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Equality, Diversity & Inclusion in the Workplace: Exploring the Experiences of Psychiatry Trainees Across the North West of England
- Victoria Ozidu, Claire-Marie Hosein, Oli Sparasci, Catarina Rodrigues dos Santos, Clare Inkster
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- Journal:
- BJPsych Open / Volume 9 / Issue S1 / July 2023
- Published online by Cambridge University Press:
- 07 July 2023, pp. S25-S26
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Aims
Everyone in the NHS deserves to work in an environment that is safe, welcoming, and free from discrimination, however recent surveys have highlighted that this is often not the case. Alarmingly, it has been recognised that few psychiatrists report any forms of discrimination and of those who have, there is often dissatisfaction with the response received from their employer. Due to a paucity of data relating to the experiences of psychiatry trainees in the North West, we sought to understand their lived experience and to co-design proposals for future work that may improve the status quo.
MethodsAll psychiatry trainees across the North West of England in 2022 and early 2023 have been invited to complete an electronic, core training or sub-specialty specific higher training survey. Basic demographic details were collected. Respondents were asked a range of questions around their experience of discrimination in the workplace and good practice observed in managing this. Subsequently, each group of higher sub-specialty trainees were invited to a two-hour reflective session held face-to-face or via an online platform. Two further reflective sessions were arranged in Liverpool and Manchester for core trainees. During reflective sessions, attendees were presented with vignettes of workplace discrimination, developed from the results of the initial survey. Session facilitators guided a discussion on the feelings evoked by each vignette, whether attendees wanted to discuss their lived experience of similar incidents and to consider ideas for what may be done to support a trainee in these situations. A post session questionnaire was circulated.
ResultsOver 100 individuals have completed the pre-session survey and attended a reflective session. Survey respondents were predominantly trainees who identified as Asian, Asian British, Black, Black British, Caribbean or African ethnicity, with a roughly 50:50 split between Male and Female.
Themes highlighted include:
That the vignettes used in the reflective sessions are representative of everyday workplace discrimination.
That training in microaggressions should be given to trainers, trainees and other clinical staff on a regular basis.
That the burden of managing discriminatory behaviour should be on the institution and not the trainee experiencing discrimination.
ConclusionMany psychiatry trainees across the North West have lived experience of workplace discrimination and systems need to be implemented to improve trainees’ experience. Proposals for future improvements; such as the formation of a deanery wide reporting and management system for trainees who have faced workplace discrimination; are being co-developed to address current challenges.
Prescribing and Monitoring of High Dose Antipsychotic Therapy (HDAT) in the Acute Inpatient Setting
- Gemma Buston, Helen Kay, Ife Nwibe, Oliver Edge, Oli Sparasci, Amit Sindhi
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- Journal:
- BJPsych Open / Volume 8 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 20 June 2022, p. S160
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Aims
High Dose Antipsychotic Therapy (HDAT) is defined by the Royal College of Psychiatrists as either: a total daily dose of a single antipsychotic which exceeds the upper limit stated in the BNF, or a total daily dose of two or more antipsychotics which exceeds the BNF maximum calculated by percentage. HDAT is defined as ‘off-label’ prescribing and the prescribing clinician should clearly document rationale for its prescription and clear discussion with the patient regarding the risks and benefits. If the patient is deemed to lack capacity, this should be clearly documented, and appropriate legal processes followed as defined by the Mental Health Act 1983. The use of HDAT comes with greater risk of physical health complications and requires regular monitoring of electrocardiogram (ECG), body mass index (BMI) and blood biochemistry. Aims: To re-audit the number of inpatients prescribed HDAT across three acute general adult inpatient wards, and to establish whether guidelines for the prescribing and monitoring of HDAT are adhered to.
MethodsInitial audit was completed in January 2020. Education sessions were provided to rotational junior doctors in the six months following initial audit. For re-audit, medication cards for each patient on the electronic bed-state at 9pm on 27/11/2021 were checked for HDAT prescription. Data were collected from electronic notes of patients identified as being on HDAT.
ResultsInitial audit in 2020 demonstrated that 3 of 49 inpatients (6%) were prescribed HDAT, with no evidence of documentation of rationale, and variable monitoring of physical health indicators. Re-audit in 2021 demonstrated that 11 of 47 inpatients (23%) were identified as being on HDAT. Of those, seven instances of HDAT were commenced during review by the multidisciplinary team or the consultant, with only two of these cases noting that the medication prescribed would result in initiating HDAT. Of the remaining cases, the prescriber was unclear. Eight had an ECG within a month prior to commencing HDAT. Only three patients had a repeat ECG within 7 days of initiation. Three patients were noted to gain at least 5 kg in weight following implementation of HDAT.
ConclusionEducation of junior doctors following initial audit had limited impact, likely due to high turnover of doctors. Implementations currently in development include: 1) Departmental teaching session for doctors of all grades, 2) Introduction of stickers on medication charts for patients prescribed HDAT to highlight monitoring recommendations, 3) Development of ward round template to include review of HDAT.
Impact of COVID-19 on mental health research: is this the breaking point?
