Aims: People with Intellectual Disabilities (PwID) have, on average, a life expectancy 20 years less than that of the general population. The Learning Disabilities Mortality Review found that in 23% of deaths among PwID, constipation was a long-term health problem. In the past year, Swansea Bay University Health Board’s (SBUHB) Mental Health and Learning Disability Delivery Unit reported four incidents of constipation among PwID living in the community, with one fatality.

Patients prescribed clozapine are more vulnerable to constipation due to side effects. This Quality Improvement (QI) project aimed to assess the current knowledge about constipation among PwID prescribed clozapine, along with their carers, and to use a brief educational tool to address knowledge gaps.

Methods: Stakeholder analysis, fishbone diagram, and process mapping were undertaken to create a driver diagram and identify change ideas. Education was chosen as the primary driver for this project, with a focus on assessing understanding, and providing patient and carer education. The project targeted all PwID prescribed clozapine within three geographical areas: Cardiff, Swansea, and Rhondda Cynon Taf. An initial knowledge survey was administered to both patients and carers, followed by a face-to-face educational session using an Easyread leaflet. Knowledge was reassessed one week later.

Results: Seven educational sessions were held, with patients and their primary carers participating. The knowledge survey revealed that all patients understood the basic concept of constipation, but fewer understood its health risks (30%) and the recommended frequency of bowel movements (14%). Knowledge improved and was retained one week after the education session, with 60% understanding the health risks and 71% knowing the recommended frequency of bowel movements. Carers demonstrated improved knowledge, particularly in using the Bristol Stool Chart. All carers recognized the increased risk of constipation among PwID and its potential fatal consequences.

Conclusion: This project demonstrated that targeted, brief educational interventions can effectively improve the knowledge of PwID and their carers regarding the risks of constipation associated with clozapine therapy. The results emphasise the importance of accessible information and suggest that continuing education is necessary for both PwID and carers. It also highlighted the importance of a stable and educated carer workforce, with appropriate training at induction. The future aim of the project team is to develop an online educational programme for carers about constipation, and how to seek timely and effective support.

Aims: Psychiatry intensive care units (PICU) are therapeutic environments that care for people with the most severe mental health conditions often characterized by heightened agitation, aggression, or self-harm behaviours. It is also one of the most restrictive units. Royal College of Psychiatrists standards for psychiatric intensive care units has given emphasis on the provision of therapeutic activities. We identified the scope to improve the choice, availability and accessibility of activities provided in PICU.

Aim: of the quality improvement project is to improve the service user satisfaction of therapeutic activities provided in the PICU from 60% to at least 80% in a duration of 6 months.

Methods: The principles of Quality improvement were followed. Did a process mapping, change ideas was collected from the whole team including service users, a driver diagram was created, changes were introduced, and impact was measured through Plan Do Study Act (PDSA) cycles.

Data was collected from service users on a scale of 1 to 5 on a daily basis in community meetings. Balance and process measures data was extracted from the records. The data was plotted as a run chart.

Results: The primary outcome measure used was service user satisfaction. Balance measures used included risk incidents (absconsion, physical and non physical assaults, self harm and sexual offences). The process measures included occupied bed days and volume of admissions or transfers.

Service user satisfaction score improved from 3 at base line to 4.2 out of 5, soon after the launch of the project. Median of rate of risk incidents reduced from 12 to 4. There was no difference in the process measures over the project period.

Change ideas tested included improving the communication between service users and staff, improving the communication between multidisciplinary staff members, improving the interests and enthusiasm of team, maintaining the enthusiasm in the therapeutic activities for both staff and service users, improving the understanding among staff of the therapeutic activities of interest in the service users and ensuring to maintain the material resources.

Conclusion: The project fostered a multidisciplinary approach, involving collaboration among psychiatrists, nurses, social workers, occupational therapists, service users and other allied health professionals. There was an inertia to initiate therapeutic activities in the ward, the project has helped to break this and the stereotypies about who needs to take initiatives on providing therapeutic activities.

Aims: To assess and improve the consistency of family, carer and community team involvement in our MDT (multidisciplinary team) ward rounds on a PICU (Psychiatric Intensive Care Unit).

Methods: Baseline date involved retrospective analysis of EPR (electronic patient records) reviewing the documentation of 27 admissions over a six-month period (February to August 2024). We recorded details of demographics, diagnosis and length of stay. We reviewed MDT documentation for a maximum of eight weeks to ascertain invites, attendees and whether family/carers had been contacted within three days of their first MDT as this was an agreed expectation. A total of 101 MDTs were reviewed.

Following baseline data collection we made the following changes:

Circulation of expected standards regarding family involvement.

Change in format of our daily handover document to include details of important family/carer contacts and most recent recorded contact.

Use of a standardised MDT documentation proforma to improve accuracy of written records.

