Suicide is a serious global public health concern. Most suicide related deaths occur in low- and middle-income countries (LMICs) such as Pakistan. Self-harm is a major predictor of death by suicide and has cost implications both in terms of treatment and subsequent suicide. Therefore, culturally relevant interventions that have the potential to reduce self-harm in Pakistan may have major implications for the costs incurred by service provision and productivity losses due to illness or premature death. This trial investigated the clinical and cost effectiveness of the CMAP intervention verses enhanced treatment as usual (E-TAU) to reduce self-harm over 12 months in Pakistan.

Participants were recruited from emergency departments, primary care settings, medical units of participating hospitals and self-referral from community settings in Karachi, Lahore, Rawalpindi, Quetta and Peshawar. Eligible consented participants were assessed at baseline, 3- (end of intervention), 6-, 9- and 12-month post-randomization. Participants in the intervention arm received 6 one-to-one sessions of culturally adapted manual assisted psychological intervention (CMAP) over 3 months. The Client Service Receipt Inventory was used to record health service utilization, both formal and informal. Health related quality of life was measured using the EQ-5D-3L. The Thailand tariff value set (developed by the EuroQol Organization) was used to calculate quality-adjusted life year (QALY) because Thailand was deemed similar to Pakistan. The Incremental Cost Effectiveness Ratio (ICER) was calculated based on between arm differences in estimated cost and Quality Adjusted Life Years (QALYs) gains in the sampled population. Costs were converted to US dollars using the currency exchange rate on February 2024 (US$1 = PKR276)

A total of 901 participants were randomized into either the CMAP arm (n = 440) or E-TAU arm (n = 461). Total QALY gained in the CMAP arm was 0.40 (95% CI: 0.36–0.45) and in the E-TAU arm was 0.33 (95% CI: 0.30–0.38) at 12-month post-randomization. The additional QALY gained due to CMAP intervention is 0.07. The difference in costs per participant between CMAP and TAU arms was US$59. The ICER for the CMAP versus E-TAU was US$843 per QALY gain.

Results revealed that the CMAP intervention is likely to be cost-effective compared with the E-TAU, given the cost-effectiveness threshold. These findings suggest that implementing culturally relevant self-harm and suicide prevention measures such as CMAP can lead to significant societal cost savings by preventing self-harm and suicides.

The aim of our quality improvement project was to explore and improve care for patients who use sensory aids, with or without dementia, on an old age ward at King's College Hospital. We sought to do this by increasing the staff awareness of each patient's sensory needs and dementia status.

Guidelines state that sensory aids (glasses and hearing aids) are important in orientating patients with delirium and dementia, yet these devices frequently go missing during admission or are not being used appropriately. This could affect communication and therefore overall care, both physical and mental. It is widely understood that delirium and dementia are associated with increased morbidity and mortality. In this project we aimed to explore issues around sensory aid use and to identify and implement impactful changes.

2 Plan, Do, Study, Act cycles were conducted between October 2022 to February 2023. A driver diagram was created following staff interviews on the ward. The first cycle focused on increasing awareness of a form in electronic patient records (EPR) and the need for documenting each patient's sensory aid possessions and dementia status. This was done through bite-size teaching sessions to the team and monitoring of completion of this form. The second cycle included utilising a new laminated bedside checklist that is manually filled in and was aimed to serve as a visual cue of the patient's sensory impairment/dementia status. A survey was used at baseline and then repeated over the course of both cycles to evaluate awareness of staff (named nurse) of each patient's sensory impairment/dementia status on the ward.

Baseline survey showed that staff were unsure of the sensory aid needs (glasses, hearing aids, dentures) of 25% of patients and 46.7% when it came to dementia status. EPR form completion increased by 14% between 14/12/22 and 25/01/23, however this was not statistically significant. 18% of bedside checklists were filled after 4 weeks. Overall, there was a statistically significant decrease in staff not knowing the sensory impairment status (by 32%) as well as dementia status (by 40%).

Whilst uptake of the forms and bedside checklist was slow, the project did show an improvement in awareness of staff and our hypothesis is that this leads to better use of sensory aids. The next step would be to assess whether this leads to better care through further PDSA cycles.

