Aims: It is well established that living, or growing up, in poverty has a negative impact on both physical and mental health. The area our service covers includes Great Yarmouth and Lowestoft, two of the most economically impoverished areas of the UK. The vast majority of our patient group will have grown up in relative poverty. While there are associations between poverty and impaired physical health and increased risk of some mental health conditions, the actual causal link is unclear.

This evaluation tried to consider the impact of poverty on future mental health, by evaluating current patient case load (this stood at 122 in Feb 2024). We considered all patients, their demographics (age, gender, diagnosis) and the factors listed above. This patient group is young people (18–25 years old), living in this area, under Mental Health Services, with or without a formal mental health diagnosis.

Methods: An analysis of current case load, recording demographics and noting diagnoses and factors associated with poverty, specifically:

Parental drug or alcohol abuse.

Parental mental health problems (if these are not well managed).

Early/premature death of a parent.

Exposure to domestic violence.

Physical abuse.

Going into the Care System.

Early drug or alcohol use.

Early separation or loss of a parent.

NB – Many of these factors will affect those who do not grow up in poverty (e.g. domestic violence and physical abuse) but they are noted to have a class and poverty association. Many, if not most, of our patients will have grown up in poverty but their mental illness does not have a specific association with poverty (e.g. OCD, Bipolar disorder).

Results: Our findings show that a significant percentage of our patient group have mental health issues directly related to poverty. Total number of patients =122. Number who have a specific factor associated with poverty =56. This equates to 46% of our current caseload. Gender: 35 female (62.5%), male 21 (37.5%).

Conclusion: “The poor bear the greatest burden of mental illness” (Office of National Statistics).

It is worth noting that the vast majority of our patient case load grew up in poverty, due to the demographics of the area we work in (a quick analysis suggests about 97% are from working class, impoverished backgrounds). We abandoned recording “parental unemployment” in this analysis, because for all but a few, this was the case. Unemployment is an entrenched issue in this area, with the demise of the shipping and offshore industries, currently standing at 5.4% in Yarmouth and 3.5% in Lowestoft (3) (National average 3.8%). For those that are employed, poverty is a significant issue with many in low paid jobs. I have also not included here factors associated with poverty, such as poor diet, smoking, malnutrition, poor dentition, and obesity, but we know these are the case for many patients seen here.

Recommendations: Given that this is the case, what can we recommend, in term of service planning and delivery? We have multiple issues here that affect our service delivery to this vulnerable patient group: geography (we cover a large geographical area, the need of this population, limited public transport – patient often have to travel some distance to be seen), staff recruitment (it would seem this area holds little appeal for new staff, especially Medics and Psychologists and recruitment uptake is low) and funding (do we need extra funding per head population, as this is such a deprived area?).

Aims: We reviewed the impact of reducing length of admission during COVID-19 for planned inpatient medically assisted alcohol withdrawal (MAAW) on relapse to daily alcohol use within one year.

We aimed to describe the demographic, social and medical characteristics of patients admitted for a planned MAAW, rate of relapse to alcohol use over time, and identify good aspects of care that improved outcomes.

Methods: A retrospective cohort methodology was used using electronic health records. Patients included were identified as alcohol dependent, admitted for a planned inpatient MAAW to a specialist unit within Swansea Bay University Health Board between January 2019 and June 2023.

Patients admitted from March 2020 to April 2022 were identified as the exposed group, and those admitted between January 2019 and February 2020 and May 2022 and June 2023 as the control group.

Results: 311 admissions for MAAW were identified (125 in the exposed and 186 in the control group). Demographic and medical characteristics were evenly matched. Mean length of admission in the exposed and control group was 6 and 10 days respectively. 57.2% of admissions had relapsed to daily alcohol use by 52 weeks, comparable with existing research.

Time-to-event analysis identified the median time to relapse as 22 weeks and 26 weeks in exposed and control groups respectively.

Hazard ratio of 1.20 (95% confidence interval 0.89–1.61, p-value 0.22) was found in the risk of relapse in the exposed group compared with the control group, suggesting a 20% higher risk of relapse in the exposed group compared with the control by 52 weeks. However, this was not statistically significant.

The hazard ratio for relapsing if discharged on relapse prevention medication (RPM) was 0.50 (95% CI 0.31–0.78, P-value 0.002), suggesting a 50% benefit to remaining abstinent at 52 weeks if discharged on RPM. Similarly, prescribing disulfiram after MAAW, had a hazard ratio of 0.39 (95% CI 0.26–0.58, P-value 0.000004), reducing the risk of relapse by 61%.

Conclusion: We were able to characterise the demographic and medical background of patients receiving planned inpatient MAAW, which will help in future design and delivery of specialist MAAW units. No evidence was found to support a reduction in the length of admission for an inpatient MAAW. RPM significantly reduced the risk of relapse, especially the use of disulfiram. Several combinations of RPMs were prescribed, highlighting the need to standardise prescribing of RPMs post MAAW.

Aims: Emerging research indicates a higher prevalence of Autism Spectrum Disorder (ASD) and Attention-Deficit/Hyperactivity Disorder (ADHD) among individuals with eating disorders (EDs) compared with the general population. Understanding this overlap is crucial for service planning, as neurodiversity assessments and tailored interventions require additional clinical resources. This study aimed to quantify the incidence of neurodiversity within a community specialist Child and Adolescent Mental Health Services (CAMHS) ED caseload to better predict workload demands and inform clinician training and treatment adaptations.

