Aims: The Early Intervention for Psychosis (EIP) service in Derby City and Derbyshire South County provides care for individuals aged 14–65 experiencing a first episode of psychosis. The service supports a diverse population across Derby City (Census 2021 population: 261,400) and Derbyshire South County (Census 2021 population: 349,000), reflecting varying demographic and clinical characteristics. This study examines diagnostic outcomes, referral sources, and discharge destinations of discharged patients.

Aim was to ascertain the diagnostic outcomes, referral sources, and discharge destinations of patients discharged from the EIP service in Derby City and Derbyshire South County.

Methods: All patients discharged from the EIP service between 1 April 2023 and 1 April 2024 were included. Included patients were under the service for at least 3 months. Some continued up to 3 years, while others were discharged earlier for reasons such as non-psychotic diagnoses. Data on diagnosis, referral source, and discharge destination were retrospectively collected from clinical records, recorded in an Excel spreadsheet, and analysed to identify key patterns and trends.

Results: Nearly half of discharged patients (46.67%) had a psychosis spectrum diagnosis (F20–F29; ICD-10). Organic psychoses (4.4%), drug-induced psychosis (8.8%), bipolar disorder with psychotic symptoms (11.1%), other mood-related psychoses (6.6%), and non-psychotic conditions (22.2%) were also identified.

Referrals came primarily from secondary mental health services (48.89%), inpatient units (34.4%), primary care (12.2%), and the Court Liaison and Diversion Service (4.4%).

Discharge destinations showed that 42.7% of patients were transferred to Community Mental Health Teams, and 47.1% were discharged to primary care. Smaller proportions were discharged to learning disabilities services (1.1%), out-of-area early intervention for psychosis services (7.87%), or the perinatal team (1.1%).

Conclusion: The Derby EIP caseload aligns with the service’s focus on first episode psychosis. Low referral rates from primary care indicate that many patients are first identified in crisis settings. However, the majority of patients being discharged to primary care highlights the effectiveness of an intensive, multidisciplinary approach. The small number of referrals to specialized services reinforces positive outcomes in EIP patients.

Aims: Individuals with mental illness face a higher risk for cardiovascular and metabolic disorders, exacerbated by psychotropic medications. Physical health assessments in CMHTs are crucial to prevent undiagnosed conditions and ensure proper care.

Guidelines emphasize the need for essential equipment for thorough assessments, as missing tools can hinder care and lead to misdiagnosis. This audit follows the POMH Valproate audit, which identified gaps in equipment availability in CMHTs across Essex.

The aim is to assess whether CMHTs have the necessary equipment for physical examinations according to trust policy, ensuring service quality by maintaining properly stocked and functional items.

Methods: This audit was conducted trust-wide across 10 CMHTs in North East, Mid, West, and South Essex from July to December 2023. A standardized proforma, aligned with the Physical Healthcare Trust policy, was used to assess equipment availability. Compliance was measured as the percentage of required items present and functional.

The audit followed these steps:

Initial Contact: We contacted the manager of each CMHT and liaised with assigned personnel responsible for physical health equipment.

Site Visits: We visited each centre, met with the physical health lead nurse (where available), and gathered data on equipment availability.

Equipment Assessment: We assessed all required equipment in collaboration with the nurse responsible for physical health and the examination room.

Discussion and Analysis: We discussed reasons for missing equipment and challenges in maintaining compliance.

Results: No site met the 100% compliance target. Key findings include:

Highest compliance: 76.6%.

Most CMHTs: 60-70% compliance.

Lowest compliance: 46.6%.

Commonly missing items: Pentorch, ophthalmoscope, otoscope, tongue depressors, reflex tendon hammer, tuning forks, peak flow meters.

Findings were presented to the Physical Health Sub-Committee and the Medicine Management Committee. Recommendations include appointing leads in each CMHT to oversee equipment checks and ensuring trust policy visibility in clinic rooms.

Following the audit, missing and non-functional equipment was restocked. Measures were taken to verify that all items were fully operational and accessible for healthcare professionals when needed. Physical examination rooms in CMHTs were also checked to ensure that the policy was visibly displayed and regularly reviewed for compliance.

Conclusion: The availability of essential physical health equipment is crucial for adhering to assessment guidelines. Gaps in equipment availability were identified, prompting corrective actions such as restocking missing items and appointing responsible leads. These steps aim to enhance patient care by ensuring thorough and effective physical health assessments.

Aims: This study investigates the demographic and clinical characteristics of young individuals (aged 17–24) transitioning from CAMHS (Child and Adolescent Mental Health Service) to Adult MHLD (Mental Health of Learning Disability) services in North Kent. It examines the reasons for psychotropic medication use, assesses medication burden, and evaluates MHLD’s effectiveness in reducing or discontinuing unnecessary prescriptions.