Copy number variants (CNVs) are large changes in the structure of DNA. Certain rare CNVs are associated with elevated chance of neurodevelopmental conditions and difficulties (NDs), including autism spectrum disorder (ASD) and intellectual disability, alongside various physical health complications. Currently, CNV testing in children with NDs is only recommended under limited circumstances, in part because their impact on outcomes and prognosis remains unknown. We aimed to investigate whether individuals with NDs in childhood, with and without rare pathogenic CNVs, differ in terms of functional outcomes in early adulthood.

Pathogenic CNV carriers were identified in the Avon Longitudinal Study of Parents and Children (ALSPAC), a UK birth cohort of individuals born in 1991–1992. Individuals with the following childhood NDs were identified through parent-reported diagnostic interviews and questionnaires, and assessment with the child: Attention Deficit Hyperactivity-Disorder (ADHD), ASD, reading difficulties, coordination difficulties, language difficulties, and chronic tics. Outcomes were measured at age 25 and included: presence of an emotional disorder, being in receipt of sickness/disability benefit, ability to make and maintain friendships, not being in education, employment, or training (NEET), and self-reported life satisfaction. We will use logistic regression to measure the association between carrying a pathogenic CNV and each functional outcome in ALSPAC. Sensitivity analyses will be conducted on all large (>250kb), rare (<1%) CNVs, as opposed to only pathogenic CNVs.

983 individuals with probable NDs (39.4% female, n = 387) were identified in ALSPAC, including 495 people with ASD, 163 with ADHD, 16 with Tourette's syndrome, 210 with reading difficulties, 295 with language difficulties, and 166 with coordination difficulties. Many individuals met criteria for more than one ND.

43 (4.4%) of individuals with an ND carried a pathogenic CNV. CNV carrier status amongst individuals with a ND was not associated with sex (4.4% of females vs 4.4% of males, OR = 1.007 [0.539–1.882] p = 0.981). Analysis of CNV carrier status on outcomes in NDs will be conducted between February and April 2024.

Evidence in support of poorer outcomes in CNV carriers could suggest that neurodiverse young people with CNVs may benefit from intervention to improve outcomes, and thus more individuals may benefit from genetic testing. Conversely, evidence indicating that CNVs do not impact outcomes may suggest that current clinical guidelines are appropriate within the current research landscape, and that further research is needed to understand the impact of carrying a pathogenic CNV in young people with NDs.

This research study aims to identify the adverse effects of alcohol and polysubstance misuse on kidneys. The study also highlights the hidden harm caused by prescribed treatments such as PPI (Proton Pump Inhibitors) and other medications.

The study was conducted in the summer of 2022 at an outpatient addiction treatment service. 63 patients (10% of the total prescribers), 49 males and 14 females participated in the study. All participants gave their consent, and data were collected including demographic details, substance misuse history, physical and mental health history, and prescribed treatments. We used a Combur-7 urinary dipstick to analyze the results provided in the kit.

Seven patients were not able to provide a sample. 60/63 patients' result showed abnormalities.

21 out of the 63 samples appeared dark and hazy. 7 samples were foul-smelling. 40 of the 63 patients were detected with a variable amount of leukocytes. 1 of the 63 patients was positive for nitrogen. The pH values range from 5 to 8. Specific gravity values were variable. 3/63 samples were positive for bilirubin. 58/63 samples were positive for protein. 19/63 samples detected variable amounts of red blood cells. 5/63 samples detected for ketones and glucose were negative in all samples.

Long-term alcohol abuse can compromise the ability to manage fluid volume and electrolyte balance. Extreme serious abuse can also impact acid-base balance, homeostasis, and even hormonal control regulated by the kidneys could be affected. This situation further complicates the presence of liver disease.

Cocaine abuse can cause acute kidney injury (AKI), malignant hypertension, and vasculitis and can lead to chronic kidney disease (CKD). Heroin-associated nephropathy (HAN) can lead to nephrotic syndrome and could progress to end-stage renal failure.

Tobacco, solvents, amphetamines, and ecstasy can aggravate a wide range of kidney diseases by their direct or indirect effect on kidney functions.

