Background: Female acute inpatient wards manage dynamic clinical risk, including self-harm, violence and security-related incidents. Beyond incident reduction, developing a culture of care, learning and multidisciplinary ownership is essential to achieving sustainable improvements in safety and patient experience.

Aim: To review incident trends over a 12-month period on a female acute ward (Hooper) at Cygnet Beckton and to describe MDT practices, learning processes and cultural factors associated with improvement and sustained low incident levels.

A retrospective descriptive review of Datix-reported incidents was undertaken for January–December 2025. Incidents were analysed monthly across violence and aggression, self-harm, security incidents (including AWOL and attempted AWOL), medication-related incidents, and injury or accident events. MDT practices, learning approaches and service developments were identified through ward-level reflection and review.

A total of 613 incidents were recorded (monthly range 22–98).

Violence and aggression incidents totalled 182, including 85 episodes of actual physical violence, with a clear reduction across the year from 23 incidents in January to 1 incident in December.

Self-harm incidents totalled 258, primarily head banging (141) and cutting (27). Monthly self-harm peaked in May (48 incidents) and reduced to 18 incidents in December.

Security incidents remained comparatively low (47 total), including attempted AWOL/abscond (8) and AWOL (2). Medication-related incidents totalled 19, while injury and accident-related incidents totalled 47.

MDT good practice and learning culture:

Quality improvement approach and MDT practice:

As part of the national accreditation-aligned QI programme, Culture of Care, Hooper ward embedded a structured culture of learning and improvement, rather than isolated incident response. MDT-led After Action Reviews were routinely undertaken following incidents, enabling systematic analysis of contributory factors, identification of improvement actions, and dissemination of lessons learned across the team.

QI interventions included care-plan-based ward rounds, shared decision-making regarding medication, patient involvement in MDT discussions (including chairing ward rounds where appropriate, chairing community meetings), co-produced safety and risk formulations, and strengthened MDT communication and escalation pathways. Learning from AARs directly informed changes to observation, engagement and care planning.

The nationally aligned QI programme, culture of care was associated with sustained reductions in violence and self-harm on a female acute ward. Structured MDT learning, accreditation-driven standards and routine After Action Reviews supported safer, more consistent and person-centred care.

Virtual RAMPPS - An Online Simulated Teaching Method of the RAMPPS Model

We delivered two separate half day courses, each including three scenarios to groups of Foundation Trainees, GP Trainees, Core Trainees and Trust Grade Doctors.Sessions were delivered on MS Teams and participants could answer next steps in their assessment/management anonymously using Slido.

Physical health emergencies covered included: Ligature Strangulation

Clozapine Induced Bowel Obstruction

Wernicke’s Encephalopathy

Neuroleptic Malignant Syndrome

Opioid Overdose

Venous Thrombo-Embolism

There was opportunity for debrief and discussion at the end of each clinical scenario, where personal and systemic factors affecting management of the cases were addressed along with questions from participants.

The study results were derived from qualitative feedback obtained from participants, which was analyzed to identify distinct themes regarding the simulation training. The findings were categorized into two primary domains: Personal Factors and Systemic Factors.

Under Personal Factors, the analysis highlighted the importance of early recognition, familiarity with guidelines, and case-specific confidence, which directly influenced the management of specific clinical scenarios such as cardiac problems, hypo- and hyperglycaemia, wound management, and overdoses.

Systemic Factors focused on operational elements, including resources, staffing, team knowledge, and the availability of senior psychiatric colleagues and nursing teams.

The results also mapped the complex logistical challenges faced by staff, such as the practicalities of transferring patients to acute hospitals, remote management, access to patient background information, and the specific limitations of medical provisions available on-site.

Positive feedback demonstrates Virtual RAMPPS is a valuable learning tool, helps with personal factors like knowledge and skills, but also develops participants ability to deal with systemic factors. We intend to expand the course to include additional cases. Consideration will be made into expanding the audience to include physical healthcare practitioners and wider MDT.

To evaluate the quality of suicide risk assessment documentation in outpatient consultations against NICE NG225 and Local Trust standards, and to assess whether a focused feedback intervention improved documentation quality.

A retrospective baseline audit reviewed the first 50 consecutive outpatient consultations from 1 December 2025. Findings were summarised and fed back to clinicians. A re-audit examined 50 subsequent consultations from 23 January using the same structured assessment criteria. Core criteria included documentation of suicidal ideation, plan, intent,access to means, history of self-harm, risk formulation, and safety planning. Additional criteria assessed shared decision-making and communication with the General Practitioner.

Substantial improvement followed the feedback intervention. Documentation of consent and confidentiality increased markedly (from 4% to 76%), reflecting greater attention to patient involvement and transparency. Recording of history of self-harm, a key predictor of future risk, improved significantly (from 28% to 76%). Protective factors, often under-recorded locally, increased from 52% to 78%, strengthening overall risk formulation. General risk formulation itself showed a notable improvement (62% to 82%), showing a clearer integration of dynamic and historical factors.

Among patients expressing suicidal ideation (baseline 28%, re-audit 50%), documentation of suicidal plan and intent improved from 0% at baseline to 84% post-intervention–representing one of the most clinically meaningful changes observed. Despite improvement in several domains, access-to-means exploration remained low (6% to 14%), identifying an important area requiring further attention. Documentation of shared decision-making showed some decline (98% to 84%), suggesting that emphasis on risk-specific domains may have inadvertently reduced focus on collaborative discussions.