Methods: A retrospective review was conducted by searching the records of patients registered with MHLD North Kent between 2011 and 2022. The study included individuals aged between 17–24 years at their first MHLD assessment, either referred from CAMHS or via GP, Community Learning Disability Team, or Community Mental Health Team. Those first seen after age 24 were excluded. Data analysis covered referral sources, demographics, co-morbidities, prescribing patterns, and treatment outcomes.

Results: Seventy-one patients were identified, with an average referral age of 19. Males comprised 65%. 82% were White British. Learning disabilities were classified as mild (38%), moderate (39%) or severe (23%), with 87% having autism and 32% diagnosed with ADHD. Epilepsy was noted in 25%. Psychotropics were primarily prescribed for behavioural challenges, with risperidone being most common (32%), followed by promethazine (30%), melatonin (23%), and aripiprazole (15%). Medication reduction was attempted in 27% of cases, with 18% achieving successful dose reduction or discontinuation. Psychological interventions were provided to 55% of patients, with 36% having a diagnosis of challenging behaviour. Importantly, no patient exceeded a psychotropic load of 100%.

Conclusion: The main reason for referral was challenging behaviour. Psychotropic prescribing was frequent, yet no direct link was found between prescribing patterns and demographic factors. The MHLD team successfully maintained psychotropic loads within safe limits and engaged over half of the patients in psychological therapies. While medication reduction efforts were undertaken, success rates remained modest.

Recommendations:

Strengthen medication monitoring systems to enhance reduction efforts.

Develop a structured STOMP/STAMP plan and share it with GPs and carers.

Regularly review care plans, particularly when side effects arise.

Improve access to MHLD services for GPs and carers to build confidence in medication management.

Work closely with psychological services to address challenging behaviour at its source.

Implement a clear medication review flowchart, incorporating it into patient records and communication with primary care.

These steps aim to enhance care for individuals with intellectual disabilities and refine medication management within MHLD services.

Aims: This service evaluation aims to identify and assess referrals made to CAMHS at a south London based GP practice. The focus of this evaluation will be on referrals for Attention Deficit hyperactivity Disorder (ADHD), autism, anxiety and other mental health conditions such as depression and suicidal ideation. It will also aim to assess if the support available to parents and children is sufficient and if the long waiting times creates pressure on the practice.

Methods: This service evaluation has a cohort of 50 patients who were randomly selected through the EMIS database and had referrals to CAMHS from the practice for autism, ADHD, anxiety and other mental health conditions. The eight parameters that are being measured in this study are:

Age.

The type of mental health support that is offered in the community for the child, e.g. counselling.

The date of first referral from the GP practice.

The date whereby the referral was accepted or rejected.

If the referral was rejected, were there any more referrals?

If the referral was accepted, the number of appointments between referral and diagnosis at A&E.

If the referral was accepted, the number of appointments between referral and diagnosis at the GP.

The type of information and support given to the parents.

Results: In this study a total of 88 extra consultations were made at the practice or A&E with 84% of these consultations made at the GP. Many extra consultations were made at the general practice due to the long waiting times and worsening mental health whilst waiting for CAMHS input. 59% of referrals were rejected or put on a waiting list after the first referral was made. After the initial referral, 32 % of patients made extra referrals, the majority being for ADHD and autism. Rejected referrals for ADHD were the highest at 14% of the total cohort and rejections for other mental health conditions were the lowest at 4%. Some patients received support in the community before or whilst waiting for a referral such as occupational therapy, counselling and school support.

Conclusion: This retrospective study highlights the need for more clarity in referral criteria for GPs and in signposting support services during initial referral and diagnosis to prevent the condition of the patient getting worse.

Aims: To identify patterns of readmission to acute wards and look for specific themes associated with readmissions – discharge planning, diagnosis, gender, social support, accommodation issues and any other associations.

To Identify improvement opportunities to align with the patient flow programme.

Methods: Data was gathered from KMPT Electronic patient record system. A total number of 12,602 admissions to all wards across KMPT between July 2019 and August 2024. The number of readmissions were extracted from this data.

12.4% of admissions were readmissions within 30 days following discharge. 95.38% of these 30-day readmissions were to Acute MH wards.

Results: Although KMPT has an improving picture in the number of 30-day readmissions compared with previous years, it is still 3% above the national average.

The 30-day readmissions have reduced over time from September 2019 to August 2024, an improving trend.

On an average KMPT currently has 24 readmissions per month. In order to achieve the national average, KMPT would have to reduce this from 24 per month to approximately 16 per month.

Patients aged between 25–35 had the highest 30-day readmission rate in the last year’s data.

There was a higher rate of readmissions for female patients.

The majority of 30-day readmissions have either not had their referral reason recorded but secondly indicate ‘In crisis’ as the reason for readmission.

Patients readmitted within 30 days of previous discharge were predominantly of cluster 8. They were also predominantly of ICD–10 code F603 at 18.75%.

Conclusion: This project is progressing under the Re-admissions pillar of the Patient Flow Improvement Project looking at both avoidable readmissions and high intensity user readmissions.

