their understanding of the FND diagnosis and about their experiences of support from local teams.

25 patients diagnosed with FND were referred to the clinic. Of those, 20 patients took up the consultation. Patients presented with range of functional syndromes. 15 families consented to follow-up interviews. Parents rated their experience at the FND clinic highly (median score 5 – very satisfied). They were very dissatisfied with follow up care (median score 1). Only one patient remained under CAMHS at the time of follow up. 3 families had sought support privately. Parents subjectively rated their children's symptoms at follow up as: much worse (3); a bit worse (1); the same (7); a bit better (2) and much better (2).

Patients and parents demonstrated high levels of satisfaction with the one-off therapeutic assessment. The majority of parents reported that the GOSH consultation helped them to understand the diagnosis of FND. All families felt they had received inadequate support from primary care, local CAMHS services and schools. Patients who struggled to access support from CAMHS/ school were less likely to experience any improvement in FND symptoms and had poorer levels of functioning.

Transcranial Magnetic Stimulation (TMS), characterized by its non-invasiveness and absence of recovery time, emerges as an optimal intervention for treatment-resistant depression. Operating through the induction of a time-varying electric field in the brain, TMS elicits action potentials in cortical neurons, leading to long-term neural inhibition and excitation, fostering neuroplasticity. Despite its efficacy, TMS remains available in a limited number of National Health Service (NHS) hospitals. This study aims to evaluate the use of TMS for treatment resistant depression and its impact upon service utilisation within Pennine Care NHS Foundation Trust.

A retrospective analysis was conducted on 76 patients diagnosed with treatment-resistant depression. Responders (n = 54) and non-responders (n = 22) were identified based on baseline, midpoint and endpoint assessments using HDRS, Beck's Inventory, PHQ-9, and GAD anxiety questionnaires. Patient data was extracted from PARIS, the Electronic Patient Record system of Pennine Care NHS Foundation, encompassing NHS service utilisation pre- and post-TMS treatment.

Comparison between 12 months pre and post-TMS treatment revealed noteworthy findings:

12 responders (22%) were admitted to hospital in the year prior to starting treatment with a total of 1134 and mean of 94.5 days. In comparison to post-TMS where 11 (20.4%) patients had total of 913 and mean of 83 days.

8 non-responders (36.4%) were admitted to hospital in the year prior to starting treatment with a total of 285 and mean of 36.5 days. In comparison to post-TMS where 3 (13.6%) patients had a total of 276 and mean of 92 days.

Outpatient appointments reduced by 15.4% for responders and 27.2% for non-responders.

Number of A&E admissions reduced by 79.3% for responders and 65.5% for non-responders.

Admissions to Home Treatment Team (HTT) decreased by 62.7% for responders and 86.7% for non-responders.

Post-TMS discharge from services was 25.9% for responders and 18.2% for non-responders.

This study underscores a reduction in service utilisation among treatment-resistant depression patients following TMS treatment, with some indication that a greater reduction is seen for responders to treatment. While there was limited benefit seen when analysing outpatient appointments and HTT involvement, a greater reduction was seen when evaluating A&E attendance and days spent in hospital. In addition to exploring the possibility of late response to treatment and how this affects non-responder data, future studies are needed to compare results with patients who did not have TMS. These studies will require larger study numbers to better analyse the enduring benefits of widespread TMS implementation within the NHS.

Opioid use disorder (OUD) is a global burden with significant morbidity and mortality. Standard of care often includes integrated treatment programs combining psychosocial interventions and Medication Assisted Therapy (MAT) which includes methadone, Buprenorphine (BUP) and Naltrexone. BUP, a partial u-opioid receptor agonist, has shown to increase patient treatment retention, reduce relapse, and improve quality of life. BUP Oral formulations can be associated with misuse, diversion, and non-adherence. Despite availability, many individuals don't receive adequate MAT treatment or discontinue medications prematurely, substantially increasing their relapse risk. Subcutaneous Long-Acting BUP (SC LABUP) injectable formulations have been associated with improved access, less burden of adherence, and greater abstinence in OUD patients. From this perspective, the OUD program at Erada Center maintains affected individuals on weekly or monthly SC LABUP injections. Our study aims to evaluate abstinence and treatment retention in Erada Center patients who are maintained on LABUP injections.