Methods: A cross-sectional survey was conducted among clinicians in a specialist CAMHS ED service. Clinicians were asked to report the number of patients on their current caseload with a formal diagnosis of ASD and/or ADHD, as well as those identified as requiring further assessment for these conditions. This methodology provided a snapshot of the prevalence of neurodiversity within active caseloads at the time of data collection.

Results: The total caseload was 96 patients. Of these, 22 (23%) had a confirmed diagnosis of ASD and/or ADHD, while 40 (42%) were identified as needing an assessment for neurodevelopmental conditions. In total, 65% of the caseload had either a diagnosis or a suspected diagnosis of ASD, ADHD, or both.

Conclusion: Our findings highlight a substantial overlap between eating disorders and neurodiversity in a community specialist CAMHS setting. The high proportion of young people requiring assessment underscores the need for integrated neurodevelopmental screening within ED services. Additionally, these results emphasize the importance of upskilling clinicians in neurodiversity-informed care and adapting treatment models to meet the needs of this population. Addressing these factors will be essential for optimizing clinical outcomes and resource allocation within specialist ED services.

Aims: Prenatal alcohol exposure (PAE) is a leading preventable cause of neurodevelopmental, mental health, and cognitive difficulties. This study evaluates the identification of Foetal Alcohol Spectrum Disorder (FASD) in a high-risk cohort of adopted and Children In Care (CIC) of the local authority, referred to Symbol Team, a specialist Tier 3 service for Children Looked After (CLA) and Adopted young people within Lewisham Child and Adolescent Mental Health Service (CAMHS).

Methods: Retrospective service evaluation was conducted on 91 children referred to Symbol Team in June 2023, who were assessed for mental health and neurodevelopmental concerns. Children were categorised based on confirmed Prenatal Alcohol Exposure (PAE) and other reported risks, including maternal alcohol misuse, drug misuse, tobacco use, mental health concerns, reduced antenatal care and a family history of substance misuse. Risk factors were identified through various reports including social service records.

Very High Risk (VHR): Confirmed PAE based on parental reports or hair strand tests.

High Risk (HR): Uncertainty regarding PAE but with 5 or more risk factors.

Moderate Risk (MR): Uncertainty regarding PAE with 3–4 reported risk factors.

Results: Of the 91 children referred, 58% (n=53) were categorised as high or moderate risk of PAE. Of these, 16% (n=15) were Very High Risk (VHR), 18% (n=16) were High Risk (HR), and 24% (n=22) were Moderate Risk (MR).

Neurodevelopmental concerns were high across categories, with symptoms related to Autism Spectrum Disorder (ASD) in 43% (n=39) and Attention-Deficit/Hyperactivity Disorder (ADHD) in 46% (n=42). In the VHR group ASD 14% (n=13) and ADHD 15% (n=14) concerns overlapped and similarly the HR group exhibited ASD 11% (n=10) and ADHD 12% (n=11).

Cognitive difficulties were reported by 52% (n=47) of children, with 15% (n=14) in VHR, 15% (n=14) in HR, and 21% (n=19) in MR groups. Mental health concerns like depression were seen in 2% (n=2) VHR, 2% (n=2) HR and 3% (n=3) MR groups. A total of 33% (n=30) received medication treatment, with 11% (n=10) VHR, 8% (n=7) HR and 14% (n=13) in MR groups.

Conclusion: Despite the high prevalence of neurodevelopmental concerns and risk factors, FASD identification and diagnosis rates were low. The study also highlights gaps in knowledge, diagnostic tools and clinician training across agencies. Some barriers include under-reporting and stigma associated with the diagnosis. Improved access to reliable records and standardised diagnostic pathways are needed to facilitate early identification of FASD in at-risk children.

Aims: The BSW (Bath, Swindon and Wiltshire) Community Physical Health Evaluation aimed to assess the implementation and outcomes of annual physical health checks for individuals with Serious Mental Illness (SMI) within the BSW region. BSW offer an assertive outreach approach for physical health checks by mental health specific nurses and support workers. The evaluation explored compliance with physical health check processes, follow-up practices for abnormal results, and the role of social deprivation in influencing health check uptake. It sought to identify barriers, assess adherence to policy guidelines, and recommend improvements for managing cardio-metabolic risk.

Methods: Data for the evaluation was drawn from the AWP (Avon and Wiltshire Partnership) electronic record system, focusing on cardio-metabolic screening forms and associated documentation. The sample period was for the financial year 2022/2023 with a total sample size of 21 service users (SU); 16 SU who received physical health checks, 4 SU who did not and 5 SU who are deceased. A literature review guided the methodological framework, focusing on studies and policies addressing cardio-metabolic risks in SMI populations. Data analysis examined compliance rates, abnormal result follow-ups, and the impact of socioeconomic factors.

Results: Compliance with annual physical health checks improved from 67% to 84%, exceeding the national target of 65%, set by NHSE. The rates of high blood pressure, dyslipidaemia and higher risk alcohol use appear to be lower in BSW than national averages. The rates of smoking, raised glucose, and obesity however are higher than national averages. Despite checks being done, the interventions recorded are low (43%) and care plans were in place for only 52% of the service users audited. Service users from socially deprived areas exhibited lower engagement rates, highlighting inequality in service access. Findings also emphasized the importance of assertive engagement strategies and specialized physical health training for mental health professionals.

