Research and literature on female offenders are relatively scarce compared to their male counterparts. In Singapore, female offenders are remanded either at the only local psychiatric hospital (Institute of Mental Health) or at Changi Prison. The judge remands them for between two to three weeks at the first instance to determine if these offenders with suspected mental disorders have the ability to plead in court and to determine if their suspected mental health conditions have any contribution to their offending behaviour. Legal determinations of unsoundness of mind at the time of offence and fitness to plead at the time of trial carry significant implications for criminal responsibility and case disposition. The psychiatrist also has to instruct the court about the nature of the mental disorder, the risk of reoffending and recidivism and whether treatment is possible and also feasible in each remandee. This study reviews the psychiatric and legal characteristics of female remandees assessed at the Institute of Mental Health (IMH), Singapore, over a one-year period.

A retrospective review of the electronic records was conducted by psychiatric doctors posted to the IMH. The details and medical records of the female remandees referred to IMH for forensic psychiatric assessment over one year was assessed by computer and a template for data extraction filled in manually. Demographic data, psychiatric diagnoses, offence characteristics, substance use history, and legal opinions on unsoundness of mind and fitness to plead were record, examined and analysed. Diagnostic distributions were analysed within the groups assessed as of unsound mind and/or without fitness to plead, with attention to overlap and discordance between these legal constructs.

Out of 280 female remandees assessed over 12 months, 12 (4%) were assessed as of unsound mind and 13 (≈5%) as unfit to plead. Schizophrenia was the most common diagnosis in both groups, followed by major neurocognitive disorder. Most individuals in both categories were charged with non-violent offences, and none had a documented substance use history. While there was substantial overlap between unsoundness of mind and unfitness to plead, several discordant cases were identified, illustrating the temporal and conceptual distinction between these determinations. Major neurocognitive disorder was particularly prominent among those unfit to plead, reflecting the central role of current cognitive capacity in trial competence. These findings challenge assumptions that forensic psychiatric morbidity is primarily associated with violence or substance misuse and highlight the relevance of endogenous psychiatric and neurocognitive conditions in female remandees.

Female remandees assessed as of unsound mind or unfit to plead constitute a small but highly vulnerable population. Their comparatively small numbers compared to male offenders has meant that most programmes and services on the whole tend to be geared towards the majority male population. However women remandees represent female offenders, who have unique issues and needs different from their male counterparts, characterised by severe psychotic and neurocognitive disorders, predominantly non-violent offending, and absence of substance use. Clear differentiation between mental state at the time of offence and present fitness to plead is essential. This would be crucial in the future development of gender-specific programmes for incarcerated women orgender-responsive programming for female offenders. To do so, we would need to assess choices and attitudes that lead to the commission of the crime but also address these factors in the context of central issues specially for women, specifically, history of trauma and violence, substance abuse and economic marginality.

To improve mental health staff confidence in recognising and assessing common physical health conditions (hyponatraemia, deep vein thrombosis (DVT)/pulmonary embolism (PE), cellulitis/sepsis, neuroleptic malignant syndrome (NMS), serotonin syndrome, and extrapyramidal side effects (EPSEs)) through a structured teaching programme on an acute psychiatric ward.

Mental health inpatients have significant physical health comorbidities and face increased risk of acute physical deterioration. Nursing and allied health staff on psychiatric wards are often the first to notice clinical changes but informally reported low confidence in recognising and initially assessing physical health emergencies. Early identification by ward staff is crucial for timely escalation to medics and improved patient outcomes.

This quality improvement project was conducted on an acute adult mental health ward within Merseycare. A three-month teaching programme was implemented, consisting of six short (<15 minutes) educational sessions covering the above conditions. Sessions were designed for busy ward staff, adapted to areas of weakness identified on the ward, and each session was paired with a summary poster that was displayed in the clinic room to enable access across all shifts. Staff on the ward were sent a pre-teaching questionnaire and a post-teaching questionnaire to identify improvement in self-reported confidence levels.

10 staff members completed post-intervention questionnaire, representing a response rate of 66.7%.

Mean confidence scores across all six clinical conditions improved from 2.6 pre-intervention to 4.3 post-intervention, representing a 65.4% increase.

Individual condition improvements:

• • Hyponatraemia: [2.5] to [4.2].

• • DVT/PE: [3.1] to [4.3].

• • Cellulitis/sepsis [2.6] to [4.4].

• • NMS: [2.6] to [4.3].

• • Serotonin syndrome: [2.3] to [4.4].

• • EPSEs: [2.1] to [3.8].

• • Confidence in escalating physical health concerns [3.9] to [4.4].

• • Confidence in advocating for physical health investigations [3.7] to [4.4].