The Improvement project will look at data in greater detail and identify avoidable readmissions and high intensity users.

The purposeful admission pillar of the Improvement project will address the need to explicitly state what inpatient admission can achieve and the expected outcome from the admission.

Aims: The consumption of ultra-processed food (UPF) is associated with many adverse health outcomes including cardiometabolic disorders, mental health disorders and mortality.

The aim of the service evaluation project is to assess the menu items of a 32-beded low secure forensic mental health hospital against the NOVA criteria for ultra-processed food. All the inpatients have a variety of severe mental health illnesses such as schizophrenia or bipolar. All are treated with antipsychotics and rates of complex physical health comorbidity are high.

Methods: 14 different menu items available from the catering department were analysed and the NOVA classification was assigned by reference to the ingredient list. The percentage of ultra-processed food in each menu item was calculated based on amount of NOVA 4 (ultra-processed food) items contained in relations to the total number of each food composition.

Results: Analysis of all 14 menu items, using the NOVA criteria, showed they contained about 68% of ultra-processed food material. This included unexpected items such as roast potatoes and omelettes. Each menu item was wrapped in plastic and had significant amount of processed material, artificial flavouring, colouring and other preservatives sufficient to be classed as ultra-processed food.

Conclusion: ‘Don’t just screen, intervene’ is the motto used to try and improve the physical health of people with severe mental illness. The Lester tool used to assess the cardiometabolic health of people with severe mental health disorder, focuses on the individual person but without the consideration of the institutional context that surrounds those detained in the forensic mental health unit for many years. The interventions all include advice to eat healthily which is impossible if all the food provided is ultra-processed. Whilst individual organisations might be able to change their catering standards to remove ultra-processed food from their menus, a systemic change to nutritional standards for mental health inpatients may be more effective.

Aims: Parkinson’s disease is a neurodegenerative condition with a lifetime risk of 2.7%, with a rise in prevalence expected in line with an ageing population. Whilst characteristically associated with motor symptoms, it is a multi-system disease with neuropsychiatric sequelae which are frequently missed by non-psychiatric specialists. Patients face barriers to access psychiatric services.

We describe a 15-month pilot of a novel integrated service for people with Parkinson’s disease in the Bristol Royal Infirmary. A monthly joint outpatient clinic was established whereby old age psychiatrists from the later life liaison psychiatry team and geriatricians saw patients within the same appointment. Additionally, we collaborated for weekly multidisciplinary team (MDT) meetings, inpatient reviews and wider liaison. Our aim was to develop a holistic integrated service with the hypothesis that this would offer value to our joint patient cohort and the wider healthcare service.

Methods: Patients were identified through triage of outpatient referrals, as inpatients and at MDT meetings. Clinical outcomes from the integrated clinic were measured using the Clinical Global Impressions (CGI) scale. Patient and professional quantitative feedback was gathered. Hospital admission data was measured against baseline admission rates for similar outpatient groups.

Results: Between November 2023 and January 2025, eleven integrated clinics were run and 33 patients attended; some patients were seen on multiple dates. The rationale for integrated working included new psychiatric symptoms (17%), pre-existing psychiatric diagnosis complicated by dopamine treatment (28%), cognitive conditions (39%) and complex psychotropic prescribing (33%). Major treatment outcomes included medication adjustment (78%), diagnostic reformulation and psychological therapy provision. There was a clear positive trend in CGI data showing benefit to patients, with overwhelmingly positive patient and professional feedback. Formal analysis of data looking at hospital admissions was inconclusive – but case series analysis shows examples of admission avoidance.

Conclusion: We believe the development of this service shows that close working between psychiatrists and physicians enhances patient care in Parkinson’s disease. Our integrated service is acceptable and beneficial for patients. It is valued by professionals and appears to be cost-effective through medication rationalisation and admission avoidance. In terms of future direction, we have applied for additional funded psychiatrist hours from the Trust to ensure sustainability of the clinic and are in the process of developing linked psychological therapy and clozapine prescribing services as a result of the success of the pilot clinic.

Aims: This observational case series describes 11 patients who underwent emergency ECT under the care of the later life liaison psychiatry team at the Bristol Royal Infirmary over a 12-month period between February 2024 and January 2025. This represents a 5-fold increase in ECT delivery from previous years. We describe patients who required ECT treatment for their psychiatric illness but were deemed to be too medically unwell or too high risk for a general anaesthetic outside of surgical theatres in an acute hospital setting. The aim of this case series was to evaluate the volume of patients requiring emergency ECT and to understand the various clinical rationales for this.

ECT is an evidence-based intervention which is recommended for the treatment of severe depression, psychosis, catatonia and other conditions. Typically, ECT is delivered by psychiatrists in dedicated ECT suites located apart from acute hospitals – as is the case in Bristol. General anaesthesia is required to safely deliver ECT.

