This report details the forensic admission of Ms X, a woman in her 40s, following an index offence of Grievous Bodily Harm (GBH) driven by fixed persecutory beliefs. It underscores the clinical challenge of identifying Autism Spectrum Disorder (ASD) when masked by “social camouflaging” or obscured by somatic comorbidities. Historically, Ms X’s difficulties were attributed to Chronic Fatigue Syndrome and depression. At the same time, her forensic presentation was initially diagnosed as “Delusional Disorder,” illustrating the risks of diagnostic overshadowing in forensic risk assessment.

Ms X presented with persistent beliefs that an online group had compromised her devices and that neighbours were surreptitiously filming her. These beliefs culminated in her confronting neighbours while armed. On admission, her presentation diverged from primary psychosis; she exhibited limited conversational reciprocity, sensory hypersensitivities (noise and olfaction), and a narrow, obsessive preoccupation with cyber-security. A retrospective developmental history revealed core ASD traits missed due to female-typical compensation strategies, including long-standing social aversion and ritualistic behaviours. This led to a formal diagnosis of ASD, replacing the previous diagnosis of primary Delusional Disorder.

The clinical formulation reframed Ms X’s “delusions” as intense manifestations of autistic cognitive style. Her beliefs were formed through a concrete, literal interpretation of ambiguous stimuli; for example, interpreting the online phrase “I see you” as evidence of physical surveillance. Her inherent cognitive rigidity rendered these beliefs resistant to challenge. Furthermore, deficits in Theory of Mind caused her to misattribute neutral or ordinary environmental actions as intentional threats. Consequently, the index offence was formulated as a reactive defence rooted in neurodevelopmental rigidity and emotional dysregulation, rather than a psychotic break.

This case highlights the imperative for forensic practitioners to screen for masked ASD in women, particularly when intense somatic or mood symptoms are present. Understanding ASD-related rigidity is crucial for accurate risk formulation and legal mitigation. Management must shift from traditional antipsychotic protocols toward integrated, specialised psycho-social interventions–such as Neurodevelopmental Outreach Services–focused on building ASD-specific insight and adaptive coping mechanisms.

To identify patient- and staff-reported barriers and facilitators influencing transition from monthly to 2-monthly aripiprazole long-acting injectable (LAI) therapy within an Adult Mental Health Outpatient Service, and to use these findings to design interventions to improve the consistency and quality of patient–clinician discussions.

Structured, anonymous surveys were administered to patients receiving monthly Aripiprazole LAI (n=11) and multidisciplinary staff involved in LAI prescribing or administration (n=23). Surveys included Likert-scale items and free-text questions exploring understanding, willingness, confidence, perceived barriers, and facilitators. Quantitative data were analysed descriptively, and free-text responses reviewed thematically. Findings informed staged interventions tested through Plan–Do–Study–Act (PDSA) cycles.

Patients: Most had long-term monthly LAI exposure (55% >5 years). Understanding of differences between monthly and 2-monthly LAI was limited (45% reporting “not at all” or “a little”). Willingness to switch was polarised: 45% not willing, while 45% willing or very willing. Key concerns included fear of relapse (18%), concern that the injection may not remain effective for two months (27%), fewer clinical contacts (27%), and prolonged side effects (27%). Perceived benefits included fewer injections (73%), increased convenience/flexibility (55%), and fewer clinic visits or reduced travel (45% each). Over half (55%) requested more information, and 36% reported greater willingness to switch if better informed.

Staff: Although 87% of staff were aware of the 2-monthly formulation, 43% had never discussed it with patients. While 52% felt confident discussing the option, only 26% felt confident with clinical switching considerations, and 43% reported low clarity regarding practical steps such as the Named Patient Registration Form. Common barriers included patient resistance (35%), fear of relapse or destabilisation (35%), concern regarding sustained effectiveness (30%), reduced clinical monitoring (26%), and lack of patient education materials (35%). Facilitators included patient leaflets (78%), structured guidance or checklists (57%), clear explanation of benefits and risks (>55%), and staff training or induction (70%).