Brief, accessible teaching sessions combined with visual reference materials significantly improved mental health staff confidence in recognising and assessing common physical health problems and emergencies within psychiatry. This low-cost, sustainable intervention addresses an important training gap in psychiatric settings and may facilitate earlier detection and escalation of physical deterioration, improving patient outcomes.

Entering core psychiatry training presents multiple challenges, including adapting to new clinical environments, learning trust-specific systems, and understanding training and portfolio requirements. These pressures can negatively affect trainee confidence and wellbeing, particularly early in training. A Buddy Scheme was introduced to provide structured peer and near-peer support by linking new CT1 trainees with senior core and higher trainees within a “psychiatry family”. Initially piloted in February 2025, the scheme was expanded for the August 2025 intake and continues for February 2026. This abstract describes the development of the scheme, its refinement, and early trainee outcomes.

A semi-structured focus group with trainees from a previous cohort exploredcommon challenges encountered at the start of training. Thematic analysis informed the design of the Buddy Scheme, including mentor composition, focus areas, and recommended contact patterns. Baseline questionnaires assessed trainee background, self-reported confidence, and familiarity with clinical systems and training processes. For the August 2025 cohort, a trainee-led peer-to-peer guidebook was developed to complement interpersonal support, providing trust-specific guidance. Follow-up feedback was collected several months into training to evaluate perceived impact, confidence, and usefulness of both the scheme and guidebook. The model continues to be refined for subsequent intakes.

All trainees joining the trust in 2025 (n=5) completed baseline surveys. Initial self-reported confidence was low, with mean scores of 2.4/5 for on-call duties and 2.8/5 for clinical skills and overall readiness for psychiatry training. Trainees also reported limited familiarity with key systems, particularly the RCPsych portfolio, prescribing platforms, and exception reporting.

Post-intervention evaluation surveys were completed by 75% of participants. At three months post-entry, respondents reported increased confidence across domains, with mean scores rising to 3.25/5 for on-call duties and 3.5/5 for clinical skills and overall readiness. Familiarity with clinical systems and training requirements also improved. The Buddy Scheme was rated as highly helpful (mean usefulness score 4.25/5), with peer relationships and access to near-peer and senior trainees consistently identified as central to benefit. The peer-to-peer guidebook was described as accessible, well-targeted, and more useful than standard trust handbooks.

Areas for development included clearer portfolio guidance and improved signposting to support and learning resources.

A structured Buddy Scheme, supported by peer resources, can enhance confidence and early training experiences for new psychiatry trainees. Delivery across multiple cohorts has enabled refinement and demonstrated sustained relevance. Further evaluation will explore longer-term effects on trainee wellbeing, confidence, and training progression, and assess potential for wider implementation.

Autism Spectrum Disorder (ASD) is associated with social communication deficits, atypical social cognition, and behavioural regulation difficulties, which can complicate forensic evaluations of criminal responsibility. This case study aims to illustrate the assessment process and clinical reasoning used to determine criminal responsibility in a young offender with ASD and below-average intellectual functioning.

A 17-year-old male was referred for forensic psychiatric assessment following an alleged vehicle theft and reckless driving. A multidisciplinary evaluation was undertaken including psychiatric assessment (developmental, behavioural, substance use history and mental state examination) and clinical psychological testing. ASD assessment used ADI-R and ADOS; cognitive functioning was assessed using the Stanford-Binet Intelligence Scales (Fifth Edition).

Assessment findings supported a diagnosis of ASD with moderate symptom severity and significant social communication deficits. Cognitive testing showed below-average intellectual functioning (Full-Scale IQ 82) with relative strengths in visual-spatial processing and weaknesses in quantitative reasoning and knowledge domains. Clinically, the patient demonstrated limited insight into broader social consequences and reduced emotional reciprocity, without evidence of psychosis. Despite neurodevelopmental vulnerabilities and contextual risk factors (including alcohol use), the forensic conclusion was that the capacity to distinguish right from wrong at the time of the alleged offence was preserved, and criminal responsibility was not negated. The case highlights how ASD-related impairments may affect judgement and impulsivity while still allowing intact understanding of wrongfulness, underscoring the need for structured, ASD-informed forensic formulation.

Forensic assessments of adolescents with ASD should integrate developmental history, structured ASD measures, cognitive profiling, and careful analysis of moral/legal understanding at the material time. This case supports a nuanced approach that balances legal accountability with neurodevelopmental formulation and recommends tailored interventions (e.g., behavioural therapy, social skills work and family psychoeducation) to reduce future risk.

St Andrews Healthcare in Northampton is a tertiary psychiatric hospital with multiple divisions, aiming to lead Complex Mental Health care. It includes secure units across 3 divisions, in varying security levels and specialist needs.