Methods: Case notes of the patients who underwent ECT in acute hospital surgical theatres were retrospectively reviewed and data was extracted on demographic features, medical and psychiatric history and details of ECT treatment. Clinical outcomes were measured using the Clinical Global Impressions (CGI) scale.

Results: 9 out of 11 patients who required emergency ECT in theatres were older adults (>65 years) with a skew towards advanced old age (>80). The most common reason for this treatment was severe depression and/or catatonia with associated need for enteral feeding due to not eating and drinking which required acute medical admission and increased anaesthetic risk. Other medical and surgical concerns included severe heart failure and uncontrolled Parkinson’s disease. Overall clinical improvement was seen across 9/11 of patients. 2 patients died within one month of undergoing ECT due to physical morbidity.

Conclusion: This case series which was conducted to evaluate a service being offered by the liaison psychiatry team illustrates the challenge of treating severely mentally unwell patients due to their associated poor physical health. We contend that ECT can (and sometimes should) be offered in the acute hospital when patients are too severely unwell or high risk to receive ECT in peripheral settings, which will particularly benefit those multimorbid older adults who stand to gain the most from ECT.

Given the volume of ECT being delivered and the apparent clinical necessity for this service, next steps will include additional training and service considerations including training liaison nurses in ECT skills.

Aims: Over 300,000 people in England and Wales reside in care home settings, with a large proportion of these people thought to have memory difficulties. Within North Kent (Dartford, Gravesham and Swanley) there are 31 care homes, with around 1,540 residents over 65 years old. The North Kent community psychiatric service therefore aims to meet their clinical needs through an in-built care home service, comprised of medical, nursing and support staff. The service facilitates medical reviews and memory assessments, liaises with social care and psychological services, offers care home-based training for staff and supports family carers. The aim of this review was to better understand the patients being supported by this service and interventions being utilised.

Methods: A review was completed of the service caseload, documenting patients’ demographics, diagnoses and current medications as of November 2024. Clinical notes were also reviewed to better understand when and why patients had been referred, and what prior contact they may have had with services.

Results: Fifty-two caseload patients were identified (around 3% of North Kent older adults in care homes), residing across 20 care homes. All were aged above 60, with the majority in their 80s (44%). Referral was mainly from GP practices (73%), most frequently for support with behavioural or psychological symptoms of Dementia. This can include verbal or physical aggression, agitation, psychotic symptoms and mood disturbance. Referrals were also received for memory assessments, medication advice and support with functional symptoms. Most patients (81%) had never been under the service previously. At the point of caseload review, the majority of patients had formal diagnoses of Dementia (81%). Ongoing intervention was predominantly for medication adjustment and response monitoring (56%). Patients were also receiving behavioural and psychology interventions, and support with depot administration.

Across the caseload, 52% of patients were on antidepressants or mood stabilisers, 42% on benzodiazepines or promethazine and 38% on antipsychotics. NICE guidance advises that for people with Dementia, antipsychotics should only be used if they are severely distressed and at risk of harming themselves or others. We therefore also analysed this for patients with diagnoses of Dementia, of which 33% were on antipsychotics, including risperidone, olanzapine and quetiapine.

Conclusion: Through identifying where patients reside, why they were referred and their ongoing needs, we can better understand the population accessing this service, develop links with other community health services and adapt training offered to care home staff to improve the care received by their residents.

Aims: Eating disorders represent a major challenge for psychiatric and broader medical care. The rate of hospitalisation has almost doubled in recent years and anorexia has a higher mortality rate than any other mental illness. Beat Eating Disorders has made recommendations for educating medical students. When making the recommendations, they did not receive responses from Cardiff or Swansea Medical Schools. This review assesses the provision of eating disorder teaching and whether it is sufficient for effective medical training.

Methods: Clinical lecturers in Cardiff and Swansea Medical School reviewed each other’s medical curricula and compared the prevalence and extent of eating disorders in each. From 1 December 2024 to 5 February 2025 we reviewed the types of learning provided, opportunities for self-directed learning, and other areas where eating disorders could arise. We compared this against the guidelines recommended by Beat for an effective curriculum. We also reviewed the schools’ official exam guidelines to assess whether eating disorders are listed as a topic in psychiatry or the broader curriculum.

Results: In Cardiff there is a dedicated lecture on eating disorders in the Year 4 psychiatry rotation, which covers all major eating disorders. There is also an optional online module written by an Eating Disorders Consultant which goes into further detail. There is no practical training in examining or communicating with a person with eating disorders.

In Swansea there was no mention of eating disorders in the curriculum yearbook. There is a lecture in Year 2 and Year 3, each an hour long. Eating disorders exist on the GMC MLA content map, so can come up in the final year OSCE (CPSA) but it is not clear whether this happens in practice in Swansea or Cardiff.

Across South Wales, clinical attachments with eating disorder services were haphazard and locality-dependent. Beat would classify both medical schools as providing “insufficient” education.