Baseline patient and staff data demonstrate that transitions to 2-monthly aripiprazole LAI are limited not by lack of awareness, but by gaps in patient understanding, clinician confidence with clinical and practical switching considerations, and absence of consistent education and process tools. The co-designed intervention–comprising a communication protocol, staff checklist, patient leaflet, targeted staff training, and peer-supported patient education–targets these modifiable gaps. This QIP highlights the value of aligning patient and staff perspectives to strengthen shared decision-making and improve consistency in LAI care, with implications for future service-level optimisation.

Transcranial direct current stimulation (tDCS) is a non-invasive brain stimulation technique used at home and delivers mild electric currents, applied through two pads on the forehead. It does not have the side effects associated with antidepressant medication, is highly acceptable and easily offered through primary care. Research studies show that tDCS can significantly improve sleep quality and provide insomnia remission. Rates of insomnia remission of between 22–50% have been seen. The aim of the project was to assess effect of ‘Flow’ tDCS on insomnia in primary care patients.

Intervention: tDCS for 30 minutes, for five sessions per week for four weeks. Baseline and follow-up scores collected. Interviews with GPs and 14 participants about their experience.

Significant improvements on 1. Sleep: Insomnia Severity Index (ISI); 2. Depression: Patient Health Questionaire-9 (PHQ-9); 3. cognitive functioning: Perceived Deficits Questionnaire (PDQ-5); Quality of Life (EQ-5D-5L); and real-world functioning: Work and social adjustment (WASA). Patients have described improved quality of life, reduction in insomnia symptoms, improved sleep, improved mood, better meaningfulness/engagement in life, and better educational, social and work functioning. The project showed that offering tDCS was feasible and effective.

Evidence about the improvement with tDCS could expand NHS treatment for millions of people who experience insomnia. Having a new effective treatment in the NHS that can be used at home could be life-changing for people with insomnia. Providing a non-pharmacological choice in primary care is essential.

Severe mental illness (SMI) is associated with significant cardiovascular disease due to a combination of lifestyle factors, metabolic effects of antipsychotic medications and reduced access to preventive healthcare. This quality improvement project (QIP) wasconducted to enhance cardiovascular risk assessment in patients with SMI by improving the efficiency and consistency of QRISK score documentation.

This study was conducted over two cycles involving patients admitted with SMI to a general psychiatric unit. Cycle 1 covered a five-month period (December 2024–May 2025), and Cycle 2 a four-month period (July 2025–October 2025). Cardiovascular risk was assessed using QRISK®3 (2018) tool, with eligible patients aged 25–84 years included. Thirty patients were analysed in Cycle 1 and 27 in Cycle 2. Data were retrospectively collected from patient’s electronic records and physical health parameters. Following baseline assessment, a standardised algorithm was implemented to improve consistency of QRISK calculation. Cycle 2 reassessed outcomes to evaluate the impact of this intervention.

In Cycle 1, 30 patients with severe mental illness (SMI) were included, of whom 70% were male. In contrast, Cycle 2 comprised 27 patients, with females accounting for 59% of admissions. The age range was 26–75 years in Cycle 1 and 32–63 years in Cycle 2. Schizophrenia was the most common diagnosis in both cycles (36% in Cycle 1 and 33% in Cycle 2), followed by bipolar affective disorder (20% and 18%, respectively). Aripiprazole was the most frequently prescribed antipsychotic in both cycles (37% in Cycle 1 and 25% in Cycle 2).

During Cycle 1, QRISK scores were not documented for 15 patients (50%). Following implementation of the clinical algorithm, this improved in Cycle 2, with only 5 patients (18.5%) lacking a recorded QRISK score. In Cycle 1, a total of 8 patients were identified as having QRISK scores >10%, of whom 2 had not been documented. In Cycle 2, 6 patients had QRISK scores >10%, with no patients missed, following intervention.

This QIP highlighted the importance of routine QRISK assessment in patients admitted with SMI, who are at increased risk of cardiovascular disease. Implementation of a structured clinical algorithm significantly reduced missed QRISK calculations, improving identification of high-risk individuals. Continued staff education and strengthened collaboration between mental health and primary care services may further enhance follow-up and long-term cardiovascular risk management in this population.

