The Personality Disorder Service in the Northern Health & Social Care Trust was originally set up to deliver evidence-based treatment for people with the diagnosis of personality disorder. This group of people historically have been stigmatised, excluded and let down by services, despite their complex needs and frequent history of childhood trauma. The team developed a Mentalization Based Therapy (MBT) programme originally commencing in 2013.

To identify recent completers of the MBT 2 18 month programme and to assess whether there was any reduction or change in pattern to the number of days spent as inpatient both during and after having completed the programme, whether there was a reduction in the frequency of same day assessments with community mental health teams or unscheduled care and finally whether there was any reduction in terms of volume of crisis assessments and presentations to Emergency Department.

Using validated Quality Improvement Methods, a Plan Do Study Act Cycle was commenced which involved identifying patients who had begun and finished the MBT programme and minimum of 12 months had passed since completion in order to follow-up.

We then broke down this data into 3 domains. By using EPEX, Paris and Electronic Care Record computer systems, it was possible to analyse days spent as inpatient, same day assessments and crisis assessments as well as Emergency Department attendance.

For these periods of time, they were split into pre-commencement of programme (18 months), during programme (18 months) and post-completion of programme (12 months) to see if there was any tangible decrease in these numbers.

19 service users were identified that had initially been referred to Personality Disorder Service between 2016 and 2018 and who subsequently began MBT2 programme between 2017 and 2019. Given the length of completion of the programme, this allowed us to gather a full set of data with regard to these patients up to completion of programme in 2021. Subsequent period of 12 months was then analysed post-completion of treatment taking us up to 2022.

The average time spent in inpatient admission days prior to starting therapy for 18 months (n = 19) was 21.74 days, this decreased to 6.53 during therapy and 3.68 post-therapy (12 month follow-up) = 5.52 adjusted for 18 months. This represents a reduction of 74.61%.

The average number of same day assessments and unscheduled care (n = 8) seeking prior to admission was 1.38. This decreased to 0.75 during therapy and 0.88 post-therapy adjusted to 1.32 for 18 months, which represents a small decline of 4.35%.

Finally, the average number of Crisis contacts and Emergency Department assessments were 2.63 in the 18 months before commencing therapy, 1.26 during therapy and 0.58 in the 12 months post-therapy, 0.87 adjusted for 18 months. This represents a reduction of 66.92%

It is clear from analysis of the data that there has been a substantial decrease in time spent as admitted inpatient as well as number of contacts with Crisis Assessors and Emergency Departments in association with completion of the MBT 18 month programme.

This demonstrates that, by using an evidence-based and well-established programme, which carries a high time commitment for both service users and practitioners, it is possible to considerably reduce use of other, more acute services and keep patients with a diagnosis of EUPD out of hospital longer and on a sustained basis and also to reduce presentations to Emergency Departments which was often on the basis of self-harm and/or overdoses.

The dual result is that it can be validated objectively that service users are suffering less distress after having completed the programme, which will lead to better quality of life, whilst also reducing the burden on costly inpatient services with the end result being an important investment in mental health services in Northern Ireland and the prototype for the developing regional service.

Irritability is a common symptom in children and adolescents, often resulting in referral to mental health services and is associated with depression. Depression in adolescents and adults at familial risk of, and with depression, is associated with reduced risk-taking on the Cambridge Gambling Task (CGT) particularly when the chance of winning is high. However, little is known about risk-taking in irritability. This study tests the hypothesis that increased irritability is longitudinally associated with later risk-taking behaviour on the CGT; specifically, that increasing irritability is associated with lower risk-taking when the chance of a favourable outcome is high.

We conducted a longitudinal study of the biological offspring of parents of children with depression (n = 337). Irritability, the exposure, was measured at wave one using the Child and Adolescent Psychiatric Assessment (CAPA). The primary outcome was risk-taking to obtain reward at varying probability ratios (6:4, 7:3, 8:2 and 9:1) measured by the Cambridge Gambling Task (CGT) at waves two and three. We investigated the longitudinal association between irritability at wave one and average risk-taking at each ratio across waves two and three using multi-level models. The extent to which risk-taking according to probability ratio varied with irritability was tested with interaction terms. We ran univariable models and then multivariable models.