Conclusion: Medical students in Wales are not receiving education on eating disorders that satisfies the Beat recommendations. Despite achieving proficiency in academic teaching, neither medical school provides the practical experience necessary to examine, support, and treat someone with eating disorders.

Greater emphasis on eating disorders is required, not just within psychiatry, but within broader medical teaching such as cardiology and gastroenterology. Eating disorders should be better incorporated into communication stations, practical examinations, and psychiatric teaching. Better access to Eating Disorder Services for medical students would also allow them to meet patients and build vital clinical experience

Aims: To examine the referrals in a newly established Living Well service at Dales community mental health team, Derbsyhire.

Methods: A retrospective review of notes on SystmOne (electronic patients records) referred for a period of 6 months from April–October 2024.

The source and rationale of the referral to the living well team, acceptance by the team, written communication to the referrer and the processes leading to the outcomes of the referral were examined.

Results: 75% of the referrals were from GP, 9% were from community IAPT teams.

67% of the referrals were accepted for input by living well teams.

70% of the referrals had a written letter sent to the referrer.

96% of the referrals led to a triage-based MDT meeting.

96% of accepted referrals had allocated member of staff making contact with the patient. 71% received a welcome call.

18% of the referrals had an outcome of being referred to the outpatients clinic.(as a long-term offer), 10% had psychology input as an outcome.

10% of the referrals were deemed after MDT discussion not to be appropriate for the service.

8% didn’t engage leading to discharge from the living well team.

15% of the referrals were due to symptoms of low mood, 14% with symptoms of anxiety, 12.2% of the referrals related to emotional dysregulation.

Conclusion: Two thirds (67%) of the referrals were accepted for a short-term offer by the team in providing support indicating a role of the living well team to provide prompt interventions regarding the mental health of patients.

A multidisciplinary approach in the team consisting of varied professionals has helped manage a lot of referrals with community-based support. 96% of the referrals were discussed with MDT approach.

A high proportion (70%) of the referrals had a letter written to the referral independent of the outcome. Written communication to the referrer is to be improved upon regardless of outcome of the referral.

A further qualitative review of the process to take place in 12 months time.

Aims: Referrals to Old Age Community Mental Health Team (CMHT OP) Guildford/Waverley have increased in number and workload. The purpose was to see the number of referrals received and how to improve the referral allocation practice concerning delegation to manage the workload burden on staff.

Methods: 1230 referrals were reviewed. The quantitative data was primarily taken from allocation meeting documentation. Additionally, information was gathered from senior staff and relevant documentation of allocation meetings on the electronic patient records when there was vague information.

Results: The data shows that during the first cycle from April to September 2023, CMHT OP Guildford and Waverley received 579 referrals. 90% (521) of the referrals were accepted, and 10% (58) were declined due to inappropriate referrals. There were 412 routine, 65 sooner and 92 urgent referrals received. Senior team members assessed and stepped down 21 of the urgent referrals. 459 patients were referred due to organic conditions, 76 patients were referred due to functional conditions, and 23 patients were referred for a mix of functional and organic conditions. 85 patients were transferred to the Care Home Pathway (CHP) service, 18 patients were transferred to the Young Onset Dementia (YOD) service, and 25 patients were transferred to the Integrated Care Team (ICT). The first cycle of the audit was presented to the team, and steps of interventions were agreed upon for the second cycle. The re-audit data shows that from October 2023 to March 2024, there were 651 referrals. 88% of the referrals were accepted, and 12% were declined due to inappropriate referrals. There were 510 routine, 57 sooner and 84 urgent referrals received. Senior team members stepped down 26 of the urgent referrals. 523 patients were referred due to organic conditions, 88 patients were referred due to functional conditions, and 48 patients were referred for a mix of functional and organic conditions. 76 patients were transferred to the CHP service, 15 patients were transferred to the YOD service, and 51 patients were transferred to the ICT.

Conclusion: The audit data objectively reflects an increasing trend in referrals between the first and second cycles. Intervention after the first audit cycle showed increased use of advice and guidance services for declined referrals, increased step-down of urgent referrals and an increased number of patients delegated to other services, particularly the integrated care team, which shows a more confident referral allocation process.

Aims: The electrocardiogram is a non-invasive test used to assess cardiac function. Certain psychotropic and antidementia medications can cause bradycardia, heart block, or prolonged cardiac repolarization, worsening pre-existing conditions. Evaluating cardiac function before treatment initiation is essential. However, in the North Older People Service (NOPS), the lack of electrocardiogram availability at the time of assessment has led to significant delays in treatment initiation, particularly for patients referred for cognitive assessments. These delays not only affect individual patients but also reduce clinic efficiency, limiting access for other patients awaiting assessment.

Aims were to evaluate how the availability of ECG at the time of patient’s assessment impact on the commencement of treatment.