Resident doctors identified through a survey that the current induction process does not support new doctors. Three main areas of concern were identified: information about their job roles, feeling confident for on-calls, and feeling welcomed. Some doctors commented that it took up to one year for them to feel comfortable in their duties.

A Buddy programme was developed with formalised sessions to support a new non-consultant doctor. These included Speciality Doctors, Clinical Teaching Fellows and Associate Specialists and all eligible new doctors participated. It began as a 6-month pilot in Medium Secure Unit before launching to the whole of Northampton site. It ran between March 2024–December 2025. A comprehensive information booklet was created to support the Lead Buddies of each division on subjects to cover with their colleague. Feedback included pre-and post-intervention survey with binary answers, a Buddy feedback form, and additional feedback through e-mails. It was sponsored by one of the Associate Medical Directors and with the approval of all Clinical Directors.

The pre-programme survey noted only 18% of Resident doctor shaving enough information during their induction.

Post-intervention survey increased this to 100%. Confidence about their role has increased from 25% to 100%.

Despite the increase of confidence for starting on-calls, there was still remaining anxiety noted about the complexity. All doctors scored for anxiety about the on-calls in the pre-questionnaire. Post-intervention feedback noted remaining anxiety due to the size of the site. The programme enhanced the preparedness for on-calls by 57%.

Feeling welcomed had increased from 60% to 100% by the end of the programme.

Buddy programme had an overwhelmingly positive effect for new Resident doctors. There are identified areas for future improvement. The organisational changes of the size of the site are likely to resolve one of these. The remaining areas include further analysis of the complexity of cases during on-calls and the turnover rate of non-consultant doctors.

Rapid tranquillisation (RT) is a high-risk intervention used in acute psychiatric settings when de-escalation strategies fail and there is an immediate risk of harm. Best-practice guidelines emphasize comprehensive pre-RT clinical assessment, documentation, and monitoring; however, adherence is often inconsistent, particularly in resource-constrained settings. This audit aimed to assess compliance with established standards for pre-RT workup and documentation and to evaluate the impact of targeted quality improvement interventions through re-audit.

This was a retrospective, episode-based audit. Forty-two RT episodes over a six-month period (January–June 2025), involving oral or parenteral psychotropic medication administered with the explicit aim of RT, were reviewed against predefined standards. These standards were derived from National Institute for Health and Care Excellence (NICE) guidance, the Maudsley Prescribing Guidelines, and British Association for Psychopharmacology/National Association of Psychiatric Intensive Care Units (BAP/NAPICU) consensus statements. Data were extracted using a structured audit tool. Following baseline analysis, quality improvement measures were implemented, including the introduction of a structured pre-RT checklist and staff education. A re-audit of 28 RT episodes was conducted six months later (July–December 2025).

Baseline compliance with pre-RT standards was variable. Documentation of de-escalation prior to RT was present in 71% of episodes, a clear clinical indication in 83%, and pre-RT clinical workup in 47%, all below target thresholds. Baseline physical observations were documented in 85% of episodes, medication details in 100%, and capacity or consent in 90%, meeting standards. Cardiac/QT risk assessment was documented in 85% of episodes involving haloperidol. However, reassessment prior to repeat dosing was documented in only 42% of episodes, airway and respiratory risk assessment in 78% of benzodiazepine-related episodes, and documentation of contraindications or drug interactions in 66%.

Following intervention, compliance improved across all domains. Documentation of de-escalation increased to 92%, clear indication to 96%, pre-RT clinical workup to 85%, reassessment prior to repeat dosing to 92%, airway and respiratory risk assessment to 92%, and documentation of contraindications to 85%. Medication safety checks, cardiac risk assessments, post-RT monitoring, senior review, and post-incident management planning met or exceeded predefined standards.

This audit identified suboptimal compliance with pre-RT documentation standards, particularly in relation to clinical workup and reassessment. Implementation of a structured checklist and staff education resulted in marked improvements across all measured domains. These findings suggest that focused, low-cost quality improvement interventions can significantly enhance patient safety and documentation standards in resource-limited inpatient psychiatric settings. Ongoing monitoring and periodic re-audit are recommended to sustain improvements.

Patients with Emotionally Unstable Personality Disorder (EUPD) are frequently admitted to acute psychiatric wards during periods of crisis. However, concerns have been raised regarding prolonged admissions, delayed discharge, and potential iatrogenic effects of high-containment care. This service evaluation aimed to compare length of stay (LOS), observation requirements, and discharge outcomes for patients with EUPD versus non-EUPD patients admitted to an acute female ward, and to explore factors contributing to prolonged admission.

