The concept of “decolonisation” has gradually evolved within higher education, and can be defined as seeking to discern how historical systems of discrimination have shaped the networks around us, and how to adjust to the perspectives of those who have been oppressed and minoritised by these systems. Our aim was to assess what gaps there are in the Edinburgh Medical School psychiatry curriculum, in order that this might inform our next steps in “decolonising” the curriculum.

We reviewed all the teaching materials used for teaching Year 5 Psychiatry at the University of Edinburgh (n = 101). We made a count of the number of people or cases in each resource and the diversity of examples used. We subsequently examined each resource to see if it touched on each of six key areas considered to be representative of a “decolonising” effort. These were the assignment of gender only where necessary, cultural/religious differences, historical context, health inequalities, the patient-doctor relationship and global topics.

Of the resources where each of the criteria were applicable, 18% only assigned gender where necessary or left gender neutral, 4.35% addressed cultural or religious differences, 5.8% discussed the historical context, 4.35% tackled health inequalities, 1.45% raised the doctor-patient relationship and none introduced global topics. Of all the resources that include a direct reference to a patient or case, only 5.41% were explicitly from a different ethnic group other than “white”.

Our results show that all the key areas can be improved on. Addressing these issues has not been a focus for the curriculum before now and our next steps will be to approach each topic in turn and consider how the key areas can be introduced. We are assembling a focus group of psychiatrists and medical students and have designed a survey for students who have completed their psychiatry block.

With time, we hope to cultivate an attitude amongst students and teachers of psychiatry at Edinburgh University that boldly confronts the historical development of our subject, acknowledges those who have suffered for it, picks up on what may be missing or misrepresented, and encourages critical analysis of research. Our teaching materials should include examples which explore stereotypes and challenge prejudices. By broadening our repertoire, confronting the darker parts of our history, listening to those with quieter voices, and paying attention to lived experience, we can foster a culture of teaching and learning which is open, flexible and humble.

Due to the high rates of mental disorder in prison there have been a number of initiatives to divert mentally disordered offenders out of custody. One of these is the Mental Health Treatment Requirement (MHTR): a criminal sentence available as part of a Community Order, offered as an alternative to short-term custodial sentences in an attempt to address recidivism and encourage concordance with community psychiatric treatment. In spite of the prevalence of mental disorder amongst offenders, MHTRs represent less than 1% of all community sentences. Here we aim to identify obstacles to the use of the MHTR at sentencing and to suggest ways of overcoming them.

A literature review and brief case series will be used to identify and illustrate what may be obstructing or limiting the use of the MHTR. The terms ‘MHTR’ and ‘Mental Health Treatment Requirement’ were searched on Google, Google Scholar, Athens, and PubMed, and results analysed for recurrent themes. The issues encountered clinically by one of the authors who referred three defendants for MHTRs in psychiatric sentencing reports in 2021 were reviewed with the same purpose.

The main barriers to the use of the MHTR which were identified were issues related to a lack of clinician awareness and experience, homelessness and housing, and service structure and provision. There may be a reluctance for Community Mental Health Teams (CMHTs) to accept offenders onto their caseloads, and there are challenges in obtaining assessments and recommendations for MHTRs. There are difficulties in securing an MHTR for homeless defendants on remand for whom identifying housing prior to sentencing, and thus a CMHT to supervise the MHTR, can be challenging. The MHTR assessment and referral process is more lengthy and cumbersome than that for most other disposals, leaving the defendant awaiting sentencing (potentially in custody) while the referral is processed.

Suggested solutions to improve access to the MHTR include increasing clinician awareness and confidence by providing teaching and training, and multi-agency meetings to enhance communication and create an understanding amongst professionals of duties, roles, and responsibilities. Initiatives to identify housing for homeless remand prisoners before their release, as well as ensuring the availability of community services to supervise treatment, would overcome some of the obstacles identified and increase availability of the MHTR. Funding for additional staff to conduct the assessment and referrals process would also be likely to improve uptake.

Currently, practice is that if patients of childbearing age provide a urine sample on admission they will also be consented to test for pregnancy. As many new patients may refuse to provide a urine sample often due to their mental state or concerns about drug testing this results in some patients not being tested for pregnancy during admission unless required for medication or at patient request. Given the high level of vulnerability and the medication implications for pregnant patients, ascertaining pregnancy status early on in admission is beneficial to patients found to be pregnant. Therefore, we aimed to audit how pregnancy status is assessed and documented on admission and aim to improve the practice where areas for development are identified.