Antipsychotics may be prescribed for severe behavioural and psychological symptoms of dementia (BPSD) but carry significant risks. National and local guidance recommends structured assessment, documentation, regular review, and timely deprescribing.

This audit assessed compliance with Nottingham Area Prescribing Committee guidance EG019 and National Institute for Health and Care Excellence guidance NG97 within the Newark and Sherwood Older Adult Community Mental Health Team.

We hypothesised that initial clinical assessment would show high compliance, while structured monitoring documentation would be inconsistent.

A retrospective audit was conducted using the RiO electronic clinical record system. A Clinical Record Interactive Search identified patients with a diagnosis of dementia initiated on antipsychotic medication by the Newark and Sherwood Older Adult Community Mental Health Team between 1 October 2023 and 1 October 2024. Diagnoses included International Classification of Diseases, Tenth Revision (ICD-10) codes F00–F04 and G31.8.

The audit tool was a locally developed audit proforma derived from the standards from the two guidances (EG019 and NG97), and it assessed documentation of symptom assessment, risk evaluation, discussion of risks and benefits, use of the Antipsychotics in Dementia Assessment and Monitoring Form, review intervals, and consideration of deprescribing. Compliance was reported descriptively as percentages.

Of 114 records screened, six met inclusion criteria.

• • Target symptoms were identified and quantified in 100% of cases, and contributing factors for distress were explored in all patients.

• • Delirium was considered in 83%, and modifiable factors were addressed in 83%.

• • Lewy body or Parkinson’s disease dementia was considered in all cases.

• • Risk of harm to self or others was documented in 67%

• • Discussion of risks and benefits with patients or carers was documented in 83%.

• • Medication review occurred in 100%, with dose reduction or discontinuation in 17%.

• • Review at or before six weeks occurred in 80% of eligible cases, with a documented rationale for continuation in 60%.

• • Regular six-weekly review and consideration of deprescribing were each evident in 60%.

• • Notably, the completion of the Trust Antipsychotics in Dementia Assessment and Monitoring Form occurred in 0%.

This audit demonstrates good compliance with recommended clinical assessment and cautious prescribing for BPSD but identifies a critical gap in structured monitoring, with no use of the Trust-mandated monitoring form. Documentation of ongoing review and rationale for continuation was also inconsistent. These findings support targeted education, improved induction processes, and system-level changes to embed structured monitoring. A re-audit, including baseline physical health monitoring, is planned.

Background:

Foetal Alcohol Spectrum Disorder (FASD) is under-recognised in Children in Care (CiC), Adopted Children (AC) and those on Special Guardianship Order (SGO) known to Child and Adolescent Mental Health Services (CAMHS. While neurodivergent conditions such as Attention Deficit Hyperactivity Disorder (ADHD), Autism Spectrum Disorder (ASD), or behavioural problems are recognised, underlying neurocognitive impairments associated with Prenatal Alcohol Exposure (PAE) remain rarely explored. This case series aims to describe the neurocognitive profiles of children diagnosed with FASD identified via local diagnostic pathways, in the CiC specialist CAMHS ‘Symbol’ team.

Case Report:

Of the four children reviewed on the neurodevelopmental care pathway, three received a multidisciplinary diagnosis of FASD. Assessments included detailed mental health assessment, developmental and family histories, school reports and information collated from CiC medical records, OT (Occupational Therapy), SALT (Speech and Language Therapy), EP (Educational Psychology) reports and social care records. Standardised cognitive assessments (WISC-V -including full-scale IQ and domain-level profiles) and Adaptive Behaviour Assessment System (ABAS) were completed. Particular attention was given to variability across cognitive domains, adaptive functioning, and discrepancies between verbal ability, working memory, processing speed and fluid reasoning. The Scottish SIGN guidance was used to guide diagnostic process.