A retrospective service evaluation was conducted of all admissions to a 15-bed acute female psychiatric ward over a 12-month period. Patients with an ICD-10 diagnosis of EUPD (n=19) were compared with non-EUPD admissions (n=54). Data were extracted fromclinical records, incident reports, and discharge documentation, including LOS, observation levels, incident patterns, and placement outcomes. One fully anonymised illustrative vignette was included to demonstrate a commonly observed clinical trajectory. No patient-identifiable data were collected.

Patients with EUPD demonstrated substantially longer admissions than non-EUPD patients, with a median LOS of approximately six months (range 3–18 months), compared with 4–8 weeks in the non-EUPD cohort. Nearly all EUPD patients required enhanced observations, including one-to-one nursing, at some point during admission, often recurrently. Attempts to reduce observation levels were frequently followed by behavioural escalation, particularly during periods of planned discharge or placement identification. Placement pathways were commonly delayed or disrupted due to ongoing risk behaviours, high observation requirements, or withdrawal of placement offers following incidents. These patterns were consistently observed across the EUPD cohort and contrasted with shorter, more linear admission pathways in non-EUPD patients.

Prolonged acute inpatient admissions among patients with EUPD appear to be driven less by illness severity and more by systemic and environmental factors within high-containment settings. Risk-averse observation practices may unintentionally reinforce dependency, contribute to behavioural escalation around transitions of care, and impede discharge planning. These findings highlight the need for alternative models of crisis support, clearer step-down strategies, and greater caution in interpreting functional assessments conducted within acute inpatient environments.

To assess documentation of smoking status on admission, delivery of smoking cessation interventions to current smokers, and identification of gaps in referral and follow-up among psychiatric inpatients, followed by implementation of targeted interventions and evaluation of improvement. Et al Authors: 6, Dr Muhammad Zubair (email:), General Practitioner, Lahore, Pakistan

A closed-loop prospective clinical audit was conducted in the Psychiatry Department >over two cycles in 2 months. A total of 60 psychiatric inpatients were included, with 30 patients in each phase. Pre-intervention data were collected from admission clerking notes and inpatient records to assess smoking status documentation, brief cessation advice, nicotine replacement therapy (NRT), referral to smoking cessation services, and follow-up planning. Interventions included staff education, reminders during admission clerking, and emphasis on documenting smoking cessation measures. Post-intervention data were collected using the same standards to assess improvement.

Pre-intervention (n=30): Smoking status was documented in 66.7% of patients. Among identified current smokers (n=12), brief cessation advice was provided in 33.3%, NRT was offered in 25%, referral to smoking cessation services occurred in 8.3%, and a documented follow-up plan was present in 16.7%. Post-intervention (n=30): Smoking status documentation improved to 93.3% (absolute improvement +26.6%). Among current smokers (n=13), brief cessation advice increased to 84.6% (+51.3%), NRT provision to 76.9% (+51.9%), referral to smoking cessation services to 53.8% (+45.5%), and documentation of follow-up plans to 69.2% (+52.5%).

This closed-loop audit demonstrated that baseline documentation of smoking status and delivery of smoking cessation interventions in psychiatric inpatients were initially suboptimal. Following targeted educational and system-based interventions, improvement was observed across all assessed domains, including smoking status documentation (+26.6%), provision of brief cessation advice (+51.3%), offering or prescription of NRT (+51.9%), referral to smoking cessation services (+45.5%), and documentation of follow-up plans (+52.5%). These findings highlight that structured interventions can significantly improve preventive cardiovascular risk management in psychiatric inpatient settings. Regular re-auditing is recommended to sustain compliance and embed smoking cessation as a routine component of inpatient psychiatric care.

Clinicians working in an Older People’s Mental Health (OPMH) inpatient unit noted that blood tests, particularly urea and electrolytes (U&E), were frequently completed when patients were commenced on psychotropic medications. An audit was undertaken to describe current practice and assess its alignment with relevant guidance. NICE and BNF guidelines do not recommend routine blood monitoring for memantine or pregabalin. RCPath advises renal function testing only if significant clinical changes indicate acute renal or electrolyte-related issues. Additionally, NHS England guidance advises all blood tests should have a documented rationale.

Case notes of 30 OPMH inpatients who were initiated on memantine and/or pregabalin and had further blood tests taken after initial admission bloods between June 2023 and June 2024 were reviewed. The audit evaluated:

(1) Whether blood tests had a documented rationale

(2) Their temporal association with initiation or titration of these medications.

92 blood tests were taken for 30 patients. Rationale was documented for 62% of tests (n=37). Of those with rationale documented, 58% had a clinical indication e.g. suspected infection, general deterioration. Monitoring renal function due to psychotropic medication was documented as the rationale for 42% (n=24), all patients had previously normal kidney function. Among tests without a documented rationale, 25% (n=23) may have related to memantine or pregabalin initiation or titration. A temporal pattern was observed, with dose changes sometimes occurring shortly after U&E testing.

