Child and Adolescent Mental Health Services (CAMHS) are navigating a landscape of significant growth in service demand and increasing clinical complexity. To ensure long-term workforce sustainability and maintain the highest standards of patient care, it is essential to understand the various factors influencing staff well-being. This project, undertaken as part of the Royal College of Psychiatrists Leadership Fellowship, sought to evaluate the current well-being landscape across a multi-disciplinary CAMHS workforce. The goal was to identify existing protective factors and pinpoint areas where additional systemic support could be optimised to foster a resilient and stable work environment.

A baseline assessment was conducted involving 65 multi-disciplinary staff members, including practitioners, psychologists, psychiatrists, and administrators. Using the Copenhagen Burnout Inventory, the project measured three domains: Personal, Work-related, and Client-related well-being. Qualitative feedback was also gathered, identifying primary stressors and the visibility and perception of existing organisational support, providing a data-driven foundation for future Plan–Do–Study–Actcycles, ensuring that subsequent interventions are tailored to the service's needs.

Preliminary findings as of February 2026 indicate a large variation in response rates across teams. While staff remain committed to their roles, notable pressures exist regarding personal (Mean=65.4) and work-related (Mean=55.0) well-being. Significantly, client-related burnout was lower (Mean=40.8), suggesting that direct clinical work remains relatively rewarding. Data identified workload, case complexity, and administrative processes as primary areas for attention.

Qualitative themes highlighted interpersonal support as a significant strength; peer and line-manager relationships were the highest-rated positive influences on resilience. The assessment identified an opportunity to improve visibility of Trust-wide initiatives, as nearly half of respondents were either unaware of available offerings or felt they lacked CAMHS-specific tailoring. This has led to a proposal for creative arts therapies as a tailored resource; these interventions have shown promise in other settings. Feasibility, training, and impact assessment for these are currently under discussion.

CAMHS staff demonstrate high dedication despite systemic pressures. While the strong culture of peer support provides a vital foundation, workforce stability requires both increased resource accessibility and the development of newer, tailored support models. These findings will be shared with the Children and Young People’s Mental Health Board for collaborative action planning. Further breakdown of responses that are team and role-specific will help address locational and job-specific burdens, fostering closer engagement between the Trust and staff to mitigate attrition and ensure a sustainable model of care for the future.

Effectively adapting a SEDU in the management of patients with T1DE – challenges, multi-professional working, capacity, and consent in determining outcomes.

Background: Individuals with disordered eating and T1DE pose a challenge across services, due to complications that arise from the interplay of this two-in-one condition, which could be life threatening.

The insidious onset of disturbed eating and its progression to disordered eating behaviours has been recodified in newer diagnostic manuals. Patients with type 1 diabetes mellitus (T1D) remain a source of consternation to professionals and families. Type 1 diabetes mellitus and disordered eating (T1DE), previously known as diabulimia, is not uncommon.

The UK APPG on Eating Disorders emphasise the need for adequate resourcing with integration of services. In response, the Royal College of Psychiatry annexe to MEED addresses diagnoses by highlighting key criteria.

Re-adapting for T1DE involved: training on T1D with diabetic specialists regarding CGM devices, traditional finger-prick testing, insulin pen management, meal planning and insulin dosing, carb-counting (DAFNE); Implementing the T1DE Behaviour Checklist, and our Quick Guide to Diabetes Management in Patients with T1DE.

Other interventions: Medical - monitoring pre/post-meal BG, serum ketones etc., Psychology – EDE-Q, PHQ-9, GAD-7, fear hierarchy, OT – MOHO-based assessment of function including exposure, Dietetic - carb and calorie counting tools, Nursing care planning with physical monitoring. Family therapy, goal planning with community ED, PC and KCL national T1DE services and application of the MHA. Pre-screening for neurodevelopmental disorders, personality disorders and common mental health conditions.

150 admissions were recorded over 24 months with complexities such as ASD, ADHD, trauma, personality disorder and self-harm being prevalent. We admitted three of four T1DE referrals – one under section 2 of the MHA, rescinded prior to discharge, and the other informal reassessed and detained under section 3, subsequently rescinded five months later. The third remained informal throughout admission. Outcomes include improvement in binge purging or restriction (>6000kcal to approximate 1800kcal daily), HBs-489C by 30-40%, weight stabilisation, and adherence to insulin doses and administration. There were marked improvements in distress tolerance, EDE-Q and anxiety scores. Two patients returned to employment or university. They responded positively to reinstating antidepressants and one to stimulant treatment.

The service adapted, utilising expert support whilst exploring innovative interventions to facilitate treatment of T1DE. Challenges encountered reinforce the need for clinicians to address barriers and improve engagement by applying a reflective MDT approach. Aligning with patients and family goals is crucial for sustained outcomes.

Background: Armed conflict severely disrupts the continuity of psychiatric care, particularly for patients dependent on long-term psychotropic medication. During the recent Gaza war, widespread displacement of patients and medical personnel and destruction of the health service infrastructure created unprecedented barriers to treatment continuity. Mental health professionals were compelled to develop innovative, context-specific solutions to prevent clinical deterioration and safeguard patient stability.