Long-term use of proton pump inhibitor and other medications such as NSAID, pregabalin, and diuretics, may affect kidney functions.

The Opiate substitute treatment dose needs to be adjusted in the presence of poor kidney functions to reduce morbidity and mortality. Early screening is required for all patients on long-term OST and other medications for comorbid illnesses.

The neuropsychiatric morbidities associated with post-COVID status are important public health issues. The range and severity of morbidity varies with the type of clinical setting and time of assessment. There are limited studies on the long-term persistence of the post-COVID neuropsychiatric symptoms (PCNS). Hence, this study aims to determine the proportion of persistent PCNS after approximately 2 years of COVID and to find any risk factors for persistent PCNS.

This study was a cross-sectional study of randomly selected 2,281 individuals aged 18–60 years, currently living in the community, who were RT-PCR positive for COVID-19 from the National Institute of Mental Health and Neurosciences (NIMHANS) laboratory (at least 4 weeks before intake) from a period of 1 June 2020 to 31 March 2022. Among them, 927 individuals who met the study criteria were screened for PCNS through telephone interviews using a validated PCNS screening tool comprising sociodemographic details, life events inventory and 20 questions to assess for PCNS. 196 individuals who came positive for PCNS were further evaluated by in-person or web-based interviews with Structured Clinical Interviews for DSM–5-Research Version and World Health Organization-Post-COVID Case Report Form for persistent PCNS. Descriptive statistics, Chi2 test, Mann–Whitney U Test, and Binary logistic regression analysis were used for data analysis. The Institutional Ethics Committee approved this study.

The median age of study participants was 34 years, and 51.3% were female. 68 out of 196 participants (34.7%) had persistent PCNS approximately 2 years (23.84 months) after COVID-19 infection. Chronic fatigue (10.2%), depression (6.1%), cognitive symptoms (4%), hyposmia (3.6%), hypogeusia (3.6%), anxiety (2.5%), panic disorder (2.5%) and insomnia (2%) are the main persistent symptoms. The median age of the participants with persisted PCNS (40 years) is higher compared with the median age of the participants without persisted PCNS (34 years) [Mann–Whitney U = 5,225.0, P = 0.021]. Even though significant associations were found between the development of PCNS after 4 weeks of COVID and female gender, symptomatic COVID-19, severity of COVID-19 (oxygen supplementation), hospital admission, total number of times of COVID-19, and presence of life events, this association were not found with persistence of PCNS at 2 years.

This study revealed that one-third of the individuals with PCNS had persistent symptoms after 2 years. Chronic fatigue is the most common persistent PCNS. Middle-aged and above age groups were found to be a risk factor for persistent PCNS.

The liaison psychiatry team at North Middlesex Hospital (NMH) noticed that many patients on clozapine were missing doses in hospital, risking the need for re-titration and deterioration in mental state. Although clozapine is a widely used medication in psychiatry, non-psychiatric clinicians may not be aware of the importance of compliance. In addition, clozapine is often not widely available in acute medical hospitals and ascertaining the correct dosage can be difficult as it is not prescribed by the GP. Furthermore, clozapine can cause a variety of side effects that our medical colleagues may not be familiar with.

The aim of this project was to improve clozapine prescribing at NMH and improve communication with the liaison psychiatry team.

We reviewed the notes of 97 admissions in which patients were dispensed clozapine from the hospital pharmacy during the period April 2020 to December 2023 to determine what proportion had missed a dose of clozapine, and the clinical implications of this. We also reviewed the reasons for the missed doses to gather information on what could be done to improve patient safety.

From July 2022 we began implementing changes. This included the creation of a hospital guideline, putting in place an automatic email that would be sent to the liaison team when clozapine was prescribed, placing an alert on the online prescribing system to emphasise the importance of not omitting doses, and providing teaching to clinicians.

We compared omissions of clozapine doses and referrals to the liaison team before and after changes were implemented. The percentage of patients inappropriately missing at least one dose fell from 67.4% to 31.1%. The proportion of patients who were referred to the liaison team rose from 40.8% to 89.2%.

