This comprehensive study seeks to evaluate the adherence of (CAMHS) service, Black Country Healthcare National Health Service (NHS) Foundation Trust to National Institute for Health and Care Excellence (NICE) guidelines in prescribing medications for children diagnosed with Autism Spectrum Disorder (ASD). Our primary objectives include identifying variations in prescribing practices across different localities within the trust and identifying specific areas that may benefit from improvement.

A meticulous retrospective analysis was conducted on 142 randomly selected cases involving children diagnosed with ASD and prescribed psychotropic or sleep medications. A comprehensive analysis of patient records, encompassing progress notes and clinic letters, facilitated the gathering of extensive data. The evaluation centred around benchmarking adherence to NICE guidelines. Throughout the process, strict adherence to ethical standards was maintained.

Within the cohort of 142 children diagnosed with ASD, 44% underwent alternative interventions before medication initiation. Notable variations were observed across localities, with 87% receiving psychological therapy as an alternative intervention. Documentation of consent for commencing medication was present in 62% of cases. Specialists consistently initiated psychotropic medications at the minimum effective dose, and 70% of cases had a follow-up within 3–4 weeks. Sleep medications were prescribed to 77% of the cohort, with 55.5% of those undergoing alternative interventions before prescription.

The study's findings underscore significant variations in adherence to NICE guidelines, emphasizing the critical importance of exploring alternative treatment modalities before resorting to medication. Furthermore, collaboration with supporting agencies is highlighted as a crucial aspect of comprehensive care. The documentation of consent forms for all patients is deemed imperative, and adherence to specified intervals for reviewing medication side effects, as outlined in the guidelines, is considered crucial for optimal and safe patient care.

A Patient Reported Outcome Measure (PROM) is a form that patients complete about their health status at a single point in time. The Recovering Quality of Life (ReQoL) questionnaire is a new PROM, developed in partnership with mental health service users to enable them to report on their mental state, and can be utilised by clinicians to track progress. The Commissioning for Quality and Innovation (CQUIN) framework set a target that 40% of adult and older adult patients accessing secondary mental health services should have their PROM recorded at least twice in a 6-month period. The primary aim of this quality improvement project was for 50% of patients under the Kent and Medway NHS Trust (KMPT) to be ReQoL compliant.

Following engagement with various stakeholders, a survey was circulated to better understand the barriers stopping staff from facilitating ReQoL completion. Moreover, a poster was created to raise awareness of ReQoLs and illustrate the practicalities behind gathering and recording patient scores. Additionally, local ‘champions’ were assigned for each community/inpatient mental health team to foster a sense of responsibility for PROM collection. Data on PROM compliance was obtained monthly, with meetings subsequently organised to scrutinise the results and brainstorm further ideas to drive improvement, such as providing patients with paper ReQoL copies to fill out in advance of their consultation/ward round.

The survey revealed that 23% of staff were unfamiliar with the ReQoL questionnaire, and only 31% routinely obtained and inputted ReQoLs. A lack of time to assist patients in filling out PROMs was the main barrier cited by staff, alongside ambiguity as to whose job it was to ensure ReQoL collection. Through the distribution of the poster, the establishment of local leads and other changes such as the paper ReQoL initiative, there was a notable uptick in the rates of PROM completion. Indeed, over a 4-month period, compliance rose locally from 46% to 61% at the acute inpatient unit, and from 0 to 21% in the community mental health service. However, over KMPT as a whole, change was modest.

This was a successful quality improvement project, resulting in an increase in PROM completion rates, especially at a local level. The measures implemented, particularly the poster and formation of ReQoL leads, were effective – although more work and participation is required to change Trust-wide compliance. Future ideas include adding a ReQoL tool into nurse/doctor clerking templates to reduce friction in completing PROMs.

Suicide is a global public health issue that requires sensitive research to inform effective prevention and treatment strategies. Despite the benefits of such research, it is accompanied by significant ethical challenges such as the potential for harm to participants' wellbeing. Various studies have explored the views of researchers in suicide research. This qualitative study aimed to explore the research ethics committee (REC) members’ experiences with suicide-related study applications to ascertain whether there are differences in approaches to dealing with suicide-related study applications.