Over the 6 month period July-December 2021 there were 105 inpatient admissions on an acute female psychiatry ward. Using a random number generator 15 patients from this cohort were selected and their notes audited as to whether a urine pregnancy test or bHCG serum pregnancy test was completed on admission. If not, we searched the admission notes for documentation of ‘pregnancy, last menstrual period (LMP), sexually active status, contraceptive use’.

Of the 15 patients audited, 7 had a documented urine pregnancy test on admission (47%). Of the 8 patients that had not had testing only 1 patient had documentation of contraceptive use prior to admission, the other 7 non-tested patients had no notes regarding their LMP/contraception. 2 patients who did not have a pregnancy test had in fact had a urinary drug screen on admission, this coincided with a time of approximately 1 month when there were no urine pregnancy test strips available on the ward. At this time serum bHCG or LMP were not routinely used. One of these patients was found one month later to be pregnant.

We propose based on our findings that a more robust enquiry as to the risk of pregnancy should be conducted on admission for female acute inpatients. We have made recommendations that this should be in the form of a checklist to be conducted as part of the nursing admissions assessment such that if a urine sample is refused then a form detailing LMP, contraceptive use and any recent unprotected sexual activity will be completed. This can then be reviewed by the medical team prior to commencing medications. The use of this checklist will be reaudited between January-June 2022.

To improve the information exchange between oncall junior doctors and ward teams between shifts including outstanding tasks, alerts and prompts to update clinical record systems accordingly (Rio). We aimed for the handover to be circulated to the correct recipients in 95% of cases as well as to improve its content. This would minimise loss of information and improve patient safety.

Handover document set up on MS Teams which is accessed by oncall junior doctors and day teams and can be updated live. Relevant training was offered to trainees during induction. We measured the number of days the document is updated and distributed and also measured the tasks not completed or not documented. We measured doctors' satisfaction via a survey.

We found that on average the handover document is updated and circulated correctly at a rate of 94.8% since the new MS Teams system was implemented. Participating doctors' survey showed that they felt that this system is safe and easy to use as well as reliable and more efficient than the previous system. They also noted that the training they received during induction was helpful and sufficient.

The digitalisation of the handover process using MS Teams, developed and improved through various PDSA cycles, has resulted in a system which the users find efficient, safe and easy to use. This leads to minimisation of information losses and improves patients' safety.

The project aims to address the barriers faced by the acute hospital and the psychiatry department in the referral process for a psychiatric opinion, at Tameside General Hospital (TGH). The Care Quality Commission (CQC) undertook a review of how people's mental health needs were met in acute hospitals in 2017 and concluded that there were barriers to this, for multifactorial reasons. Examples included: acute hospital staff not feeling adequately prepared to treat mental health conditions and lack of mental health care services 24/7. The current referral process at TGH for the acute hospital doctors requesting a psychiatric opinion presents a challenge for the referring doctor and psychiatry doctor in receipt of the referral. Many at the acute hospital have found the process of referral unclear, and many in the psychiatric department have found that referrals seldom contain sufficient information to determine whether a psychiatric review is required and whether it needs to be prioritised.

To understand the specific difficulties encountered during the referral process, two questionnaires were created. One for TGH acute trust doctors and one for the psychiatry doctors, asking what the perceived barriers were and how these could be overcome. Data were collected between September and October 2021.

We obtained results from 17 acute trust doctors. The results revealed that most referring doctors found the referral process unclear. 100% agreed that they would benefit from guidance with the referral process e.g., a psychiatry specific referral form and/or a flow chart outlining the referral process. All responders wanted guidance around the roles and responsibilities of the psychiatric team in relation to the hospital setting.

We obtained results from 7 psychiatry doctors. Most were not satisfied with the referrals received. 100% would like to see a specific psychiatry referral form implemented in the acute hospital.

Key findings were: the referral process is unclear, acute trust doctors don't feel well enough equipped to manage mental health concerns, referrals don't contain sufficient patient information, and that the acute trust doctors don't know where to ask for help. The project reflected earlier CQC findings.

After discussion with the acute trust, our action plan includes creating a psychiatry-specific referral form, to be distributed together with a flow chart which directs acute trust doctors to the appropriate source for psychiatric opinions. We also aim to join departmental and junior doctor teachings regularly to distribute and educate on the process.