Conclusion: While progress in compliance rates reflects successful implementation efforts, challenges persist in ensuring comprehensive follow-up care and addressing health inequalities. The evaluation recommends enhanced collaboration between secondary and primary care, improved training for staff, and targeted interventions for socially deprived groups to mitigate cardio-metabolic risks. Future efforts should focus on refining data-sharing processes and promoting integrated care to ensure sustained health outcomes for SMI populations.

Aims: Are neurodiverse university students, referred to Greater Manchester University Student Mental Health Service (GMUSMHS), receiving the Disability and advisory support services (DASS) input they are entitled to? If not, are GMUSMHS recognising this and signposting appropriately?

Methods: In the interest of improving equality and diversity, along with access to higher education, services to support the increasing numbers of neurodiverse students are available. GMUSMHS uses a needs-led approach, across the 5 Greater Manchester universities. It can also ensure those struggling with complex mental health needs, alongside neurodivergence, can be signposted to appropriate educational support/adjustments. Enabling them to thrive and reach their academic potential.

16 referrals mentioning Neurodiversity within the designated 3-month period were identified. Initial referral forms, GMUSMHS assessment notes and outcomes were reviewed for DASS input. There were no exclusion criteria.

Results: From our sample 69% had a working diagnosis of Autistic spectrum condition (ASC). In all cases, where the diagnosis was not confirmed, the student was offered screening or onward referral for diagnosis. Six of the students were not noted to be under DASS and were not documented to have been signposted. All students who engaged with GMUSMHS were offered an intervention, this included extended assessment, case management, formulation sessions, Connecting people, emotion regulation/compassion focused therapy group, and PTSD/trauma education group.

Conclusion: Neurodivergent students may not be accessing the educational support and adaptations they are entitled to. GMUSMHS are supporting referrals for diagnosis of neurodiversity. They are not, however, consistently documenting if these students are accessing, or have been referred to DASS. Raising awareness and improving a collaborative approach between GMUSMHS and DASS is required. Including prompts on referral forms and assessment proformas may be helpful. A neurodivergent service lead has been allocated and service development to improve access for this client group has begun.

Aims: Alcohol specific mortality and alcohol-related hospital admissions in England have continued to rise, with local statistics for Derbyshire worse than the national average. Alcohol Care Teams (ACTs) aim to improve the care received by those in hospital for alcohol misuse, with evidence showing they can reduce admissions, readmissions, and length of stay. Since ACTs have been stipulated in the NHS long-term plan, we wanted to gain insight into our local provision at the Royal Derby Hospital and the impact of the service two years post implementation.

Methods: Data relating to presentations, care provision, and outcomes were extracted from the electronic patient record system from September 2022 to August 2024. 3514 adults aged 18 years and over were referred to the ACT. Data regarding hospital admission rates, readmission rates, length of stay, and admission codes were requested from the University Hospitals of Derby and Burton Trust.

Results: Alcohol referral numbers have increased by 58%, with 76% of patients receiving an assessment or advice and guidance. For those not seen, 70% were discharged before an intervention could take place. 49% of patients had an AUDIT-C (Alcohol Use Disorders Identification Test for Consumption) score of 12, with scores over 10 indicating potential alcohol dependency and significant complexities. Alcohol-related readmissions have decreased with an overall reduction of 16.67% post-implementation despite an increase in readmissions across all hospital presentations. Length of stay for these patients increased from 6.56 days to 7.39 days in year one but dropped to 5.93 days in year two. 37.5% of referrals to the ACT were referred to, encouraged to self-refer to or already under the care of community alcohol services and 21% of patients were offered a FibroScan appointment with the ACT.

Conclusion: Based on local estimates of a readmission costing £2000, the service has demonstrated savings of £1.14 million in year 1 and £448,000 in year 2. Length of stay data for hospital admissions increased in year 1, but we suggest that this may be a proxy for poorer quality of care prior to the ACT, resulting in higher readmission rates. Despite the team evidently operating at their ceiling of capacity with clear unmet need remaining, the evaluation shows the success of our ACT. The service has improved the care offer for patients and has contributed to the reduction of the burden of disease within the hospital, positively impacting the wider system and providing evidence for the efficacy of these services.

Aims: There is good qualitative evidence in the literature of the challenges of transition from Child and Adolescent Mental Health Services (CAMHS) to Adult services at aged 18 faced by young people, their families or carers and professionals. Eating disorders typically present in adolescents and persist into early adulthood with an average age of onset at around age 18. This population is therefore often faced with the challenge of transitioning between services during periods of treatment. Some community eating disorder teams in the UK have started to move towards an all-age model, however, inpatient services do not seem to have kept pace with this change.

Methods: A literature search using PubMed was conducted to identify any publications relating to the transition between CAMHS and adult services in eating disorder treatment. An evaluation of the service at Cotswold Spa Hospital was done, and a review of admissions and discharges in the last year. The evaluation aimed to identify, understand and assess the ability to transition from CAMHS to Adult services in an eating disorder inpatient setting.