In univariable (n = 207; Coef. 0.006, 95%CI −0.011–0.023, p = 0.470), and fully adjusted (Coef. 0.011, 95%CI −0.007–0.029, p = 0.213) models there was no evidence of a main association between irritability and risk-taking on the CGT. There was evidence of an interaction between irritability and risk-taking ratio (p = 0.019). In fully adjusted models including the interaction, a one-point increase in irritability was associated with relatively higher risk-taking at the less favourable ratios (6:4 – 0.018 (95%CI −0.002–0.037) and 7:3 – 0.015 (95%CI −0.005–0.035)) relative to the more favourable ratios (9:1 – 0.001 (95%CI −0.019–0.021) and 8:1 – 0.011 (95%CI −0.008-0.031)).

We found no evidence of relationship between irritability and subsequent risk-taking on the CGT overall. However, there was some evidence that those with higher irritability were relatively more risk-taking when less likely to win compared with when a favourable outcome was more likely. These findings warrant further investigation of the association between prior irritability and later depression in a larger community cohort. If prior irritability and depression are both associated with risk-taking, this strengthens the case for focussing on risk-taking as a potential target for preventive intervention.

The audit aimed to study missed seizure frequency, management, and restimulation rate at NHFT's ECT clinic.

We conducted a retrospective analysis of ECT treatments administered between October 1, 2021, and March 21, 2023, collecting data on stimulation frequency and doses, duration of motor seizures and EEG activity, and patients' demographics. The study compared current practice with the NHFT ECT protocol, which defines missed seizures as treatments failing to induce convulsions and EEG activity. Management entails restimulation at least once or twice according to the stimulus dosing protocol during the seizure-threshold (ST) determination phase or by increasing the dose by 10% (50 millicoulombs) during the treatment phase, alternatively recording reasons for not re-stimulating. The ratio of missed seizures to total stimulations was used to determine the missed seizure rate, and the ratio of total restimulations to missed seizures was used to calculate the restimulation rate.

The clinic provided 268 treatment sessions and 26 courses of bilateral ECT to 23 patients aged 17–84 years, primarily female (60%) and Caucasian (74%), with a 12.6% missed fit rate and a 67.5% restimulation rate. Thirty missed seizures occurred during the initial ST determination phase, with twenty-two restimulated. Four of these could not be restimulated due to the maximum limit of three stimulations per ECT session. Seven missed seizures occurred later in the treatment phase, with three restimulated. For restimulations during the seizure-threshold determination phase, only eight of the twenty-two restimulation doses matched the stimulus dosing chart, and over half of these patients were stimulated at a lower-than-recommended dose. Once a seizure was generated and the threshold was identified, suboptimal maintenance doses were chosen, with 47% of patients stimulated on the same dose and 37% on doses only marginally over the ST in consecutive sessions. During the treatment phase, two out of three restimulations were performed with a dose lower than the specified 10% increase. The reasons for deviating from the guidelines were not documented.

National audits of ECT clinics in 1981 and 1992 showed 50% and 25% missed seizure rates, respectively. Bridgend ECT Clinic maintained a missed fit rate of ≤5% over a 6-year period, which is half that of NHFT. Missed seizures have been associated with treatment failure and post-ECT adverse effects; hence, to effectively manage them, we propose that all ECT administration personnel be familiar with the NHFT ECT protocol, including the stimulus-dosing protocol, and document any clinical grounds for deviations.

In line with the 2023 legislative change and move to the New Standard of CESR, this will be an informative and educational presentation directed at CESR applicants, and Local Trusts who wish to implement support for CESR. With this suite of support we aim to dispel concerns relating to CESR.

Mapping guidance to the New Standard of CESR. Production of College guidance in line with the legislative changes, to support success in CESR. Building a CESR Network for all stakeholders.

Delivery of training, a suite of guidance and CESR Roadshows across the four nations.

Creating awareness and spreading communication. Ongoing support for Applicants, Trusts and other CESR stakeholders. Clarity for Applicants, particularly in relation to which Cohort to select, what evidence to include and how to submit a successful application first time.

Psychosis is a common neuropsychiatric symptom associated with Parkinson's disease (PD), with prevalence rates of up to 75%. Parkinson's disease psychosis (PDP) is associated with increased morbidity, caregiver burden, depression, poorer quality of life and progression of dementia. It has also been shown to be a strong predictive factor for long term care placement, and results in up to 71% increase in risk of mortality compared with PD patients free from psychotic symptoms. Use of antipsychotics for PDP is common, with up to 35% of PD patients prescribed at least one antipsychotic within 7 years of PD diagnosis. This systematic literature review aims to search, appraise and synthesise the best available and most up-to-date evidence for the use of antipsychotics in the treatment of PDP, and their effects on PD motor symptoms.