Aims were to identify the main challenges affecting psychotropic medication adherence among war-affected patients in Gaza and to describe adaptive strategies that supported treatment continuity under crisis conditions.

This study was conducted between October 2023 and January 2024 within five community mental health centres and two psychiatric hospitals in Gaza. This was a mixed-methods study, that used triangulated data from semi-structured interviews with clinicians, focus group discussions with multi-disciplinary teams, clinical records and medication tracking data. Thematic analysis of interviews and focus groups was used to identify recurring patterns of non-adherence, contributing factors, and responsive interventions. Themes were identified and refined through iterative discussions to ensure they reflected clinical observations across sites. Descriptive statistics were used to describe reasons for medication interruption as recorded in clinical records.

Medication discontinuation was due to drug shortages (45%), forced displacement (33%), and restricted mobility caused by security risks (22%). Thematic analysis identified several adaptive strategies: decentralised medication distribution through NGO partnerships, telepsychiatry follow-ups, substitution with pharmacological equivalents, and family engagement in adherence monitoring. Clinicians reported that these strategies reduced relapse rates and preserved treatment stability in most high-risk cases.

Maintaining psychotropic medication adherence during armed conflict is both a clinical and ethical imperative. The Gaza experience demonstrates that flexible, community-driven, and ethically grounded models of care can sustain treatment continuity in extreme humanitarian settings. Strengthening emergency medication supply chains and integrating psychosocial support into humanitarian response frameworks are essential to protect psychiatric outcomes in conflict-affected populations.

The Mental Capacity Act (MCA) 2005 requires healthcare professionals to assess a patient’s capacity to make decisions about their treatment and care. When a patient lacks capacity, a best interest assessment (BIA) must be completed to guide safe and lawful decision-making. Ensuring timely and accurate completion of these forms is essential for safeguarding patient rights and maintaining compliance with legal and Trust-wide standards.

The aim of the audit is to evaluate the completeness and timeliness of Mental Capacity Assessments (MCA) and Best Interest Assessments (BIA) completed for all new admissions to older people’s Ward between 1 January and 30 June 2025, in alignment with the MCA 2005 and local Trust policy.

A retrospective review of the Trust’s patient information system was conducted to identify all admissions to older people’s Ward during the study period. Transfers from other mental health wards were excluded, and readmissions were counted once. For each admission, the following were recorded: admission status (informal, MHA sections, or DoLS), whether an MCA was completed within 24 hours, capacity outcome, and whether a required BIA was completed within 24 hours. Copies of completed MCA and BIA forms were reviewed for completeness and quality of documented rationale. Data were recorded and analysed using Microsoft Excel.

Thirtytwo patients were admitted during the study period. Most admissions were under section 2 of the Mental Health Act (75%), with additional admissions under section 3 (6%), DoLS (3%), and informal status (16%). MCA forms were completed within 24 hours for 84% of admissions, while 16% were not completed in the required timeframe. One patient (3%) required a BIA; however, this was not completed within 24 hours. All completed MCA forms demonstrated full completion of required sections with clear rationales documented.

The majority of patients admitted to older people’s Ward received timely and welldocumented capacity assessments; however, delays remain in a minority of cases, including the timely completion of BIAs. These findings highlight the need for improved consistency in meeting the 24hour documentation requirement and suggest potential areas for staff training, workflow improvement, and strengthened oversight to ensure full compliance with the Mental Capacity Act 2005.

Bangladesh is one of the most densely populated countries globally and carries a substantial burden of mental illness. National survey data estimate the prevalence of mental disorders at approximately 16.8–18.7% among adults and 13–14% among children, alongside a marked treatment gap, with over 90% of affected individuals not receiving formal mental healthcare. Public psychiatric services remain limited in capacity, are geographically concentrated in urban centres, and are often characterised by delayed presentation, prolonged inpatient stays, and poor continuity of care. In this context, private psychiatric hospitals are increasingly accessed in urban areas. There is little published evidence describing the service role, clinical acuity, and patient profile of private-sector psychiatry in low- and middle-income countries.

Aim: To describe the clinical, sociodemographic, and service characteristics of patients admitted to a private psychiatric hospital in Bangladesh and to contextualise these findings within international psychiatric service models.

A retrospective descriptive review was conducted of consecutive inpatient admissions to The HUB over a ten-month period (April 2025 – January 2026). Patients accessing only outpatient or triage services were excluded. Anonymised data were extracted from routine clinical assessment documentation, including age, gender, socioeconomic background, education and employment status, psychiatric diagnosis, prior treatment history, risk factors, legal status, and admission pathways. Data were analysed descriptively.

The cohort comprised 44 consecutive inpatient admissions. Patients were predominantly adults, with a male predominance of approximately 60%. Most patients were from upper or upper-middle socioeconomic backgrounds and demonstrated relatively high educational attainment, including undergraduate and postgraduate qualifications. Employment status was heterogeneous, encompassing professionals, business owners, students, and unemployed individuals.

