Community Treatment Orders are legal powers within community mental health services designed to support patient compliance with medication and overall continuity of care while maintaining the least restrictive principles of care. Their effective use, however, is dependent not only on effective clinical decision-making but also on accurate and timely completion of Community Treatment Order reports, which are essential for tribunal reviews and renewal decisions. Capacity assessments regarding whether the patient can consent to such a legal process are another important step in safeguarding the patient’s human rights, and their completion is fundamentally essential to the whole process.

In practical reality, however, the Community Treatment Order process is often experienced by doctors and nurses as administratively complex, with unclear processes and procedures, and reports frequently required in a time-pressured fashion. This can lead to breaches of legal requirements for reviews. MHT Medway is an example of this, where concerns were raised about delays in report completion rates by locality, leading to tribunal delays, increased clinician workload, and governance concerns. This prompted a retrospective audit to understand the status quo and initiate a system change.

A twelve-month retrospective audit covering January 2025 to January 2026 was conducted across the three localities in Medway Community Mental Health Team (Gillingham, Chatham, and Rochester). Anonymised data collected included the Community Treatment Order start date, report completion status, completion date, and type of report submitted (full medical report or addendum), capacity forms to consent, the clinician who completed the report, and the responsible clinician for each patient. Data were collected manually by reviewing physical and digital records and entered into an Excel spreadsheet for analysis.

There appeared to be variation in report completion rates across localities, withChatham at 66.7%, Gillingham at 73.3%, and Rochester at 33%. Report completion was unevenly distributed across the months, with clustering around periods when reviews were due. Full medical reports accounted for 74% of completed reports, addendum reports accounted for 16%, and the remainder were combined reports.

In more than two-thirds of cases, capacity forms appeared to have been completed, with rates ranging from 100% in Rochester to 66% in Chatham. Of the six clinicians in the team, only three were completing reports, accounting for approximately 100% of completions. Completion rates were 73% and 50% across the two responsible clinicians. Access to previous reports was inconsistent. Physical and digital copies of current documentation were not available for some patients, and communication between localities regarding current caseload lists was limited.

This audit highlighted system-level variation in medical report completion, clinician and locality differences in completion rates, and timing of reports being closely linked to review dates. These findings informed the implementation of a centralised communication system, improved documentation access, and enhanced administrative processes. A further audit is planned to evaluate the impact of the intervention.

The Haringey Community Rehabilitation team has a high burden of patients on depot antipsychotic medication (n=45). This quality improvement project aims to increase the proportion of depots being administered on time to ensure treatment is delivered as intended, reduce time spent in MDT meetings identifying depot due dates and improve staff-reported ease of tracking depots.

A baseline audit of depot administration was conducted over four weeks in November 2025. Weekly counts of missed depot administrations found that, on average, 16% of depot injections were either missed or not administered on the scheduled date. In response, a spreadsheet tracking tool, “the depot tracker”, was developed which recorded patient name, depot name and dose, date last administered, date next administration due and named carecoordinator. A traffic-light system was used to indicate depot status: green (due that day), orange (due within seven days), and red (overdue). This allowed prompt identification of which depots are due and which are overdue and facilitated weekly forward planning, including cover during care coordinator leave.

The depot tracker was implemented in December 2025 and incorporated into the weekly MDT meeting agenda with resident doctors updating the tracker weekly. A follow-up audit was conducted post-implementation to reassess rates of timely depot administration. Pre-and post-implementation staff surveys were conducted to assess staff views on ease of tracking when depots are due, including when care coordinators are on leave, and whether tracking depots took up time in MDT meetings. The survey gathered quantitative (5-point Likert scale) and qualitative (free text question) data.

Prior to the depot tracker being introduced a weekly average of 16% of depots were not being administered on time. This reduced to an average of 10% of depots being missed, based on eight weeks of post-implementation data. Regarding improving ease of tracking when depots are due there was a 71.4% improvement noted by MDT members (n=10) and a 66.6% improvement in tracking depots when care coordinators are on leave. In addition, there was a 46.8% improvement in time taken during MDT meetings to look up depot information (n=10).

Following implementation of the depot tracker there has been a reduction in frequency of depots being missed, as well as improvements in staff-perceived ease of depot tracking including improved continuity of depot delivery during care coordinator leave, and increased time efficiency of MDT meetings.

Undergraduate medical students frequently have limited exposure to acutely unwell psychiatric patients, resulting in reduced confidence and practical competence in psychiatric history-taking and Mental State Examination (MSE). This study describes the development, delivery, and evaluation of a single-site simulation-based psychiatric teaching programmeaimed to deliver realistic and structured simulation experiences. The primary aims were to enhance students’ skills in psychiatric assessment, differential diagnosis, and initial management planning, whilst also strengthening understanding of mental health law and pharmacological treatment.