Targeted feedback led to clear and meaningful improvements in several domains central to high quality suicide risk assessment, particularly self-harm history, protective factors, overall risk formulation, and documentation of plan and intent among patients with suicidal ideation. Persistent gaps in assessing access to means highlight a priority area for additional intervention. Future work would focus on embedding structured reminders within clinical templates, reinforcing collaborative practice, and conducting further re-audits to sustain improvement.

To describe the clinical complexity of an adolescent presenting with severe restrictive eating, emotional dysregulation, and high-risk behaviours where the diagnosis of Anorexia Nervosa (AN) remained uncertain within Child and Adolescent Mental Health Services (CAMHS). Additional objectives include examining how social adversity and fluctuating engagement shaped the evolving formulation and management needs.

A retrospective review of clinical notes, inpatient episodes, Mental Health Act assessments, and multidisciplinary documentation was undertaken. Key events were organised chronologically, including physical health parameters, episodes of self-harm, social context, and engagement with services.

An adolescent known to services for a few years, demonstrated early self-harm, restrictive eating, purging, and excessive exercise. Over the years, the young person (YP) experienced multiple overdoses, admissions under the Mental Health Act, nasogastric feeding, and medical instability related to low food intake.

Although YP exhibited low weight, calorie restriction, and distress related to body image, co-existing mood instability and relational stress made the diagnosis of Anorexia Nervosa uncertain throughout CAMHS involvement. Interventions included selective serotonin reuptake inhibitors, antipsychotics, crisis work, therapy and multi-agency safeguarding involvement.

Periods of stabilisation alternated with relapse and disengagement. YP was transitioned to the adult services when 18.

This case highlights the need for flexible, formulation driven care where restrictive eating coexists with high risk behaviours. Diagnostic ambiguity should not delay intervention, instead, consistent relational work, coordinated safeguarding, and careful transition planning are essential to support recovery.

Postpartum depression (PPD) affects 10–25% of women worldwide, contributing to maternal morbidity, infant developmental issues, and elevated suicide risk. While PPD is widely recognised as multidimensional within the biopsychosocial model, comprehensive syntheses that integrate biological, psychological, and social determinants are limited. This umbrella review aims to identify and classify the strength and certainty of biological, psychological and social risk factors associated with PPD.

This PRISMA-compliant umbrella review was prospectively registered on PROSPERO (CRD420251241065). Medline, Embase, PsycINFO, Scopus were searched from inception to November 2025. Systematic reviews and meta-analyses examining risk factors for PPD were included. Two independent reviewers screened titles/abstracts and full texts, with a third resolving discrepancies. Methodological quality was assessed using AMSTAR-2. Credibility was evaluated via umbrella review criteria (URC: Class I [convincing] to IV [weak]), and certainty using GRADE (high to very low).

Seventy-seven systematic reviews with meta-analyses, comprising 1658 studies and 25,737,929 women were included. Studies varied in quality and certainty. Biological factors associated with increased PPD risk included gestational diabetes mellitus (pooled OR/RR 1.3–2.7), caesarean section (OR 1.26–1.48), preterm birth/low birth weight (OR 1.79–1.97), perinatal pain (OR 1.29–1.75), and sleep disorders (OR 2.36–3.69). Psychological factors included antenatal depression (OR 4.58–7.70) and anxiety (OR 2.64–7.07), history of depression (OR 3.09–4.82), adverse childhood experiences (OR 2.31), and prenatal stress (PR 1.82). Social factors included intimate partner violence (OR 2.5–4.4), unintended pregnancy (OR 1.53–3.46), lack of social/family support (OR 2.57–5.96), and poor marital relationship (OR 3.47–3.56).

Across biopsychosocial domains, obstetric complications (biological), antenatal mental health (psychological), and intimate partner violence (social) emerge as potential risks. High heterogeneity reflects variability in PPD definitions, timing, measurement tools and populations. Reliance on observational data precludes causality. Future research should focus on identifying and clarifying these risk factors to target screening and early intervention for at-risk mothers in varied contexts. Clinically, these findings support multidisciplinary interventions to mitigate PPD burden and improve maternal-infant outcomes.

Our aim was to evaluate the psychiatric service provided by NHS Lothian, specifically the Royal Edinburgh Hospital (REH), which provides inpatient care for patients in Edinburgh, East Lothian and Midlothian.

Data was collected from NHS Lothian analytical services, the Director of Public Health Annual Report 2024, NHS Benchmarking Network findings (2022/23), the Scottish Government Mental Health Inpatient Census 2024, the National Records of Scotland and the World Health Organisation (WHO). Data was anonymised in line with NHS Information Governance Policy.

We evaluated the service provided for working age adults (18-64 years old) in REH using key performance indicators (KPIs) including bed occupancy, re-admission rates, length of stay (LOS) and staffing. Results were compared with other health boards in Scotland.

The relevant population is approximately 480000 people. Since 2001, East Lothian, Midlothian and Edinburgh are the fastest growing populations in Scotland (27.7%, 23.4% and 18.2%).