We conducted semi-structured interviews with members of RECs (n = 9) from research-intensive universities and ethics committees in Pakistan. We also conducted a discussion group (n = 13) with members of REC from Pakistan, Nigeria and Sri Lanka. The topic guide delved into the opinions of REC members regarding ethical issues that they have come across while reviewing self-harm/suicide-related research proposals, the relevance of these issues with specific study designs, recommendations to resolve these issues, their approach to balancing risk and benefit, and guidance for researchers.

The preliminary findings from thematic analysis revealed five major themes; 1) Ethical challenges, 2) Reasons for application rejection, 3) Areas of improvement, 4) Suggestions for addressing ethical issues, and 5) Researchers' attitudes towards amendments. Challenges in self-harm and suicide research included the sensitivity and stigma surrounding the topic, lack of interest and support, and difficulties in participant recruitment. The application faced rejection from the ethics committees primarily due to methodological errors, lack of procedural clarity, and insufficient understanding of the research procedure. Identified areas for improvement were the need for enhanced methodology and research patterns, as well as a better understanding of the methodological procedure. Recommendations for developing a robust research proposal included training and supervision for intervention studies, the inclusion of comprehensive ethical elements and practical plans in the proposal, and a focus on data protection, confidentiality, risk management, and harm identification. While a significant number positively acknowledged reviewer comments, some researchers opted for in-depth discussions rather than directly addressing the issues.

The study highlights the importance of ethical considerations and emphasises the need to address the lack of robust methodological procedures in self-harm and suicide research. Addressing these challenges and adopting suggested improvements is paramount for advancing ethical and impactful research in this context.

The respect of a patient's autonomy and choices is one of the cornerstones of good psychiatric care. Key to this is ensuring the timely and thorough assessment of a patient's capacity to consent to admission and treatment once in contact with mental health services.

The aim of this quality improvement project was to optimise the Trustwide completion of capacity assessments for all newly admitted patients within 24 hours of admission at South West London and St Georges Mental Health NHS Trust. Our goal was for 100% completion of the Trust's Brief Capacity and Consent (BCAC) form by July 2023.

We obtained a list of all new admissions to inpatient wards across the Trust's three hospital sites between 1–14 February 2023. A retrospective audit was then undertaken to establish the baseline BCAC completion rate. Following this a quality improvement strategy was created using the Plan-Do-Study-Act (PDSA) model of creating change. A series of three interventions were implemented and subsequently analysed using the PDSA model. These included creating an admission checklist and placing this in doctors' on-call rooms across the trust, distributing the checklist to wards across hospital sites and service lines and lastly, sending out reminder emails to doctors at the Trust. A re-audit was completed after each intervention.

The baseline BCAC completion rate was 60.5% (n = 76) in February 2023. This increased to 63.75% (n = 80) following the creation of the admission checklist. Distributing the checklist throughout the Trust resulted in a further improvement to 76.5% (n = 81). In July 2023, the final data collected 6 weeks post reminder email demonstrated a BCAC completion rate of 75% (n = 68).

Through the application of the PDSA model, alongside focused interventions aimed at raising Trust-wide awareness of the BCAC form, we managed to obtain a 14.5% increase in BCAC completion rates between 13 February and 31 July 2023. Whilst not achieving the initial goal of 100% completion, this quality improvement project helped to bring a renewed focus to the timely completion of capacity and consent assessments at the Trust. Moving forward, we hope to build on this improvement by exploring additional strategies to reach a 100% BCAC completion rate, thereby promoting patient safety and autonomy.

To audit compliance with electronic admission documentation relating to substance use.

The initial admission forms in the electronic records of all current patients on the male ward were reviewed (n = 12). The information in core admission document was compared with other substance abuse history information on records.

Seven of the twelve patients were asked about substance misuse during their admission review. 5 patients were not asked. One of these patients had no history of substance use but his alcohol use history was also unclear in other records. 9 patients had at the very least met the ICD–10 criteria of harmful use of alcohol. 11 patients had at the very least met the ICD 10 criteria for harmful use of illegal substances. Two patients had excessive amount of alcohol use to the point of dependence since teenage. Mean age of onset of both substance and alcohol use was 11, with range of 0 to 20. The most commonly misused substances were alcohol and cannabis (11 out of 12 patients). Eight patients had abused drugs other than cannabis. All but one of these then progressed to using other substances. The reasons for using substances and attitudes to substance and alcohol use were not explored in admission assessment in most cases.

