Aims: To analyse the in-hours emergency/crisis caseload trends of the King’s College Hospital (KCH) CAMHS Paediatric Liaison Service from November 2018 to December 2024, focusing on the impact of the COVID-19 pandemic and the subsequent recovery. The study aims to identify patterns in service demand and contextualise these trends with key pandemic milestones.

Methods: Monthly caseload data for in-hours referrals were collected and analysed over a six-year period from November 2018 to December 2024. The data were examined in relation to key events, such as lockdowns, school closures, and reopening phases, to explore potential influences on caseload trends. Median monthly caseloads were calculated, and patterns were compared across different stages of the COVID-19 pandemic and its aftermath.

Results: In the pre-COVID phase, monthly caseloads were stable, with a median in-hours emergency referrals of 30. During the COVID phase, caseloads dropped sharply during the first lockdown in March 2020, likely due to school closures and disruptions to referral pathways. Attendance began to recover during the partial reopening of schools in June 2020 but fluctuated with subsequent lockdowns. In the post-COVID recovery phase, caseloads steadily increased but appeared to return to pre-pandemic baselines by 2024. These findings demonstrate a clear relationship between school closures and reduced referrals during COVID lockdowns, as national lockdowns without school closures contributed to higher A&E attendance. This emphasises the critical role of schools in facilitating access to mental health services.

Conclusion: This study highlights the significant impact of the COVID-19 pandemic on CAMHS service demand and the resilience of paediatric liaison teams in adapting to fluctuating caseloads. The findings underscore the critical role of schools in identifying and referring young people for mental health support and emphasise the importance of collaborative planning between healthcare and education sectors to prepare for future crises.

Aims: This study examines the level of medical input for physical conditions provided to older age psychiatry patients compared with general adult ward patients. The assessment focuses on the frequency of medical reviews, the reasons for these reviews (e.g. falls, infections, heart failure), and National Early Warning Score (NEWS) escalations. The aim was to identify disparities in medical involvement and determine whether increased staffing is necessary in older age psychiatry wards.

Methods: The study included patients from an old age psychiatry ward (aged 65 and above) and a general adult ward (aged 18–64) over a one-month period. Data were collected from medical continuation sheets, patient records, and NEWS score documentation. Key variables included the number of medical reviews, reasons for these reviews, and the frequency of NEWS score escalations (≥5). A total of 46 patients were included in this study. Comparative statistical analysis was conducted to quantify medical input disparities between the two wards.

Results: The analysis revealed significant differences in medical input between the two wards. The mean age of patients in the old age psychiatry ward was 73.2 years, compared with 35.1 years in the general adult ward. Older patients required substantially more medical reviews, with a mean of 5.05 per patient per month, whereas younger adults had a mean of 0.91 review per patient (a significant difference, P<0.0001). The most common indications for medical reviews in older adults included falls, infections, heart failure, and respiratory distress. In contrast, younger adults primarily presented with milder complaints such as gastrointestinal issues and minor injuries. NEWS score escalations (≥5) occurred in 9% of older patients, compared with none in the younger cohort. Additionally, 21.7% of older patients required emergency department visits, significantly higher than the 4.3% observed in the general adult ward.

Conclusion: This study confirms a significantly higher requirement for medical input for older age psychiatry patients compared with general adult ward patients. It is recommended that additional medical staffing provision is considered in old age psychiatry wards. Additionally, regular training on NEWS escalation management and interdisciplinary collaboration between psychiatry and medical teams may improve patient outcomes.

Aims: Adolescents with eating disorders often require intensive inpatient care, and pharmacotherapy, including olanzapine, has been proposed as an adjunct to support weight restoration and reduce psychological symptoms such as food-related anxiety. However, evidence on olanzapine’s effectiveness in real-world adolescent settings remains limited. Ty Llidiard is the only inpatient general adolescent unit covering the whole of South Wales. The aim of this project is to evaluate whether Ty Llidiard provides effective medical care for its patients with eating disorders. The primary aim is evaluating weight restoration achieved as well as overall improvement in functioning. The secondary aim is evaluating whether the use of olanzapine is effective in achieving the primary aim.

Methods: A retrospective evaluation was conducted on all adolescents admitted to Ty Llidiard unit between May 2018 and December 2023 with a primary diagnosis of an eating disorder. Data collected included demographic information, length of stay, changes in %mBMI, and functional outcomes as measured by the Children’s Global Assessment Scale (CGAS). Comparisons were made between patients receiving olanzapine and those managed without pharmacotherapy. Data anonymization protocols ensured confidentiality. All patients admitted to the unit over the study period were included which eliminates selection bias.