In 2014, European Union members had on average 77 beds per 100000 population. The United Kingdom had 46 beds per 100000 population. In 2015, the REH was rebuilt with a 20% reduction in capacity, with 105 acute adult beds. This equates to 22 beds per 100000 population (Scotland mean=28/100000).

The Royal College of Psychiatrists recommends a maximum safe bed occupancy of 85%. Mean bed occupancy for acute adult beds in REH has increased from 96.2% in 2021 to 109.5% in 2025. This was last under 100% in March 2022.

Over the same timescale, mean LOS has increased (19 days to 27 days) and mean admissions per month have fallen (154 to 131).

11% of patients required re-admission within 30 days of discharge (Scotland mean=8%). Lothian had the highest percentage of compulsory admissions at 33% (Scotland mean=19%).

Turnover of hospital staff was 18% (Scotland mean=15%). Community teams had 33 staff per 100000 population (Scotland mean=76/100000) with 20% vacancies (Scotland mean=17%).

There has been a failure across all KPIs. Re-admissions, compulsory admissions and staffing are all worse than the Scottish average and bed occupancy has not been below 100% for 4 years.

Population growth puts pressure on all services, but NHS Lothian has failed to adjust for this to provide safe and effective inpatient care. Low community staffing only exacerbates the problem.

These findings indicate the need for review of managerial and funding decisions for psychiatric services in NHS Lothian to optimise patient care.

Patients with neurological disorders frequently present with co-occurring psychiatric symptoms, often requiring assessment within specialist neuropsychiatric services. This study aimed to describe the spectrum of psychiatric presentations seen in a specialist neuropsychiatry outpatient population and evaluate the prevalence and severity of anxiety and depressive symptoms among patients attending a tertiary neuropsychiatry clinic.

A descriptive cross-sectional study was conducted in a tertiary regional neuropsychiatry outpatient clinic in London. Consecutive patients attending the service were invited to participate. Participants completed a standardised questionnaire collecting demographic data and standardised measures of mood and anxiety were administered using the Patient Health Questionnaire-9 (PHQ-9) and the Generalised Anxiety Disorder-7 (GAD-7). Of those invited, 79 participants were included in the final analysis.

High levels of psychiatric comorbidity were observed across the neuropsychiatric cohort, with substantial variability between diagnostic groups. Patients diagnosed with functional neurological disorder (FND) demonstrated the greatest affective symptom burden: 92% reported at least mild depressive symptoms and 83% met criteria for clinically significant anxiety. Other neuropsychiatric subgroups similarly exhibited notable levels of anxiety and depression although to a lesser extent than the FND group.

This study demonstrates a substantial and heterogeneous psychiatric symptom burden among patients attending a specialist neuropsychiatry outpatient service. The particularly high prevalence of affective symptoms in individuals with FND highlights the need for comprehensive, integrated, and multidisciplinary approaches to assessment and treatment. Improved recognition and management of psychiatric comorbidities may have important implications for clinical outcomes, patient experience, and long-term prognosis within neuropsychiatric populations.

Zopiclone is licensed for the short-term management of insomnia, with recommended treatment durations of 2–5 days for transient insomnia, 2–3 weeks for short-term insomnia, and not exceeding four weeks including tapering, in line with NICE TA77 guidance. Elm Ward’s initial audit (Oct–Dec 2023) identified widespread prescribing beyond these limits. This re-audit provides updated patient-level data to assess progress following practice changes introduced after the initial audit.

The re-audit aimed to:

1. Evaluate current zopiclone prescribing patterns.

2. Compare durations of use with the 2023 audit.

3. Assess compliance with recommended maximum treatment duration.

4. Identify remaining gaps in documentation and review processes.

The first audit included 48 patients, of whom 22 received zopiclone. The re-audit sampled 43 patients from Elm Ward (Dec 2025–Feb 2026), identifying 12 prescribed zopiclone. Data sources included Kardex, EPMA, and CITO. Variables collected included demographics, indication, dose, start/stop dates, duration, review documentation, and use of alternative or non-pharmacological interventions. Where stop dates were missing, an end date of 05/02/2026 (the re-audit completion date) was applied to allow duration calculation.

In 2023, the mean duration of zopiclone use was 7.7 weeks (median 8.3; range 0.2–16), with only 27% (6/22) within the recommended ≤4-week limit. In the re-audit, 12 of 43 patients (27.9%) were prescribed zopiclone, with a mean age of 40 years. Using the audit end-date assumption, the mean duration was 3.42 weeks (~24 days), the median 1.29 weeks (~9 days), and the range 0.14–20.29 weeks. Overall, 83.3% (10/12) were within the ≤4-week maximum, and 16.7% (2/12) exceeded it. Indications were predominantly short-term insomnia, though documentation was incomplete in some cases. When judged against indication-specific NICE time windows, 30% of evaluable cases met the appropriate duration. Three patients received alternative sleep medications, and no non-pharmacological sleep interventions were documented. Dose was recorded in 83.3% (10/12), all at 7.5 mg.

The re-audit shows a substantial improvement in prescribing duration compared with 2023, with most patients now receiving treatment within the recommended four-week limit. However, missing stop-date documentation continues to affect duration calculations and contributes to misclassification of treatment length. Persistent gaps remain in documenting non-pharmacological interventions, indications, and review plans. Continued reinforcement of documentation standards, pharmacist-led review prompts, and a repeat audit in 12 months are recommended to ensure sustained improvement.

