Irritability is common and easily identified in childhood. It is transdiagnostic and a common reason for referral to mental health services. Irritability which does not decrease during early childhood is associated with adolescent depression. We hypothesised that irritability would be associated with increased risk-taking overall but reduced risk-taking in response to loss.

We used data from the Millennium Cohort Study, a population-based cohort of 18,552 children born in 2000–02. We examined whether irritability at 3, 5 and 7 years is associated with risk-taking on the CGT using multilevel mixed effect generalised linear models (MEGLMs). We also calculated the change in irritability between 3–7 years for each participant using multilevel mixed models. We then examined the association between this change measure and risk-taking on the CGT using MEGLMs. Analyses were adjusted for a broad range of confounders.

We found that children whose irritability did not decrease as would be expected from 3 to 7 years were more likely to stake a higher number of points per trial on the CGT at 11 years. This increase was most evident when the previous trial had been won. Irritability at 7 years was associated with staking a higher number of points per trial on the CGT (coefficient 0.52, 95%CI −0.04–1.08, p = 0.067) in fully adjusted model, whereas irritability at 3 and 5 years were not (3 years – coefficient 0.02, 95%CI -0.62–0.65, p = 0.961; 5 years – coefficient 0.14, 95%CI −0.45–0.73, p = 0.641). There was evidence of an interaction between irritability at seven years and whether the previous trial was won (p = 0.014). Childhood irritability which did not decrease between 3–7 years was associated with staking a higher number of points per trial on the CGT (coefficient 1.36, 95%CI 0.44–2.28, p = 0.004); there was evidence of an interaction between change in irritability and whether the previous trial was won (p = 0.056).

This is the first longitudinal population-based study examining the relationship between changes in irritability during early childhood and risk-taking behaviour measured by the CGT. Our findings illustrate that irritability in children is characterised by an increase in risk-taking at age 11 years, reflecting differences in how children behave in relation to rewards and losses based on prior irritability. Further understanding of how the processes such as risk-taking which link childhood phenotypes such as irritability, relate to future mental health, may enable the development of new interventions focussing on reactions to rewards and losses.

To measure the proportion of Attention Deficit Hyperactivity Disorder (ADHD) referrals that result in a positive diagnosis and medication prescription at a community mental health team (CMHT) in Cardiff.

To compare patient journeys from referral to diagnosis – documenting the use of GP mental health liaison, private psychiatrists, questionnaires and CMHT appointments.

To measure the proportion of patients with a pre-existing private diagnosis of ADHD that subsequently received a positive diagnosis by the CMHT.

230 referrals were made to Pendine CMHT in 2022 for consideration of ADHD. Patient e-records were manually reviewed over a 12-month period following initial referral.

We recorded whether a patient had a pre-existing private diagnosis and whether they were subsequently diagnosed with ADHD by the CMHT. It was also recorded if medication was prescribed or if an alternative diagnosis was suggested.

We recorded whether the patient was asked to see GP mental health liaison team, fulfil an ADHD questionnaire, or attend a doctor appointment before a diagnosis of ADHD was made or refuted.

For positive diagnoses, patient records were reviewed to record whether this diagnosis was later changed on subsequent appointments.

Of 230 referrals, 32 received a CMHT diagnosis of ADHD (14%) and 25 were prescribed medication for ADHD (11%).

Of the 25 patients who received a positive diagnosis and medication, 4 had the diagnosis changed on a subsequent appointment and medication stopped.

21 patients had a pre-existing private sector diagnosis of ADHD, of which 9 (43%) were given a positive diagnosis by CMHT and 8 (38%) were prescribed medication.

Of 230 total referrals, 33 were asked to see their GP mental health liaison team for information gathering before re-referral to the CMHT. 112 were asked to complete a questionnaire before an appointment would be considered. 87 were given a consultant psychiatrist appointment at CMHT.

When ADHD was not diagnosed, the most common alternative diagnoses suggested by the CMHT were anxiety, substance misuse or emotional dysregulation (36, 23 and 9 patients respectively).

Referrals to the CMHT for ADHD assessment result in a low rate of positive diagnosis and even lower rates of medication prescription, even for those with an existing private diagnosis.

Patient journeys vary markedly, which we propose reflects the variable quality of referrals and pressure on the CMHT to protect clinic time.

Future work to create ADHD referral guidance is needed to ensure better patient experience and proper utilisation of secondary mental health resource.

Clozapine is the most effective antipsychotic medication for patients with treatment-resistant psychotic disorders. Its discontinuation can precipitate relapse that can be often challenging to treat.

