The coronavirus crisis occurs at a time when many clinicians have already experienced burnout. One in three Irish doctors were suffering from burnout in the 2019 National Study of Wellbeing of Hospital Doctors in Ireland; rates are also high in Irish Psychiatry. We present a perspective on the use of narrative in medicine and recognise that storytelling, and the patient history are very much at the heart of medicine. Clinician storytelling, such as Schwartz Rounds and Balint group work, has very much come to the fore in Irish Psychiatry and in training. Projects such as MindReading have explored overlaps between clinicians, humanities experts and experts by experience. We give an overview of some approaches from the movement around narrative in medicine to bolster this. We explore why clinicians write as ways to support identification, catharsis and a way to process experiences. Clinicians and patients may also use literature and poetry to promote coping. The historical context and practical strategies are highlighted, particularly with reference to poetry use during the current crisis.

Referrals to Child and Adolescent Mental Health Services (CAMHS) have increased in recent years. Services are already under-resourced and the adverse psychological impact of Covid-19 is likely to increase demand. Accordingly, an understanding of prevalence of mental health (MH) disorders among youth is imperative to help inform and plan services.

Objective: An audit of referrals to a child psychiatry clinic is described. The process of asking families to confirm appointments and offering appointments to other families if no confirmation is received was analysed.

Method: Referral information on those refusing appointments offered, whether by declining the offer or by default, was compared with that of families attending first appointments.

Results: Longer waiting times and referral for treatment as opposed to assessment or advice were associated with higher likelihood of appointment refusal

Conclusion: The referral process resulted in a reduction in wasted professional time.

Infanticide and child murders have been known to all civilisations throughout time. This study looks at the problem from an Irish perspective, particularly with regard to the forensic psychiatry service. The case notes and legal files of 64 women admitted to the Central Mental Hospital (CMH), Dublin, between May 1850 and 2000 were examined. This group represents a complete sample of female inpatients charged with these offenses over the 150 year history of the institution. Sociodemographic and clinical data were analysed to provide psychiatric and social backgrounds to the cases. There has been a considerable decrease in the number of women admitted to the CMH on charges or conviction for infanticide and child murder in recent years. It appears that the attitude of the judiciary to these women has altered. The cases are discussed in the context of the prevailing attitudes of the era.

Objectives: We set out to review all admissions from the criminal justice system to the Central Mental Hospital from January 1997 to December 2003, with particular attention to patient diagnoses, offences, source of admission, length of stay, and patterns of discharge. This study was undertaken to assist with future service planning and determination of resource needs.

Methods: The service maintains a combination of electronic and handwritten records of all admissions. Information was extracted concerning all admissions from January 1, 1997 to December 30, 2003. The data was analysed using a statistical package, SPSS 11.0 for Windows.

Results: Nine hundred and eighty-six admissions of 780 individuals from the criminal justice system were recorded from January 1997 to December 2003. There has been an increase in the proportion of patients admitted suffering with severe mental illness. There has also been a significant shift in the pattern of discharges, with a higher proportion of patients leaving to return to their local hospital. The proportion of admissions returned to prison has fallen from 91.1 % in 1999 to 64.7% in 2003, while 3.3% of individuals admitted became new long-stay cases.

Conclusions: A shift in the profile of patients admitted in recent years reflects changes within the National Forensic Mental Health Service. An increased provision of regular and structured psychiatric input to the prisons has facilitated the identification of prisoners with mental illness. The shift from prison liaison to diversion from the Criminal Justice System to mental health services is however in its early stages.

The COVID-19 pandemic has posed many challenges in maintaining standards of care and treatment for patients while managing the increased anxieties of patients, carers and the public in general. This paper highlights several clinical, administrative, medicolegal and IT implications of COVID-19 on the delivery of mental healthcare to an elderly vulnerable patient cohort due to recommended social distancing measures. Our Psychiatry of Later Life team has adapted to this by restricting face-to-face consultation, while continuing to provide telephone support. We have modified our documentation standard and have improved some aspects of our team working by facilitating flexible working arrangement and relevant training for staff as well as by embracing new technology. Notwithstanding the challenges therefore, this exceptional time has also opened avenues for new and innovative opportunities that can be further explored even when the current crisis eventually passes.