Clozapine is the gold-standard treatment for treatment-resistant schizophrenia but carries serious cardiac risks, including sudden cardiac death (SCD). Specific risk factors for SCD in clozapine-treated patients remain poorly defined.

Aims were to systematically identify and synthesise evidence on risk factors for SCD and sudden unexplained death (SUD) in clozapine-treated patients, to guide clinical monitoring.

We conducted a systematic review following PRISMA guidelines (PROSPERO: CRD420250646384). Five databases were searched from inception to 13 October 2025. Studies reporting SCD or SUD in clozapine-treated patients were included without restrictions on study design, demographics, or diagnosis. Two reviewers independently screened studies and extracted data. Quality was assessed using JBI checklists and ROBINS-E tools. Given study heterogeneity, we performed structured narrative synthesis.

Twenty-one studies (1989–2023) were included, comprising 498 cases of SCD/SUD in clozapine-treated patients. Risk factors were grouped into four categories: treatment intensity (high doses 525 mg/day, rapid titration), drug interactions (valproate, benzodiazepines, polypharmacy), lifestyle factors (smoking, obesity, diabetes, substance use), and monitoring. Two patterns emerged: early inflammatory myocarditis (weeks 2–6) and late-onset cardiomyopathy (months–years).

Clozapine-associated SCD appears multifactorial. These findings suggest a role for gradual titration, avoidance of high-risk co-medications, baseline biomarker monitoring, and ongoing management of metabolic and cardiovascular risk factors. Increased multidisciplinary surveillance may help identify patients at higher risk and inform clinical decision-making in clozapine-treated patients.

Patients discharged from inpatient mental health services can experience multiple adverse outcomes, including a 191-fold higher suicide risk within three months of discharge from inpatient mental health services. The SAFER-MH intervention was co-designed to improve quality and safety in this vulnerable period. Preliminary research suggests it is feasible, acceptable, and offers vital support during inpatient and pre-discharge phases. However, its use is limited to secondary care. This study aimed to strengthen SAFER-MH by co-producing a community follow-up element of the intervention to enhance continuity of care post-discharge.

A three-phase sequential design was used. Phase 1 involved focus groups with patients, carers, and professionals from primary and community care to explore current practices. Phase 2 used a Nominal Group Technique (NGT) workshop to generate and prioritise feasible solutions. Phase 3 consisted of a co-design workshop with the stakeholder groups described above to collaboratively refine and assess the feasibility of proposed interventions.

Seventeen participants took part across three workshops: Phase 1 included fourindividuals from three abovementioned stakeholder groups; Workshops 2 and 3 added three inpatient professionals and two replacements for those who withdrew. Six themes emerged in Phase 1, including fragmented communication and coordination between services, inadequate discharge preparedness, service limitations and inequalities, patient/carer related barriers, quality and safety concerns and pharmacological care challenges. The NGT workshop generated 33 potential solutions, with 17 receiving votes. Top priorities included a one-stop hub and peer support, assuming no resource or implementation constraints. In Phase 3, participants focused on which elements would be feasible as part of SAFER-MH and the top three interventions included adopting a true multidisciplinary team approach to care, improving medication follow-up, and devising a community peer support element.

This study highlighted shared problems faced by all stakeholder groups post-discharge centring around communication breakdowns, medication challenges, and limited patient involvement. Integrating multidisciplinary teamwork, medication follow-up, and peer support within SAFER-MH is feasible and could enhance continuity and safety during transitions from inpatient to community care.

This study was co-designed and co-produced with patient and public contributors and key stakeholders throughout all stages, resulting in a strengthened SAFER-MH intervention that is now ready for evaluation in a national randomised controlled trial.

The use of antipsychotics in behavioural and psychological symptoms of dementia (BPSD) increases the risk of cerebrovascular adverse events and mortality. The aim is to check whether the use of antipsychotic medications for BPSD is in accordance with the NICE guidelines, i.e.,

1. Documentation of specific BPSD.

2. Exclusion of clinical or environmental causes.

3. Use of non-pharmacological interventions prior to commencing antipsychotics.

4. Use of structured assessment such as an ABC chart for assessing BPSD.

5. Antipsychotic review every 6 weeks to consider the need for continuation of antipsychotics.

The audit was carried out across the care homes, nursing and residential homes under the Older Adult Community Mental Health Services in West Essex (Epping, Uttlesford, and Harlow). The data collection was done between July to September 2025, and the information was retrospectively gathered from SystmOne records between 01/10/2024 and 31/03/2025. The patients with a formal diagnosis of dementia prescribed with antipsychotics were included in the study. They were excluded if prior to the first 6-week review of antipsychotics they were transferred out of area, moved out of a care homes, nursing and residential homes, deceased, or had the antipsychotics discontinued. A specially designed data-collection tool was used to collect the data by the data collectors.