A notable proportion of blood tests lacked a documented rationale and observed monitoring practices for memantine and/or pregabalin did not consistently align with current guidance. The observed temporal pattern may suggest an association, but this represents our own interpretation of the available documentation. Some tests may have been clinically justified but not recorded. While routine blood testing can support early detection of clinical issues, it also carries potential drawbacks, including patient distress and incidental findings that may prompt further investigations. We recommend multi disciplinary discussions to review the rationale for current monitoring practices, encourage adherence to guideline recommendations, and clear documentation of rationale for all blood tests.

A prescribing model was co-developed with consultant psychiatrists and pharmacist peers to establish the pilot clinic in June 2024. The pharmacy prescriber clinic was set up with an aim to reduce appointment wait times and improve efficiency. This study evaluated the pilot pharmacist prescriber clinic within a perinatal community mental health team from June 2024 to June 2025 using continuously collected quantitative and qualitative data. Patients and relatives attending face-to-face appointments were invited to complete anonymous feedback forms. The pharmacist held weekly clinics, providing pre-conception and follow-up appointments, managing urgent patient calls, and responding to queries from general practitioners (GPs), local mental health teams (LMHTs), consultants, and perinatal community psychiatric nurses (PCPNs). Clinical supervision was provided after each clinic by a perinatal consultant psychiatrist.

A quality improvement approach was used through the evaluation of the problem (longer wait times), stakeholder engagement, and continuous measurement in the planning and design of the pilot clinic. Data was collected on all consultations and interventions. Appointment wait times were the main outcome measure. Feedback was sought from patients, relatives, and perinatal colleagues.

Pre-conception wait times decreased from an average of 43.7 days (6.2 weeks) to 15.6 days (2.2 weeks). Across the study period, the pharmacist conducted 86 interventions: 20 pre-conception consultations, 10 follow-ups, 5 patient calls, 11 GP queries, 3 LMHT queries, 33 consultant/resident doctor queries, 3 PCPN queries, and 1 referral query. A total of 17 feedback forms were completed (11 patients, 5 partners, 1 supporter). Respondents unanimously agreed they were treated with dignity and respect, received the information they required, and found the pharmacist polite and approachable. Sixteen rated the consultation “very helpful”, and one rated it “quite helpful.” All rated the service as excellent. All respondents strongly agreed that they were provided with all the information they wanted and felt they needed. Colleague feedback highlighted that the clinic shortened wait times, improved consultant capacity to manage other complex issues, improved patient care and safety, provided comprehensive and valued information, and facilitated robust care planning. Consultants also reported that pharmacist clinic letters served as exemplars for training resident doctors and non-medical prescribers.

The pharmacist-prescriber clinic significantly reduced pre-conception wait times, released consultant time, and enhanced both patient care and safety. Initially launched as a pilot, the clinic has continued due to its demonstrable benefits, although future fundingarrangements remain under discussion.

Repeat FP10 prescribing from secondary care increases administrative burden, risks medication gaps for patients, and may delay timely access to treatment. The South Hub (Yewcroft) team initiated a QI project to streamline repeat prescribing processes and increase timely initiation of Enhanced Shared Care Agreements (ESCAs) so that stable patients could be managed by primary care.

By 31 January 2025, we aimed to reduce the weekly frequency of repeat FP10 issues for patients under Yewcroft CMHT by 20%.

A multidisciplinary project team used Plan–Do–Study–Act(PDSA) cycles to test multiple change ideas across four domains: (1) facilitate use of the electronic prescribing and medicines administration system (EPMA) for FP10 generation; (2) improve accuracy and accessibility of repeat-prescription tracking; (3) strengthen liaison with GPs through timely ESCA initiation and repatriation letters; and (4) introduce a duty doctor rota to improve prescribing responsiveness. Process measures included weekly counts of repeat FP10s, reception calls about FP10s, and weekly antipsychotic FP10s. Baseline data were collected over eight weeks (median 6 repeat FP10s/week).

Multiple interventions were implemented, including EPMA prompts, printer-use guidance, an edited shared spreadsheet for tracking, repatriation letter templates, and a duty rota. Data collection revealed intermittent peaks and troughs without a sustained shift in the primary outcome during the project period. Operational challenges limited impact: variable staff access to systems, frequent staff rotation, printer failures, and constrained administrative capacity impeded consistent implementation and reliable data capture. Despite not meeting the 20% reduction target, the project improved local prescribing processes, increased awareness of ESCA pathways, and produced practical tools (templates, tracking spreadsheet) that the team judged beneficial.

Rapid introduction of multiple changes in a resource-limited context made it difficult to demonstrate measurable improvement within the project timeframe. Future work should adopt a phased approach, secure protected data-collection capacity, prioritise system access for prescribers, and include ESCA-signed rates as an additional outcome. With these adjustments, the interventions piloted here have potential to reduce repeat FP10 burden and improve continuity of care.