This is a case study of a female patient in her early 40s who is known to the mental health services with a diagnosis of schizoaffective disorder. She was admitted to acute psychiatric inpatient unit due to relapse characterised by psychotic, catatonic features and poor physical health condition due to refusal to eat and drink. She was stable on clozapine for more than a decade and had become unwell after discontinuation of clozapine in the community due to platelet count below 50 × 109/L with normal other parameters. Low platelet count was detected during routine monthly blood monitoring after a few years of commencing clozapine.

Whilst an inpatient, there were several trials of re-titration of clozapine which had to be withheld because of ambiguity regarding the cause of persistent thrombocytopenia. Other treatment options including alternative antipsychotics and 12 sessions of ECT were tried without any success. Haematologist opinion was sought at early stage of admission and blood investigations were done but there was delay in bone marrow biopsy due to practical issues.

The treating team re-commenced oral clozapine to which she remained initially non-compliant due to catatonic features. With advice from the specialist psychosis services a few doses of intramuscular clozapine was used to facilitate re-titration. Following regular compliance and optimisation of oral clozapine, there was significant remission of clinical symptoms, with patient returning to her baseline mental state and functioning. During the period of admission, platelet counts were closely monitored which kept fluctuating reaching sometimes below 30 × 109/L without any clear association with clozapine dose. No bleeding symptoms or signs were ever reported.

Clozapine is a medication with haematological side effects; however, low platelet count is very rare. This patient ultimately underwent bone marrow biopsy which established Immune thrombocytopenia. She was discharged to the community with a plan of continuing clozapine, close monitoring of blood count and regular follow-up with haematology services for further clinical management.

Careful clinical evaluation and timely investigation is important to establish the cause for side effects before associating it with clozapine and discontinuing the treatment. This helps in ensuring continuity of clozapine in patients who clearly benefit from long-term use of clozapine.

We sought to determine to what extent guidelines regarding 72 hour follow-up and 6 week medical review were being followed in a Community Mental Health Team in Brixton. Further, we aimed to find out what was happening in situations where these guidelines were not met, then implement interventions to ameliorate some of the identified barriers.

First, we conducted a retrospective review of all patients discharged from any hospital or home treatment team, over a time period from 01/07/2023 to 01/11/2023. Patients with discharge dates not in this timeframe, or those still admitted to hospital, were deemed ineligible and excluded. We extracted the dates of discharge, 72 hour follow-up, and medical review, and calculated percentages of patients who received follow-up in the required time who should have received it. Supplementary data on care-coordinator contact within a month, and primary support contact were gathered as well.

Our primary intervention was direct engagement with the involved community mental health team, delivering the findings of our retrospective review in an oral presentation on 01/11/2023. We also designed an informational poster to be disseminated among the team as well as a discharge template proforma for care coordinators to bring to patient discharges to help them acquire vital contact information details. Following the intervention, we gathered the second round of data in the same way as described earlier, from 01/11/2023 to 19/01/2024.

A considerable improvement was noted in the rate of 6 week medical review, with 69% of patients successfully achieving this target in the post-intervention population (n = 18), as compared with 56% in the pre-intervention population (n = 18). However, no significant change was observed in rates of successful 72 hour follow-up between the populations (63% to 58%). This was attributed to deep-rooted barriers such as lack of robust communication services between the wards and community mental health teams, which potentially shows a need for development of underlying system integration. Qualitatively, positive feedback was given by members of the team who described dedicating more time than previously on checking if patients have been followed up on time.

Overall, we demonstrate moderate success for a low-intensity quality improvement intervention bringing about significant improvements in 6 week medical review compliance. Interestingly, our results indicate that the longer-term 6 week medical review may be more amenable to our awareness-based intervention than 72 hour follow-up, suggesting a different array of logistical barriers between the targets.

The importance of the humanities has been highlighted in developing a holistic person-centred model of psychiatry. The use of film to explore topics related to psychiatry, known as ‘cinemeducation’, has been shown to encourage reflection. Wellbeing has been identified as a key area in the quality of psychiatry training, however there is currently no evidence exploring the wellbeing and educational benefits of ‘cinemeducation’ within psychaitry training programmes

Our primary aim was to measure the impact of ‘cinemeducation’ events on attendees’ wellbeing and professional development, with a secondary aim to explore attendees experience of ‘cinemeduation’.

The hypothesis is that attendees will experience a wellbeing and educational benefit from the initiative.