Results: Cotswold Spa Hospital is a private provider of NHS commissioned inpatient eating disorder treatment. It offers both acute inpatient and day patient eating disorder treatment to CAMHS and adult patients with the same treating team at one site. This allows the potential for young people to transition from CAMHS to Adult services whilst undergoing inpatient or day patient treatment, without the need to move setting during this most crucial part of their recovery. It is one of very few settings in the UK where this is possible at present. There are 8 CAMHS beds and 4 adult beds on different floors of the hospital, and the day unit is in a separate building. In the last year (2024) four patients were admitted aged 17 and continued their treatment at Cotswold hospital beyond their 18th birthday. Without this service it is likely that their care would have been interrupted with an inpatient transfer.

Conclusion: Transition between CAMHS and Adult services at age 18 whilst undergoing inpatient eating disorder treatment presents numerous challenges. Service evaluation identified Cotswold Spa Hospital offers a rare approach which can avoid this disruption to recovery by continuing care in the same setting.

Aims: Dual diagnosis is very common in patients who have a psychotic disorder. This impacts symptom severity, treatment outcomes, and relapse rates. Following multiple incidents of drug misuse on a high dependency unit and inconsistent staff approach in dealing with these issues, we recognized the need to assess staff knowledge as a first step toward providing effective patient care. The aim of this survey was to assess knowledge and skills of mental health professionals to manage patients who misused substances while being admitted to a high dependency unit.

Methods: Data was collected using an online questionnaire to evaluate staff’s knowledge and perception of substance-related mental health risks with occasional and regular use and their role in managing it.

Results: 23 professionals participated in this survey – psychiatric nurses, healthcare assistants, occupational therapist, and psychologists. 72% of respondents believed occasional cannabis use while 90% believed regular use could exacerbate mental illness, 100% agreed that cannabis worsened existing mental health conditions with 95% feeling the need to counsel patients against its use.

In terms of class A drugs, 95% agreed that occasional use could cause mental health problems, while 100% recognized that these substances used long term could lead to worsening of mental illness.

86% were aware of the importance of drug and alcohol history on admission with 81% believed in providing advice and guidance. 91% supported referral to COMPASS (Specialist Drug Services). 78% felt they could diagnose opiate overdose and 100% were aware of naloxone use in opiate overdose. 100% recognized the importance of urine drug screening while 76% supported searches without consent if necessary. 55% felt police should be notified, and 45% supported placing patients on a contract, where discharge is part of the contract if breached.

91% agreed that staff required specialist training. Knowledge of synthetic opioids was limited, with only 53% recognizing their impact on mental health.

32% staff believed occasional alcohol use could worsen existing psychosis, while 77% recognized risks of heavy intake. 100% agreed that alcohol exacerbates existing mental illness.

Conclusion: Mental health professionals on HDU demonstrated awareness of substance-related mental health risks, particularly related to class A drugs, chronic cannabis and alcohol misuse. However, variations in patient management approaches, and lack of knowledge about synthetic opioids indicate the need for enhanced training.

Aims: This project aims to assess staff awareness of the Physician Associate (PA) role and the impact of PAs on an acute male psychiatric ward and a male psychiatric intensive care unit (PICU) in Kent and Medway NHS and Social Care Partnership Trust (KMPT).

PAs are integral to supporting the effective functioning of inpatient psychiatric wards and contributing to service development. At KMPT, there are currently five PAs working across 5 inpatient wards with 880 combined admissions last year. Bed pressures have increased annually, making consistent medical support essential. PAs, due to the nature of their role, can provide continuity and act as a key point of contact for staff.

Hypothesis: We hypothesize that staff may have limited awareness of the PA role due to its recent introduction in the trust, but that PAs will have a positive impact on patient care in mental health settings.

Methods: Data was collected through a survey to assess staff understanding of the PA role and its impact on patient care, collaboration, and team dynamics. Staff across various multidisciplinary team (MDT) roles, including the medical, nursing, occupational therapy, and psychology teams in the male PICU and a male acute ward were surveyed.

Results: A total of 32 responses were received.

Staff Awareness: 81.2% reported working closely with PAs daily. While 65.6% were very familiar with the PA role, 31.2% were somewhat familiar. Notably, 17.15% mistakenly believed PAs can prescribe medication and order ionizing radiation investigations.

Impact on Patient Care: 81.25% reported PAs made a significant impact in assessing and diagnosing physical health conditions, compared with 50% for mental health conditions. 64% said PAs significantly improved patient communication and engagement with carers.

Collaboration and Team Dynamics: 65.6% found PAs to be “very effective” in collaborating with the MDT. 58.3% agreed that PAs significantly reduced workload and administrative burden, improved continuity of care, and provided a consistent point of contact for ongoing care.

Overall Impact: 71.8% of staff reported a “very positive” impact of PAs; 28.1% felt it was “positive”; and 93.7% recommended expanding the role to other mental health services.

Conclusion: This survey shows most staff have daily contact with PAs; are familiar with their role; and believe PAs have a significant positive impact on patient care, collaboration, and continuity of care in inpatient mental health settings. However, there are knowledge gaps about specific limitations of the PA role, suggesting a need for further education to enhance staff understanding.

Aims: The on-call doctor at Bushey Fields Hospital, Dudley, has multiple responsibilities out-of-hours, including covering 5 wards (both general and older adults), clerking new admissions, attending reviews with the Psychiatric Liaison Team, receiving calls from CRHTT for medication advice, and carrying an arrest bleep for emergencies.