There has been scant exploration of the social and emotional wellbeing (SEWB) of young Indigenous populations that identify as LGBTQA+ (Lesbian, Gay, Bisexual, Transgender, Queer/Questioning, Asexual +). Given the vulnerability of this cohort living in Western settler colonial societies, wider investigation is called for to respond to their needs, experiences and aspirations. This paper summarizes existing research on the topic highlighting the lack of scholarship on the intersection of youth, Indigeneity, LGBTQA+ and SEWB. The paper takes a holistic approach to provide a global perspective that draws on an emerging body of literature and research driven by Indigenous scholars in settler colonial societies. The paper points to the importance of understanding converging colonial influences and ongoing contemporary elements, such as racism and marginalization that impact on young Indigenous LGBTQA+ wellbeing.

Objectives: We report a patient-controlled benzodiazepine discontinuation programme in a generic multidisciplinary community mental health service.

Method: A prescribing audit identified suboptimal benzodiazepine use which stimulated a discontinuation programme [prescribing policy, psychoeducation, anxiety management] to encourage benzodiazepine cessation. Benzodiazepine status was re-assessed at 12 and 24 month follow-ups.

Results: 158 patients were receiving benzodiazepines at study onset. At 12 month follow-up, 68 of these were still receiving benodiazepines. This was due to discontinuation (n = 32), dose reduction (n = 26) and service dropout (n = 71). Benzodiazepine status at follow-up was predicted by attendance at anxiety management sessions (p = 0.01) and shorter duration of benzodiazepine use (p = 0.005). Patients attending anxiety management sessions were 2.5 times more likely to reduce use. Discontinuation followed four patterns: (a) rapid and complete discontinuation (n = 19); (b) total discontinuation in a gradual manner (n = 13); (c) partial dose reduction without total discontinuation (n = 18) and (d) almost total discontinuation with continued low-dose use (n = 8). The patients that achieved total discontinuation were younger (p = 0.01) and in receipt of benzodiazepine agents for a shorter duration (p = 0.009). At 24 month follow-up only three patients had relapsed into benzodiazepine use and a further 13 had achieved total discontinuation.

Conclusions: Many chronic benzodiazepine users can achieve lasting discontinuation with patient-controlled dose tapering. Patient refusal and service dropout are common during discontinuation programmes. Anxiety management is a valuable adjunct to discontinuation.

Objectives: To examine eating concerns in a cohort of Irish adolescents.

Methods: Students from a stratified random sample of post primary schools were screened using the EAT-26, the EDI-III and a study specific questionnaire.

Results: A total of 3,031 students (mean age 14.74, range 12–19) enrolled in the study. The majority of respondents felt popular (91%), happy (75.2%) and perceived themselves to have a good quality of life (86.8%). Despite this, 32% of females dieted, 29.4% were dissatisfied with their bodies, and 10.8% scored above 20 on the EAT-26. Adolescents always on a diet reported a lower quality of life (QoL) X2(16, N=2,961) =144.43, p <.000, perceived themselves to be less popular X2(15, N=2,963) =53.26, p <.000 and less academically able X2(16, N=2,297) =43.96, p<.000, than those who never dieted. Comparing EPICA values to published norms, Irish males had significantly lower EAT scores, females had comparable total EAT-26 scores but significantly lower levels of dieting and higher levels of bulimic features and oral control. Girls in mixed schools had higher rates of body dissatisfaction F (1,2855) = 16.61, p <.001 and drive for thinness F (1,2860) = 11.78, p <.005 than girls attending same sex schools.

Conclusions: Weight and body image concerns were high among Irish adolescents, especially females, with higher than expected levels of bulimia and oral control scores on the EAT but lower scores on the dieting subscale. Females attending mixed sex schools appear most at risk of eating pathology.

Objectives: To determine whether assessments of patients admitted to a general hospital following deliberate self-harm (DSH) were in line with the Royal College of Psychiatrists guidelines. To examine the profile of cases and presentations and to make recommendations for improvements to the service.

Method: Clinical and demographic data recorded on 70 admissions after DSH during 1997-98 were analysed retrospectively. A checklist was also developed, using factors shown by previous research to be associated with future risk of suicide, to determine the quality of assessments.

Results: The majority (70%) of assessments took place within 24 hours of admission thereby meeting College recommendations. Medical personnel performed all adult assessments. Circumstances of the overdose, recent stresses, psychiatric diagnosis, immediate risk and follow-up arrangements were documented in the majority of cases. Family psychiatric history, past suicidal behaviour, alcohol and drug abuse history, and previous violence, were frequently not documented. A copy of a discharge summary to the GP was found in 41% of charts. Overdoses accounted for 93% of cases of DSH. The most frequently recorded problem (37.5%) was adjustment disorder.