6 events were assessed between January and August 2023. Each event involved the showing of a feature length film, followed by a 30-minute discussion. 4 out of 6 events were facilitated by guest speakers, usually a consultant psychiatrist. Following events, questionnaires were distributed which included a series of statements with Likert scales and open ended questions. Mean Likert scale scores were calculated with qualitative data interpreted by the authors using thematic analysis.

A total of 108 trainees attended events, predominantly core trainees (64.52%). All events scored consistently high for self-reported wellbeing, however facilitated events demonstrated higher scores for self-reported reflective and educational benefits. The themes derived from qualitative data were of ‘cinemeducation’ being a novel educational opportunity where attendees were able to use film to work through challenges associated with psychiatry, as well as being an opportunity for connecting with other trainees, where attendees could share experiences and foster a sense of community.

Core psychiatry trainees in particular, appear to value ‘cinemeducation’ as a tool to connect with their peers and develop their understanding of psychiatry in a relaxed, but stimulating environment, which is best achieved under the guidance of a senior colleague. The study suggests that the introduction of ‘cinemeducation’ across psychiatry training programmes would benefit trainees’ wellbeing and development. Further research is required to assess the impact of such initiatives across a broader cohort of trainees, using more robust methods of data collection, as well as formal measures of skills such as reflective functioning.

Despite the high prevalence of mental health disorders in children and young people (CYP) with long-term health conditions (LTCs), these difficulties are often overlooked and untreated. Previous research demonstrated the effectiveness of low intensity psychological support provided via a drop-in mental health centre in a single specialist paediatric hospital. The aim of this study is to determine the effectiveness and acceptability of accessible low intensity mental health services for CYP attending a general hospital.

This project was part of a wider prospective non-randomised single-arm multi-centre interventional study (Trial registration: ISRCTN15063954). CYP aged up to 25 years old with a LTC, who had been receiving care for their LTC for 6 months or more, and their parent/carer were eligible to be referred by their clinician or self-refer to the trial. The primary outcome is the difference in the total difficulties score on the Strengths and Difficulties Questionnaire (SDQ) reported by parent or CYP between baseline and 6 months. Interventions provided were: low intensity CBT, onward referral or signposting.

53 families were recruited at this hospital which made up 44% of the total study sample (120 families). Patients recruited were made up of 34 females, 18 males and one young person who identified as non-binary. The mean age of the CYP was 16.13 years and they were living with a range of different LTCs including cancer, asthma and diabetes. At baseline the average self-reported and parent reported SDQ scores were within the “very high” range (21.52 and 22.03, respectively). All participants were offered an initial assessment within 3 weeks of consenting (average 19.6 days) and treatment began within a month. Qualitative feedback from families has identified how the service “fills a gap” between physical and mental health and their satisfaction with how “time-sensitive” support was available.

There is significant demand for this service and CYP living with different LTCs are accessing and utilising the service provided. This model of intervention allows timely access to evidence-based mental health support for CYP attending a general hospital for their physical health needs, compared with standard waiting times in other services.

There are a shortage of specialist services available for Functional Neurological Disorders, especially within the paediatric population. Patients and families often find themselves falling within the borderland between medical and psychiatric services. Functional symptoms can cause significant morbidity and disruption to the lives of children and young people, impacting their access to education and social lives. Early diagnosis and explanation of FND is a mainstay of treatment, and is associated with positive outcomes. A Functional Neurological Disorder pilot MDT clinic was set up within Great Ormond Street Hospital, with the aim to provide a one-off therapeutic assessment and psychoeducation. We surveyed families who attended the clinic to assess their experiences and outcomes.

A pilot clinic was set up for patients referred within GOSH with a confirmed diagnosis of FND. The Multidisciplinary team consisted of a CAMHS psychiatrist, paediatric neurologist, physiotherapist and occupational therapist. Patients received a one-off outpatient consultation to discuss FND symptoms and background history. Clinicians provided psychoeducation for patients and families about the diagnosis and devised treatment plans including follow-up assessments, onward referral to local services and a consultation with teams where appropriate. A follow-up survey was conducted using semi-structured telephone interviews and patient satisfaction questionnaires. Questionnaires were scored using a Likert rating scale (1: very dissatisfied – 5: very satisfied). Parents were asked about their understanding of the FND diagnosis and about their experiences of support from local teams.