Majority admissions reflected established psychiatric illness rather than first-episode presentations. The majority of patients had a documented history of prior psychiatric treatment, frequently within private healthcare settings. Notably, over three-quarters had previously received psychiatric care outside Bangladesh, indicating prominent international care pathways. Diagnostic profiles included mood disorders, psychotic disorders, anxiety-related disorders, and substance-related conditions, consistent with a broad general adult psychiatry case mix.

Clinically significant risk was common. Approximately one in six patients had a history of self-harm, and a similar proportion presented with behavioural disturbance or aggression. Suicidal ideation was documented in a subset of cases, although recording was variable across assessments. Admissions occurred via both planned and acute or crisis pathways. While many patients were admitted voluntarily, some required higher levels of containment and intensive risk management.

This study demonstrates that private psychiatric hospitals in Bangladesh manage patients with substantial clinical complexity, risk, and prior treatment exposure, challenging assumptions that private-sector psychiatry predominantly addresses low-acuity or elective care. The observed service and clinical profile shows important parallels with private services in high-income countries. These findings support the inclusion of private-sector data in global mental health research and highlight private hospitals as important components of mental health systems where public capacity is limited.

Clozapine is the most effective treatment for treatment-resistant schizophrenia but is associated with a high risk of constipation which can lead to serious and potentially fatal complications if not recognised and managed early. This Quality Improvement Project (QIP) aimed to enhance the monitoring of clozapine-related constipation on Sunstone Ward by increasing the proportion of clozapine-treated patients with a fully completed Bristol Stool Chart (BSC) and constipation symptom screening documentation to 100% by mid December 2025.

This QIP was conducted on Sunstone Ward, a 17-bed male high-dependency rehabilitation unit. Baseline data were collected in April 2025 through retrospective review of clinical documentation for clozapine-treated patients.

Four Plan–Do–Study–Act (PDSA) cycles were implemented between June and December 2025. Interventions included daily assigned nurse-led bowel movement assessments using the BSC, structured documentation prompts, routine review of BSCs during ward rounds, increased patient engagement in reporting bowel habits, and a targeted staff teaching session on clozapine-related constipation.

Outcome measures were the percentage of clozapine-treated patients with fully completed BSCs and constipation symptom screening documentation.

Baseline data showed poor monitoring, with only 25% of patients having a fully completed BSC and 37.5% having documented symptom screening. Following PDSA Cycle 1, modest improvements were observed (BSC 50%, symptom screening documentation 62.5%). In PDSA Cycle 2, BSCs were routinely reviewed during ward rounds, leading to marked improvement in compliance (both measures 87.5%). PDSA Cycle 3 focused on patient engagement, resulting in BSC completion reaching 100%, although symptom screening documentation plateaued at 87.5%. Following a targeted staff teaching session in PDSA Cycle 4, both BSC completion and symptom screening reached and were sustained at 100% by mid December 2025.

This QIP demonstrated that clozapine-related constipation monitoring can be significantly improved through daily assigned nurse-led bowel assessments, structured documentation prompts, routine review of BSCs during ward rounds, patient engagement and staff education. While early interventions improved compliance, patient engagement and staff teaching were key to achieving full and sustained monitoring. Embedding bowel monitoring into routine inpatient care enhances patient safety and reduces the risk of seriouscomplications. The approach is sustainable and transferable to other inpatient mental health settings whereclozapineis prescribed.

In the West Midlands, limited addiction placements and a shortage of suitably endorsed assessors have made it difficult for core psychiatry trainees to meet revised RoyalCollege of Psychiatrists (RCPsych) curriculum requirements, including completion of two addiction-specific workplace-based assessments (WPBAs). Without targeted intervention, trainees risk failing to demonstrate required competencies, with implications for future specialist workforce capacity as there continue to be fewer addiction psychiatrists working in substance misuse services.

Aims were to improve access to, and quality of, addiction psychiatry training opportunities for core psychiatry trainees in the West Midlands, with a particular focus on enabling completion of curriculum-mandated addiction workplace-based assessments (WPBAs).

Baseline data were obtained from a cross-sectional review of ARCP outcomes in December 2024 which showed trainees were struggling to meet their addiction workplace-based assessment (WPBA) requirements. We focused on four intervention methods: (1) assessor training in completing addiction workplace-based assessments (WPBAs), (2) development of a regional assessor network and addiction training plan for each Trust in the region, (3) experience and special interest days within addiction services with opportunities to complete assessments, and (4) expansion of addiction teaching within the MRCPsych programme.

Outcome and process measures included proportion of trainees meeting addiction WPBAs requirements, number of trained assessors, availability of more learning opportunities, and trainee feedback.

