Home Treatment Teams, first established in England in 2000, play a key role in delivering community-based psychiatric care. Socioeconomic deprivation has previously been linked with an increased risk of mental illness and poorer health outcomes. However, there is limited local-level research examining how deprivation shapes referral patterns and service utilisation.

This study aimed to investigate the association between socioeconomic deprivation and referral patterns to the Wandsworth Home Treatment Team at the ward level.

It was hypothesised that wards with greater deprivation would have higher referral rates.

A quantitative retrospective observational study was conducted using anonymised, routinely collected patient data from the Wandsworth Home Treatment Team for 2024. The dataset comprised 801 patients, of whom 685 were included in the analysis following exclusion of individuals residing outside the London Borough of Wandsworth. Ward-level population data were obtained from the 2021 Census.

Referral rates were calculated for each ward and standardised per 1,000 population. Socioeconomic deprivation was measured using a population-weighted average Index of Multiple Deprivation (IMD) score calculated from IMD deciles across the 22 wards of Wandsworth. Pearson’s correlation analysis was performed to examine the association between ward-level deprivation scores and referral rates.

Referral rates varied across wards within the London Borough of Wandsworth, ranging from approximately 0.9 per 1,000 population in the least deprived wards to 3.7 per 1,000 population in the most deprived wards. Lower ward-level IMD scores (reflecting greater socioeconomic deprivation) were associated with higher referral rates, demonstrating a strong negative correlation (Pearson’s r=-0.789, p <0.001).

The strong association between socioeconomic deprivation and higher Home Treatment Team referral rates underscores the importance of understanding how socioeconomic determinants and environmental context shape mental health need and service utilization. Integrating deprivation-informed approaches into both patient management and local service planning within psychiatric care frameworks may optimise resource allocation, enhance responsiveness to community-level mental health needs, and ultimately improve patient outcomes.

Sexual dysfunction is a commonly encountered adverse effect associated with the treatment of psychotropic drugs, particularly antidepressants and antipsychotics. This adverse effect causes significant challenges, as it can severely impact the quality of life and treatment compliance among patients.

This audit aims to evaluate the extent to which sexual dysfunction is assessed, discussed, and documented for adult patients assessed by a Liaison Psychiatry service and commenced on psychotropic medication.

A retrospective clinical audit was conducted of consecutive patient assessments undertaken by the Liaison Psychiatry service over six months from March 2025 to August 2025.The total number of patients was 1214, out of which 97 were started on psychotropic medication.

Inclusion criteria were. 1. patients ≥18 years of age 2. those who were assessed and commenced on, or reviewed for initiation of, psychotropic medication.

Exclusion criteria were those who were not started on psychotropic medication or were already established on psychotropics before assessment.

Clinical records were reviewed to identify documentation of discussion regarding sexual dysfunction, potential medication-related sexual side effects, and evidence of informed consent. All data were fully anonymised, and no identifiable patient information was recorded.

The audit standard was set at 100%, requiring documentation of the presence or absence of sexual dysfunction and/or evidence that advice regarding potential sexual side effects was provided at the time of medication initiation, in accordance with NICE guidance and local trust Policies.

The audit findings revealed

• • Consent for psychotropic medication initiation was documented in only 64% of patients.

• • Discussion of sexual side effects of medication was documented in only 4% of patients

• • Discussion and documentation of other side effects of medication were completed in only 19% of patients

These findings demonstrated significant gaps in assessment and documentation practice within the Liaison Psychiatry service and a lack of compliance with NICE guidelines. Addressing these deficits within the Liaison Service through clear documentation and education is vital to ensure patient-centred care in line with national guidelines and local trust policies.

A re-audit will be conducted within 8 months after recommendations are put in place, to assess improvement in compliance withNICE guidelines and local Trust Policies.

To establish a weekly Mentalization Based Art Psychotherapy Group on Kestrel Ward, North Wales Adolescent Service.

To achieve 75% attendance from young people admitted to the ward between May and September 2025.

We decided to use the Quality Improvement ‘Plan, Do, Study, Act’(PDSA) cycle to assist in evaluating the process of setting up and maintaining a sustainable and well-functioning Mentalization Based Art Psychotherapy Group.

We completed 4 PDSA cycles looking at establishing the group, engaging difficult to reach young people and promoting staff understanding of the group.

A weekly inpatient Mentalization-based art psychotherapy group was established, with 13 group sessions taking place over a period of 17 weeks. During this process facilitators reflected on how to adapt the group to both the setting and the patient cohort. There is no clear blueprint for this type of intervention within the inpatient setting and to establish the group it was necessary to innovate. This meant working in an adaptive manner based on the needs and opinions of the young people present on the ward at any given time.

