Interventions to support people with autism are multidimensional, but primarily psychosocial in nature. These interventions include behavioural, educational and support therapies. Some psychotropic medications are used to manage medical and psychiatric comorbidities associated with autism, which interfere with daily social and occupational functioning or limit the implementation of psychosocial interventions. The aim of this study is to describe the trajectories of psychotropic medications in people newly diagnosed with autism according to sex and age.

This is a retrospective cohort study based on medico-administrative data from the Régie de l'assurance santé du Québec. The cohort included all people living in the province of Quebec (Canada) with a first diagnosis of autism (incident cases) recorded during hospitalisation or during a medical visit between January 2012 and December 2016 (index date: first diagnosis). Only individuals covered by the public prescription drug insurance plan one year before and one year after the index date were included. A patient was considered exposed to a drug from the date a prescription was claimed at a community pharmacy and for the time the drug was provided. However, as no information was available on inpatient drug, the drug trajectory represents the outpatient drug trajectory. The five classes of psychotropic drugs considered were: 1) anticonvulsants and mood stabilisers; 2) antipsychotics; 3) antidepressants; 4) anxiolytics/hypnotics; and 5) psychostimulants. Drug trajectories are represented using state sequence analyses.

The study cohort included 3284 people, of which 867 (26.4%) were females and 2417 (73.6%) were males. Overall, 51.6% of the cohort claimed a psychotropic medication in the year preceding diagnosis and 61.1% in the following year, with higher proportions among females and increasing with age. Psychostimulants were the most prescribed medications among people diagnosed at ages ≤12 years, while antipsychotic use increased considerably with age, becoming the most commonly prescribed medication among those diagnosed in adulthood (≥18 years), with use rates reaching as much as 80% among those diagnosed between 36 and 60 years. State sequence analyses demonstrate slight variations in the use of psychotropic medications over time, but significant variations by age category and sex.

Although psychosocial interventions are recognised by clinical practice guidelines as the cornerstone of interventions for people with autism, the use of psychotropic medications is widespread. This highlights a significant gap between the recommendations of these guidelines and what is observed in the real world.

FND can be considered as an umbrella term that includes range of motor and sensory system dysfunctions with genuine symptoms including paralysis, tremors, sensory disturbance, speech disturbance and seizure. Functional seizures usually termed as Non-Epileptic attack disorder (NEAD) can result in profound persisting disability. Brief bouts of unprovoked and uncontrollable laughter, spontaneous in origin, combined with facial contraction in the form of smile, is termed as ‘gelastic seizures’. Modafinil is a dopamine modulating molecule for which evidence is accumulating towards its cognitive enhancement role in multiple domains. Furthermore, it has been shown to promote hippocampal neurogenesis and synaptic plasticity in pre-clinical studies. We report a case of FND in which pharmacological (Modafinil) and non-pharmacological interventions (Brain retraining) resulted in resolution of symptoms of probable gelastic episodes.

A 50-year-old lady who was referred by consultant neurologist to our Neuropsychiatry pilot service with episodes of uncontrollable laughing, singing, screaming and suffering from staggering and imbalance. Following these episodes, patient described sleeping for hours to days with fatigue. Her husband first noticed low mood 12 years ago during post-natal period. Treatment with fluoxetine reportedly contributed to ‘cyclical highs and mood variations’. One year later, her ‘gelastic episodes’ started and continued to occur every 2 or 3 months and they were brought on by a range of factors including tiredness, menstrual periods and stress. Patient also reported atypical cognitive deficits such as ‘losing vocabulary’ and ‘stuck every couple of seconds’. Furthermore, detailed history confirmed possible traits of attention deficit and hyperactive thinking since her childhood.

Following a comprehensive assessment, the role of the brain in the manifestation of her symptoms was discussed and agreed upon. Strategies based on Cognitive Behaviour Therapy principles such as active distraction, brain retraining, engaging in therapeutic activities and expressive writing were discussed and agreed upon. Following detailed risk-benefit analysis, modafinil was initiated at 200 mg dose in the morning. Patient made a remarkable recovery nearly back to her baseline with resolution of her gelastic episodes and thus improvement in her mental state. She continues to be stable in the community.

This case highlights the importance of recognising and treating cluster of symptoms which might belong to the impulsive-compulsive spectrum. This further emphasises the role of dopamine-modulating agents such as modafinil along with brain-retraining strategies.

