To develop and evaluate a tailored teaching session for local non-medical primary care staff on common CAMHS (Child and Adolescent Mental Health) conditions. It was hypothesised that quizzes administered before and after the educational session would evidence an improvement in clinician's knowledge of these clinical presentations.

Invitations were extended to all local PCNs to attend educational sessions held on four separate occasions in December 2022 and January 2023. Multiple choice quizzes were administered before and after a presentation on four common CAMHS conditions. The presentation and quizzes covered the presentation, diagnosis, and management of autism, eating disorders, depression and emotional dysregulation. Quizzes were scored out of a maximum 16 points with four questions per clinical condition. A paired T-test (following tests for normal variance) was performed using JASP software to compare the before and after scores.

A total of 22 non-medical clinical staff attended the sessions. This included physician associates (n = 1), allied health professionals (n = 5), practice nurse (n = 3), care coordinator (n = 3), health care assistant (n = 4), social prescriber (n = 1), mental health practitioner (n = 3), advanced clinical practitioner (n = 1) and advanced nurse practitioner (n = 1). For the 22 pairs of quizzes, mean differences and 95% confidence intervals (CIs) were calculated between before-and-after scores. The mean difference between total score was 6.9 CI [6.1, 7.7] which was statistically significant (p < 0.001).

More than 31,000 additional staff have been recruited into healthcare roles at general practices across the country since 2019 to meet soaring demand for primary care services. Since the pandemic record numbers of children and adolescents are presenting with mental health difficulties, therefore, it is likely that primary care clinicians will encounter these presentations in their practice. Our results suggest that such a tailored approach can offer effective means in improving knowledge in this growing group of professionals. Such sessions may also provide informal spaces in which to network with secondary mental health professionals, improving links between services.

Delirium poses a significant risk in hospitals, with a prevalence of 20–30%. Queen Elizabeth Hospital conducted an audit focusing on delirium cases referred to the Greenwich Mental Health Liaison Team for Older Adults (GMHLT OA) between January and April 2023.

The audit aimed to assess immediate and medium-term outcomes, identify improvement areas, and propose strategies for optimizing delirium treatment within GMHLT OA.

Patient referrals received by OAMHLT are meticulously recorded in a logbook. Among the referrals, 39 patients from the target population were identified through a manual review of the documentation. To augment the data collection process, electronic databases were also reviewed to ensure comprehensive data retrieval.

Key Findings:

39 cases audited, predominantly females (62%).

Most affected age group: 71–80 years.

Infective causes (49%) and low mood (30%) were common.

Antipsychotic treatment administered in 56% of cases.

36% required institutionalization post-discharge.

The audit underscores the complexity of delirium care, aligning with epidemiological data. It provides a foundation for targeted improvements to enhance patient outcomes within GMHLT OA. Based on the results the following recommendations and action plan were made:

Implement multifaceted interventions and non-pharmacological approaches.

Strengthen collaboration between departments for diverse referral sources.

Explore regional resource allocation and establishment of care pathways based on local implications.

It is estimated that approximately 15% of adults over 60 years old suffer from a mental disorder. Self-harm and suicidal ideation are associated with a range of mental disorders, and high rates of suicide. The aim of this project is to identify the characteristics of older people who present with self-harm and suicidal ideation to an emergency department (ED) in a university hospital. In examining the variables associated with self-harm we may be better able to identify the characteristics of older adults who are at highest risk.

We conducted a cohort study of older adults (aged 65 years+) who presented to the Mater Misericordiae University Hospital with a mental health problem from 2008–2022 (a 15-year cohort). Data were extracted from the Electronic Patient Records including all patients who presented to the ED in that time period with a mental health triage code. We examined this cohort to collect detailed information on the characteristics of those older people presenting with self-harm and suicidal ideation.

We identified 30,941 ED attendances with a mental health triage code between 2008 and 2022. Of these, 946 (3.1%) were older adults. One-fifth (20%) presented with self-harm, a further 21% reported suicidal ideation. Of these, 8% reported previous self-harm and 32% had previously been reviewed by psychiatry. Over one-third (38%) were admitted. Of those, the majority (78%) were admitted to a medical or surgical ward, 16% to a psychiatric ward and 5% to critical care.