25 patients diagnosed with FND were referred to the clinic. Of those, 20 patients took up the consultation. Patients presented with range of functional syndromes. 15 families consented to follow-up interviews. Parents rated their experience at the FND clinic highly (median score 5 – very satisfied). They were very dissatisfied with follow up care (median score 1). Only one patient remained under CAMHS at the time of follow up. 3 families had sought support privately. Parents subjectively rated their children's symptoms at follow up as: much worse (3); a bit worse (1); the same (7); a bit better (2) and much better (2).

Patients and parents demonstrated high levels of satisfaction with the one-off therapeutic assessment. The majority of parents reported that the GOSH consultation helped them to understand the diagnosis of FND. All families felt they had received inadequate support from primary care, local CAMHS services and schools. Patients who struggled to access support from CAMHS/ school were less likely to experience any improvement in FND symptoms and had poorer levels of functioning.

Sickness absences within the NHS have been on the rise with 27 million days across 2022, 22% of which were due to mental health and wellbeing related issues. The 2022–23 report on progress in improving NHS mental health services found that increased workload and staff shortages within the mental health sector was leading to concerns of staff ‘burnout’ and higher rate of staff turnover. There is an indication that CAMHs staff are at higher risk of poor wellbeing despite limited research in the UK. The audit aimed to gain insight into the wellbeing of staff working in CAMHs within the trust according to NICE Mental Wellbeing at Work (NG212) and highlight areas of concern and propose recommendations to improve staff wellbeing.

Anonymous self-report questionnaire, based on a validated tool recommended in the NICE NG212 guidance, was disseminated across four boroughs within the trust to measure wellbeing in the workplace. The survey had 19 questions, 17 requiring scores on Likert scales and 2 descriptive questions, aimed to gain information on the five drivers of wellbeing in the workplace (health, relationships, environment, security, and purpose).

A total of 123 responses were analysed. Across all four boroughs, physical health scored worse than mental health. 44.7% of respondents felt they had inadequate facilities in the workplace to support their health and wellbeing. Further, 32.5% of responses disagreed/strongly disagreed that change was managed well in their organisation compared with 25% who agree/strongly agree. Key words such as staff-appreciation and team-building days recurred in qualitative responses across the trust. There were further site-specific differences. Research shows that provision of workplace exercises can be safely used for the promotion of employees' physical and mental health. Cost-effective strategies such as staff-appreciation and gratitude can improve job satisfaction thereby promoting staff retention. To consider elements of face-to-face contact with colleagues could also have a positive impact on psychological wellbeing due to more productive meetings; increased networking; increase of engagement and job satisfaction.

The CAMHS staff wellbeing survey provided useful insight into staff perception of their wellbeing at work. Repeating the survey, after implementing recommendations, would help identify important determinants. Despite the survey being limited to the specific trust, further research into CAMHs staff wellbeing across the UK could help facilitate improvements and help with staff retention.

Depression poses a significant public health concern globally, characterized by prolonged periods of sadness, loss of interest, and impairment in daily functioning. With over 800,000 annual deaths attributed to suicide, it stands as the second leading cause of mortality among 15–29-year-olds worldwide. To address this growing crisis, various digital methods are being increasingly developed for screening depression efficiently in large populations. However, the ethical implications surrounding the use of these tools remain debated. This scoping review aims to explore the landscape of research on digital screening methods for depression in India, elucidating ethical challenges and identifying research gaps.

By synthesizing available evidence, this study seeks to contribute to the discourse surrounding the ethical use of digital tools for depression screening in India, ultimately striving for improved mental health outcomes in the population.

Using a pre-tested search strategy in January 2024, we searched PubMed and Google Scholar for studies regarding digital divide in the use of digital technology for mental health. Relevant studies were selected using a two phased screening process. Studies included in the review were synthesised qualitatively using a thematic synthesis approach.

Out of 379 titles identified in our database search, only four were included in the qualitative synthesis. Two of these were cross-sectional, followed by a qualitative study and a pre-post evaluation. These studies were conducted in remote villages in the state of Andhra Pradesh, urban slums of Delhi, pan-Indian national survey and rural and under resourced urban areas.

The studies examined diverse aspects of the digital divide in India, revealing profound socio-economic disparities and gender inequities. Disparities in ownership of digital devices and usage were stark, with less educated, lower-income, and lower-caste groups facing marginalization due to limited access and skills. There were gender discrepancies in mobile phone ownership and internet access, with females significantly less likely to possess these technologies compared with males. However, there is a strong potential of mobile technology in increasing mental health service utilization in rural areas, fostering community awareness and stigma reduction.