1. 1. To evaluate standards of practice regarding initiation and administration of covert medication(s), with comparison to the previous audit completed in January 2021.

2. 2. To highlight improvements and weaknesses requiring further recommendations for effective future practice.

This clinical audit assessed the current practice in Amber Ward (Old Age Ward for Dementia patients) against the same standards of practise used in the previous audit.

The Audit Checklist included 10 standards from Maudsley prescribing guidelines for Covert Medication Pathway.

A retrospective review of the paper and electronic records of 21 service users initiated on a covert medication plan between January 2021 and June 2022 was carried out.

A descriptive statistic on the data and presented results in tables comparing frequencies and percentages with the data from previous audit was then performed.

1. 1. An increase in percentage of documented evidence of covert medication plan being discussed with a relative with Lasting Power of Attorney or in a Best Interest Meeting to 95% (n = 20) from 85% (n = 12) in the previous audit.

2. 2. An increase in percentage of documented evidence of pharmacy input on covert medication administration plan to 100% (n = 21) from 47% (n = 7) in the previous audit.

3. 3. An increase in percentage of documented evidence of covert medication administration in the drug charts to 100% (n = 21) from 53% (n = 8) in the previous audit.

4. 4. An increase in percentage of documented evidence of covert medication review date on the covert medication initiation forms to 85% (n = 18) from 67% (n = 10) in previous audit.

5. 5. A decrease in percentage of documented evidence of MDT discussion prior to starting covert medication plan to 90% (n = 19) from 100% (n = 15) in previous audit.

This re-audit showed some improvement with 100% compliance in 4 out of 10 standards, however, there's still room for improvement to get the compliance to 100% across all the standards.

We therefore recommended strict adherence to existing covert medication initiation plan form, with particular attention to be paid to the standard of proper documentation of the details of MDT discussions around covert medication plan initiation, as there was surprisingly a reduction noted in this standard.

Finally, we recommended that another re-audit be considered within 2 years of completion of this re-audit.

Exposure to traumatic experiences during childhood and adolescence is a significant risk factor for the development of psychiatric disorders in adulthood. An estimated 50% of the worldwide incidence of depression and anxiety can be attributed to childhood maltreatment (Li et al., 2016). In addition, approximately one-third of psychotic experiences are attributable to a history of developmental trauma (McGrath et al., 2017). It is thought that long-lasting, trauma-induced adaptive changes in neurobiological function may lead to a predisposition towards pathophysiology (McCrory and Viding, 2015). However, the precise mechanisms through which developmental trauma exposure alters brain function on cellular and circuit levels remain poorly elucidated.

A systematic literature search and meta-analysis was performed to establish how dopaminergic functioning in adulthood is affected by developmental stress in rodents. Three databases, Medline®, Embase®, and PsycINFO®, were systematically searched initially on 2nd December 2023. Terms for three superordinate concepts (‘childhood’ terms, ‘trauma’ terms, and ‘dopamine’ terms) were combined. Cohen's d statistic was used for effect sizes. This protocol is pre-registered on PROSPERO® (ID: CRD42018106382).

A total of 104 studies met our inclusion criteria. Meta-analysis indicated that developmental stress exposure leads to complex and long-lasting effects in basal and post-amphetamine extracellular dopamine concentrations in the medial prefrontal cortex, amygdala, and nucleus accumbens. In addition, there is a significant downregulation of D1 receptors and upregulation of D2 receptors in prefrontal and striatal regions involved in threat and reward processing. Effect sizes ranged from 0.36 to 1.55.

These findings strongly suggest that dopaminergic dysfunction is a mechanistic link between developmental trauma and vulnerability towards mental illness in adulthood.

Outcome measurement is central to transforming mental health care by quantifying change, enabling comparison and driving improvement. In recognition of this, the Royal College of Psychiatrists (RCPsych) has established a working group on outcome measures, led by an Associate Registrar.

To support routine outcome measurement capture in clinical services, RCPsych has developed the ‘Outcome Measurement in Psychiatry’ report.

The working group intends to launch a survey of Members to:

1. 1) Understand psychiatrists’ current use of outcome measures.

2. 2) Understand psychiatrists’ views on barriers and facilitators to the use of outcome measures.