A three-hour simulation session was delivered to small groups of third- and fourth-year medical students during their psychiatry placement, with 3–5 students per session. Each student conducted a focused psychiatric history and MSE with a simulated acutely unwell patient, followed by presentation of findings, differential diagnosis, and an immediate management plan. Sessions incorporated structured multi-source feedback from peers, facilitators, and the simulated patient actor. Pre-and post-session questionnaires measured baseline and post-session self-efficacy, knowledge, and learner perceptions. Comparative placement evaluation data were reviewed between cohorts with and without embedded simulation teaching. Session design was informed by experiential, constructivist, and adult learning principles, with careful attention to cognitive load and psychological safety.

Students demonstrated substantial improvements in self-efficacy across all assessed domains. Pre-session ratings averaged 2–3/5 for psychiatric history-taking, MSE, and communication with acutely unwell patients, increasing to 4–5/5 post-session, representing a 90% increase in self-reported confidence. Cohorts with embedded simulation reported consistently higher satisfaction with their psychiatry pathway than cohorts without simulation, including higher ratings for overall week quality (mean 4.3–4.5 vs 3.0), usefulness of the introduction (mean 4.7–5.0 vs 3.9), and feedback in clinical reasoning (mean 4.0–4.7 vs 3.0). Qualitative feedback described the session as “the most helpful thing of the placement”,highlighting realistic acting, varied scenarios, and the value of structured feedback within a supportive, non-judgemental environment. Following positive evaluation, the programme progressed from a pilot to integration within the University of Plymouth undergraduate psychiatry pathway, with planned expansion to affiliated hospitals.

Simulation-based psychiatric teaching effectively addresses gaps in undergraduate exposure to acutely unwell patients, improving confidence, practical skills, and reflective practice. This sustainable and scalable model demonstrates how locally developed simulation can enhance placement quality and achieve wider institutional adoption, offering an innovative and transferable approach to undergraduate psychiatry education.

To systematically evaluate the structural and functional capacity of mental health services in Gaza following over 2 years of active conflict (Oct 2023–Jan 2026), quantify infrastructure and workforce losses, and identify critical service gaps requiring humanitarian response prioritization.

This service evaluation utilized triangulated data sources: (a) official Ministry of Health Mental Health Department records (Oct 2023–Jan 2026); (b) field observations carried out by World Health Organization (WHO) fieldworkers (Oct 2024–Nov 2025); (c) Mental Health and Psychosocial Support (MHPSS) Technical Working Group coordination data and facility assessments (Oct 2023–Jan 2026). The evaluation was conducted using standardised MHPSS assessment toolkits adapted to the local context. Evaluation scope encompassed all governmental psychiatric facilities, community mental health centres, selected local and international non-governmental organisation (NGO) service points, workforce capacity, medication supply infrastructure, and service accessibility across Gaza Strip. Analysis employed descriptive statistics and thematic categorization of operational barriers. Data sources comprised aggregated, non-identifiable service statistics and infrastructure assessments.

Gaza's sole functional psychiatric hospital (39-bed capacity, 2,200 annual emergency presentations, 719 annual admissions pre-conflict) sustained structural damage, rendering it non-operational since November 2023. A replacement psychiatric hospital that was planned before the war and was due to open in 2024 sustained damage before activation. All six governmental Community Mental Health Centres (serving approximately 100,000 annual service users) were destroyed (during April 2024–2025).

Workforce capacity declined critically: over 10 mental health professionals were confirmed killed, with only three Board-certified practicing psychiatrists remaining in Gaza (two more projected upon completion of the current training cohort in 2026). Pre-war, there was a single Board-certified child and adolescent psychiatrist, currently unable to practice within Gaza. Multiple NGO facilities sustained destruction or damage. Psychotropic medication supply chains were severely disrupted following the destruction of the WHO's pharmaceutical warehouse. Health information infrastructure, including electronic medical record systems and referral pathways, became non-functional. Several key service restoration priorities were identified, including: establishing minimum psychiatric referral capacity for acute presentations; securing sustainable psychotropic medication supply and implementing clinical supervision and psychological support systems for the remaining workforce.

Findings demonstrate structural collapse of specialized mental health service capacity. Feasible mechanisms to support the identified priorities for service restoration include integrating MH inpatient services in primary and secondary health facilities, context-specific capacity building, international tele-supervision partnerships and workforce protection measures as integrated response components.

Attention-Deficit Hyperactivity Disorder (ADHD) is a neurological developmental disorder that involves a criterion which requires an onset of symptoms before 12 years of age for clinical diagnosis (American Psychiatric Association, 2013).

Be that as it may, longitudinal studies have identified cohorts of adults with symptoms of ADHD but also lack a clear childhood history of symptoms. This phenomenon challenges the core diagnostic criteria described in the DSM–5 and creates notable uncertainty clinically (Moffitt et al., 2015).

This systematic review aims to critically analyse and evaluate the published evidence that both supports and contradicts the validity of adult-onset ADHD being a diagnostic construct, as well as to investigate other possible causalities for this type of clinical presentation.

Following PRISMA guidelines (Page et al., 2021), a comprehensive search of PubMed, PsycINFO, and Embase was conducted for peer-reviewed studies that have been published from 2000 onwards, exploring late-onset ADHD. Studies were screened by one reviewer. Due to the heterogeneity of the studies, a narrative synthesis was performed usingthe extracted data to arrange findings into arguments based on the various topics that materialised, pertaining to methodology, aetiology, and differential diagnosis.

