Our team of core and higher psychiatry trainees aimed to improve secondary mental health service detection of and response to gender-based violence (GBV) in South East London. We audited home treatment team (HTT), drug and alcohol (D&A) service and in-patient ward clinical records (n = 90) for female and non-binary patients. We implemented brief, cost-neutral staff engagement and education interventions at service, borough and trust levels before re-auditing (n = 86), completing a plan–do–study–act cycle.

Documented enquiry about exposure to GBV increased by 30% (HTT), 15% (ward) and 7% (D&A), post-intervention. We identified staff training needs and support for improving GBV care. Up to 56% of records identified psychiatric symptoms related to GBV exposure.

Moves to make mental healthcare more trauma-informed rely on services first being supportive environments for enquiry, disclosure and response to traumatic stressors. Our collaborative approach across clinical services increased GBV enquiry and documentation. The quality of response is more difficult to measure and requires concerted attention.

The Psychiatry Early Experience Programme (PEEP) is a long-standing scheme, collaboratively run by GKT School of Medical Education and SLaM Trust, which pairs medical students with core psychiatry trainees for clinical shadowing, mentoring and educational talks for the duration of their degree. We aimed to understand the motives of first year students signing up to PEEP and compare these to their feedback after one year.

Before the 2015 and 2016 academic years we administered an online survey to 159 medical students interested in joining PEEP, asking the free-text questions: “What do you most hope to get out of PEEP?”, and “Why are you interested in the PEEP programme?”. Eighty students were selected for enrollment and of these, sixty who participated in one year of the programme completed a follow-up survey, including the question “What have you taken away from your experience of PEEP so far?”. Authors conducted thematic analysis of the qualitative responses at both timepoints, identifying common themes and seeking feedback from third raters when conflicts emerged.

Themes identified in responses to the baseline survey fell into two categories: psychiatry-related and non-psychiatry-related. The three most common psychiatry-related themes, were: Better understanding of the specialty (n = 67), Role of a psychiatrist (n = 16) and Evaluating interest/suitability to the specialty (n = 7). The four most common non-psychiatry-related themes were: Obtaining clinical experience (n = 70), Insight into the role of a junior doctor (n = 22) and to the Training pathway (n = 10) and Developing clinical and communication skills (n = 14).

Themes identified in responses to the follow-up survey closely reflected those from the baseline survey. Students commonly expressed that they gained a better understanding of what psychiatry is and what working in psychiatry entails (n = 24) and explored their interest in pursuing a career in psychiatry (n = 10). Similarly, they valued the ability to gain early clinical experience (n = 16) and to develop their clinical and communication skills (n = 9).

The results support the value of PEEP in providing opportunities for medical students to better understand what psychiatry is and explore their interest in the specialty. PEEP is also meeting students’ expectations outside of the realm of psychiatry by facilitating early clinical experience and the development of clinical and communication skills which are less available for medical students in their pre-clinical years.

Further collection and analysis of annual quantitative and qualitative data will ensure continuous evaluation and tailoring of the scheme to meet both students’ expectations and its purpose to foster interest in psychiatry.

Lambeth Home Treatment Team (LHTT) provides short-term intensive community psychiatric care to a diverse South London population. The high turnover of patients requires a streamlined process to review and discuss their progress. We aimed to discuss patients in more frequent, targeted and shorter meetings, and to improve continuity of medical care using a ‘named doctor’ system. We assessed impact on length of stay with LHTT, on staff time as well as on both patient and staff satisfaction.

The system of once-weekly day-long discussions of entire caseload was replaced by twice-weekly discussions of new and concerning patients only. The system of medical reviews was changed from ad hoc to MDT-agreed allocation to a specific doctor for the duration of LHTT stay.

Data on duration of treatment and caseload size were taken from regular LHTT statistical reports. Staff and patient questionnaires assessed impact on satisfaction and time spent in review discussions.

Qualitative reports of staff experience revealed that the new system was felt to provide better continuity of care, better time efficiency (less time spent learning about new patients) and improved learning experiences for doctors in training. Downsides included lack of ‘automatic second opinion’ when a patient was reviewed by a different doctor, felt to be mitigated by more frequent discussions in MDT reviews when needed.

Patient feedback showed no significant change was noted in overall experience of LHTT, although patients were more likely to feel involved in their care (88% said ‘definitely’ compared to 68% before the change).

Time spent discussing patients in clinical review meetings reduced from an average of 38.5 to 28.5 person-hours per week.

Average caseload reduced from 57 to 42. However, duration of treatment increased from 18.8 days to 20.4 days.

The reduction in staff time in reviews suggests that the system had been appropriately streamlined. While caseload size reduced, duration of stay slightly increased, so the new system was not found to have had a significant impact on objective measures of patient care.

Staff feedback was generally favourable, highlighting continuity of care and time efficiency. Patient feedback, while good both before and after our change, suggested a greater feeling of involvement in their care, possibly due to clearer communication and discussion of plan from the start of LHTT care.