Collectively, these findings illuminate the multifaceted challenges of the digital divide in India, emphasizing the urgent need for targeted interventions to promote equitable access to technology and bridge socio-economic gaps.

High Dose Antipsychotic Therapy (HDAT) should only be used in exceptional circumstances, as there is little evidence to suggest that higher than recommended doses of antipsychotics are more clinically effective than standard doses, with potential side effects being greater. In practice, there are several clinical scenarios where HDAT may be prescribed and the potential benefits must outweigh the potential risks. NICE guidelines for psychosis and schizophrenia advise that dosages outside the range given in the British National Formulary should be justified and recorded.

This evaluation aimed to determine prevalence of HDAT across the 16 general adult inpatient wards and the Psychiatric Intensive Care Unit (PICU) in Mersey Care NHS Foundation Trust.

A list of all inpatients admitted to the 16 general adult inpatient wards and to the PICU in the Trust between 17th and 20th of July 2023 was obtained. The electronic prescription record for each patient was scrutinised to determine whether the patient was subject to HDAT and, if so, whether this was due to antipsychotic monotherapy, combination of two or more antipsychotics, or due to regular and as required (PRN) antipsychotic medication.

Of the 215 inpatients on the 16 general adult wards and the PICU, a total of 29 (13.5%) patients were prescribed HDAT. Four wards had no patients on HDAT; one ward had 5 patients on HDAT. Two of the 12 patients on the PICU were on HDAT. Of the 29 HDAT patients, none were on just one regular antipsychotic, 11 were on one regular antipsychotic and one PRN, 11 on two regular antipsychotics only, 4 were on two regular antipsychotics and one PRN antipsychotic, 1 patient was on three regular antipsychotics and 2 patients on three regular antipsychotics and one PRN antipsychotic. Of the 29 HDAT patients, 14 (48%) had schizoaffective disorder, 9 (31%) had schizophrenia, 5 (17%) had bipolar disorder and 1 (4%) had emotionally unstable personality disorder.

Only a minority of inpatients on the general adult wards and the PICU are prescribed HDAT. There was variation in HDAT prescribing across the wards and this may reflect the degree of diagnostic variability of each ward's inpatients. In those patients that are subject to HDAT, there is a need for appropriate baseline physical investigations to be completed and for appropriate monitoring of ECG and relevant blood tests. There is a need to consider whether each HDAT patient has been considered for treatment with clozapine, if appropriate.

International medical graduates (IMG) are an important and integral part of the NHS workforce. The 2022 General medical council (GMC) Workforce Report showed that of the doctors who joined the workforce in 2021, half (50%) were IMGs and 39% UK graduates. This report also emphasized the need for better inclusion and support for IMGs in order to enhance future retention.

With this conference we aimed to empower IMGs and their educators with tools and knowledge to better recognize and help mitigate the challenges that IMGs endure whilst working in NHS. We discussed about the factors affecting IMG career progression, wellbeing, and ways to overcome them.

It was a one-day conference targeted to the PAN-London cohort of IMGs and their educators of medical and surgical specialties. The programme included distinguished speakers from all branches of medical fraternity, the GMC and medical indemnity organisations. Five poster submissions were also selected to be presented on the day. The programme started with IMG consultants describing personal challenges and success stories with a focus on long-term NHS equality diversity inclusion plan. This was followed by an invigorating ‘Schwartz round’ wherein attendees were able to engage in open and reflective discussions of shared experiences in transition to the United Kingdom. The latter half of the day included workshops on mitigating differential attainment and medico-legal aspects of clinical practice. The conference was concluded by an informative discussion led by the head of GMC London.

The conference was well-attended with 94 attendees present on the day. The audience encompassed a varied set of professionals including medical education managers, directors of medical education, educational supervisors and IMG doctors of all grades and specialties across different London trusts. The feedback was overwhelmingly positive with all the respondents in agreement that the learnings from the conference were relevant to their professional needs. The qualitative response from the attendees in summary was that conferences of a similar agenda and focus should be organized in the future as well.

Historically, there is clear evidence in literature that IMGs have lower success rates in both job and training progression, in comparison to British medical graduates. By organizing such conferences, the endeavor is to kick start a productive dialogue between IMGs and their educators, to target more favorable and successful overall outcomes, on a long-term basis. We hope that this initiative sets the building blocks for the way of the future.

This study sought to assess and compare the psychological well-being of both children and adults with cleft lip and palate (CLP) in contrast to those without CLP. The focus was on self-satisfaction regarding facial appearance, popularity among peers, and self-esteem.