The synthesis identified a notable conflict in the evaluated literature. Multiple longitudinal studies provided evidence supporting a late-onset ADHD presenting subtype. Nevertheless, this evidence is countered by literature arguing that findings in support of adult-onset ADHD are attributable to limitations in methodology, including both recall bias when patients self-report retrospectively as well as the failure to detect “masked“ childhood symptoms (Faraone et al., 2016). Moreover, a significant amount of literature explores the idea that there may be an overlap of symptoms with conditions that present similarly to ADHD such as complex trauma, emotional dysregulation and misuse of substances.

The evidence analysed and evaluated for a distinct late-onset neurological developmental subtype of ADHD remains inconclusive. These adult presentations outline a complex reality facing the clinicians of which require further meticulous and thorough assessment. This systematic review shows a need for this late-onset ADHD subtype to be further explored and studied with more subjects, as well as investigating possible strategies that could be implemented to mitigate undiagnosed or misdiagnosed patients. Healthcare professionals should make conducting a comprehensive differential diagnosis and recording collateral history a priority, in order to avoid a patient remaining undiagnosed and to distinguish ADHD from similar presenting and/or mimicking conditions.

The value and utility of psychiatric diagnoses have been heavily debated within the literature, with proponents advocating that they offer evidence-based treatment and ease of professional communication. The role of social determinants of mental health has been gaining traction, and one alternative to psychiatric diagnoses has been proposed to use phenomenological codes within the current medical system to record both symptoms and the social determinants that service users report. The literature suggests that this approach has been minimally used, however, to date, no research has explored mental health professionals’ views on using this within clinical practice. This research had two broad aims: to elicit the views of psychiatrists working within general adult mental health services on the use of psychiatric diagnoses and alternatives to these, with a focus on using phenomenological codes and to explore how these alternatives may be utilised within clinical practice, specifically focusing on the positives and challenges.

14 Consultant Psychiatrists were recruited from three NHS sites across the North West of England from a range of adult mental health services. Semi-structured interviews were completed either virtually or face-to-face which included a video explaining the idea of using phenomenological codes. The interviews were recorded with consent, transcribed, and analysed using reflexive thematic analysis.

Six overarching themes and 18 subthemes were generated from the interviews. These included: psychiatric diagnoses are imperfect but practical, coding may be helpful but impractical, we are all just stuck in the system, psychological input is helpful but a luxury and moving forwards towards best practice. The results demonstrated the multitude of factors that both impacted on views of psychiatric diagnoses and the ability to implement potential alternatives within NHS mental health services.

Overall, participants demonstrated enthusiasm towards non-diagnostic approaches and exploring the role of social determinants, however felt that coding would be logistically challenging. Participants discussed the complexity of this area, exploring both the impact of personal and professional views shaped by experience alongside wider systemic factors such as professional identity and the constraints within NHS services. Future research could explore further how to integrate medical and non-diagnostic approaches to highlight the role of social determinants in the development of mental health difficulties and how this can be effectively applied within clinical services.

Primary: To increase the proportion of A&E referrals to the Mental Health Liaison Team (MHLT) at a medium-sized district general hospital with documented reasons for breaching the one-hour response target. Secondary: To improve the team's shared understanding of breach causes.

The MHLT 'A&E Assessment' proforma separately records referral time and assessment initiation time from which monthly ‘breach’ statistics are produced. November 2025 data was audited to establish whether ‘breach reasons’ were consistently recorded. During early November open-forum team consultations occurred where frequent breach codes were agreed, these were: 1: Multiple referrals within 1 hour, 2: Staffing levels–shortages/sickness, 3: Patient not medically fit, 4: Patient left department, 5: Other, specify. The proforma was amended accordingly and was emailed to all team members on 17.12.2025. All were advised of the audit and encouraged to use the new proforma, with posters in the MHLT office acting as a further reminder. Data was re-audited between 18.12.25–17.1.26 to determine overall breaches (with reason recorded) and percentages per category.

In November 2025 (30 days) MHLT accepted 97 A&E referrals. 32 breached the one-hour target (33%), 10 recorded a breach reason (30%).

From 18 December 2025–17 January 2026 (31 days) MHLT accepted 44 A&E referrals. 20 referrals breached the target (45.5%), 9 recorded reasons (45%) as follows: Code1: 1 (11%), Code2: 6 (67%), Code3: 0 (0%), Code4: 1 (11%), Code5: 1 (11%).

The re-audit showed a 50% increase in recording of breach causes. Team agreement on common breach reasons supported engagement, and the project showed that embedded prompts can improve recording. Documentation rates remain low however, reflecting ongoing service pressures (see Code2 results). It is suggested that further reinforcement through amended team systems will support improved documentation e.g. staff induction, education and embedded prompts. Notably 50% fewer referrals were accepted during the re-audit phase. An influencing factor might be audit timing (Christmas/New Year). Re-auditing over a longer period is advised whilst cross-referencing against staffing levels.