- Oli Sparasci, Kamaldeep Bhui, Asit Biswas, Samuel Chamberlain, Bernadka Dubicka, Robert Dudas, Saeed Farooq, Tamsin Ford, Nusrat Husain, Ian Jones, Helen Killaspy, William Lee, Anne Lingford-Hughes, Ciaran Mulholland, Judy Rubinsztein, Rohit Shankar, Aditya Sharma, Lindsey Sinclair, James Stone, Allan Young
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- Journal:
- The British Journal of Psychiatry / Volume 220 / Issue 5 / May 2022
- Published online by Cambridge University Press:
- 17 February 2022, pp. 254-256
- Print publication:
- May 2022
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There are many structural problems facing the UK at present, from a weakened National Health Service to deeply ingrained inequality. These challenges extend through society to clinical practice and have an impact on current mental health research, which was in a perilous state even before the coronavirus pandemic hit. In this editorial, a group of psychiatric researchers who currently sit on the Academic Faculty of the Royal College of Psychiatrists and represent the breadth of research in mental health from across the UK discuss the challenges faced in academic mental health research. They reflect on the need for additional investment in the specialty and ask whether this is a turning point for the future of mental health research.
High dose antipsychotic therapy (HDAT) in the Greater Manchester mental health adult psychiatric inpatient setting
- Oli Sparasci, Emma Horrell, Gemma Buston, Oliver Edge, Tatiana Campo Celaya, Daniel Shaw, Daisy Alston, Matthew Miller
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- Journal:
- BJPsych Open / Volume 7 / Issue S1 / June 2021
- Published online by Cambridge University Press:
- 18 June 2021, p. S105
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Aims
To identify the number of adult inpatients prescribed HDAT across GMMH.
To establish whether guidelines for the prescribing and monitoring of HDAT are adhered to.
To consider the initiation of HDAT, evaluating whether prescriptions of HDAT are intentionally made by consultant psychiatrists and the MDT, or by rotational junior doctors.
BackgroundHigh Dose Antipsychotic Therapy (HDAT) is defined by the Royal College of Psychiatrists as either: a total daily dose of a single antipsychotic which exceeds the upper limit stated in the BNF or A total daily dose of two or more antipsychotics which exceeds the BNF maximum as calculated by percentage.
The decision to prescribe HDAT should be made by a consultant psychiatrist and discussed with the patient and wider MDT. Clear documentation of this discussion, including the clinical indication, should be recorded within the case notes.
The use of HDAT comes with greater risk of physical health complications and requires regular monitoring of ECG, BMI and blood biochemistry. For patients detained under the Mental Health Act, consent and appropriate consultation with a SOAD should be sought for HDAT where the patient lacks capacity.
This audit investigates prescription of HDAT in the acute adult inpatient population within Greater Manchester Mental Health NHS Foundation Trust (GMMH).
MethodSix junior doctors were recruited to collect data across the 5 sites covering general adult inpatients within GMMH. Data were collected week beginning 21st January 2020. Data were collected from all 20 general adult inpatient wards within the trust. Medication cards for each patient on the electronic bed-state at 9am on the day of the audit were checked for HDAT prescription. Subsequently, data were collected from electronic notes of patients identified as being on HDAT. Data were collated and submitted to the audit lead for analysis.
Result31 patients were identified as being on HDAT, of those, 21 instances of HDAT were commenced during the patients MDT, although in only 2 of these cases was it noted that the medication prescribed would result in initiating HDAT. Of the remaining cases, 8 were prescribed by junior doctors and 2 were unclear. 15 out of 31 patients had an ECG within a month prior to commencing HDAT, of 24 patients on HDAT for longer than 3 months, only 5 had a repeat ECG within this time.
ConclusionGuidelines are not closely adhered to, there is clear and necessary scope for improvement.
High dose antipsychotic therapy (HDAT) prescibing practice within the south trafford community mental health team
- Oli Sparasci, Luis Rojo
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- Journal:
- BJPsych Open / Volume 7 / Issue S1 / June 2021
- Published online by Cambridge University Press:
- 18 June 2021, pp. S105-S106
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Aims
High Dose Antipsychotic Therapy (HDAT) is defined by the Royal College of Psychiatrists as either: “A total daily dose of a single antipsychotic which exceeds the upper limit stated in the BNF” or “A total daily dose of two or more antipsychotics which exceeds the BNF maximum as calculated by percentage.”
The use of HDAT is associated with significant risks to physical health and as such requires regular monitoring of various physiological parameters such as ECG, bloods and an assessment of cardiometabolic risk.
Following previous audits of HDAT prescribing practice in the inpatient setting within Greater Manchester Mental Health (GMMH) NHS FT, an audit of HDAT prescription in a general adult CMHT was conducted in Summer 2020, with the following aims:
To identify patients in the South Trafford CMHT who are prescribed HDAT.
To assess the prescription of HDAT against local guidance on the use of unlicensed medications.
To highlight good practice and areas for improvement in the prescription of HDAT.
MethodAll patients under the South Trafford CMHT in Summer 2020 were identified. Current prescriptions for antipsychotic medication were ascertained through review of electronic patient records. Those noted to be on HDAT were assessed against audit criteria derived from the GMMH Unlicensed Medicines Policy, previous audits of HDAT use and the RCPsych consensus report on HDAT prescription.
Result11 of 252 patients (4%) were identified as being on HDAT, of which eight were due to polypharmacy and three to high dose of a single antipsychotic. For 1/11 patients target symptoms and a risk/benefit rationale were documented. The mean length of time on HDAT was 6 years. 7/11 patients had either tried or considered clozapine in the past. 8/11 patients had not had an ECG within the last year, 4/11 had not had yearly U&E. 8/11 had regular mental health reviews.
ConclusionCompliance with the audit standards was found to be highly variable. This may reflect many factors, including the length of time since commencing HDAT and the complex shared care arrangements currently in place in Trafford. Thus, the following recommendations have been made:
To start a register of all patients prescribed HDAT.
To review local guidelines and documentation to ensure they are up to date and can be effectively implemented in routine clinical practice.
To ensure that the responsibility for conducting yearly physical health checks for patients prescribed HDAT is communicated to the relevant parties.