Results: The cohort comprised 93 patients. The average length of stay was 105 days, during which patients achieved a mean weekly weight gain of 1% mBMI (approximately 0.5 kg per week) and an overall increase in %mBMI of 13.1%. Functional improvements were observed, with CGAS scores increasing from admission to discharge with an overall increase of 18.9 points. However, no significant differences in weight restoration or CGAS improvements were found between the olanzapine and non-pharmacotherapy groups. This result was no different when the analysis was limited to detained patients (marker of severity) or included those with any diagnosis of ED (not just as a primary diagnosis). There was more use of MHA in more unwell patients.

Conclusion: Ty Llidiard unit demonstrated effective treatment for weight restoration and functional improvement in adolescents with eating disorders. Evidence from RCTs and meta-analyses on olanzapine use in adolescents with eating disorders presents mixed findings. However, the findings from Ty Llidiard indicate that olanzapine does not provide additional benefits for these outcomes. These results challenge the routine use of pharmacotherapy in high-acuity inpatient settings and underscore the need for further research into the role of olanzapine in adolescent eating disorder treatment. This provides real-world generalisable information, especially for clinicians working in specialist inpatient services.

Aims: Manual and mechanical restraint are restrictive practices that are applied as a last resort in a high secure psychiatric setting in order to manage risk to self, others and to deliver safe care. These interventions can have inherent risks to the physical and mental health of patients and staff. Previous studies have shown a discrepancy in the way patients from different ethnic backgrounds can experience restrictive practice in mental health care settings. This service evaluation aims to understand whether a patient’s ethnicity has an influence on the use of manual and mechanical restraint at Broadmoor High Secure Hospital by considering restraint variables alongside demographic and risk factors.

Methods: This quantitative study involved the retrospective data collection of all manual and mechanical restraints in the hospital between April 2023 to April 2024. Manual restraints included 63 patients and 354 incidents. Mechanical restraints included 12 patients and 70 incidents.

Demographic variables included patient ethnicity, length of admission, index offence and psychiatric diagnosis. Restraint variables included frequency, duration, type, reason for restraint and target of the incident.

Results: Inferential analysis showed no statistical difference between the ethnic distribution of the manually restrained patient population and the ethnic distribution of the whole hospital patient population.

Descriptive analysis found varied distributions of restrictive practices across ethnic groups. Further inferential statistics revealed a significant difference between ethnic groups for manual restraints due to self-harm. Correlational analysis revealed a significant positive relationship between length of admission and frequency of manual restraints across a one-year period.

Conclusion: This service evaluation explored the use of restraint practices among patients of differing ethnicities within Broadmoor High Secure Hospital, enabling clinical and research recommendations to be made. This project highlighted varied distributions in relation to how different ethnic groups experience manual and mechanical restraint. Future projects should include a dataset spanning over a larger number of years to enable more robust conclusions to be drawn on whether there are ethnic disparities in restrictive practices. Future projects should also involve qualitative data from patients and staff to better understand the complexities surrounding the treatment of differing ethnicities within mental health care settings. The authors of this service evaluation have already planned to look at the use of short term seclusion and long term segregation among differing patient ethnic groups within Broadmoor High Secure Hospital, to further understand this critical issue.

Aims: Individuals with severe mental illness (SMI) are at significantly higher risk of physical health comorbidities compared with the general population. Factors such as long-term antipsychotic use, lifestyle choices, and reduced healthcare engagement contribute to this increased risk. Comprehensive annual physical health checks are recommended to identify and manage these risks. This study aimed to evaluate and improve the process of conducting annual physical health checks for patients with SMI in a Glasgow psychiatric rehabilitation unit, focusing on identifying risk factors, promoting a multidisciplinary team (MDT) approach, and ensuring timely follow-up of outstanding health concerns.

Methods: National guidelines from the National Institute for Health and Care Excellence (NICE), the National Institute for Health and Care Research (NIHR), and NHS Scotland were reviewed to establish key standards for physical health monitoring in psychiatric rehabilitation. A structured audit tool was developed covering systemic and lifestyle reviews, physical examinations, medication monitoring, external specialty input and general health screening. Annual health reports and clinical notes were retrospectively reviewed for 30 inpatients with a minimum one-year admission between November 2023 and October 2024. Based on audit findings, a new structured health check template and an improved MDT handover protocol were implemented before re-auditing their next review.