In 2023, 75% of resident psychiatry doctors (n=210) in Southeast England had experienced verbal abuse, 50% physically threatened, and only 33% felt confident in workplace security measures. A similar survey was carried out within South London and Maudsley NHS Foundation Trust (SLAM) in 2023, which found 70% of Foundation Doctors had experienced verbal or physical abuse from patients. Measures were put in place to improve safety, however were not clearly defined, and a review of their effectiveness has not yet occurred. This research aimed to bridge this gap by understanding the safety measures currently in place, and to determine whether doctors feel safe within their psychiatry placements.

We conducted a cross-sectional survey of SLAM Foundation Doctors on psychiatry placements between August 2025 to February 2026, to explore perceptions of safety during their training. The survey was distributed electronically and comprised of both quantitative and qualitative items, including closed-ended and free-text questions. Using this data, we identified areas that need improvement, and now aim to implement strategies to aid in improving foundation doctor experiences.

A total of 8 doctors responded to the survey. 62.5% of doctors feel unsafe or somewhat safe in their psychiatry placement. 87.5% did not receive any personal safety or breakaway training on starting their job. Only 25% of doctors received a safety induction for their ward or hospital, including how to locate emergency buzzers and staff alarms. 62.5% of doctors have been verbally assaulted, and report experiencing something they found traumatic during the rotation.

Qualitative data highlighted fears surrounding being left alone with acutely unwell patients due to a lack of safety induction and information on personal safety alarms.

Our research highlights that a high proportion of foundation doctors report feeling unsafe during their psychiatry placements. Most respondents did not receive personal safety or breakaway training, and only a minority received a local safety induction. Qualitative findings reinforced these findings, highlighting concerns around being left alone with acutely unwell patients, alongside a lack of safety and de-escalation training. Experiencing violence or aggression alongside a lack of safety training may adversely affect doctors’ experiences, engagement with learning opportunities, and ability to deliver a high standard of care. Identifying gaps in safety provision is therefore essential to inform targeted quality improvement initiatives and enhance both doctor training experiences and patient outcomes.

A Quality Improvement Project (QIP) aimed to reduce the pharmacological interventions for behavioural and psychological symptoms of Dementia(BPSD) by 40–60% on Bryngolau Ward, a specialist Old Age Psychiatry unit in Prince Philip Hospital, Llanelli; through optimised non-pharmacological strategies.

Using the Model for Improvement and Plan–Do–Study–Act (PDSA) cycles, the project implemented a combination of interventions including staff education, sensory room utilisation, guideline promotion, and structured assessment tools (e.g., ABC charts). Baseline data (two 15-day periods) were compared against four PDSA cycles (15 days each)measuring BPSD incidence, use of pharmacological and non-pharmacological interventions, and falls.

Pharmacological interventions decreased from 44.3% (baseline) to 23.5% (Cycle 4), exceeding the target (average reduction: 42.5%). Non-pharmacological interventions rose from 55.7% to 76.5%. BPSD incidents dropped by 56% (Cycle 4), and falls reduced by 76% (Cycle 3). Variability in Cycle 3 highlighted situational challenges, but overall trends demonstrated sustained improvement.

The QIP successfully shifted practice towards non-pharmacological BPSD management, reducing medication use and improving patient safety; adhering to national guidelines. Key drivers included staff training, sensory resources, and iterative PDSA refinements. Recommendations include embedding these strategies into standard practice, ongoing staff development, and expanding monitoring to ensure sustainability. This project provides a replicable framework for dementia care settings aiming to minimise pharmacological reliance.

Dissociative fugue is a rare dissociative disorder characterised by sudden, reversible loss of autobiographical memory, identity disturbance, and purposeful wandering, often precipitated by acute psychological stress. Due to its infrequency and overlapping presentation with psychosis, delirium, and substance-induced amnesia, dissociative fugue is frequently misdiagnosed. We present a case of dissociative fugue in a previously high-functioning adult, highlighting diagnostic clarity, multidisciplinary management, and the critical role of family involvement in recovery.

A man in his late thirties with no known psychiatric or medical history was brought to hospital by police after being found wandering outdoors inadequately dressed during winter. He was unable to identify himself, his personal history, or recognise family and friends, although he adopted an alternative name. He appeared emotionally neutral about his identity loss and demonstrated preserved ability to follow ward routines independently. Orientation to time was impaired, with reduced awareness of seasonality, while orientation to place was intact. There were no hallucinations, delusions, thought disorder, or features of delirium. Physical observations remained stable throughout admission.

Extensive investigations, including neuroimaging and blood tests (including infection and metabolic screening), were normal. Urine toxicology was negative, with no evidence of intoxication or withdrawal. Organic, psychotic, neurological, and substance-induced causes were excluded, and a working diagnosis of dissociative fugue was formally established. Psychosocial assessment revealed a sudden relationship breakdown preceding symptom onset alongside occupational stress. Psychological formulation conceptualised the presentation as trauma-related dissociation with identity fragmentation.