The older population in Ireland is expected to represent 31.6% of the population by 2057, doubling from 15.1% in 2022. As the population ages, it is important that teams are adequately staffed to deliver a high standard of care. According to Ireland's Specialist Mental Health Services Model of Care for Older People, there should be 1 POA team per 10,000 people over 65 years old, with 10 members in the MDT of various disciplines.

Our objective was to identify gaps in MDT provision in POA teams nationwide through comparing existing staffing numbers with the recommendations from the Model of Care. This data is being used to develop a strategic 5-year plan to improve staffing in POA.

The College of Psychiatrists of Ireland and the National Clinical and Group Lead (NCAGL) Mental Health Office contacted Consultant POA team leads, Executive Clinical Directors and Regional Champions. Key data was collated on clinical staffing for Community Mental Health Teams (CMHTs). This data was cross-referenced, validated and compared with recommendations from the Model of Care.

All Regional Health Areas (RHAs) are below recommended staffing levels across all disciplines. There is a large difference in total staffing across RHAs, with the highest level of recommended staff being 61.8% in RHA F (West North West) and the lowest being 33.5% in RHA D (South West). There are also large differences between roles as well when comparing the same role across RHAs. This data was presented to key decision-makers which led to the allocation of 28 new POA posts in 2026, up from 4 posts in 2025.

There is a significant deficit in MDT staffing nationwide. There is only 65.3% of recommended Consultant staffing in place, highlighting the need to develop new POA CMHTs. Secondly, there is significant understaffing of existing teams. Collation of staffing data is crucial in identifying staffing gaps and advocating for services.

The demographic pressures highlight the need for specialist mental health services for older people across the country. Priority must be given to POA CMHTs to adequately staff existing teams. It is also vital to plan for the development of new POA teams both in the community as well as in other integrated roles, such as in POA Acute Hospital and Nursing Home Liaison. This gap analysis identifies target areas for the 5-year plan to address unmet needs in Older Persons Mental Health.

This study aimed to examine the associations of childhood trauma, psychosocial resources (social support and resilience), and emotional distress with quality of life (QoL) in patients with functional dyspepsia (FD), and to explore potential differences between the epigastric pain syndrome (EPS) and postprandial distress syndrome (PDS) subtypes.

This cross-sectional study included 152 FD patients and 79 healthy controls who completed the Beck Depression Inventory (K-BDI-II), Beck Anxiety Inventory(K-BAI), Childhood Trauma Questionnaire (K-CTQ), Multidimensional Scale of Perceived Social Support (MSPSS), Connor–Davidson Resilience Scale (CD-RISC-K), and World Health Organization Quality of Life Assessment Instrument Brief Form (WHOQOL-BREF). Negative affect was computed as a PCA-derived composite from K-BDI-IIemotional/cognitive items and K-BAI; QoL was a composite of WHOQOL-BREF domains. Group differences were assessed using ANOVA, and hierarchical regression analysis identified predictors of QoL within the patient group. Finally, multivariate regression models compared subtype-specific psychosocial pathways.

Compared to controls, patients with FD reported higher emotional distress and childhood trauma, lower psychosocial resources, and QoL. Negative affect was consistently associated with lower QoL in both subtypes (EPS β=−0.360; PDS β=−0.300). Although direct statistical comparison of pathways between subtypes showed no significant differences, the most prominent protective factor within each group appeared to differ: in the EPS group, higher social support was the most significant predictor of better QoL (β=0.381, p=0.001), whereas in the PDS group, resilience was the key protective factor (β=0.360, p=0.001).

Reducing emotional distress remains a central target for improving QoL in FD. Subtype-tailored emphases may be helpful–enhancing social support in EPS and bolstering resilience in PDS–while noting that between-subtype differences were limited and require confirmation in larger samples.

The ethos of this project was that regular users of mental health services have complex needs, often falling through the cracks of service provision, which can result in poor and inconsistent care. In the context of our work, these high intensity users (HIU) are defined as having five or more referrals to acute psychiatric services within 90-days. Our aim was to improve the patient experience through working holistically, in a co-produced manner, within a whole system approach, as endorsed within NHS Right Care, Right Person and The Mental Health Crisis Care Concordat.

Co-production with:

• • Staff: HIU leads have been empowered to adapt overarching processes to their local population. Staff feedback has been considered.

• • Patients/carers: Focus groups were conducted with lived experience representatives, with ongoing input at system-wide interface meetings.

• • External stakeholders: Workshops were conducted with statutory and non-statutory partners.

Resulting in:

• • HIU leads in acute and community directorates, supported by clinical lead.

• • Multi-agency professional meetings to inform safety planning.