The MSc Psychiatry at Cardiff University is an established postgraduate programme offering students a sound theoretical basis in psychiatry as a medical science and specialty. The programme currently offers six taught modules (focusing on mood and anxiety disorders, psychosis, old age psychiatry, forensic psychiatry, substance misuse, and child and adolescent psychiatry), as well as a dissertation module that students complete towards the end of the programme. In catering for the professional needs of clinical students and students pursuing careers in academia, two additional taught modules have been proposed exploring Leadership and Management in Psychiatry and Advances in Psychiatric Research. Feedback on the proposed introduction of the new modules was collated from the current full-time and part-time student cohorts.

A total of 57 students currently enrolled on the programme were surveyed in relation to the proposed additional taught modules. The survey was created using Microsoft Forms and deployed via the programme's virtual learning environment (i.e., Blackboard). A mixed methods design was employed, with both Likert scale and open-ended items included in the survey. Students were informed that future cohorts would be offered a choice between the existing Forensic Psychiatry & Substance Misuse module and the proposed Leadership and Management in Psychiatry module, as well as a choice between the existing Child and Adolescent Disorders module and the proposed Advances in Psychiatric Research module.

Responses from the current student body were collated and analysed. A total of 29 (51%) students surveyed were medical professionals, with the remaining 28 (49%) students being science graduates or other clinical professionals. Descriptive analysis of the quantitative data revealed that an overwhelming majority of students viewed the introduction of the new modules as a positive development that would further enhance the student learning experience and continuing professional development. Content analysis of the qualitative data revealed further insights on the nature of the proposed modules and preferences on how these should be included within the existing programme schedule.

Students currently enrolled on the MSc Psychiatry favour the introduction of the proposed modules tailored to support professional development. Specifically, students view the proposed module on Leadership and Management in Psychiatry as catering to the needs of clinicians working in a variety of healthcare settings, whilst the proposed module exploring Advances in Psychiatric Research was considered to supplement existing course content on evidence-based medicine and caters for students with an interest in pursuing a career in academia.

The COVID-19 pandemic highlighted a greater need for multidisciplinary input for psychiatric patients with complex physical comorbidities at Reaside Forensic Medium Secure clinic. It was also felt that junior doctors would benefit from support in managing complex physical health matters as well as issues arising whilst on-call in order to improve morale and support their educational needs. We aimed to add to existing services by offering junior doctors a regular discussion group (Physical Health Huddle) to support with complex cases, share different perspectives on patient treatment and open conversation regarding issues arising whilst on-call. We further hoped to improve communication, provide education for junior trainees with limited experience of forensic psychiatry and support their involvement in patient care and multi-disciplinary meetings.

Junior doctors were invited to a monthly informal Huddle (in person and online) and supported to propose patients for discussion. A proforma was supplied to assist. The junior doctor presented the summary and following discussion we explored various ideas on how to manage the patient's physical health. Feedback was provided to the patient teams afterwards and short before and after questionnaires were used to monitor effectiveness and collect feedback.

The result showed a significant increase in support felt and individual feedback highlighted the need to continue this effort. The Huddle therefore provided a safe reliable space to freely discuss concerns regarding the day-to day management or escalation of complex physical health issues on psychiatric wards as well as on-call.

The Huddle successfully created a sustainable, effective and interactive short learning session which has shown to be effective in engaging trainees in this vital area and help us meet our aim. This format further has the potential to be refined and rolled out to a wider audience in the future to improve learning throughout the trust regarding physical health matters.

Background: The impact of the pandemic and resultant restrictions on suicidal thoughts may vary across populations, geographical areas, between high and low socio-economic groups and vulnerable populations. Aim: To investigate the psychological impact of COVID-19 and resultant restrictions on suicidal thoughts in the United Kingdom.

The study group conducted a cross sectional survey using a questionnaire based on published approaches (Generalised Anxiety Disorder 7, Patient Health Questionnaire 9, Impact of Events Scale-Revised) to understand the psychological impact of COVID-19 and the resultant restrictions on suicidal thoughts. The study was conducted in 3 phases to capture the different phases of the pandemic restrictions:

• Phase 1: 1st May 2020 to 31st July 2020

• Phase 2: 12th November 2020 to 12th February 2021

• Phase 3: 1st July 2021 to 30th September 2021

Analysis strategy: Descriptive analysis and logistic regression is applied in this study.