Results: Baseline data: The majority of our patients were male (74.1%), White British (74.1%), English speakers (88.9%), from the local area (81.5%) and had a diagnosis of a schizophrenic, schizotypal or delusional disorder (51.9%). The average age was 35 years and length of admission 35.5 days.

59.3% of admissions had documented contact with relevant family/carer within three days of their first MDT review.

On average relevant family/carers/professionals were invited to 61.4% of MDTs and attended 45.3% of the time.

On average MDT attendance reduced over time from 48.1% in week one to 33.3% in week eight.

Re-audit data: We are in the process of prospective re-audit between the period of January to March 2025. Thus far we have reviewed the records for 9 patients and analysed data entry of 18 individual MDTs.

100% of admissions had documented contact with relevant family/carer within three days of their first MDT review.

On average relevant family/carers/professionals were invited to 81.5% of MDTs and attended 59.3% of the time.

The MDT documentation proforma use was 61.5%.

We expect to have a larger data set as collection is ongoing.

Conclusion: Quality and accuracy of documentation is likely to have underestimated the frequency of contact with carers, particularly in the baseline data.

Timely, regular and meaningful liaison with family, carers and community professionals improves outcomes and quality of care for PICU patients. Simple interventions and reinforcement of expected practice can improve frequency and consistency of patient and carer involvement.

Aims: Serious mental illness is associated with higher rates of sexual assault and gynaecological cancers, alongside pre-menstrual disorders and the menopause which can be implicated in psychiatric presentation, relapse or treatment resistance. This project aimed to ensure better screening and referral for sexual and reproductive health issues in order to improve relevant health outcomes.

Methods: Two pre-existing health-recording forms were highlighted to nursing staff and encouraged using information posters placed in staff areas. Six individual referral pathways were developed for doctors’ use. Data was collected pre- and post-intervention including proportion of forms completed, abnormalities identified, appropriate follow-up initiated, and time spent carrying out these tasks. Reasons for non-completion were analysed. PDSA cycles were used to guide improvements and increase engagement.

Results: Prior to intervention, 53% of patients had the ‘women’s physical health’ (WPH) form completed, 0% the contraception form. Despite 59% of these finding abnormalities, 0% were referred for investigation or treatment (32 patients over a 2-month period August–September 2024). Post-intervention, completion of the forms remained static at 50% of WPH and 0% of contraception forms, though detected abnormalities rose to 88% and appropriate referrals to 40%. Of the remaining 60%, 7 patients identified as requiring a referral declined, most commonly refusing a smear test. 1 further patient was too unwell to engage. Overall patient group size was similar with 34 patients over a 2-month period November 2024–January 2025. Average time for form-reviewing and referring was 6.9 minutes per patient. Independently of the forms, 1 patient who remained admitted throughout both data periods was followed up for 3 separate issues, and 4 patients without completed forms were noted to have concerns, and subsequently referred appropriately.

Conclusion: Though patient referrals increased from 0 to 40% after the referrals guide was created, the proportion of concerns addressed remained low. Patient education is a key target for improvement, specifically cervical screening, and eye-catching patient education posters are to be displayed on the ward for this purpose. Form-completion rates did not improve, suggesting further engagement with nursing colleagues and specific time-allocation for completion would be of benefit. Perhaps most significantly, the increased identification of reproductive and sexual health concerns of patients without a completed form highlighted the team’s increased awareness of these issues. This suggests that clinician education can help in utilising inpatient admission as an opportunity to improve sexual and reproductive health for women with serious mental illness.

Aims: To determine whether an in-house phlebotomy clinic would reduce the length of time taken for blood tests to be completed and results reviewed within the CAMHS Eating Disorder Service in Coventry and Warwickshire Partnership NHS Trust, which would reduce patient safety incidents caused by these delays.

Methods: Collation of baseline data which includes the timeframe in days between:

Blood tests being requested and blood tests being taken.

Blood tests being taken and blood results being reviewed.

Blood tests being requested and blood results being reviewed.

This baseline data has been displayed in a statistical process chart to show the current length of time taken for each of the above. The baseline data also shows which patients had abnormal blood results that required A&E attendance for urgent repeat testing. It also reviews the near misses that occur due to the length of time taken to review blood results.

Testing change ideas using Plan-Do-Study-Act cycles for each change idea:

Created a central list of all patients who have had blood tests requested.

Introduced standardised days for checking if the blood test has been taken and reviewing the results accordingly.

Increased the number of standardised days for checking if the blood test has been taken.

Development of an in-house phlebotomy clinic.

Results: The statistical process charts show that since introducing the change ideas, the overall mean for the timeframe between blood tests being taken and blood results being reviewed has reduced from 17 days to 2 days. This shows the change in process has had a positive impact on this step. However, the same improvement has not been shown in the timeframe between blood tests being requested and blood tests being taken, nor blood tests being requested and blood results being reviewed. We hope to see an improvement in these two steps with the introduction of our in-house phlebotomy clinic.