Of those presenting with self-harm 37% were admitted to hospital – 32% to a medical or other ward and 5% to psychiatric unit. There was a significant difference in those who were admitted with self-harm versus suicidal ideation (p < 0.001).

Our results demonstrate key insights into older adults who presented to the ED with self-harm and suicidal ideation. These patients were more likely to be admitted to a medical ward than a psychiatric unit, and those with self-harm were more likely to be admitted medically compared with those with suicidal ideation.

Possible reasons for these results include the higher rate of medical co-morbidity in older adults and the potential high lethality of self-harm in this cohort. Another explanation could be the scarcity of acute psychiatric beds necessitating medical admission. There is a need for further exploration of this high-risk population.

We aim to systematically document our reflections regarding the establishment of a perinatal-focused Compassion Focused Therapy (CFT) group within an expanding service. It aims to highlight specific outcomes and client experiences resulting from group completion.

Synthesizing information from established CFT Group protocols across various National Health Service (NHS) contexts, scholarly investigations, and our CFT training, this study instituted a 10-week perinatal-CFT group intervention. Recruitment targeted individuals already engaged in our services, resulting in the referral and screening of eleven potential participants. Nine eligible individuals provided informed consent, with seven successfully completing the program. Assessments, including the Clinical Outcomes in Routine Evaluation (CORE-10), Postpartum Bonding Questionnaire (PBQ), The Forms of Self-criticizing/Attacking & Self-reassuring Scale (FSCRS), and Maternal Antenatal Attachment Scale (MAAS), were administered pre- and post-group. Quantitative findings were analysed and compared, supplemented by qualitative insights distilled from thematic analyses of feedback forms and post-group reviews with each participant.

Though we had a small number of participants (n = 4) who completed the pre and post measures and the post group review, we received overall positive feedback for the group intervention. During the post group review and from their feedback forms, participants expressed the value of the group experience and found the discussions and exploration of CFT concepts to be helpful in reflecting on their self-critical thoughts.

On the Core-10, there was a reliable and clinically significant change for 75% of participants. Two participants completed the PBQ, and both showed a reliable but not clinically significant change in scores. We had one antenatal client who showed a reliable but not clinically significant change on the MAAS.

The FSCRS comprises three scales: Inadequate Self (IS), Reassured Self (RS), and Hated Self (HS). On the IS subscale, a reliable and clinically significant change was observed for 75% of participants. The HS subscale showed a reliable change but lacked clinical significance for 50% of participants. No reliable change was observed in the RS scale for any participant.

While the study's results are not generalizable due to the small sample size, positive feedback suggests the well-received nature of online perinatal CFT groups. Despite a preliminary evidence base, this paper contributes reflections and experiences, highlighting the potential effectiveness of online CFT groups in the perinatal period. These findings underscore the need for further research and exploration in this promising therapeutic approach.

Evidence supports associations between polyunsaturated fatty acids (PUFAs) such as docosahexaenoic acid (DHA) and psychosis risk. However, longitudinal PUFA trajectories in the general population have not been characterised. The aims of this study were: 1) To describe longitudinal trajectories of plasma omega-6:omega-3 ratio and DHA levels in a large general population sample; and 2) To evaluate associations between these trajectories and psychosis-spectrum outcomes in early adulthood. Based on previous research, we hypothesised that trajectories characterised by higher omega-6:omega-3 ratio and lower DHA levels would be associated with increased odds of psychosis-spectrum outcomes.