We conducted a retrospective cohort study of all individuals following at Erada Center from January 2023 until January 2024, who were maintained on weekly or monthly LABUP injection. 174 individuals were identified, with diagnosis of OUD as per ICD–10 criteria, and receiving LABUP injection during inpatient admission or outpatient follow up. Primary outcomes were abstinence period (defined as negative urine drugs test apart from q-BUP), and retention in treatment (defined as compliance with attendance with OUD program). These were assessed at three time intervals: 24, 36, and 48 weeks from taking the first LABUP injection.

174 individuals were maintained on LABUP injection. Participants were all males, aged 18–65 years old, and polysubstance users with opioids being their drug of choice.

70 patients completed at least 24 weeks and received at least 2 doses of LABUP. Out of those, 53 achieved full abstinence and retention in 24 weeks (75.71%), 32 patients achieved the same for 36 weeks (45.71%), 25 patients achieved the same through 48 weeks (35.71%). Reasons for being lost to follow-up included relapse, incarceration (military service or custodial sentence), or drop out for no identifiable reasons.

To the best of our knowledge, this is the first study in the UAE and Arab world looking at the outcomes of individuals with OUD maintained on LABUP injection. Results highlight a notable abstinence and retention rates as above. Further studies should look at reasons for relapse and loss for follow-up.

King Edward Memorial Hospital (KEMH) is the largest tertiary women's hospital in Western Australia and a tertiary referral center for complex pregnancies, for example, adolescent pregnancies (12–19 yr olds), pregnancies with obstetric complications or fetal anomalies, statewide drug and alcohol antenatal service and preterm births. With 6000 births annually, this women's hospital does not only provide obstetric care, but also looks after gynecology, oncology and chronic pain patients. We would like to share the model of care for our women's mental health service which provides statewide Childbirth and Mental illness (CAMI) service looking after women with chronic enduring mental illness, statewide drug and alcohol antenatal service (WANDAS), adolescent model of care and our service for all other women attending this tertiary hospital within a unique consultation liaison model.

Our team comprises 3.0 full time consultant psychiatrists, 2 Psychiatry trainee registrars, 5 clinical psychologists, 2 triage nurses and administrative staff. In total, we had 1959 referrals to our service in 2022–23 financial year. These women had varying amount of input from our service during their treatment in hospital: one assessment with advice and signposting to brief therapy, up to a fully comprehensive Multidisciplinary Team (MDT) care as provided by an adult community mental health service. In addition to comprehensive assessment, MDT interventions include risk assessment, pharmacological interventions, psychological interventions, working alongside child protection services, infant mental health and attachment work.

Our most common diagnostic categories included post-traumatic stress disorder (10%), adjustment disorders (10%) followed by Generalized anxiety disorder and recurrent depressive disorder (6% each). Our key performance indicators include: number of consumers (541 in 2022–23) that received comprehensive intervention from us in last 12 mths, consumer and carers’ feedback and rate of completion of outcome scale at point of admission and discharge from service. These figures have remained consistent for the last 5 yrs.

Our hybrid model of care is unique as it incorporates a consultation liaison and a community mental health care model for women attending our hospital. This allows us to provide a safe, specialized, timely service to women in their most vulnerable period of life.

In the United Kingdom Specialist Community Forensic Teams (SCFT) are a new national development, aiming to enable and support earlier discharge from secure hospitals, and provide treatment to patients on a forensic pathway, in a community setting.

This project's ambition was to yield data to support future development of the service. The following research question was developed, as a focus for the project:

The project was accepted by Cardiff University and South West Yorkshire Foundation Trust as a service evaluation.