Methods: A retrospective review of electronic health records was conducted for patients referred to the North Older People Service, between January and February 2023. Of 62 accepted referrals, 5 patients were deceased, and 2 had not yet been assessed, leaving 55 for analysis. Data collected included referral dates, assessment dates, electrocardiogram availability, whether an electrocardiogram was required before treatment, treatment initiation dates, and diagnoses.

Results: Of the 55 patients analysed, 70.9% were started on new medications, while 29.1% were not due to mild cognitive impairment, existing treatments, or diagnoses such as vascular dementia. Among those who commenced treatment:

10.25% had an electrocardiogram at assessment and were started on treatment immediately.

71.79% did not require an electrocardiogram and were initiated on treatment without delay.

17.94% required an electrocardiogram before treatment initiation. Of these, 85.7% had dementia.

The waiting period ranged from 4 weeks and 6 days to 30 weeks and 2 days, with an average delay of 18 weeks and 2 days.

Conclusion: The findings support the hypothesis that the absence of an electrocardiogram at the time of assessment contributes to significant treatment delays, particularly for dementia patients. To address this issue, referring clinicians should include electrocardiograms in pre-assessment investigations, and the triaging team should ensure that electrocardiograms are requested when necessary. Implementing these measures could reduce delays, improve efficiency, and enhance patient outcomes.

Aims: People with intellectual disabilities have higher rates of mental health difficulties than those without. The physical health inequalities and premature mortality that they experience is even more pronounced. In the United Kingdom, physical healthcare has traditionally been co-ordinated and delivered through primary healthcare settings. There is a case that physical health inequalities for those with intellectual disability and mental health difficulties can be reduced further if primary care interventions are supplemented by Enhanced Physical Health Clinics (EPHCs) co-located in mental health outpatient settings.This paper describes the structure and setting up of an EPHC for people with intellectual disability and mental disorders and an evaluation of its first 2 years.

Methods: The EPHC database which contains patient demographics and process data for the clinic regarding tests and interventions completed was utilised for this study. This includes sociodemographic, psychiatric, and physical health diagnoses, prescribed medication, physical health assessments and interventions.

Results: During its first two years, the clinic saw 463 patients. The mean age was 44 years and 62% were male. There was considerable developmental and psychiatric comorbidity, with high rates of autism and major mental illness. The most common physical health diagnoses were epilepsy, hypothyroidism, diabetes, hypertension, and asthma. A range of previously unidentified unmet healthcare needs that warrant further assessment and treatment was identified.

Conclusion: The EPHC was effective in promoting physical health monitoring and screening in a population which experiences significant health barriers. Recommendations regarding clinical practice and future research are provided.

Aims: The cost to the NHS of missed appointments each year is highly significant. PIFU is an alternative to the conventional follow-up model where patients request appointments as-needed in attempt to reduce this cost, and is part of the Outpatient Recovery and Transformation Programme component of the NHS Long-Term Plan. This model is well established in chronic conditions under secondary care like gynaecology and rheumatology outpatients but has more recently been brought into psychiatry. Currently, there is minimal research on the suitability of this model in psychiatry. The Exmouth CMHT in Devon have had a PIFU model for the last 4 years, and this project evaluated this model and analysed the associated costs.

Methods: We present the model used to form the PIFU service in Exmouth. A service evaluation was conducted of the Exmouth PIFU model and is presented in this poster looking at the team constructed, pathways into the service, and the hours this service provided for patients. Patients under the service also have given feedback on their experience of the service. We then compare the costs of this service with equivalent referrals through primary care.

Results: In the absence of a standardised PIFU model for psychiatry, the Exmouth CMHT model was compared with the PIFU model described in the NHS Long-Term Plan. Our service evaluation demonstrates that limited staffing and budget can provide a suitable PIFU service for our patients. Patients gave positive feedback about their experience of PIFU and felt this had benefited their care. Cost comparisons demonstrate the relative costs, overall demonstrating savings to the NHS.

Conclusion: Despite a lack of research to guide the transition of PIFU into psychiatry, the Exmouth CMHT have created an effective model for their team that patients have found helpful. This model was adapted to the changing needs of the service over the years, demonstrating flexibility in the model, but despite this, it could be used as a template for the implementation of PIFU in other services. Cost comparisons demonstrate the saved time in primary care is most significant. Further research is planned to develop an evidence-based model for PIFU, and to look at staff perceptions of PIFU implementation.

Aims: Substance misuse is a common comorbidity in severe mental illness, contributing to increased morbidity and poorer clinical outcomes. Effective management requires accurate documentation and structured interventions. However, existing practices in psychiatric inpatient care are often inconsistent, necessitating a thorough evaluation to inform service development.

Aims were to assess the prevalence of substance misuse and evaluate its documentation and management among patients admitted to Willow Suite Psychiatric Intensive Care Unit (PICU), Pinewood (male acute ward), and Cherrywood (female acute ward) at Littlebrook Hospital between June and July 2024.

