We aimed to explore the characteristics of referrals to an NHS outpatient neuropsychiatry service, define patient pathways, and identify interventions provided.

We included all new referrals to the service between 1/10/2024 and 31/01/2025. We examined electronic clinic records (Rio) retrospectively and extracted anonymised data using an NHS-approved online data-collection tool (‘Gather’). We used ‘Gather’ and Excel for data analysis, employing descriptive statistics. 165 records were reviewed.

93% of referred patients were of working age, with 4 referrals aged under 18.Most were female (64%) and 80% were white British. 129 patients had working status recorded: 52% received welfare benefits. 75% had social support; mostly from family. Most referrals came from Primary Care and Neurology.

70% of referrals had a functional neurological disorder (FND) (30% non-epileptic attack disorder (NEAD), 40% other FND). Other diagnoses included epilepsy (n=8), traumatic brain injury (n=1), Huntington’s disease (n=2), MS (n=2) and Tourette's/tic disorder (n=4). 103 patients (62%) had previous psychological history and 59% had previous mental health service contact. 67% were prescribed psychotropic medications at referral. The most common comorbid mental health problem was anxiety (45 patients, 27%), 37 patients had depression (22%). 16 patients were autistic (10%). 70% had previous physical health problems; 39% previous neurological problems, 18% non-neurological problems and 43% both.

All referrals received multidisciplinary team (MDT) review; 52% of referrals were accepted following this. Mean waiting time between received referral and MDT discussion was 10 days. Most patients (52%) had documented investigations at referral. Of these, 81% had brain imaging or EEG completed. Mean waiting time for initial assessment/triage was 52 days; most patients were triaged by specialist nurse. 14% of referrals were discharged post-triage, mostly to primary care/self-help. Average length of stay within the service was 233 days. During the period evaluated, 19% of patients were receiving psychotherapy (11% 1:1 therapy, 8% group). 16 patients were referred to neurophysiology. 36% were prescribed medication during their treatment, mostly antidepressants. Of discharged patients, 67% were discharged to GP and 15% to community mental health services.

Referrals to the community neuropsychiatry service were characterised by complex comorbidities and clinical challenges. A significant percentage of referrals involved functional neurological presentations, with psychiatric comorbidities and social vulnerabilities. Clients received multiple types of interventions. The findings emphasise the importance of multidisciplinary assessments and integrated care pathways to address the needs of this population and guide future service development.

Additional authors: Dr Sylvia Fatunla, Prof Rafey Faruqui

Medical students experience higher rates of mental health problems compared with the wider student population. Stigma and fitness-to-practise concerns can deter help-seeking, with students often turning to peers. Mental Health First Aid (MHFA) is a psycho-educational programme developed for the general public, designed to support recognition of mental health difficulties and responses to people in distress. We present an innovative, co-constructed mixed-methods study exploring medical students’ experiences of MHFA training,delivered as a student-selected component within a medical school curriculum. We aimed to explore the motivators, enablers and barriers to student engagement, and students’ perceptions of the value and relevance of MHFA in relation to mental health knowledge, self-care, help-seeking and supporting others. The study also sought to inform the development of a bespoke course tailored to the needs of medical students.

MHFA was delivered in four half-day face-to-face sessions to Year 1 and 2 medical students at Kent and Medway Medical School. Data were collected via post-session questionnaires, in addition to post-course student-led focus groups and optional semi-structured individual interviews. Questionnaire data were analysed using descriptive statistics, and qualitative data were analysed thematically.

Twenty-five students participated; 21 attended all four sessions (range was 21–25 students). In post-session questionnaires, students rated MHFA content positively in relation to self-care and supporting others, and noted areas of overlap with the medical curriculum, including psychosis, suicide and communication skills. Analysis of qualitative data from four focus groups (n=22) and nine individual interviews identified common themes. Students described generally positive experiences of MHFA training and valued having an adaptable framework for guiding conversations about mental health in professional and personal contexts. An additional theme related to suggestions for adapting the course to better suit the needs of medical students. These included a faster-paced format, case scenarios that more closely reflected medical student experiences, greater integration of skills practice, and increased focus on issues specific to medical students, such as disclosure of mental illness and fitness to practise, exam-related anxiety, and inclusion of doctors’ lived experience of mental illness.

MHFA training was generally experienced positively by medical students and perceived as relevant to self-care and supporting others. Students also identified limitations in how well the course aligned with the specific contexts and pressures of medical training. Together, these findings support the development of a bespoke mental health support course for medical students, building on MHFA approaches while addressing discipline-specific needs.

Navigating a Serious Incident (SI) investigation and participating in a Coroner's Court proceedings can pose challenges for psychiatry trainees. The Higher Training curriculum emphasizes active participation in activities that enhance patient safety and care quality. This project aims to enhance patient safety and trainee confidence by improving training on SI investigations and Coroners Court proceedings.

Using Quality Improvement (QI) methodology, in the first cycle an initial survey was distributed to all psychiatry trainees and middle grade doctors working in Kent and Medway (n = 67) to establish baseline knowledge and confidence levels in areas related to risk assessment & management, SI investigations and Coroner's Inquests.

In response to the identified need for training, we organized the Initial Training Event with support from Deputy Chief Medical Officer for Quality and Safety, Patient Safety Team and Medical Education Department. The half-day, in-person event was opened to all doctors and featured 5 sessions: Serious Incident Investigation Process, Thematic Review of Suicides, Systems Engineering and Human Factors in Patient Safety, Learning from Mortality and Structured Judgement Review along with ‘Being Involved in Investigation – An Investigator's Guide’. Data from a survey of attendees (n = 47) informed the development of a tailored training session for psychiatry Core and Higher Trainees.