The project methodology considered the impact of trauma throughout, given the forensic setting and high prevalence of trauma in individuals accessing forensic services.

A questionnaire was developed, which covered several relevant themes regarding the service, including the research question, and was distributed to patients, professionals, and referrers, either using, or associated with the team.

The total number of participants recruited was n = 45. These were made up of service users (n = 17), referrers to the service (n = 10), and other professionals (n = 18).

Participants felt they understood the purpose of the SCFT, placed importance on being involved in service evaluation, and were confident their responses would influence service development.

Reasons to refer to the SCFT were the perceived helpfulness of the team, supporting transitions, risk management, teamwork, therapeutic alliance, quality, and clinical knowledge.

Results favoured multi-disciplinary team agreement as being an important factor in the timing of SCFT referral. Upon admission, or granting of unescorted leave, were also cited as appropriate times to refer to the service. Clinically appropriate timing, individual needs, and service user motivation were additional indicators for SCFT referral.

The West Yorkshire SCFT offers previously unavailable pathways from secure services into the community. The clinical model uses a trauma-informed, formulation-driven, collaborative approach to care, treatment, and risk management, which participants found favourable. Improved community pathways and connections offer a sense of improved hope, and a feeling of being helped, which is supportive of personal recovery.

There are recommendations which suggest that a community pathway agenda, embedded into services from admission, will support clinically appropriate timing of SCFT referral, and should be a decision which is made collaboratively, with patients, carers, and the multidisciplinary services around them.

We undertook a service evaluation obtaining feedback from service users in an inpatient rehabilitation setting about a weekly Boxercise class. The aim was to assess the experiences of service users, and the role it has in their recovery.

We hypothesised that the class would be well received by service users in aspects of enjoyment, impact on biopsychosocial wellbeing and recovery based on positive comments made by service users.

There is an increasing trend to utilise physical activity as an adjunct to improve mental health within healthcare settings; to increase motivation, educate on healthier lifestyles and to enhance well-being outcomes. This Boxercise programme has been developed by the Healthy Living Advisor within the rehabilitation inpatient facility at Leeds and York Partnership Trust. The programme has run for one year, and there has been a large uptake of service users who participate in the group. The Boxercise classes aim to encourage discipline, communication, spatial awareness, and cognitive skills in a modality that is interesting to service users.

Service users who are regular participants in a Boxercise programme at an inpatient rehabilitation centre completed a questionnaire. A five-point Likert scale assessed participant views across seven domains. Participants were then asked to write three words that describe their feelings about the Boxercise programme, complete a drawing showing their thoughts after a Boxercise class and provide suggestions for improvement.

Eleven participants completed the questionnaire. Average scores for the domains were as follows: enjoyability 4.45/5 (89%), physical health 4.55/5 (91%), mental health 4.27/5 (85%), recovery 4.09/5 (82%), socialising 3.91/5 (82%), safety 4.64/5 (93%), continue after discharge 3.36/5 (67%).

The ‘three words' were put in a word cloud generator with highest weighted words: ‘Fun', ‘Good', ‘Energetic', ‘Confident'.

Common themes from the pictures shown were smiling faces and ‘strongman' images.

Six participants gave feedback that more equipment (pads and gloves) would help to improve their experience in the classes.

The Boxercise programme received positive feedback from participants that aligns with the hypothesis; particularly in safety, enjoyability, benefit to physical health and benefit to mental health.

The participants had positive views on the class as an adjunct to the management of their physical and mental wellbeing. The feedback from all the participants is that they felt safe during the classes.

This service evaluation indicates that the participants value the Boxercise classes as an enjoyable activity and as an adjunct to their treatment.

The effect of menopause on mental health is increasingly well recognised. Studies assessing peri- and post-menopausal women report higher incidences of depression and anxiety. Without recognition and treatment, the negative impact on mental health during menopause can lead to long-lasting effects on quality of life. NICE and the British Menopause Society (BMS) guidelines recommend cognitive behavioural therapy (CBT) and an individualised approach, for women experiencing depression and anxiety as a result of menopause. The aim of this project was to collect data relating to the provision of mental health interventions (and how they are accessed) for women seeing menopause specialists across the UK. This data can then be used to inform and promote improvements in the delivery of care for menopause mood symptoms.