We carried out a comprehensive literature review and meta-analysis following the PRISMA statement for systematic reviews.

Four studies investigated quetiapine, three investigated olanzapine, two investigated clozapine and a further two investigated pimavanserin. Both quetiapine and olanzapine showed no significant improvement for PDP over placebo, however meta-analysis of olanzapine groups showed significant motor worsening, UPDRS +2.89 (95% CI 1.22 to 4.56) compared with placebo. Clozapine showed a significant improvement in psychosis vs placebo in both studies, with a large effect size in their primary outcome measure; -0.82 (95% CI -1.37 to -0.26), -0.89 (95% CI -1.42 to - 0.36). Pimavanserin showed significant improvement in psychosis vs placebo -0.48 (95% CI -0.77 to -0.18). Quetiapine, clozapine and pimavanserin showed no significant worsening in motor scores vs placebo group.

Although Olanzapine and Quetiapine are commonly used to treat psychotic symptoms in Parkinson's Disease, the only medication with robust evidence is Clozapine. This finding may have implications for service delivery.

• • Identify themes in experience of Postpartum Psychosis (PP) recovery in Mother and Baby Units (MBUs) from the perspective of mothers, partners and MBU professionals.

• • Develop a Conceptual Framework of recovery from PP in the MBU setting.

Systematic review using published and unpublished literature identified through database searches and grey literature sources. A narrative synthesis approach was taken and used to form a Conceptual Framework of recovery from PP in the MBU setting.

Four databases were searched, yielding 8 includable studies. A further 3 grey literature sources met the inclusion criteria. Most of the sources focussed on the womens' experience of recovery.

Stakeholders experienced MBUs as providing a positive therapeutic milieu for recovery. The broad themes identified for improvement encompassed: knowledge of PP, accessibility of services and discharge practises.

This review provides valuable insights into the experience of recovery from PP within UK MBUs from the perspectives of multiple stakeholders. Areas for improvement identified include antenatal education on PP, knowledge of PP amongst non-specialist healthcare professionals, partner involvement in care, and discharge processes.

The outcomes of this review have the potential to shape the design, implementation, and expansion of MBUs and their practices both nationally and internationally.

To review compliance with current blood monitoring guidelines of Older Adult Community Mental Health (OACMHT) patients who are on clozapine within the community teams of Herefordshire and Worcestershire Health and Care NHS Trust. This is for full blood count, prolactin, glycated haemoglobin (HbA1C), liver function, renal function, lipid profile, glucose, and clozapine assay.

Our trust guidelines state the following blood parameters should be monitored every 6 months:

1. 1. Full Blood Count (FBC)

2. 2. Glucose (fasting if possible)

3. 3. Prolactin

4. 4. Urea & electrolytes (U&E)

5. 5. Lipid profile (fasting if possible)

6. 6. Liver Function Tests (LFT)

7. 7. HbA1c (annually)

8. 8. Clozapine plasma assay (annually)

We reached out to the medical secretaries of the following OACMHTs: Wyre Forest, Malvern Evesham & Pershore, Worcester & Droitwich, Redditch & Bromsgrove to collate a list of patients on clozapine. We then retrospectively looked at blood test results in the past 1 year from 31.12.22 to 31.12.23 and assessed compliance of the 8 haematological parameters.

In total, 7 patients were identified across the 4 OACMHTs caseloads who were on clozapine. In the past 1 year, we would expect 2 episodes of monitoring for FBC, Glucose, U&E, Prolactin, Lipid profile, and LFT, as well as 1 episode of HbA1C and clozapine drug levels.

Compliance for FBC monitoring for 2 episodes was achieved for 100% (n = 7) of the patients. Compliance for 2 episodes of glucose and prolactin monitoring were 0%. Compliance for 2 episodes of renal profile monitoring was 57% (n = 4), but 86% (n = 6) of the patients had at least 1 episode of renal profile monitoring. Compliance for 2 episodes of Lipid profile monitoring was 0%, however 43% (n = 3) of the patients had at least 1 test. In terms of LFTs, 71% (n = 5) of the patients achieved the expected 2 episodes of monitoring, and 100% of them at least 1 episode of monitoring. For HbA1C monitoring, 100% of the patients had the expected 1 episode of monitoring annually. For clozapine plasma levels, 43% (n = 3) of the patients achieved their expected annual episode of monitoring.