Management focused on psychological and systemic interventions rather than pharmacological treatment. Input included trauma-informed psychological therapy, occupational therapy with graded re-exposure, and structured family involvement. Identity reintegration was facilitated through in-person family visits, video calls, photographs, familiar language cues, and supported visits to the patient’s home. A marked emotional breakthrough occurred during the third week of admission, when the patient became tearful upon seeing his brother, coinciding with gradual restoration of autobiographical memory. Retrospective consent was obtained once capacity returned.

This case demonstrates that dissociative fugue is not merely a theoretical diagnosis but a real and reversible clinical presentation in contemporary psychiatric practice. Preserved executive functioning, emotional neutrality towards identity loss, and absence of psychotic features were key diagnostic clues. Without early diagnostic clarity, the patient was at significant risk of misdiagnosis as dementia, psychosis, or substance-induced amnesia, potentially leading to unnecessary pharmacological treatment or prolonged institutionalisation. Coordinated multidisciplinary care, early collaboration with police and community services, and family involvement were central to recovery.

Following a serious untoward incident (SUI) involving a service user under the care of the Intensive Home Treatment Team for Older People (IHTT) in Leeds, a learning need was identified around the recognition of medication overdose, particularly in community mental health settings. Debrief around the incident highlighted a gap in confidence and awareness, particularly among non-medical staff in recognising potential overdose presentations outside acute hospital environments.

To address this, we designed and implemented a targeted teaching session with the aim of strengthening clinical vigilance and early identification of possible overdose and provide practical, scenario-based education for frontline staff, to ultimately reduce the risk of similar incidents by improving knowledge, confidence and decision-making.

A teaching session was developed by resident doctors in response to the SUI learning. It was designed for delivery to non-medical, community-based mental health staff and focused on recognising overdose presentations, including atypical or non-specific symptoms. Teaching sessions were delivered across a 1-hour format and incorporated case-based discussion, practical scenarios, and guidance around escalation and response. Feedback was collected through online forms in addition to informal verbal and email responses. Quantitative and qualitative analyses were performed to evaluate the quality, relevance andperceived impact of the teaching.

More than 50 staff members have attended the sessions so far, with more sessions planned. Quantitative analysis showed high levels of satisfaction and perceived benefits: 100% of respondents rated the quality, clarity and relevance of the session as 5/5. Participants reported a significant improvement in understanding of overdose presentations (mean score 4.83/5) and 94% reported increased confidence in responding to suspected overdose situations (mean score 4.39/5). Qualitative feedback highlighted strong engagement with the session content, with particular value placed on worked case examples. Suggestions for improvement included covering additional scenarios, proving an accessible quick-reference document and shortening the session to allow wider staff engagement.

This project successfully addressed an identified learning gap following an SUI and was positively received by community mental health staff. Early feedback suggests it improves confidence and awareness in recognising potential overdose presentations in community settings. Future plans include wider and sustained implementation through a concise 15-minute core teaching package, development of a quick-reference guide, and further delivery to additional community teams, as well as inpatient units that have expressed an interest.

The initiative demonstrates how structured, reflective learning from adverse events can translate into meaningful improvements in frontline clinical practice.

A literature review search ran in April 2025 over five databases (Cinahl, Emcare, Medline, Cochrane Library, PsycInfo) showed there is substantial high-level evidence supporting the use of mindfulness-based interventions (MBIs) for perinatal depression and anxiety.

Nature exposure has been shown to have protective effects on mental health among both general adults and perinatal populations. However, there is insufficient existing research to draw firm conclusions about the effects of nature-based interventions (NBIs) on perinatal mental health. No studies had been found that combine MBIs with NBIs for the perinatal population. A ward-based mindfulness group was devised with the aim to provide a stress-relieving space for patients and staff.

A Mindfulness in Nature group was developed and led on New Horizon Mother and Baby Unit in Southmead, Bristol from March until July 2025. Ward staff, patients, their babies, and visiting relatives were invited take part. Sessions were led outdoors in the ward garden. Sessions followed a common structure and began with a poetry reading. Participants were then invited to take part in 2–3 group and individual mindfulness activities. Each week the group ended with a guided mindfulness closing practice. Quantitative data was collectedvia pre- and post-session feedback forms which were filled out contemporaneously over 8 weeks. Participants were asked to rate how stressed they felt on a scale of 0–5 before and after the session. They were also asked to rate how they found the session via a face rating scale. Qualitative feedback was collected to gain participants views on the sessions.

Eighteen feedback forms were collected from seven sessions by ten participants. Two forms were partially completed and could not be counted. Two completed forms were by staff. Every participant rated the session as being “good” (smiling face). Eleven forms showed a reduction by 1 in participant stress levels after the session, three forms showed reduction by 2 points, and one form reduction by 3 points. One participant rated their stress as the same before and after the session. None reported an increased level of stress post-session.

Participation in a ward-based mindfulness in nature group reduced self-reported stress levels of staff and patients who attended. Positive qualitative feedback was also received. More rigorous studies would be indicated to assess the efficacy of mixed nature and mindfulness-based interventions for improving symptoms of stress, depression and anxiety for the perinatal patient and staff populations.