Of the 78 patients assessed, the majority were females and in their 80’s. The most common diagnosis was Dementia in Alzheimer’s disease, mixed type. The documentation of BPSD showed full compliance with the guidelines. There was good compliance (91%) with evidence of investigations undertaken to exclude organic conditions and delirium. However, the documentation regarding excluding environmental causes of BPSD and the use of non-pharmacological methods prior to commencing antipsychotics was unclear and hence could not be audited. The evidence of use of ABC chart for assessing patients with BPSD was found only in 38.5%. Two- thirds of the patients were on Risperidone, followed by Quetiapine (14%) and Aripiprazole (9%). A total of 59 (75.6%) patients received an initial 6-week review and only 43 (55.2%) patients had subsequent reviews at 6-weekly intervals.

The audit revealed that the review of patients with Dementia prescribed with antipsychotics was not found to be concordant with the NICE guidelines. Implementing a standardised antipsychotic review record may help improve documentation and support the setting of a tentative review date, thus reducing non-compliance to the standards and thus ensuring safety and a better quality of life for patients with Dementia.

To investigate (1) the prevalence of anxiety and depression, (2) the association between physical activity (PA) and these mental health outcomes, and (3) the mediating role of social support in this relationship among college students, while controlling for gender and age.

Nationwide cross-sectional online survey (March 2024–May 2025) of 1,069 college students recruited through student-union mailing lists in China (92.7% response rate, mean age=21 years, 68.2% female). PA was assessed using the International Physical Activity Questionnaire-Short Form (IPAQ-SF) and categorized into low, moderate and high levels; continuous MET-min/week scores were also used. Anxiety and depression were measured by the Zung Self-Rating Anxiety Scale (SAS) and Depression Scale (SDS), reported as binary outcomes (SAS≥50, SDS≥53) and standard scores. Social support was evaluated using the Social Support Rating Scale (SSRS). Analyses included binary logistic regression and mediation analysis using PROCESS Model 4 with 5,000 bootstrap samples, controlling for gender and age.

Overall, 34.0% of participants screened positive for anxiety (10.5% moderate, 5.5% severe) and 43.5% for depression (9.4% moderate, 1.0% severe). Logistic regression showed that compared to high PA, low PA was associated with significantly higher risks of anxiety (OR=2.21, 95% CI:1.58–3.09) and depression (OR=2.91, 95% CI:2.10–4.01). Higher social support was associated with lower risks of both anxiety (OR=0.95) and depression (OR=0.96). Mediation analysis revealed that social support partially mediated the PA-mental health relationship: for anxiety, total standardized effect of PA β=−0.127 (p<0.001), indirect effect through social support β=−0.044, 95% CI [−0.062,−0.028] (34.2% mediated); for depression, total effect β=−0.173 (p<0.001), indirect effect β=−0.053, 95% CI [−0.073,−0.035] (30.5% mediated). Gender and age were not significant covariates in the mediation pathways.

This study identifies social support as a significant partial mediator in the PA-mental health relationship among college students.The mediating effect is proportionally larger for anxiety, although the association of social support is stronger for depression.These findings suggest that interventions should integrate PA promotion with social support enhancement to maximize mental health benefits.

Older adult psychiatric patients frequently present with significant physical comorbidities and frailty when admitted. Despite national DNACPR guidance emphasising proactive, individualised resuscitation planning and shared decision-making, advance care planning is often given lower priority in mental health inpatient settings. The Mental Capacity Act (2005) mandates structured capacity assessment and best interests decision-making where appropriate, yet documentation of resuscitation status can remain unclear orabsent. Baseline review on a 10-bed older adult male psychiatric ward demonstrated that 0% of patients had documented DNACPR status or recorded evidence of resuscitation discussions, representing potential clinical, ethical and governance risk. This quality improvement project aimed to achieve 100% documentation of DNACPR status and increase documented patient and/or family discussions within a two-month period (December 2025–January 2026).

Baseline measurement confirmed absence of DNACPR documentation or recorded discussions across all inpatients. Data were obtained retrospectively through electronic clinical record (RiO) review. Two sequential PDSA cycles were implemented. Cycle 1 embedded mandatory DNACPR status review into weekly multidisciplinary ward rounds, with documentation recorded in the electronic clinical record for all patients. Cycle 2 introduced clinician-led discussions with patients and/or families regarding resuscitation preferences; where patients lacked capacity, decisions were guided by Mental Capacity Act principles, including documented capacity assessment and best interests reasoning, and formal DNACPR documentation was completed where clinically appropriate. Outcome measures included: (1) percentage of patients with documented DNACPR status; (2) percentage with documented patient or family discussion; and (3) percentage with an active DNACPR form in place. Sustainability was supported by incorporating DNACPR review into the ward round documentation to embed the intervention within routine clinical review.

Following Cycle 1, documented DNACPR status increased from 0% to 100% of inpatients. Following Cycle 2, 50% of patients had documented resuscitation discussions and 30% had an active DNACPR order in place (baseline 0%). Discussions clarified previously undocumented patient preferences and facilitated structured best interests decision-making inpatients lacking capacity. Documentation compliance remained at 100% at four-week follow-up after completion of the intervention period, demonstrating sustained change beyond the initial implementation phase.

Embedding DNACPR review within routine weekly ward processes resulted in rapid and sustained improvement in documentation and initiation of advance care planning in an older adult psychiatric setting. The intervention strengthened alignment with national guidance, improved preparedness for medical deterioration, and enhanced governance standards within the inpatient service. Although limited by small sample size and short follow-up duration, the project demonstrates a low-cost, scalable model for improving parity between physical and mental healthcare. We plan to extend this approach to a 20-bed female older adult ward on the same site and a 20-bed mixed older adult ward at another Trust site to promote consistent advance care planning practices across services.