Working the patients' way was clearly effective, but it was challenging to do so in a stressful and busy ward environment that was not always conducive to staff or patient's mentalizing processes.

The group has now become well established and sustainable with most young people who are admitted to the ward attending on a weekly basis. It is hoped that engagement will be further improved through continuity and gaining increased input from young people with regards to liked activities.

To ensure the on-going provision of the Mentalization Based Art Psychotherapy Group the facilitators recommend the following:

Group provision is continued on a weekly basis.

The availability of a practitioner with a background in psychological therapies/psychiatry is essential to co-facilitate alongside the art therapist (and this must consistently be the same person).

Dedicated specialist clinical supervision for group facilitators is provided monthly.

Active planning takes place in relation to provision of a suitable therapeutic group space and facilities.

There is provision of staff training and supervision based on mentalizing principles.

Type 1 diabetes (T1D) requires relentless self-management and carries a substantial psychological burden. In individuals with complex or disengaged diabetes, this burden frequently manifests as diabetes distress, anxiety, low mood, maladaptive coping behaviours, and disengagement from treatment. These presentations often overlap with psychiatric symptomatology yet remain under-recognised within mental health services. This study aimed to explore the lived psychological experience of adults with complex T1D and to examine changes in psychological distress following initiation of continuous subcutaneous insulin infusion (CSII) with hybrid closed-loop (HCL) technology.

This work formed part of a prospective Quality Improvement Project within an NHS diabetes service. Semi-structured psychosocial questionnaires were completed by adults with T1D and significant diabetes distress prior to initiation of CSII/HCL (n=12). A subset of participants (n=7) completed the same questionnaire six months after commencing CSII/HCL. Data were analysed using inductive thematic analysis, grounded in patient narratives. The project was conducted as a service evaluation with organisational governance approval; individual consent was obtained as part of routine clinical care.

Pre-CSII/HCL narratives revealed a profound psychological burden. Four dominant themes emerged: (1) chronic cognitive and emotional exhaustion driven by continuous monitoring and decision-making demands; (2) anxiety-driven behaviours, including intentional hyperglycaemia to avoid hypoglycaemia, driving risk, or social embarrassment; (3) depressive cognitions characterised by hopelessness, self-blame, and perceived inevitability of complications; and (4) identity disruption, stigma, and defensive disengagement from care.

Post-CSII/HCL questionnaires demonstrated consistent qualitative change. Participants described reduced mental load, improved confidence in diabetes management, decreased fear of hypoglycaemia, and greater emotional stability. Several reported improvement in mood and anxiety symptoms, re-engagement with daily activities, and enhanced quality of life without escalation of antidepressant or anxiolytic medication. While psychological distress was not eliminated, participants described a shift from crisis-driven coping to a more manageable and contained relationship with diabetes.

Apparent “non-compliance” in T1D often represents a defensive response to untreated psychological distress rather than behavioural failure. Hybrid closed-loop technology may function as both a metabolic and psychological intervention by reducing cognitive burden and restoring self-efficacy. These findings highlight a clear role for psychiatry in diabetes care: screening for diabetes-related distress, anxiety, and mood symptoms, supporting engagement with technology, and contributing to integrated care pathways where improving confidence in physical illness management can meaningfully improve mental health outcomes without default reliance on psychotropic medication.

Antipsychotics are the mainstay of treatment for severe mental illness (SMI) but cause metabolic side effects, such as rapid and clinically significant weight gain, hyperglycaemia, and hypercholesterolaemia, increasing the risk of type 2 diabetes and cardiovascular disease. Metabolic side effects develop through physiological mechanisms (e.g. plasma glucose dysregulation), but also through behaviour changes (e.g. increased calorie intake, sedentary lifestyle). This study aimed to characterise the behavioural determinants associated with developing metabolic side effects by exploring people’s experiences of taking antipsychotics for an SMI.

Participants (n=22) were recruited, as members of the public via Mental Health charities and an existing database of people who had been previously prescribed antipsychotic treatment for an SMI (n=20), and via National Health Service Trusts who were recently initiated on antipsychotic treatment for an SMI (n=2). Sociodemographic characteristics (age group, biological sex, ethnic group, index of multiple deprivation) were collected from participants to ensure a diverse sample. Individual, reflective interviews with a semi-structured style were undertaken to explore determinants associated with changes in behaviour when antipsychotics were initiated. Template analysis was undertaken, comprising an inductive approach and a priorithemes.

