South Asia bears a substantial burden of developmental and psychosocial adversity among children and adolescents, yet specialist mental health resources remain scarce. Scalable, non-specialist delivered interventions have been proposed as a solution, but the breadth, characteristics, and evidentiary foundations of such interventions across developmental stages remain poorly synthesised.

This review aimed to systematically examine the existing evidence on child-centred interventions delivered by non-specialists in South Asia, including whether such interventions demonstrate successful outcomes, are predominantly preventive or promotive in focus, are developmentally targeted, and are implemented with acceptable participant retention across diverse settings.

A scoping review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidance (PRISMA). Web of Science and PubMed were searched for peer-reviewed intervention studies published from 2010 onwards. Eligible studies were clinical trials with a comparison group, conducted in South Asia, targeting infants, children, or adolescents up to 19 years, and aiming to improve developmental or wellbeing outcomes through prevention, promotion, or treatment approaches. Pharmacological studies, qualitative designs, and samples with high baseline psychiatric morbidity were excluded. Screening, full-text review, and data extraction were undertaken independently by multiple reviewers with consensus resolution.

Forty-seven studies met inclusion criteria, encompassing 57,951 participants at baseline and 49,321 at endline, with an overall attrition rate of approximately 15%. Nearly half of studies were conducted in India, followed by Bangladesh and Pakistan. Most interventions were randomised or cluster randomised trials and were delivered in schools, homes, or community settings. Non-specialists delivered 87% of interventions, including health workers, lay counsellors, peers, and teachers. Interventions predominantly focused on promotion (68%) or prevention, with only two treatment-focused trials.

Perinatal and early childhood interventions predominantly emphasised developmental stimulation (n=21), parenting practices (n=18), psychoeducation related to child health, development, nutrition, or maternal wellbeing (n=19), and responsive caregiving or maternal responsiveness (n=11). In contrast, adolescent interventions primarily targeted psychosocial wellbeing (n=8), positive youth development approaches (n=5), life skills, stress management, or resilience-focused outcomes (n=multiple studies; exact counts varied by domain).

Cognitive behavioural components were present in a minority of interventions (n=7 overall), most commonly embedded within multi-component programmes rather than delivered as stand-alone therapies. The use of standardised developmental and psychosocial outcome measures was common, with the Bayley Scales of Infant and Toddler Development (Second edition: n=6; Third edition: n=11) most frequently used for early childhood outcomes, and the Strengths and Difficulties Questionnaire (n=7) most commonly employed for child and adolescent psychosocial wellbeing.

Over the past decade, South Asia has generated a substantial and methodologically robust body of evidence demonstrating the feasibility and acceptability ofnon-specialist delivered child and adolescent developmental interventions across settings and developmental stages. However, the literature remains heavily weighted toward promotion and prevention, with notable gaps in middle childhood and treatment-focused interventions. Future research should prioritise theoretically explicit, mechanism-informed designs and address under-represented age groups to inform scalable, equitable child mental health strategies in low-resource settings.

This audit focused on the recording and reporting of patient deaths across the Acute Old Age Psychiatry wards at the Royal Edinburgh Hospital (REH), Scotland. All inpatient deaths should be reported electronically via the NHS Lothian health board ‘DATIX’ incident reporting system. A patient death is recorded as ‘expected’ or‘unexpected’. This audit aimed to identify how many patient deaths had occurred over a 2 year period and if they were appropriately reported via ‘DATIX’.

In January 2025 retrospective data was gathered for the review period from January 2023 to December 2024.

Following a patient death, a physical Medical Certificate of Cause of Death (MCCD) was issued by medical staff. The MCCD log books are held on the Acute Old Age Psychiatry wards at REH. Each log book entry was reviewed and the number of deaths were recorded.

Electronic data from the ‘DATIX’ reporting system was gathered by the Assurance and Improvement Team for the REH, who are involved in the review of Significant Adverse Events.

The information from the MCCD log books and ‘DATIX’ system were cross-referenced.

A total of 14 patients died whilst an inpatient during the review period. These were all due to a primary medical condition and not primarily resulting from a psychiatric disorder.13 MCCD were issued. 1 MCCD could not be issued due to legal reasons. The patient deaths occurred on 3 of the 4 wards.

‘DATIX’ data identified that 7 deaths were reported; all 3 ‘unexpected’ deaths and 4 ‘expected’ deaths.

Therefore, 50% of the patient deaths occurring on the Acute Old Age Psychiatry wards at REH were not reported via the ‘DATIX’ incident reporting system.

This audit identified the number of patient deaths that occurred during the 2 year review period on the Acute Old Age Psychiatry wards at REH and elucidated that not all patient deaths were being reported to the ‘DATIX’ incident system. In particular, ‘expected’ deaths were not reported consistently. This meant data held by the Assurance and Improvement Team was not accurate and highlighted that clinical teams were not aware of the need to report every inpatient death. Following this audit, issuing of the MCCD at REH became electronic. Senior management also ensured all clinical teams were informed of the requirement to report all deaths via ‘DATIX’. Future audit is required.