At baseline, none of 13 core trainees in the baseline data had completed the required two addiction WPBAs, although 11 had completed one. Assessor training sessions were organised which generated positive feedback and volunteers leading to the development of anaddiction training plan for each Trust with directory of assessors. Experience days enabled trainees to complete assessment of clinical expertise (ACEs) and case-based discussions (CBDs) with appropriate supervision and were associated with improved confidence and engagement with addiction psychiatry. By the June 2025 ARCP, all CT3 trainees had completed the required addiction WPBAs.

This project shows that practical, system-level changes can make a meaningful difference to trainees’ access to addiction training and their ability to meet curriculum requirements. In particular, developing assessor capability, prioritising experiential learning, and working collaboratively at a regional level were central to progress. Ongoing senior leadership is needed to sustain this momentum so that the changes can be embedded into routine practice, and to ensure equitable access across regions.

This case report reviews a rare presentation of a young male patient presenting with Catatonia, who was later diagnosed with Wilson’s Disease (WD), and explores the diagnostic challenges faced with atypical neuropsychiatric presentations and how this affects long-term outcomes.

A previously healthy Caucasian man in his early-30’s presented with acute-onset catatonia over 48 hours, characterised by social withdrawal, psychomotor retardation, staring spells, and posturing. He was initially diagnosed as having catatonia with depression and psychotic symptoms and treated with Lorazepam, Sertraline, Promethazine, and Olanzapine. Over the proceeding few months he deteriorated, showing signs of tremulousness, muscle rigidity with autonomic features, and hyper-reflexia. MRI Head demonstrated abnormal signal intensity in the corpus striatum, ventrolateral thalami, and brainstem, with basal ganglia and substantia nigra hypointensity on SWI sequences suggestive of iron or mineral deposition. Blood tests revealed low caeruloplasmin (0.1g/L), elevated 24-hour urinary copper excretion (5.37umol/24h), elevated CK (1907 U/L), and elevated ALT (105U/L). Kayser-Fleischer Rings were evident on ophthalmology assessment, Liver Ultrasound revealed a coarse irregular liver, and genetic studies confirmed mutations in the ATP7B gene. He had no family history of liver or movement disorders. He was treated with penicillamine, zinc supplements, muscle relaxants, and anticholinergics with no paradoxical worsening.

Wilson’s Disease (WD) is a rare inherited autosomal recessive disorder of copper metabolism resulting mainly in neurological and hepatic pathology. However, in 10-25% it can present with progressive neuropsychiatric symptoms, often resulting in delayed diagnosis for up to 65-months. Notable psychiatric manifestations include personality and mood disorders, sleep disturbance, cognitive impairment, and occasionally psychosis. Rarely, WD can present with Catatonia – a neuropsychiatric syndrome characterised by mutism, stupor, posturing and catalepsy, echolalia and staring. Research suggests that up to 65.6% of patients with WD are initially misdiagnosed, prolonging commencement of treatment and potentially worsening patient outcome. Copper chelation therapy with D-Penicillamine and Zinc can in some cases reverse neuropsychiatric manifestations in WD, and if these are not tolerated Trientine Dihydrochloride is a possible second line agent.

Wilson’s Disease (WD) is a rare condition with a vast range of clinical manifestations, and prompt diagnosis can improve patient outcomes. This case highlights the importance of having a high index of suspicion for WD, particularly during refractory acute-onset psychiatric presentations, and notably for those with no personal or familial psychiatric history. Diagnostic tools include testing for caeruloplasmin levels, 24-hour urinary copper excretion, ophthalmology assessment, MRI Head scanning, and ATP7B genetic testing for diagnostic confirmation.

Severe psychiatric illness (SPI), defined as schizophrenia and related psychoses, bipolar disorder (BPAD), and depression with psychosis, is associated with a reduced life expectancy of 15–20 years, largely attributable to physical illness.

SPI, and the sometimes-compulsory treatments, are associated with adverse effects on physical health, while other illness features like impaired decision-making ability, abnormal mood, and negative symptoms can impair engagement with health services. Consequently, regular monitoring and proactive management of physical illnesses are especially important. For these reasons, General Practice (GP) patient registers and outreach were previously considered necessary; however, the Quality and Outcomes Framework (QOF), which paid GPs to perform these roles, was withdrawn in Scotland in 2016 and cut back in England in 2025.

Therefore, we undertook a service evaluation of physical health monitoring in CMHT SPI outpatients. A constituent survey of contact with primary care services is reported here.

CMHT keyworkers recorded BMI and asked their SPI outpatients when they last saw their GP and when physical health was last discussed in primary care.

Schizophrenia (n=212): 41% obese; schizoaffective disorder (n=11): 70% obese; BPAD (n=23): 56% obese; depression with psychosis (n=6): 80% overweight or obese; and delusional disorder (n=2). Among SPI patients with BMI ≥30, 47.1% had not seen their GP in over a year; for BMI ≥35, the figure was 46.5%; and for BMI ≥40, 45%. Overall, 51%(n=134) SPI patients thought they had seen their GP in the previous year, and only 36% (n=94) reported discussing physical health with a primary care provider during that time.