Discussion:

There was variability in overall cognitive functioning across the children assessed, ranging from Mild Learning Disability to Low Average cognitive ranges. Across cognitive domains, there was great variability, with the majority showing relative strengths in Verbal Comprehension. There was variability in the Working Memory domain across assessments, and all children showed significant relative impairments in Processing Speed, Fluid Reasoning and Visuo-Spatial domains. This “spiky profile” contributed to diagnostic overshadowing, as average/ low average full-scale IQ scores sometimes masked clinically significant cognitive impairments at domain level. The ABAS often revealed gaps between cognitive abilities and real-world functioning.

Conclusion:

FASD may be under-diagnosed in CAMHS populations, particularly where children present with complex needs and uneven cognitive profiles. Awareness of “spiky” neurocognitive patterns and systematic multidisciplinary assessment can improve diagnostic accuracy and inform educational and therapeutic support. The ABAS, alongside cognitive assessments are important in identifying domains of difficulty in the real world. Early identification has significant implications for care-planning, family understanding and psychological support in receiving a diagnosis of FASD.

To examine whether psychedelic-like states of consciousness can be induced through brain stimulation techniques, evaluate their potential advantages over pharmacological psychedelics, and explore how stimulation-assisted psychotherapy may offer a clinically viable model for mental health treatment.

A structured narrative review was conducted using PubMed and PsycINFO,examining peer-reviewed studies of non-invasive and invasive brain stimulation techniques, including transcranial magnetic stimulation (TMS), transcranial alternating current stimulation (tACS), transcranial direct current stimulation (tDCS), and deep brain stimulation (DBS). Literature describing subjective phenomenology, neuroimaging findings, and therapeutic outcomes was reviewed alongside evidence from psychedelic-assisted psychotherapy to enable mechanistic comparison. Findings were synthesised thematically with reference to clinical relevance.

Across multiple studies, targeted brain stimulation was shown to induce transient alterations in perception, emotional salience, self-experience, and cognitive flexibility–phenomenological features overlapping with psychedelic states. Neuroimaging and electrophysiological data indicate that both psychedelic states and brain stimulation modulate large-scale brain networks, particularly through reduced dominance of the default mode network, increased global connectivity, and altered thalamocortical and corticolimbic signalling.

Unlike pharmacological psychedelics, brain stimulation avoids systemic drug exposure, reducing risks of prolonged perceptual disturbance, pharmacokinetic unpredictability, substance interactions, and psychosis precipitation related to serotonergic agonism. Stimulation parameters can be titrated, paused, or terminated in real time, offering enhanced safety, reproducibility, and clinical governance.

Importantly, evidence from psychedelic research indicates that therapeutic benefit is primarily mediated through psychotherapeutic processes–such as insight generation, emotional processing, and narrative restructuring–rather than the altered state alone. Brain stimulation may similarly act as a catalyst for psychological change by transiently increasing neural and cognitive flexibility, thereby enhancing responsiveness to psychotherapy across conditions including depression, trauma-related disorders, and addiction.

Brain stimulation techniques may offer a controllable, non-pharmacological means of accessing key neural and psychological mechanisms associated with psychedelic states, while mitigating many drug-related risks. When integrated with structured psychotherapy, stimulation-assisted models may provide a pragmatic translational pathway for harnessing psychedelic-relevant mechanisms within existing mental health services. Further research is required to establish optimal stimulation parameters, safety profiles, and disorder-specific applications before routine clinical use.

Bodily distress disorder (BDD) involves presence of excessively distressing somatic symptoms to which individuals direct excessive attention despite repeated contacts with healthcare providers or even if another condition is causing the symptoms,paying excessive out of proportion attention to symptoms. BDD is more prevalent following Covid-19, but data from Asia remains sparse. Thus, this study is done to determine the prevalence of BDD among patients seeking outpatient treatment at Colombo North Teaching Hospital (CNTH), Sri Lanka.