This clinical audit aimed to assess and quantify patient wait times across all localities within the TEWV Trust, benchmarking these durations against Trust and National averages. Timely care for individuals with dementia is critical, not only for patients and their families but also for broader community health outcomes. Early diagnosis is essential for providing customized support, facilitating effective treatment options, enabling proactive planning, and preventing crises. Reducing the wait time between referral to a Memory Assessment Service (MAS) and the subsequent diagnosis and care plan is crucial, as delays can significantly burden the NHS and adversely affect the long-term mental health of patients and their caregivers. According to the National Audit of Dementia for 2023/2024, wait times have risen sharply from 124 days in 2021 to 151 days, with only 10% of patients obtaining a diagnosis within six weeks of referral.

The audit was conducted over a four-week period from September 28 to October 28, 2024. A random sampling method was employed to select 149 patients referred to 15 memory services throughout the TEWV Trust. Data were collected through the analysis of referral letters, initial assessments, diagnostic appointments, case notes, and correspondence from CITO. Analysis was performed using a custom tool developed in Excel.

The analysis yielded average access times, diagnostic wait times, and overall wait times ranging from 30 to 207 days, 3 to 147 days, and 92 to 323 days, respectively. Notably, none of the Mental Health Service for Older People (MHSOP) services within the TEWV Trust met the national benchmark for overall wait times of six weeks. Furthermore, only 25% of the services succeeded in providing a diagnosis within the 6 to 18-week timeframe, while the remaining 75% experienced wait times extending to 18-52 weeks. A comparative analysis revealed that the average wait times (access, diagnostic, and overall) within the Trust exceeded those of the National averages.

The audit underscored substantial discrepancies between the various memory services’ performance and the National recommendations of a six-week wait. Among the services assessed, only one was marginally compliant with a 92-day mark, falling short of the National benchmark of 42 days. This evaluation not only identified critical challenges faced by the services but also presented a series of recommendations to address these gaps.

Tees, Esk and Wear Valley’s Eating Disorder teams recognised a lack of guidance to inform the introduction of exercise in young people with eating disorders. An MDT group reviewed evidence and international guidelines to inform the drafting of a decision-making tool in line with national risk assessment frameworks.

1) A multidisciplinary team assembled monthly, including physical and mental health clinicians and dieticians, to develop and refine guidelines.

2) A literature search was conducted to seek up to date best practice globally.

3) The impact and utility of the framework was assessed through pre-and post-guideline questionnaires distributed to the Eating Disorder Team.

4) Artificial Intelligence assisted Thematic Analysis explored pre-and post-guideline responses.

Thematic Analysis highlighted:

1. Guidance and decision tree were seen as helpful and providing more structure. There were still some requests for improved communication and shared application.

2. Some variation in decision making exists post guidelines, but several team members noted improved consistency with guidance/decision tools. Some pockets of inconsistency remain.

3. Greater reflection on balance of risk. Some felt the team were still overly cautious in the reintroduction of exercise, but others noted guidance enabled positive risk-taking for young people.

4. Confidence generally higher in this area within the team. Respondents highlighted MDT strength and guidance as supportive tools. Some newer staff still unsure around advice in this area.

Themes emergent from pre-and post-draft guideline questionnaires reflected those identified in wider clinical studies around the management of exercise in Eating Disorder interventions. Teams believed exercise was crucial to recovery, bringing benefits to mental and physical health, providing connection with past activities that previously brought enjoyment. The introduction of new clinical guidelines were felt to enable positive risk taking whilst improving consistency and confidence within the MDT.

Current DVLA guidelines advice that patients admitted to hospital for serious mental health conditions should not drive for 3 months following stabilisation and should inform the DVLA of their mental status. This closed loop audit, completed on a Working-Age Adult ward, evaluated current practice and introduced an intervention with subsequent re-evaluation.

A baseline audit was conducted (n=12) which demonstrated that driving status was explored 25% of the time, and of these 67% were given DVLA advice and 67% were told to inform the DVLA. It was concluded that driving status was not routinely involved in MDT discussions, with a clear scope of change. Therefore, an intervention was introduced – the addition of a “driving status” to the electronic ward round template to standardise screening during ward reviews. A prospective re-audit during a 10-week period of 20 patients was then completed. The aims were to implement a sustainable change to improve on current practice and to re-audit to assess impact of intervention. Measured parameters were driving status exploration, advice given regarding driving and was advice to contact DVLA provided.

Following re-auditing, driving status exploration had improved to 85%.Furthermore, of that cohort that drove, 86% were given the relevant DVLA advice regarding whether they could drive or not, an increase from 67% at baseline. Of that cohort that drove 71% were advised to contact the DVLA, as opposed to 67% at baseline. These results suggest that the electronic ward round template intervention introduced did significantly improve the exploration of driving status, and that in this cohort the providing of relevant DVLA advice was improved.