32% of Scottish adults are obese, and 92% report seeing their GP at least annually, with contact rates higher among those with limiting long-term conditions. This contrasts with our SPI patient data, in which most were obese and only around half could recall seeing their GP within the past year, with only 36% recalling any discussion of physical health.

In 2012, SPI patients saw their GPs approximately three times annually. Our data suggest this level of engagement has declined markedly since then. As noted, the QOF incentives for GP management of the physical comorbidities associated with reduced life expectancy in SPI have been withdrawn in Scotland and cut back in England; this may have compounded an existing healthcare inequality and geographical disadvantage.

These data will be expanded to advocate for better community management of the physical health risks faced by people with SPI.

Psychiatry inpatient staff are frequently exposed to patient aggression, including verbal abuse and physical threats. While aggression is widely recognised as a workplace hazard, the relative contribution of different aggression types to staff burnout remains poorly explored. Therefore, we aim to examine the association between patient aggression exposure and burnout among psychiatry inpatient staff.

We conducted an anonymous cross-sectional survey of inpatient psychiatry staff (n=115) across multiple ward types. Burnout was measured using a 7-item composite scale (Cronbach’s α;=0.915), which was approximately normally distributed (Shapiro–Wilk p=0.147). Exposure to patient aggression over the preceding six weeks was assessed using frequency-based Likert items covering verbal aggression, threats of harm, attempted assault, physical assault, sexual harassment, and racist or discriminatory abuse. Analyses included Pearson correlation, one way ANOVA to assess dose response relationships, and multivariable linear regression adjusting for professional role group, years working in psychiatry, and work pattern. All statistical analyses were performed using IBM SPSS Statistics.

Mean burnout score was 1.92 (SD 0.87). Verbal aggression was reported by 93.9% of respondents, with 41.8% experiencing it weekly or more often. Other aggression types were also common, including threats of physical harm (73.9%) and physical assault (58.3%).In unadjusted analyses, burnout was positively correlated with verbal aggression frequency (r=0.21, p=0.024), but not with other aggression types. Mean burnout differed significantly across verbal aggression frequency categories (F (5,109)=2.43, p=0.040), demonstrating a dose response pattern. In multivariable regression, verbal aggression remained independently associated with higher burnout scores (B=0.16, 95% CI 0.03–0.29; p=0.014).

Among psychiatry inpatient staff, frequent verbal aggression is common and shows a dose response association with burnout. These findings highlight verbal aggression as a key occupational stressor and a potential target for prevention strategies in inpatient psychiatric settings.

Pineal cysts are frequently identified as incidental findings on neuroimaging and are generally considered benign. However, the pineal gland plays a central role in melatonin secretion and circadian rhythm regulation, processes closely linked to mood stability, sleep, and affective vulnerability. Neuropsychiatric presentations occurring alongside pineal cysts, particularly during hormonally and circadian-sensitive periods such as the perinatal phase, remain poorly understood.

This case report describes a 37-year-old woman, employed as a nurse, who experienced recurrent affective episodes over a ten-year period. A comprehensive psychiatric assessment was conducted. Neuroimaging findings were reviewed alongside neurological and psychiatric management. The patient’s clinical course across four episodes was documented, with particular focus on the most recent episode occurring in the postpartum period and managed using a multidisciplinary team approach.

The patient experienced four episodes characterised by manic symptoms such as elevated and labile mood, marked anxiety, reduced need for sleep, and transient psychotic features. No depressive episodes were reported. The most recent episode occurred approximately four months postpartum, following a stressful Caesarean section and significant sleep disruption related to infant care. There was a family history of depression but no history of neurological symptoms. Magnetic resonance imaging during the first episode identified a pineal cyst measuring 8 mm with a well-defined rim which remained stable on subsequent imaging and demonstrated no mass effect on adjacent structures. Neurological assessment concluded that no surgical or disease-specific intervention was indicated. Psychiatric management consisted of low-dose olanzapine, short-term sedative medication, and supportive interventions targeting sleep restoration, resulting in good symptomatic recovery after each episode. Prominent sleep–wake cycle disruption was a consistent feature across all presentations. Melatonin was not prescribed, though its potential role in sleep regulation and relapse prevention was considered.

This case illustrates the diagnostic complexity that arises when recurrent affective symptoms coexist with incidental neuroimaging findings. Although a causal relationship between pineal cysts and affective episodes cannot be established, the pineal gland’s role in circadian regulation suggests a possible indirect neuroendocrine contribution, particularly during the perinatal period. The case highlights the importance of integrating neurobiological, circadian, and phenomenological perspectives in psychiatric assessment and management.

Metabolic dysfunction is a major driver of excess morbidity and premature mortality in people with severe mental illness (SMI). Converging evidence suggests that disturbances in brain energy metabolism may contribute to psychiatric symptoms in SMI. Despite growing interest in metabolic psychiatry, research in this area has largely been shaped by academic priorities, with limited structured input from people with lived experience, carers, or front-line professionals regarding which metabolic interventions and outcomes matter most to them. Consequently, evidence to guide metabolic approaches that improve physical and mental health outcomes in SMI remains fragmented and poorly aligned with stakeholder priorities. The James Lind Alliance (JLA) Priority Setting Partnership (PSP) for Metabolic Interventions in SMI was established to identify and prioritise research uncertainties that matter most to people with lived experience, carers, and professionals.