Admission assessment to a rehabilitation ward is also an opportunity to screen for any barriers to recovery as well to use brief motivational interviewing intervention if appropriate clinically. There is a need to improve the quality of our admission assessment in relation to substance use history.

Most of our patients had a very early onset of alcohol and substance use, as young as age 8. Apart from one outlier, all had started using substances and alcohol by age 15. This raises concerns regarding missed early prevention and safeguarding opportunities.

Our aim was to see if the following have been done during medical reviews:

1. 1. For service users with a diagnosis of psychosis or schizophrenia; is there clear documentation of employment status in case notes?

2. 2. To see if supported employment/alternative education or occupational activity is being offered to unemployed service users in their Outpatient Clinic Appointments.

3. 3. Whether acceptance or refusal of offered support is being documented and followed up.

This is a re-audit and it was done to check the compliance of our service with recommended NICE guidelines following the first cycle audit.

The NICE Guidelines (CG178 – Psychosis and Schizophrenia in Adults: Prevention and Management and NG181 – Rehabilitation for adults with complex psychosis) recommend the following for all patients with diagnosis of psychosis or schizophrenia.

Standard 1:

Offer supported employment to people with psychosis or schizophrenia who wish to find or return to work (CG178 Psychosis and schizophrenia in adults: prevention and management – 1.5.8 – Employment, Education & Occupational Activities).

Standard 2:

Facilitate alternate educational or occupational activities for people who do not wish to pursue mainstream education or work (NG181 Rehabilitation for adults with complex psychosis – 1.8.9 Engagement in community activities, including leisure, education and work).

This re-audit was carried out in the Community Adult Mental Health Services at Taylor Centre, Southend.

A list of service users that attended Outpatient Services at the Taylor Centre during the months of August and September 2023 was obtained.

Case notes of service users with diagnosis of psychosis or schizophrenia that attended an Outpatient Clinic over the 2-month period as new appointment or follow up were reviewed retrospectively. The 2 months (August and September) were chosen at random to achieve a reasonable sample size.

Service users within age range of 18–68 years were selected as they fall into the working age group range in UK.

The following details were checked:

1. 1. Is the service user's employment status recorded in case notes?

2. 2. For those who are unemployed – is supported employment offered?

3. 3. Service User's acceptance or refusal and any alternative educational or occupational activity facilitated if they refuse mainstream work.

The data was collected on an Excel spreadsheet and analysed.

Findings:

• • In the case notes of our sample, Employment status was documents in 97% of the cases; 78% were not actively seeking work.

• • The type of appointment in which employment was most often discussed was in the follow up appointments = 87% of the cases.

• • Supported Employment was offered to 38% of the sample. It was noted that 64% of service users that were offered supported employment had declined the offer.

Based on individual service users’ circumstances alternative educational or employment options like prevocational training was offered to 47% of the sample. This is a notable improvement from 26% in first cycle.

There was good documentation of employment status in the case notes of 97% of the sample which shows that Employment history is being taken for almost all the service users that attend our Outpatient Service.

The type of appointment in which employment was most often discussed was in the follow up appointment (87% of the cases). This could be due to service users’ mental state at the time of their first appointment, with them being unwell; hence it may be unsuitable to discuss employment options at that time.

Supported Employment was offered to 38% of the sample. The initial audit showed that this was offered to 35% of the non-working sample; therefore, a small improvement in offering supported employment has been noted. However, it is worth noting that 64% of the people that were offered supported employment have declined the offer, which reiterates the attitude towards mainstream employment in people with serious mental illness.

Only 33% of the service users were followed up, but this could be due to the fact that some of the service users are still waiting to be seen in clinic.

Overall, there has been an improvement following the initial audit especially in offering other educational activities if supported employment is not appropriate or if the service user is not interested.