Some of the strengths of the audit included its closed-loop design, which allowed for an evaluation of the intervention introduced. There was also an increase in sample size from the baseline audit to the re-audit. Additionally, the simplicity of the intervention allowed for a sustainable change in practice. Limitations of the audit included the sample size, which reflected a single ward in the hospital and as a result may not generalise across other services. Further actions included introductions of posters on the ward, qualitative information gathering of MDT awareness and expansion of audit into other wards in the hospital.

Harmful and dependent alcohol use frequently co-occurs with psychiatric disorders and is more prevalent amongst psychiatric inpatients than in the general population. Patients admitted to general adult psychiatric wards are at increased risk of alcohol withdrawal.Early identification of alcohol misuse at admission is essential to guide appropriate investigation, monitoring, pharmacological management, and referral to specialist alcohol services.

This re-audit of assessment and management of alcohol misuse in a general adult psychiatric inpatient setting in Mersey Care NHS Foundation Trust follows the original audit conducted in 2021 and re-audit in 2022 and evaluated whether assessment and management of harmful or dependent alcohol use, as defined by ICD-11 criteria, had improved since previous audits and assess effectiveness of previous recommendations implemented.Key areas reviewed were documentation of alcohol history, identification of alcohol misuse, monitoring for withdrawal, prescription of evidence-based treatments, appropriate investigations, and referral to community alcohol services.

A retrospective audit of all patients on eight general adult inpatient wards in the Trust was conducted on 22ndof April 2025. The electronic patient record and prescription chart for each patient were reviewed. Patients with no documented history of alcohol misuse were excluded from monitoring for and management of withdrawal. Audit standards were based on the Trust’s alcohol detoxification policy and NICE guidance.

The total sample was 130 inpatients - 52% male, 48% female.55% of patients had an alcohol history documented on admission.28% of patients had a prior history of alcohol misuse but only 28% of these had their average weekly alcohol intake recorded.Among patients with identified alcohol misuse, a CIWA score was documented within 24 hours in 17% - an improvement from 1% in 2021 and 4% in 2022. Prescribing of withdrawal-related medications remained inconsistent - 14% were initiated on Chlordiazepoxide, 25% on Thiamine, and 3% on Vitamin B Compound Strong within 24 hours of admission.Relevantblood tests - gamma GT level - 31% and Mg2+ - 25% were incompletely performed. No patients were offered referral to community alcohol services, a deterioration compared with previous audits.

Despite modest improvements in CIWA documentation, significant gaps remain in assessment and management of alcohol misuse in general adult inpatients.Inconsistent clerking practices, limited use of structured proformas, and poor referral rates to community alcohol services represent missed opportunities to reduce withdrawal-related morbidity and support long-term recovery.Increased use of clerking proformas and targeted education on alcohol withdrawal management were recommended.

Doctors working in stand-alone mental health hospitals frequently need to refer patients to acute and specialist services to manage physical health problems. These referrals can involve multiple acute hospital trusts, resulting in unclear and inconsistent referral pathways. Resident doctors who rotate regularly between placements may in particular be unfamiliar with local pathways, which can lead to inefficiencies and impact quality of patient care. The aim of this quality improvement project was to assess and improve doctors’ confidence in making appropriate referral pathways by developing and implementing a referral guidance resource. It was hypothesised that compiling a comprehensive referral guidance resource would improve doctors’ self-reported confidence.

This quality improvement project was carried out at Atherleigh Park Hospital using two Plan–Do–Study–Act cycles. Two cohorts of doctors participated (Cycle 1: n=10; Cycle 2: n=6). Baseline confidence in identifying referral pathways was assessed using a questionnaire with a five-point Likert scale (1=not at all confident, 5=very confident). A referral guidance resource outlining commonly required specialty referral pathways was developed and implemented. Following implementation, participants completed a repeat questionnaire assessing confidence, resource usage, ease of access, and included opportunity for qualitative feedback.

Baseline confidence varied across both cohorts. Following the introduction of the referral guidance resource, 100% of respondents reported having used the resource whilst 94% reported knowing where to find it. All respondents also reported an improvement in confidence in identifying appropriate referral pathways. Post-intervention confidence scores across both cohorts ranged from 4 to 5, with a mean score of 4.5 out of 5. Ongoinguncertainty in specific specialties, such as referrals to respiratory medicine, venous thromboembolism clinic, and referrals outside the main acute hospital trust affiliated with the mental health hospital were identified through qualitative feedback. The findings have informed priorities for further development of the resource.

The introduction of a referral guidance resource was associated with improved self-reported confidence. There was high uptake of the resource among doctors at a stand-alone mental health hospital. The findings support the hypothesis that a structured referral resource can improve clinician confidence and show the capacity to contribute to meaningful local service improvement. Further work will focus on expanding specialty coverage within the resource, which has already been incorporated into the resident doctor induction sessions at the hospital with the aim to expand its impact.

Improve identification of patients with restricted eating, standardise the assessment and weight monitoring of patients with restricted eating and improve monitoring for at-risk young people.

This project followed a Plan–Do–Study–Act cycle. The Reading West CAMHScommunity patient list was analysed to gain a baseline measurement of:

• The consistency in identification of patients with restricted eating.