Conclusions: Despite evidence showing that non-psychiatric medical staff are competent in assessing DSH and guidelines encouraging multidisciplinary involvement, DSH assessments remain the preserve of the medical psychiatric team. Closer attention should be paid to all the risk factors associated with suicide by assessors; a checklist could prove helpful. There is room for improved communication between psychiatric services and GPs following DSH. The setting up of a self-harm service planning group could improve the co-ordination and efficiency of delivery of general hospital services to this patient group.

Objectives: This study examines the frequency of childhood sexual abuse and physical abuse in a cohort of opiate addicted patients and looks at clinical correlates in those abused.

Method: Fifty-two consecutive patients attending an out patient drug treatment programme were interviewed using a semi-structured technique. Demographic details, details of schooling, marital status and number of children were recorded. The duration of drug abuse, age of onset of opiate abuse, early life experiences of both child sex abuse and childhood violence and a family history of alcohol abuse were also investigated.

Results: 21.2% of patients gave a history of sex abuse, with 23.1% of patients having a history of exposure to violence as a child. Those exposed to sex abuse had an earlier age of onset of opiate injection. A correlation between parental alcohol abuse and sex abuse and violence was noted.

Conclusions: A history of child sex abuse was associated with earlier onset of opiate abuse in this group of patients. The relatively frequent incidence of abuse and violence in those with opiate abuse must be born in mind when providing treatment. The addressing of issues relating only to addiction leaves earlier traumas continuing to exert an influence on the patient.

Objectives: To determine the frequency of reported suicidal thoughts and acts in (a) a school-based sample of Irish adolescents, (b) adolescents attending a community child and family mental health service.

Method: The study population consisted of: (a) 195 adolescents aged 13-15 years attending ten secondary schools throughout Ireland. The schools were selected to represent a wide social and cultural spread: and (b) 66 adolescents aged 13-15 years attending a community child mental health service. The measures used were the Child Behaviour Checklist completed by the parents of the adolescents and the Youth Self Report completed by the adolescents.

Results: Within the school sample, the parents of 3% of adolescents reported that their child had talked of harming him/herself, but none reported acts of self-harm. Fifteen percent of the adolescents themselves reported that they had thoughts of harming or killing themselves, and 8% reported that they had tried to harm or kill themselves.

Within the mental health clinic attenders sample, the parents of 33% of the adolescents reported that their child had talked of harming him/herself, and the parents of 27% reported that their child had tried to harm or kill themselves. Twenty-one percent of the adolescents themselves reported that they had thoughts of harming or killing themselves, and 21% percent reported that they had tried to do so. In both groups, adolescents with higher total problem, internalising and externalising scores on the questionnaires, indicating greater disturbance, were more likely to report thoughts and acts of self harm.

Conclusions: Thoughts of suicide and acts of self harm are common in Irish adolescents and are not limited to those attending mental health services. Parents are frequently unaware of these thoughts. Further studies involving interviews with adolescents at risk are indicated to determine the significance of these thoughts and how adolescents deal with them.

The medium- to long-term consequences of COVID-19 are not yet known, though an increase in mental health problems are predicted. Multidisciplinary strategies across socio-economic and psychological levels may be needed to mitigate the mental health burden of COVID-19. Preliminary evidence from the rapidly progressing field of psychedelic science shows that psilocybin therapy offers a promising transdiagnostic treatment strategy for a range of disorders with restricted and maladaptive habitual patterns of cognition and behaviour, notably depression, addiction and obsessive compulsive disorder. The COMPASS Pathways (COMPASS) phase 2b double-blind trial of psilocybin therapy in antidepressant-free, treatment-resistant depression (TRD) is underway to determine the safety, efficacy and optimal dose of psilocybin. Results from the Imperial College London Psilodep-RCT comparing the efficacy and mechanisms of action of psilocybin therapy to the selective serotonin reuptake inhibitor (SSRI) escitalopram will soon be published. However, the efficacy and safety of psilocybin therapy in conjunction with SSRIs in TRD is not yet known. An additional COMPASS study, with a centre in Dublin, will begin to address this question, with potential implications for the future delivery of psilocybin therapy. While at a relatively early stage of clinical development, and notwithstanding the immense challenges of COVID-19, psilocybin therapy has the potential to play an important therapeutic role for various psychiatric disorders in post-COVID-19 clinical psychiatry.