The PSP followed the five-stage JLA methodology: defining scope, gathering questions, refining and verifying uncertainties, interim prioritisation, and a final consensus workshop. An international open-call survey collected research questions from people with lived experience of SMI, carers, and professionals. Submissions were thematically synthesised into summary questions and checked against evidence through an umbrella review of meta-analyses to identify unanswered uncertainties. Verified uncertainties were ranked in an online survey. A structured, facilitated online workshop using nominal group techniques produced the final Top 10 priorities.

In the first survey, 456 participants submitted 1,439 research questions. After removal of out-of-scope submissions and qualitative synthesis, 51 summary questions across 13 thematic domains were generated. Evidence checking identified two questions as adequately answered, leaving 49 verified uncertainties. In the interim prioritisation survey, 317 participants ranked these uncertainties, producing a shortlist of 19 questions. Thirty stakeholders (16 with lived experience or carers; 14 professionals) took part in the final online workshop. The resulting Top 10 priorities focused on dietary interventions, combined lifestyle strategies, GLP-1 receptor agonists for medication-related weight gain and potential mental health benefits, micronutrient deficiencies, physical activity, metabolic effects of psychiatric medications beyond weight gain, gut-brain mechanisms, brain changes associated with metabolic improvement, and the role of ketone bodies in symptom improvement and remission.

This PSP establishes the first stakeholder-driven research agenda for metabolic psychiatry in SMI, identifying priorities that integrate diet, physical activity, pharmacological adjuncts, and mechanistic pathways linking metabolic and mental health. The Top 10 priorities provide a translational roadmap for future trials, mechanistic studies, and implementation research aimed at reducing cardiometabolic inequalities and improving psychiatric outcomes in SMI.

This work was funded by UK Research and Innovation (UKRI) through the Hub for Metabolic Psychiatry.

Depression is common amongst young adults and is frequently managed in primary care. Antidepressant medications are commonly initiated or adjusted, however the early stages following this are associated with an increased risk of suicidality in those aged 18-25 years, with the highest risk being observed within the first 28 days of treatment. NICE guidelines therefore recommend close monitoring of this group, including review within one week of initiation or dose increase, followed by further review no later than four weeks. The aim of this audit was to assess compliance with NICE guidelines for follow-up after initiation or dose increase of antidepressant medication in those aged 18-25 years in a primary care setting

A retrospective audit was conducted in a primary care setting. Electronic medical records were used to identify patients aged 18-25 who were either newly prescribed or had a dose increase of an antidepressant between October 2025 and January 2026. 95 eligible patients were identified, of which 55 were randomly selected. The data collected included the timing and mode of follow-up. The standards that were measured were if patients had been reviewed within one week and within four weeks of antidepressant initiation or dose increase.

3/55 patients (5.5%) were seen within one week and again within four weeks, thus fully compliant with the guidelines. However, only 4/55 patients (7.3%) were reviewed within one week and 8/55 (14.5%) were followed up within four weeks. 35 patients were reviewed during the study period, but not within the recommended guideline timeframes. 12 patients had no documented follow up review since medication initiation. Where reviews occurred, they were most commonly conducted via telephone consultation.

This audit identifies opportunities for improvement in adherence to NICE guidelines for follow-up of antidepressant treatment in young adults within primary care. Given the prevalence of antidepressant prescribing and recognised vulnerability of this age group, untimely follow-up may represent a patient safety concern at a population level. System based interventions to support routine early review may improve adherence, such as automatically booking a 1-week follow-up telephone review at the time of antidepressant initiation or dose increase. Followed by implementing clear pathways for urgent review and escalation if suicidal ideation is identified during follow-up.

We aimed to compare findings from the first year of the NHS Wales 111 Press 2 mental health service and the CAMHS Crisis Connect (CCC) service that had been developed by the CAMHS Service in the Government of Western Australia.

We aimed to explore the commissioning and evaluation of these services, identify cross-national learning opportunities, and develop future models of mental health care in Wales that align with a “no wrong door” approach to support.

We utilised a mixed-methods approach to evaluate service impact across two continents. For the Welsh 111 Press 2 service, researchers conducted a comprehensive review of 12 months of operational data (over 100,000 calls), utilising deprivation mapping against the Welsh Index of Multiple Deprivation (WIMD) to understand local need.

For the Western Australian CAMHS Crisis Connect (CCC) service, an Interrupted Time Series (ITS) analysis was employed to evaluate hospital resource utilisation - including emergency department (ED) presentations and inpatient admissions - between 2014 and 2024.