• The effectiveness of weight monitoring being undertaken for the patients on the team caseload.

An anonymous survey was sent to the multidisciplinary team to analyse perceived barriers to identifying patients with restricted eating and gather perspectives.

A focus group was organised involving clinical psychology, psychotherapy and medical teams to examine these barriers and to generate potential interventions.

Based on these findings, changes were implemented in the team, with the intention to expand to other localities if shown to be effective.

Interventions:

• Development of a standardised protocol for documenting weight.

• Addition of screening questions for restricted eating to the proforma for initial assessments of young people.

• Education for the MDT on the risks associated with restricted eating and the importance of early identification and consistent monitoring.

These interventions were disseminated across the team using established channels.

Of the 49 patients on the treatment list, 19 (39%) had documented evidence of restricted eating. Of these, 7 (37%) had adequate weight monitoring and documentation.

Reviews of the notes of these patients found that weight was not always documented, and if it was it was not in a standardised format.

Survey responses highlighted recurring themes including a lack of training and confidence in identifying restricted eating, concerns about the impact of monitoring on therapeutic relationships and the absence of a local protocol. Additional concerns were raised regarding escalation pathways and clinical responsibility.

The preliminary findings indicate that patients with restricted eating make a significant proportion of the caseload, however monitoring of these patients and documentation is not standardised. This indicates missed opportunities to identify and monitor these at-risk patients.

Several barriers to the identification and efficient weight monitoring of at-risk patients were found. These included staff training and confidence and poor standardisation of practice.

We anticipate improved consistency in weight monitoring and identification of high-risk patients with the implemented changes. Repeat analysis will be needed to confirm the post-intervention effect.

Further work will include the development of robust monitoring protocols, establishment of clear escalation pathways and implementation of defined clinical responses for young people identified as high risk.

Autistic and other neurodivergent people experience substantial health inequalities, including poorer mental health outcomes, barriers to accessing care, and premature mortality (autistic people are 7 times more likely to attempt suicide than non-autistic people). These preventable outcomes reflect systemic inequities rather than autism itself. There is, therefore, need for a radical new approach to ward-, service- and organisational-level change to address this profound, unmet need within mental healthcare systems.

Aim: to create a novel Trust-wide Neurodivergence Specialist Advisor role within Essex Partnership University NHS Foundation Trust (EPUT), to improve quality, safety and across all services and age groups through co-produced partnership working to drive professional development, system transformation and an essential cultural shift around all neurodivergence.

This service-development initiative involved partnership working between an Autistic/ADHD psychiatrist and a lived-experience expert, grounded in participatory and co-production principles. Activity domains will include: bespoke patient and service clinical consultations; supporting Patient Safety Incident Investigations, Inquest, LeDeR panels, and Prevention of Future Death processes to turn learning into transformational change;delivery of co-produced training addressing workforce knowledge gaps (e.g. National Autism Trainer Programme – additional and complementary to Oliver McGowan Mandatory Training); service development aligned with organisational governance quality priorities; and collaborative partnership working with local authority and system partners to address interface gaps where neurodivergent people are excluded from support and care pathways.

Significant drive leading to the successful implementation of this new frameworkand advisory role is an outcome of sustained lived-experience advocacy and campaigning, reflecting the influence, expertise, and leadership of the co-authoring lived-experience partner, reinforcing the value and principles of participatory and co-production in healthcare design.Experiential knowledge is essential to shaping equitable systems, not as an adjunct perspective.

Structured evaluation is planned at six months, including audit of activity and service impact (including patient safety data), thematic analyses, and review through executive governance processes as defined by EPUT’s “Working with Neurodivergence” group. This will explore perceived accessibility, workforce ability and confidence, system responsiveness, and identification of previously unrecognised gaps across service pathways. Findings will inform iterative refinement of the role and contribute to organisational learning regarding scalable neurodivergence-informed service transformation.

Embedding neurodivergence expertise and lived experience at organisational level represents a scalable approach to addressing structural inequities in mental healthcare for neurodivergent people. This model emphasises transformational co-production, workforce development, and cross-system collaboration as mechanisms. Early implementation insights will guide wider adoption and contribute to improving outcomes for neurodivergent populations.

• • To collect a database of all patients with ADHD in the adult mental health community team.

• • Investigate current compliance with following NICE guidelines on physical health monitoring for patients with ADHD taking medication.

• • Ensure all patients on medications were under the care of the Physical Health Monitoring Team (PHMT) who undertake the monitoring.

• • Make recommendations for improvement in care where guidelines are not being adhered to.

A database was compiled with patients suffering from ADHD and those on medications were noted.

The following criteria from the NICE guidelines on ADHD management were included:

• • Baseline observations (heart rate (HR), blood pressure (BP), height, weight) – we reviewed this for those patients who had commenced ADHD medications less than one year ago.