Facebook, Instagram, TikTok and other social media applications have become an integral component of everyone's social life, particularly among younger generations and adolescents. These social apps have been changing a lot of conceptions and beliefs in the population by representing public figures and celebrities as role models. The social comparison theory, which says that people self-evaluate based on comparisons with similar others, is commonly used to explore the impact of social media on body image. There is a need to study the influence of those social platforms on the body image as there has been an increase in body dissatisfaction in the recent years.

This was a cross sectional study that used a self administered questionnaire on a simple random sample of 133 female medical students of the first year. Data were analyzed using SPSS.

Finding shows that the response rate was 75%. There was an association between social media usage and noticing how the person looks (p value = 0.022), but no significant association between social media use and body image influence or dissatisfaction was found.

This study implies more research under this topic in Sudan as the literature are scarce.

The extent and nature of child sexual abuse (CSA) and its consequences with respect to psychiatric morbidity is still poorly described in children. This was a community based cross sectional study to describe the social demographic profile and identify psychiatric morbidity in children with CSA and to further examine the association between the sexual assault profile and the psychiatric illness present.

This study includes 100 children aged between 6–17 years ascertained as sexually abused at the time. The setting was BHAROSA centre, which is a society for protection of women and at-risk children with funding from the Department of Women and Child Development Telangana state, India. Simple random sampling was used to choose the participants and a pre-tested semi structured questionnaire was used to assess the sexual assault profile. The Developmental Psychopathology Checklist (DPCL) which is the Indian adaptation of Child behaviour checklist was used to understand the associated psychopathology. The prevalence of psychiatric morbidity was discerned by the Diagnostic Statistical Manual Text Revision (DSM V-TR).

The average age for the first CSA encounter was 10.87 years. Most often the perpetrator was found to be an acquaintance (66%) of the child's family. ‘Vaginal/anal penetration’ (55%) was the most common form of abuse. In half of the cases there was a significant delay of two days-two weeks between the last episode of abuse and its discovery. 12% attributed themselves fully responsible for the abuse. 23% reported unsupportive reactions from the caregivers such as being dismissed or being blamed themselves for the abuse. More than half (53%) had at least one psychiatric disorder with post-traumatic stress disorder (PTSD) being the most common (28%) followed by conduct disorder (21%) and depression (17%). 28% had quasi psychotic symptoms and 25% non-specific somatic symptoms. 12% reported suicidal thoughts/ideation. 5 children tested positive for HIV and 2 were pregnant. Children who experienced ‘Vaginal/Anal penetration’ and those who pretended the act did not take place were found to have statistically significant rates of depression, PTSD and suicidality.

All children and adolescents who have been sexually abused must be evaluated for psychiatric morbidity regardless of their social demographic and abuse profiles. Additionally, all parents and caregivers should be sensitised on the fact that the majority of the perpetrators are acquaintances to the subjects. Coping strategies of the children especially self-blame and poor social support exert direct negative effects on victims’ adjustment.

The Royal College of Psychiatrists provides guidance regarding the experience of Foundation Doctors and Core Trainees, during their Psychiatry rotations. At The Mount, an Older Adult Mental Health unit in Leeds, it was observed by trainees that management of physical health conditions was occupying a large portion of their time.

Aims:

1. 1. Measure how much time is spent on physical health activities, between Foundation Doctors and Core Trainees at The Mount.

2. 2. Consider the impact of physical health workload on the doctors’ experience of Psychiatry.

3. 3. Explore the mental health experience of doctors during this rotation.

This Audit was conducted in three stages:

1. 1. Anonymous collection of quantitative data regarding the proportion of time spent on physical health work. This data was collected for current doctors across all wards, for a two-week period in October 2023.

2. 2. A focus group of junior and senior doctors, to consider onward actions.

3. 3. An anonymous qualitative survey regarding mental health experiences and suggestions for improvement. This was circulated to any Foundation Doctor or Core Trainee who worked at The Mount in the past 12-months, via an online survey.

The quantitative survey showed that Foundation Doctors and Core Trainees at The Mount were spending at least half their time on physical health jobs, such as: clinical reviews, skills such as blood tests and ECGs, and referrals to other clinicians or specialties. This was considered unsurprising by doctors at all levels during the focus group.