We conducted a cross-sectional study recruiting consecutive, consenting patients attending the outpatient department (OPD) of CNTH from April to June 2025. Presence of somatic symptoms were determined by applying Bradford Somatic Inventory. Relationship of somatic symptoms to bodily distress disorder, depression or anxiety was determined according to ICD–11 criteria through clinical interviews by a senior registrar in psychiatry. In patients diagnosed with BDD lack of an adequate biological explanation for symptoms or in patients with established medical conditions contributing to symptoms, degree of attention to symptoms being excessive despite appropriate clinical examination, investigations and reassurance was confirmed by the Consultant Physician in charge of OPD.

We studied 236 patients (female 83.1%, mean age 62±11.8 years, educated up to orbelow grade eleven–83.1%, residency urban or suburban–89%). Prevalence of somatic symptoms was 94.1%. Out of those, BDD was diagnosed in 28.1%, depressive disorder in 14.3% and anxiety disorder in 7.1%. Prevalence of BDD was higher in females 29.1% compared with males 15% (Chi square 3.4,pvalue 0.06) and higher in people with education up to or below grade eleven–27.0% when compared with above grade eleven–25.0% (Chi square 0.7, p value 0.79). BDD was higher in people below 60 years (Chi square 5.6, p value 0.18) and in people residing in urban, and suburban areas (Chi square 11.0, p value 0.00). Number of comorbidities is positively correlated with BDD status. Most common two presenting symptoms were aches and pain (41.8%) and lack of energy/fatiguability (37.2%). Majority of those with BDD were on polypharmacy therapy (60.3%) and 22.2% were on analgesics.

Prevalence of BDD among this whole sample of people seeking outpatient treatment at a tertiary care hospital in Sri Lanka was 26.7%. Age below 60years, urban and suburban residency,multi-morbidity were significantly associated with BDD.

To evaluate the implementation and mental health outcomes of physical activity-based interventions within contexts specifically relevant to Wales.

We aimed to identify existing gaps in the literature, explore implications for local clinical practice, and provide a strategic solution for common mental health settings.

We sought to establish a framework for action and quality statements to embed physical activity within routine mental health care.

Prioritise action that will support the improvement of the physical health of people with severe and enduring mental health conditions, reducing the mortality gap between people who have severe and enduring mental health conditions and those that do not. This is inkeeping with aspirations of Welsh Government’s Mental Health and Wellbeing Strategy Delivery Plan 2025–2028.

We utilised a multi-faceted methodology, including a structured mapping and narrative analysis of the broader international evidence base alongside a systematic review of Wales-specific evidence.

The systematic search followed PRISMA guidelines, targeting databases such as MEDLINE, PubMed, and PsycINFO using key terms like “mental illness”, “exercise”, and “Wales”.

Grey literature sources were also analysed to capture real-world practical challenges. Articles were screened, with inclusion limited to those published after 2007 to remain consistent with modern legislative definitions.

The findings indicate that physical activity interventions significantly improve mental wellbeing across various settings in Wales, including community-based programmes, secure units, and exercise referral schemes.

Key benefits identified include reduced symptom severity for both common mental disorders and severe mental illness (SMI), improved sleep quality, and mitigation of premature mortality risks.

However, significant barriers to implementation were identified:

• Systemic Barriers: Limited funding, a shortage of qualified physical activity professionals, and insufficient training for healthcare staff.

• Individual Barriers: Low motivation, poor baseline physical health, and low self-esteem among service users.

• Environmental Barriers: The “obesogenic” nature of secure inpatient units, which often lack the flexibility or resources to prioritize physical activity.

Integrating physical activity into mental health services is essential but requires a shift in clinical culture and investment.

We propose four Quality Statements to guide leaders, emphasising collaborative design with physical activity professionals, inclusive programming for diverse needs, equitable care in secure settings, and sustainable investment in community programmes.

Effective implementation depends on moving toward a person-centred, evidence-informed approach that addresses both social and commercial determinants of health.

Dissociative identity disorder (DID) is characterised by the existence of two or more distinct identities within an individual, affecting their consciousness, behaviour, and memory. Accounting for only 1% of the psychiatric population, it is a rare and often controversial diagnosis. This case report describes the diagnosis of DID in a neurodivergent adolescent from an ethnic minority background, whose assessment was complicated by layers of complexities. Through his journey within the mental health services in England, the successes and challenges in supporting the needs of young people in similar circumstances will be discussed. All identifying details have been anonymised.