3. 3) Get feedback on the College Report.

The ‘Outcome Measurement in Psychiatry’ report was developed with input from all RCPsych Faculties and is scheduled for publication prior to the RCPsych International Congress.

Feedback will be sought on the ‘Outcome Measurement in Psychiatry’ report about whether the guiding principles are right, and if the College should be endorsing specific measures or advocating for the routine use of outcome measures. This will be used to guide future revisions of the report.

The working group believes the proposed survey will enable it to explore the facilitators and barriers to routine outcomes data capture both locally and nationally, including:

• • how to consider organisational drivers and buy in of clinical staff

• • digital enablement

• • understanding time points in a chronic relapsing remitting condition in the community vs. episode of therapy or hospital admission

• • clinical burden/benefit and buy in

• • training.

The group intends to use the intelligence gather to inform, influence and shape policy that promotes routine outcome data capture and publish its findings for wider dissemination.

Outcome measurement is a top priority for the RCPsych. A new Associate Registrar and working group is spearheading the College's work in this area, publishing guidance and conducting further research. Engagement and learning from our colleagues would provide critical intelligence to inform and influence future policy and strategy to enable routine outcome gathering embedded in mental health services.

The war-ridden northern part of Syria was struck by a powerful earthquake in February 2023 leaving thousands of people dead or injured. The consequences of the earthquake on people's mental health are harder to evaluate but are likely to be severe and long-lasting, especially as people have lived through years of war and devastation.

This poster reports on facilitating reflective practice groups, online, where Syrian mental health professionals in northern Syria explored the psychological impact of the earthquake on them as individual and as professionals.

The author facilitated a series of online reflective practice group meetings. Three distinct groups of mental health workers were formed, each group consisting of 6–12 participants. Each group met twice, each session lasting an hour and a half, resulting in 6 meetings that took place between the 25th of February and the 18th of March 2023. In the first session the group discussed the psychological impact of the earthquake on them as individuals, and in the second the psychological impact on them as professionals.

Thematic analysis was conducted on the discussions in the 6 reflective group meetings, resulting in three main themes: emotional responses, cognitive responses and helpful strategies. These themes are grouped detailed in terms of the impact of the earthquake on the personal and the professional lives of the participants.

Notwithstanding the limitations of this experience, it highlights the importance and value of group reflective spaces, as a way of helping mental health professionals process their emotional experiences in the aftermath of natural disasters.

1. 1. Evaluate user engagement.

2. 2. Evaluate safety.

3. 3. Evaluate efficacy.

   1. a. To reduce drinking.

   2. b. To address comorbid symptoms of anxiety and depression.

Study Population

Participants applied via social media, identifying as individuals seeking to change relationships with alcohol. Inclusion criteria: Aged >18, Alcohol Use Disorder Identification Test (AUDIT) score of 8–16, no history of withdrawal symptoms, or AUDIT score 16–20 but already abstinent for >14 days. Participants who had already been abstinent for >30 days excluded.

The Programme

Participants given unlimited access to Alma mobile application (app) for 4 weeks. Programme consisted of daily pledge to cut down drinking, drink diary to record alcohol use, weekly feedback on Generalised Anxiety Disorder-7 (GAD-7) scores and Patient Health Questionnaire-9 (PHQ-9) depression scores, unlimited access to mindfulness videos to manage cravings.

Statistical analysis

Mixed-effects linear regression used for analysis.

57 people volunteered for pilot study. 31 eligible to participate.

Engagement

Progressive weeks of programme showed attrition in user numbers. By end of 4-week programme, 77% (24/31) remained, 58% (18/31) submitted all data.

Safety

All participants asked if they had experienced no harm or distress from using app. 25 participants answered, 100% (25/25) responded “no”.

Efficacy

Self-reported capability to reduce drinking significantly increased over time (mean increase from baseline +0.3; p = 0.007). At week 4, 8/17 (47.1%) said that Alma had helped them cut down drinking a lot, and a further 8/17 (47.1%) said it helped them cut down a bit.

There was a trend for units drunk on the heaviest drinking day to reduce over time (−0.48 units) and total weekly consumption of units to reduce (−1.01 units), however not statistically significant. There was no trend for drinking days per week to reduce over time.