We examined a large cohort in the Avon Longitudinal Study of Parents and Children (n = 3635, 2247 [61.8%] female). Plasma omega-6:omega-3 ratio and DHA % total fatty acids were measured by nuclear magnetic spectroscopy at 7, 15, 17 and 24 years, then standardised by sex. Trajectories were evaluated using curvilinear growth mixture modelling, contemporaneously adjusting for body mass index. Psychosis-spectrum outcomes were assessed at 24 years. Psychotic experiences (PEs), At-Risk-ental-State status, psychotic disorder and number of PEs were measured using the Psychosis-Like Symptoms interview. Negative symptoms score was measured using the Community Assessment of Psychic Experiences. Associations were evaluated using logistic, negative binomial or linear regression as appropriate, adjusting for sex, ethnicity, parental social class, smoking and alcohol use. Multiple imputation was used to impute missing exposure and covariate data across ten imputed datasets.

A three-trajectory solution was optimal for both omega-6:omega-3 ratio and DHA. Relative to stable average, persistently high omega-6:omega-3 ratio and persistently low DHA trajectories were associated with increased odds of PEs and psychotic disorder, with these associations explained by included covariates. In fully adjusted analyses, the persistently high omega-6:omega-3 ratio trajectory was associated with number of PEs (adjusted β 0.41, 95% confidence interval [CI] 0.05–0.78) and negative symptoms score (adjusted β 0.43, 95%CI 0.14–0.72), as was the persistently low DHA trajectory (number of PEs: adjusted β 0.45, 95%CI 0.14–0.76; negative symptoms: adjusted β 0.35, 95%CI 0.12–0.58).

In this first description of plasma PUFA trajectories in a large general population cohort, trajectories characterised by persistently high plasma omega-6:omega-3 ratio and persistently low plasma DHA levels were associated with psychosis-spectrum outcomes in early adulthood. In the case of number of PEs and negative symptoms, these associations were not fully explained by included covariates. Optimisation of PUFA status during development warrants further investigation as a malleable protective factor in relation to specific psychosis symptom domains in early adulthood.

Non epileptic attacks (also referred to as psychogenic non-epileptic seizures, functional seizures or dissociative seizures) are similar in appearance to epileptic seizures but are not accompanied by ictal electroencephalographic (EEG) discharges. NEAD is classified as either a conversion or dissociative disorder in DSM-V and ICD11 respectively, and is often associated with significant long-term disability. People with NEAD often access care across many different specialties and healthcare settings. Their experiences of doing so are frequently negative, based both on interactions with clinicians and integration of care.

The aims of this study were to review the existing literature on the attitudes of clinicians towards non-epileptic attack disorder (NEAD), and any differences that exist between professional groups.

The study followed PRISMA 2020 guidelines and was registered on the international prospective register of systematic reviews (PROSPERO). Three electronic databases (MEDLINE, EMBASE and PsycInfo) were searched for studies of clinician attitudes towards NEAD using pre-developed terms. These terms were optimised following familiarisation with the literature. Specific inclusion and exclusion criteria were applied, and studies were selected if they included data regarding the attitudes of healthcare professionals from any group towards NEAD. A data extraction template was used to synthesise study characteristics and outcomes. The Mixed Methods Appraisal Tool was used to appraise methodological quality of the included studies. Two reviewers independently completed the selection process and data extraction.

The search strategy yielded 2885 citations, of which 76 were selected for review of the full publication based on the title and abstract. Inclusion/exclusion criteria were applied to full texts. The literature mainly included clinicians from general practice, neurology, emergency department and psychiatry. There was general negative stereotyping of people with NEAD and a lack of confidence in management. Attitudes differed between professions, particularly with respect to aetiology.

The literature highlighted that many clinicians held a negative attitude towards people with NEAD, and there was evidence of a general lack in confidence towards NEAD across all healthcare professional groups. There was a difference between healthcare professional groups, mostly related to views on aetiology. The review highlights the need for greater education related to NEAD with a focus on understanding aetiology and greater transparency in interdisciplinary working.