We identified several recurring causes of missed doses. These included doctors not being aware of clozapine prescriptions or dosages, poor awareness that clozapine is a critical medicine and long stays in accident and emergency. There were also incidents where clozapine was stopped by the medical team without obtaining advice from psychiatric colleagues.

We were able to reduce the proportion of patients missing doses by improving awareness of clozapine compliance within the hospital. We were also able to improve communication between medical and psychiatric teams.

The clozapine guideline and prescribing alerts will continue to be utilised within the hospital. We plan to continue to provide regular teaching to rotational junior doctors and to pursue a similar project for lithium prescribing.

• • To find out the proportion of patients for whom the dates of births of their children, age and their due date were recorded during their initial assessment as a means of reducing risks through safeguarding.

• • According to the Royal College of Psychiatrists: Standards for Community Perinatal Mental Health Services 5th Edition (2020), Under Section 5 – Rights, Infant Welfare and Safeguarding: during the initial assessment, the baby's age and date of birth and mother's due date should be recorded as part of the infants' physical and emotional care needs assessment.

• • All new patients discussed during multidisciplinary team meetings within a 2 month period from 01/08/2023 to 30/09/2023 were identified

• • Their clinical records were audited.

• • This information was cross-checked with the information provided on their referral letters.

• • Patients attending preconception counselling were excluded.

• • The initial results were presented in one of the multidisciplinary team meetings.

• • The recording of the children's ages, date of birth or due dates of their mothers was re-audited two months later.

Audit

• • A total of 70 new patients were discussed within the initial two months period.

• • 25 out of the 70 (36%) did not attend their appointments and two patients (3%) cancelled their appointment.

• • 1 patient who attended for preconception counselling was excluded.

• • Of the remaining 42 patients that were assessed, 6 (14%) were primigravida while 36 (86%) patients were multiparous patients.

• • 15 out of the 42 (36%) had their children's age, dates of birth and due date recorded while 27 out of the 42 (64%) lacked this record.

Re-audit

• • A total of 65 patients were identified during the re-audit period

• • 18 out of the 65 patients (28%) did not attend their appointment and one patient cancelled her appointment.

• • One patient that attended for preconception counselling was excluded from the re-audit process.

• • Of the remaining 45 patients that were assessed, 2 (4%) were primigravida and the remaining 43 (96%) were multiparous women.

• • The age, dates of birth and the due date were recorded for 26 (58%) out of 45 patients while 19 out of the 45 patients (42%) did not have this record.

• • The children's ages were commonly recorded compared with their date of birth.

• • Gestational ages of the pregnant mothers were commonly recorded compared with their due dates.

• • Date of birth is needed for a quick check on a child for safeguarding reasons and this is useful during the admission of mothers onto a mother and baby unit.

• • The re-audit showed a significant improvement in the documentation of this information in the patients' records.

This project aims to evaluate the effectiveness of Skills Training in Affective and Interpersonal Regulation (STAIR) psychotherapy delivered by Core Psychiatry Trainees (CPTs) within the Sheffield Specialist Psychotherapy Service; a regional tertiary psychotherapy service for people with complex trauma and personality difficulties.

STAIR is a manualised evidence-based skills-based psychotherapy for people with Complex Post Traumatic Stress Disorder (cPTSD) awaiting trauma processing that is deliverable by a range of qualified and non-qualified staff. It was introduced to address two key difficulties the service faces: a long waiting list for trauma processing potentially contributes to patient deterioration, and a difficulty in identifying suitable cases for CPT short psychotherapy case requirements given the majority of potential patients awaited longer term psychotherapy.

A modified STAIR protocol was developed to meet the requirements of CPTs.

A 1-year prospective evaluation was used to compare pre and post patient reported outcome measures. These include the Nine item Patient Health Questionnaire (PHQ9) for depression symptoms, Impacts of Events Scale Revised (IES-R) for trauma symptoms, Recovering Quality of Life – 10 question (ReQoL-10) for quality of life, and the Short form Inventory of Interpersonal Problems (IIP-32) for relational symptoms. Descriptive statistics were used and data analysed using repeated measure t-tests.