Resident doctors’ meetings have raised the issue of admissions frequently occurring out of hours, and that doctors are often unaware until the patient has arrived, giving less time to prepare. These lead to patients and ward staff waiting at late hours for assessment, delays in prescribing and administering medications, and increased workload for the on-call doctor.

The aims of this project were to: determine during which shifts patients are most commonly admitted; determine a timeline of when the bed is identified, when the patient arrived, and when clerking is completed; and look into how to involve doctors more in the process.

Methods: This was a retrospective audit conducted on admissions to all 5 wards at Bushey Fields Hospital from August to November 2024 (inclusive). The Trust audit department provided data, including patient demographics, admitting ward, day and time of admission, and whether this was in or out of hours. Out of hours shifts were established as any shift outside of 9 am–5 pm Monday to Friday.

Additional data was collected from notes on the Trust’s online system Rio; this included the date and time a bed was identified, when the clerking proforma was started, and what shifts these occurred on. 10 patients were selected at random from each ward, for a total sample size of 50 patients.

Results: During the time frame evaluated, there were 180 total admissions, of which 15% (27) were in hours, and 85% (153) were out of hours.

Of the 50 randomly selected patients, the bed was identified on a day shift for 50% (25), but 84% (42) were admitted out of hours. For 90% (45) of patients, the clerking process was started out of hours, and for 76% (38), the clerking document was started after the patient’s arrival.

Conclusion: As the results show admissions largely occur out of hours, we have suggested several recommendations. These include informing doctors of admissions beforehand, and for the patient’s parent team to pre-fill the clerking proforma sections about demographics, background and history to reduce the workload for the on-call doctor, as the document can be edited.

Aims: The NHS Southern Gambling Service (SGS) opened in 2022, and provides evidence-based assessment and treatment for people affected by gambling disorder across the South East of England. It is known that gambling venues are often placed in highly deprived areas, where populations vulnerable to gambling disorder reside. Little is known about whether geographical presence of gambling venues is linked to higher rates of referrals for gambling disorder to clinical services. The aims were to draw insights on the association between the incidence of referrals at the SGS and number of registered gambling venues across the geographical footprint of the regional service, while we adjust for indices of multiple deprivation.

Methods: Service level data for referrals per Low-Tier Local Authority (LTLA) level were merged with open access national datasets for indices of multiple deprivation (Office for National Statistics 2021) and number of gambling venues in each area (Gambling Commission 2024). Linear regression analyses were performed in-sample to identify the strength of the associations between the number of referrals and number of registered venues, adjusted for indices of multiple deprivation (IMD). This service evaluation was pre-registered with the Hampshire and Isle of Wight Healthcare NHS Foundation Trust Clinical Effectiveness team. All data analysis was conducted in R version 4.4.2.

Results: A total of 668 participants were referred to the SGS from September 2022 to end of November 2024. The correlation between venues and referral incidence was strong (Pearson’s r=0.58, p<0.001). Number of venues per LTLA were statistically associated with incidence of referrals to the SGS (t=3.9, p<0.001) including after adjusting for IMD indices. The model which included only the number of venues as a predictor explained 33.3% of the variance in incidence rate (R²=0.3325, p<0.001).

Conclusion: Number of gambling venues was strongly associated with incidence of referrals to the SGS. This association remained strong even after adjusting for indices of multiple deprivation. These insights can help the SGS in the strategic planning of development and utilization of its future resources, and highlight the need to examine sources of referrals nationally and links to contextual factors such as presence of gambling venues. Further work is warranted to define the optimal granularity for dissecting the geospatial links between the location of gambling venues and referrals to NHS Gambling Treatment Services, to further establish the stability and generalizability of these findings, as well as to explore a broader range of implicated bio-socio-economic factors.

Aims: Concerns about the inadequacies in eating disorders (EDs) training are widely acknowledged. Through this comprehensive project, we aim to delve deeper in identifying knowledge and training gaps regarding EDs in Wales. The specific aims are: to ascertain gaps in understanding of EDs amongst psychiatry trainees in Wales, and to evaluate the current teaching and training offered to them.

Methods: Between 7 and 14 October 2024, two cross-sectional, Microsoft web surveys were distributed among core trainees’ year 3 (CT3s) and higher trainees (HTs) in psychiatry across Wales. Participation was voluntary and anonymised. Surveys included seven Likert-scale questions and one free-text question. Postgraduate teaching and training on EDs between August 2023 and August 2024 by Health Education and Improvement Wales (HEIW) and the six university health boards (UHBs) offering psychiatry training were also surveyed.

Results: A total of 28 HTs and 13 CT3s completed the surveys. Over 60% of trainees reported low confidence (rated 5 and below) in describing various EDs, their prevalence, and risk profiles. Only 50% of HTs felt confident (rated 6–10) diagnosing EDs compared with 69% of CT3s. Additionally, only 57% of HTs felt confident in communicating with people with EDs and assessing their needs, compared with 77% of CT3s. Furthermore, 75% of HTs felt unsure about the stages and types of EDs management compared with 54% of core trainees. On the other hand, 85% of CT3s and 68% of HTs felt confident in describing medical emergencies in EDs.