There was a significant reduction in PHQ-9 scores over time (−1.03; p < 0.001) and significant reduction in GAD-7 scores (−0.69; p < 0.001).

A total of 22/24 (92%) respondents said they would recommend Alma to friends and family, 1/24 (4%) would not.

• • Relatively high engagement with Alma compared with similar digital products.

• • Pilot study suggests Alma is acceptable, safe and shows potential efficacy in helping reduce alcohol intake and comorbid anxiety/depression, however interpretation limited by small sample size.

• • Next steps will be to widen user-base to facilitate larger studies, and gain further insights into factors influencing relapses by studying associations with health-related data from wearable devices and other user inputs.

Since 2020, there has been an increase in children with mental health presentations ending up on general paediatric wards. Hospitals are identified as a place of safety for young people in crisis, though admission to a paediatric ward is not without risk for the child and staff involved in their care. Stays are often prolonged and classed as delayed discharges. This evaluation looks at 22 admissions to general paediatric wards within an acute health trust in Greater Manchester.

Local CAMHS teams identified 22 patients with a mental health presentation who had been admitted to paediatric wards and had delayed discharges between September 2021 and December 2023. Their electronic notes were analysed to identify number of bed days and CAMHS contacts, legal status, and discharge destination. Incident reports of each admission were analysed, and categorised into ‘Restraint/Rapid Tranquilisation’, ‘Assault on staff’ ‘Self harm’ ‘Abscondence’ and ‘Other’.

Of the 22 cases analyses, total bed days were 1469. The average number of bed days was 66.7. 6 admissions were over 100 days with the longest being 186 days. The majority (19) of the presenting complaints were categorised as ‘self-harm’ and /or ‘suicidal ideation’. The average number of core CAMHS contacts was 23 per admission, with an average of 9 consultant contacts, 5 Junior doctor out of hour contacts, and 32 meetings (e.g. discharge meeting, strategy meeting) requiring CAMHS attendance. 11 admissions involved assault on staff, with the highest number of assaults 48 during a single admission. 18 of the admissions required additional staffing (clinical support worker, security). Three patients required police to be called to the ward due to assault on staff. 9 of the patients were discharged to a social care placement, 8 were discharged home. The remaining were discharged to inpatient unit, day unit or to a family member.

Mental health admissions to paediatric wards are associated with a high level of CAMHS contacts provided by Tier 3 staff, which creates a previously unseen burden on the service. Admissions can be prolonged. Patients are cared for in an environment which is not designed to meet their needs. This is demonstrated by high level of patients absconding from the ward and increased restrictive measures such as restraint and 1:1 observation. Admissions are also associated with high levels or assault on staff. Further work is needed to evaluate the economic impact of additional staffing on paediatric wards, as well as the impact on paediatric nursing and security staff.

This study aims to explore the characteristics of the individuals who engage in suicidal behaviour.

Hypothesis:

1. 1) Patients attempting suicide are more likely to have co-existing axis I or axis II disorder when compared with patients with no reported suicidal attempt.

2. 2) Various OCD related domain like symptom types, symptom severity, age of onset of OCD, duration of illness and presence of other OCD spectrum disorder has higher chances of attempting suicide.

3. 3) Family history of suicidal behaviour increases the risk of suicidality.

Retrospective file review of all patients registered at the OCD clinic, NIMHANS hospital, Bangalore, India between Jan 2008–Dec 2018 was undertaken. Out of 1017, 814 met the eligibility criteria. Individuals with a documented suicide attempt were compared with those without. Chi square test, unpaired t-test and Regression analysis was done to identify predictors of life-time attempt.

Lifetime attempt was noted in 19.8% patients (161 out of 814). On comparison, female gender, unemployment, lower socioeconomic status, severe to extreme avoidance, severe to most severe CGIs, presence of depressive disorder, history of engagement in suicidal acts, past NSSI, past suicidal ideation, younger age at onset of OCD, younger age at first OCD consultation and YBOCS at index assessment are significantly associated with higher risk of suicidal attempts. Female gender, BPL status, age at onset of OCD and presence of depressive disorder can significantly predict lifetime suicidal attempts. Out of 814 eligible patients reviewed, 32 patients i.e. 4.79% had made ≥1 suicide attempt after their first contact to the OCD clinic. Risk of re-attempting suicide is highest in the first three years post index visit to the OCD clinic.