17 patients completed STAIR delivered by CPTs. There was statistically significant mean improvement in Quality of Life (p = 0.001), trauma symptoms (p = 0.009) and depression symptoms (p = 0.019). Mean ReQoL-10 and IES-R improvements additionally met criteria for reliable change. There was non-significant (p = 0.0146) improvement in relational symptoms measured by IIP-32.

This evaluation demonstrates promising patient outcomes from STAIR delivered by CPTs for people with Complex PTSD awaiting trauma processing. This may help both negate any potential deteriorations whilst awaiting therapy, as well as prepare patients. Further evaluations could focus on acceptability and outcomes for CPTs.

Whilst the nature of this small evaluation limits further interpretation and generalisability, this pathway offers a promising means of meeting CPT psychotherapy competencies whilst also improving outcomes for patients.

Our aim was to evaluate the extent to which the risk assessment protocol post self-harm incidents for patients aged over 65 at the Black Country Healthcare Trust is aligned with the recommendations set forth in the NICE Guideline (NG225). We specifically sought to determine whether safety plans are incorporated as recommended by the NICE Guideline (NG225), and in the absence of a distinct safety plan, whether essential components of such a plan are integrated within the risk assessment framework utilised following episodes of self-harm.

A retrospective audit was conducted utilizing data from the trust on self-harm incidents over a six-month duration. Of the 1,408 recorded incidents, 68 involved individuals aged 65 years or older. A sample of 30 incidents was randomly selected from this cohort to constitute the target sample for this study. Each case was anonymized with a unique identifier and subjected to a comprehensive review employing a bespoke data collection instrument, expressly developed for this audit. The review process was facilitated by the trust's digital record system (RIO). Data collated for analysis encompassed a range of variables, including demographic details, diagnostic classifications, geographical location, care setting, self-harm methodologies, the severity of the self-harm events, the origin of data, and compliance with the stipulated criteria of the NICE Guidance (NG225).

Comprehensive safety plans were present in a minority of cases, specifically 6.7% (2 out of 30 patients). The documentation of individual components of the safety plan, analysed separately, yielded the following results:

1. 1. Documentation of self-harm mechanisms was achieved in 70% of cases (21/30).

2. 2. Identification of precipitants or triggers was noted in 56.7% of cases (17/30).

3. 3. The formulation of coping strategies was documented in 20% of the sample (6/30).

4. 4. The enumeration of essential contacts was completed in 33.3% of cases (10/30).

5. 5. The identification of family members pertinent to the patient’s support network was noted in 33.3% of cases (10/30).

6. 6. The inclusion of contact details for these identified individuals was present in 30% of cases (9/30).

7. 7. Guidelines to ensure a safe environment were applicable and recorded in 38.9% of the relevant cases (7/18).

The majority of patients did not have a safety plan post self-harm incidents. Notwithstanding the absence of a comprehensive safety plan, critical elements prescribed by NICE Guidance (NG225) were insufficiently addressed within the risk assessment and subsequent management planning post self-harm.

To compare receipt of acute cardiac care in people with versus without severe mental illness (SMI) and investigate the impact of the COVID-19 pandemic on any differences in care. We hypothesised that, compared with those without SMI, patients with an SMI are less likely to receive guideline recommended acute cardiac care and that disparities worsened as a result of the pandemic.

We conducted a cohort study using data from the CVD-COVID-UK resource, which links electronic health data from multiple sources. Our cohort included 95,125 adults with a non-ST-elevation MI (NSTEMI) recorded in the Myocardial Infarction National Audit Programme (MINAP) dataset between 1 November 2019 and 31 March 2022. We defined SMI as schizophrenia, schizoaffective disorders or bipolar disorder (BD), ascertained through recorded diagnosis in primary care or hospital admission records. We examined receipt of cardiac care standards for NSTEMI, including: admission to a cardiac ward; angiogram eligibility; receipt of angiogram (in those eligible); angiogram within 72 hours; secondary prevention medication prescribing at discharge, and arrangement of post-discharge cardiac rehabilitation. We used logistic regression to obtain odds ratios (ORs) for the association between SMI and receipt of each care indicator, adjusting for age, sex and time period. We tested for an interaction between SMI and time period in order to determine if any disparities had changed since the start of the COVID-19 pandemic.

