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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

41% of the attendees had raised BMI.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

• • Average journey 0.005t CO2

• • Total journeys 0.472t CO2

• • Assuming average sized petrol car used

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

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

The current system impacts on:

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

• • Clinician's travel time.

• • Carbon emissions.

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

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

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

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

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

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

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

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

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

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

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

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

1. 1) Identify the factors that shape alcohol consumption and accessing support for excessive alcohol consumption in the BSP community.

2. 2) Establish the current provision of alcohol-related education in the UK medical school curriculum and analyse if this is suitable to address alcoholism in the BSP community.

3. 3) Provide recommendations to be made to the curriculum to help medical students approach the issue of alcoholism in specific communities in a culturally competent manner.

Two narrative literature reviews were conducted. 37 studies were included. The first search underwent thematic analysis with reference to a Public Health England framework, and the second underwent inductive thematic analysis. Subsequently, the results from both searches were compared to produce appropriate recommendations.

Factors Influencing Alcoholism in the BSP Community

• • Experiences of racial discrimination result in psychological distress, and the need to acculturate to decrease this risk.

• • Loneliness, mainstream Punjabi music, and a decreased self-reported importance of religion.

• • The role of masculinity was emphasized, with both those who abstained and those who drink viewed as masculine.

Alcohol-related Education and Medical School

• • Alcohol use has increased among UK medical students.

• • The drinking habits of medical students are crucial to their own health, their clinical practice, and indirectly as role models in society for acceptable lifestyle behaviours.

• • Approximately 14 hours are dedicated to alcohol and drug-misuse teaching over the 5-year medical school degree.

• • Lack of alcohol-related-policies at UK medical schools.

• • Doctors’ negative attitudes towards patients with AUD were frequently reported.

• • Medical students are eager to learn about AUD.

Recommendations for the Medical School Curriculum:

• • Development of a comprehensive and supportive alcohol-related policy.

• • Pre-clinical teaching: seminars with an individual who has recovered from an AUD.

• • Clinical stage teaching: encourage students to write and present cases of patients with AUD.

• • Encourage the use of non-judgemental labels.

• • Lectures including speakers from voluntary AUD services.

• • Encourage Alcoholics Anonymous attendance for students.

Overall, the BSP population fail to access treatment services due to fear of shame and stigma. Medical schools have immense potential to make changes to their alcohol-related education to ensure that future doctors provide holistic care, leading to earlier detection and management of alcohol-use disorders. Recommendations were made with the intention of providing culturally competent services.

To identify if patients discharged from an older adult psychiatric ward were followed up in line with national recommended guidelines. Current National Institute for Clinical Excellence (NICE) guidelines recommend follow up and final discharge letters (FDLs) being available within 7 days of discharge.

A record search was conducted to identify all patients discharged from one ward during a one year period.

Each patient's notes were reviewed to identify what follow up they had in place and how long it took for this to be implemented. We also examined the time taken for a final discharge letter (FDL) to be made available to their General Practitioner (GP).

We identified 99 patients who were discharged from the ward within the specified period.

The mean time taken for patients to be followed up after discharge was 9.72 days. In 63.16% of cases this follow up was provided by Community Psychiatric Nurses (CPNs), with 51.58% being reviewed in medical clinic. A further 9.47% had their initial follow up with an occupational therapist, 4.21% with a psychologist, 4.21% with the addictions team, 4.21% with care home liaison, 2.11% with social work, 2.11% with continuing care and 1.05% with rehab.

FDLs were sent to GPs, on average, 13.6 days after patients were discharged.

Within our data set a few outlier values markedly increased the mean for both outcomes. Using median figures, average follow up time fell to 6 days, meeting national guidelines, and FDL time fell to 8 days, exceeding recommendations by just 1 day.

Within our department, measures have since been put in place to ensure secretaries are reminding medical staff of the recommended time frames for final discharge letters and it should be noted that an immediate discharge letter (IDL) is routinely sent to GPs containing key clinical information prior to patients being discharged.

The results show that our current practice does fall somewhat short of matching national guidelines and further work should be done to investigate how we can improve standards.

This study aims to explore the experiences of autistic adults who were previously diagnosed with Borderline Personality Disorder (BPD).

This interpretive phenomenological study aims to explore the experiences of autistic adults who were previously diagnosed with BPD. Data were collected using sixty-minute, one-to-one, virtual, semi-structured interviews. The audio-recordings of the interviews were transcribed and analysed using an interpretive phenomenological analysis.

Participants had autistic features since childhood which went unnoticed. Camouflaging, gender and lack of awareness of the spectrum nature of autism had contributed to missing autism in childhood. The commonality of trauma, suicidality and self-harm, in the context of wider systemic issues, resulted in participants receiving a diagnosis of BPD. It was revealed that the diagnosis of BPD was readily given and inappropriately disclosed. This diagnosis was emotionally damaging for participants and highly stigmatising. Treatment for BPD was inadequate, ineffective, and distressing. There were several negative impacts of the BPD label, including diagnostic overshadowing. Participants felt that misdiagnosis is preventable with various measures. Autism diagnoses were difficult to obtain in adulthood, but receipt of one was beneficial for participants in various ways. However, participants felt there was a need for more autism awareness and autism-friendly services.