Results: Twenty-eight patients agreed to be reviewed, with 25 assessed using the old template and 15 so far with the new template. The proportion of patients receiving their health check within 12 months increased from 28% (7/25) to 73.3% (11/15). Physical examinations were documented in 96% (24/25) of previous reviews, with action-oriented comments in 40% (10/25). Following the introduction of the new template, documentation increased to 100%, with 53.3% (8/15) of cases including actionable comments. Systemic enquiry documentation improved from 92% (23/25) to 100%, with action-orientated comments rising from 36% (9/25) to 73.3% (11/15). Health screening documentation improved from 60% (15/25) to 100%, with 60% (9/15) requiring action. Diabetes risk was previously recorded in only 8% (2/25) of cases but increased to 100%, with 75% (10/15) prompting action. Previously, 60% (15/25) of outstanding health concerns were discussed within the MDT, whereas 86.6% (13/15) were formally addressed post-implementation.

Conclusion: This study highlights the effectiveness of a structured template in improving the quality and consistency of annual physical health checks in psychiatric rehabilitation. The new template enhanced documentation, facilitated multidisciplinary discussions, and improved identification of health risks. Strengthening MDT handover processes ensures timely follow-up, reinforcing the importance of structured, standardised approaches in psychiatric physical healthcare.

Aims: Antipsychotic medications are associated with metabolic syndrome and increased cardiovascular risk. Monitoring the physical health of patients receiving these medications is a key part of delivering safe and effective care.

Since 2020, audit cycles in the North-West Edinburgh Community Mental Health Team (NWCMHT) have found this monitoring to be consistently poor.

An experienced nurse was appointed lead of a new physical health clinic and it was incorporated into timetables of junior doctors to facilitate liaison with primary care. This weekly clinic was established in NWCMHT in 2023 focusing on those prescribed depot antipsychotic medication and clozapine.

We aim to assess the impact of this service development on patient care.

Methods: Scottish Intercollegiate Guidelines Network publication 131 was used as the gold standard, which cites 9 domains to monitor annually – past medical history (PMH), family history (FH), smoking history, BMI (or weight or waist circumference), blood pressure (BP), HbA1c, lipids, prolactin and ECG.

Data was collected for these domains for patients prescribed and administered depot antipsychotic medication or clozapine in the NWCMHT for the calendar year of 2024. Data was collected from the local computerised clinical notes system (TRAK) and anonymised in line with NHS Information Governance Policy.

Results: 163 patients were prescribed depot antipsychotic medication or clozapine by the NWCMHT in 2024. 58% (n=95) of these patients were offered an appointment at the physical health clinic, with 37% attending (n=60).

Across all domains, monitoring of those who attended clinic was better than those who did not – PMH (97% vs 48%), FH (95% vs 36%), Smoking (95% vs 44%), BMI (87% vs 28%), BP (97% vs 69%), HBA1c (82% vs 55%), lipids (74% vs 49%), prolactin (51% vs 35%) and ECG (85% vs 36%).

Of all 163 patients, the average completed monitoring across all nine domains was 60% in 2024. The average across all domains before the clinic was established was 30%.

Conclusion: There has been a significant improvement in monitoring in this patient group since the clinic was established in 2023. Patients who attend this clinic are monitored more effectively.

However, there are opportunities for further improvement. This would include identifying barriers that arise in achieving 100% across all domains in attendees and assessing factors that impede attendance at the clinic.

These results support plans to expand the clinic to ensure that the physical health of this patient group is appropriately monitored to achieve safe and effective care.

Aims: To reduce the waiting list, senior Psychologists and Psychotherapists started undertaking ADHD assessment as well as Psychiatrists in a CAMHS Outpatient Clinic. The aim of this Service Evaluation was to see if there was any difference regarding who performed the initial assessment and the management offered.

Methods: New assessment letters were reviewed from February–November 2024.

Data was collected including demographics, type of clinician, diagnosis and management.

Categorical data was assessed for statistical significance using Chi-square tests and numerical data using ANOVA.

The data was presented to the MDT to think about clinical significance.

Results: 103 patients were assessed with an average age of 11.7. Fifty-four were seen by a Psychiatrist, 39 were seen by a Psychotherapist and 10 were seen by a Psychologist. 25 of these patients required a follow-up with a Psychiatrist.

28 of the patients had a previous diagnosis of ADHD and therefore were required to be seen by a Psychiatrist. Of these patients, 26 retained their diagnosis at the point of initial assessment.