Above 80% of trainees expressed dissatisfaction with education and training provided. No ED-related postgraduate teachings or specific placements were offered across most UHBs during the review year. Exposure to ED patients was primarily through Child and Adolescent Mental Health Services placements, with limited opportunities based on trainees’ interest. HEIW offered one teaching session on EDs to each CT1 and CT2/3 cohorts; however, the CT1 session was cancelled. Since 2023, HEIW has been funding the Royal College of Psychiatrists’ ED credential for interested HTs in Wales.

Conclusion: The noticeable gaps in trainees’ understanding and training in EDs highlight the urgent need for improved educational and training programs. To effectively address these gaps, gaining insight into trainees’ perspectives and working collaboratively with trainers can lead to the development of more effective training strategies.

Aims: Obsessive-compulsive disorder (OCD) is a condition characterised by remitting and relapsing symptoms that can be debilitating, significantly impacting a young person’s daily life. Individuals with this condition experience distressing symptoms that include obsessions in the form of repetitive, intrusive thoughts and compulsions manifested as persistent rituals. All children and young people with OCD should be offered guided self-help, psychological support, and pharmacological treatment options tailored to the patient’s developmental age. This audit aimed to evaluate the clinical management of OCD in children and adolescents at the Behavioural Science Institute, Al Ain Hospital, United Arab Emirates. We analysed compliance with the standards set forth in The National Institute for Health and Clinical Excellence (NICE) Guideline 31 regarding the diagnosis and management of OCD in children and young people.

Methods: This hospital-wide audit involved a retrospective review of electronic case notes. A questionnaire was developed to anonymously capture the necessary information. The audit sample consisted of 39 service users diagnosed with OCD who were treated in the child psychiatry clinic between January 2019 and December 2023. Data collection occurred between April and June 2024.

Results: Of the 39 patients, 20 (51%) were male, with 18 (46%) being Emirati citizens. The age range of the sample was between 7 and 15 years, with a mean age of 9.4 years. Among the 39 patients, only one received clear, guided self-help materials in the form of access to an interactive app for breathing exercises and relaxation strategies. Thirty-two (82%) of the patients received psychotherapy, with the number of sessions ranging from 1 to 28. Psychotropic medications were administered to 28 (72%) of the patients, all treated with a selective serotonin reuptake inhibitor (SSRI). Sertraline was the most commonly prescribed medication, followed by fluoxetine and fluvoxamine.

Conclusion: This audit has identified areas for improvement in the current practice of treating OCD among children and adolescents, including the need to develop local guidelines, increase access to self-help materials for patients, and enhance the services provided for psychotherapeutic interventions. We recommend improved staff training to enhance the quality of discussions with the young person and their family, which may help increase compliance with psychotherapy. A re-audit of the practice will be conducted one year after the implementation of the aforementioned action plan.

No financial sponsorship has been received for this evaluative exercise.

Aims: Lithium is a well-established mood stabiliser used for conditions such as bipolar disorder, mania, and depression. Given its narrow therapeutic index, regular monitoring is essential to prevent toxicity, which can cause confusion, seizures, coma, or death. This audit evaluated long-term lithium monitoring compliance for adult community-based patients at the Behavioural Science Institute, Al Ain Hospital, United Arab Emirates. We assessed adherence to local hospital guidelines, which align with The National Institute for Health and Clinical Excellence (NICE) Guideline CG185, recommending six-monthly checks of serum lithium levels, thyroid function, renal function, calcium levels, and BMI, with some patient groups requiring more frequent testing notably older adults, those taking medications interacting with lithium, and patients at risk of kidney, thyroid, or electrolyte abnormalities.

Methods: This retrospective audit reviewed electronic case notes of 38 patients on long-term lithium therapy under community mental health services from January 2018 to January 2019. A questionnaire was developed to capture the necessary information anonymously. Data collection occurred between March and May 2024.

Results: Of the 38 patients, 20 (53%) were male, with an age range of 20–64 years and a mean age of 35.2 years. The most common diagnosis was bipolar disorder, which accounted for 44.7% of cases, followed by schizoaffective disorder at 18.4% and major depressive disorder at 10.5%. Regarding six-monthly monitoring, serum lithium levels were measured in 25 patients (65.8%), with documented reasons provided for only six of the 13 patients who did not undergo testing. BMI was monitored in 36 patients (94.7%), while thyroid function tests were conducted for 31 patients (81.5%). Renal function was assessed in 27 patients (71%), with urea and electrolytes checked in 32 patients (84.2%). Notably, serum calcium levels were measured in only three patients (7.8%), highlighting a significant gap in monitoring adherence.

Conclusion: The audit revealed considerable inconsistencies in lithium monitoring, particularly in the assessment of serum lithium and calcium levels. To address these gaps, we recommend enhancing staff training on lithium prescribing and monitoring protocols to ensure adherence to guidelines. Optimising electronic prescribing systems to generate automated reminders may improve compliance, while better documentation practices are needed to ensure that any deviations from standard monitoring are appropriately justified. A re-audit will be conducted one year after implementing these measures to evaluate their effectiveness.

No financial sponsorship has been received for this evaluative exercise.