Conclusion: Our findings show that the changes in process have had a positive impact regarding the reduction in time between blood tests being taken and the blood results being reviewed. We hope to see a continued improvement in this and all steps of the process with the introduction of our in-house phlebotomy clinic.

Aims: To improve multidisciplinary team awareness of doctor availability within the East-North-East Leeds Community Learning Disability Team.

To create and implement a resource listing accurate availability per half-day, contact details, and named cover in cases of absence.

To improve team communication, reduce uncertainty, and streamline contact and escalation processes.

To utilise baseline and post-intervention outcome measures to assess improvements in practice.

Methods: This project was formulated following reports of uncertainty around doctor availability, inefficient methods of contact attempts, and with no current effective rota system in place.

A Plan-Do-Study-Act (PDSA) approach was taken to assess and adopt continuous improvement throughout.

Baseline questionnaires were distributed to staff to assess current levels of awareness of doctor availability, escalation pathways, and perceived usefulness of a planned resource.

Key stakeholders (consultants, resident doctors, managers, senior administrators) were engaged to adapt and expand a current limited senior doctor rota, to include all doctors, named cover, enhanced contact methods, and a wider audience. This utilised Outlook calendars, was displayed in the team office, and was updated weekly.

Post-intervention questionnaires were circulated to assess the impact of the intervention.

Further procedures were implemented to sustain this change, including commitments from permanent staff to take responsibility in maintaining the resource, standard operating procedures formulated for administrative and medical teams, and safeguards created to identify future issues encountered.

Results: Response rates from staff were 32% and 36% pre- and post-intervention respectively.

Staff confidence in knowing which doctors were available and when rose from 22% to 91%.

Staff knowledge of how to immediately contact an available doctor rose from 44% to 91%.

Staff knowledge of how to further escalate concerns rose from 67% to 91%.

91% of staff reported using the resource, 91% found it useful, and 82% found it accurate.

Further adaptations were made as the project progressed and in response to feedback and issues encountered.

Conclusion: This project successfully resulted in improving awareness of doctor availability in all domains measured, and was well received.

By developing a clear, accessible rota and engaging staff in its use, staff confidence and team communication improved.

This project led to lasting changes in practice, ensuring ongoing effectiveness sustained beyond the project’s conclusion.

Key points of discussion include engagement of key stakeholders in planning, implementing, and sustaining improvement, ensuring feasibility and longevity. Furthermore, reflecting on the effective use of PDSA principles with simple, measurable changes, and implementing ongoing review processes.

Aims: Hampshire has an older population structure, compared with the national average, with increases predicted amongst the older population, aged 75 years and older. This group is more susceptible to social isolation, particularly those living in towns of the New Forest. We therefore are focusing on a project aimed at the older population, particularly men, in the town of Lyndhurst.

Our aims are threefold: to understand what current nature-based activities are on offer for older people in the New Forest, to appreciate the barriers for engagement to these and lastly through insights with this group to set up a heritage and nature group to try to tackle isolation and improve physical activity levels.

Methods: We have held several insight groups with local community groups to better understand their route to engage in nature-based activities and what barriers they faced. Additionally, we have met with social prescribers in the New Forest PCN to better understand isolation in the elderly population.

We have arranged two focus groups at the Heritage centre in Lyndhurst to better understand the current community offering and to also help us launch our pilot heritage and nature group running at the centre.

Results: Common themes were highlighted as barriers to engagement in nature activities including poor public transport, reduced mobility, caring responsibilities, lack of diversity of activities as well as the intangible barrier of ‘it’s not for me’. Digital barriers further negatively impact those who are unable to access information about groups in the local area and space can be difficult to find for groups to run such as for the Lyndhurst shed.

Conclusion: Our work so far has highlighted that older people are more susceptible to isolation and that it is more of a concern in towns rather than rural areas in the New Forest. We have identified that there is a gap in heritage and nature-based activities on offer in the New Forest, which would encompass several aspects of the 5 ways to wellbeing such as connecting with others, being active (brief history walk) and learning new things. By involving local older people in the set-up of the group through focus groups we have been better able to address any barriers they may have to engage in nature and heritage activities. This project adds to the existing evidence of the positive interaction between heritage and wellbeing.

Aims: Little is known about the proportion and patient profile of conditionally discharged patients supervised by general adult community mental health teams (CMHTs). In this study we aimed to evaluate the number of patients and their demographic, clinical and risk profile, and current practice in terms of supervision and structures.

Methods: We conducted a retrospective case note service evaluation of all conditionally discharged patients within a typical NHS Trust’s CMHTs.

Results: A third of all conditionally discharged patients within the Trust were supervised under the care of general adult community teams. The majority of patients were older, male, unemployed with schizophrenia and related disorder diagnoses. Main index offences were serious violence to others with use of weapons.