Of the children that had not been previously diagnosed with ADHD, 72% were given a new diagnosis of ADHD at initial assessment. After accounting for previously diagnosed patients, there was no statistical significance in number diagnosed by the different types of clinicians. There was no statistically significant difference between the management options offered and the type of clinician assessing.

Conclusion: Since this change, the service was able to nearly double the number of young people seen. This is a vital step as the number of referrals for the service has also increased over this time.

It was felt that there was a consistent approach across the service as there was found to be no statistically significant difference in either diagnosis given or management options offered by clinician types, after accounting for prior diagnosis. This allows some confidence that patients get the same, unbiased approach, regardless of clinician type.

Psychiatrists had a follow-up appointment with about half of the patients assessed by other clinicians. The follow-up takes less clinical time compared with the new assessment, however, this must be considered in the planning of a service.

Once a child has been diagnosed it is crucial that they are able to be offered the necessary services (Family Therapy, Psychology, Psychotherapy, Medication reviews) in a timely manner. Services must ensure a good balance between new assessments and looking after those post diagnosis.

Aims: It was intended to explore the change in nonattendance rate at outpatient clinics following the introduction of Short Message Service (SMS) reminders in the Black Country Healthcare NHS Foundation Trust, which serves four regions in the West Midlands.

Methods: The Trust introduced an SMS system in March 2024 to prompt the patients about their upcoming outpatient appointments. In a mirror-image design, we analysed the Did Not Attend (DNA) rates for 6 months pre and post-SMS introduction, from September 2023 to February 2024 and April 2024 to September 2024 respectively. All the patients offered an outpatient appointment were included in the data collection; with no exclusion. The study was approved by the Research and Innovation team of the Trust as a service evaluation.

Results: A total of 14094 appointments were taken into consideration before the introduction of SMS reminders, and a total of 14852 appointments were analysed post-SMS introduction. Before the introduction of SMS reminders, the average DNA rate across all four regions of the Trust was 22.8% (95% CI: 22.2–23.5) with a range of 19.9–24.8 in the six months. After the introduction of SMS reminders, the average DNA rate changed to 23.2% (95% CI: 22.5–23.8) with a range of 21.3–25.1 in the six months; and this change was statistically non-significant (NS). Two regions had an increase of DNA (21.1% to 21.9%, NS; and 20.7% to 24.7%, p<0.05) and others had a decrease (25.2% to 23.1%, p<0.05; and 24.7% to 23.6%, NS).

Conclusion: It appeared that within six months of the introduction of the SMS reminder system, there was no significant change in the DNA rates in the Trust; although there were regional variations of both increase and decrease in rates. There are multiple factors that can influence attendance at outpatient clinics such as accessibility, patient-related factors, and the effectiveness of a reminder system. It is also probable that the first six months may be early for the SMS system to establish its potential, and longer-term observational data might be needed. Similarly, the difference in DNA rates between regions cannot be explained without more in-depth data. There was a limitation in finding out whether all the patients were sent or received the reminders. There may be a scope to decrease the number of missed appointments through SMS, but further studies are required. In addition, the effectiveness of local processes of inviting patients and sending reminders needs to be checked.

Aims: One of the aims of this project was to look at changes in working patterns within our local Eating Disorder service over time, paying particular attention to changes in rates of accepted referrals, and rates of inpatient admissions during and after the COVID-19 pandemic. A secondary aim was to look at rates of co-morbidity in the local Eating Disorder Population and compare this to the general population of a similar age group. In order to do this, findings for the general population were extrapolated from the Youth Wellbeing Prevalence Study Northern Ireland (YWPS).

Methods: Data on accepted referrals was extracted from a locally used electronic systemic LCID which came into use in 2018 in Northern Trust CAMHS. Additional information regarding admissions and co-morbidities were obtained using another electronic system widely used in Northern Ireland, NIECR. Data included referrals accepted between October 2017 and September 2024, and excluded referrals made to the CAMHS Eating Disorder Service which were rejected. Information regarding admissions to Beechcroft, a regional psychiatric inpatient unit for young people under the age of 18, was obtained from medical administration in the Belfast Trust. Data was generated regarding admissions accepted specifically from our Eating Disorder Service.