One in five individuals with OCD attempt suicide with higher risk in female population, greater illness severity (higher baseline YBOCS scores and early age of OCD onset) and presence of comorbid depression. Importantly, risk of repeated attempt is greatest within three years of contact but no factor could determine reattempt risk. Hence, regular screening for suicidality in patients with OCD could be of utmost importance in preventing any future attempts. The findings also highlight the need for future studies that explore the neurobiological underpinnings of suicide vulnerability in OCD.

Psychiatric illnesses are common in the perinatal period and many women are treated with psychotropic medications. Prescribing psychotropic medications often raises concern among patients and clinicians, because of a lack of information and no license to prescribe during pregnancy. This project aimed to evaluate the interventions offered in a perinatal clinic against the Perinatal College Centre for Quality Improvement standards. This included evaluating medications prescribed in the antenatal and postnatal periods; counselling regarding medication risks and benefits, provision of verbal and written information and psychosocial interventions.

Data of 60 patients (30 antenatal and 30 postnatal) attending perinatal outpatient clinics covering two cities in Midlands, England, consecutively from November 1st 2023 were collected from electronic clinical notes and clinic letters. Patients who did not attend their appointment were excluded.

The mean age of the sample was 30.3 ± 5.2 (range 19–41). Average gestational age was 6.5 ± 2.1 months (range 2.0–9.5) for antenatal women, and average postnatal duration was 6.5 ± 5.0 months (range 0.1–22.0) at the time of review. All women had psychiatric diagnosis, except one who was discharged back to primary care. The most common diagnoses were mixed anxiety and depression (38.3%), emotionally unstable personality disorder (38.3%), and postnatal depression (20%). The majority (75.0%) were prescribed psychotropic drugs. Antidepressants were prescribed in 66.7% of antenatal and 76.7% postnatal patients; most commonly prescribed overall were sertraline (33.3%) and citalopram (23.3%). Antipsychotics were prescribed in 30.0% of antenatal and 46.7% of postnatal patients. Aripiprazole and quetiapine were most commonly prescribed in the antenatal (both 13.3%) and postnatal (both 20%) periods. A larger proportion (40.0%) of women had as required medications; promethazine (20.0% vs 30.0%), diazepam (6.7% vs 13.3%) and zopiclone (3.3% vs 13.3%) were most frequently prescribed, with figures indicating prescription rates in the ante- versus postnatal period. None of the medications were prescribed above licensed limits nor met criteria for high dose antipsychotic monitoring. Verbal and written information about medications was provided in 78.3% and 35.0% of all cases respectively. Most (65.0%) women were offered psychological therapies, and of these, 69.2% received it.

Most women in the perinatal period were prescribed psychotropic drugs, with higher proportions in the postnatal period. The findings suggested areas of improvement, such as offering written information, documenting the discussion of medication counselling, and to increase the psychotherapeutic support. It also suggests developing manualised educational interventions to improve information sharing with patients, and perinatal care.

This team of simulation fellows at a London teaching hospital created an immersive simulation course for core psychiatry trainees to explore the intersection between physical and mental health and impact on provision of care. The course was fully mapped to the updated Royal College Core Training Curriculum as well as Crisis Resource Management principles, and focusses on the integration of care across mental and physical health provisions. Scenarios are set in a range of inpatient and community environments to allow participants to consider differences in delivery of holistic care, prioritisation, ethical and legal considerations across settings. This would be particularly relevant for participants early in training with limited prior exposure who may be unfamiliar with handling emergencies on psychiatric wards and the nuanced limitations in providing medical care.

Scenarios were written in consultation with speciality experts and allied health professionals including mental health nursing, dietetics, and pharmacy. The course is written to enable participants to explore the intersection between physical and mental health, and the practical and social implications of an individual's mental and physical condition on provision of care. Alongside debriefing technical and non-technical learning objectives, participants reflected upon the wider determinants of each patient's current physical and mental state and discussed ethicolegal considerations such as patients’ legal status, capacity to consent, and practicalities of transferring patients between services and facilitating holistic care.