Conclusion: Conditionally discharged patients represent a low volume, high risk population. Supervision in the community is time and resource intensive. There is a need for NHS Trusts to ensure adequate support and structures, supervision, training, and joint working opportunity with forensic services to ensure safe quality care.

Aims: Mental health apps are increasingly available and accessible to the public. Global research indicated variable rates of use among people with main barriers identified are cost, privacy concerns, and difficulty of use. Little is known about prevalence and barriers of use of mental health apps in Saudi Arabia.

Methods: Descriptive questionnaire-based cross-sectional survey of a sample of Saudi adult population. We adopted a multiple logistic regression modelling of data to evaluate the impact of potential barriers and facilitators on use of mental health apps.

Results: The survey included (n=636) participants. The prevalence of use of mental health apps was (n=80, 12.6%), with only (n=32, 40%) finding them useful. Younger age, females, separated marital status, students, history of mental illness, taking psychiatric medications, attending psychiatric services, seeing a psychologist (offline and online), and chatting to psychiatric patients online were all associated with unadjusted increase in use of mental health apps. However, the adjusted impact on use of mental health apps was significant only for those using psychiatric medications (odds ratio (OR)=0.1289, p=0.0243), individuals who requested online psychology intervention (OR=7.9866, p<0.00001), individuals who believed in costliness of mental health apps (OR=2.9358, p=0.00034) or difficulty using them (OR=4.1875, p=0.0002). Stigma and privacy concerns were not statistically impactful on use of mental health apps.

Conclusion: Use of mental health apps is very low among Saudi patients. Those who use mental health apps remain sceptical of their therapeutic values and report concerns in terms of difficulty to use them and their cost-effectiveness. Design of effective, readable, safe, and cheap mental health apps should be attempted by health educators and mental health professionals to engage Saudi patients in using mental health apps.

Aims: Mother and Baby Units offer specialised treatment to women in the antenatal period from 32 weeks gestation to 12 months postpartum. All referrals are screened for admission suitability. Reasons to reject referrals include absence of serious mental illness and high risk of violence.

To analyse relationships between referrals received and accepted admissions regarding clinical and social variables, including deprivation levels, timing of referrals, diagnosis and ethnicity.

Methods: Retrospective data collection looking at all referrals to Yorkshire and Humber Mother & Baby Unit between 1 April 2023 and 31 March 2024. Total 129 referrals. Patient records were used for data collection.

Results: Deprivation decile: Most referrals were from the most deprived decile (35%). Least from the least deprived decile (3%). Of the most deprived decile referrals, 86% were accepted. All from least deprived decile were accepted.

Ethnicity: Most referrals were white British (71%), then Asian/Asian British (13%), then black/black British (6%). Least were ‘other ethnic group’ (4%). 6% had no ethnicity stated.

Of the referrals for white British ethnicity, 87% were accepted. For Asian/Asian British ethnicity, 94% were accepted. For black/black British ethnicity, 71% were accepted. For other ethnic group, 40% were accepted. With no ethnicity stated, 63% were accepted.

Diagnosis: Most referrals were for diagnosis of Psychotic Disorder (46%), followed by Mood Disorder (33%), Multiple (10%), Other (7%), and least for Anxiety Disorders (4%).

Of referrals for Psychotic Disorder, 88% were accepted. Mood Disorder, 90% were accepted. Multiple, 53% were accepted. Other, 66% were accepted. Anxiety Disorders, 80% were accepted.

Time of Referral: For point of referral in perinatal timeline, most referrals were between 2–12 weeks postpartum (36%), then 12+ weeks postpartum (32%), 0–2 weeks postpartum (20%), and least from pregnancy (12%).

At 2–12 weeks postpartum, 85% were accepted. At 12+ weeks postpartum, 88% were accepted. At 0–2 weeks postpartum, 96% were accepted. During pregnancy, 47% were accepted.

Conclusion: The data highlighted discrepancies in number of referrals received from different deprivation decile areas and ethnicities, significantly higher from more deprived areas and higher number of referrals for white British ethnicity patients. The acceptance proportion was higher in less deprived areas, this could be due to significant difference in number of referrals. The acceptance proportion for different ethnicities were fairly in the same range. Targeted interventions to promote awareness could improve equitable access.

Aims: Assessing the referral patterns, patient characteristics, constraints, immediate and wider benefits of a GP/CMHT fortnightly consultation-liaison clinic as a component of an enhanced community mental health service design.