The following main themes were created which were associated with changes in behaviour influencing the development of metabolic side effects: environmental determinants (e.g. Covid-19 pandemic, weather, finances); social determinants (e.g. social exclusion, social support, provision of food from family/friends); emotional determinants (e.g. experience of trauma, low mood, shame); and motivation around healthy eating and physical activity (e.g.convenience, cravings, self-medication). Integrative themes included: impact of weight gain (e.g. on identity, quality of life, comorbidities); experience of being a mental health patient (e.g. clinical support, monitoring of side effects); and impact of medication/side effects on eating and physical activity behaviours (e.g. sedation, decreased energy, prior knowledge of side effects).

There are a variety of determinants influencing behaviours associated with developing antipsychotic-induced metabolic side effects. Current clinical practice is to treat side effects with pharmacological and/or non-pharmacological interventions once they have developed as per National Institute for Health and Care Excellence Guidelines and the Lester Tool. Interventions targeting specific behaviours and determinants should be implemented at the start of antipsychotic treatment to prevent metabolic side effects from developing. Further research should explore interventions and ongoing support appropriate to, and developed in partnership with, this population.

This study was sponsored by a University of Leicester PhD scholarship and Pharmacy Research UK.

The Dynamic Appraisal of Situational Aggression (DASA-IV) is a brief, structured tool designed to assess short-term risk of violence in psychiatric inpatients. Whilst it has been used by nursing staff in some settings, evidence regarding the impact of systematic implementation and the role of medical staff in initiating its use remains limited.

This audit evaluated the impact of introducing routine, doctor-completed DASA-IV assessments on a general adult inpatient ward, with the intention of presenting findings to nursing staff and informing potential ward-wide implementation to support incident reduction and patient safety.

The primary aim was to assess whether weekday doctor-led completion of the DASA-IV was associated with changes in recorded agitation, aggressive incidents, and observation levels on the ward.

The secondary aim was to assess the feasibility and potential value of routine DASA-IV use as a precursor to broader nursing-led implementation.

It was hypothesised that consistent doctor-completed DASA-IV assessments would be associated with a reduction in aggression-related incidents and indicators of elevated clinical risk.

A two-phase case-note review was conducted over four consecutive weeks on a general adult inpatient ward.

During the first two weeks (baseline phase), weekday nursing documentation was retrospectively reviewed to capture episodes of agitation, recorded aggressive incidents, andobservation levels, with no change to usual care.

During the subsequent two weeks (intervention phase), the ward doctor completed the DASA-IV daily on weekdays alongside routine clinical work, while the same outcome measures continued to be collected.

Data from the baseline and intervention phases were compared to explore changes temporally associated with the introduction of doctor-led DASA-IV assessments. Data collection was restricted to weekdays in both phases.

Across 84 patient-days (baseline n=44; intervention n=40), incident-day rates were similar (11.4% vs 10.0%), as were agitation-days (13.6% vs 12.5%). One-to-one observations occurred on one baseline day and none during intervention.

Forty weekday DASA-IV assessments were completed; scores were low overall (mean 0.7, median 0, range 0–5). Using standard thresholds, 80% were low risk, 15% moderate and 5% high. All incident- and agitation-days occurred with DASA-IV ≥2 (100% sensitivity). Specificity was 88.9% for incidents and 91.4% for agitation, with negative predictive values of 100%.

Doctor-led weekday DASA-IV use was feasible and provided actionable risk stratification, with no events on low-risk days. Over this short audit, it was not associated with reduced incidents or agitation. Larger, longer evaluations with planned nursing-led implementation are needed.

Enhance PF understanding.

To ascertain what PF is, when/how/why played, and the potential effects of a ‘game’, a composite definition was developed:

An ostensibly non-partisan issue or problem that politicians from different parties argue about, primarily in order to obtain advantage for themselves rather than seeking to resolve the issue per se, as to do so may entail disadvantage in terms of acceptance of blame/responsibility, or inadvertently reveal the true scale of the problem, and the resources needed to meaningfully address the same.

The (sporting) metaphor was extended.An established PF was selected for a worked example - youth offending (YO) in New Zealand (NZ) - in order to explore if an additional underlying psychological process could be identified.

PF should matter to psychiatry.Mental health is itself sometimes designated as a PF, and a psychological lens can help to dissect a phenomenon with potential to affect us all.

Whilst PF is at heart a calculated opportunity for political gain, it also appears to represent the psychological defenses employed by the player, with evidence of a projection-driven othering noted with respect to the worked example (given overwhelming evidence of almost ubiquitous childhood adversity prior to YO, it is hard to conceive that the governmental introduction of a ‘boot-camp’ for YO, can be anything other than a deliberate attempt to obscure confronting aspects of societal reality in favour of short-term political gain).