Aims: Clozapine is a cornerstone in treating resistant schizophrenia, with evidence linking threshold plasma levels to positive clinical outcomes. The Maudsley Guidelines recommend levels of 250–420 µg/L for an adequate trial. Our trust requires trained staff to collect venous samples, with results taking several days. The updated clozapine pathway suggests checking levels at initiation and 12 months, prompting consideration of the Saladax MyCare Insite Analyzer. This point-of-care device uses a finger-prick sample and delivers results in 7 minutes. Despite promising studies, its effectiveness depends on local acceptance, warranting a pilot.

Aims were:

To evaluate the acceptability of the finger-prick test among patients and staff.

To enhance patient care with a quicker method, enabling timely referrals and decisions.

Methods: Clozapine testing was conducted at Lyme Brook Clozapine Clinic (23.10.2023–17.11.2023) using the Saladax MyCare Insite Analyzer on pin-prick samples, with prior patient consent and staff training. Separate anonymised questionnaires were provided for staff and patients.

Results: Patients (n=31) were aged 21–70 years (64.5% male, 35.5% female), majority follow ups (64.5%).

96.9% of tests were completed within 15 minutes (32.3% within 0–5 min, 58.1% within 5–10 min, 6.5% within 10–15 min, 3.2% within 15–20 min). Compared with venous blood tests, 87.1% had a positive experience, 90.3% were satisfied with the test and care received, and 90.4% valued the time-saving benefits. Overall, the test was acceptable to 90.3%, and 71.0% preferred the finger-prick test (22.6% unsure) over venous, with 90.3% willing to use it again (6.5% unsure), and 83.9% would recommend it (9.7% unsure). 97% reported no issues, with only one instance of test repetition.

Staff (n=32) were aged 31–64: 56.3% doctors, 6.3% nurse associates, 12.5% STRs, 25% trainee nurse associates; 68.8% female, 28.1% male.

96.9% completed testing within 15 minutes (0–5 min: 9.4%, 5–10 min: 62.5%, 10–15 min: 25%, 3.1% unspecified). 96.9% highly rated their experience (3.1% no response), while 100% valued time efficiency, ease of use, and care quality. 93.8% found it acceptable (6.3% neutral). 94% reported no issues, with one test repetition. All staff preferred the finger-prick test and wished to continue using it.

Conclusion: The pilot project showed strong acceptability of the finger-prick method among patients and staff, with high satisfaction, minimal issues, and improved time efficiency. Both groups preferred it over venous testing, supporting its potential to improve patient care.

Further evaluation of cost-effectiveness, clozapine pathway integration, and training for wider implementation across trust is recommended.

Aims: To explore factors in service design that can account for difference in length of stay (LoS) in acute inpatient care for general adult patients between a public mental health service in London, North London Foundation Trust (NLFT) with one in regional Australia, South West Healthcare (SWH).

Methods: Information was gathered from the mental health organisations as below:

1. Data comparison of the 2 services over the period Nov 2023 to Dec 2024 relating to patient flow.

2. Comparison of service design in the two systems such as staffing levels, availability of supporting services and clinical practice.

3. Audit in each service comparing factors that can affect LoS.

Results: SWH had a shorter length of stay compared with NLFT (13 vs 43 days) in keeping with national and statewide comparison of LoS. Re-admission rates were also lower in SWH (9% vs 15%). There was a significant difference in the number of very long stayers (>60 days) with no such patients in the Australian service.

NLFT had a higher proportion of patients admitted formally (88% vs 65%) and a higher proportion of patients with a psychotic disorder (85% vs 75%).

The service comparison demonstrated higher levels of senior medical input available in the Australian service (1.2 vs 0.6 FTE per 10 patients) and medical staffing in general and more frequent reviews with a Consultant Psychiatrist (4 times weekly in SWH vs once a week in NLFT).

The audit showed more frequent use of high-dose antipsychotic prescribing at discharge (25% vs 18%) and higher amounts of antipsychotic doses in general in the Australian service (79% vs 59% of BNF Maximum Antipsychotic dose) at discharge.

Conclusion: The difference in LoS between the services is consistent with benchmarking data. The service evaluation identified several factors that might explain the difference.

There were more patients admitted with psychosis and a higher use of formal admissions in the UK service, both associated with longer LoS.

There were higher levels of medical staffing and in particular Consultant and Registrar levels in SWH. This is likely to explain the difference in frequency of senior reviews for patients in SWH which may result in frequent changes in management plans. The results suggest the use of higher doses of antipsychotic prescribing in SWH.

Staffing models and prescribing practice is likely to impact LoS. It would be important to consider differences in patient experience in the two systems in future evaluations of services.

Aims: Smoking contributes to poor mental health and increases inequalities in physical health and premature mortality. Smoking is a leading contributor to the 7–23-year lower life expectancy among people with severe mental illness (SMI) compared with the general population.

In Wales, an estimated 14.1% of people are smokers. Smoking is much more common (33% prevalence) among people with mental health conditions and is even higher among those with SMI (40.5% prevalence).

Welsh Government commissioned NHS Wales’ Joint Commissioning Committee and RCPsych Wales to develop a framework to help reduce smoking rates among people with mental health conditions in Wales.

The framework sought to address three priority areas for action:

Address misperceptions about smoking in mental health settings.

Improve implementation of quitting strategies in mental health settings.

Address the lack of data on smoking and quitting among people with SMI.

Methods: In partnership with the Public Mental Health Implementation Centre; a review of data, current interventions, policy and strategy across Wales was undertaken.