An interesting observation of note was that a number of blood parameter investigations were performed by GPs/hospitals as part of another investigation, not exclusively for the sole purpose of clozapine monitoring. For example, 50% of the U&Es, 33% of lipid profiles, 71% of LFTs, and 43% of HbA1c tests were done by the GP/hospital.

The OACMHTs within our trust achieved 100% compliance with FBC and HbA1c monitoring in the past 1 year. 71% compliance was achieved with LFT monitoring, 57% was achieved with U&E monitoring and 43% compliance was achieved with the annual clozapine monitoring.

With regards to tests done by GP/hospitals, on one hand, repeated phlebotomy of patients would come with increased direct medical (equipment, facilities) and non-medical (time) cost to service and intangible costs (pain) to patients. It would also not be cost effective to repeat these tests if done recently. Hence one could use recent test results as part of their monitoring routine. However, if these patients do not happen to see their GPs or have a hospital admission for unrelated issues, would they have missed their ideal monitoring targets? This unpredictability of timely monitoring raises the question of whether there is a need for the creation/standardisation of clozapine clinics within the OACMHTs, especially if the clozapine patient caseloads continue to grow.

There is still little information available on the negative impact of online activities on psychotic experiences. This limitation is further compounded for online gaming, where even a beneficial impact has been suggested via the evocation of positive emotions. We aimed to examine how problematic online gaming (POG) is associated with subsequent psychotic experiences in adolescents.

This birth cohort study employed randomly sampled adolescents born between September 2002 and August 2004. The eligibility criterion was those who did not have psychotic experiences at age 14. We analyzed the association between POG at age 14 and subsequent psychotic experiences at age 16. Adolescents were categorized into the no, low, and high POG groups based on the behaviors and emotions related to online gaming at age 14. Missing data were handled using random forest imputations.

A total of 1722 adolescents without psychotic experiences at age 14 were analyzed. At age 16, 55 adolescents exhibited psychotic experiences, while 225 showed potential psychotic experiences. Compared with the no POG group, a higher risk of psychotic experiences was shown in both the low (RR 1.93, 95% CI 1.74–2.15) and high (RR 2.81, 95% CI 2.50–3.15) POG groups. Findings were consistent when analyzing potential psychotic experiences.

POG appears detrimental to the development of psychotic experiences in adolescents. Our findings provide public health implications in the context of policymaking.

Background. The importance of the social determinants of health (SDOH) is increasingly recognised. However, medical students are taught about them as epidemiological facts. We established a programme in North Wales involving prison placements for medical students, accompanied by specific teaching to contextualise SDOH to individual patients’ mental health problems. This is being evaluated over a four-year follow-up. We report findings of qualitative evaluation of the second-year cohort.

Individual interviews with students and free text data from questionnaires were analysed thematically.

Previous teaching about SDOH:

• • “You do not understand until you see it in your own life. Lectures do not always deliver a point.”

• • “Mentioned but not very explicit session like here.”

Baseline knowledge and attitudes to SDOH

• • “I knew mental health and social determinants are a lot intertwined, but I would not have thought of it in such depth before coming here.”

• • “I knew what SDOH were, but I have not seen it on this scale.”

• • “Some students related the teaching to their personal experience of hardship.”

Prison placement

Impact of the placements

SDOH incorporation into medical education

In previous publications, we reported positive responses to prison placements. By integrating a module about SDOH, students can develop a broader understanding of health and gain the awareness needed to address these factors in clinical practice.

1. 1. To measure the extent to which medication orders in inpatient prescription charts conform to the section in BNF (British National Formulary) on prescription writing.

2. 2. To implement changes with the intention of improving prescriptions and administration records.

Prescription charts of patients admitted in adult male and female psychiatry ward were analysed in three cycles, (1 September to 20 October 2022, then 1st December to 31st 2022 and then: 1st January 2023 to 28th February 2023) which added up to a total of 431, 170 and 490 prescriptions in respective cycles.

Each drug prescription was examined to see if it met the standards outlined in BNF.

Percentage of prescriptions meeting each standard was calculated in each cycle.