Methods: A Transformation initiative pilot GP/CMHT Consultation-Liaison huddles convened over 20 (21) months via video-link; January–December 2021 (23) to September 2022 (14). Initial session in December 2020 enabled both teams comprising two managers, GP, Psychiatrist, Primary care link worker and GP community outreach specialists and CMHT admin support established the format of the Hour long sessions. At various times Other GP Colleagues/Specialist Addiction Services/Sexual Health Consultants/team members/Memory Clinic Specialists joined as appropriate. The sessions provided opportunities for a few video-linked patient consultations and trainee observations. Ahead of the fortnightly sessions is an email list of patients from GP to Psychiatrists with specific queries. Number of patients range from 4 (2) to 12 (14) each session. However, some queries were addressed ahead of sessions or concluded at the meeting. Enquiries varied, ranging from referrals tracking, medication or management advice, diagnosis, risk mitigation strategies and learning on incidents.

Results: Total 354 patient encounters were listed or discussed with number of patients per sessions ranging from 2 to 15 mean of (9). Total 37 sessions with 223 patients (2021) and 131 (2022) discussed. Recurring patient encounters range from 2–14 times. Non-recurring patients overall 113 (32%). All patients were within working age group, with the youngest aged 17 plus and the oldest 67 years (four patients). Mean age 38.4 years. Patient characteristics, diagnoses, risks and immigration issues and impact to access to services frequently encountered. Presentations discussed varied with more complex cases frequently recurring.

Conclusion: Consultation liaison model has evolved over the years. With recent pandemic, demand for secondary care interventions has increased to the degree innovative approaches offer alternatives to mitigate risks, support primary care services, strengthen GP confidence and most importantly, improve transfer to primary care. Further research is required to strengthen approaches to CMHT/Primary care interfaces.

Aims: This study investigates the timing and patterns of patient admissions to a community psychiatry hospital, with the goal of optimizing resource allocation by identifying peak arrival times.

Methods: This study was conducted at Udston Hospital within NHS Lanarkshire. The hospital comprises two older adult wards, each with a capacity of 20 beds. Patients admitted to these wards were mainly aged over 65 and were admitted either informally or under the Mental Health Act. A duty doctor handles admissions during working hours, 9 am to 5 pm, while an off-site duty doctor covers evenings and weekends.

Data from 50 randomly selected patients admitted between January 2024 and January 2025 were collected using the electronic patient record platform MORSE. The primary outcome was patient arrival time, categorized into predefined time slots. The secondary outcome analysed admission sources (home, care home, or hospital) and whether patients were admitted informally or under detention (Emergency Detention, Short-Term Detention, or Community Treatment Order).

Categorical data analysis was employed to identify any significant trends in admissions.

Results: The study identified a notable peak in the afternoon. A majority of admissions, 37 patients (74%), occurred after 2 pm, with 23 patients (46%) being admitted between 2 pm and 4 pm. In contrast, only 7 patients (14%) were admitted between 9 am and 12:59 pm, highlighting an underutilization of morning hours for patient transfers. Half of these admissions were informal and originated from patients’ homes.

Conclusion: Late afternoon admissions delay lab results, requiring follow-up by the off-site duty doctor, which may postpone treatment or escalation to the out-of-hours GP. This disruption can affect sleep, a modifiable risk factor for delirium, raising fall risk and worsening outcomes.

Staff are also impacted, particularly during the evening shift and night shift, where reduced resources and increased workloads heighten admission errors, contributing to moral distress and lower job satisfaction.

Systemically, late admissions disrupt patient flow and worsen inefficiencies. Research links evening and weekend admissions to poorer outcomes.

Addressing this issue requires streamlining workflows through measures such as designated admission timeframes for informal patients, prioritizing safer morning hours for non-urgent cases, and optimizing resource allocation through greater staffing levels during peak periods.

These strategies will enhance patient safety, alleviate the strain on staff, and improve overall operational efficiency.

Aims: This study assesses the frequency and adequacy of handovers for newly admitted patients in a community psychiatry hospital, focusing on formal communication to the duty doctor.

Methods: This study was conducted at Udston Hospital within NHS Lanarkshire, which comprises two older adult wards, each with a capacity of 20 beds. Patients, primarily aged 65 and above, were admitted either informally or under the Mental Health Act.

Data from 50 randomly selected patient admissions between January 2024 and January 2025 were collected using the electronic patient record platform MORSE. Handover was defined as any documented verbal or written communication to the duty doctor regarding a patient’s admission. Categorical data analysis was performed to identify trends in handover practices.

Results: The study revealed significant deficiencies in handover communication, with 54% of patients admitted without a formal handover. Home was the most common admission source (70%), with an even split in handover rates (51.4% handed over vs 48.6% not handed over). In contrast, hospital admissions had the lowest handover rate, 71.4% not handed over, suggesting direct transfers without a formal process in most cases. Care home admissions were also less likely to involve a handover with 62.5% not being handed over. Regarding detention status, 56.7% of informal patients were not handed over. In contrast, all patients under a Community Treatment Order (CTO) were handed over (100%), likely due to legal requirements for coordinated care. Patients under Short-Term Detention Certificates (STDC) and Emergency Detention Certificates (EDC) had a near-equal split in handover rates. These findings suggest that handover processes are more structured for detained patients but remain inconsistent for informal admissions and transfers from hospitals and care homes.