This study was registered at the University of Dundee, including various study designs such as randomized controlled clinical trials, longitudinal, cross-sectional, and observational studies. Only studies concentrating on non-syndromic CLP in children and adults were considered. No limitations were set on age or language. Self-reports, including validated and unvalidated questionnaires, interviews, and observational/clinical assessments, were deemed suitable. Database searches were performed in Medline, Pubmed, Scopus, Cochrane, and Web of Science (January 2019). An electronic search yielded 334 results, with 74 articles meeting the inclusion criteria. After screening and risk of bias assessment, four articles were included in the qualitative analysis, three of which were included in the meta-analysis.

The review encompassed four studies conducted in China, Japan, Sweden, and the United States, involving 442 participants (non-CLP control group n = 305, CLP group n = 137). While the majority of individuals with CLP did not exhibit significant psychological issues, certain challenges were noted, particularly concerning speech or hearing difficulties, depression, anxiety, and interpersonal relationships. Age did not seem to correlate with the occurrence or severity of psychological problems in CLP patients, with gender playing a significant role, as females tended to be more sensitive to facial appearance. The level of self-satisfaction was not statistically significant between the two groups (OR = 0.85) while the non-CLP group was more likely to rate themselves as being more popular among their peers (OR = 1.48). Also, the non-CLP group has higher self-esteem than CLP patients (OR = 1.05).

Limited evidence suggests that some individuals with cleft lip and palate may face psychological challenges, indicating a need for more structured approaches to assess the psychological well-being of CLP patients.

Today the problem of suicide remains one of the topical issues among Asian countries like South Korea. The primary objective of this Systematic Review (SR) was the identification of the risk factors in suicide attempts and completions in South Korea. South Korea has one of the highest reported suicide rates in the world, and there was no prior systematic review on this topic. The main intention was to provide evidence-based results for future research studies and to inform suicide prevention policies.

PubMed, Science Direct, and Medline databases were searched from 1990 to October 2022. Studies focused on the problem of suicide in South Korea were selected with an emphasis on risk factors. Since the rate of suicide rises with age, studies examining 18-year-olds and above were included. Studies examining people of different sociodemographic backgrounds and people diagnosed with psychiatric/psychological disorders and those who attempted suicide, as well as those without a psychiatric/psychological problem, were also included. To assess the overall quality of the included studies, the Critical Appraisal Skills Programme (CASP) checklist was applied for the evaluation of case-control and cohort studies. The National Institutes of Health (NIH) Quality Assessment Tool was implemented for the evaluation of cross-sectional studies. The Jadad Scale was used to assess the risk of bias. PRISMA reporting guidelines were followed.

Ten studies met the eligibility criteria to be included in SR: Four cross-sectional, two cross-cultural, and four cohort studies. Risk of bias assessment demonstrated low quality and moderate risk of bias. The quality assessment showed an acceptable level of relevance and quality. Findings suggested factors leading to suicide in South Korea were mental health conditions, financial status, such as unemployment and low income, education level less than high school, and households with poor living conditions. The identified risk factors significantly increased the likelihood of suicide ideation, suicide attempt and suicide completion among people in South Korea. Stigma was identified as a barrier to those with mental health conditions seeking professional help.

The identified risk factors are similar across the world; however, the suicide rates are not as high in other Western cultures as they are in South Korea. Future studies could compare Western countries to hierarchical countries to identify if there are any local risk factors that can help guide local prevention policies and educational programs with city officials’ engagement. Moreover, it would be essential to investigate the impact of stigma thoroughly since it is still hard to clarify whether it is a cultural issue or a worldwide issue preventing individuals from getting professional help.

In the United Kingdom Specialist Community Forensic Teams (SCFT) are a new national development, aiming to enable and support earlier discharge from secure hospitals, and provide treatment to patients on a forensic pathway, in a community setting.

This project's ambition was to yield data to support future development of the service. The following research question was developed, as a focus for the project:

The project was accepted by Cardiff University and South West Yorkshire Foundation Trust as a service evaluation.

The project methodology considered the impact of trauma throughout, given the forensic setting and high prevalence of trauma in individuals accessing forensic services.

A questionnaire was developed, which covered several relevant themes regarding the service, including the research question, and was distributed to patients, professionals, and referrers, either using, or associated with the team.

The total number of participants recruited was n = 45. These were made up of service users (n = 17), referrers to the service (n = 10), and other professionals (n = 18).

Participants felt they understood the purpose of the SCFT, placed importance on being involved in service evaluation, and were confident their responses would influence service development.