Within our cohort, 620 patients (0.6%) had schizophrenia and 575 (0.6%) had BD. Compared with people without SMI and after adjusting for age, sex and period, patients with an SMI were less likely to receive each of the cardiac care standards. For example, compared with those without SMI, those with SMI were less likely to: be admitted to a cardiac ward (schizophrenia: OR 0.72, 95% CI 0.61–0.85; BD: 0.74, 95% CI 0.63–0.88); be eligible for an angiogram (schizophrenia: 0.37, 95% CI 0.29–0.47; BD: 0.52, 95% CI 0.40–0.68); receive an angiogram (schizophrenia: 0.22, 95% CI 0.18–0.28; BD: 0.51, 95% CI 0.39–0.66); and receive an angiogram within 72 hours (schizophrenia: 0.71, 95% CI 0.56–0.90); BD: 0.80, 95% CI 0.64–1.00). We generally found no evidence that disparities had changed since the start of the COVID-19 pandemic.

We identified marked SMI disparities in receipt of acute cardiac care among people treated in hospital for a NSTEMI. Further research should seek to identify reasons for, and inform interventions to, address these disparities.

The purpose of this study is to analyze the prevalence and factors of depression among the elderly population, a significant issue in Korea's aging society. By doing so, we aim to provide basic indicators for improving mental health and quality of life while efficiently managing healthcare costs.

From February to December 2021, a study was conducted on a population of 19,158 elderly individuals aged 65 and above residing in Gyeongsangbuk-do province. The severity of depression was evaluated using the Korean version of the Patient Health Questionnaire (PHQ)-9, which was adapted for use as a depression screening tool in clinical settings. In addition, demographic information such as place of residence, age, gender, and education level was collected to analyze factors that may influence depression. The data were analyzed using cross-analysis, two independent sample t-tests, one-way ANOVA, multiple regression analysis, and Scheffe's post-hoc analysis.

In the PHQ-9 screening, the average score of the elderly population was 3.65. The results showed that 13,705 individuals (71.5%) were in the normal group with scores ranging from 0 to 4, 3,683 individuals (19.2%) were in the mild group with scores ranging from 5 to 9, 1,575 individuals (8.2%) were in the moderate group with scores ranging from 10 to 19, and 195 individuals (1.0%) were in the severe group with scores of 20 or higher. It was found that place of residence, education level, type of housing, top two difficulties in daily life, subjective economic status, desired services, subjective mental health, past and current history of mental health treatment, and medication for physical illness had statistically significant (*p < 0.05) effects on depression.

Various factors were found to have a significant impact on depression among the elderly population in Gyeongsangbuk-do. Proactive prevention and treatment tailored to the population characteristics of the region may be necessary.

NICE guidelines stipulate that alternative causative factors for Behavioural and Psychiatric Symptoms of Dementia (BPSD) must be considered before starting antipsychotic treatment. The symptoms of BPSD include agitation, aggression, wandering, hoarding, sexual disinhibition, shouting, repeated questioning, sleep disturbance, depression, anxiety and psychosis. Those who do develop non-cognitive symptoms or behaviours should at first be assessed to exclude alternative causes, such as physical health issues (pain/infection), side effects of medication, environmental factors, psychosocial factors, individual biography (e.g. religious beliefs) etc. Then, non-pharmacological approaches should always be used as the first line in treating behavioural problems before antipsychotics (e.g. haloperidol or risperidone) are started at a low dose and titrated up. Once these have been started, the patient should be reviewed at 6 weeks. The rationale for conducting this audit is to try and understand if the antipsychotic prescribing in the ward is in line with the NICE guidelines.

A retrospective study to compare the treatment of all the patients admitted for dementia in the Old age psychiatry wards located in University Hospital Llandough from November 2022–April 2023 with the NICE guidelines.