An expert panel of psychiatry, gynaecology and general practice clinicians designed an online survey which considered NICE/BMS guidance, the current evidence base and local referral/funding pathways. This was piloted on health care professionals in primary and secondary care before review by BMS Council Members. A link to the survey was distributed via email to members of the BMS on one occasion.

139 responses were received from menopause specialists across the 15 UK Deaneries. 71% worked in primary care and 29% in secondary care. 65% of clinicians offer CBT for mood symptoms but 99% reported suboptimal provision of this intervention. 43% of respondents reported over half of their patients with mood symptoms would benefit from psychological support, however 80% do not have a designated mental health wellbeing practitioner. 35% of specialists have referred complex patients to secondary mental health services. When asked what mental health resources would be most beneficial for their patients, 83% desired improved access to CBT, 65% psychological support attached to all menopause clinics, 53% guidance on managing mood symptoms in menopause and 39% an MDT clinic.

The data suggests that complex mood disorders are common in women presenting to menopause services and require non-hormonal interventions to support benefits seen with HRT. The results suggest poor provision of psychological interventions, particularly talking therapies, for women experiencing mood disorders as part of their menopause. Improved cross-specialty working and training, and improved access to CBT were identified as methods of addressing this. Locally, these results have formed the basis of a service funding bid for CBT and development of a pilot cross-speciality gynaecology/psychiatry MDT Hub.

This project evaluated the accuracy and evolution of psychiatric diagnoses in patients admitted through the Outpatient Department (OPD) and Emergency Room (ER) at Benazir Bhutto Hospital. It aimed to understand the factors contributing to diagnostic changes, especially the impact of comorbid conditions and interdisciplinary discussions.

Over an eight-month period, this study reviewed 200 patient records from the psychiatric department. It compared initial psychiatric diagnoses from OPD and ER admissions with final diagnoses at discharge. The evaluation examined the influence of ward round discussions, serial mental state examinations, and newly identified comorbid medical conditions, such as thyroid disorders and neurological issues, on diagnostic changes.

Analysis showed that 38.2% of ER admissions had a revised diagnosis by discharge, compared with 22.5% from OPD. Initial diagnoses primarily included major depressive disorder (30.1%) and bipolar disorder (27.2%). By discharge, increases were observed in personality disorders (up by 18.3%) and substance use disorders (up by 14.7%). Comorbid medical conditions were newly diagnosed in 26.8% of patients. Factors influencing diagnostic changes included ward round discussions (57.3%), serial mental state examinations (40.2%), lab findings (33.5%), and medical/interdisciplinary consultations (29.6%).

The service evaluation at Benazir Bhutto Hospital reveals significant diagnostic evolution in psychiatric care, more pronounced in ER admissions. The identification of additional disorders and comorbid medical conditions highlights the necessity for comprehensive, ongoing psychiatric assessment. Lab findings and interdisciplinary consultations played a crucial role in refining diagnoses, suggesting the importance of an integrated care approach. Recommendations include improving initial diagnostic processes in ER settings and strengthening interdisciplinary communication to enhance accuracy in psychiatric diagnosis and patient treatment outcomes.

The 2016 Junior Doctor’s contract offers guidance as to the rest periods needed during non-resident on-calls (NROCs). The Rotherham, Doncaster and South Humber (RDaSH) NHS Foundation Trust currently works on a NROC trainee rota. NROC work undertaken is monitored via a log form, returned by the trainee after their shift. A retrospective audit was completed with only a 28% return rate of log forms. Though anecdotal evidence suggested inadequate rest and high workloads during on-calls, due to low engagement in monitoring formal data was lacking. Therefore, a trainee-led prospective audit was designed to formally monitor on-call workload over a period of 4 weeks.