Findings were presented at a roundtable that was hosted by the Learned Society of Wales, and further visual illustration was provided to capture findings. The roundtable had input from experts by experience, policy professionals, researchers and clinicians from both Wales and Australia.

• • NHS Wales 111 Press 2: Over 100,000 calls were received in the first year, with 99% of callers reporting a reduction in distress following triage. Approximately 50% of cases were resolved with self-care advice, while 10% required immediate crisis intervention.

• • Western Australia CAMHS Crisis Connect: The ITS analysis demonstrated a 29% reduction in ED presentations for mental health concerns and a 28% decrease in inpatient admissions directly attributable to the service's introduction.

• • Geographic Insights: Deprivation mapping in Wales revealed unexpected call patterns, such as high rates of suicidal ideation calls from affluent areas, highlighting the need for localised awareness strategies.

We conclude that specialised mental health crisis lines can be effective in de-escalating distress and reducing the burden on acute hospital resources.

Future development should focus on co-production with young people, improving digital accessibility (e.g., via TikTok or WhatsApp), and utilising predictive analytics to manage demand during external events like climate hazards or economic shocks.

A formal partnership between Wales and Western Australia will continue to drive comparative research and data-driven service improvements.

Paternal postpartum depression (PPD) is an emerging concern globally but remains under recognized in low-resource and patriarchal societies. In Pakistan, sociocultural stigma and lack of mental health infrastructure may exacerbate this burden. This study aimed to assess the prevalence of paternal PPD, identify associated risk factors, and evaluate awareness among Pakistani fathers.

A cross-sectional, multicentre study was conducted across three provinces of Pakistan, enrolling 475 fathers of infants under one year of age. Participants completed the Beck Depression Inventory (BDI) and a structured questionnaire covering demographics, reproductive history, awareness of PPD, and psychosocial stressors. Statistical analyses included t-tests, chi-square tests, ANOVA, and Pearson correlation.

A BDI score ≥10, indicating mild or greater depressive symptoms, was observed in 70.1% of participants, while 10.1% had severe symptoms suggestive of clinical depression. Only 19.4% of fathers were aware that men could experience PPD. Significant associations were found between paternal depression and maternal PPD (p=0.002), adverse life events (p=0.003), and lack of family support (p=0.045). Age showed a weak positive correlation with depression severity (r=0.19, p<0.001). No significant associations were observed for occupation, number of children, awareness, or access to leave policies. A majority (94.7%) reported no access to paternal mental health services.

This is the largest study to date on paternal PPD in Pakistan, highlighting a substantial burden of depressive symptoms among new fathers. Cultural stigma, poor awareness, and lack of support structures contribute to under-recognition and under-treatment. Multi-level interventions to address paternal PPD, including but not limited to screening strategies, paternal-inclusive care, and public education are urgently needed

To understand the influence of adjuvant ketogenic diet on behavioural dysregulation in individuals with bipolar disorder through a review of the available literature.

A systematic review was conducted across the databases of Medline Ovid, PubMed, PsycINFO, the Cochrane Library, and the University of Sheffield Star Plus library, following the PRISMA guidelines. Relevant articles were identified using Inclusion and Exclusion criteria. Critical appraisal tools (the Critical Appraisal Skills Programme (CASP) and the Joanna Briggs Institute (JBI)) were used to assess the quality of the selected publications.

Twenty-two articles were identified as suitable for the review. Out of this, 10 were systematic reviews, and 6 were case reports. Eighteen publications have deduced that ketogenic diets aid in stabilising mood.

The review identified that ketogenic diets have the potential to reduce behavioural dysregulation in bipolar patients. The descriptive analysis suggests the need for additional clinical research, as the available studies were mainly uncontrolled and included a limited number of participants.

In a community mental health setting, we studied real-world relapse rates in patients with a history of psychosis, before and after switching from oral antipsychotics to a long-acting injectable antipsychotic (LAIA). We also aimed to evaluate the relevance of metabolic/demographic factors in relapse rate.

Twenty-five individuals with a past history of psychosis and variable medication concordance who were switched from oral antipsychotics to LAIAs were included in the study. Oral agents were converted to olanzapine equivalents whilst LAIA generics were converted to flupenthixol depot equivalents. The depot equivalent oral dose of olanzapine was calculated, assuming an oral bioavailability of 40%. Relapse-rates occurring over the time periods on oral therapy were compared with rates occurring following initiation of LAIAs. Relapse was defined as any psychiatric hospital admission.

A multivariable Poisson regression model including drug formulation/age/sex/smoking status/BMI were fitted with follow-up time as an offset to estimate adjusted incidence rate ratios and associations with relapse outcomes.

The mean±SD age of the 25 individuals was 50.6±13.9 years whilst 12 (60%) were male. Mean BMI of males/females was 28.1±9.3 kg/m2/ 32±6.4 kg/m2(higher in women) respectively. 65% of patients received either flupenthixol or zuclopenthixol depot with next most common depot being Risperidal Consta. The median (IQR) of daily oral olanzapine equivalent was 10mg (6.9 – 20.0mg)/day and after switching to depot was 16.0mg (5.4 – 40.7mg)/day. The 4-week depot equivalent dose for services users switched to depot was flupenthixol 480mg (200 – 1220mg) / 4-weeks.