The study recruited 29133 participants in phase 1; 83851 participants in phase 2 and 75204 participants in phase 3. The largest age group of participants was 45–64 years. About two thirds of respondents were female. Majority of participants were of White British ethnicity. 31% participants in phase 1, 30% in phase 2 and 19% in phase 3 reported suicidal thoughts.

The preliminary regression analysis indicates that younger and male participants reported more suicidal thoughts among other findings which will be reported in the presentation.

Limitations: The non-probability sample design and time limited surveys meant that longitudinal changes were not possible to elicit.

There is mixed evidence on whether rates of suicidal thoughts increased during the pandemic. The results of this study will add to the evidence base and influence future pandemic planning and efforts to developing resilience and good mental health in society.

Patient and public involvement and engagement (PPIE) is recognised as an essential part of health research. It provides an opportunity for patients to shape health research and acquire research skills, in the inpatient mental health setting, PPIE may have additional value in providing meaningful activity and enhancing recovery, as defined using connectedness, hope, identity, meaning and empowerment (CHIME) principles. An eight -session PPIE programme (“Discovery Group”) was designed to support patient-led research in a secure mental health hospital. This feasibility study aims to evaluate the acceptability of the programme from the perspective of patients and identify potential outcomes.

A retrospective single-arm post-programme evaluation of Discovery Group was undertaken. Participants attended an evaluation workshop where they were interviewed individually to complete an acceptability questionnaire designed using the domains of the Theoretical Framework of Acceptability. Participants also completed an outcomes questionnaire, which included CHIME-based recovery items. Quantitative data were analysed descriptively. Direct content analysis was applied to qualitative data.

In our sample, eight participants attended at least one session of the discovery group with one patient attending all sessions. Most of the participants felt positive about taking part in the group and expressed interest in joining another group in future. All participants experienced some burden from the effort required during group sessions, but a low level of opportunity cost in terms of the extent to which they perceived they had to forfeit benefits to participate in the programme.Some described the group as effective in helping them learn about research. Of the five CHIME recovery domains, only connectedness was reported as a benefit of the group. The participants valued the opportunity to use their time.

Discovery Group is a novel intervention that offers high level, non-tokenistic PPIE suitable for use in secure mental health inpatient settings. It produces research of value to patients through a programme of high acceptability and provides them with potential benefits of recovery as well as research knowledge and skills, and an activity that alleviates boredom, enhances autonomy, breaks down some important power and paternalistic barriers that can be experienced by patients detained in secure mental health settings. Finally, a future evaluation study that involves patients during the design, implementation, evaluation and writing stages, aiming to measure the potential outcomes identified in the present study using pre- and post-testing with a control group would reliably demonstrate the effectiveness of the revised Discovery Group and ensure meaningful involvement with patients as co-researchers.

In 2021 The Department of Health published a report into the safer use of medicines in health and justice mental health services, advocating sustainable prescribing as a way of improving patient care and reducing carbon emissions. Improving prescribing behaviour could lead to a reduction of 170,000 kg CO2e per year across England, along with cost savings which contribute to higher value service provision and improved service user experience. We aim to evaluate and improve the prescribing of antipsychotic depot and ‘as required’ (PRN) medication in a male secure unit.

Baseline data were gathered from the patient population in a male secure unit (1 low and 2 medium secure wards, total 50 beds) in December 2021. This included the number of patients prescribed a depot, the type of depot prescribed and whether or not these were administered at the longest evidence-based interval. As part of a wider trust initiative “prn” medication was moved to a fortnightly review cycle to ensure medication was used for as short a duration as necessary. Over a six-week period medication rationale was analysed and discussed with the Responsible Clinician for the service user to optimise prescribing. Data collected following this intervention was compared with baseline results.

The project found that 26 patients in the service were prescribed an antipsychotic depot in December 2021. In this group 17 (65%) were prescribed their medication at the longest evidence-based interval. Of the 9 (35%) that were not, 5 had clinical reasons why a change would not be appropriate at present, however it was agreed this could be considered later in their pathway. Of the remaining service users, two had their dose of medication reduced and their prescribing interval increased. “As needed” (PRN) medications of 15 patients were evaluated; 9 (60%) had medications prescribed which were not in use (4 patients had 3 or more prescribed not used within 2 weeks). Following intervention this reduced to 2 patients, both of which had only 1 PRN medication which required review.