The main aim of this project was to review the average amount of hours worked during an NROC shift and compare achieved rest periods against agreed standards (derived from 2016 contract). These standards indicate that 90% of shifts should achieve 8 hours rest in 24 hours and 5 hours continuous rest between 22:00–07:00. In order to accomplish this we first aimed to increase the return of completed on-call log forms to 75%.

Work was predominantly concentrated around increasing return rate of the log forms including: running teaching sessions, regional promotion, and sending daily reminder emails to return the forms. These forms were then reviewed and analysed.

Across the 4 week audit period, the return rate of log forms was 95%, compared with the previous return rate of 28%. Average hours worked across all three localities exceeded the expected hours by RDaSH. When compared with the standards outlined, 1 in 3 shifts in Rotherham, 1 in 5 in Doncaster and 1 in 4 in South Humber did not achieve contractual rest periods. Out of these, not reaching 5 hours continuous rest was the most common reason for not meeting contractual rest periods.

RDaSH worked collaboratively with trainees to generate a number of interventions to mitigate the breaches in rest periods including: creation of a new clinical role to filter calls, reviewing the suitability of the NROC rota and increasing pay to reflect the increased workload. There is currently work underway to redesign the rota.

This audit highlights the importance of prioritising regular reviews of NROC work to ensure the safety of both staff and patients through achieving adequate rest periods.

We carried out a theme analysis of SAER (Significant Adverse Event) reports completed in Older Adults Mental Health Services in Greater Glasgow & Clyde. We wanted to identify common themes to bring about shared learning.

We analysed 19 SAERs from 2017 to 2023, using deductive coding. The ‘Human & Contributory Factors’ included within the SAER toolkit formed the coding system. Coding was then discussed between authors to explore the themes.

Considering the demographics of the group, patients who died by suicide demonstrated gender distribution and methods in keeping with recognised statistics. However there was an over-representation of anxiety disorders and grief reaction (64%). This may prompt clinicians to hold a lower threshold for risk management strategies in this group.

Theme #1: ‘Management & Organisation’. In the period covering the pandemic, reports reflected the need for rapid changes in practice and how in some cases this had an impact on patient care e.g. restricting the possibility for review in the patient's home.

Challenges in liaising with external agencies such as Police Scotland were also highlighted

Many reports reflected that practice could have been updated, encouraging willingness to scrutinize long-standing practice.

Theme #2: ‘Communication & Team factors’. Communication failures between staff were more common than with patients. It was more common for communication failures to occur between teams than within.

This theme also covered issues with availability of information, such as the hybrid model of working with electronic systems but also with some paper records, and the opportunity for information to be missed as a result.

Theme #3: Quality of Care. This theme referred to recommendations for more robust or formalized methods of working, or for care to be more clearly patient-centred.

Delays accessing care were also highlighted. This might refer to a delay accessing other treatments within the inpatient setting, or to missed opportunities or delays in outpatient assessment.

Factors around specific tasks were frequently identified. Most often this referred to guidelines not being followed (updating formal risk assessments, referral to Tissue Viability, etc.). In a smaller number of reports it was identified that guidance was insufficient with recommendations for these to be reviewed.

The importance of patient factors was acknowledged in all reports without this apportioning blame to them or absolving the team from identifying areas for improvement.

This theme analysis identified a number of key themes for older adult psychiatry teams to consider. Results have been disseminated locally.

High Dose Antipsychotic Therapy (HDAT) should only be used in exceptional circumstances, as there is little evidence to suggest that higher than recommended doses of antipsychotics are more clinically effective than standard doses, with potential side effects being greater. In practice, there are several clinical scenarios where HDAT may be prescribed and the potential benefits must outweigh the potential risks. NICE guidelines for psychosis and schizophrenia advise that dosages outside the range given in the British National Formulary should be justified and recorded.

This evaluation aimed to determine prevalence of HDAT across the 16 general adult inpatient wards and the Psychiatric Intensive Care Unit (PICU) in Mersey Care NHS Foundation Trust.