This was complemented by consideration of:

Overview of current evidence-based strategies in Wales.

Scaling evidence-based interventions for smokers with mental health conditions and SMI.

Addressing misperceptions among smokers and health professionals.

Upskilling mental health professionals to enable them to motivate and support quit attempts.

Results: In addressing the three priority areas for action, the framework focused upon:

Understanding local needs and assets.

Working Together.

Taking action for prevention of smoking, mental health promotion, and reducing inequalities.

Evaluation and measuring outcomes.

Additionally, a deficit in the following areas, led to several recommendations:

Provide training resources for upskilling people working in mental health to support smoking cessation.

Review and augment the implementation strategy for Help Me Quit and the Tobacco Control Delivery Plan to support people with mental health conditions.

Improve accessibility to nicotine replacement therapy (NRT) and other smoking cessation medication. People wanting to quit should have access to more than one quitting aid.

Address data gaps by collecting reporting information on rates of smoking, including among people with mental health conditions.

Conclusion: Several next steps are necessary to reduce smoking among people with mental health conditions in Wales:

Develop an implementation strategy for the Tobacco Control Delivery Plan to target people with mental health conditions including SMI.

National campaigns promoting positive mental health should include messages about the mental health harms of smoking.

Major gaps in data on smoking and quitting must be addressed.

Aims: This project aimed to evaluate our transition service for young people, from Child & Adolescent Service (CAMHS) to Adult Mental Health Services (AMHS), and to audit NICE transition guidelines compliance.

Methods: A retrospective case note survey of complex patients who had transitioned between January 2021 and September 2024 was undertaken. NICE Guideline standards on transition were compared with current practices.

Results: All individuals had been seen by a consultant psychiatrist prior to transitioning, usually with diagnoses confirmed, and medications stabilized.

37 participants were female and 7 male. 38 were transferred to community mental health team (CMHT), 3 to a learning disability team and 3 to early intervention in psychosis service.

13 participants had a diagnosis of bipolar affective disorder. 21 had a diagnosis of autism spectrum disorder (ASD) and 5 had attention deficit hyperactivity disorder (ADHD). A few awaited diagnoses confirmation. Emotionally unstable personality disorder was the second most common diagnosis, seen in 8 cases.

Individuals with severe anorexia nervosa and possible autism proved the most difficult to engage in treatment following transition. Most individuals continued to be managed in the community. Only 3 required brief admission to hospital for a maximum stay of 3 days.

Only one had contact with the criminal justice system.

Two continued to receive care from CAMHS post 18th birthday, as they didn`t meet the adult service eligibility criteria.

We compared our current practices with NICE standards. There was good compliance with most, other than Standard 1, regarding age at transition planning. Adult service policy was to identify a named worker only a month before the young persons` 18th birthday. Hence, most individuals transitioned aged 17 years and 11 months.

There was NICE compliance for having a coordinated transition plan, a named worker to coordinate transition care and support before, during and after transition., and a patient meeting practitioner from each anticipated adult service.

Conclusion: This review has helped us in confirming that our transition pathway is largely effective in transitioning complex and enduring cases to adult services and has identified gaps which require attention. We believe that having a dedicated consultant psychiatrist providing continuity of care, pre and post transfer has been pivotal in reaching these goals.

Additionally, good and early patient preparation, and focused, prioritised, multidisciplinary support for complex cases has been crucial.

Aims: The aim of this study was to explore the experiences and challenges faced by staff in pediatric wards when managing young patients with complex emotional and behavioural difficulties. It sought to understand the specific nature of these challenges, their impact on healthcare providers, and to identify potential strategies for improvement, particularly focusing on the staff’s interaction with Child and Adolescent Mental Health Services (CAMHS).

Methods: The study involved a qualitative survey of 16 healthcare professionals, including 12 nurses, 3 administrative or support staff, and 1 doctor, working in a Paediatric ward setting. Open-ended questions were used to gather detailed insights into the staff’s experiences. The responses were then segmented and analysed, focusing on the nature of the challenges faced, the impact on staff, suggestions for improvements, and the dynamics of their relationship with CAMHS.

Results: The survey revealed a multifaceted set of challenges. Staff reported a significant knowledge gap in managing patients with complex emotional issues, often leading to feelings of inadequacy and stress. These challenges were not just clinical but also emotional, affecting staff morale and mental health. The responses underscored the need for better support, specialized training, and enhanced resources. A recurring theme was the pivotal role of CAMHS, with staff expressing a need for more effective collaboration and communication. The data also hinted at nuanced challenges, such as dealing with manipulative behaviours, difficulty in patient–family interactions, and the emotional toll of such encounters. These findings highlight the complexity of emotional and behavioural management in pediatric care, extending beyond patient interaction to encompass broader aspects of the healthcare environment.

Conclusion: The study confirmed that Paediatric ward staff face considerable challenges in managing young patients with complex emotional difficulties. These challenges go beyond clinical management, significantly impacting the staff’s emotional well-being. The findings point to an urgent need for targeted training and support initiatives, along with stronger collaborative ties with CAMHS. Implementing such measures could lead to improved patient care and staff satisfaction. Additionally, regular debriefing sessions and feedback mechanisms are recommended to continually adapt and optimize care strategies in Paediatric wards, ensuring a resilient and empathetic healthcare environment.