Undergraduate Psychiatry placements often struggle to provide the bedside teaching familiar to students from other specialties. Efforts to reproduce this experience in tutorials can be impaired by lack of interactivity, high student-to-teacher ratio, and use of mostly didactic pedagogy. Psychiatry trainees have provided weekly tutorials in ‘Clinical Skills' to University of Glasgow students on Psychiatric placement for several years. Unfortunately, these tutorials suffered from poor attendance, poor engagement, and difficulty recruiting facilitators. We created an afternoon of teaching structured around three presentations of a fictional patient in a narrative fashion aimed at solving these issues and providing excellent experience for students.

Together with Glasgow University tutors, we selected Learning Objectives that would benefit from additional formal teaching. We then created a fictionalised patient narrative incorporating presentations of self-harm, delirium and postnatal depression. Teaching materials were created using mentimeter.com to allow for maximal engagement and interactivity. The content included brief summary slides, groupwork, Word-Clouds, anonymous quizzes, and simulated clinical encounters/roleplay. Custom illustrated vignettes accompanied each scenario to increase verisimilitude. The day is delivered by three Psychiatry trainees to up to forty students in their penultimate week of placement. Feedback is gathered digitally and anonymously on the day.

77/80 students invited attended. 71 (92%) completed feedback: 100% ranked the day positively - either “very helpful” (85.9%) or “somewhat helpful” (14.1%). Students advised it was “extremely useful” preparation for both clinical placements (73.2%) and exams (88.7%). All attendees provided free-text remarks; quotes include “One of the best teaching days I've been to” and “Best teaching of the block”. 84.5% felt “very involved” in the day and the word “interactive” was used 30 times in freetext. When asked on what could be improved, the most common response was “another session” (34%).

Recruitment to Psychiatry relies on positive experiences during placement. Retention of Psychiatrists relies on providing rewarding and varied working experiences. Our hope is that successful events like this support both aims. The creative use of narrative, illustrated vignettes, roleplay and interactive questions afforded excellent engagement and enjoyable experiences for student and facilitator, as reflected in the feedback.

Going forward, we plan to refine this case and develop another. We are seeking review and design input from patient representatives and EDI experts. Comparison of students' exam outcomes and feedback from the replaced tutorials is also planned. Use of this format across other specialties is also being pursued.

A significantly higher prevalence of neurological conditions has been found both before and after a diagnosis of schizophrenia, bipolar disorder and other psychotic illnesses compared with the general population.

We aimed to understand the cumulative prevalence of 16 neurological conditions in people with severe mental illness (SMI) from 5 years before to 5 years after their SMI diagnosis. We hypothesised that individual neurological conditions would have differential temporal relationships relative to SMI diagnosis.

In a longitudinal matched study, we identified a cohort of patients aged 18–100 years from Jan 1, 2000, and Dec 31, 2018, from the UK Clinical Practice Research Datalink (CPRD). Neurological conditions were classified using ICD–11 criteria into umbrella clusters of disease. Outcome of interest was a diagnosis of SMI. Each SMI patient was matched 1:4 to patients without SMI in the CPRD cohort, matching for sex, 5-year age band, primary care practice and year of practice registration. The cumulative prevalence of 16 neurological conditions was recorded cross-sectionally at 5, 3, 1 years prior to SMI diagnosis, at SMI diagnosis (index), and 1, 3 and 5 years after SMI diagnosis. Logistic regression modelling aided comparison of differential prevalence of neurological conditions, adjusting for sociodemographic variables, and with further adjustment for body mass index, smoking, alcohol and non-prescription drug use. Multiple imputation was applied in cases of missing data.

We identified 68,789 patients with SMI, matched to 274,827 controls. The median age was 40.9 years, 49.05% of the overall cohort were female (33,783 SMI patients, 134,740 controls), and the majority were of White ethnicity (35,228, 51.2% SMI patients, 125,518, 45.7% controls). The most prevalent neurological conditions across seven timepoints were cerebral palsy, cerebrovascular disease, dementia, epilepsy, multiple sclerosis, paralysis and Parkinson's disease. Conditions with the highest fully adjusted odds ratios (ORs) for SMI diagnosis were dementia 3 years after SMI diagnosis (5.32, 95% CI 4.95–5.71) and Parkinson's disease 5 years after SMI diagnosis (4.26, 95% CI 3.68–4.94).