• • To evaluate the referral patterns and uptake of the ECT service in relation to patient demographics and diagnosis.

• • To assess referrers’ experiences of the ECT referral process and identify barriers influencing referral quality and access.

• • To determine patient outcomes following ECT and evaluate the overall effectiveness of this treatment modality.

A retrospective longitudinal design was used. Case records for all patients referred for ECT between 01/04/2022 and 31/03/2023 were reviewed, forming a complete 12 month cohort. Demographic, clinical, and referral information was extracted from electronic patient records, and each case was followed for two years to assess longerterm outcomes. Data were collated using a structured Microsoft Excel tool prior to analysis.

Seventy patients were referred during the evaluation period. Forty nine completed treatment (69%), eight declined despite being assessed as suitable, and twelve referrals were screened out–primarily due to administrative errors where ECG referrals were mistakenly submitted as ECT requests. Referrals were predominantly female (48 vs. 22 males), with most patients aged 55 or older. Ethnicity analysis showed a majority of White British patients (n=48), with lower representation from minority ethnic groups. Most referrals originated from the MHSOP inpatient acute team (n=26). Waiting time analysis showed that 36.2% of patients waited more than 10 days from referral to treatment. Diagnostic profiles were dominated by severe depressive episodes, particularly psychotic depression (n=19). Short term outcomes were strong, with 73.5% maintaining improvement at one month. The highestrelapse risk occurred between 1–6 months, with maintained improvement falling to 49% at six months. At two years, 51% remained well, although attrition increased to 20.4%.

A robust continuation plan is needed between the 1 to 6 months post ECT which is consistent with known patterns where ECT response can fade. Also in practical terms, the post ECT outcome data points to it being effective for acute episodes, but maintenance of gains is not automatic and depends on timely continuation pharmacotherapy, structured relapse-prevention planning, psychological and social supports, and for some patients, continuation/maintenance ECT. Service level findings indicate opportunities to improve referral accuracy, reduce pathway delays, address demographic disparities, and strengthen patient education and referrer training to enhance accessibility, efficiency, and clinical effectiveness

To evaluate and improve the Critical appraisal teaching experience for residents at Surrey and Borders NHS Foundation Trust (Foundation year, GP and Core Psychiatry Trainees) within the SABP East Locality using a structured, iterative quality improvement approach, and to enhance trainee confidence in preparation for MRCPsych examinations and clinical application of the critical appraisal skills.

A multi-cycle project was carried out in line with the quality improvement framework between October 2024 and July 2025. A baseline survey within the SABP East locality assessed the confidence of trainees in critically appraising research and their views on critical appraisal teaching. Pre- and post-cycle surveys were conducted, and changes in trainee confidence were measured across multiple critical appraisal domains. Based on survey insights, interventions were introduced across three cycles, including restructuring journal club sessions through embedding peer-led critical appraisal teaching, systematically using critical appraisal skill programme checklists, and developing supporting online learning resources. This model was adapted and further rolled out to other SABP localities following successful implementation within the SABP East locality.

There was a progressive improvement in self-reported confidence across all cycles. Overall confidence in critically appraising research increased from approximately 50–55% at baseline to nearly 80% following cycle III. Improvements were seen across appraisal of diagnostic, prognostic, qualitative, and randomised control trial designs, as well as systematic reviews. The structured journal club format, use of Critical Appraisal Skill Program checklists, and accessible online resources were consistently rated positively by trainees.

Restructuring of the Journal club sessions with a focus on the peer-led critical appraisal teaching model improved trainee confidence and engagement with evidence-based medicine. Incorporating the Critical Appraisal Skill Program checklists provided a consistent, practical appraisal framework, with online resources supporting independent learning. Successful implementation within the SABP East locality further enabled the rollout of this approach across other SABP localities. Future work will aim to evaluate implementation and impact across all localities, including longer-term effects on training outcomes, success in MRCPsych examinations and clinical decision-making. However, findings should be interpreted in the context of trainee turnover, as only core psychiatry trainees contributed consistent longitudinal data.

Alcohol use in the workplace is typically addressed through impairment-focused policies or reactive disciplinary responses. Yet national data suggest a deeper, systemic relationship between work-related stressors and higher-risk alcohol consumption. The aim of this work is to quantify the prevalence of higher-risk alcohol use among full-time workers and investigate the role of work-related stressors and workplace-specific barriers in shaping drinking behaviour and help-seeking patterns.

Data from a population survey of 2,037 UK adults (mean age=48.77 years, standard deviation=17.74; 1,066 female [52.33%], 971 male [47.67%]) were analysed to examine the prevalence of higher-risk drinking among full-time workers, demographic distribution, attribution of drinking to life stressors, and work-specific barriers that inhibit help-seeking.