The BPD label in autistic people can be harmful to their physical, mental and social health. In contrast, an autism diagnosis in adulthood can be beneficial despite the multiple barriers in receiving such diagnosis. Misdiagnosis is preventable by training clinicians, screening risk groups and developing dedicated autism services.

Background: Mental health policy is crucial for enhancing mental health and well-being. Despite the significant contribution of mental disorders to the global burden of disease, 68% of the countries possess a comprehensive mental health policy. This review aimed to identify similarities and differences between low-income countries' (LICs) and lower middle-income countries' (LMICs) mental health policies, along with key gaps, limitations, and strengths, to inform Pakistan's mental health policy.

We conducted searches on Google, the WHO Mental Health Atlas, and the country's Ministry of Health website for mental health and general health policies. Recent mental health policies were included from LMICs that were available in English, whether published or unpublished. Scholarly articles, commentaries, books, and health policies that did not address mental health were excluded. Data extraction covered document title, policy status, country, policy formulation process, human resources, suicide prevention, finances, health service delivery, governance, leadership, involvement of ministries, and implementation plans. We synthesized the data through a comparative narrative review in both text and tables.

Fifty percent (8/16) of LICs and sixty-five percent (17/26) of LMICs have health and mental health policies in English. These policies cover topics like psychiatric disorders, psychotropic drugs, forensic mental health, substance abuse disorders, and communicable and non-communicable diseases. Approximately 65% of LMICs' policies outline the structure of their federal or national government, and 59% provide information on provincial and local government structures. Most LICs include their vision, mission, and objectives in their policies.

Mental health is often neglected in the healthcare policies of LICs and LMICs. To reduce the burden of mental illness and prevent self-harm, suicide, and substance misuse disorders, the implementation of evidence-based mental health policies in line with the Sustainable Development Goals (SDGs) is crucial.

Promoting recruitment and retention in psychiatry is one of the core objectives for the Royal College of Psychiatrists and coaching initiatives are recognised as a means of improving retention. We developed a programme of medical coaching, available to all career-grade doctors in an NHS Trust in Northern England to support professional development. This overview describes the results of the first 4 years of the programme.

The setting was a large NHS Trust covering County Durham, Teesside and North Yorkshire employing around 150 consultants and 60 SAS psychiatrists (mean age = 49 years, 51% female). Coaching was promoted to all these doctors through the feedback form sent following their annual appraisal meeting. This coaching was later also made available to locally employed doctors and core and higher specialist trainees working temporarily in the Trust. The intervention was initially provided as a single session coaching event delivered by a consultant psychiatrist trained in medical coaching, and the programme evolved following requests from doctors. It was stated explicitly that the purpose was professional development, not an attempt to retain doctors considering their future. The outcome was measured using a post-coaching questionnaire.

Data was collected from coaching delivered from May 2019 to January 2024. 145 doctors (84 consultants, 23 SAS doctors, 6 Trust doctors, 26 training-grade doctors, 6 grade not-stated) took up the coaching offer. 524 sessions were provided in all. The mean (SD) number of sessions was 3.8 (3.7), for consultants 3.5 (3.9) and for SAS doctors 4.8 (4.4). 48 doctors accessed a single coaching session. 56% of the career-grade doctors receiving coaching were female. Data was collected from 127 post-coaching questionnaires with 116 strongly agreeing and 11 agreeing with the statement that the coaching provided was useful and many reporting a positive impact on well-being.

Findings show that the programme was popular with the medical workforce, with about half of career grade psychiatrists taking up the offer. It evolved following requests to both provide follow-up sessions and to extend the offer to trust doctors and trainees. The sessions were highly valued by the doctors with reported benefits to their well-being, but we cannot measure the impact on retention. The programme is valued by the Trust with an intention to make the programme sustainable into the long term and it now forms part of the Trust's medical workforce charter.

To improve the detection of delirium amongst patients aged over 65 in Queen's Hospital, and then incorporate a clearer management pathway for these patients to be treated safely with more appropriate intervention and better follow up care. As part of the management pathway, the aim was to increase the delirium referrals made to the local Dementia and Delirium Team for quicker implementation and education regarding non-pharmacological interventions in treating delirium, whilst ensuring that Psychiatric Liaison Service (PLS) referrals for delirium were also appropriate.

A multi-phase approach to quality improvement and service development for patients with delirium has been adopted, and the first step is to improve the screening of patients over 65 years old with delirium and then to refer to appropriate teams accordingly. Our first intervention was changing the PLS referral form. It has been simplified with less input data required, and now includes a mandatory 4AT screening score for delirium, as well as a mandatory referral to the Dementia and Delirium Team for any patient with positive screening for delirium. The intervention was implemented in November 2023, with pre and post intervention data collected in October and December 2023 respectively. Data was collected prospectively and retrospectively using medical notes.