The initial survey received 32 responses (response rate: 47.76%). 71.88% of respondents had little to no understanding of SI investigation processes. Remarkably, 87.5% expressed strong interest in receiving training on conducting SI investigations. 90.62% were extremely or very interested in receiving training on participating in a Coroner's Inquest.

47 doctors attended the Initial Training Event. 30 responded to the feedback questionnaire (47.76%). All doctors found the training useful, with over 90% rating it ‘very’ or ‘extremely’ useful. 97% felt that the training would improve their clinical practice in terms of patients’ safety. After the training, 60% understood the process of conducting an SI investigation a moderate amount; 33.33% understood the process a lot or to a great extent. Nevertheless 92.86% felt a need for additional training in SI investigations. 63.33% suggested making training available yearly, and 36.67% favoured making it mandatory training.

This project identified a significant need for training in SI investigations and Coroner's Court proceedings among psychiatric trainees. An Initial Training Event developed from the first QI cycle survey data received positive feedback. The next phase involves developing a tailored training program that addresses identified knowledge gaps. Further considerations include making this training a regular event.

People with Functional Neurological Disorder (FND) exhibit diverse symptoms, ranging from motor and sensory issues to non-epileptic attacks, potentially causing reduced functioning and quality of life. East Kent Neuropsychiatry Service developed written and video resources to educate patients about FND. We aim to improve patient education on FND through increasing resource options and identifying optimal implementation of the materials within the care pathway.

We implemented an existing symptom self-management psychoeducation booklet and novel video resources as part of a quality improvement project (QIP). The first QIP cycle trialled the resources across different treatment pathways using three groups, each of seven patients. Group 1 received the booklet first, then the video two weeks later. Group 2 received the video first, then the booklet after two weeks. Group 3 received both resources at the same time. After 4 weeks, patient feedback was collected by 4 medical students by telephone. Qualitative and quantitative data was obtained from 8 patients. Quantitative feedback was obtained using a 5-point Likert scale. In the second QIP cycle, 10 patients received both resources simultaneously, with improvements made to resource accessibility and readability.

The first QIP cycle highlighted that the videos were helpful in explaining FND, with 75% of patients rating the videos the same or higher than the booklet. Qualitative responses commented that videos were more personal and easier for family members to understand. Across both video and booklet resources, 67% of patients agreed or strongly agreed the resources were useful for explaining FND and their experience. One patient, in group 1, stated the resources improved their symptoms. 54% of patients agreed that they received the resources at the appropriate time; a common theme across all groups was the desire to access the resources earlier within the pathway. In the second QIP cycle (8 patients, 25% response rate), all agreed the resources improved FND understanding and self-management strategies.

Our study highlights that video resources are a valuable addition to FND psychoeducation, with benefits for patients, carers and family members. Both booklet and video resources were helpful in improving patient education on FND. Our findings emphasise the need for early integration of psychoeducation in the care pathway. Future developments could include collaborating with other specialties involved in the care of FND patients, such as neurology and emergency departments, to enable early integration of psychoeducation resources, empowering clinicians to effectively communicate about FND and enhancing patient psychoeducation.

Additional authors: Mr Alan Dunlop, Ms Wendy Collison and Professor Rafey Faruqui.

Doctors completing on-call shifts at sites across a mental health trust identified a need to improve aspects of on-call work. This quality improvement project (QIP) aimed to improve response to trainee concerns arising from on-call work and support to junior doctors on-call.

A previous QIP cycle identified trainee concerns regarding on-call processes. In our first QIP cycle, surveys were sent to all consultants and SpRs working on non-residential on-call rotas, and Foundation, GP and Core Psychiatry trainees (on residential on-call rotas) in the Trust, regarding perceptions of on-call processes, senior support and on-call issues. A monthly, online forum was introduced in August 2023 to improve on-call feedback and communication. Trainees, consultants and SpRs from 2 localities were invited, along with representatives from the medical staffing team, medical education team and medical management. After 4 forums, participants who had attended an on-call forum were sent a further feedback survey collecting quantitative and qualitative data. Subsequently, forum frequency and scheduling were amended, advertisement improved, and the forum was expanded to include on-call doctors across the whole Trust.

First cycle data revealed consultant support for a regular meeting with trainees and senior colleagues to bring issues from on-calls for discussion (56% felt that an on-call forum would be helpful, 33% felt it might be helpful). Mean forum attendance was 14, with attendance from all grades. Feedback data from trainees (5 responses) was that most found the forum useful (80%); 80% felt listened to; all felt able to raise concerns, and all wanted the forums to continue. Qualitative feedback included: ‘we started a new QI project from the forum and many on-call guidelines became more defined.’ Consultant feedback (4 responses) was that most found the forums useful (75%); 100% gained a better understanding of trainee concerns; 100% thought forums should continue, although 50% thought the frequency should be reduced. Most consultants and trainees did not feel it would be useful to discuss clinical cases in the forums. Consultant qualitative feedback reported that the forum was helpful to understand trainee concerns, but there should be wider attendance.

Establishing an on-call forum was a valuable intervention for both consultants and trainees working on an on-call rota and has led to a further quality improvement project. Respondents felt that clinical supervision offered sufficient space to discuss clinical cases. Increasing trainee and consultant engagement with the forum is the next phase of this project.