Out of the 39 patients who met the criteria, the results indicate a predominant prevalence of Alzheimer's (46%), followed by mixed dementia (23%) and vascular dementia (21%), among the diagnosed cases. In 67% of instances, healthcare professionals have considered alternative causative factors for the observed symptoms beyond the identified dementia subtypes. In 62% of cases, patients received treatment for alternative causes, while non-pharmacological approaches were attempted in 51%. The utilization rates among patients indicate a predominant prescription of risperidone at 77%, followed by quetiapine at 31%, olanzapine at 10%, and aripiprazole at 5%. 95% of patients were commenced treatment at the lowest dose, while information for 3% (1 patient) was not available. 62% were monitored according to guidelines and 56% were reviewed every 6 weeks.

There is room for improvement in terms of considering other causes of behavioural symptoms, utilizing non-pharmacological approaches, and adherence to monitoring and review intervals outlined in the guidelines. These findings underscore the importance of continuous evaluation and refinement of clinical practices to enhance the overall management of BPSD in dementia patients.

1. 1. To identify various physical and social health characteristics of heroin users to reduce further risks presenting to ED in Chesterfield, North Derbyshire.

2. 2. To consider whether any characteristics identified could develop a targeted screening tool for enhanced interventions.

A retrospective review of ED notes was conducted from Chesterfield Royal Hospital using electronic patient records of heroin users who are under the care of Drug and Recovery Partnership (DRP) in Chesterfield, North Derbyshire. We developed a proforma for data collection analysis using Microsoft Excel.

100 patients were chosen over a time interval of one year in which they have had at least one ED presentation.

We looked into Body mass index (BMI), physical health diagnoses, number of presentations to the ED in one year, psychotropic medications, dose of opioid substitution therapy and living circumstances of the attendees. These characteristics were identified in a previous study of local mortality data.

46% of the attendees only presented once in the study interval.

83% of the attendees presented to ED due to a medical reason.

41% of the attendees had raised BMI.

73% of the attendees who attended were on Opioid Substitution therapy (OST). 51% of the attendees were using a dose between 70–100 ml of methadone.

27% of the attendees had co-morbid COPD and Asthma.

47% of the attendees were on prescribed psychotropic agents. 56% of them were prescribed mirtazapine.

44% of the attendees lived alone, 33% with a partner.

1. 1. Based on the sample, 83% of the heroin users presenting to ED in this period of study attended due to physical health concerns.

2. 2. As half of the sample were not serial attenders (46%), it is important that opportunities of assessment for this high-risk group of people are not missed.

3. 3. Nearly three quarters (73%) of the attendees were on prescribed OST, half of those were within optimised dose. This suggests for tighter links between liaison to local drug services to alert presentations with specific consideration of harm reduction interventions, dose optimisation or re-titration onto OST.

4. 4. The data collected over this period supports the development of a pilot screening tool to prioritise enhanced care interventions with a specific focus on harm reduction for a specific group of high-risk heroin users.

To make a case for E-prescribing within the Paediatric Neurodevelopmental Team in Wrexham Maelor Hospital.

To trial a different way of approaching 6 monthly reviews within the ADHD clinic (option for remote reviews).

To show how we could reduce the carbon footprint of the ADHD clinic.

Process mapping was completed to consider areas in the ADHD prescribing process that could be made more sustainable.

For each patient appointment in the ADHD clinic a questionnaire was completed. The data collection period was over 3 weeks during August and September 2023. Data was collected and interpreted.

99 appointments were offered, 82 appointments attended. 77 appointments were face-to-face and 22 were via telephone. Of the face-to-face appointments, 54 families travelled in by car and 4 used public transport (2 taxis). Of those who commented 31 people found it hard to find parking by the clinic, 13 people did not.

Of the appointments attended face to face via car/taxi (57):

• • Average of 4.4 miles travel to the clinic (8.8 miles total journey)

• • Shortest journey 1.1 miles (2.2 miles total journey)

• • Longest journey 16 miles (32 miles total journey)

• • Total patient mileage for these appointments (assuming travel to and from clinic) 855.8 miles

• • Average journey 0.005t CO2

• • Total journeys 0.472t CO2

• • Assuming average sized petrol car used

• • Extrapolating this data for a whole year approximately: 8.024t CO2 from patient journeys to and from the ADHD clinic

We have made a case for e-prescribing within the ADHD clinic in Wrexham Maelor Hospital.