The pilot course took place on July 4th following consultation with stakeholders including senior simulation and education leads within the Trust, and deanery Training Programme Directors, to ensure the course was formally endorsed to allow participants to apply for study leave to attend. Post-course feedback was collected through use of Likert-scales and white space questions; the response was highly positive and showed the programme met its aims and filled a training need. Feedback showed increased confidence managing integrated physical and mental health issues and balancing conflicting priorities with increased understanding of practical and social implications of mental and physical condition on provision of care.

Next steps involve collaboration with service users to allow accurate representation of the unique needs of a diverse population, and potential use of actors to sensitively and ethically portray simulated patients. Local psychiatry training schools could be approached to consider formal implementation of the course within academic programmes, in addition to potential reformulation of scenarios for use in established courses at the host site such as Undergraduate or Foundation training days.

To determine if the physical health monitoring of day-care patients in the Adult Eating disorder service (AEDS) is done in line with the recommendations of NICE guidelines and relevant Medical Emergencies in Eating Disorders (MEED) Guidance on Recognition and Management.

1. For every attendance of patients to the day-care Clinic it is expected that the physical health monitoring to be offered would include:

• • Weight

• • Height (if first attendance)

• • BMI

• • HR (Pulse rate)

• • Sitting/Standing BP

• • Temperature

2. Relevant blood tests and ECGs on a schedule based on patient's BMI or as needed based on clinical indication.

23 patients were identified as having been seen in AEDS day-care centre between April 2021 till the point of discharge. 9 were deemed inappropriate due to incomplete information. Of the remaining 14, 9 patients were randomly selected, their documentation were looked from admission to day-care to the point of discharge. The monitoring was audited at 3 points of contact over the course of their first clinic appointment, the middle and point of discharge.

1. 1. Comparing data from previous audit, the average admission in day-care decreased from 5.5 to 3.5 months.

2. 2. There was overall improvement in the ECG and blood test monitoring.

3. 3. At the admission and the last assessment there was 100% monitoring of BMI, weight, blood pressure and pulse.

4. 4. There was a drop in temperature monitoring by 11.1% in the first and last assessment due to faulty equipment.

5. 5. The ECG and bloods percentage dropped by 11.1% at all the monitoring points.

6. 6. At the midpoint there was no documentation of BMI, Blood Pressure, and pulse for 1 patient.

1. 1. Investigations were delayed from the patient's side.

2. 2. Due to COVID there was difficulty in accessing the primary care appointments for investigations.

3. 3. The temperature equipment was not working properly.

Recommendations:

1. 1. Keeping a fixed format for documenting day-care visits on the SystmOne software. A Sample format made available for documentation.

2. 2. Document all the parameters checked in the patients’ electronic records on the same day.

3. 3. Day-care clinical team to upskill on ECG via training.

4. 4. Team Resources to be allocated to have in-house ECG in day-care.

5. 5. SUSS test to be done for all RED (High risk) patients as clinically indicated and clearly document in the notes, e.g. SUSS: done/not done and reason with date SUSS conducted on.

Rates of stillbirth and neonatal deaths are high in low- and middle-income countries including Pakistan and these are one of the most stressful life-events for parents and families. Society does not appropriately recognize perinatal loss and support from healthcare professionals is often very limited or non-existent in Pakistan. Therefore, we aimed to co-develop and assess the feasibility of a bereavement support program for parents who experienced stillbirth/neonatal death in a public health facility in Pakistan.

This study adopted a sequential mixed-method design. The first phase involved co-development of a bereavement support program through a consensus process involving multidisciplinary health professionals, stakeholders and parents with previous experience of perinatal death (n = 23) using the Nominal Group Technique. Phase 2 includes a feasibility assessment using before and after cohort design. Sixty women (30 per phase) with recent experience of stillbirth and/or neonatal death will be recruited, from a public hospital in Pakistan. The main outcome measures will include recruitment and retention and acceptability of the study processes and data collection.

Following the consensus process, agreed intervention components included an educational workshop for healthcare staff, creation of a bereavement champion group of health workers in the facility and offering post-natal telephone peer support to bereaved mothers. The educational component for healthcare staff includes Advance Bereavement Care (ABC) workshop for all staff and bereavement champions (n = 15 healthcare workers) who later received one day's training and one-day training refresher. This component aims to improve care, act individually and as a group to identify areas for development, encourage good practice and support colleagues. The peer support component includes telephone support provided by women with previous experience of perinatal death (n = 7) trained by the research team. Supervision arrangements are in place for champions and peer supporters. The feasibility study is ongoing.