Conclusion: Inconsistent handover practices for new admissions highlight a critical gap in communication. Findings highlight the urgent need for standardized handover protocols, including mandatory documentation for all admissions, to enhance patient safety and care continuity. Implementing structured communication frameworks, such as SBAR (Situation, Background, Assessment, Recommendation), may enhance handover reliability and reduce patient safety risks.

Improving handover communication is critical to minimizing patient safety risks and ensuring seamless transitions of care, particularly in psychiatric settings where detailed histories and individual care requirements are crucial. The absence of a structured handover posed risks of fragmented care, delayed treatment initiation, and insufficient awareness of patient-specific needs.

Future research should investigate barriers to effective handovers and evaluate interventions that improve adherence and patient outcomes in psychiatric settings.

Aims: Evaluate the frequency of mental disorders patients present with in different sites in SCCMHT to inform quality improvement to better match patient needs. To assess the non-attendance rate in various sites for future projects to explore factors associated with patient non-attendance. To quantify outcomes following patient reviews to explore discharge/follow up frequency.

Methods: The service evaluation was done retrospectively for three-month period from September to November, 2024, by collecting data from WCCIS database. Patient WCCIS identifiers were only stored in the spreadsheet used. Descriptive statistics were used to identify the most common diagnoses, outcomes, and non-attendance rates through various methods of stratifying the data. The data was compared when split between consultant clinics vs speciality doctor, Risca Health Centre Base vs Mill Road Base, and between urgent and non-urgent clinics.

Results: Mill Road and Risca OPA clinic had 172 and 76 appointments attended respectively over three months. Mill Road OPA had higher rates of non-attendance (26.18%) compared with Risca OPA (21.65%). Patients in Risca clinic are booked in for less frequent follow ups (72% with 4–6 months of follow up). A substantial percentage of patients being seen urgently are subsequently discharged from the CMHT (29%). This includes urgent patients seen in the Home Treatment Team Clinic, which often uses urgent consultant reviews to support discharge of patients. DNA rates are similar between consultant and speciality doctor clinic (23.2% and 25.85% respectively). DNA rates are approximately 1/4 across total clinics (24.84%). Despite a separate ADHD service and a supervised Physician’s Associate Clinic for ADHD separately, ADHD reviews still account for a considerable amount of outpatient clinic time (32 among 248 consultations). Similarly, PTSD/CPTSD and Borderline Personality Disorder account for a large number of urgent reviews (13 among 34 patients consulted).

Conclusion: DNA rates would require further assessment. They have not been included in analyses of diagnoses; a further exploration of the data is indicated to identify factors/diagnoses associated with non-attendance. A high prevalence of patients requiring urgent review are patients with borderline personality disorder and PTSD/CPTSD indicating Trauma Informed Approaches especially in crisis are required. Demands for ADHD assessments/follow ups remain high despite the presence of a ADHD service and Physician’s Associate Clinic (review of stable shared care patients). Patients remain under the CMHT even if they have no additional CMHT needs outside of Shared Care ADHD reviews, highlighting ongoing resource demand on the CMHT.

Aims: Immersive virtual reality has the potential to give people admitted on inpatient ward settings a break from these limited environments. This service evaluation reviewed the use of immersive virtual reality relaxation activities as a part of routine occupational therapy sensory sessions in an older people’s inpatient mental health ward for dementia and functional conditions. We assessed acceptability and feasibility by reviewing user experience and therapeutic engagement in terms of relaxation, engagement and interaction.

Methods: This evaluation was approved by Cambridge and Peterborough Foundation Trust Quality Improvement panel and assessed routinely collected data from 32 users (9 from dementia unit, 23 from functional unit) across a total of 158 sessions visiting nature scenes on a Pico 4 headset across an 11 month period in 2023. Demographic information included age, gender, mental health and other diagnoses, reason for admission, regular medication and legal status. Occupational therapy notes were assessed for subjective experience, positive and negative effects, interaction, therapy engagement, preferred scene, duration and repeat use.

Results: Average user age was higher on the dementia unit vs functional unit (77.5 vs. 74.5 years). Primary mental health diagnosis was a dementia subtype for most service users on the dementia unit (6/9) compared with a wider variety of diagnoses on the functional unit (depression or bipolar disorder 7/23 each; schizophrenia, alcohol related or delusional disorder 2/23 each; obsessive compulsive disorder, dementia, or personality disorder 1/23 each). Most service users on the dementia unit and functional unit (96% vs. 97%) reported a positive experience and therapists reported relaxation in most users (88% vs. 83%). Duration of use was shorter on the dementia unit compared with the functional unit (mean 5 minutes 36 seconds vs. 7 minutes 42 seconds) and repeat use was also lower (2.7 sessions vs. 5.4 sessions). No serious adverse effects were noted and <3% sessions resulted in any side effects.