The current system impacts on:

• • Patient and carer's travel time and convenience.

• • Clinician's travel time.

• • Carbon emissions.

Accurately and comprehensively assessing physical health risk for people with intellectual disability (ID) is paramount in improving health outcomes, reducing the need for acute hospital admissions and preventing mortality. We aimed to compare the existing approach to assessing physical health risk with the use of a novel standardised risk stratification tool, the Decision Support Tool for Physical Health [DST-PH]. We hypothesise that DST-PH will be useful in improving and streamlining the assessment of physical health risk factors in people with ID.

People with ID are more likely to have poorer physical health outcomes and are at increased risk of premature and preventable death. Annual data from LeDeR (Learning from lives and deaths – People with a learning disability and autistic people) consistently underlines the need for developing strategies that reduce the risk of people with ID developing conditions associated with high causes of morbidity and mortality.

The DST-PH is an online tool that helps clinicians to identify people with ID who are at increased risk of early and preventable death. The tool captures key patient data about underlying health issues and risk factors that can contribute to poor health outcomes. Patients are then stratified according to their overall level of risk using a ‘RAG’ (red, green, amber) system. This allows targeted intervention and monitoring for those patients in need.

All patient-facing staff in the Wandsworth Learning Disability Service were surveyed about their confidence levels in assessing physical health risk factors independently. We then asked each member of staff to assess physical health risk and assign a RAG rating for 2 randomly selected patients using their usual methods (clinical judgement). We then assessed the same patients using the DST-PH tool. Results were then compared to determine the degree of correlation between clinicians' existing risk assessment methods and the risk ratings assigned using the DST-PH.

Survey results showed that staff would welcome the introduction of a risk stratification tool. Comparison of risk assessment data showed a significant correlation between clinicians’ assessment and the results from the tool.

Results evidenced the drive for ID clinicians to be observant of the physical health care needs of their patients. Introduction of the DST-PH may help to streamline the risk assessment process and increase confidence levels of clinicians.

Helplines and crisis lines are a standard component of a public health approach which appear to be intuitively supportive and useful to a population in acute distress and prevent severely adverse outcomes i.e., suicide. These services exist in different formats throughout the world. They have the advantage of being widely accessible, approachable, and bypass the waiting times and bureaucracies of referral systems for accessing secondary mental health services. The authors set out to study the range of outcomes used to evaluate mental health helplines and crisis lines. The focus was not simply to explore whether mental health helplines were effective or not. Rather the authors wanted to investigate what outcomes were being considered as evidence.

The authors aimed to conduct a systematic review of evidence for mental health outcomes of service users of helplines and crisis lines.

The research question was, ‘What outcomes are evidenced in published literature for mental health helplines and/or crisis lines in terms of efficacy, effectiveness or efficiency?’

This was a systematic review of literature using the PRISMA-2020 statement. Literature searches of Web of Science, Ovid (PsycINFO, Medline, EMBASE), PubMed and Scopus were conducted in December 2022. Relevant information from eligible studies was extracted by using a structured data extraction form. Mixed Methods Appraisal Tool (MMAT) was used to assess quality of the included studies. While the heterogeneity of studies prevented a meta-analysis, it provided a rich landscape for exploring the topic through a thematic analysis.

Eighteen studies finally met the inclusion and exclusion criteria. The projects studied used both trained professionals and volunteers trained to offer crisis intervention. Both qualitative and quantitative outcomes were evaluated across the studies. Outcomes were frequently subjective assessments of service users and/or the personnel delivering the intervention. Studies evaluated outcomes in various ways. Anonymity of the callers made long-term follow-up difficult in most cases, though it is understandable that anonymity might have contributed to the helpline being more accessible and less intimidating to the callers. MMAT scores showed the papers have a range of methodological soundness.

There is lack of consensus and uniformity regarding what outcomes can evidence the efficacy, efficiency, and effectiveness of mental health helplines. Before more investment in helplines, there needs to be discussion, planning and understanding among policy makers and service developers in deciding what they want to achieve from a mental health helpline. This will help researchers focus on relevant outcomes to evaluate mental health helplines. Services need clarity regarding what difference they are trying to make when such helplines are set up.