Higher-risk alcohol use was substantially elevated among full-time workers (30.8%), second only to students, and distributed across all income levels, including 40% earning £50,000+. Only 9.6% of this group self-identified as heavy drinkers. Work-related pressures emerged as a core driver: 25.7% of higher-risk workers cited work stress, nearly double the rate among all drinkers (14.3%), with additional attribution to cost-of-living pressures, loneliness, and remote working (2.4× more common than in the general sample).These findings support a model in which alcohol use reflects a stress-response pattern rather than individual pathology. Workplace structures also shaped barriers to accessing support: concerns about career impact (17.8%) and difficulty taking time off work (17.1%) featured prominently among higher-risk adults, indicating that traditional clinic-based services are poorly aligned with the needs of working populations.

Workforce alcohol harm in the UK is widespread, socially invisible, and tightly linked to occupational and economic stressors. Reliance on self-disclosure, performance deterioration, or manager-led referral will systematically miss the majority of affected workers. These findings emphasise the importance of incorporating AUDIT-C screening into occupational health processes and routine workplace wellbeing assessments, ensuring that alcohol-related risk is identified proactively rather than reactively. Alcohol use should be recognised as a meaningful indicator of occupational mental health, considered alongside other markers such as workplace stress, sleep disruption, and burnout. It is also essential to commission flexible, digital, or remote care pathways that minimise career-related stigma and reduce the need for employees to take time away from work in order to access support. Finally, workplace alcohol interventions should be reframed away from an emphasis on individual responsibility and instead approached as part of a broader organisational mental health strategy, acknowledging the role of workplace conditions in shaping alcohol-related risk.

High-quality clinical documentation is essential for patient safety, continuity of care, and compliance with regulatory standards. However, maintaining documentation quality within complex electronic medical record (EMR) systems can be challenging in training environments, particularly in psychiatry where documentation requirements are extensive. While resident involvement in quality improvement is encouraged, there is limited evaluation of structured trainee-led governance models in clinical informatics. This study aimed to evaluate the impact of a trainee-led informatics leadership initiative on EMR documentation compliance within the Psychiatry Residency Program at Hamad Medical Corporation (HMC). It was hypothesised that formal trainee leadership and continuous engagement would be associated with improved compliance across key documentation indicators.

A longitudinal quality improvement evaluation was conducted following the establishment of the Cerner Documentation Leadership Subcommittee in August 2022. The subcommittee consisted of psychiatry residents assigned formal leadership roles focused on documentation quality and clinical informatics. The initiative included monthly educational sessions, targeted feedback on documentation performance, iterative workflow optimisation, and continuous auditing of documentation standards. Compliance was assessed using 16 documentation indicators aligned with Joint Commission International (JCI) standards. Longitudinal compliance data were extracted from Cerner audit reports and reviewed across 2023 to examine trends, improvements, and variability in documentation performance over time.

Following implementation of the trainee-led leadership model, sustained improvements were observed across multiple documentation domains. History and Physical documentation and Medication Reconciliation maintained consistently high compliance rates throughout the evaluation period, with average compliance ranging between 86% and 90%. Comprehensive Assessment documentation showed the most notable improvement, increasing from a baseline compliance rate of 13% to 77% by the end of the evaluation year. Active trainee involvement in institutional reaccreditation processes and collaboration with Health Informatics teams supported optimisation of Cerner documentation templates and improvements in clinical workflow. Periodic declines in selected metrics were observed during resident rotation changes and onboarding of new trainees, indicating the influence of workforce turnover and the need for ongoing education and reinforcement.

This evaluation demonstrates that a structured trainee-led informatics leadership model can improve EMR documentation compliance within a psychiatry residency program. Embedding residents in formal documentation governance roles supported sustained quality improvement while promoting accountability, leadership development, and systems-based practice. Ongoing education and continuous monitoring are necessary to maintain gains, particularly during trainee transitions. Integrating informatics leadership into residency training may strengthen regulatory readiness and support safe, high-quality psychiatric care.

By January 2026, 90% of eligible patients will have a documented anticholinergic burden (ACB) score enabling identification of at-risk service users and medication risk management through shared decision-making and partnership working with service users and their general practitioners.

A structured QI framework was applied, incorporating process mapping, a driver diagram, and iterative Plan–Do–Study–Act (PDSA) cycles. Process mapping identified gaps in assessment, documentation and communication pathways. Stakeholder engagement included MDT discussions, an inpatient pharmacist's guidance on ACB scoring resources, and feedback from community GPs.

PDSA cycles were implemented:

1. MDT Education and updated new patient assessment proforma: MDT teaching on anticholinergic burden and embedding an ACB scoring prompt and ACBcalc.com link into the new patient assessment proforma.

2. Patient/carer involvement: development of a written information leaflet for patients with high burden (ACB ≥3).

3. Eligibility refinement: focusing ACB scoring on patients with cognitive impairment, falls risk, or polypharmacy (≥5 medicines).

4. Enhanced communication: integrating ACB scoring and optimisation recommendations into GPcorrespondence and MDT discussions.

5. Sustainability: monthly run charts, repeated audit cycles, and ongoing MDT feedback.

Process measures included ACB documentation rates, communication of ACB scores to GPs, and documentation of optimisation actions. Outcome measures examined the percentage of eligible patients with a documented ACB score and the percentage of patients with high ACB (≥3) who had a documented optimisation plan. Balancing measures assessed the time impact and clinician workload associated with implementing routine ACB scoring.