The qualitative survey explored this further, with observations that doctors were sometimes unable to attend MDT meetings, tribunals or CPAs due to the high physical health workload. It was felt that senior staff were proactive in offering support, however trainees still felt that opportunities for mental health experience were limited.

Suggestions for improvement were made during the survey, including:

1. 1. Increased input by senior medical staff, such as GPs or Geriatric Trainees.

2. 2. Additional staff to support with upkeep of equipment, or skills such as phlebotomy.

3. 3. Increased use of technology rather than paper charts.

4. 4. Greater clarity regarding minimum staffing and whether locum doctors can be arranged to cover gaps.

In summary, the physical health workload for Foundation Doctors and Core Trainees was noted to be significant and impacting their mental health experience. Following this Audit, consultants at The Mount will be meeting with Senior Leadership to discuss methods for improving the training experience.

Suicide is a global public health concern, affecting not only the individuals but also families. It is the leading cause of maternal death during pregnancy and up to one year after birth and commonly occurs after a period of suicidal ideation (SI). It is imperative to have interventions to help with SI and behaviors. We therefore aimed to adapt and test the feasibility and acceptability of a culturally adapted intervention for SI in women during postnatal period in Pakistan.

This is a two phase, mixed method Randomized Controlled Trial (RCT). First phase included adaptation of an existing Culturally Adapted Manual-Assisted Problem-Solving intervention (CMAP) for women experiencing SI. Adaptation process included two focus group discussion (FGDs), one with lived experience experts (women who experienced suicidal ideation during postnatal period), the other with health professionals (n = 8 in each group). Second phase involves a feasibility RCT with aim to recruit and randomize a total of 90 postnatal women experiencing suicidal ideation (screened using the Beck Scale for Suicidal Ideation), randomize into either of two study arms: CMAP (n = 45) or Treatment as usual (n = 45). Potential participants are being recruited from hospitals, communities, and self-referrals from 5 major cities in Pakistan. Culturally adapted CMAP is a brief problem-solving therapy of 6 individually delivered sessions, lasting about 50 minutes. The primary outcome is to assess the feasibility of CMAP through semi-structured qualitative interviews. Secondary outcomes include measuring SI, self-harm, depression, social support, and quality of life. Assessments will be conducted at baseline and 3rd month post randomization.

Analysis of qualitative data from FGD with lived experience experts highlighted importance of incorporating additional techniques of trust building, modifying thinking behavior, mindfulness, distraction exercises including religious practices as a preventive measure of self-harm, child safety measures, and involvement of partner in intervention. Analysis of FGD with healthcare professionals emphasized addition of visualized content, re-assessing depression and suicidal ideation in-between the sessions to monitor relapse, involving family, and capacity building of health professionals to improve their understanding about perinatal mental health problems.

Women in postnatal period are at high risk of SI, specifically those women from low- and middle-income countries, due to limited resources and mental healthcare provision. The earlier detection of SI, early intervention for suicide risk by delivery of culturally sensitive interventions can help reduce maternal mortality rates.

Gaming Disorder (GD) was recognised in the addiction field by the International Statistical Classification of Diseases and Related Health Problems in 2018. The National Centre for Gaming Disorders (NCGD) is the first NHS clinic to accept referrals from adults and young people who are struggling with the characteristics of GD. The NCGD opened in 2019. Since then, we have received over 1,000 referrals from either gamers, their family members, or from parents seeking support. The team is multidisciplinary and led by Addiction Psychiatrists and Consultant Psychologists.

This service evaluation aims to understand the demographics, clinical characteristics, and gaming behaviours and trends of those with a GD who are accessing our service.

The data included in this service evaluation is based on 380 gamer referrals. Data was collected through our referral form.