All 16 neurological conditions have higher prevalence in the SMI cohort compared with controls, with different prevalence patterns observed over the 10-year study period. A consistently lower OR for schizophrenia compared with other SMI warrants further exploration, as neurological conditions risk being under-recorded.

A greater understanding of the temporal relationship between SMI and neurological conditions may help promote earlier diagnosis, increased screening and better holistic management of both conditions.

The intensive psychiatric care unit (IPCU) is a 10-bedded unit which houses some of the most unwell psychiatric inpatients, generally those with psychosis and mania who require enhanced care and restriction. Admissions can be long and involve high levels of clinical complexity. This project identified the need for clear communication at the point of discharge with regards to rationale for decision making, mental health act status, risk and outstanding issues. The aim was to develop and test a tool for communicating this: the step-down summary.

Three plan, do, study, act cycles were run. The first involved creating a draft proforma and testing this with 3 complex patients, gathering qualitative feedback from receiving clinicians. The proforma was then improved and a full-scale trial including all patients with stays of 2 weeks or more was conducted, a total of 18 patients. Data were collated on the timing of summary completion and further improvements to the proforma were made based on consultant feedback. Finally, a third cycle was run to establish whether the new process was sustainable between rotating trainees.

Initial feedback was positive with clinicians highlighting that the summaries saved time reading extensive notes, clearly identified outstanding tasks, and helped with final discharge document writing. It became clear that there was a need to agree a cut-off time of how long a patient should be in IPCU to merit a stepdown summary. Of the 18 patients who met this cut-off in the 2nd cycle all had a stepdown summary at the point of transfer with 89% of these fully complete before their next clinical review. During the 3rd cycle, there were 19 relevant patients only one of whom did not have a summary, due to their transfer coinciding with trainee leave. Feedback remained positive, highlighting that the summaries avoided duplication of work.

Overall, the use of stepdown summaries proved useful to receiving clinicians in both communicating important information and in saving further time when later creating final discharge documents. It was sustainable between trainees, however there remained an issue with these not being produced during trainee leave. It may be useful to consider alternate clinicians who can support with the production of summaries to minimise this as well as measuring more clear clinical outcomes, such as the repetition of investigations. This would support an expansion to other UK IPCUs.

The 2024 National Student Psychiatry Conference, hosted at the University of Sheffield with the theme 'Me, Myself and I,' explored the intersection of the ‘self' and the ‘other.' It delved into the dynamics of individuals in the context of their lived experiences, environment, and emerging paradigms within psychiatry and beyond. Talks and workshops aimed to heighten attendees’ interest in psychiatry by challenging societal stigma and traditional norms and expanding their perspectives of psychiatry.

The pre-conference questionnaire included attendees’ year of study, university/NHS trust affiliation, current likelihood of pursuing psychiatry and career aspirations, knowledge of conference themes, and ten subspecialties represented at the conference via a faculty carousel. The post-conference questionnaire enquired about changes to the above aforementioned factors, to explore changes in career aspirations. Standardized dropdown options were used in both forms to facilitate data evaluation.

71 attendees were included in the final evaluation; 17 were excluded due to duplication or not completing both forms. Of the attendees, 31% were in their pre-clinical years, 56% were in their clinical years, and 4% were doctors. 9% of the participants were non-medical attendees.

Demographics of attendees included a majority from Yorkshire and Humber (52%), Midlands (11%), South England (6%), North England (10%), North East (8%) and Others (13%).

21% of attendees had been to a prior psychiatry-related conference and 34% were currently taking part in or had completed a psychiatry-related project in the past.

The level of interest in attendees aspiring to pursue psychiatry increased from 62% to 72%. An increased interest in medical psychotherapy (82%), forensic psychiatry (68%), and perinatal psychiatry (67%) after the faculty carousel was observed.

Following the conference, 97% reported increased knowledge of each theme. Findings from the faculty carousel revealed that, on average, over 90% of attendees reported an increased understanding of each speciality represented.