People with intellectual disability are frequently prescribed psychotropic medications for challenging behaviour, despite guidance advocating for holistic and non-pharmacological Multidisciplinary Team (MDT) support to understand and address the underlying causes of challenging behaviours. Approximately 17% of adults with intellectual disabilities receive antipsychotics for symptomatic management in the absence of mental illness, a rate 16 times higher than the general population. STOMP (Stopping The Over Medication of People with Intellectual Disabilities and/or Autism) is a national project to reduce inappropriate prescribing. Decreasing psychotropic medications without appropriate alternatives risks destabilisation, and so we wanted to ensure our STOMP pathway provided holistic support tomeet the needs and wishes of service users, their carers and care providers. We used a co-production methodology to achieve this.

Service users eligible for STOMP review were identified. Semi-structured interviews were conducted with family carers (n=8) and care-provider representatives (n=4). Interview guides were based on STOMP principles and refined by the MDT. Interviews were analysed using content and thematic coding. Findings were reported back to participants and cross-verified using a large language model for research triangulation, and then translated into pathway components during MDT design meetings.

Interviews highlighted shared priorities for reducing challenging behaviour and improving quality of life. Both groups stressed the need for coordinated input from the Integrated Learning Disability Service and primary care, predictable routines, meaningful tasks with supported independence, clear plans for care changes, an allocated worker, and communication support. Participants felt medication provided stability but did not address underlying triggers. They requested more thorough medication reviews with clearer explanations of rationale and side effects. Significant concern was expressed about destabilisation if medication was reduced without reliable alternatives and clear crisis plans. Service improvement priorities included respite provision, timely social care responses, better access to physical healthcare, and tailored staff training.

Co-production identified significant anxieties about medication reduction, but emphasised that it is feasible when reliable alternatives are in place, such as coordinated MDT input, communication support, and clear crisis plans. The analysis showed that good social care support forms a large and essential element of this, including community access,day opportunities and respite provision. Integrated Learning Disability Services (with health and social care working together in the same organisation) can make such a service user focused approach much easier to deliver, which should result in significant improvements in quality of life, and reduced side-effect burden.

Substance and alcohol misuse are highly prevalent and frequently comorbidin forensic psychiatric populations. This comorbidity is clinically important because it is associated with relapse, poorer engagement, and heightened risk of re-offending.

To evaluate substance and alcohol misuse risk/relapse-prevention provision within KMMH inpatient forensic services by: (1) describing the cohort’s substance/alcohol misuse profile and related risks; (2) assessing whether substance/alcohol misuse was assessed at admission; and (3) describing programme offer and uptake.

Service evaluation using routinely collected clinical data for current inpatients across KMMH forensic services. Data were extracted from electronic health records and analysed descriptively.

Sample: N=102. Gender: male 87/102 (85.3%), female 15/102 (14.7%). Assessment at admission: substance and alcohol misuse assessed in 54/102 (52.9%) and not assessed in 48/102 (47.1%). Active substance misuse was recorded in 14/102 (13.7%) and active alcohol use in 13/102 (12.7%). Withdrawal symptoms/incidents were recorded in 2/101 (2.0%) and detoxification was required in 1/101 (1.0%). IV drug users 3/102 (2.9%). Incidents of ongoing substance misuse: yes 5/102 (4.9%).

Substance categories recorded (multi-label; percentages use N as denominator): Cannabis/cannabinoids 50/102 (49.0%); Stimulants 42/102 (41.2%); Alcohol 32/102 (31.4%); Novel psychoactive substances (NPS) 14/102 (13.7%); Opioids 11/102 (10.8%); Hallucinogens/dissociatives 8/102 (7.8%); Sedatives/hypnotics 4/102 (3.9%).

Comorbid mental health diagnosis (multi-label; percentages use N as denominator): Psychotic illness 64/102 (62.7%); Mood disorder 14/102 (13.7%); Anxiety disorder (9.8%); Personality disorder 24/102 (23.5%); Neurodivergent 22/102 (21.6%); Paraphilias 2/102 (2.0%); Other 7/102 (6.9%).

Substance misuse programme provision: a substance misuse programme was offered to 44/102 (43.1%). Of those offered (n=44), 33/44 (75.0%) attended and 11/44 (25.0%) did not attend.

Previous engagement with substance misuse services (as recorded in the notes–percentages using N as denominator): Community setting 14/102 (13.7%); Acute inpatient setting 3/102 (2.9%); Forensic inpatient setting 16/102 (15.7%); Prison setting 7/102 (6.9%).

This service evaluation highlights two key quality-improvement opportunities. First, nearly half of patients had no recorded drug or alcohol misuse assessment at admission, suggesting inconsistent screening and/or documentation.

Second, although recorded active use and acute withdrawal/detoxification needs were relatively uncommon, a large proportion of the cohort had histories involving multiple substance classes. This supports the case for proactive relapse-prevention pathways in forensic settings, even when current dependence indicators are not prominent.