First Cycle was followed by presentation of BNF guidelines of prescription writing on 7th December 2022 and copies of those BNF guidelines were placed at both male and female nursing counters. After 1 month, a short re-audit was done to assess the improvement which was satisfactory but this audit's results were not presented. Lastly, after one year of presentation of BNF guidelines in the department, two months of prescription charts were re-audited in cycle 3.

• • Cycle 1: Initial evaluation revealed significant discrepancies in prescription accuracy and adherence to administration protocols. Key areas for improvement were identified and discussed with the postgraduate residents.

• • Cycle 2: Following the implementation of targeted interventions, a re-evaluation showed measurable improvements in prescription accuracy and compliance with administration protocols. However, areas for further improvement were still identified, particularly in the documentation of prescription changes.

• • Cycle 3: The final cycle demonstrated further improvements in prescription practices, with a significant reduction in discrepancies and errors.

• • Legibility remained high across all cycles, with a slight improvement in Cycle 3.

• • The use of generic drug names saw a remarkable increase from 40.6% in Cycle 1 to 84.69% in Cycle 3, indicating a strong adherence to best practices.

• • Block letters usage improved significantly from 17% in Cycle 1 to 71.42% in Cycle 3, enhancing the clarity of prescriptions.

• • The practice of providing a start date saw near-perfect compliance by Cycle 3, increasing from 82.8% in Cycle 1 to 99.18%.

Other findings were similar as well.

The audit successfully demonstrated the effectiveness of clinical audits in improving prescription quality in male and female adult wards. It highlighted the effectiveness of the interventions and the importance of continuous monitoring and feedback.

Climate change, and the effects thereof, present challenges in all domains of life. Mental wellbeing is an often-overlooked area when considering the direct and indirect impact of climate uncertainty. Worrying about the outcome of current and future climate events and experiencing distress at the perceived lack of action taken by world leaders has given rise to reports of climate anxiety. Whilst not a diagnosable psychiatric illness, individuals experiencing climate anxiety report to experience excessive worry and fear that may impair activities of daily living. In addition, anxiety over the climate and environmental matters may exacerbate existing conditions such as generalised anxiety disorder (GAD).

In an effort to raise public awareness of climate anxiety, a leaflet was designed by medical students for dissemination in General Practice surgeries, along with an interactive electronic version of the leaflet being made available for online dissemination. The World Health Organization's (WHO) guidance on health literacy in empowering communities and diverse audiences was adopted in the design of the leaflet. Key information was reported using interactive means that enabled the audience to engage with the content of the leaflet and to consider the impact of climate anxiety on mental wellbeing. A survey was embedded at the end of the leaflet, using a QR code, to collate feedback from the public and from clinicians on the usefulness and educational value of the leaflet.

The leaflet was shared with General Practitioners affiliated with the School of Medicine at Cardiff University, to disseminate at their surgeries, and was promoted by online and social media channels affiliated with the School of Medicine. Members of the public reported that the leaflet highlighted the importance of mental health considerations in relation to the climate crisis and provided a good overview of climate anxiety. Clinicians also reported the overall usefulness of the leaflet as a resource of information on climate anxiety.

Climate anxiety is a relatively new phenomenon that most people are not familiar with or know little about. Raising public awareness of the impact the climate crisis might have on mental wellbeing is crucial. Of equal importance is improving clinical awareness of climate anxiety as a risk or perpetuating factor of existing anxiety and/or mood disorders, such as GAD.

• • Study current practices in Old Age Psychiatry (OAP) wards regarding Do Not Attempt Cardiopulmonary Resuscitation (DNACPR) documentation.

• • Create an intervention to improve compliance with Scottish Government guidance.

Hypothesis:

• • An intervention could improve likely inconsistencies in current DNACPR practices.

Background: DNACPR forms are a contentious issue in the media, impacting patients and families’ views. The Scottish Government's ‘Cardiopulmonary resuscitation decisions – integrated adult policy: guidance’ from 2016 seeks to prevent inappropriate attempts at CPR and subsequent distress to patients and families. It makes various recommendations for clinicians when making these decisions and completing DNACPR forms.

This was a two-cycle retrospective audit utilising physical and electronic notes for all patients across two OAP wards at the Vale of Leven Hospital, Alexandria. Data were collected on demographics, presence and adequacy of DNACPR forms based on Scottish Government guidance. Between the first (12/09/22) and second (25/11/22) cycle, a poster to aid DNACPR decisions and documentation was created and displayed in the ward office.