• • 6 monthly weight

• • 6 monthly HR and BP

• • 6 monthly psychiatry review

• • Assessment for side effects at review – This includes cardiovascular issues, emerging tics / abnormal movements, sexual dysfunction, seizures, sleep, worsening behaviour

• • 21/31 patients with confirmed ADHD were being medicated for same.

• • 10/21 medicated patients were not under the care of the PHMT nor did they have a key worker.

• • Medications included forms of methylphenidate or lisdexamfetamine and/or both:9/21 (43%) Concerta XL, 5/21 (24%) Equasym XL, Lisdexamfetamine 6/21 (29%), methylphenidate 3/21 (14%).

• • 9/21 (43%) did not receive appropriate baseline observations.

• • 14/21 (67%) did not have a 6 monthly weight documented.

• • 15/21 (71%) did not have 6 monthly HR/BP checks

• • 8/21 (38%) did not have a 6-month psychiatry review.

• • Regarding assessment for side-effects, on reviewing clinical letters, 1/21 (5%) of letters did not document any discussion regarding side effects. Variation in side effects discussed was evident with 10/21 (48%) documenting general side effects such as sleep and 8/21 (38%) documenting more specific side effects such as tics or sexual dysfunction.

This audit highlighted that ADHD monitoring was being neglected in a large percentage of patients on our ADHD database and variation in documentation regarding side effects.

• • Review led to the following improvements being made:

• • We developed an identifiable case load of patients with ADHD which is helpful for future audit and monitoring.

• • Patients were referred to the PHMT for follow up of monitoring, helping to improve the likelihood that NICE guidelines will be adhered to.

• • A reflection on the need for more specific documentation regarding monitoring of side effects in clinical letters.

Lithium is an effective mood stabilizer for older adults but carries increased risks due to age-related physiological changes, comorbidities, and reduced renal function. Regular monitoring of lithium levels, renal and thyroid function, and electrolytes is essential to prevent toxicity, ensure safe dosing, and optimize treatment outcomes.

This audit aimed to evaluate lithium monitoring practices within psychiatry of old age services in Mental Health Services for Older Persons. It focused on the monitoring of lithium levels and relevant blood tests, as well as the completion of comprehensive lithium assessments to ensure safe and effective use in older adults keeping in view of the vulnerability of this age group.

A retrospective review of all lithium patients attending the service was conducted, assessing lithium evaluations, documentation, monitoring of side effects, and adherence to recommended blood monitoring standards following NICE and Maudesley guidelines.

In Cycle 1, deficiencies were noted in documenting side effects, medication interactions, and regular monitoring of eGFR and physical health. In response, Cycle 2 introduced a service development project with structured monitoring tools. Lithium flowsheets were implemented to record blood tests every three months, and lithium stickers were used by nursing staff to document results in clinical notes. A two-page clinical assessment form, incorporating tick-boxes for side effects, interactions, and patient education, ensured all areas were systematically addressed. A GP template was also developed to prompt timely blood tests.

These interventions resulted in significant improvements in lithium monitoring and documentation. Additionally, a formal lithium policy was established within the North Dublin Mental Health Services for Older People Community Mental Health Team, supporting consistent and safe practice.

Overall, the implementation of structured monitoring tools and policy measures enhanced adherence to recommended blood tests, improved documentation of side effects, and strengthened patient education. These initiatives have collectively improved the quality, safety, and effectiveness of lithium prescribing in older adults.

Psychiatric inpatient units are often geographically, organisationally and culturally distinct from tertiary care hospitals, creating separation. When these two worlds inevitably collide, challenges often arise. Evidently, there is a limited understanding of each team’s challenges and, in this game of tug-of-war, patients bear the ultimate price.

Case Presentation

A 67-year-old man with dementia was admitted to a psychiatric inpatient unit for management of behavioural and psychological symptoms. During admission, he developed an acute change in mental state, consistent with delirium. He was therefore referred to tertiary care, where investigations revealed urinary retention, with an estimated three litres in the bladder.

Despite discussions between the emergency department (ED) and Psychiatry, the patient was discharged back to the psychiatry unit, with advice for catheterisation and intravenous (IV) antibiotics. Unfortunately, mental health wards could not perform these tasks due to a lack of experience, staff and equipment. Hence, the patient was transferred back to ED. On re-presentation, twenty-four hours after initial escalation, the patient became unconscious, was intubated and admitted to intensive care.

This case illustrates the systemic challenges posed by the mental-physical health interface. From a psychiatric perspective, there was a sense of frustration and helplessness, whilst ED was similarly challenged due to the complexity of the patient’s confusion. Pressures on services to remain efficient and meet targets, coupled with the disconnect between psychiatry and acute care, led to poor understanding of each party’s limitations, meaning the underlying cause of the patient’s life-threatening distress remained untreated. Limitations include a psychiatric unit’s inability to administer IV medications, lack of medically trained psychiatry staff and the increasing demands placed on services. Inadequate awareness of these challenges, along with the patient’s dementia, legal status, and psychiatric admission, may have subtly influenced how their needs were prioritised.