Demographics: The average age of gamers at referral was 19 years, with 60% of gamers aged between 13–18 years old. Male gamers represented 90% of the sample, with the remaining 10% made up of gamers identifying as female (9%), trans, or other. People who identify as White (British, Irish, or Other) represent 74% of referrals. The remaining 26% are from individuals who identify as Asian or Asian British, Mixed, Black or Black British, or of other ethnicities. Individuals based in London, or the South-East of England make up 60% of referrals. Comorbidities: 1 in 10 gamers had been formally diagnosed with a neurodevelopmental disorder at the time of referral. 1 in 8 gamers had an existing mental health condition. Gaming Trends: The three most popular games played were Fortnite, Minecraft, and Call of Duty. Our sample spent on average 10 hours per day gaming. In-game purchases were present in 17% of gamers. The average in-game expenditure at the point of referral was £4,500. In our sample, 46% were aggressive and 30% were physically violent to family members when interrupted from gaming.

As of date, we have had 530 gamer referrals, and we are continuing to extract relevant information on the demographics and characteristics of individuals with a GD. Our data suggests that the typical gamer accessing our service is male, young, white, and from London. The most popular game played is Fortnite. A substantial proportion of our sample are aggressive or physically violent to family members when their gaming is interrupted, whilst others are at risk of spending thousands of pounds on in-game purchases.

Objectives: In youth and young adults, it is common to encounter non-medical use of benzodiazepines, defined as use without a prescription or use for reasons other than that for which the medication is intended. Benzodiazepine use disorder remains understudied and overlooked, especially in youth and young adults. The primary objective of our study was to highlight the proportion of youth and young adults with aberrant use of benzodiazepines and diagnosed with benzodiazepine use disorder in a single centre. The secondary objective was to determine factors associated with aberrant benzodiazepine use and benzodiazepine use disorder in that sample.

This retrospective chart review screened for benzodiazepine use in 310 adolescent patients aged 12–19 seen for the first time in a concurrent disorders clinic, at a tertiary care clinic in Canada. Of those 310 patients, 167 were included in the final chart review.

97.6% of patients who used benzodiazepines demonstrated aberrant use, and 39.3% of patients received a diagnosis of benzodiazepine use disorder.

This review showed that a substantial percentage of youth and young adults in a concurrent disorders clinic in Canada are presenting with aberrant benzodiazepine use and are being diagnosed with benzodiazepine use disorder. Despite this prevalence, there is little by way of literature to guide treatment of benzodiazepine use disorder in this population.

• • The audit aims to improve the quality of physical health monitoring and physical health interventions that the EIP service provides to people with psychosis.

• • To ensure adherence to RCPsych standards for physical health monitoring in patients with First Episode Psychosis.

• • To ensure adherence to RCPsych standards for provision of required physical health interventions and health promotion in patients with First Episode Psychosis.

• • A retrospective case note audit and re-audit was conducted for 13 patients on the caseload of the North Wales EIP service from December 2022 to December 2023.

• • The case notes were audited against RCPsych standards for physical health monitoring and physical health interventions using an adapted version of the National Clinical Audit of Psychosis (NCAP) audit tool.

• • Alcohol and substance misuse screening status improved to 100% in re-audit.

• • There was significant improvement noted in Hypertension, Body Mass Index and Cholesterol screening.

• • Mental health medication review, advice or referral for diet and exercise with regards to weight gain/obesity and hypertension improved to 100%.

• • No specialist interventions were offered around health promotion and illness prevention as most of the patients were either not in the abnormal range, identified as high risk for developing the above mentioned physical health conditions or refused to have interventions for these conditions.

• • A definite increase was observed in frequency of interventions being reviewed and reoffered for those accepting and declining interventions at baseline.

• • Training for staff to complete bloods and physical health screening.

• • Increase availability of equipment to carry out physical health screening.

• • Monthly, three and six monthly prompts in the case notes for staff to discuss physical health interventions with patients.

• • Staff to use headings for physical health screening and interventions to improve documentation in case notes.

The aim of this study was to understand current clinical practice, adherence to evidence-based guidelines, and the perceptions, knowledge and attitudes of the multidisciplinary team caring for inpatients with eating disorder/disordered eating on general adult psychiatric ward.