The National Student Psychiatry Conference plays a significant role in increasing exposure of psychiatry to medical students and increasing their understanding of the diverse career paths within the speciality. The conference fosters networking opportunities and facilitates meaningful connections within the field, positively influencing attendees' considerations and perceptions.

Psychogenic polydipsia (PP) is a term used to describe a repetitive behaviour that characterises compulsivity in psychiatric patients resulting in excessive fluid consumption. It is a common clinical problem in patients with severe mental illness, learning disability, autism and acquired brain injury. Up to 20% of patients with schizophrenia have polydipsia, and many develop hyponatraemia and water intoxication, which can lead to irreversible brain damage or death.

Psychogenic polydipsia may not be obvious to staff in a busy care setting, leading to delayed identification and appropriate care.

The objective of this study is to assess the existing knowledge of psychogenic polydipsia among mental health staff and promote greater awareness of the condition.

To investigate the understanding of psychogenic polydipsia among healthcare staff, an online survey has been chosen as the research method. This survey will help identify any knowledge deficiencies in this area. It consists of both closed and open-ended questions, allowing for quantitative and qualitative analysis. The open-ended questions are designed to provide an opportunity for participants to share their individual experiences. Additionally, the survey will collect information on participants' age groups, years of experience in mental health services, and level of expertise. The survey was created using Qualtrics online survey software. Participant recruitment will be conducted at St Matthews Healthcare, with an estimated sample size of n = 101. The collected data will be analysed using statistical software such as SPSS, NVivo, or other appropriate tools.

The results of this study will be presented. Data are being collected and analysis will be completed in March. The abstract will be updated. These findings will serve as the basis for future recommendations and suggestions.

Comprehending patients' illnesses is a crucial aspect of providing quality healthcare. However, identifying psychogenic polydipsia has proven to be challenging within mental health settings. Failure to recognize excessive fluid intake can result in ineffective treatment, exacerbation of psychiatric symptoms, and in severe cases, coma or even death. The findings of this study have the potential to contribute to the creation of a training program for healthcare providers. Such a program would enable the development of improved care plans for patients who engage in excessive fluid consumption and are at risk of developing hyponatremia and water intoxication.

The primary aim of this rapid review was to evaluate the evidence base for the efficacy of ketamine across all formulations and routes of administrations in the treatment of adult patients with treatment resistant depression (TRD).

This rapid review retrieved controlled trials on use of ketamine across all of its formulations, including all isomers and across all routes of administration in TRD patients for achieving response and remission. This review included PubMed and PsycINFO databases. The retrieved studies were screened with the help of a screening tool and data were extracted by using data extraction forms by two authors. The studies were evaluated for quality of evidence, ethical issues and critically analyzed. Narrative synthesis was used for data synthesis.

This review retrieved 10 placebo controlled randomized controlled trials (RCT) on intravenous (IV) ketamine, IV esketamine, intranasal (IN) ketamine and IN esketamine in TRD patients. IV ketamine and esketamine showed higher rates of remission and response in comparison with placebo groups in TRD patients. There was no significant improvement in response and remission rates in TRD patients on IN esketamine in comparison with placebo. The adverse effects in the intervention groups were of mild to moderate severity and short lasting mostly resolving within a day.

This review recommends IV ketamine and esketamine can help in achieving early response and remission in TRD patients and it seems to be a well-tolerated treatment option. Further studies are needed to assess these issues around safety, ease of administration and potential for dependence.

NEWS 2 is integral to post-admission physical health monitoring, guiding baseline establishment and observation frequency decisions. MDT discussions, involving medics or nurses per guidelines, ensure tailored care. Trust Standard Operating Procedure (SOP) and Physical Health policy, provides detailed procedures for assessment, recording, and actions. Adhering to NEWS 2 and SOP 1.62a, aligned with Trust standards, facilitates prompt escalation in case of patient deterioration, reinforcing our commitment to superior healthcare.

AIM

• • To evaluate if NEWS2 monitoring is done as per set Trust standards/guidelines.