Reasons to refer to the SCFT were the perceived helpfulness of the team, supporting transitions, risk management, teamwork, therapeutic alliance, quality, and clinical knowledge.

Results favoured multi-disciplinary team agreement as being an important factor in the timing of SCFT referral. Upon admission, or granting of unescorted leave, were also cited as appropriate times to refer to the service. Clinically appropriate timing, individual needs, and service user motivation were additional indicators for SCFT referral.

The West Yorkshire SCFT offers previously unavailable pathways from secure services into the community. The clinical model uses a trauma-informed, formulation-driven, collaborative approach to care, treatment, and risk management, which participants found favourable. Improved community pathways and connections offer a sense of improved hope, and a feeling of being helped, which is supportive of personal recovery.

There are recommendations which suggest that a community pathway agenda, embedded into services from admission, will support clinically appropriate timing of SCFT referral, and should be a decision which is made collaboratively, with patients, carers, and the multidisciplinary services around them.

Background:

The cumulative effect of having one or more prescription drugs with anticholinergic properties is known as the Anticholinergic Burden (ACB). ACB can increase mortality and morbidity. Adults with learning disability are a high-risk group for this.

Aims:

To evaluate Anticholinergic Burden (ACB) for adults with learning disability and co-existing mental health conditions and make practice recommendations.

A baseline audit was carried out over a period of 1 month on those treated within two specialist in-patient units in England. Routinely collected information including diagnosis, prescribed medication, clinical outcomes (Clinical Global Impression – CGI) and side-effect scales (ACB calculator, Anticholinergic Effect on Cognition – AEC, Liverpool University Neuroleptic Side-effect Rating Scale – LUNSERS, Glasgow Antipsychotic Side-effect Scale – GASS) were collated and analyzed using quantitative methods.

19 patients were included. Mean age was 37 years, 89% (n = 17) were male and 95% (n = 18) of white British ethnicity. The clinical diagnoses included 74% (n = 14) with mild learning disability, 68% (n = 13) with a major mental illness (psychosis or affective disorder), 53% (n = 10) with autism and 32 (n = 6) with a personality disorder. 89% (n = 17) were on antipsychotics, 63% (n = 12) on mood stabilizers, 58% (n = 11) on antimuscarinic drugs for antipsychotic side effects, 58% (n = 11) on anxiolytics, 32% (n = 6) on antidepressants and 89% (n = 17) on medication for physical conditions. Including pro re nata (prn) medication, the mean ACB calculator score was 6.68 and 4.21 on the AEC scale. On LUNSERS, the mean score was 23.13 (medium side effects), on GASS 8.87 (mild or absent side effects), on CGI efficacy index 6 (decided clinical improvement with side-effects not significantly interfering with functioning) and on CGI global improvement 2.37 (much improved).

The ACB in people with learning disability and mental health problems is high. While an ACB calculator score of 3+ is described as associated with increased mortality and morbidity in the general population, the mean score in this sample was double that if prescribed prn medication was included. Medication prescribed for both mental and physical health reasons. Despite the high ACB, they show good clinical improvement and functioning regarding their mental health. The scores on other side effect scales are not exceedingly high either. There is a need for more research to set the specific practice standards regarding ACB measurement and monitoring in this group. Adequate health education for patients and staff should be a priority to maintain vigilance regarding ACB effects.

According to NICE guidelines on antenatal and postnatal mental health, recommendation 1.7.3:

• • To identify the proportion of women referred for psychological interventions in the perinatal period who are assessed for treatment within 2 weeks of referral.

• • To identify the proportion of women referred for psychological interventions in the perinatal period who start psychological interventions within 4 weeks of assessment.

• • To identify the barriers to accessing psychological interventions within 6 weeks of referral of women with mental health problem in the perinatal period.

The sample cohort were perinatal women referred for psychology interventions in the central specialist perinatal community mental health team (SPCMHT) between 12th June 2023 and 15th November 2023. Data was collected quantitatively and qualitatively. Quantitative data was collected retrospectively from the central psychology SPCMHT database shared drive and on Rio. Qualitative data was obtained through a purposeful sampling technique. Psychologists working in the central SPCMHT were identified. Survey link with specific questions was sent to the identified participants to complete. The SPCMHT psychology pathway was reviewed to clarify the local arrangement in place for women to start psychological intervention within 6 weeks of referral.