The structural separation between mental health services and acute medical care within the UK healthcare system continues to widen, despite ongoing efforts from psychiatry liaison services. This case underscores the need for a shared understanding of resources, capabilities and clinical responsibility across services. Fragmentation between teams can lead to ambiguity, with acute medical services overestimating the capabilities of psychiatric units due to their designation as tertiary hospitals, while mental health services lack the infrastructure to deliver routine medical care.

Improved education, cross-service exposure and enhanced ward provisions may strengthen communication, clarify escalation pathways and, ultimately, improve patient outcomes.

Since 2022, rising living costs have intensified strain on families, leaving many families struggling to meet their basic needs. Economic instability increases the risk of adverse childhood experiences (ACEs), which are associated with long-term mental health (MH) challenges. This project aims to assess the impact of the cost-of-living crisis on children’s MH, focusing on the deprived area of Stoke-on-Trent. Following which, strategies to support children and families most affected will be explored both in terms of public health campaigns and strategies within mental health services.

Initially, a literature review evaluated national trends of the impact of cost-of-living crisis on child MH. More substantial qualitative data on such themes was then developed through interviews with local general practitioners, mental health charities, schools, family hubs, and community centres to gain a better understanding of the local impact so that targeted strategies could be developed.

The crisis has led to children more frequently exposed to neglect and other forms of abuse, increasing ACE exposure. Local charities noted higher food bank reliance among families, and GPs reported rising malnutrition cases. Adolescents in colder homes reported worsened MH symptoms, often due to effects of overcrowding and fuel poverty, including increased witnessing of domestic violence and increased risk of chronic respiratory infections, with chronic diseases known to have long-standing mental health implications. Children from financially unstable families faced bullying due to unclean uniforms, as heating and washing were unaffordable. Limited access to transport and technology prevented families from attending MH appointments, deepening health inequalities. Activities such as sports clubs or swimming lessons were often sacrificed to protect family finances, preventing young people from attending activities known to maintain their MH, and isolating them from their peers. Local community centres found their budgets affected, with cuts to adolescent substance misuse and violence programmes, contributing to increased numbers of first-time young offenders.

The cost-of-living crisis has amplified MH risks for many children, with more families experiencing financial insecurity and as such children experiencing ACEs. Recommendations to alleviate these effects include utilising principles of Make Every Contact Count, to identify and support struggling families as early as possible. Further considered are local programmes to expand school and community wellbeing services based on the ‘5 ways to wellbeing’ framework such as free activity programmes and social groups at family hubs. Furthermore, improving access to virtual MH appointments by supporting digital access through initiatives like ‘Tech 4 Families’.

Tobuild a Multiprofessional Neuropsychiatry educational network. To provide high standard educational meetings through complex case presentations which promote neuropsychiatry across the East Midlands.

Neuropsychiatry as a sub-speciality is not endorsed by the GMC, and as such formal training pathways do not exist for psychiatrists in the UK. The Neuropsychiatry Discussion Group (NPDG thereafter) is a monthly forum designed for clinicians across all levels and specialties to explore complex neuropsychiatric presentations. Each session a clinician presents a complex case that challenges diagnostic frameworks and treatment strategies. In the past 12 months we have expanded the network, hosted guest speakers from experts to trainees with an interest in neuropsychiatry and formalised the programme. We regularly have 70+ attendees across neighbouring trusts in the East Midlands and are continuously expanding the network to foster professional collaboration.

We base the programme on the RCPsych Faculty of Neuropsychiatry suggested syllabus to ensure curriculum coverage over the year and have developed a standardised feedback form for the sessions using a Likert scale as well as free text to collect data.

Analysis of participant feedback across multiple sessions demonstrated strongengagement and consistently high satisfaction with the educational content and delivery.The programme successfully incorporated a broad range of presenters spanning training grades and seniority, from CT1 trainees to Professors of Neuropsychiatry, reflecting an inclusive academic culture and exposure to varied perspectives. This breadth was frequently reflected in comments.

Quantitative data showed that participants rated the clarity of session objectives, clinical and academic relevance, and effectiveness of teaching methods predominantly at levels 4 and 5, indicating a high degree of perceived educational value and quality.

Qualitative feedback reinforced these findings. Attendees frequently emphasised the strengths of the case-based format, praising the sessions for their real-world clinical applicability, multidisciplinary input, and opportunities for collaborative discussion. The format was noted to support deep, reflective learning, particularly in areas where diagnostic and treatment paradigms are complex or evolving.

Ongoing evaluation will remain integral to the development of the group. We will continue to systematically collect and analyse participant feedback across sessions.

We are working with neighbouring trusts and organisations in order that attendance at the sessions can be used for CPD activity.

We aim to continue to widen the NPDG network, therefore fostering rich, cross-specialty dialogue. We wish to deepen clinical insight, share perspectives, and enhance collaborative care across the region.