There were a total of 13 patients in cycle 1 and 14 patients in cycle 2. The number of patients with forms increased from 3 to 8 between cycles (including all those with organic diagnoses in cycle 2). Between cycle 1 and 2, there were improvements in the proportion of forms: completed at admission (66.7% to 87.5%, respectively), correctly filed (66.7% to 100%), with review timeframes specified (0% to 62.5%) and consultant signatures (33.3% to 100%). The mean age of patients with DNACPR forms was higher than those without forms in both cycles (86.7 and 85.7 in cycle 1 respectively versus 77.9 and 77.7 in cycle 2). The mean number of comorbidities did not vary significantly between those with and without forms or between cycles.

The project revealed various shortcomings in DNACPR practices across both wards. The creation of a poster intervention helped to improve DNACPR practices and compliance with Scottish Government guidance. Despite this, notable areas for improvement still remain. Incorporating these new practices into hospital policy alongside more audit cycles could aid further progress in outstanding areas for improvement.

The aim of the audit was to assess compliance with prescribing standards for antipsychotics in patients with BPSD as outlined within NICE guidance and with trust policy, Physical Health Monitoring of Patients Prescribed Antipsychotics.

The Bannerjee report published in 2009 highlighted the problem of inappropriate use of antipsychotic medication in the treatment of patients with behavioral & psychological symptoms of dementia (BPSD).

When antipsychotic use is considered appropriate, good practice is imperative to minimize risk and ensure optimal outcomes for patients. This audit looked to assess whether the use of antipsychotics in patients within CTT with a diagnosis of dementia adhered to best practice standards as outlined by the Bannerjee report and NICE guideline. The audit looked to assess adherence to physical health monitoring requirements as per trust policy for patients prescribed antipsychotics. Currently, there is limited guidance around monitoring of antipsychotics for use in BPSD as they are not licensed in the longer term.

A retrospective audit was undertaken for patients under the care of CTT between September 2020 and September 2021. 49 patients were prescribed an antipsychotic for BPSD.

Within the sample, 84% of patients were prescribed an antipsychotic at 12 months, 94% at 6 months and 98% at 3 months.

Compliance with the Audit standards showed: 82% of the patients had capacity assessed and documented prior to initiation of an antipsychotic.

98% of patients and/or carers had adverse effects of antipsychotics reviewed.

The risks and benefits of antipsychotics are discussed with the patient and/or carer(s) prior to antipsychotic initiation (94%). In 92% of patients, non-pharmacological interventions are tried prior to initiation of an antipsychotic. Clinical indications (target symptoms) are clearly documented (100%).

Although good prescribing practice was demonstrated, there was an area of concern due to a lack of compliance with physical health monitoring requirements. Most patients were prescribed an antipsychotic for longer than the licensed treatment period.

Agreed Actions:

Discussion with all professionals to emphasise the necessity for effective communication and a documented care plan for antipsychotic monitoring and review.

Present and disseminate audit findings within locality groups and wider teams.

Simulation-based education (SBE) is widespread in both undergraduate and postgraduate medical education, but less frequently in psychiatry. Despite this, the relatively small evidence base suggests high levels of participant satisfaction and educational benefit from SBE in psychiatry. Bringing SBE into the virtual environment presents another set of challenges we identified both through current medical education research and through our own experience. Our poster will demonstrate our current model of virtual simulation, the evidence base we used to develop this, and the feedback we have had from this new venture.

Background – As part of our undergraduate CAMHS teaching, where students spend 1 week within our service as part of a 3-week psychiatry clinical placement, we provide a single session of CAMHS SBE. This is delivered by 2 facilitators and a professional medical actor providing the role of the adolescent patient. Our virtual simulation teaching session has now been integrated into our teaching program. We have developed this session in line with current medical education research, and have presented this at the Annual Medical Education Conference and integrated feedback on our session into the current model.

We have successfully adapted this session to be delivered remotely, and have received overwhelmingly positive feedback from our students, citing improvements in their confidence and learning after our session. Along with the challenges to engagement, participation, and patient involvement of remote teaching, we further adapted our session to accommodate increased numbers of students attending – a national trend. However, from current research and our experience, there are also benefits to both educators and students from virtual SBE.

Our results show that simulation can be used effectively in psychiatry through virtual media to expand student clinical experience and provide excellent educational opportunities. We present our model for virtual SBE and the evidence base we have used to develop this session, along with the feedback we have had from students, staff, and teams across the country.