Unsurprisingly, media influences the perceived ripeness of an issue for PF selection.When a PF becomes perennial, it may intersect with other PF issues, and can even appear bigger than it actually is, like a super-moon (NZ YO decreased, 2014-2024).

Reducing a complex issue to binary terms, is also misleading.With respect to YO in NZ, PF robbed the general public of the chance to develop a view on what can be reasonably expected to work in a complex situation i.e. the populist proposal for a ‘boot-camp’ likely won ‘tough-on-crime’ votes, but without reference to the confronting evidence of societal drivers, risks being construed as disingenuous.

Blunt dissection can expose PF for what it actually is (shallow, self-interested psychologically insulated) and what it is not (meaningful, thoughtful, harmless). Thus PF stands as a - very human - obstacle to positive societal change. Better understanding of PF is therefore important, including with respect to the psyche of individuals playing for power.

Psychotropic medications are commonly used as an adjuvant to treat children having an eating disorder. Though there is little evidence on the rationale of use of psychotropic medications in eating disorder, they have often been used to address the associated psychiatriccomorbidities. While eating disorder owing to its complexities requires regular physical monitoring, introducing psychotropic medication makes it even more important for carrying out a regular monitoring. Hence the audit was designed as clinic practice mandatesits needs.

Data collected from patient records in two different timelines- Dec 2022-Jan 2023 and Dec 2023-Jan 2024. Trust and NICE guidelines on monitoring antipsychotic medications and NICE guidelines for antidepressant monitoring were taken as standard guidelines.

31 patients were started on psychotropic medications in these time periods with most prescribed drug being Fluoxetine, followed by olanzapine and sertraline.It was seen that the compliance for physical health parameters (Blood Pressure, Heart Rate, BMI etc) was almost 100% except for waist circumference which was not being done on a regular basis. With the bloods, there was a good compliance on LFT, U&Es, FBC, Blood glucose levels but lipid profile, creatinine phosphokinase was not being routinely done for the young people

The MEED monitoring is normally used in the eating disorder clinics which does not always coincide with the monitoring for psychotropics, for example - timing and/or type of investigations, therefore there is sometimes a gap in monitoring psychotropics. Waist circumference could be a difficult parameter to monitor because young people deal with body image concerns, hence this could be tricky to monitor. Based on the findings, we have designed a monitoring tool which the physical health team has been using from now. We are hoping to see better results when reaudit is done.

Psychiatric rehabilitation focusses on adults with complex psychosis and requires a whole system approach, spanning general adult and forensic services.

This report describes the clinical and demographic characteristics of inpatients in psychiatric rehabilitation services, and the different levels of care, including secure and non-secure services. Factors associated with longer lengths of stay are explored and reasons for longer lengths of stay on forensic units investigated.

Demographic, clinical, and service factors were recorded on specified dates across 12 rehabilitation wards, encompassing general adult, forensic and learning disability secure rehabilitation units. Statistical analyses were performed on SPSS. Medians and non-parametric tests were used. Stepwise linear regression was performed with natural log transformation of length of stay data.

There were 173 patients; 137 in non-secure and 36 in forensic services. Majority were male (77%) with an average age of 45 years (range 20-72). Female patients were 5 years older on average. 12% were voluntary patients; 68% detained under civil sections and 20% detained under forensic sections. Schizophrenia was the most common diagnosis (N=107, 62%). 90% (N=155) had a diagnosis within the complex psychosis framework.

Multimorbidity of psychiatric diagnosis was the norm (total diagnoses=314, mean=1.8, median=2, range 1-5). Median length of stay was 262 days (range 7-3,309, IQR=465). Linearregression identified increasing age, number of psychiatric diagnoses, diagnosis of schizophrenia/schizoaffective/delusional disorder, being subject to a restriction order, diagnosis of autism, diagnosis of depression, and female gender as associated with longer lengths of stay. Chi-square and ANOVA testing indicated higher levels of multimorbidity, restriction orders and psychosis in forensic medium and low secure units compared to non-secure wards.

Better treatments for complex psychosis, particularly with comorbid autism, are required. Increasing age and, to a lesser extent, female gender were identified as impacting on treatment outcome. Medium and low secure units had the highest rates of schizophrenia and restriction orders, as well as high rates of multimorbidity. Learning disability secure rehabilitation units had the oldest average age and the highest rate of multimorbidity. Inpatient typologies need to be expanded to include medium secure rehabilitation units and interface with learning disability services.

Long acting injectable buprenorphine (LAIB – BuvidalTM) is a well-recognised, effective licensed opioid substitution therapy (OST). It works as a partial mu-opioid receptor agonist and kappa opioid antagonist. The Buvidal Psychological Support Service (BPSS) is a rapid access organisation service, offering a 3-tiered trauma informed psychological support system for those on LAIB in Cardiff.