Hypothesis: Substance misuse is prevalent among psychiatric inpatients and is under-documented and sub-optimally managed across acute and PICU settings at Littlebrook Hospital.

Methods: A retrospective review of clinical records for 96 consecutive admissions (Willow Suite PICU: n=28, Pinewood: n=35, Cherrywood: n=33) was conducted. Data collected included demographics, diagnoses, substance misuse history, documentation practices, and management interventions such as care planning, multidisciplinary team (MDT) discussions, CPA meetings, referrals to specialist services, and psychoeducation.

Results: Of the 96 patients, 53% (n=51) had a history of substance misuse, with current misuse documented in 33% (n=32). PICU had the highest prevalence (60%, n=17), followed by Pinewood (51%, n=18) and Cherrywood (48%, n=16). Cannabis was the most frequently reported substance (100% in Willow Suite, 29% in Pinewood, 33% in Cherrywood), followed by cocaine (45%), alcohol (14%), and opiates (10%). Polysubstance use was noted in 47% of Willow Suite patients, 45% in Pinewood, and 44% in Cherrywood.

Across the wards, substance misuse was documented in 34% of core assessments and 42% of progress notes. Care plans addressed substance misuse in only 12% of cases, while MDT reviews and CPA meetings discussed it in 22% and 13%, respectively. Referrals to external substance misuse services were rare (3%, n=3). Psychoeducation was offered to 15% (n=15) of patients.

Conclusion: Substance misuse is highly prevalent among inpatients, yet its management remains inconsistent. Gaps in documentation and limited referrals to specialist services indicate the need for improved screening, structured care planning, and closer collaboration with external agencies. These findings highlight an urgent need for targeted service improvements to enhance care for this vulnerable population.

Aims: Clozapine is an effective treatment for adults with schizophrenia, who have not responded to two other antipsychotic medications. However, there are challenges prescribing when patients who take clozapine in the community are admitted to a General Hospital for physical health reasons. These challenges can include physical health co-morbidities, medication interactions, blood dyscrasias, changes in smoking status and bowel movements, infection, missed or incorrect doses of clozapine prescribed, and clozapine toxicity.

Our aim was to evaluate the management of clozapine for patients admitted to a General Hospital, including the interaction with Liaison Psychiatry.

Methods: Data were collected retrospectively, between January 2022 and January 2023, from two General Hospitals in England. There were a total of 45 admissions to a General Hospital for 34 patients who were identified as prescribed clozapine in the community. Electronic records were accessed for the community, General Hospital and Mental Health service. Records were reviewed to assess if the clozapine prescription was correctly recorded on the community record, and if a referral to Liaison Psychiatry was made on admission. Within the Liaison Psychiatry review, records were reviewed for documentation of full blood count, medication concordance, smoking status, bowel movements, physical health concerns, medication interactions, signs of clozapine toxicity and recommendations for a clozapine level.

Results: The clozapine prescription was documented correctly in 16% (7/45) of occurrences in community records.

On admission to a General Hospital, 49% (22/45) of patients were referred to Liaison Psychiatry. The mean time for referral from admission was 41.07 hours. Of the 22 admissions that were referred, 68% (15/22) were seen within 24 hours by Liaison Psychiatry.

On review with Liaison Psychiatry, the frequency of documentation seen was: full blood count (65%), medication concordance (65%), smoking status (50%), bowel movements (41%), physical health concerns (91%), medication interactions (38%) and signs of clozapine toxicity (18%). Advice regarding a clozapine level was documented for 35% of patients.

Conclusion: Local education was arranged for the community, General Hospital and Mental Health Trust. A Trust-wide policy was written for the General Hospital to utilise for patients that are prescribed clozapine. This included the importance of referring immediately to Liaison Psychiatry to reduce disruption in treatment and the need to monitor for bowel-related complications. A clozapine admission checklist was introduced for local Psychiatry teams to use when reviewing a patient who takes clozapine. With these measures now implemented, data will be collected to review the effectiveness.

Aims: The WHO estimated that 1 in 5 people living in conflict areas have some form of mental disorder. On top of this, limited access to mental health care in these areas continues to amplify the issue. However, hope can be found through the increased use of telehealth during the COVID-19 pandemic, which has opened the opportunity to apply the platform in conflict zones.

The pre-existing need of mental health services in Myanmar was aggravated by the 2021 coup and the ongoing COVID 19 pandemic. The Ministry of Health (MOH) of the National Unity Government (a chosen government formed with democratically elected MPs) developed a system of free telehealth care. The Tele Health Clinic was initially composed of healthcare workers from the liberated borders of Myanmar and later joined by local/international clinicians. The Tele Mental Health (MH) Clinic was then opened in August 2021 to address the devastating mental health burden superimposed by the combination of coup and pandemic.

Objective of the Study: To describe the development of a telepsychiatry clinic amidst the current political turmoil in Myanmar.