Deprescribing can have a significant impact on patient care and safety and can reduce the environmental impact of a service. This project demonstrated the advantages gained from regular medication reviews and taking into consideration dose and administration interval when prescribing antipsychotic depots. Using protocols for prescribing as needed medications, a structure for reviewing prescriptions, collaboration with patients and utilising patient group directions where appropriate can all aid in improving prescribing sustainability.

The aim of this audit is to look at the presentation of women who were pregnant or less than one-year post-partum presenting with psychotic symptoms in the A&E Department, general hospital and calls to crisis line, particularly with the fact that the pandemic impact remains on the nation. Our aim was to ensure that all referred patients were assessed within the first 24 hours, all the assessments were completed face-to-face, a biopsychosocial assessment was completed for each patient and an outcome was agreed on and clearly documented in the notes.

All referrals to West Essex access and assessment team from the A&E department, the general hospital and calls logged to crisis line were included. Data were collected prospectively over a six-month period from mid-November 2020 to mid-April 2021. For the purpose of this audit, an identification form was designed and disseminated to access and assessment and crisis teams to identify illegible patients. Our data collectors then used the main audit tool to gather the data.

In total, our sample included sixteen patients who met our criteria over the six months period. There was only one patient who was out of area. Most of the patients were of white British ethnicity (ten out of sixteen) and other six patients were five white other and one of Asian origin. The mean maternal age in our sample was 27.3 years old and the majority of the referrals came from the labour ward in Princess Alexandra hospital (57%). The two main outcomes of our audit were to check the response time and the way the initial assessment was carried over. Our results show that the team responded to all referrals on the same day with no delays. All the assessments were carried out in a face-to-face fashion in the general hospital apart from one assessment that came through the crisis line and this was carried out in the patient's home.

From our data we can identify that the access and assessment team met the standards we set for this audit. This fulfills the recommendations of MBRRACE-report and the RCPsych. One of our recommendations was to provide educational sessions to the emergency department in the general hospital to raise awareness on psychotic presentation during perinatal period.

Theory of mind (ToM) is the ability to represent one's own and other's mental state. Studies in bipolar affective disorder show mixed results possible due to confounding factors like intelligence, attention, phase of illness and current mood. Purpose of this study is to study ToM in remittent bipolar disorder patients and compare with normal controls to find if there are residual deficits during remission

40 bipolar patients in remission and 40 age and sex matched controls were recruited. Clinical remission for 3 months with YMRS <4 and HAM-D <7 was inclusion criteria. ToM was assessed by Faux Pas test. Data were analysed using SPSS-11.5 for Windows with parametric and non-parametric tests as indicated. Level of significance taken as p < 0.05 (two tailed).

Mean age of onset of illness in patient group was 23.8 years with duration of illness 11.3 years. Mean number of episodes 6.7 and duration of remission 4.15 months. ToM test result revealed deficit in recognizing social cues in faux pas test by bipolar patients as compared to normal controls. There was no difference between both groups in test result on control stories.

Results suggest that ToM deficits are present in bipolar disorder patients even during apparent clinical remission, indicating it may be a trait marker of the illness. There is no deficit in understanding a regular social context without faux pas. It also revealed that there is no correlation with ToM and duration of illness

To explore the effect of hindsight bias on retrospective reviews of clinical decision making prior to adverse incidents to inform future approaches to incident investigations.

We have undertaken focus groups with doctors of varying grades across the North West of England and North Wales. A vignette based on a real-life case from the publicly available NHS England Homicide Independent Investigation report database was presented to each group in one of three versions which differed in terms of the ending of the vignettes (i.e. suicide, homicide, no adverse incident). Using a semi-structured interview approach, the group participants were encouraged by the facilitators to reflect on issues relating to risk and risk management. All groups were provided with the same vignette which initially made no reference to the outcome and asked to comment on matters of risk and risk management. Halfway through the discussion, one of the three outcomes was disclosed, and further group discussion was held. The recorded interviews were transcribed and thematic analysis was undertaken using an adapted Framework Method.

Preliminary results (n = 10) indicate that participants identified the potential for significant harm, particularly to others, and identified evidence of key psychopathological and historical correlates to support assertive management of risk and admission to hospital.

Whilst knowledge of the outcome did not lead to participants changing their favoured management plans, it did alter how they appraised the case and led to participants constructing “narrative” explanations for the outcome given. The level of conviction participants held for their management plan reduced when their expectations about the outcome were confounded.