25 patients were identified in total in the 6-month review period. 16 had been assessed and 9 were on the assessment waiting list. The elapsed time for assessment waitlist was between 3 and 23 weeks. Of the 16 assessments, only 2 were done within 2 weeks of referral. The time to assessment for the remaining 14 patients was between 3 and 18 weeks. Following assessment, there were 11 cases on the therapy waiting list, 4 open cases, and 1 wait and watch case. The elapsed time for the therapy waitlist was between 4 and 22 weeks following assessment. None of the open cases started therapy within 4 weeks of initial assessment. Overall, none of the 25 patients were assessed or provided psychological intervention within the recommended timeframe. The qualitative theme suggests “understaffing” as the major barrier to prompt service provision. It also suggests a lack of awareness of the current NICE standards timeframe for provision of psychological intervention for perinatal women. The trust SPCMHT psychology pathway has no timeframe for the start of psychological therapy following assessment.

The audit findings suggest massive delays in service provision. The major barrier to this is limited capacity compared with the number of referrals. Hence, there is need for more resource allocation for perinatal psychology service provision.

Seclusion is a method used by mental health teams around the world to manage aggressive and disturbed behaviour in psychiatric patients in situations where there is immediate risk of harms to others.

A quality improvement project was carried out over two hospital in-patient sites containing 6 wards to see if seclusion reviews were completed safely and documented appropriately according to the guidelines set out by South West Yorkshire Mental Health Trust and the Royal College of Psychiatrists.

The quality improvement project was carried out to first audit data to see if seclusion reviews were being done to the local guidelines and standards set by the Mental Health Legislation and Royal College of Psychiatrists. This was followed by training junior doctors and reauditing date to see if any improvements were observed.

A retrospective quality improvement project was conducted assessing medical seclusion reviews carried out by on-call junior doctors between November 2022 and January 2023. Data was initially collected retrospectively spanning over a period of 4 weeks over the month of November 2023 including the analysis of 30 seclusion reviews. These results were presented as an audit to doctors and managerial staff at the end of November. Post training seclusion review data was collected over a period of 4 weeks over January 2023.

An overall improvement in 7/9 domains. The biggest improvement (54% rise) was checking for side effects and EPSEs which was only documented 4/23 times in the first pre-training run. 18% improvements were also noted for assessing and documenting if the patient had any distress or pain, clinical appearance in terms of the cardiac domains such as perfusion and colour of the skin and also their level of orientation in place person and Glasgow Coma Score.

The only two domains in which an increase was not observed was to document if seclusion should continue and justification for why this is the case. These two domains were already at 100% and the System 1 seclusion review template prompts doctors to do this at the end of the review which is possibly one of the reasons it was done well both before and after the training.

A great deal of interest and feedback was garnered and the idea was agreed that a further audit could be carried out after providing training for the current doctors and to gather post-training medical seclusion review data for comparison.

To identify professional and organisational-related themes in Coroners' PFDs reports which contributed to mental health related suicide.

We reviewed Coroners' PFDs reports via the UK Judiciary website. We filtered reports by those which were mental health related deaths and included the keyword ‘suicide’. 100 reports were reviewed starting with the most recent which was August 2023. We reviewed which Coroner's area the reports originated from and the age and gender of the deceased. Then, we examined the contents of the PFDs reports including the inquest conclusion, circumstances of death and concerns raised by the coroner. Themes were identified and grouped into patient-related, professional-related, and organisational-related factors that may have contributed to the death by suicide.

Reports were reviewed from across the UK. The highest number of reports were from the coroner area of Manchester South (12%).

From those reports whereby the deceased's age was mentioned, the mean age was 36 with an age range of 14–81 years (35% of reports did not include the deceased's age).

61% of reports were of males and 39% females.

The main professional-related factors identified from thematic analysis of the PFDs reports were issues around risk assessment and management (45%), lack of interprofessional communication and collaboration (33%), inadequate clinical queries/assessment (25%), lack of consultation of family/carers (17%) and lack of treatment/follow up plan following discharge (11%).

The main organisational-related factors were inadequate service provision for the population covered (20%), inadequate training/knowledge (18%), inadequate staffing or reliance on agency staff (15%), poor systems in place including information technology (13%) and lack of audit or evidence of learning from prior investigations & events (11%).

Patient-related factors were less commonly identified but included lack of engagement with services, denying suicidality and autistic spectrum disorder.

The commonest theme was issues around risk assessment and management which was identified in 45% of suicides. It is hoped by highlighting common themes arising from PFDs reports across the UK this analysis could inform targeted improvements in practice that will lead to reductions in mental health related suicide which is the need of the hour.