-To establish the impact of the BPSS for those on LAIB treatment. With the objective to analyse therapy status, retention on Buvidal opposed to alternative OST and coinciding illicit drug use other than opioids of those referred.

-To determine whether completion of BPSS Tier 1 (8 sessions) is associated with a decrease in long term opioid and overall illicit drug use.

-To determine LAIB treatment retention vs other OSTs.

Use of PARIS database to obtain data on 289 BPSS referrals to date. Quantitative data on therapy status, date of initial and latest LAIB dose and current substance use was obtained and analysed. Qualitative data on the status of referrals was also obtained. Individualised chi-squared tests were conducted, significance set to p <0.05 to determine the association between the completion of Tier 1 of the BPSS service and a reduction in illicit drug use. Categorical data of each referral from the PARIS database was used to record individual illicit drug use.

Those completing Tier 1, showed significantly lower illicit opioid use (1.5% vs 10.5%, p <0.05 ) and overall illicit drug use (48.4% vs 20.2%, p <0.05) compared to those not engaged or discharged from the service. Alcohol, benzodiazepine, cocaine, crack, cannabis and gabapentin use did not differ between those who completed Tier 1 to those discharged/not engaged (p >0.05).

Those on LAIB – Buvidal treatment as an opioid substitute medication can be referred to the BPSS. Of those referred retention of Buvidal as the opioid substitution treatment, is markedly higher than that of alternative OSTs. Completion of the Tier 1 BPSS service can be associated with an increased likelihood of being free of illicit drug use and reduced opiates use. Alcohol, benzodiazepine, cocaine, crack, cannabis and gabapentin use did not differ between those who completed Tier 1 compared to discharged, this perhaps associated with lack differentiation between self-medication or recreational use. Despite this, completion BPSS Tier 1 can be strongly associated with a decrease in illicit drug use, therefore long-term, more comprehensive research could be vital in reinforcing this potential.

Background:

Timely multidisciplinary formulation meetings are a cornerstone of patient-centred care in mental health inpatient settings. TEWV NHS Foundation Trust standards recommend completion within 72 hours of admission, with full MDT participation. This audit aimed to evaluate compliance with these standards on Maple Ward, identify delays, and assess attendance patterns to inform quality improvement.

A retrospective audit was conducted on 67 cases admitted to Maple Ward between January and August 2025. Data were extracted from audit registries and case notes. Variables included admission and formulation dates, attendance by role, and documentation completeness. Descriptive statistics summarized timeliness and attendance. Correlation and linear regression analyses explored associations between delay and team composition.

Timeliness: Mean interval from admission to formulation was 4.9 days (median: 4; range: 1–10 days). Only 27% of cases met the 72-hour standard, indicating low compliance.

Attendance: Consultants (100%), nurses (97%), patients (93%), and resident doctors (91%) were most frequently present. Psychologists (13%) and occupational therapists (25%) attended infrequently; carers were present in 46% of sessions.

Associations: Team size showed negligible correlation with delay (r ≈ 0.03). Regression analysis indicated attendance variables did not significantly predict timeliness (Adjusted R² ≈ –0.038; p ≈ 0.71).

Documentation: Major gaps included missing documentation of assessment of capacity (91%), legal status (55%), and clinical impression (49%).

Compliance Level: 27%.

The audit reveals systemic delays and limited psychosocial input in formulation meetings. Attendance patterns suggest strong core clinical presence but weak representation from psychology and Occupational therapy. Documentation gaps further compromise quality.

Recommendations

Improvement strategies include:

• • Early scheduling triggers and escalation for delays beyond 72 hours; daily updating of patient board and discussion at report-outs.

• • Protected daily formulation slots (Actioned by Ward Manager and Administrative staff)

• • Ensure Full involvement and participation of all multidisciplinary team members especially for complex cases.

• • Develop a standardized documentation template and induction for resident doctors.

There is a high prevalence of metabolic abnormalities in patients with severe mental illness. Metabolic abnormalities are more likely to be present among individuals of black, Asian or minority ethnic groups. This study aims to assess the ethnic breakdown of the Early Intervention Service (EIS) for first episode of psychosis in Sheffield Health Partnership University NHS Trust. We aim to assess the metabolic parameters (blood pressure, HbA1c, BMI, triglycerides and cholesterol) in Asian patients on the EIS caseload.

Data on ethnicity was collected for all patients on the EIS caseload in 2025 using electronic patient records. Data on BMI, blood pressure and blood results were collected for patients of Asian ethnicity. Data was analysed using descriptive statistics and presented on graphs using Microsoft Excel.