The audit was undertaken at inpatient general adult psychiatry ward between 1st July 2022 to 30th April 2023. A retrospective method was used to collect data on admissions of patients with eating disorder/disordered eating alongside qualitative data retrieved for perceptions, knowledge and attitudes of the multidisciplinary team (MDT) and use of and adherence to national guidelines. The data was collected from everyday bed state and MDT handover, admission summary, electronic notes which included physical health charts and discharge summaries. The MDT staff involved were nurses, doctors, health care assistants, dieticians, psychologist, and occupational therapist.

Patients were included if eating disorder management was indicated and undertaken at some stage during the admission, even if the eating disorder was not the primary reason for admission. The age group was above 18 years and included male and female patients. Eight discrete admissions (6 females, 1 male and 1 transgender patient) were included in the audit. Adverse events like refeeding syndrome, electrolyte derangement needing Intravenous/Nasogastric tube feeding, self-harm, level of cooperation between medical and community eating disorders team, community mental health teams and outcomes were recorded. Data analysis was done through Microsoft Excel. Percentages of patients who had met each of the standards were calculated. Documented practices were compared in line with standards of NICE (National Institute for Health and Care Excellence) guidelines and MEED (Medical Emergencies in Eating Disorders) guidelines.

The audit concluded that gaps exist between evidence-based practice and patient care. Despite being admitted due to concern about eating difficulties, a substantial number of patients were not given an eating disorder diagnosis on discharge. And the patients who had eating disorder as primary diagnosis had limited inreach support from specialist team.

There is major challenge in management of disordered eating presentations within inpatient general adult psychiatry units and inreach specialist support for those admitted with eating disorders as primary diagnosis. These findings emphasize for targeted implementation strategies to improve patient care and uptake of research into practice.

NHS England's ‘Transforming Care’ initiative introduced care and treatment reviews (CTRs) for adults with intellectual disabilities and/or autism to avoid inpatient admissions, improve inpatient care quality and support timely discharge. CTRs are completed by an independent panel including an expert by experience, a clinician, and the commissioner. Since 2015, thousands of CTRs have been carried out. In a survey of ID psychiatrists involved in CTRs, many felt that discharge planning was limited by a lack of appropriate community placements. Proposed changes to the Mental Health Act indicate that CTRs should become statutory.

Our aim was to obtain the views of professionals working in intellectual disability services on the proposed reforms to the Mental Health Act and CTRs.

A mixed methods 34-item questionnaire exploring views of professionals working in ID services (n = 66) on the CTR process, their perception on its usefulness and the proposal to make CTR recommendations statutory. Survey shared with ID MDT professionals working in the UK. Of the respondents, 30% were psychiatrists, 29% psychologists and 21% nurses, with average length of mental health service of 18.2 years. More than 80% work in the NHS and most worked either in inpatient or forensic units.

Although in 80% of CTRs attended, patients have a current risk assessment and management plan, in less than 10% of CTRs attended were people ready for discharge and had a current discharge plan. In terms of CTR actions, 70% of the time, patients were receiving the right care, over 60% of the time, care was person centred, person's health needs are met and 50% of the time key areas of concerns were covered. In less than 40% of CTRs were the person's rights always upheld, family or carers always involved, medications being used appropriately or were there clear, safe and positive approaches to risk. Reasons for delayed discharges included no placement options (68%), no placement profile or community needs assessment (24%), placement funding disputes (23%), no agreed social care responsibility (18%) and no agreed community clinical care responsibility (18%). Only 7% of respondents felt CTRs were always useful, 44% felt they were sometimes useful and 23% often useful. Professionals had mixed views about whether CTRs should become statutory/enforceable (45%) versus those who did not (48%).

This is a survey with a relatively representative sample of MDT professionals involved in CTRs. It gives insight into the typical CTR process, duration, and professionals involved. It summarises the opinions of clinicians towards CTRs and their views on proposed changes.

RAMPPS (Recognising and assessing medical problems in Psychiatric settings) training was set up over a decade ago by the then Health Education Yorkshire and Humber Task Group of Clinical skills project workers. Main aim was to address the Physical health agenda in mental health. It was felt that the clinical and support staff in psychiatric settings lacked confidence in recognising and managing physical health issues early on, possibly due to inadequate training in this area. RAMPPS course was designed to address this gap. The course is set up as a face to face multidisciplinary, interprofessional simulation based training with simulated actors, mannequins and other hybrid teaching models .Like any such training, there is a constant need for resources, mannequins, simulated actors, space and funding which could limit the extensive use of this training. We adapted this face to face teaching model for virtual audience to deliver an interprofessional interactive adaptable teaching module using realistic scenarios.