• • To identify areas of improvement in the use of this observational tool.

• • To improve the services and care of patients.

We conducted a comprehensive review of each section of NEWS 2 charts for 39 patients admitted to Ward 6 and 7 at Harplands Hospital over a 3-week period. Patient stays varied from 21 to 67 days. No pregnancies were noted; all patients were aged between 59–96, with a near equal gender distribution. Utilizing SPSS, we conducted data analysis, comparing results against Trust-set standards.

Of the 39 charts, 37 were completed at admission, with notable issues: 9 lacked demographics, 13 had date/time missing. Weekly NEWS was predominant, but challenges included 6 missing signatures, 9 illegible entries, and 12 incomplete sections (4 without connecting observations). GCS completion issues were identified in two charts if CPVS score was more than 3. Escalation patterns varied: scores 1–4 were often routed to a Registered Nurse before medics, while scores >4 were mainly escalated directly to medics. Most charts were uploaded to electronic records, yet the electronic versions were frequently left unfilled.

In conclusion, the implementation of NEWS charts at admission, consistent chart uploads to Lorenzo, and effective escalation practices underscore a commitment to patient monitoring. The detailed procedures, including demographics completion, trend identification, and weekly reviews, contribute to a comprehensive approach. The incorporation of printed patient information labels and targeted education sessions for ward teams further reinforces the emphasis on standardized and meticulous documentation practices, enhancing overall patient care and safety. Discussions with ward management will further support the ongoing success of these initiatives.

Above recommendation has been completed and Re-Audit in planned few months.

The Royal College of Psychiatrists (RCPsych) introduced the new psychiatry training curriculum in February 2022. Since then there have been various updates in both the e-portfolio platform and curriculum requirements.

A survey was undertaken to understand issues experienced in navigating these changes by psychiatry trainees and supervisors within the Black Country Healthcare NHS Foundation Trust (BCHFT), specifically assessing the generation of Placement Specific Personal Development Plans (PSPDPs) for each training placement.

The aim of this study was to survey user experience and reflect on the results to identify how best to support trainees and supervisors in using PSPDPs, a key curriculum requirement, with greater ease and confidence.

The survey comprised tailored questionnaires distributed to two cohorts- trainees (30) and supervisors (37) within the BCHFT. Anonymised responses were collected over one month. Likert scales were used to determine (a) confidence levels in setting up PSPDPs, (b) confidence in mapping activities to both PSPDPs and the curriculum, and (c) user-friendliness of RCPsych guidelines on this topic. Checklists and free-text responses were used to assess which support resources were being utilised by both groups. Suggestions were requested on how the whole process could be improved.

Amongst trainees (response rate 63%), 78% did not feel confident in setting up PSPDPs. 94.7% sought additional support in PSPDP setup, of which peer support was the most utilised (77.8%). Other resources included the RCPsych website and emails as well as supervisors. 58% of trainees lacked confidence in linking activities to PSPDPs and the curriculum. Only 10.5% of the trainees found the RCPsych Implementation Hub user friendly.

In the supervisor cohort (40% response rate), 64% of the trainers felt confident in guiding their trainees in setting up PSPDPs. 85% utilised support from various sources including the Implementation Hub (91.7%), trainees (58.3%) and peers (50%). 64.2% of supervisors found the RCPsych website user friendly.

Common themes that emerged were that both trainees and supervisors felt the process of setting up PSPDPs was quite complex, with a confusing web interface. Resources on the RCPsych website required better signposting. Both cohorts felt they would like additional training e.g. step by step videos and training sessions (local peer trainee and supervisor run sessions were found useful).

This feedback has identified the importance of arranging local training sessions to improve engagement. Additionally, we hope that relaying this feedback to RCPsych may influence future systemic changes.

This study aimed to analyse contributory factors to serious incidents (SIs) involving adult patients with intellectual disabilities receiving NHS care in a mental health trust. People with intellectual disabilities face considerable preventable harm and disparities in care. In-depth analysis of contributory factors to incidents involving adults with an intellectual disability, using human-factors based frameworks is lacking. Individual SI reports contain useful data, but learning is often limited without aggregated analysis.