Out of the 309 patients on the EIS caseload, 9.2% (29 patients) identified as Asian or Asian British.72% of Asian patients had a recorded BMI. Of these, the majority (71%) had a raised BMI. 13% of patients with recorded data had raised blood pressure. 83% of Asian patients had blood tests for lipids, cholesterol and HbA1c. The mean HbA1c was 36.08mmol/mol and no patients had a HbA1c in the pre-diabetic or diabetic range. 29.2% of Asian patients had a raised TG:HDL ratio.

We used the diagnostic criteria of metabolic syndrome as at least 3 of: waist circumference >102cm for men or 89cm for women, triglyceride >1.7mmol/L, HDL <1.0mmol/L for men or <1.3mmol/L for women, BP >130/85 or fasting BM >5.6. This identified 20.7% of Asian patients as having metabolic syndrome. However, only 3 patients (10.3%) had all 5 parameters recorded, suggesting there could be unidentified patients with metabolic syndrome.

The majority of Asian patients on the EIS caseload had a raised BMI, highlighting a potential area of intervention to improve health outcomes. Some Asian patients have raised blood pressure, increased TG:HDL ratio and metabolic syndrome. This study identifies low rates of measurement of metabolic parameters; it is striking that 89.7% of patients did not have all the recorded data that is needed to make a diagnosis of metabolic syndrome. It is likely that there are unidentified patients with metabolic syndrome who are not able to access appropriate lifestyle support and medical treatment to improve health outcomes.

Teaching on an inpatient acute ward is often ad-hoc and deprioritised due to clinical pressures, with structured teaching usually targeted primarily at medical trainees. The aim of this project was to establish a weekly ‘bitesize’ teaching programme delivered immediately following the Wednesday morning huddle. The objectives were to improve shared understanding of physical health and core psychiatric topics, improve inter-disciplinaryunderstanding and to create a positive culture of regular, expected and structured MDT teaching on the ward.

A weekly ‘bitesize’ teaching programme called Wednesday wisdom was established and delivered immediately following the Wednesday morning team huddle. Sessions were designed to be time-efficient and sustainable within a busy inpatient environment, lasting 10–15 minutes. Members of staff from multiple disciplines were contacted to deliver sessions, including pharmacists, dieticians, chaplaincy and mental health nurses.

Anonymous pre-programme questionnaires were distributed to the MDT to assess perceived adequacy of current teaching opportunities on the ward and acceptability of the proposed programme.

Baseline questionnaires (n=7) highlighted a lack of structured MDT teaching, with 71% of respondents reporting that there were not enough opportunities for MDT teaching on the ward. Mean self-rated confidence scores were 6.4/10. There was a high perceived likelihood of attendance if the sessions were scheduled immediately after the Wednesday morning huddle (72%).

Post-programme feedback demonstrated high satisfaction across all measured domains. 100% of respondents wanted the programme to continue and would recommend the format to other wards. Mean scores were high for relevance to role 9.7/10, being pitched at an appropriate level 9.3/10, appropriate session length 10/10, overall usefulness 9.6/10, increased confidence at applying learning 9.4/10, inclusivity and relevance to MDT 9.5/10 and integration intoward routine 10/10. A small number of respondents suggested refining pharmacy and medically focused sessions to ensure accessibility for the wider MDT.

This programme demonstrates that short and structured MDT teaching embedded within existing ward structures can be a highly effective way of improving learning opportunities in a busy inpatient psychiatric setting and can be delivered with minimal resources.

Legal herbal supplements are increasingly used as “natural” alternatives for mental health issues. Nymphaea caerulea (Blue Lotus) is promoted online as a relaxant, though its neuropsychiatric effects remain poorly understood. This short review aims to examine the available literature onNymphaea caerulea(Blue Lotus), with a focus on its pharmacology, psychoactive and neuropsychiatric properties, and to describe illustrative examples from clinical practice. The review also seeks to raise awareness of potential associations between new-onset psychotic presentations and legal herbal supplements, and identify gaps in the evidence base requiring further research and regulation.

A narrative literature search was conducted in PubMed, Google Scholar, and grey literature up to 2025 using the terms “Nymphaea caerulea”, “Blue Lotus”, “herbal psychoactive”, and “psychiatric symptoms”. Pharmacological sources and regulatory reports were also reviewed. Two brief anonymised clinical vignettes from clinical practice were also included to illustrate real-world psychiatric presentations temporally associated with Blue Lotus use.