Conclusion: This service evaluation demonstrates feasibility and acceptability of immersive virtual reality relaxation activities as part of routine occupational therapy sensory sessions on an older people’s mental health ward supporting services users with a wide variety of mental health diagnoses. Relaxation and calming were reported by therapists with no serious adverse effects. Many patients chose to return to the headset on multiple occasions especially on the functional unit where they completed longer sessions compared with the dementia unit. Research is planned into potential benefits for anxiety, stress reduction, sleep and medication use.

Aims: Intellectual Disability is defined as an IQ below 71. People with intellectual disability frequently experience menstrual distress leading to use of hormonal medications such as depot medroxyprogesterone acetate (DMPA). Despite risks like reduced bone mineral density (BMD) and weight gain, DMPA is widely used in this group, prompting an investigation into its suitability and associated risks.

Methods: A narrative review and local case series were conducted. PsycINFO and Medline were searched for articles post 1995 on contraception in people with intellectual disability post-menarche and pre menopause. The case series examined contraceptive use in 100 randomly selected menstruating people with intellectual disability. Data were collected on physical health issues. Primary care records were reviewed for contraceptive administration and risk discussions. Surveys were sent to DMPA users to assess awareness, risk understanding, and satisfaction.

Results: The review identified 27 papers which showed higher DMPA use in the intellectual disability population compared with the general population, and specific BMD risks. The case series found 23 people with intellectual disability using DMPA, and revealed knowledge gaps in risk and monitoring, inappropriate use given individual risk, and poor proactive risk management.

Conclusion: Findings indicate disproportionate DMPA use in people with intellectual disability, with inadequate clinical justification and risk awareness. Many women with intellectual disability and carers were unaware of additional BMD risks, and alternatives to DMPA were often not considered. Individualised contraceptive management and closer review of DMPA use in women with intellectual disability is needed. Monitoring could include DEXA scans, vitamin D and calcium supplementation, and weight management. Further research is needed on reasons for higher DMPA use and risks within the intellectual disability population.

Aims: Eating disorders are complex, serious illnesses that can result in physical and psychiatric co-morbidities, medical emergencies and progressive health consequences. The aim of this service evaluation was to explore current knowledge and understanding of eating disorders amongst medical students in South Wales, and evaluate current teaching and training.

Methods: Two separate cross-sectional web surveys were designed for final year medical students at Swansea and Cardiff Universities using Microsoft Forms. Participation was voluntary, and anonymised. Surveys consisted of eight Likert-based questions and one free text question, allowing participants to share personal details should they wish to participate in future data collection. The survey was disseminated via email between 7 and 14 October 2024.

Results: A total 16 final year medical students from Swansea and 21 from Cardiff completed the surveys.

Over 80% of medical students reported low confidence (rated as 5 or below /10) in their ability to describe the seven types of eating disorder. 90% of students from Cardiff and 75% of students from Swansea reported low confidence in their knowledge of the prevalence and their ability to describe a medical risk profile. 62% from Cardiff and 44% from Swansea reported low confidence in their ability to elicit symptoms of eating disorders and make diagnoses. As a result, only 38% of Cardiff students and 56% of Swansea students reported feeling confident (rated 6–10 /10) to assess the needs of patients with eating disorders and communicate with them effectively. Over 75% of the entire student cohort described low confidence in their ability to identify stages and types of management for eating disorders. Fewer than 10% of students from both Universities felt highly confident (8–10/10) that they would be able to describe medical emergencies in eating disorders.

The entire student cohort from Cardiff and over 80% of students from Swansea expressed dissatisfaction with the education and training provided on eating disorders.

Conclusion: There are significant gaps in medical students’ understanding of eating disorders and confidence in assessing and managing eating disorders is low. Eating disorders may be stigmatised, and this may introduce additional barriers to teaching and to clinical exposure.

This service evaluation highlights the need for a review of medical school curricula to confirm the provision of eating disorder teaching.

More effective and comprehensive teaching, and clinical exposure will be indicated in order to improve confidence and competence in the assessment and management of eating disorders amongst medical students before graduating.

Aims: Early intervention for psychosis (EIP) programmes are specifically designed mental health initiatives aimed at the early identification and optimal management of the initial stages of psychotic disorders. The successful launch, development and consolidation of EIP programmes typically span decades and involve many factors. While quantitative meta-analytic studies have assessed the overall efficacy of EIP programmes, there remains a need for more nuanced evaluations that delve into less quantifiable processes. Such detailed accounts are crucial for facilitating the optimisation of similar programmes, especially in settings with limited resources, but they are rarely available. This study provides a comprehensive account of the development and optimisation of an early intervention programme in Hong Kong over 24 years, offering pertinent insights particularly for low- to middle-resource mental health environments.