Queen's Hospital PLS received a total of 60 older adult referrals in October 2023 and 49 referrals in December 2023, of which the total proportion of referrals diagnosed with delirium was 47% and 35% respectively (12% absolute reduction). The proportion of patients referred to the PLS team with delirium, who did not require further intervention after initial assessment, had reduced by 29% (87% to 58%). The proportion of patients with delirium referred to PLS, who had also been appropriately screened and referred to the Dementia and Delirium Team prior to PLS assessment, has also increased by 4%. There has been a marked increase in total delirium referrals to the Dementia and Delirium team after intervention, from 31 referrals in October to 85 referrals in December (174% increase).

There is an improvement in screening for delirium, with marked increase in referrals made to the Dementia and Delirium team. There is a decrease in uncomplicated delirium referrals who do not require further PLS intervention and can be appropriately managed with the Dementia and Delirium team input.

The COVID-19 pandemic has significantly impacted healthcare systems, economies, and global health, raising concerns about its potential effects on mental health. A recent systematic review found a 40% prevalence of poor sleep quality, with 34%, 26%, and 27% prevalence for psychological distress, depression, and anxiety. The systematic review investigated COVID-19-related stress, suicidal ideation, and self-harm thoughts among low- and lower-middle-income countries (LLMICs).

We search four electronic databases (PsycINFO, Medline, Embase, and PubMed). Quantitative studies, including both published and grey literature, from LLMICs focused on the prevalence of suicidal ideation or psychological distress during COVID-19 were included. Qualitative studies, non-English studies without full-text English translation, meta-analysis, commentary, books, and discussion articles were excluded.

1157 titles and abstracts were screened for inclusion and exclusion, resulting in 79 full-text articles. After full text screening, 11 articles were included. In Bangladesh, 12.8% of university students reported suicidal ideation (SI), while 19% of young adults had SI, and 18.5% reported suicidal planning. In addition to this, in Iran, 12.8% of pregnant women and in the Philippines, 24.9% of the general population reported SI. Mental health conditions like depression and anxiety, female gender, younger age groups, economic loss or financial stress, fear of COVID-19 infection, lack of social support, family problems, lower education levels, smoking, and substance use are identified as risk factors. Moreover, anosmia and dysgeusia symptoms were associated with a 30–80% increased risk of transitioning to suicidal ideation or depression in India. A study from Nepal reported a 44% increase in suicide attempts during lockdown compared with pre-pandemic periods in Nepal.

The findings of this review suggest that the impact of the COVID-19 pandemic on mental health in LLMICs is substantial. In addition to the increased risk of SI and suicide attempts, there was a significant rise in depression and SI associated with anosmia and dysgeusia symptoms. These results underscore the urgent need for increased psychosocial support in LLMICs to address the growing mental health burden caused by the pandemic. Moreover, understanding the long-term effects of the pandemic is crucial for developing effective interventions and support systems. Further research is needed to examine the lasting impact of the pandemic on mental well-being and identify future strategies.

The project aims to evaluate the referrals from North Kent for admission to our PICU from April to November 2021.

Hypothesis:

There are very few surveys of PICU referrals. We expect more referrals for younger men with psychotic illnesses and comorbid diagnoses; to be for aggressive behaviours; and most will be admitted to acute wards with ongoing support from the PICU liaison team.

Our PICU services in the trust include one 12-bedded male PICU, 5 contracted female PICU beds and the PICU liaison service. PICU liaison team ‘gatekeep’ the PICU beds for patients meeting the admission criteria and supporting the other referrals’ admissions to non-PICU acute beds by working closely with the staff and patients on these wards.

Data was collected for all referrals for PICU admission made to one of the three PICU Liaison practitioners in North Kent from April to November 2021, recording the demographics, clinical information and outcomes.

There were 126 referrals in this time period, of which 68% were males. 38% were aged 18–30 and 25% were 31–40 years old.

43% of referrals were from inpatient acute wards, 21% from community, 21% from other settings and 7% from Places of Safety. 75% of the referrals were detained under the Mental Health Act.

The primary diagnosis was Schizophrenia in 25%, Bipolar Affective Disorder in 25%, Schizoaffective Disorder in 13%, Personality Disorders and Substance misuse related disorders were 7% each. 32% of the referrals had a comorbid diagnosis; 43% of which was substance use related, 23% had personality disorder and 34% had other conditions including neurodevelopmental disorders.

42% had previous admissions to PICU and 52% had forensic history.

Reason for referral was aggression in 76%; 10% did not have any indications for PICU and 18% was for current or recent prison stay.

30% of the referrals were admitted to PICU and 58% were either admitted to or remained on the acute wards with support from PICU Liaison Team. While 5% were diverted to the forensic pathway, 7% remained in the community.

In conclusion, the data shows patients referred for PICU admission were more likely to be young men with aggressive behaviour and a primary psychotic illness, using illicit substances. Most referrals came from the inpatient wards as is to be expected. They were also more likely to have previous PICU admissions and a significant forensic history.