The results of the search revealed fewer than ten publications, with only one peer-reviewed case series, which described five individuals presenting with agitation, confusion, derealisation, and anxiety following ingestion or vaping. Routine toxicology screening was negative in all cases. Two brief anonymised clinical vignettes from recent clinical practice were also included, illustrating hypomanic and psychotic presentations following Blue Lotus use.

Regulatory alerts from the UK Office for Product Safety and Standards have raised concerns around the safety of Nymphaea caerulea (Blue Lotus), particularly the lack of information on dosages, variability in psychoactive content, and concerns regarding purity standards. Pharmacological reports have described the main active compounds, including nuciferine and aporphine, which act on dopaminergic and serotonergic receptors and may induce both calming and euphoric effects. The concentration of these alkaloids may vary depending on the plant, extraction method, and storage, resulting in unpredictable clinical effects. Furthermore, nuciferine has been identified in Blue Lotus resin used in electronic-cigarette devices, confirming the presence of psychoactive compounds in products marketed for inhalation.

Nymphaea caerulea is a legally obtainable, yet psychoactive herbal supplementthat may provoke neuropsychiatric symptoms. Clinicians should inquire about herbal/“natural” supplement use in new-onset psychiatric presentations. Regulation and further research are needed.

Clozapine is an effective medication for adults with treatment-resistant schizophrenia. However, its safe prescribing and monitoring can be challenging during General Hospital admissions. An initial service evaluation conducted in 2023–2024 identified inaccurate documentation of clozapine in community records, delayed referrals to Liaison Psychiatry and inconsistent monitoring of clozapine-related risk factors. In response, quality improvement interventions were implemented, including local education, a Trust-wide clozapine policy for General Hospitals and a clozapine admission checklist. This second-cycle service evaluation aimed to assess whether these interventions improved the safety and consistency of clozapine prescribing and monitoring.

A retrospective review was conducted of patients prescribed clozapine in the community who were admitted to two General Hospitals in England between March 2024 and February 2025. There were 66 admissions involving 53 patients. Electronic records from community services, General Hospitals and Mental Health services were reviewed. Data collected included the accuracy of clozapine documentation on community records, whether referrals to Liaison Psychiatry were made and the timeliness of referral and review. Liaison Psychiatry documentation was reviewed to determine whether key clozapine-related factors were considered, including full blood count monitoring, medication concordance, smoking status, bowel function, physical health concerns, medication interactions, signs of clozapine toxicity and advice regarding plasma level monitoring.

Clozapine prescriptions were correctly documented in community records in 26% (17/66) of admissions, compared with 16% in the first cycle. On admission, 79% (52/66) of patients were referred to Liaison Psychiatry, with a reduction in mean time to referral from 41.07 hours to 32 hours. Of those referred, 87% (54/62) were reviewed within 24 hours, compared with 68% in the first cycle.

Within Liaison Psychiatry reviews, documentation rates were highest for medication concordance and physical health concerns (both 88%) and full blood count monitoring (78%). Documentation was lower for medication interactions (59%), bowel movements (50%), signs of clozapine toxicity (33%) and smoking status (19%). Advice regarding plasma level monitoring was documented in 40% of cases.

This second-cycle service evaluation demonstrates improvements in referral rates to Liaison Psychiatry, timeliness of review and the quality of Liaison Psychiatry documentation following targeted quality improvement measures. However, challenges remain in the consistent documentation of clozapine prescriptions in community records and routine assessment of smoking status and signs of toxicity. Further quality improvement initiatives and repeat evaluation cycles are recommended to support safe and consistent clozapine management in General Hospitals.

Multidisciplinary Team meetings are essential to care planning, rehabilitation, and discharge. However, MDTs are often experienced differently by each service user. Each service user brings their own preferences, communication styles and expectations to the MDT setting. This quality improvement project aimed to explore their views on MDT and developed a sustainable process whereby patients' views are explored and the MDT process is adjusted to their needs and preferences.

We used the 6-step quality improvement approach and completed three Plan–Do–Study–Act cycles. Baseline insight was gathered using a structured Likert scale questionnaire to explore service users’ views and experiences of MDT meetings. Responses were rated on a five-point scale from very satisfied to very unsatisfied. The questionnaire explored aspects of MDTs including: feeling prepared for the MDT; preference for order of speaking; comfort with the number of people present; understanding who is in the meeting and their roles; having enough time to share views; comfort within the MDT environment; feeling listened to; feeling safe and respected; whether personal topics were discussed; understanding what was being said; understanding next steps; whether the MDT gave hope for recovery; and overall MDT experience.