A 38-year-old male with an 8-year history of schizophrenia presented with inadequate response to multiple antipsychotics and tardive dyskinesia. Tetrabenazine was initiated for dyskinesia, and Clozapine was started with gradual titration. On day 14, T. Clozapine was increased from 125 mg to 150 mg. Following this, the patient had an episode of sleep disturbances and purposeless motor movements that lasted for half an hour. Afterwards, the patient slept well, and the following day, his mental status examination revealed no new findings. The following night, 3 hours after receiving the second dose of Clozapine 150 mg, the patient developed disorientation, restlessness, and visual hallucinations. He was not cooperative with any instructions. Laboratory investigations, including haematological and metabolic parameters, were performed and were within normal limits. The acute onset of these clinical features supported the diagnosis of Clozapine-Induced Delirium.

Case Report

Management included immediate discontinuation of all medications. Pharmacological sedation with parental Lorazepam and Haloperidol was required. Even after this, the patient had to be retrained to start intravenous Ringer’s lactate for maintenance of hydration. Delirium subsided within 18 hours, and orientation returned without any residual deficits. S. Clozapine levels could not be done due to financial limitations. This adverse drug reaction suggests a probable link between Clozapine and Tetrabenazine, precipitating delirium, possibly through cholinergic-dopaminergic imbalance.

To the best of our knowledge, this is the first known case of its kind where the combination of Tetrabenazine with Clozapine, at relatively low dosage, has led to the life-threatening side effect of delirium. This case highlights the complexities of treating a patient who has become hypersensitive to both first-generation and second-generation antipsychotics, including Clozapine. While further research needs to be done regarding this unusual reaction, clinicians should remain vigilant for delirium during clozapine initiation, particularly when used alongside VMAT2 inhibitors such as tetrabenazine.

Dopamine agonists like cabergoline are considered first-line therapies for prolactin-secreting pituitary microadenomas. Although efficacious from an endocrinological perspective, the use of dopaminergic stimulation can potentially exacerbate or unmask psychiatric symptoms, including psychosis. The management of emergent psychosis in this scenario is a challenge, as antipsychotic dopamine blockade can potentially worsen hyperprolactinemia. Aripiprazole, a dopamine D2 partial agonist, is often preferred for its antipsychotic properties and relative prolactin neutrality; however, its efficacy in the treatment of severe psychosis while on dopamine agonist therapy is unclear.

A 29-year-old woman with a 12-year history of obsessive-compulsive symptoms, who had remained stable and had never been hospitalized, was diagnosed with hyperprolactinemia after the development of galactorrhea and menstrual disturbances. MRI showed a 6 mm pituitary microadenoma, and cabergoline 0.5 mg twice a week was started with good biochemical control. Shortly thereafter, she experienced severe psychiatric deterioration, including persecutory delusions, ideas of reference, refusal of food, severe self-neglect, and social withdrawal, requiring psychiatric hospitalization. Mental state examination showed prominent psychotic features coexisting with the patient’s previous obsessive phenomena.

Aripiprazole was started at 5 mg/day and gradually increased to 20 mg/day over three weeks, chosen for its partial dopamine agonist properties and prolactin-sparing action. Despite optimal dosing, good tolerability, and maintenance of prolactin levels, there was little relief from psychosis or behavioral disturbance. Because of persistence of severity, aripiprazole was stopped and olanzapine started at titrated upto 15 mg/day. An SSRI was continued for obsessive symptoms. Cabergoline was continued under strict endocrinological follow-up.

Within two weeks of the initiation of olanzapine, there was a marked improvement in persecutory delusions and behavioral disturbance, along with the return of appetite, sleep, and self-care, and partial recovery of insight. Serum prolactin levels remained within acceptable limits (46 ng/mL), and follow-up MRI at three months showed no progression of the tumor.

This particular case illustrates the shortcomings of aripiprazole in dealing with severe psychosis, especially in the setting of dopamine agonist therapy, even in the presence of theoretical endocrine benefits. In situations where endocrine function is substantially affected, psychiatric management may need to focus on effective antipsychotic therapy, with close interdisciplinary attention to minimize endocrine risk.

Starting a new post can be intimidating when induction varies between trusts. This project aims to look at doctors’ experiences with induction within different NHS trusts in the West Midlands. A secondary aim was to use the survey as a benchmarking exercise, comparing experiences at Birmingham Community Healthcare (BCHC) (psychiatry trainees rotate through intellectual disability (ID) placements) compared with other trusts. Initial audit identified limited understanding of MDT working in ID Psychiatry, highlighting need for greater support at induction.

An online survey was distributed to doctors who started posts in psychiatry across different NHS trusts. It had multiple choice and free text questions covering pre-start information, induction quality, IT systems and team inclusion. The standard was induction provides new trainees with timely IT access and clear understanding of MDT roles and referral confidence. Quantitative data was summarised as percentages, while free-textresponses were reviewed to identify common themes. Following identification of uncertainty around MDT working in BCHC a separate MDT confidence survey was distributed to assess trainee confidence in MDT referral process within ID service.