ACB scoring increased to 100% of eligible patients by December 2025, with a sustained upward trend across the 6-month study period. Overall, 66% of eligible patients (23/35) had documented ACB scores, reflecting early implementation months. All high-burden patients (8/8) had documented optimisation plans.

Process measures showed that 96% of completed scores (22/23) were communicated to GPs, and 100% of high-ACB patients (score ≥3) had shared decision-making discussions.

Balancing measures indicated improved efficiency following introduction of the quick-reference guide, ACBcalc.com link, and refined eligibility criteria.

Routine ACB scoring was successfully embedded into MHSOP practice, improving identification of high-risk patients, deprescribing opportunities and communication with GPs. The intervention is low-cost, sustainable and reproducible, with potential to reduce medication-related harm in older adults.

International Medical Graduates (IMGs) are essential to the delivery of care in the UK National Health Service (NHS) but their work is often examined through workforce metrics rather than lived clinical practice. So far, this study presents one of the first in-depth UK-based ethnographic analyses of IMG doctors, examining how they negotiate professional belonging, authority, and recognition, and how cultural translation and plural clinical reasoning operate under conditions of rota pressure, visa constraint, and racialised evaluation.

An interpretative qualitative study was conducted using ethnographic methods. Data were generated through 13 life-history interviews with IMG doctors working across NHS hospital settings, supported by reflexive field diaries and digital ethnography within IMG professional WhatsApp groups. Participants represented a range of specialties, grades, contract types, and intersectional identities. Data were analysed thematically using concepts from medical anthropology and sociology, with attention to recognition, translation practices, and institutional governance. Ethical approval was obtained from the relevant institutionalethics committee, all participants provided informed consent, and data were anonymised in accordance with governance and data protection requirements.

IMGs contributed more than clinical labour. Participants described sustained cultural translation work, rendering care credible across accents, professional rubrics, and patient moral worlds. Many enacted plural clinical rationalities, making small, evidence-tested adaptations to standard protocols that stabilised pressured services and supported patient trust. These practices were frequently unrecognised or misread as inefficiency. Professional recognition was unevenly distributed and patterned by race, accent, grade, and visa status, with service-heavy posts limiting access to protected training and clinical voice. Performance, strategic silence, and low-visibility resistance emerged as everyday tactics through which IMGs preserved dignity, mitigated risk, and advocated for patients.

The NHS already functions as a global medical system but its infrastructures of recognition remain misaligned with this reality. Recognising cultural translation as clinical work and embedding safe mechanisms to evaluate plural practices could improve equity, patient safety, and workforce retention. Practical implications include protecting training in service-heavy roles, decoupling communication assessment from accent policing, embedding IMG-led forums into quality improvement processes, and designing visa-aware governance.

Benzodiazepines are commonly prescribed for short-term treatment of anxiety andagitation on acute adult psychiatric wards, though long-term use can lead to dependence and withdrawal. ‘It is widely recognised that discharge prescriptions from mental health hospitals have high levels of prescribing and communication errors, and Sussex Partnership NHS Foundation Trust (SPFT) have written guidelines to ensure benzodiazepines are weaned effectively and communicated clearly to the GP.

• • To improve compliance with Sussex Partnership Trust Guidelines.

• • To provide safe weaning regimens for benzodiazepines.

• • To provide clear handovers to GPs, and avoid unnecessary repeat prescriptions of benzodiazepines in the community.

The standards audited against were the SPFT guidelines that 100% of patients should have:

1. The date of initiation and indication of benzodiazepine recorded.

No patient should be discharged from hospital on a benzodiazepine unless they were established on long-term treatment prior to admission or continued use is supported by a consultant psychiatrist.

If the benzodiazepine is expected to continue, the indication, duration, dose and details of any reducing regimen should be communicated to the GP.

A preliminary audit was completed for patients discharged from the Eastbourne Department of Psychiatry from September to October 2024. Data were taken from carenotes, discharge summary, scanned medication charts and ward review notes.

Following the preliminary audit, teaching on appropriate benzodiazepine prescribing was delivered to residents at the start of their rotation. Following this, we reaudited with same standards from October 2025 to January 2026.

In the initial audit, 12.5% were prescribed regular benzodiazepines and 15% PRN on discharge. Of these 80% patients were documented to be on long-term treatment and 40% had documented indication and reducing regimen.

In the repeat audit, 9% were prescribed regular benzodiazepines on discharge and 0% PRN on discharge. Of this 100% of patients had this supported by a consultant and had indication, duration of treatment and reducing regimen documented.

The reaudit showed a reduced frequency of prescribing of benzodiazepines on discharge, and all had a reducing regimen documented, demonstrating significant improvement. Due to difficulty in arranging teaching for the whole cohort of residents, the teaching and repeat audit focused only on the male ward at the Department of Psychiatry. The wards may have different prescribing patterns which limits the generalisability of the results. Future plans involve arranging a teaching session at the induction of new residents, and re-audit to see if the improved compliance is maintained.