Thirty anonymized serious incident reports (2014–2023) from an NHS mental health Trust's intellectual disability service were analysed qualitatively using the Yorkshire Contributory Factors Framework, followed by reflexive thematic analysis (RTA) to identify patterns across the data. This enabled nuanced themes to emerge across errors at the sharp end and systems-level factors at the blunt-end.

Across 30 reports, 606 discrete factors were identified. Situational factors such as behavioural escalations and staff competency gaps were most frequent (n = 187, 31%). Other factors included active failures, such as slips, lapses, mistakes, violations (n = 109, 18%), organisational influences (n = 107, 18%), communication breakdowns (n = 75, 12%), unfavourable working conditions (n = 62, 10%), cultural factors such as reluctance to voice safety concerns (n = 51, 8%), and external system factors (n = 15, 2%).

Using RTA, we identified recurring themes across incidents involving interactions between sharp-end human and blunt-end system factors, with broader issues shaping frontline performance. Patient marginalisation, excessive workloads, lack of resources, and cultures tolerant of shortcuts aligned to permit errors. Deficient coordination across fragmented healthcare systems and overdependence on non-permanent workers and bank staff obstructed comprehensive incident reviews. Failure to adequately probe cultural influences and external pressures further reflect the limited extent of investigational efforts.

Adults with intellectual disabilities are subject to serious incidents caused by interacting human and system-level factors, including organisational, cultural and external factors. Addressing under-resourcing and improving investigation quality are paramount to enhancing safety of care for people with intellectual disabilities.

Sleep problems are common in opioid users and in patients receiving opioid agonist treatment. The aim of the present study was to study the pattern and prevalence of subjective sleep disturbances in opioid dependent subjects maintained on opioid agonist treatment (buprenorphine and methadone).

Methods: A cross-sectional observational study was conducted in a tertiary health care center in India. 106 adult opioid dependent male patients maintained on buprenorphine and 50 adult opioid dependent male patients maintained on methadone who were initiated on medication at least six months prior, on stable dose of medication for last one month and were adherent on medication for at least 50% occasions in last one month were included in the study.

The mean age of the sample for buprenorphine-maintained group and methadone maintained group was 41.1 (SD: 14.3) years and 27.7 (SD: 7.8) years respectively. Tobacco, alcohol and cannabis were used by majority of the participants in both the groups. Most participants had used heroin by smoking before starting buprenorphine (n = 68, 64.1%) and methadone (n = 46, 88.5 %). The duration of use of illicit opioids was for median duration of 10 (IQR: 5, 22) years for buprenorphine group and 5 (IQR: 3, 7) years for methadone group.

In buprenorphine group, the participants had been on buprenorphine for a median duration of sixty (IQR: 17, 120) months. The mean current dose of buprenorphine was 10.2 (SD 3.8) milligram per day. The mean PSQI score was 6.6 (SD 3.4). About 63.2% (n = 67) of the participants have scores more than five (PSQI > 5) suggesting sleep problems. The mean subjective total sleep time of the sample was 403.5 (SD 94.8) minutes and median sleep latency was 35 (IQR 18.8, 62.5) minutes.

Similarly, in methadone group, the participants had been on methadone for a median duration of seventeen (IQR: 10, 22) months. The median current dose of methadone was 20 (IQR: 14, 36) milligrams per day. The mean PSQI score was 5.2 (SD 2.8). About 44.2% (n = 23) of the participants have scores more than five (PSQI > 5) suggesting sleep problems. The mean subjective total sleep time of the sample was 466.5 (SD 114) minutes and median sleep latency was 30 (IQR 15, 97.5) minutes. Subjective sleep problems were associated with past three months opioid use.

The methadone group had relatively younger population with early onset of substance use. They were on relatively lesser dose of methadone. This group also had lesser sleep problems than the buprenorphine group.