• • Specific HIU safety plans, coproduced as therapeutic tools. These plans empower and support clinicians to provide consistent and safe care, with a focus on working with emergency services.

• • Monthly, system-wide HIU interface meeting with external partners.

• • Information sharing with our system-wide partners.

• • Trust wide promotion and resources.

Within the HIU cohort, there was a reduction in the average number of ‘acute’ referrals per month from 80 between August-December 2024, to 28 between August-December 2025. With a notable reduction in 136 referrals from 9 in August 2024, to approximately 2 per month in December 2025. There was also a reduction in the number of admissions to acute wards from an average of 8.8 between August-December 2024, to 3 between August-December 2025, with variation in the average length of stay. There were several ‘good news stories’ of successful collaboration with individuals who were previously struggling to engage with community mental health services. Staff have provided positive feedback, reflecting on the benefits of joint working and that the HIU project is “valuable to get to know patients with long history in services but are not engaging well’.

The partnership has demonstrated value for patients and professional across the system, through providing a coordinated approach to crisis care. Testimonials from partners highlight this: “it shows how Police and mental health services can work together to create a more compassionate, joined-up approach to crisis care, one that listens, responds, and supports rather than reacts or restrains.”

Life expectancy in serious mental illness (SMI) can be reduced by 15–20 years on average. This is in part due to lack of integration between physical and mental health services.

Prior to this project, there was no formal referral system for mental health inpatients in Central Northwest London (CNWL) to seek advice or refer to physical health services. In the community, GPs use Electronic Referral System (eRS) for accessing secondary services. eRS provides an entirely paperless system for contacting other health professionals, using a secure system. This system also improves access and reduces the admin time required to make and chase appointments and advice requests. It is widely used by GPs.

The aim of our project was to introduce eRS onto all the wards within St Charles Hospital Mental Health Unit (MHU). This was intended to reduce the time between a referral being planned, and a response being received from physical health services, by 50% within a year.

The initial stage was to collect a baseline measurement of the number of days it took between a plan being made for physical health input and receipt of a response.

We engaged stakeholders including Information technology services, General Practitioners and physical health colleagues to implement eRS in the MHU.

We collected data of the number of days it took from a plan for a physical health referral being made to response prior to eRS. We then re-audited the number of days it took once eRS was in place. The first cycle involved one ward, Redwood ward, for older adults. Following each cycle we scaled the project up, and introduced eRS to all wards at St Charles MHU.

Once eRS was integrated the number of days between a plan being made for a physical health referral and a response being received reduced on average by 94% from 53.95 days to 3.2 days on Redwood ward. The ward doctors provided feedback, saying “the system is much better and easier to follow”.

Data collected in St Charles MHU showed the number of days between a plan being made for a physical health referral and a response received reduced on average by 79% from 20 days to 4.4 days.

eRS has shown itself to be helpful for improving access to physical health. There is now widespread awareness of the system among doctors at St Charles and eRS will improve integration between physical and mental health.

Challenging behaviours in individuals with intellectual disability and autism spectrum disorder are complex, multifactorial phenomena that often result in significant distress for patients, families, and caregivers. They are associated with poor quality of life, increased use of mental health services, and heightened risk of trauma for carers. Pharmacological management has traditionally favoured antipsychotics, with limited evidence supporting the use of antidepressants.

We report the case of a 26-year-old woman with moderate learning disability and autism spectrum disorder who exhibited severe challenging behaviours, including self-harm, aggression and property damage. These behaviours persisted despite trials of benzodiazepines, analgesia, and multidisciplinary behavioural interventions. Antipsychotics were avoided due to comorbid pituitary tumour.

Following a clinical review that identified anxiety as a perpetuating factor, trazodone was introduced and titrated to 50 mg three times daily.

Initiation of trazodone has resulted in marked reduction in the frequency and severity of challenging behaviours, improved identification of triggers, and enhanced engagement in structured ward activities. Residual incidents are shorter, less severe, and easily redirected, with fewer requiring physical intervention. The patient demonstrated improved participation in therapeutic activities, and staff reported greater confidence in managing residual behaviours.

This case highlights the potential role of trazodone, an antidepressant, in managing challenging behaviours in individuals with intellectual disability and autism spectrum disorder. It underscores the importance of individualized treatment approaches and contributes to the limited evidence base supporting alternative psychotropic strategies beyond antipsychotics. Further studies are needed to assess antidepressant efficacy in managing challenging behaviours.

To assess whether a structured psychiatry shadowing programme at Hamad Medical Corporation (HMC) is associated with improved clinical preparedness among trainees and to examine whether motivation and well-being modify the relationship between shadowing quality and preparedness.