Participants presented with the suicide outcome vignette described their difficulties appraising risk to others and their over-sensitivity to that risk. Participants faced with the ‘no adverse outcome’ vignette perceived the original management plan far more favourably in hindsight. The groups that were presented with the homicide outcome vignette initially focused on both risks to self and others as well as the perceived need for further information. Following knowledge of the outcome, there was a tendency to highlight parts of the letter pertaining to risk to others which they previously had not given as much attention.

The initial analysis of our data confirms the findings from previous studies that hindsight colours the appraisal of adverse events. However, this study is novel in that it describes the nature of the thought processes underpinning the influence of hindsight on appraisals of risk.

Studies of thalamic structure and function in Progressive Supranuclear Palsy (PSP) suggest it may play a role in key aspects of the clinical syndrome. This study examined thalamic changes across PSP phenotypes investigating (i) thalamic atrophy (ii) thalamic functional connectivity and (iii) the relationship between thalamic structural and functional connectivity changes with clinical severity.

Participants

92 participants with PSP [63 PSP-Richardson's Syndrome (RS), 24 PSP-cortical, 5 PSP-subcortical] and 104 age-matched controls were recruited from the Cambridge Centre for Parkinson's Plus Disorders cohort. Clinical assessments and imaging were conducted within 1 year of diagnosis.

Structural Analysis

Thalamic volumes (TVs) were obtained using FreeSurfer. Bayesian multiple regression (brms, R) was used to model (i) mean TVs (ii) group differences in mean TVs (iii) relationships between Z-standardised clinical scores and TVs with age, gender, and total grey matter as covariates.

Functional Analysis

Voxel-wise seed-based functional connectivity of the thalamus used the Functional Magnetic Resonance Imaging Expert Analysis Tool (FEAT) in FMRIB's Software Library (FSL). Inter-group differences and relationships between clinical scores and functional connectivity for each group were assessed using a general linear model with age and gender as covariates.

Structural Analysis

TVs for all PSP subgroups were smaller than controls. No differences between PSP subgroups were detected. There was evidence for a relationship between TVs for the entire PSP group and Revised Addenbrooke's Cognitive Examination (ACER) scores [ß = 0.28, 95% credible interval (CI) = 0.04–0.53]. Subgroup analysis showed evidence for a relationship between ACER scores and TVs in PSP-RS [ß = 0.33, 95% CI = 0.09–0.57] and PSP-cortical [ß = 0.46, 95% CI = 0.12–0.83] phenotypes. A negative influence of TVs on total PSP rating scale scores was found for the PSP cohort a whole [ß = −0.51, 95% CI = −1.00 – −0.02].

Functional Analysis

PSP patients as a group showed decreased thalamic functional connectivity in higher cortical regions. Subgroup analysis revealed decreased connectivity in those areas compared to controls but in distinct distributions and magnitude. Increased thalamic connectivity with the middle temporal gyrus correlated with ACER scores for PSP patients as a group and in the PSP-cortical subtype.

Thalamic volume loss is a prominent aspect of PSP and is associated with a wide network of changes in functional connectivity that may be distinct between PSP subtypes. Changes in thalamic structure and function predict clinical severity, particularly in PSP-RS and PSP-cortical subtypes.

To Improve the mental health of psychiatric inpatients and caregivers. To improve communication skills of postgraduate trainees.

Setting; Consented, monitoring and observation of communication skills during weekly, inpatient Psychoeducation sessions at Department of Psychiatry and Behavioural Sciences, JPMC, Karachi.

Data collection; Retrospective, communication skill records of postgraduate trainees from last 10 sessions from July 2019 to October, 2020. Based on a 13-items self-made questionnaire for communication skill. The overall communication skills of each postgraduate trainee were recorded from excellent, very good, good, improvement needed and lots of improvement needed category based on their performance.

Current practice showed that communication skills of 70% of postgraduate trainees were recorded as very good communication skill, 30% into excellent while none was noticed in another category.

: It was started soon after implementation of action plan from November, 2019 to January, 2020, with monitoring of weekly inpatient psychoeducation sessions similarly as done previously. The result of reaudit concluded significant improvement in individual and overall communication skill which were recorded as very good 50% and excellent 50% and none had other poorer categories of communications Skills.

Individual feedbacks to doctors immediately after the psychotherapy session according to the audit tool questionnaire to improve current communication skills.