Recent years have seen renewed emphasis on the importance of mental health policy as a key component of health and social policy at both national and international levels. In 2001 the European Commission produced a public health framework for mental health in the EU. In the same year, the World Health Organisation devoted its annual health report to mental health and called on countries to formulate, update and implement mental health policies. The EU and WHO initiatives both recognised that the challenges facing mental health policy makers are increasingly transnational in scope, related to issues such as rapid demographic change, increased transnational migration, the protection of human rights and the implementation of a growing number of international laws, directives and protocols in relation to mental health care.

Significant progress has been made in the development of Irish mental health services over the past 40 years. Nevertheless, many challenges remain. The aims of this paper are to outline:

• Prevailing theoretical perspectives on mental health policy

• Mental health policy in Ireland since the last major policy revision in 1984

• Relevant economic and demographic changes in Ireland since 1984

• Relevant clinical, legislative and policy developments in relation to mental health

• Future directions for mental health policy.

Electronic literature searches were performed using Psyclit (American Psychological Association, 1887–2003), Medline (United States National Library of Medicine, 1985 – 2003), with broad search terms related to mental health policy. Additional books and papers were identified by tracking back through references and consulting with colleagues. Policy documents and selected literature on Irish psychiatric services were reviewed and related to recent literature on mental health policy.

Objectives: This study evaluated the effectiveness of group cognitive behavioural therapy (GCBT) for the treatment of anxiety disorders in children over an initial period of 12 weeks and to one-month follow-up. Parents of the children receiving GCBT participated in adjunctive psycho-education sessions and the effect of these sessions on parental anxiety was also evaluated.

Methods: Participants were 12 children, six male and six female, aged between 11 and 15 years who were attending a child mental health service. Participants were interviewed with their parents and anxiety symptoms assessed, using the following measures: Anxiety Disorder Interview Schedule – revised, the Children's Depression Inventory, the Revised Children's Manifest Anxiety Scale, the Coopersmith Self-Esteem Inventory and the Child Behaviour Checklist. Parental anxiety levels were assessed using the Depression, Anxiety and Stress Scale. The 12 children were randomly assigned into two age- and sex-matched groups. While the first group received therapy, the second group acted as a treatment-as-usual control (TAU) group. The second group began group cognitive behavioural therapy after the 10-week waiting period. All participants and their parents provided structured feedback on the intervention.

Results: Group cognitive behavioural therapy was significantly effective in reducing both child-reported depressive symptoms, and anxiety on the physiological, worry and total anxiety subscales of the Revised Children's Manifest Anxiety Scale. There were associated significant increases in the childrens' subjective levels of general and total self-esteem, that relating to their self-confidence with peers and when engaging in social and academic pursuits. Diagnosis of anxiety disorder reduced by an average of 67% immediately post-treatment, and by 72% by the onemonth follow-up period. Parents reported significant reductions in their children's levels of internalising symptoms, thought and attention problems. However, parents reported no significantly positive changes in their own levels of depression, anxiety and stress symptoms.

Conclusions: Group cognitive-behavioural therapy is a useful and clinically effective intervention for the treatment of anxiety disorder in children.

Objective: Benzodiazepine misuse among opiate addicts is well described but few studies have reported on the occurrence and management of benzodiazepine dependence within this group. This study reports on the nature and extent of benzodiazepine dependence among a group of opiate addicts and describes the patients' treatment progress and requirement for substitute medication.

Method: Over a 12 month period routinely collected data on all admissions of opiate addicts to our inpatient treatment and research unit were searched. Specific details were then extracted for those 61 admissions who were opiate dependent and also currently misusing benzodiazepines.

Results: 26 (43%) of the 61 admissions were found to bephysically dependent on benzodiazepines. Temazepam and diazepam (respectively) were the most commonly misused preparations and 22% of those using temazepam were injecting it. Patients requiring detoxification were stabilised on doses of diazepam ranging from 20mg to 80mg daily (mean; 40mg). No correlation was found between reported use of benzodiazepines and the dose of diazepam required for stabilisation. Users found to be physically dependent on benzodiazepines more commonly reported daily use and use of two or more benzodiazepines concurrently.

Conclusions: Our findings suggest: 1) that benzodiazepine dependence occurs in opiate addicts with a frequency similar to that reported previously for other groups of benzodiazepine users; 2) that individuals using benzodiazepines on a daily basis may be more at risk of developing physical dependence; and 3) that clinically it is difficult to accurately predict requirements for substitute medication solely from patient's reported daily use prior to admission.