The co-development process ensured the cultural relevance of both components of the bereavement support program. The process also contributed to improving the sense of ownership by healthcare facility. Feasibility study will confirm whether parents are willing to take part, acceptability and whether future research to assess the effectiveness of the intervention on improving care after SB/NND is feasible.

This is a qualitative evaluation of a simulation/debrief based training session to address discrimination in an NHS workplace, delivered to psychiatry trainees. Videos portraying discrimination acted as the simulation, followed by a diamond model informed debrief.

This evaluation aimed to:

• • assess the effectiveness of this training session in terms raising awareness of discrimination, problematising discrimination, empowerment to act and skills building

• • explore the extent to which these stated aims are relevant to participants’ experience of discrimination, harassment and bullying at work

• • establish if this is a meaningful and acceptable training model for this topic

• • establish if there are more relevant themes that this training session should be focusing on and if so, what these are?

A total of 8 trainees were interviewed between December 2022 and May 2023, having recently completed the training. A thematic analysis was undertaken by two researchers following established recommendations, seeking to bring out latent themes with an inductive, interpretative approach within a constructionist paradigm.

Trainees attended with existing knowledge, skills and attitudes about discrimination, harassment and bullying, and about the training session itself.

Both the simulation and debrief were valued by trainees. The debrief was more than just a discussion. Portrayals of discrimination in the videos/simulation could have been more subtle, and tackled a more diverse range of examples such as LGBTQ+.

The learning objectives were largely met, and related to real challenges that trainees face. Trainees took away more than this, citing learning related to team cohesion and developing their sense in which discrimination in the context of mental illness requires special consideration.

This model of training is providing good value in addressing a topic of strategic importance in a novel way. The impact on empowerment and skills development is likely to be particularly valuable in impacting real world responses to workplace experiences of discrimination. Promoting team cohesion and a space to thoughtfully consider the special case of discrimination in the context of mental illness are important additional benefits. The simulation/debrief model is likely to be crucial, providing learning which would be inaccessible to didactic or e-learning based modes of delivery. The simulation materials may be improved by depicting LGBTQ+ issues, and a more subtle portrayal of discrimination. While this evaluation was situated in a psychiatric context, it could have wide applicability to tackling similar challenges throughout NHS workplaces.

Cognitive disorders, such as dementia, are a possible comorbidity and an important differential diagnosis to consider in older adults admitted to psychiatric wards with a functional disorder. Whilst cognitive assessment tools (e.g. ACE-III) and neuroimaging (e.g. MRI scans) are well established, there is significant variability in how and when they are used, which can result in inconsistences in their use. The aim was to identify the types of inconsistencies that may occur, and to provide a standardised framework in order for these tools to be used consistently on our functional rehabilitation ward.

This QIP retrospectively assessed data for all patients discharged over a 7-month period between October 2022 and May 2023, from an older adult functional rehabilitation ward. Clinical notes were reviewed to determine whether a cognitive assessment and neuroimaging had been considered, and if so, whether the assessment or investigation was appropriate and completed without delay. Correspondence to the GP or CMHT was reviewed to determine whether this had appropriate information about the relevant cognitive screening completed, and had included an appropriate follow-up plan. Data collected was checked for accuracy through screening by a second clinician, after which a consensus meeting was held to account for discrepancies.

25 patients were discharged during the 7-month period. 52% were identified as having an issue or delay in their cognitive screening and correspondence; 32% had a delay in completing a cognitive assessment; 32% did not have an appropriate follow-up plan communicated in their discharge summary regarding future monitoring of their cognition; and 8% had a delay in considering or requesting neuroimaging.

Team discussion identified that staff uncertainty relating to the use of cognitive tools and neuroimaging was a significant contributing factor to the issues identified in our results. We subsequently delivered training using a flowchart for doctors, nurses and allied healthcare professionals on the ward, which included information about the benefits and disadvantages of different screening tools and imaging modalities, in order to assist selection of the most appropriate tools on a case-by-case basis. The flowchart included the need for MDT discussion and senior psychiatrist involvement, but aimed to improve team confidence in understanding the rationale for these decisions. Based on the results of our post-intervention data, we will consider adapting the training and flowchart delivered to meet the needs of other older adult services in the trust.