This study explored the association among dissociative experiences, recovery from psychosis and a range of factors relevant to psychosis and analysed whether dissociative experiences (compartmentalisation, detachment and absorption) could be used to predict specific stages of recovery. A cross-sectional design was used, and 75 individuals with psychosis were recruited from the recovery services of the Gloucestershire Health and Care NHS Foundation Trust. Five questionnaires were used – the Dissociative Experiences Scale – II (DES), Detachment and Compartmentalisation Inventory (DCI), Questionnaire about the Process of Recovery, Stages of Recovery Instrument (STORI), and Positive and Negative Syndrome Scale – and a proforma was used to collect demographic data.

Our findings indicated that compartmentalisation, detachment and absorption, as measured by DES and DCI, do not predict stages of recovery as measured by the STORI.

The results of this study suggest that there is no simple relationship between dissociative and psychotic symptoms. They also suggest a need to assess these symptoms separately in practice and indicate that special approaches to treatment of psychosis may be needed in cases where such symptoms have a significant role.

Neuropsychiatry training in the UK currently lacks a formal scheme or qualification, and its demand and availability have not been systematically explored. We conducted the largest UK-wide survey of psychiatry trainees to examine their experiences in neuropsychiatry training.

In total, 185 trainees from all UK training regions completed the survey. Although 43.6% expressed interest in a neuropsychiatry career, only 10% felt they would gain sufficient experience by the end of training. Insufficient access to clinical rotations was the most common barrier, with significantly better access in London compared with other regions. Most respondents were in favour of additional neurology training (83%) and a formal accreditation in neuropsychiatry (90%).

Strong trainee interest in neuropsychiatry contrasts with the limited training opportunities currently available nationally. Our survey highlights the need for increased neuropsychiatry training opportunities, development of a formalised training programme and a clinical accreditation pathway for neuropsychiatry in the UK.

The medical workforce in psychiatry is increasingly diverse, but not necessarily in its senior leadership in the UK’s National Health Service (NHS). We aimed to describe the characteristics of psychiatrists with board-level responsibility in mental health trusts in England in 2024, comparing the current picture with that of 2016 and 2020, using publicly available data.

The proportion of medical directors who are female has not changed, so women remain underrepresented, while the proportion who are international medical graduates has increased substantially, so they are no longer underrepresented. Although fewer in number, intellectual disability psychiatrists are underrepresented.

Greater attention will need to be paid to developing female medical leaders if representative leadership is to be achieved.

Non-attendance at out-patient appointments of adult attention-deficit hyperactivity disorder (ADHD) services incurs significant costs and contributes to lost service provision and unmet clinical needs. This cross-sectional study of clinical contacts, between 1 July 2022 and 30 June 2023 in a specialist adult ADHD service, aimed to identify factors, including type of consultation, associated with non-attendance.

Of 3673 organised clinic appointments, 2815 (77%) were attended: 2314 (82%) by telephone and 501 (18%) as in-person appointments; non-attendance rates were 17 and 42%, respectively. Patient characteristics associated with improved attendance included: female gender, age >30 years and presence of other psychiatric diagnoses.

This study will assist adult ADHD service providers to maximise patient attendance. The role of telephone (or virtual) clinics must be considered. Enhanced appointment reminders and improving access to services targeting at-risk groups could also improve attendance rates.

An equitable child mental health service provides access to treatment proportionally to the need of individual demographic groups. Despite qualitative and survey-based evidence of barriers disadvantaging some demographic groups, it is not well understood how these barriers translate into quantifiable inequities. We calculated the treatment access rate for English children aged 6–16 years in 2021–2022, using the patient-level Mental Health Services Data Set and Mental Health of Children and Young People Survey.

The number of primary school children in treatment needs to increase nationally by 173%, the number of boys by 65% and the number of children from a White ethnic background by 31%, to achieve equity in treatment access. There was no evidence of inequities by area deprivation.

Child mental health services in England should not only increase overall access rates, but also pay more attention to equity in access across different demographic groups.

This study aimed to evaluate an artificial intelligence-assisted tool for psychiatric case formulation compared with human trainees. Twenty trainees and an artificial intelligence system produced formulations for three simulated psychiatric cases. Formulations were scored using the integrated case formulation scale (ICFS), assessing content, integration and total quality. Time taken was recorded, and assessor predictions of formulation origin were analysed.

Artificial intelligence produced formulations significantly faster (<10 s) than trainees (mean 52.1 min). Trainees achieved higher ICFS total scores (mean difference 8.3, P < 0.001), driven by superior content scores, while integration scores were comparable. The assessor identified artificial intelligence-generated formulations with 71.4% sensitivity, but overall accuracy of who produced the formulations was only 58.3%.

Artificial intelligence shows promise as a time-saving adjunct in psychiatric training and practice, but requires improvements in generating detailed content. Optimising teaching methods for trainees and refining artificial intelligence systems can enhance the integration of artificial intelligence into clinical workflows.