The scandal of sub-postmasters wrongly accused by the post office of offences relating to the faulty IT Horizon system is of ongoing media prominence.

Since May 2021 I have undertaken personal injury medico legal assessments at the request of a solicitor representing those falsely accused and convicted of offences by the post office. Their convictions had been quashed in the court of appeal.

I interviewed fourteen individuals, age range 35 to 70 years, five women and nine men. Ten had brought claims for Malicious Prosecution. The remaining four sub-postmasters were part of the historical financial shortfalls scheme set up for those who had not been prosecuted but were applying for compensation.

Of the ten convicted sub-postmasters, four spent periods in prison and the remaining six were given suspended or community sentences. Those in prison were often separated from young children by distance or withholding family members.

I assessed to what extent and in what way their mental health and that of their families had been adversely affected as a result of their experiences.

Assessments were undertaken remotely, including speaking with a family member.

ICD 10 diagnostic criteria were used.

All of the cases revealed evidence of psychopathology at the time of the allegations or convictions and continued to varying degrees subsequently.

A diagnosis of PTSD was made in five cases, Adjustment Disorder in 2 cases, Dysthymia in one case and depressive illness in eight cases. In only four cases had the disorders resolved.

Four of the five cases of PTSD had evidence of a past psychiatric history prior to becoming sub-postmasters. Past history included depression, impulsive overdose, eating disorder, problems related to gambling and abuse of alcohol and cocaine.

Both sub-postmasters who had been accused of taking money due to faulty software and those who had been wrongly convicted had high rates of psychopathology.

These findings are consistent with the only other study of the psychological effects on sub-postmasters which found high rates of psychopathology in both accused and convicted individuals.

Existing diagnostic criteria were limited in capturing the suffering of individuals who had endured such complex trauma so a narrative description including the effects on family members was also used.

This study of the mental health of falsely accused sub-postmasters demonstrates a high degree of psychopathology which may require therapeutic intervention.

The project aimed to review the Trust Medical Appraisal policy and offer a platform to update the Trust policy locally and align it to a National recommendation in the Medical Appraisal Guide besides gathering consensus for change for other relevant issues to the Trust.

The project was undertaken as a part of the ‘Leadership and management fellowship Scheme’ sponsored by the Tees Esk and Wear Valley NHS Foundation Trust and conducted in collaboration with the Royal College of Psychiatrists, UK and Faculty of Leadership and Management, UK 2022–23 with data collection lasting from January till August 2023. The methodology consisted of drafting a document comparing the information from the review of the existing Trust medical appraisal policy and the guidance in the Medical Appraisal guide, drafting a questionnaire which covered the complex issues in the appraisal process and where the Trust medical appraisal policy was identified as having gaps which required further opinions to be generated for a possible revision to the policy, and gathering consensus opinions from focus group discussions for different groups of staff which included appraisers who are not managers, consultants who are not appraisers, medical managers who are not appraisers, consultants who are appraisers and SAS doctors who are not appraisers. The focus groups were conducted virtually as well as face to face groups and consensus opinions were then synthesised with information available from the guidelines to draft recommendations. The recommendations were then presented to the senior managers in the Trust appraisal process to seek feedback and approval.

The main recommendations that followed from the review were: to promote supportive and developmental nature of the appraisal process by making the process less document intensive by modifying appraisal portfolio and appraisal sections, educating staff on not duplicating information, promote verbal reflection, and modifying corporate supporting information section to reduce burden on doctors; maintaining 3 year appraiser turnover; avoiding line manager to be the appraiser of the appraisee; not sending appraisal summary to the line manager and considering how to facilitate communication and input of the line manager to the revalidation decision; clarifying requirements of supporting information for appraisal of particular group of doctors (Trust doctors, International Medical Graduates (IMG), academics, and on zero hour contracts); expand corporate supporting information to include General Medical Council (GMC)/Trust disciplinary and low level concerns; to promote wellbeing discussion by adding prompt for doctor to comment on their wellbeing; adding a wellbeing statement to the appraisal template and finally to add trainer accreditation statement to the appraisal template to facilitate reporting of trainer accreditation. Most of the recommendations were accepted by the Trust except one on expanding the corporate supporting information for doctors and addition of a wellbeing template in appraisal section.

