To assess the documentation of medication across all Child and Adolescent Mental Health Service (CAMHS) teams in the south region of Derbyshire Healthcare NHS Foundation Trust against a locally agreed protocol. The aim is to ensure accurate and timely documentation of medication history in a standardised way to reduce the risk of medication errors.

We randomly selected 78 patients across seven teams within CAMHS that were currently prescribed medication as of November 2020. We reviewed each patient to see if medication history had been recorded in the specified section of the trust's patient database PARIS. We then cross referenced this information with the patient notes, clinic letters and prescriptions to review accuracy of information in terms of recording of drug name, dose, frequency, and whether the medication was regular or as required. We compared the data to the results of a previous audit in 2017 which used the same methods.

Of the 78 patients, 74% (n = 58) had medication recorded in the correct section of PARIS compared to 13% in the 2017 audit. We found that compliance varied between different CAMHS teams ranging from 0% to 100%. Of those with medication history recorded, 86% had all drug names listed correctly, 79% had all drugs listed at the correct dose, 71% had the correct frequency recorded and 81% had whether the medication was regular, or PRN recorded.

Although we have seen improvement in standardised documentation of medication history since 2017, it remains difficult to rely on this information being up to date and reliable. There was a wide range of compliance in documentation of medication history across different teams, possibly reflecting how effectively the teaching following the previous 2017 audit had been delivered to each team. We have completed more teaching for medical and non-medical prescribers across all localities to highlight the importance of timely and standardised documentation. This is particularly important in CAMHS where the prescribing of medication often remains the responsibility of secondary care, with clinicians regularly prescribing on behalf of colleagues from other teams. Our findings support the move within the Trust towards a system where medication can be both documented and electronically prescribed in the same place (System One).

The Dynamic Appraisal of Situational Aggression (DASA) is one of a few instruments designed for the prediction of violence specifically for inpatient populations. It is important that risk assessment tools demonstrate clinical utility, and that barriers to successful implementation are addressed. If successful, the tool should not only predict risk, but lead to the utilisation of interventions intended to manage and reduce risk. The aim of this study is to learn more about the acceptability of the tool (adherence), it's outputs (nursing interventions), and the outcomes (inpatient aggression and violence). Understanding more about the relationship and processes between an intervention and its outcomes is a key step in intervention evaluation.

Data were collected over a three-month period within a medium secure forensic hospital. A total of 43 patients were included for analysis.

Categories of nursing intervention were coded and content analysis of electronic health records analysed. Incidents of aggression/violence to others was recorded as aggression to patient and aggression to staff. Data were gathered on the completion of the DASA score for all patients for each 24-hour period. A DASA score of 2–3 for moderate risk and ≥4 for high risk was used. The change in DASA score (before and after intervention) and frequency of incidents was calculated for each intervention implemented.

The average adherence of the DASA tool was 58.82% (Range 1.09% - 90.02%). The most frequent intervention following a moderate and high DASA score was that no interventions were provided. The second most frequent outcome following a high score was a focussed discussion with the patient, the use of increased monitoring and the use of seclusion. For those patients that recorded a high score on the DASA tool, eight of those scores were followed by an incident of aggression (n = 8 / 50%). There was no statistically significant difference between the change in DASA scores between interventions implemented, for both high and moderate scores.

The ultimate goal of risk assessment is the management and prevention of risk. Thus, if a high score does not result in strategies for intervention, it renders the assessment process worthless. A recommendation for future clinical practice would be the systematic recording of interventions and risk management strategies when in receipt of a high score on the DASA. Greater operationalisation of risk management strategies and their ability to reduce aggression is needed to enhance risk assessment research and clinical practice.

The global burden of mental disorders continues to grow with significant health, social and economic consequences. Unfortunately, the gap between the need for mental health care and its provision remains wide all over the world. The recruitment and retention of psychiatrists is a long-standing concern in the United Arab Emirates (UAE), with social stigma playing a potential role. This study aimed to investigate the factors that affect the choice of psychiatry as an area of practice by psychiatrists in the UAE. A secondary aim was to assess differences in the factors which affected career decisions among those participants with different backgrounds to establish any cultural and generational differences in choosing psychiatry as a career.

We conducted correlational research using an anonymised 30-item online questionnaire. We recruited qualified psychiatrists currently working in the UAE. The structured questionnaire assessed the participants’ sociodemographic factors and reasons for choosing psychiatry. Ethical approval was received from the Social Sciences Research Ethics Committee (SS-REC) at United Arab Emirates University. Statistical analysis, including Pearson correlations and chi-square tests, was performed using the statistical package for the social sciences (SPSS) version 26.

Out of 70 participants approached, 54 completed the questionnaire with a response rate of 77%. 69% of the participants were female, with a mean age of 38 years. 46% were UAE citizens. We found that the doctors trained in the UAE were statistically more likely to face opposition to specialising in psychiatry (p-value <0.001). Participants with a family member or friend as a psychiatrist were more likely to choose psychiatry as a first choice (p-value 0.01). Psychiatrists below the age of 35 were more statistically likely to face opposition to their decision to specialise in psychiatry (p-value 0.006). Psychiatrists who regretted their decision to specialise in psychiatry were statistically more likely to feel this way in their first year of residency (p-value <0.001). This study had its limitations, including the generalisability of findings and the sociodemographic factors of participants. The self-reported methodology could have subjected findings to bias, including social desirability bias.

Multiple sociodemographic factors influence the decision to specialise in psychiatry in the UAE. These findings would be helpful to identify hurdles faced by the young UAE clinicians in choosing psychiatry, partly explaining the dearth of UAE-trained psychiatrists in the country. Further research is required to study these reasons in detail, helping to improve the recruitment and retention of UAE psychiatrists in the future.

Easily accessible, impactful, evidence-based resources are needed to assist mental health workers to best support voice-hearers in managing and living well with voices. Let’s Talk About Voices (LTAV) is an innovative suite of resources designed for mental health workers to use in supporting voice-hearers.

This study aimed to assess the impact of LTAV on mental health workers’ self-reported capacity to work with voice-hearers.

A randomised, controlled crossover design was used, with assessment at three time points. The assessment measure was co-developed by researchers, clinicians, peer workers and voice-hearers based on the aims of LTAV and the Theory of Planned Behaviour. Participants were randomised into two groups. The immediate group received access to LTAV following the first assessment; the delayed group received access following the second assessment. In total, 256 mental health workers commenced the study, with 120 completing all assessments.

Between-group comparisons for change between times 1 and 2 found a significant difference with a large effect size (F = 40.2, P < 0.001, ηp2 = 0.19). Significance remained on intention-to-treat analysis (F = 22.9, P < 0.001, ηp2 = 0.08). Pairwise repeated-measures comparisons found a significant increase in scores for both groups following access to LTAV, which was sustained at follow-up. Fourteen of 24 individual items showed significant change. Changes were consistent across professions, work settings and experience working with voice-hearers, but those with less confidence in working with voice-hearers on intake showed significantly stronger improvements.

This research indicates that LTAV has the potential to substantially improve mental health workers’ attitudes and confidence in supporting voice-hearers.