Following adjustment for age/sex/smoking status/BMI, relapse rates were significantly lower during LAIA treatment compared with oral treatment (incidence rate ratio [IRR] 0.13, 95% CI 0.08–0.22, p<0.001). Thus depot antipsychotics were associated with an 87% reduction in relapse rates compared to oral therapy. Male sex/younger age/lower BMI were independently associated with higher relapse rates (Exp (beta) 1.9/0.98/0.94 respectively (p<0.05)).

In this real-world community mental health setting, this study highlights that depot antipsychotics provide a dramatic and sustained reduction of 87% in relapse rate for individuals with a history of psychosis. These findings support early prescription of LAIAs in prevention of psychosis relapse. Further evaluation is warranted to elucidate the potential of LAIAs as a treatment option after first presentation of psychosis.

Et al:

Ruth Parkman-Eason, Salford Royal Hospital, UK

Sophie Manttan, Salford Royal Hospital, UK

Yasitha llangasekera, University of Peradeniya, Sri Lanka

Discharge summaries (aka electronic discharge notifications, eDNFs) are a vital part of care, ensuring clear and timely communication between services and allowing for an accurate record of care to be maintained. If eDNFs are not completed in a timely fashion, or not completed at all, service users struggle to access follow-up care, repeat prescriptions and referrals to other services. In mid 2024, on Vincent Square Eating Disorders Unit (VSEDS), eDNFs were not being completed in a timely manner – many were not completed at all. From May 2024 to August 2024, of 15 patients discharged:

• • 5 had an eDNF completed at time of discharge (33.3%).

• • 3 had an eDNF completed late (20%).

• • 7 did not have an eDNF completed at all (46.7%).

Our aim: 70% of patients discharged from VSEDS will have an eDNF completed within 24 hours

This project ran from mid 2024 to early 2025. We implemented 4 PDSA cycles, which included:

PDSA 1: weekly scheduled meetings between ward doctors and pharmacists.

PDSA 2: discharge medications prescribed and email sent to pharmacy at time that decision to discharge is made.

PDSA 3: attempted implementation of protected time for ward doctors to complete eDNFs (unsuccessful).

PDSA4: On Wednesday mornings pharmacy notified of all potential discharges; all discharge medications prescribed at this time.

Our QI project included input from a number of Experts by Experience, service users who have had previous experience of discharge from VSEDS. They emphasized the importance of a timely, clear and concise eDNF and spoke about the impact on their ongoing care and wellbeing. Some of their feedback is represented in our poster.

From November 2024 to February 2025:

• • 14 patients were discharged from the ward.

• • All of these patients had a discharge summary completed within 72 hours of discharge.

• • 12 of these patients (85.7%) had a discharge summary completed within 24 hours of discharge.

Our first PDSA cycle was unsuccessful – we found that in practice this simply added another meeting without making a difference to efficiency. PDSA cycle 2 appears to have the most impact by allowing pharmacy to process TTAs without having to wait for ward doctors to write a lengthy discharge notification first. We were ultimately unable to implement PDSA 3 successfully. In PDSA 4, we attempted to systematise PDSA 2 by setting a once weekly notification process for pharmacy regarding upcoming discharges.

Adults living in deprived coastal communities face disproportionately high rates of self-harm and suicide, yet little is known about the barriers they experience when attempting to access preventative and mental health support. This study explored how Jaywick residents navigate existing support pathways, identified key barriers and unmet needs associated with accessing services for self-harm and suicidality, and examined approaches that may strengthen engagement and early intervention within this coastal setting.

Two stakeholder workshops were conducted with 14 participants from statutory health providers and community and voluntary organisations operating in Jaywick. Workshops were audio-recorded, transcribed verbatim, and analysed using reflexive thematicanalysis. Discussions focused on experiences of service navigation, barriers to accessing care for self-harm and suicidality, and opportunities for system improvement.

Three overarching themes were identified. First, access barriers: digital exclusion, low literacy, and poor signposting impeded residents’ ability to access mental health support, leaving many dependent on others for referrals. Second, social and cultural dynamics: deep-rooted mistrust of statutory services, normalisation of symptoms, and strong community tribalism hindered help-seeking and engagement. Third, vulnerability and risk: entrenched cycles of poverty, addiction, trauma, and isolation were prevalent, with migrants and refugees experiencing added disadvantages. Fragmented service provision meant that those with co-occurring needs frequently fell between service thresholds and were often only supported at crisis point.

Barriers to accessing support for self-harm and suicidality in Jaywick are complex, intersecting, and reinforced by long-standing structural inequities. Enhancing trust, embedding services locally, and reducing digital exclusion are essential to improving early intervention and access. Co-produced, community-based models, including health navigation and outreach approaches, offer promising routes to addressing the significant unmet needs within this coastal community.