A list of all inpatients admitted to the 16 general adult inpatient wards and to the PICU in the Trust between 17th and 20th of July 2023 was obtained. The electronic prescription record for each patient was scrutinised to determine whether the patient was subject to HDAT and, if so, whether this was due to antipsychotic monotherapy, combination of two or more antipsychotics, or due to regular and as required (PRN) antipsychotic medication.

Of the 215 inpatients on the 16 general adult wards and the PICU, a total of 29 (13.5%) patients were prescribed HDAT. Four wards had no patients on HDAT; one ward had 5 patients on HDAT. Two of the 12 patients on the PICU were on HDAT. Of the 29 HDAT patients, none were on just one regular antipsychotic, 11 were on one regular antipsychotic and one PRN, 11 on two regular antipsychotics only, 4 were on two regular antipsychotics and one PRN antipsychotic, 1 patient was on three regular antipsychotics and 2 patients on three regular antipsychotics and one PRN antipsychotic. Of the 29 HDAT patients, 14 (48%) had schizoaffective disorder, 9 (31%) had schizophrenia, 5 (17%) had bipolar disorder and 1 (4%) had emotionally unstable personality disorder.

Only a minority of inpatients on the general adult wards and the PICU are prescribed HDAT. There was variation in HDAT prescribing across the wards and this may reflect the degree of diagnostic variability of each ward's inpatients. In those patients that are subject to HDAT, there is a need for appropriate baseline physical investigations to be completed and for appropriate monitoring of ECG and relevant blood tests. There is a need to consider whether each HDAT patient has been considered for treatment with clozapine, if appropriate.

Rapid Tranquillisation (RT) is the administration of parenteral sedation to de-escalate situations where patients may harm themselves and/or others. RT is a restrictive intervention potentially breaching patients’ human rights and is reserved for situations where other measures have failed. NICE guidelines (NG10) state that once immediate risks are managed, post-RT incident debriefing of patients and staff should be conducted. This study examines concordance with NG10 at an adult inpatient psychiatric unit and explores ways to improve compliance and patient/staff experience.

Adult psychiatric inpatients (aged 18–65) who received single or multiple RT therapy during the admission study period (October 2023) were included. Data collected from Electronic Patient Records and chart review included gender, age, ward type, date of RT and drug(s) administered. Following RT, anonymised data was collected on the presence, nature and details of debriefing.

49 adult psychiatry patients were admitted during the study period and there were 32 episodes of RT use in 9 patients (18.4% of inpatients). 56.7% of these occurred on general wards and 43.8% on psychiatry intensive care, with 6 patients (66.7%) >1 episode. Intramuscular drugs used included one or more of lorazepam (78.1% of patients), haloperidol (25%), promethazine (21.9%) and aripiprazole (9.4%). After 46.9% (15/32) of RT episodes debrief was offered, and occurred in 28.1% (9/32); 40% (6/15) of those offered debrief did not participate. 52.4% (11/21) of female patients were offered debrief with 81.8% (9/11) uptake, compared with 36.3% (4/11) of male patients offered with 25% (1/4) uptake. No accounts were taken from patients’ advocate, carer or witnesses. Details of debriefs conducted were documented in 33.3% (3/9). Reasons for not conducting debriefing were documented in 43.5% (10/23). The most common reason given was “not clinically appropriate”. During debriefs, no patients were offered information leaflets about the RT medication used. Finally, staff debriefing occurred in 31.3% (10/32) of episodes.

Compliance with NG10 guidelines for debriefing inpatients following RT was low and was worse in male than female patients. Staff debriefing was poor and no witness or advocate accounts were utilised. These findings may be due to the stressful ward environment or disrupted patient-professional relationship immediately following RT administration. Understanding the reasons for the gender differences in uptake, patient, staff or environmental factors contributing to lack of debriefing will allow interventions and improve holistic patient care following RT. Information and awareness of RT therapy should be available for patients more readily on ward admission and following RT.