In 2024, a comparative cross-sectional anonymous online survey was distributed to psychiatry trainees at HMC (N=45). Participants were grouped by completion of the shadowing programme. Preparedness was measured across core clinical domains including psychiatric interviewing, management of psychiatric emergencies, independent patient management, electronic medical record use, and multidisciplinary team collaboration. Perceived skills gained, satisfaction, and attitudes toward the programme were captured. Multiple linear regression assessed predictors of overall preparedness (shadowing quality, motivation, well-being). Moderation analyses examined whether motivation and well-being modified the association between shadowing quality and preparedness.

Of 45 respondents, 26 (57.8%) had completed the shadowing programme. Confidence in conducting psychiatric interviews increased significantly, with the proportion rating themselves as “confident” rising from 4.4% before shadowing to 28.9% after shadowing (χ²=15.556; p=0.016). The most frequently reported gains were familiarity with the electronic medical record system (48.9%) and psychiatric interviewing skills (46.7%). Shadowing quality was a strong predictor of preparedness (β=0.46; p<0.0001). Motivation and well-being were not independent predictors but significantly moderated this relationship (well-being: p=0.0012; motivation: p=0.030), indicating stronger benefits of high-quality shadowing among trainees with higher well-being and motivation. No adverse outcomes were reported.

As one of the first evaluations of a structured shadowing programme in a psychiatry residency context, this study demonstrates a meaningful association between high-quality shadowing and trainee clinical readiness. Findings support the integration of structured shadowing into early residency curricula, alongside parallel investment in trainee well-being and engagement to maximise educational impact.

The aim of this audit is to assess adherence to the local VTE (venous thromboembolism) risk assessment guidelines across inpatient older adult psychiatry care in the Black Country Healthcare NHS Foundation Trust (BCHFT). An update to the National Institute for Health Care and Clinical Excellence (NICE) VTE risk reduction guidelines in 2018 included specific guidance for assessing acute psychiatric patients. In line with this, the BCHFT VTE risk assessment guidelines were updated in 2024. These local guidelines state that patients should be risk assessed within 14 hours of admission, at first multi-disciplinary (MDT) review, and at any change in clinical condition during admission. Additionally, local guidelines include the assessment of psychiatry related risk factors for thrombosis.

The patient electronic records were reviewed retrospectively for all older adult inpatients (n=58) across the BCHFT trust on the 1st January 2026. All patients had been inpatients for at least one week. Data was collected on the time from admission to first risk assessment, whether risk assessments were updated at MDT review, and whether any risk assessments were updated due to change in clinical condition. Secondly, data was collected on the number of risk assessments that included psychiatric specific risk factors where appropriate.

69% (n=40) of patients had a VTE assessment completed. 55% (n=22) were female and 45% (n=18) were male. 64% (n=37) had their assessment completed within 14 hours of admission. 2% (n=1) of patients had an updated VTE assessment at first MDT review. 9% of patients (n=5) had another VTE assessment completed on re-assessment, due to change in clinical condition. 0% of VTE assessments (n=0) included psychiatric specific risk factors in their assessment, such as anti-psychotic use, severe depression or catatonia.

There is considerable scope for improvement in VTE risk assessment compliance across the BCHFT trust, particularly regarding VTE re-assessment at first MDT review. Additionally, incorporation of psychiatric risk factors in the assessment has not been implemented in practice, despite its inclusion in the local guidelines. Recommendations include updating the electronic patient record templates to be in line with local and national guidelines. Further education for MDT members is planned to ensure the completion of re-assessments within necessary time limits. These results are to be presented at local trust teaching, with the aim to re-audit in one year.

To compare Core Psychiatry training experiences in the UK of British and International Medical Graduates in the Northwest Deanery of England and identify challenges faced by each group across multiple domains.

A cross-sectional mixed method survey was conducted (Electronic and Paper) amongst core psychiatry trainees in the Northwest Deanery of England. The survey consisted of multiple-choice questions and free text box. Quantitative data was analysed using descriptive statistics (Chi square, Fisher’s exact andoddsratio) to compare BMG and IMG responses while the qualitative responses were analysed thematically using the Braun and Clarke the maticanalysis.

48 trainees responded (IMG:28, BMG:20). Burnout was reported more frequently by IMGs than BMGs. IMGs were significantly more likely to report cultural differences, perceived preparedness to enter training. Thematic analysis identified concerns around day-to-day training, prioritising clinical workload over learning, frequent changes in placements, social isolation and disruption in community building. Moreover, concerns around inequity in pay and inconsistent on call demands across trusts were identified.

IMGs experience a higher degree of burnout compared with their BMG counterparts, and more likely to report challenges like cultural differences, perceived preparedness to enter training. Challenges like increased workload, navigating the NHS systems, rota pressures and prioritising service provision over learning were commonly reported by both the groups.