Initial data identified five domains impacting MDT experience: preparation for the MDT, feeling listened to, having key topics discussed, environmental comfort, and understanding next steps following the MDT. Across three PDSA cycles, targeted interventions were introduced to improve service user experience of MDT meetings. Theseincluded adding the My MDT preferences tool to the Care Plan that allowed service users to express personal preferences regarding MDT format, environment, timing, and support. Another change involved improving the existing pre-MDT preparation form, and introducing a process whereby administrative staff emailed weekend staff. Another adjustment included offering a post-MDT form. Following the interventions, Likert scale scores improved in all questions. The greatest improvement was seen in feeling listened to (mean score improved from 2.0 to 1.5) and understanding next steps after the MDT (1.9 to 1.5).

A flexible and person-centred MDT process can improve service user experience. The project has been adopted into routine practice with plans for ongoing monitoring to sustain improvements. This approach is transferable to other inpatient settings aiming to strengthen service user experience in MDTs.

This audit aimed to assess current practice within NHS Borders Mental Health for Older Adults Service (MHOAS) regarding the use of neuroimaging in memory assessment clinics. Specifically, it sought to determine the proportion of patients with suspected dementia who had a documented decision and rationale regarding neuroimaging, and the proportion who underwent neuroimaging as part of their assessment. This was compared with findings from a previous audit conducted in 2014.

Patients referred to NHS Borders Older Adult teams with suspected dementia between January and March 2024 were identified from administrative referral records. A retrospective review of initial cognitive assessment letters was undertaken between February and August 2025. Data collected included whether there was documented consideration and rationale for neuroimaging, and whether neuroimaging was subsequently performed. The agreed audit standard was that all patients with suspected dementia should have a documented decision and rationale regarding neuroimaging, and that the majority should undergo imaging unless a clear clinical justification was recorded.

Fifty-one patients were included in the audit. Documented consideration of neuroimaging was present in 45 patients (88.2%), representing a substantial improvement compared with 59% in the 2014 audit. Neuroimaging was performed in 27 patients (53%), compared with 18% in 2014. Of the 24 patients who did not undergo neuroimaging, eight (33%) had already received neuroimaging within the preceding two years, and repeat imaging was deemed clinically unnecessary. In the remaining cases, the most common documented rationale for not performing neuroimaging was that the diagnosis was already clear and that imaging was unlikely to add diagnostic value or alter management.

This audit demonstrates a marked improvement over the past decade in both the documentation and utilisation of neuroimaging within the NHS Borders memory assessment clinic. Current practice is more closely aligned with national NICE and SIGN guidance, with appropriate clinical reasoning documented where neuroimaging is not performed. The findings suggest that neuroimaging is being used proportionately and appropriately, balancing guideline recommendations with principles of Realistic Medicine.

Undertaking a psychotherapy long case is part of the Core Psychiatry Training curriculum. While the value of psychological skills within psychiatry is well recognised, for many trainees starting the first psychotherapy case is an anxiety provoking task. The need for more formal teaching has been identified in previous studies. The aim of the project was to understand challenges faced by resident doctors and based on this knowledge, to improve the quality of psychotherapy training in North Central London (NCL).

NCL doctors in Core and Higher Psychiatry Training were invited to complete an anonymous survey which consisted of qualitative and quantitative questions. The feedback was used to design 2 three-hour long teaching sessions between September and October 2025. Both modules had strong focus on experiential learning which included reflecting on video recorded psychotherapy sessions and discussing observations in small groups, whilst providing only brief theoretical introduction to core psychodynamic concepts. The overall experience and effectiveness of teaching was evaluated by collecting data through formal and informal feedback.

A total of 14 responses to the initial survey were received. 50% of respondents hadalready completed a long case, 29% were seeing a patient, 21% were preparing to start by attending a supervision group.

Qualitative analysis showed themes of being underprepared and having not enough formal teaching before seeing a long case. Doctors who were about to start the long case wanted more theoretical teaching, while the ones who had already completed the long case put emphasis on the value of learning through experience e.g. in Balint and supervision groups. All trainees who had already started or completed the long case found the experience very useful or useful (73% and 27% respectively) in helping them to understand psychodynamic concepts better.

Psychotherapy teaching modules were very well attended. First and second teaching session formal feedback was overwhelmingly positive with 40 and 32 responses rating teaching as good (15% and 28%) or excellent (83% and 72%), respectively. Respondents particularly emphasised the usefulness of interactive elements of the teaching, seeing psychotherapy in action through the video material and the discussions in small groups.

While Core Psychiatry Training curriculum provides little guidance on provision of psychotherapy teaching, our project highlighted the usefulness of interactive and experiential teaching methods, which was evidenced by the initial survey results, high teaching attendance rates and very positive formal and informal feedback.