The project served as a significant leadership experience in my training role to undertake a project driving a Trust-wide change in medical appraisal policy based on participative leadership, generating consensus and developing a phased action plan towards implementation.

Learning about and appreciating the use of Electroconvulsive therapy remains an integral part of the undergraduate psychiatry curriculum. The existing literature indicates that medical students frequently have unfavourable views regarding ECT and its adverse effects.

Therefore, this study aimed to introduce a new teaching tool that supplements traditional didactic ECT teaching with simulation-based procedural demonstration thus providing a real-life experience of an ECT room and subsequently evaluate the learning gains conferred by such a curriculum.

The demonstration was carried out by Clinical teaching Fellow with the help of a high-fidelity manikin and a live actor who played the role of the patient, in the ECT suite in Birmingham.

Participants of the study were fourth year medical students who completed a self-administered questionnaire before and after the simulation session. This survey was designed to explore changes in knowledge, attitudes, and perceptions of the students towards ECT and its side effects.

Within a cohort of 88 students, 52 students successfully completed the pre-session questionnaire, and 43 students completed the post-session questionnaire. Students reported a global improvement in knowledge regarding ECT, when comparing results from both questionnaires. Prior to the simulation, many students used negative terms to describe ECT such as ‘torture’, ‘barbaric’ and ‘uncontrolled’, suggesting outdated stigmas around ECT. However, after the simulation, many students expressed a positive change in opinion, describing ECT as ‘controlled’, ‘beneficial’ and effective’.

Additionally, students reported improved knowledge about the side effects of ECT, especially regarding pain, memory loss and brain injury. Many students reported that their initial apprehension had been addressed over the course of the ECT simulation. Many noted ECT was more effective and beneficial than originally thought and the process was less extreme and invasive than they believed.

The results of the study reflect that the use of simulated ECT within medical students can help disperse some of the stigma and myths regarding this treatment. Simulation can humanise the process and shift attitudes around ECT by allowing students to become fully immersed into an almost real-life scenario. It can also address knowledge gaps around ECT indications, process, risks, side effects and benefits. This will in turn help educate future clinicians have a better understanding about ECT in the treatment of severe mental illness, thus optimising the utilisation of this effective treatment. Furthermore, such technique can be a useful tool for demonstrating ECT to potentially wider group of students, trainees and other health practitioners.

The disruptive force of the COVID pandemic has highlighted the importance of leadership for all medical educationists to prepare the future workforce with the ever-changing healthcare practice. Early career medical educators must attain leadership skills as early as possible. The only way to learn leadership is through experiential learning, i.e. learning while leading. Therefore, this self-study is aimed to share the reflection on the journey of a psychiatrist specialist trainee from North Wales in leading different psychiatric educational projects.

This is self-study research on the reflective experience of working as a medical educational fellow while undergoing specialist training in psychiatry from January 2022 to December 2023. The data reflected were sourced from publications, end-of-project reports, meeting minutes, participant and peer feedback, personal records, educational portfolios, and appraisals.

Nine psychiatric educational quality improvement projects (QIPs) had been conceptualised and implemented, i.e. three series of mock exams (Special Preparation in CASC Exam), continuous coaching and mentoring in portfolio-based learning (Café of RCPsych Portfolio), continuous mentorship in academic writing (Mini North Wales-Academic and Research Clinic), continuous peer supervision in psychotherapy (Gogledd Cymru-Peer Supervision in Psychiatry), mock interview for job application, digitalisation of departmental induction, psychopathology training (3P: Psychopathology for Postgraduate Psychiatrists Trainee), and two international collaborative educational programmes (Perinatal Psychiatry Perinatal and Infant Psychiatry Educational Programme of Wales, Tanzania, and Malaysia; and Bhutan Old Age Psychiatry Educational programme). Five peer-reviewed publications had been completed while the other academic writings were ongoing. Three of the projects (33.3%) were expanded from a Welsh initiative to the whole United Kingdom and a bigger team was formed to ensure sustainability could be achieved. Two projects (22.2%) started as an international collaborative project. All projects provided opportunities for the members of the QIP to obtain workplace-based assessments and evidence for yearly appraisal while improving the educational experience of trainees and professionals in the field of mental health.

All challenges come with the opportunities to be innovative in problem-solving. Communication skills and people management are crucial for resource gathering and conflict resolution. Lastly, talent development is required as part of the effort to sustain all the projects.