Attendance was high among those offered a programme (75%), indicating acceptability; however, fewer than half of the overall cohort were documented as being offered a programme, suggesting possible unmet need or variation in eligibility identification.

To evaluate the impact of AI use on psychotherapy training for “core trainee” psychiatry residents as understood by the psychotherapy tutors. The psychotherapy training for residents includes theory-based teaching, courses, Balint groups, and completion of two psychotherapy cases across different modalities, all supervised by experienced psychotherapists. This includes an anonymised case summary with a formulation.

A questionnaire was sent to the psychotherapy tutors via a national (England) email list enquiring about their use of AI in psychotherapy training. The data is both quantitative and qualitative, summarising emerging themes. A similar survey was done for core trainees and is reported in a separate poster.

16 tutors completed the questionnaire (sent to 48 tutors).

75% of tutors stated that they don’t use AI for psychotherapy training or teaching. Of the 4 tutors who use AI, their responses include using it to: brainstorm, create images, find references, summarise different models, or serve as a “thinking partner”.

Most tutors (56.3%) were unsure whether residents used AI; 18.8% said residents used it, and 25% reported they didn’t. 7 tutors commented on the residents’ use of AI, with 4 expressing concerns about its use for formulations or summary letters. Other examples of AI use included teaching planning and creating captions for recorded sessions.

When combining the “yes” and “maybe” responses, support for potential AI use was greater for teaching psychotherapy concepts than for assisting with scribing or aiding formulations (75%, 43.8%, and 43.8%, respectively).

56.3% of tutors expressed concerns about the impact on relevant learning and critical thinking, especially the reflective and emotional aspects of the psychotherapeutic work. Further concerns regarding confidentiality and misrepresentation of the cases were raised if AI was used to record or summarise information. Two tutors also expressed concerns about how patients may be using AI.

When asked how best to use AI, the most common response (37.5%) was to use it to summarise concepts or theory.

The results demonstrated concerns regarding the impact on psychotherapy training (acquiring reflective capacity skills, emotional learning, critical thinking skills) and confidentiality, however there was support for utilising AI especially for learning or summarising psychotherapy concepts. Some concerns may be more easily addressed through governance policies (e.g. data protection), but the potential impact on experiential learning requires further discussion and guidance.

To gather the views of UK-based resident doctors on their local MRCPsych courses.

MRCPsych courses aim to broaden resident doctors’ knowledge of psychiatry andprepare them for the Royal College of Psychiatrists membership examinations. The courses vary widely between deaneries. Understanding resident doctors’ experiences is needed to help ensure equitable and high-quality delivery.

A cross-sectional survey was created and disseminated to UK-based resident doctors via the Psychiatric Resident Doctors Committee. Information was gathered on satisfaction, barriers and suggestions for improvement.

A total of 25 responses were received.

69% of respondents felt that their MRCPsych course is useful for their development as psychiatrists, but only 36% felt it was helpful in preparing them for the examinations.

Respondents valued interactive sessions, online flexible learning and recorded sessions, practical sessions, and found it helpful when sessions followed the syllabus. They preferred when sessions were delivered by a clinician and highlighted teaching on subspecialties as particularly helpful due to lack of exposure in certain regions.

Respondents found their courses less helpful when the sessions did not follow the syllabus, out of date material was used, and when there was no introduction to the MRCPsych examinations. Respondents preferred if lecturers had a knowledge of their syllabus and format of examinations. They also highlighted issues with travel when courses were held far away from their base.

Respondents suggested improvements could be made by having a set curriculum and structure, addition of simulation-based learning, more CASC teaching and incorporating lived experience into the sessions. They preferred to be informed of the topic in advance so they could engage in pre-learning activities. They suggested that co-production of the course with themselves and relevant stakeholders would result in a higher quality and more useful course.

79% of respondents reported that they get protected time for attending the course, with 17% maybe and 4% no. Common issues cited were on-call requirements and people working on inpatient wards finding it difficult to leave due to higher demands.

Respondents identified using online paid-for resources and question banks, reading textbooks and guidelines, small group practice and attending conferences as supplementary activities to support their learning.

The MRCPsych course is well-received and appreciated by resident doctors, however there were some suggestions about how it could be improved. A more standardised approach could be helpful to ensure equitable access to high quality courses across the UK.

Background

There is no safe level of alcohol consumption during pregnancy, and NICE guidelines recommend complete abstinence. Even low levels of alcohol intake are associated with increased risks of miscarriage, prematurity, low birth weight, and Foetal Alcohol Spectrum Disorder. Women with mental health difficulties are at higher risk of alcohol use during pregnancy, potentially due to social disadvantage, increased stress, limited support networks, and reduced awareness of alcohol-related risks. Routine enquiry about alcohol use, including level and pattern of consumption, is therefore essential in all pregnant women.

Aim

To determine whether alcohol use is routinely discussed and documented during initial assessments of pregnant women referred to the South West community Perinatal Mental Health Team (SW-PMHT).

A retrospective analysis of electronic records and assessment letters was conducted for all initial assessments of pregnant women referred to the SW-PMHT between April and June 2025. Of 48 identified patients, 13 were excluded due to discharge prior to assessment, non-attendance, or assessment by other services (e.g. CMHT or MBU). The final sample included 35 patients. Documentation was reviewed to determine whether alcohol use was explored during assessment.