In the UK, Black doctors experience higher levels of discrimination, bullying and harassment compared with other doctors. This study aims to explore the impact of this on perceived well-being and mental health. A UK survey of 109 Black psychiatrists asked about racism, othering, microaggressions, bullying and harassment, plus any links to career progression or mental well-being.

Sixty-three survey participants (57.8%) had faced workplace microaggressions, 44 (40.4%) had experienced workplace bullying and 41 (37.6%) had faced workplace harassment. Forty-seven (43.1%) participants reported a detrimental impact on their mental health, with 35 (32.1%) considering quitting and 24 (22%) reporting a poorer work performance.

These experiences are unacceptable and can be traumatic. The impact of racism and discrimination can also undermine effective service delivery. Barriers to reporting can prolong mistreatment and deter professional aspirations among Black psychiatrists. Collective action is needed to drastically improve the workplace environment, including the widespread institutional adoption of an anti-discriminatory stance.

There is growing consensus on essential components of care for hospital-presenting self-harm and suicidal ideation, yet these are often inconsistently implemented. This qualitative study aimed to explore the implementation of components of care across hospitals. Interviews were conducted with health professionals providing care for self-harm and suicidal ideation in hospital emergency departments. Participants (N = 30) represented 15 hospitals and various professional roles. A framework analysis was used, where factors affecting each care component were mapped by hospital and hospital grouping.

A timely, compassionate response was facilitated by collaboration between liaison psychiatry and emergency-department staff and the availability of designated space. Other factors affecting the implementation of care components included patient preferences for, and staff encouragement of, family involvement, time taken to complete written care plans and handover and availability of next care impacting follow-up of patients.

The findings suggest a need for further integration of all clinical professionals on the liaison psychiatry team in implementing care for self-harm; improved systems of handover; further training and awareness on the benefits and optimal processes of family involvement; as well as enhanced access to aftercare.

Advances in generative artificial intelligence, particularly through large language models, like GPT-4, have opened opportunities to develop cognitive agents to enhance clinical productivity, especially in complex secondary and tertiary care settings. However, as artificial intelligence begins to occupy the cognitive space traditionally held by human clinical reasoning, transparency becomes a significant concern. Unlike human decision-making, artificial intelligence-generated outputs may not be traceable to a transparent chain of clinical reasoning, potentially impacting safety if used without adequate ‘clinician reach’ into the reasoning space of artificial intelligence.

We highlight the need for a consensus framework to guide the responsible use of generative artificial intelligence in mental healthcare, which, it is argued, has cognitive demands and features distinct from physical medicine. We propose such a framework, Clinical Reach into the Cognitive Space (CRITiCS), to support clinician involvement in the deployment of these technologies.

This paper aims to spark dialogue and interest in both the clinical and artificial intelligence development communities.

This study examines more than 5.8 million bed days of data from private and National Health Service care providers who contribute to the Mental Health Services Monthly Statistics in the UK. The use of oral chemical restraint is compared with provider size, and the relative use of oral chemical restraint as opposed to seclusion is investigated.

The data-set has large amounts of missing data. The use of oral chemical restraint is proportional to provider size in terms of bed days. Analysis of those providers who reliably submit data demonstrates patterns of reported use of oral chemical restraint versus use of seclusion.

Further research is required into the institutional characteristics that are correlated with increased use of oral chemical restraint. Efforts to investigate the use of restrictive interventions in mental health settings are frustrated by inconsistent reporting.

We aimed to quantify attention-deficit hyperactivity disorder (ADHD) and autism assessment requests, and explore correlations with public interest and COVID-19 restrictions. We collected data on referrals to adult ADHD or autism services, Google searches for ‘autism’ or ‘ADHD’, birth gender ratios, ADHD prescriptions in England and COVID-19 restriction measures in four countries.

ADHD assessment demand tripled from July 2020 to January 2023, with Google searches for ADHD rising in parallel. Autism referrals and searches saw smaller, similarly timed rises. Female referrals outstripped males. ADHD prescriptions rose particularly in those aged 30–34 years. Google searches for ADHD unexpectedly rose from July 2020 in four countries, correlating with sustained intensity of national COVID-19 restrictions.

Public interest may have driven demand for ADHD assessments, with COVID-19 restrictions encouraging social media use facilitated by easy electronic information access. The public has decided that ADHD is important, independent of professional views. It is now critical that a consensus is reached to determine who benefits most from an ADHD diagnosis and medication.

To investigate the impact of the widespread availability and use of the semi-synthetic cannabinoid hexahydrocannabinol (HHC) on hospital admissions owing to psychosis. Medical records of patients admitted for psychotic illness to University Hospital Galway were examined to assess HHC or other illicit drug use before admission.

Of the 214 total admissions for psychotic illness, 28 admissions (13.1%) were preceded by use of HHC, nine of whom used only HHC. Sixteen (34%) admissions of first-episode psychosis were preceded by HHC use, with seven of these using only HHC.