Results: The admission rate (including admissions to adult medical wards) was 13.84% (35–50% UK wide). Of the 64 young people who were admitted to the paediatric ward 11% were male and 89% were female. The average length of admission to A2 was 21.13 days and the average age at the time of admission was 13.64 years old. The rate of Autism/Autistic traits in those Eating Disorder patients admitted to the paediatric ward was nearly 4.4 times greater than the population from the YWPS. Rates of anxiety were increased by more than 4 times. Rates of low mood/depression were increased by more than 11-fold.

Conclusion: The hospital admission rate within our service is significantly lower than the UK-wide admission rate for Eating Disorders. There was a sharp increase in referrals to the CAMHS Eating Disorder Service during the COVID-19 pandemic. Following the end of the COVID-19 lockdowns and easing of restrictions there has been a return to almost pre-pandemic levels in terms of referrals. Paediatric admissions and psychiatric admissions increased significantly during the COVID-19 pandemic. Rates of psychiatric admissions for eating disorders are now much lower than pre-pandemic levels. Rates of paediatric admissions for eating disorders remain elevated.

Aims: Cherry Tree Close, a mental health rehabilitation and recovery unit based in Derby, England was assessed in October 2023 to compare current standards against the quality standards outlined in the Standards for Inpatient Mental Health Rehabilitation Services 4th Edition though did not fulfil the required criteria to achieve accreditation. Since then, the service has made further developments.

This is a service evaluation study to compare the current service delivery of Cherry Tree Close, against the quality standards set out in the Standards for Inpatient Mental Health Rehabilitation Services 4th Edition document to identify progress towards achieving accredited status.

Methods: The electronic patient records of service users admitted to the ward were reviewed between November and December 2024. Service users and members of the multidisciplinary team were interviewed. A visual inspection of the unit was carried out. Relevant standard operating procedures were reviewed.

To achieve accreditation, services are required to meet 100% of type 1, 80% of type 2 and 60% of type 3 standards.

Results: For type 1 standards, 95/109 standards (87.1%) were achieved in 2024 when compared with 93/109 (85.3%) in 2023.

For type 2 standards, 39/50 standards (78.0%) were achieved in 2024 when compared with 38/50 (76.0%) in 2023.

For type 3 standards, 8/14 standards (57.1%) were achieved in 2024 when compared with 5/14 (35.7%) in 2023.

The improvement relates to development of a local community enhanced rehabilitation service and expansion of the multidisciplinary professionals including recruitment of team psychologists, assistant psychologists, and resident doctor in training.

The remaining unmet standards relate to the infrastructure of the unit, care pathways, staff training, supervision, wellbeing, and service management.

Conclusion: Currently, Cherry Tree Close has not fulfilled the criteria to achieve accreditation status.

Further meetings have been arranged with the transformation team to work on further developing the service towards achieving accreditation.

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. Derby City (Census 2021 population: 261,400) is ethnically diverse, with White residents forming 73.8%, Asian residents 18.1% (including mixed White/Asian, and Arab), and Black residents 6.1% (including White and Black Caribbean, mixed White/Black, and African). In contrast, Derbyshire South County (Census 2021 population: 349,000) has a predominantly White population (95.2%), with Asian residents at 2.8%, Black residents at 1.4%, and other ethnic groups at 0.5%.

Aim was to ascertain the ethnic profile of patients discharged from the EIP service in Derby City and Derbyshire South County, comparing these findings with respective census data.

Methods: All patients discharged from the EIP service between 1 April 2023 and 1 April 2024, who were under the service for more than 3 months and typically not more than 3 years, were included. Data on ethnicity was retrospectively collected from clinical records, recorded in an Excel spreadsheet, and analysed to identify disparities compared with census demographics.

Results: In Derby City, White patients were under-represented at 60.87% compared with 73.8% in the census. Asian patients were over-represented at 21.74% versus 18.1%, and Black patients accounted for 17.39% of discharges compared with 6.1%. Other ethnic groups were absent (0%) compared with 2.0% in the census.

In Derbyshire South County, White patients represented 61.36% of discharges, lower than 95.2% in the census. Asian patients were over-represented at 27.27% compared with 2.8%, and Black patients at 11.36% versus 1.4%. No representation was observed from other ethnic groups, despite a 0.5% census presence.

Conclusion: The study highlights disparities in the ethnic profile of discharged EIP patients. Asian and Black populations were consistently over-represented, while White populations were under-represented, especially in Derbyshire South County. The absence of other ethnic groups raises concerns about service access. Further investigation is needed to explore factors such as socio-economic influences, cultural perceptions of mental health, referral pathways, and potential systemic biases.

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.