Methods: Review of the historical data of Myanmar civil war, military coup in 2021 and Civil Disobedience Movement.

Review of UNHCR data on the impact of current conflict.

Literature review of mental health in conflict zones and role of telepsychiatry in conflict settings.

Review of the process of development of the Tele Mental Health Clinic in Myanmar.

Descriptive analysis of one year data of the clinic.

Results: The Tele-Mental Health clinic was developed following the collapse of the healthcare system after the 2021 military coup in Myanmar. The clinic uses innovative ways to recruit clinicians and to provide psychiatric services. While there is ongoing risk of military junta’s persecution, arrest and torture, the clinic continues to thrive and expand.

Conclusion: Telepsychiatry can be used as a safe and effective way to bridge the barriers to mental health care throughout the current political turmoil in Myanmar. The evidence on the effectiveness, cost-effectiveness, process of implementation and long-term measures to overcome challenges are areas of future research interests.

Aims: There are high rates of Neurodevelopmental Disorders (NDD) and mental health needs in young people who engage in offending behaviours. Incompletely assessed development can be a factor in engaging with legal proceedings and with those involved in their care. Young people open to the three Gwent Youth Offending Services (YOS) and Tier 3 Gwent Forensic Child & Adolescent Mental Health Service (FCAMHS) have previously been identified as having traits indicative of an underlying NDD. No specific ND assessment pathways exist within YOS for suspected Autism Spectrum Disorder (ASD) and/or Attention Deficit Hyperactivity Disorder (ADHD); those requiring assessment are referred to the CAMHS ND Team. Some cases are Not in Education, Employment or further Training (NEET), may not reside with family, and can struggle to engage in typical referral pathways.

An evaluation is taking place regarding the use of existing Gwent CAMHS and YOS resources for piloting a Tier 3 Gwent Forensic CAMHS Neurodevelopmental Assessment Pathway (FCAMHS NDAP).

Methods: Gwent FCAMHS is a small Multidisciplinary Team (MDT):

One part-time Consultant Forensic Child & Adolescent Psychiatrist.

Four Psychiatric Nurses.

One part-time Forensic Psychologist.

Between December 2023–December 2024 the number of YOS cases referred for and receiving ND assessment were logged. Assessment outcomes were considered with ongoing discussions with each of the YOS to ascertain ongoing roll-out of a pilot FCAMHS NDAP.

Results: Between December 2023–December 2024:

7 cases were referred (5 for possible ADHD, 2 for ASD).

6 of the referrals were not in mainstream education or NEET.

6 ND assessments were completed.

5 resulted in an NDD diagnosis (ADHD=4, ASD=1).

2 cases necessitated ADOS-2 assessment and 1 case was assessed using the Qb Test protocol.

Upon diagnosis, 2 elected to trial ADHD medication.

Referrals originated from all three YOS in Gwent: Newport (2), Blaenau Gwent-Caerphilly (4) and Monmouthshire-Torfaen (1).

Conclusion: Cases were diverted from the CAMHSND waiting list to FCAMHS. YOS support in case engagement and obtaining information was vital for the assessments. YOS managers recognise the role an FCAMHS NDAP has for some cases in the Gwent YOS who would struggle to engage in the typical pathway. Requests have been received for YOS staff training in NDD.

A formal roll-out of a Gwent FCAMHS NDAP pilot with specific inclusion criteria has been agreed with the YOS teams and Gwent FCAMHS, commencing January 2025. Quality Improvement methodology is utilised and training packages for YOS staff are being developed.

Aims: This audit aimed to evaluate the initial assessment, investigation, management, and communication strategies for paediatric patients presenting with Functional Somatic Symptoms at Alder Hey Children’s Hospital. The audit addressed a significant gap in existing national NHS and local guidelines for guidance of medical professionals in diagnosing and managing Functional Somatic Symptoms presenting to paediatric services.

Methods: A parallel-running retrospective analysis was performed jointly by the General Paediatrics team and the Child Health Psychology (Liaison) team on young people admitted under General Paediatrics and/or attending outpatient Psychiatric services over a four-month period. Summary narratives were generated for each patient detailing the journey from first presentation with functional symptoms to diagnosis and management. This was then interpreted by systematic data analysis – both qualitative and quantitative.

Results: The audit’s key finding was the absence of a standardized approach to the assessment, investigation, and management of Functional Somatic Symptoms. Patients underwent excessive investigations across multiple departments without coordinated multidisciplinary team (MDT) involvement. Furthermore, very few received a formal diagnosis of Functional Somatic Symptoms by discharge; communication and psycho-education around this diagnosis with young people and their families was distinctly lacking.

Conclusion: These findings highlight an urgent need for the development of both national and local structured guidelines and integrated care pathways to improve the management of Functional Somatic Symptoms in children and young people across physical and mental health services. This is needed to ensure timely diagnosis, psycho-education, appropriate intervention, and better long-term outcomes for affected young people and their families.