Methods: A narrative account by the author, who has led the service for over 20 years. The author also has regional and international experiences in early psychosis service. Key processes involved in the service’s development, consolidation, maintenance and refinement were described. Factors that facilitate, as well as those that constrain development, were explored. The inter-relationship between these factors over time was specified.

Results: This long-range exploration revealed a complex network of interacting factors which both facilitated and impacted the direction and fidelity of early psychosis programmes. The network is visualised with key processes as nodes, and the mutual influence between factors as links. The evolution of this network over time is described qualitatively. Key observations involve the impact of unexpected external factors, the emergence of new data, the transition of personnel, the changing demographics, as well as relationships with other mental health programmes. The ways in which these factors interact over time are discussed.

Conclusion: While some programme processes can be anticipated at initial planning, many factors emerged over time and were unlikely to be addressed by an initial planning process. There are also some inherent tensions between EIP and a public mental health system. A distributed constraint satisfaction approach is proposed as a more suitable approach (than centralised pre-planning) to real-life optimisation of EIP programmes.

Aims: The Early Intervention in Psychosis (EPIP) team in Singapore extended its remit to see 12–15-year-old patients presenting with diagnosed psychosis (not ARMS) in 2019. This program has been running for 4 years and a sizeable data set is now available on this group of patients. This is a novel service. Research and evaluation of this service will add to the understanding of how to configure services for this clinically challenging population.

Methods: De-identified operational data is available at the Institute of Mental Health. Data from 2019–2022 was extracted with the permission of the Data Protection Officer and de-identified through the Data Science Office. Patients aged 12–18 seen by EPIP from 2019–2021 were included in the study. This will allow 1 year’s data to be included and studied. Descriptive statistics looking at the demographics, orders, chargeable contact points with the hospital, admissions and payment information are described for this group.

Results: 78 patients were found from this dataset to have been included in the 12–18 EPIP program. In the 3 years 2019–2021, there were gradually increasing numbers of patients seen in this program, 21, 25 and 32 respectively. There were similar numbers of patients in the 12–15 age group as compared with those accepted into the service between 16–18. There was a higher representation of ethnic minorities and females into the program.

Conclusion: This is a new service looking at confirmed cases of psychosis in the younger age group 12–15. As an estimate, this figure is similar to the number of patients accepted to Early psychosis intervention programs aged 16–18. There is an over representation of females and ethnic minorities in this clinical population. There is a distinct need for services targeting this group of patients.

The effort required for analysis of operational data is high and dependent on the quality of the operation data repository. The current state of the data sets in IMH are not conducive for studying and may limit the reliability of the data presented here. Knowledge of the dataset and its clinical implications was required to be able to process the data. Further exploration of this data is planned.

Aims: Patients with Parkinson’s disease commonly have comorbid mental health conditions. There is a direct interplay between Parkinsonian and antipsychotic medication which can lead to difficult management decisions. Most mental health and Parkinsonian services are separate, with little coordination or communication between services. A multidisciplinary (MDT) clinic in Leicester was started two years ago to allow an MDT approach to the care of complex Parkinson’s patients. This is held by a geriatrician, an old age psychiatrist, and a Parkinson’s specialist nurse. The aim of this service evaluation was to formally evaluate the utility of the clinic.

Methods: We gathered quantitative information from the medical notes of patients seen between November 2023–May 2024, and qualitative information via interviews with carers and Community mental health team (CMHT) psychiatrists. Demographic data was gathered, as well as whether the patient was under a CMHT, whether there was a psychiatric component to appointment, and have we avoided hospital admission. Carers and CMHT consultants were asked about their experience of the clinic and whether the joint service was helpful for them.

Results: Notes of 23 patients were reviewed. Most had a primary diagnosis of Parkinson’s disease and were on two or more psychiatric medications (69.6%) and Parkinsonian medications (69.6%). 43.5% were already known to CMHT. Most had a clear psychiatric input to each consultation, such as medication change, cognitive assessment, or cancellation of CMHT appointment. The medical notes suggested 30.4% avoided CMHT referral and 17.4% may have avoided hospital admission. Six of the 23 patients had a reduction in carer strain.

CMHT consultants felt it was a useful addition which could lead to more timely care of patients. Both felt they were not confident in managing complex Parkinson’s patients or adjusting Parkinsonian medication and would have to refer to either geriatrics, neurology or Parkinson’s specialist nurses.

We interviewed three carers of patients. All were very happy with the care received, felt it was superior to the separate care they received before and felt they received more holistic and timely care. All felt it had reduced carer strain and prevented admission to hospital.

Conclusion: Carers and patients have benefited from the joint geriatrics, old age psychiatry Complex Parkinson’s clinic, compared with the separate care they were receiving before. Clinicians and carers feel it has allowed for efficient and holistic treatment of patients, avoided further appointments, avoided hospital admission in some cases and reduced carer strain.