Clinicians should explicitly enquire about the use of HHC in patients presenting with first-episode and relapse of psychotic illness. Sufficient evidence has now accumulated from research of a link between HHC and psychosis. Such psychoses appear to be more prominent in young people with early-phase psychosis, and highlights the need for authorities to change legislation to avoid further harm.

Restraints in mental health in-patient settings can negatively affect recovery. This study aimed to examine the prevalence and associated factors of restraint use. A retrospective cohort study was conducted in a rural NHS mental health trust in the UK, covering all adult in-patients from July 2020 to July 2021.

The prevalence of restraint was 34%. Factors associated with restraint included age 18–25 or ≥65 years, female gender, disability, long-term sickness benefits, detention under the Mental Health Act, frequent admissions and a diagnosis of depressive or severe mental illness. Statistically significant associations were found for age ≥65 years (odds ratio 3.920), Section 2 detention (odds ratio 5.72), more than ten previous admissions (odds ratio 5.672) and depressive disorders (odds ratio 3.478).

Restraint use remains common and is linked to identifiable risk factors. These findings support the need for targeted interventions to reduce restraint, particularly for high-risk patient groups.

Non-pharmacological interventions (NPIs) are recognised for their potential in treating dementia symptoms. However, little is known about the extent of their use. In this study, we conducted structured interviews with people with dementia and their family caregivers (n = 50), professional caregivers (n = 42) and dementia care coordinators (n = 42) on the use of 14 NPIs.

Cognitive stimulation/training, physical activity and occupational therapy were implemented by most participants, whereas neurofeedback, drama therapy and phototherapy were rarely used. Most NPIs were carried out weekly. People with dementia and their caregivers reported using significantly fewer NPIs than other participants (P < 0.001). Participants perceived effects for, on average, 90.3% (s.d. = 31.3%) of the NPIs that they used.

Providing targeted support and funding might help to increase the use of NPIs by family caregivers as well as in institutional care settings.

To determine the most acceptable term for borderline personality disorder (BPD). We conducted a cross-sectional study of patients who know what it feels like to be diagnosed with a mental disorder. The main outcome measures were the proportion of participants offended and confused by alternative terms for BPD.

Seventy-two people participated in the study. Being diagnosed with a condition was more offensive than being diagnosed with a disorder (χ2 = 41.18, d.f. = 1, P < 0.01). Fluxithymia offended the fewest participants (13%), but was the most confusing term (31%). Emotionally unstable personality disorder was the most offensive term (63%). After fluxithymia, emotional intensity disorder was the least offensive term, and not especially confusing (11%). Changing BPD to emotional intensity disorder would avoid an offensive event every 3.6 diagnostic announcements.

The diagnostic term BPD should be replaced with emotional intensity disorder, because this term provides a balance of clarity and inoffensiveness.

To examine whether unconscious and systemic biases regarding ethnicity have an impact on equity of access to a national tic service for children and young people (CYP) at Great Ormond Street Hospital for Children, London, UK. We retrospectively reviewed triaged referrals over an 18-month period and examined differences in triage decision, re-referrals required before acceptance and symptom severity at initial assessment by clinician-perceived and self-assigned ethnicity.

There was no evidence of an unconscious bias within the triage process. CYP from racially minoritised ethnic backgrounds were underrepresented and presented with greater overall need at initial assessment.

Better recording of ethnicity is a requisite starting point for research. We encourage local services to audit ethnicity of the CYP they refer to national and specialist services. Findings call for greater awareness of challenges faced by patients from racially minoritised ethnic backgrounds.

The British Paediatric Surveillance Unit of the UK Royal College of Paediatrics and Child Health contacts participating consultant paediatricians each month to survey whether particular rare conditions or events have been seen in their services. This national surveillance of rare paediatric events has allowed a large amount of research into multiple paediatric conditions. In 2009, the Royal College of Psychiatrists established a similar system – the Child and Adolescent Psychiatry Surveillance System (CAPSS) – to survey consultant psychiatrists in UK and Ireland. Since many conditions involve mental and physical health features, seven studies have been run using reporting to both systems, with simultaneous surveillance across both paediatricians and psychiatrists. Given the desire by policymakers, commissioners and clinicians for well-integrated physical and mental healthcare (‘joined-up working’), and if the surveillance systems were functioning well, the CAPSS Executive expected high rates of parallel reporting of individual patients to the two systems. The current study synthesises the rates of parallel reporting of cases to those two systems. We assimilate rates of parallel reporting across the seven studies using figures that have already been published, and by contacting contributing research groups directly where the relevant figures are not currently published. No new primary data were collected.

Of the 1211 confirmed cases, 47 (3.9%) were reported by both psychiatrists and paediatricians. No parallel reporting occurred in four of the seven studies.

Our findings raise questions about whether joined-up working in mental and physical healthcare is happening in practice. Research into challenges to obtaining comprehensive surveillance will help epidemiologists improve their use of surveillance and control for biases.