Joseph is a 14-year-old asylum seeker of Black ethnicity who arrived in the UK at age 9. Known to the mental health service from age 13 for low mood, he was reviewed following a suicide attempt by jumping from a bridge. Joseph, however, stated that it was not him but ‘Karl’ who took the leap. This behaviour was initially hypothesised to be part of autistic thinking or passivity phenomena of an emerging psychotic episode. Joseph continued to describe being in distinct personality states across various contexts, and his mother corroborated episodes of dissociation involving behavioural changes and memory disruption. A diagnosis of DID was made following multiple specialist assessments.

Joseph’s care involved multi-agency collaboration between a range of specialist teams across the public sector. The Crisis team provided a swift response and intensive follow-up during periods of escalated risks. The Outreach team, which specialises in engaging young people who are difficult to reach, built rapport with Joseph at home. Educational and social care agencies played active roles in navigating uncertainties regarding Joseph’s legal status. Engaging with a young autistic person required persistence and skill. Understanding the family’s cultural and religious backgrounds was crucial for differentiating culturally congruent experiences from those that were pathological and distressing. A key barrier to planning management from the formulation was the gaps in services and training to address such intricate presentation holistically.

While DID may not be a commonly encountered diagnosis, the context which this case brings is a familiar one: ethnic minorities constitute 18% of the UK population; autism is diagnosed in 3% of adolescents; dissociative disorders have a prevalence of 10% in the clinical population and are strongly associated with trauma. Resource allocation for training professionals to become trauma-informed, culture-aware, and neurodivergence-sensitive across mental health and non-mental health services would therefore be essential.

Autism Spectrum Disorder (ASD)-related catatonia presents a significant diagnostic and management challenge, due to the overlap between catatonic features and core autistic traits. Adolescents with ASD appear to be at increased risk of catatonic deterioration often triggered by psychosocial stressors and underlying neurobiological factors. This case describes a 16-year-old female adolescent whose catatonia was primarily driven by underlying autism, illustrating the crucial role of ASD-related mechanisms in both her deterioration and recurrence. Current literature review reveals a small number of documented adolescent catatonia cases indicating limited clinical and research consideration to this population.

A multidisciplinary treatment approach integrating pharmacological, psychological, and environmental strategies was implemented. Pharmacological management included Lorazepam (1 mg BD) targeting motor symptoms, alongside Olanzapine (5 mg ON) and Sertraline (150mg OD) to address comorbid anxiety, emotional dysregulation, and behavioural rigidity. Regular physical health monitoring remained unremarkable throughout. Additionally, the adapted for children version of the Bush Francis catatonia scaled was utilised to measure symptoms. Psychological interventions focused on anxiety reduction, restoration of independence, and development of structured daily routines. Environmentally, a low-arousal setting was prioritised with consistent 1:1 support as part of Level 3 observations. This provided containment, predictability, relational stability and reduced sensory overload. Collaborative multidisciplinary working and graded Section 17 leave facilitated a smooth transition back to the community.

A clinical decline was observed when Lorazepam was tapered and observation levels reduced to Level 2 (15-minute checks). Catatonic features including behavioural “stuckness,” delayed motor initiation, increased ritualistic behaviour, and reduced self-care re-emerged. Marked improvement was observed following the reintroduction of 1:1 support as part of Level 3 observations and an increased Lorazepam dose. This clear temporal association emphasises that environmental structure and sustained relational support are as critical as pharmacological treatment.

This case highlights the importance of recognising catatonia as a treatable manifestation of ASD. The clinical course established how ASD specific neurobiological vulnerabilities impacted to the initial deterioration and subsequent relapse. Recovery was dependent not only on benzodiazepine responsiveness but also on maintaining consistency, predictability, and therapeutic connection. A formulation driven, multidisciplinary approach balancing pharmacological, psychological, and environmental interventions is essential for sustaining improvement and preventing relapse in autistic adolescents with catatonia.

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.