We adapted some of the scenarios from the RAMPPS module which suited the virtual audience and incorporated into Power point presentation and using an interactive teaching software called Slido we developed Virtual RAAMPPS.

Conducted a few trial sessions within the team and later produced a sample scenario and presented to the medical education team at the trust. The main teaching is the interactive discussion whilst going through the scenarios allowing an impact as close to a face to face teaching as possible.

Next is to do a PILOT Virtual RAMPPS morning session delivered to a group of trainees (psychiatry and foundation trainees) and gather detailed feedback and continue to deliver the pilot teaching a few more times at other avenues and continuously modify the teaching based on the feedback.

Collecting Qualitative feedback from PILOT conducted.

The aim is not to replace simulation based face to face training, but to provide a near enough realistic virtual experience of real life scenarios and to think through them in a systematic and structured way thus enabling better management of some of the physical health dilemmas faced in our psychiatric settings.

It provides the multidisciplinary staff a functional working knowledge of common physical health conditions and its complications encountered in psychiatric setting. The teaching can be modified based on the audience by changing the scenarios relevant to that area of clinical practise or of the patient group.

Allowing anonymity in responses provides a non-judgemental and safe place to make mistakes and eventually improving patient safety and staff experience within Psychiatry.

The aim of the audit is to improve the patients’ experience in the ward round, to ensure all the patients feel included in their ward rounds, to find out if their physical health gets as much attention as their mental health and to establish they receive appropriate feedback of their treatment progress while being inpatient.

By carrying out the audit, our target was to ensure patients are prepared, that service users and carers are involved, clear goals are set, patient confidence is increased, there is direct patient interaction, and the ward round is a positive experience for both the patient and the care team.

This audit included 34 patients from our acute adult psychiatry mixed unit and perinatal psychiatry unit, who have had at least two ward rounds in the inpatient setting, have the capacity to consent to treatment and have insight to their mental health issues.

Data collection was done by a face to face patient interview with a questionnaire by the junior doctors in the wards. The questionnaire was discussed with the head of patient experience team and clinical audit & improvement facilitator team prior to starting the audit. Confidentiality was maintained and at no point were the patients requested to reveal their identity.

Among the patients admitted during the period of October 2022 to November 2022, 40 patients were chosen randomly. Among them, data was collected from 34 patients according to the inclusion criteria.

Based on the patients’ feedback and experience, 52.9% service users thought the ward round time tables ran by schedule, whereas 11.8% service users thought they did not run by schedule at all.

20.6% service users reported that they were not informed in advance, if there were any change in the ward round time schedule; whereas 41.2% service users were informed of the changed time schedule.

50% service users reported that they received appropriate support prior to the ward round should they need this, on the other hand 8.8% said they did not require any support, therefore refrained from answering the question.

Majority of the service users 94.1% reported that they were happy with the ward round physical environment, the sitting arrangement and the ambience and 88.23% service users reported being reviewed by the consultant at least once a week. None of the service users were found, who was not reviewed by the consultant at least once weekly during their stay in the inpatient wards.

47.1% service user reported that they did not feel confident and comfortable in front of all the professionals present in the ward round.

20.6% service users complained that their physical health was not getting as much attention as their mental health in the psychiatric wards and they were not referred for their physical health needs accordingly.

23.5% of service users had little to moderate understanding on what was being discussed in the ward round meeting, whereas 76.5% understood completely what was being advised in the ward round.

8.8% of the service users did not feel involved in their ward round at all and majority of the service users, 52.9% got regular feedback on the treatment progression and a chance to talk with their named nurse after the ward round.

Ward rounds are the formal meetings where service users come to the professionals with their queries and are informed about their progression on treatment. These meetings should be comfortable and palatable for both sides of the table. Further arrangements are required to improve the settings and make it more service user friendly to get the best outcome from ward rounds.