Initial survey comparing induction experiences across trusts in the West Midlands had 28 doctors respond. Clear pre-induction information reported by 61% of doctors. Overall induction rated as good by 64% with 21% rating it poor. 79% felt they had what they needed to be productive but access to key resources were delayed with 61% receiving laptop on day one, while 22% waited two weeks. Administrative issues reported by 57% of doctors in first week, 29% completed mandatory training in their time, but 93% of doctors felt welcomed. In contrast, BCHC implemented a structured induction and IT access at trust headquarters and appointments booked from the following week. The secondary survey focused on MDT confidence had nine resident doctors within BCHC complete it. 78% felt confident working within the MDT however confidence varied by referral type. 56% felt confident referring to physiotherapy compared to 44% for psychology and OT. 67% reported hesitating to refer, 56% delayed referrals and only 23% felt confident making timely referrals.

This benchmarking audit highlights a significant variation in induction experiences across trusts with lack of efficient processes. It highlights a lack of confidence to refer to our MDT colleagues within ID Psychiatry. Based on survey findings, targeted intervention of an MDT guide and teaching session for new trainees was conducted at BCHC for February 2026 intake. Survey on MDT confidence has been undertaken by the new cohort prior to the intervention and will be repeated in 6 weeks to assess impact of the new MDT guide for trainees.

To identify quantitative studies of patients with psychotic disorders prescribed second generation antipsychotics (SGAPs), measuring new-onset or worsening obsessive compulsive symptoms (OCS) after treatment, and to evaluate whether SGAPs induce or exacerbate these symptoms.

A systematic review was conducted using MEDLINE, EMBASE, CINAHL, PsycINFO and Web of Science, following PRISMA guidelines. Search terms covered psychosis, OCS and SGAPs. Of 2524 references retrieved, 1939 remained after duplicate removal. Screening by two independent reviewers identified 58 eligible abstracts, with 43 full-text studies included. The Yale–Brown Obsessive Compulsive Scale (Y-BOCS) was the most commonly used outcome measure.

Across 43 studies, 9044 participants with psychotic disorders were included, predominantly with schizophrenia (mean age 36 years). Clozapine was studied in 28 reports, with additional evidence for risperidone, olanzapine, ziprasidone and aripiprazole. Seventeen studies demonstrated statistically significant results, most associating clozapine with de novo OCS. Olanzapine was also linked to emergence or worsening of OCS symptoms, while adjunctive aripiprazole showed evidence of improvement in some cases. Most studies were observational, limiting causal inference.

Preliminary evidence suggests clozapine is associated with new-onset OCS, potentially mediated by 5HT2a and 5HT2c antagonism. The association is less clear for other SGAPs, though there is evidence that olanzapine can contribute to a worsening in severity of OCS or emergence of new-onset OCS, and evidence that adjunctive aripiprazole can improve OCS outcomes. Further longitudinal, prospective trials are required to clarify these associations.

To address (the outcome of) a survey (on patient safety) indicating resident doctors atthe Trust did not feel able to raise patient safety concerns, or that if they did these concerns would not be addressed.To increase resident doctor satisfaction by 20% in two years and improve two-way communication with Trust patient safety infrastructure.

This project utilised a sequential Quality Improvement (QI) methodology. The steps undertaken:

1. Baseline Assessment:Collated from the NHS national staff survey, Trust-wide DATIX reporting trends and specific survey for resident doctors to identify specific cultural and procedural barriers to safety reporting.

2. Governance and Advocacy:Representatives attended the monthly Trust Patient Safety Committee to represent frontline concerns. They acted as accessible points of contact for trainees, ensured “closed-loop” feedback on raised issues, and provided peer-led encouragement for formal DATIX reporting when indicated.

3. Closed-Loop Communication:A regular “Patient Safety Bulletin” was implemented to summarise key learnings, systemic issues, and specific resolutions using a transparent “You Said, We Did” framework.

4. Leadership Development:A programmewas launched allowing higher resident doctors to join internal Service Quality Reviews (SQR) as team members, to improve their experience of involvement in clinical governance.

5. Sustainability:To ensure project longevity, the representatives created a formal job description and offered the opportunity for resident doctors to undertake the role each year.

6. Evaluation:A repeat survey was distributed to resident doctors to measure the impact of the intervention against baseline metrics.

Resident doctors’ satisfaction with the reporting process rose from 13.5% (n=5/37) in 2025 to 65% (n=13/20) and confidence in effective action increased from 13.5% (n=5/37) to 60% (n=12/20) in 2026. 95% of resident doctors undertaking the survey found the trainee representative role and their actions helpful. Higher trainees provided positive feedback (n=7/7) on SQR involvement experience.

Other outcomes include resolution of a cross-site emergency protocol discrepancy, optimisation and promotion of ‘Consultant connect’ to enhance access to specialist physical health advice, and resident doctor representation at the Physical Health and Resus Committee.

Peer-led representation provides a structured mechanism to reconcile the gap between safety awareness and clinical action. By formalising the feedback loop through transparent communication and creation of opportunities for involvement, this model addresses the perceived futility of reporting and establishes a sustainable pipeline for medical leadership in (clinical) safety governance. This approach offers a reproducible framework for enhancing safety culture and trainee engagement across mental health services.