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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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.