Within a multidisciplinary team of medical and non medical prescribers the aim of this project was to improve SSRI prescribing safety by 30% by June 2022. This was with view to enhance prescribing provision across the trust.

Multiple methods were done to improve staffs perception of safety. Criteria were set out in keeping with NICE guidance, RCPSYCH and BAP guidance on prescribing. Psychoeducation and focus groups were held to gauge colleagues thoughts on SSRI prescribing. This was along with pulse surveys.

An SSRI clinic was set up, with referral pathway, protocol for referral and staff clinics for reviews and new prescribing. This was to improve prescribing safety.

Health promotion leaflets were also made for the clinic in terms of non pharmacological methods to improve mental health.

Improved staff safety from a Good (3) to Excellent (5).

Established SSRI clinic which will be spread trust wide to the other clinics.

Better monitoring and education of SSRIs.

Health promotion benefits.

Improved staff safety from a Good (3) to Excellent (5).

Established SSRI clinic which will be spread trust wide to the other clinics.

Better monitoring and education of SSRIs.

Health promotion benefits.

The COVID-19 Pandemic has had an impact on most aspects of functioning on the world in general. We wanted to see what impact of COVID-19 Pandemic has had on a Crisis Resolution Home Treatment Team North Peterborough. The main objectives of this audit were to see changes in Crisis Resolution Home Treatment Team North number and source of referrals, average length of stay, total number of patients Home Treated during this period (Pre and during COVID-19 pandemic) and to also identify whether patients with a certain diagnosis deteriorated or presented more to services compared to others.

We retrospectively reviewed case-notes and data were collected from RiO Electronic Patient Records (EPR) covering all the factors we wanted to analyse. Data collection periods were pre-COVID-19 between 1st April 2019 and 30th September 2019 and COVID-19 pandemic (1st Lockdown) between 1st April 2020 and 30th September 2020. Total number of referrals received between April and September 2019 pre-pandemic were 844 and total number of referrals received during COVID-19 pandemic between April and September 2020 were 660. Data were exported from the electronic patient record into Microsoft Excel and quantitative analysis was performed using Microsoft Excel.

The results showed 21.8% drop in total number referrals from 844 to 660 and there were 20.89% (79) less patients Home Treated from April and September 2020 during first lockdown compared to the similar period in 2019. Significant increase observed in patients with bipolar affect illness by 32% (from 86 to 128 patients), acute stress reaction and adjustment disorder by 15% (from 68 to 80 patients) and psychotic disorder by 11.5% (from 245 to 277patients) in 1st lockdown period compared to 2019 similar period. Declining trend observed in intentional self-harm by various means by 20.75% and 4% drop in personality disorder patients. Anxiety and depression patients number remained same in both periods.

Although referral numbers dropped significantly and Crisis Resolution and Home Treatment Team caseload decreased during the COVID-19 pandemic first lockdown, the number of patients with serious mental illness presented to services increased remarkably (bipolar and psychotic illness). Overall, no major change in length of stay of patients with Crisis Team was observed when compared both periods and referral numbers remained low from all sources during COVID-19 pandemic.

VTE-related deaths are a leading cause of preventable mortality amongst all hospital inpatients. Psychiatric inpatients are at greater risk of this, due to administration of antipsychotic medication and longer inpatient stay. This is particularly significant during the COVID-19 pandemic, not least as it is a disease known to cause hypercoagulability, but also due to an increase in mental illness and extended admission, resulting from an overwhelmingly run social service. The objective is to analyse VTE risk assessments performed for the 23 patients at Lambourn Grove, a continuing care unit for old age psychiatric inpatients, diagnosed with dementia. The aims are to assess; the frequency at which VTE risk assessments are performed, the accuracy of each assessment and the subsequent management and appropriateness of preventative measures taken.

A retrospective study was conducted of 23 service users. Data were collected from the VTE assessment form on the local electronic patient record system, and analysed to assess compliance with local guidance. GP records were consulted to cross check data and ensure accuracy of information inputted. Improvement measures include presenting at the local teaching session and implementing a mandatory monthly review onto the ward round proforma. A second cycle will be carried out to assess the success of these interventions in improving best medical practice.