Alcohol use was explored in 16 out of 35 patients (45.7%), with one patient disclosing alcohol consumption during pregnancy. Alcohol use was not explored in 19 patients (54.3%).

This results demonstrated that alcohol use was not routinely explored in over half of pregnant women assessed by the SW-PMHT, representing a significant gap in care given the known risks of alcohol exposure during pregnancy. This highlights a clear need for improved and consistent screening practices.

Actions and Re-audit

Findings were presented at the multidisciplinary team meeting in September 2025, with action agreed to ensure routine enquiry and documentation of alcohol use at all initial assessments, using the AUDIT screening tool where appropriate.

Completion of the cycle

A re-audit was conducted using the same methodology over a three-month period (October–December 2025). Of 22 pregnant women included, alcohol use was explored in 17 patients (77.3%), compared to 5 patients (22.7%) where it was not explored, demonstrating significant improvement from previous results.

Conclusion and future direction following completion of cycle

The re-audit demonstrated improved compliance with assessment for alcohol use in pregnancy. To further enhance awareness and prevention, an information leaflet was developed and introduced for service users, outlining the risks of alcohol use during pregnancy and breastfeeding, with relevant resources and support links.

Regardless of comorbid personality disorder there is value in use of ECT for treatment resistant depression. We present a case of a patient with treatment resistant depression and dependent personality disorder.

There is evidence that ECT used to treat depression with a comorbid personality disorder has poorer outcomes. Ferrea et al., 2023, found poor response rates in comorbid personality disorder as opposed to depression alone, with increased risk of relapse, but still showed a remission rate of 1 in 3 and 50% response rate. However, most of the studies included didn’t differentiate the type of personality disorder, leaving us without clear evidence around the impact of dependent personality disorder specifically.

We present a case of a 78-year-old female patient with diagnoses of recurrent depressive disorder and generalised anxiety disorder. The patient had two admissions in two years under the mental health act with similar presentations in keeping with severe depression. In the community she was being investigated for autism, underlying cognitive impairment, dependent personality disorder and being treated for recurrent depression and generalised anxiety disorder which didn’t fully remit in the 2 years she was open to the service.

She is followed through admission and investigations to a course of treatment with Bilateral ECT lasting for 12 sessions.

On Montgomery-Åsberg Depression Rating Scale the patient scored 34 before starting ECT treatment, and after completing the course scored 20. Clinical global impression rating rose from 6- severely ill, before course of ECT to 4- moderately ill, following.

Despite the potential multiple contributing diagnoses, the patient’s mental state and presentation improved in response to treatment with ECT.

There is evidence of benefit in switching and augmenting antidepressants in older adults where there is treatment resistance (Lenze et al. 2023). This case supports the hypothesis that in treatment resistance in the elderly population we should persevere up to and including the use of ECT, until remission is achieved.

There’s a lack of research looking specifically at the impact of comorbid dependent personality disorder on efficacy of ECT for depression. Most of the existing evidence focusses on Emotionally unstable personality disorder.

This case study supports the hypothesis that there is evidence of treatment response with the use of ECT for treatment resistant depression regardless of comorbid dependent personality disorder.

National standards require that adults start to receive help within four weeks of referral, which may include advice, support, or an initial assessment. Nevertheless, meeting this standard has been increasingly challenging for the Barnet West Community Mental Health Team due to rising referral volumes and clinical complexity. This project initially aimed to increase the proportion of referrals receiving first contact within 28 days by ≥10% over 1 year. As cycle 1 surpassed this target, cycle 2 aimed for a further ≥20% over 6 months.

Stakeholder consultation suggested that establishing a non-clinical Referral Coordination team could improve access without increasing clinician workload. The team would provide proactive early telephone contact to gather information, assess risk, and escalate or relay clinician advice where required.

In cycle 1, Foundation Year doctors piloted the Referral Coordination role. To minimise impact on their training, they contacted only incomplete or high-risk referrals.

Following demonstrated safety and benefit, cycle 2 employed 2 non-clinical workers to form a dedicated Referral Coordination team. They contacted all new referrals and reviewed outcomes at weekly multidisciplinary meetings.

The primary outcome measure was the proportion of referrals receiving first contact within 28 days of referral. Patient satisfaction with waiting times was measured as a secondary outcome via telephone survey. Due to high referral volumes, outcome measures were collected for a random sample of 50 patients per cycle.

Baseline data showed that only 24% of referrals were contacted within 28 days. Median time to initial contact was 51.5 days (range 307, IQR 53), and 34% of referrals reported satisfaction with waiting times.

In cycle 1, 44% of referrals were contacted within 28 days, with a reduced median wait of 31.5 days (range 284, IQR 73); satisfaction increased to 48%. In cycle 2, 96% were contacted within 28 days, with a median wait of 5 days (range 41, IQR 4); satisfaction was reported by 44%. Notably, only 21% reported dissatisfaction whilst 15% abstained, stating they had not wished to be referred.

The Referral Coordination team was successful in achieving near-universal timely contact. It also acted as an early warning system for clinical risk and reduced competing demands on doctors. Patient satisfaction did not correspond directly with access, suggesting influence from contextual factors such as patient expectations. Future work mayexplore additional drivers of patient experience to ensure service changes deliver meaningful benefit for patients and carers.