Of the 23 service users, 20 patients had their VTE risk assessment completed on admission and there was a delay of over a month with the remaining 3 patients. Of significance is that of all initial VTEs, 6 out of 23 contained inaccurate details, such as omission of comorbidities or a subjective assessment of mobility, indicating the need to use a standardized tool which allows for comparison across time. The mean admission duration for all 23 inpatients, as of February 2022 was calculated to be 16.2 months, with a range of 2 and 59 months. 15 patients did not have their VTE risk assessment repeated during admission, and of these 2 did have a change in their risk profile, indicating non-adherence with NICE guidelines.

This study has identified significant areas for improvement, specifically the need for clear timing for repeated VTE assessments, consistent sources of patient's medical history and documentation of mobility status. The project has highlighted the need for a more robust VTE assessment protocol which is currently being developed, to improve patient mortality and outcomes.

Research demonstrates greater mortality and physical health morbidity in those with mental illness, as compared to the general population. National Health Service (NHS) England has introduced policies to reflect this and promote improvements in physical healthcare for mental health patients. Inpatient admission provides a valuable opportunity to action such recommendations and offer a detailed health review, guided by local frameworks. A new annual audit commenced in Cheshire and Wirral Partnership NHS Foundation Trust (CWP) assesses admission physical health screening on its adult acute inpatient wards.

Audit standard was 100% compliance to CWP's admission pathway (Policy CP35). Parameters included doctor's review, medical history, physical examination, drug history, medication chart, allergy status, venous thromboembolic risk, blood tests, electrocardiogram (ECG), physiological observations, smoking history, body mass index (BMI) and falls risk. Data were collected retrospectively for all patients admitted or transferred to Juniper Ward, an acute adult inpatient unit in Bowmere Hospital in Chester, during October 2020 (cycle 1) and September 2021 (cycle 2). Different months were assessed due to senior staff changes in October 2021.

30 patients were identified in 2020 and 37 in 2021. In 2020 the most consistently achieved parameters were, in order, medication chart/drug history, doctor's review and past medical history. In 2021 the most consistently achieved parameters were medication chart/drug history, smoking status and past medical history. Across both years completion of the cardiometabolic tool was lowest, although this improved from 6.7% to 16.2%. In 2020 there were 5 parameters achieving <50% compliance (cardiometabolic, physiological observations, smoking status, BMI and falls risk). In 2021 this reduced to 3 parameters (doctor's review, cardiometabolic tool, falls risk). Local policy was updated following the 2020 results, amending the criteria for doctor's review from commenced within 6 hours, to completed within 12 hours. Improvement was seen in all other areas in 2021, with medication chart/drug history documentation achieved in 100% of admissions.

Generalised improvement was seen following the 2020 audit, although only one parameter reached 100% compliance and most remained under 75%. The first cycle led to a policy change with respect to the doctor's review timeframe, although this limited direct comparison between years. A flow chart will be trialled on Juniper Ward, highlighting required tasks and assigning ownership to specific team members. The local Medical Education team were also made aware of the results to inform junior doctor induction. The audit will be repeated in Autumn 2022.

To assess whether consultant discharge letters from the mental health liaison team are: 1. Written to patients as advised by NICE shared decision making guidance. 2. Easy to read using the Flesch Reading Ease Test as advised by the Academy of Medical Royal Colleges, which equates to a score of 60 to 70.

50 consultant discharge letters were collated from April to November 2021. Each letter was assessed whether they were written directly to a patient and scored according to their Flesch Reading Ease (FRE) and Flesch-Kincaid Grade Level (FKGL) via Microsoft Word.

FRE scores a text from 0 to 100 from the average length of sentences and the number of syllables in words to indicate its difficulty to read. The higher the score achieved, the easier it is to read the text. It is a recommended tool by The Academy of Medical Royal Colleges’ guidance on outpatient clinic letters, however, does not specify a target level of readability. A score of 60 to 70 equates to plain English easily understood by students aged 13 to 15 years and was concluded to be the equivocal score expressed in the guidance.4

The FKGL presents a score as a U.S. grade level to indicate the level of education generally required to understand a text. Words per sentence and syllables per word are factored in to calculate the grade.5

The median FRE was 50.9 (n = 50, IQR 8.9). Only one letter met the desired standard. The mean score was 50.6 (SD 6.4). This mean was significantly different from a hypothetical ideal mean of 65 (t(df) = 15.9(49), p < 0.0001) so could not, unfortunately, be explained by chance. The median FKGL was 10.1.

Overall, the letters were of greater difficulty than the desired score of both FRE and FKGL. Lay language and patient-directed writing will aid in improving scores.