To synthesise qualitative evidence on the lived experiences transitioning from child to adult health and social care services for young people with Attention Deficit/Hyperactivity Disorder (ADHD) in the UK.

A systematic search of MEDLINE, PsycINFO, Embase, Scopus, ASSIA, and grey literature sources was conducted on 3 June 2025. Eligible studies were qualitative or mixed-method, published from 2014 onwards and examined the transition experiences of young people with ADHD in the UK. Studies were excluded if they were purely quantitative, non-UK, or pre-2014. Methodological quality was appraised using the Critical Appraisal Skills Programme checklist. The data was synthesised using thematic analysis and narrative synthesis.

Nine studies were included: seven peer-reviewed papers and two grey literature reports. Across 224 participants (90 young people, 82 family members, 52 clinicians), three overarching themes were identified: (1) communication as a determinant of transition experience, (2) negotiating discontinuity and change and (3) interdependence of individual and systemic factors.

Transition to adult services for young people with ADHD is commonly experienced as fragmented, poorly coordinated and psychologically distressing. The findings highlight the need for developmentally informed, person-centred transition protocols that recognise transition as an active process rather than a discrete administrative event. Future research should prioritise disengaged young people and investigate long-term trajectories to inform evidence-based policy and service development.

The purpose of this thematic review was to analyse and explore the underlying factors contributing to differences in mortality rates among service users from different racial and ethnic groups within South West London and St George’s Mental Health NHS Trust (SWLStG), specifically in ethnic minority groups. By systematically examining deaths occurring under the care of the Trust, the review aimed to identify recurring themes, potentially to inform recommendations to reduce inequalities and improve patient safety.

Information was collected on all reported deaths between February 2025 and April 2025 of service users under the care of the Trust’s mental health services. A total of 145 deaths were reported and included in the review. Incident reports were extracted from Ulysses. Demographic and clinical information was checked and verified using RIO, including recorded ethnicity, progress notes, and relevant clinical and risk assessment documentation.

Of the 145 deaths reviewed, most occurred among White British (66%) or “other white” service users (10%), and of confirmed or suspected suicides, 73% were from white British or “other white” service users. 6.21% of service users’ ethnicity was unknown. Most deaths (84%) were due to natural causes, often at relatively older ages and in the context of significant physical health comorbidity. A proportion of deaths occurred following loss of contact with services, due to patient disengagement or during transition between mental health teams. There was limited information available for some deaths, making cause and circumstance unclear. Variation in service engagement and clinical documentation was observed across teams. Most service users had a documented mental disorder, most commonly cognitive decline or dementia (27%) and mixed anxiety and depression (25%). Among patients who died by possible suicide, 31.8% had a history of drug or alcohol dependence. No clear ethnicity-specific themes were identified, with interpretation limited by the small sample size.

This review highlights that most deaths among mental health service users were due to natural causes and were associated with physical health comorbidities. Recurrent themes included disengagement from services, communication gaps during care transitions, and variable documentation. Although ethnic minorities were a small proportion of the sample, evidence of lower access of these populations to mental health services remains relevant. Improving consistency of ethnicity recording, clinical documentation, engagement with service users, as well as strengthening communication between services, is indicated.

To assess whether reminder telephone calls improve patient ‘Did-Not Attend’ (DNA) rates; evaluate whether specific demographic groups are less likely to attend appointments.

Over 35% of psychiatric outpatient appointments are not attended. High DNA rates increase waiting times and lead to inefficient use of healthcare resources. They are associated with poorer health outcomes, medication non-adherence and higher chances of hospital re-admission.

Reasons for non-attendance are multifactorial, including socioeconomic factors, illness severity and forgetting appointments. Reminder telephone calls were utilised to assess their effectiveness in improving attendance.

A retrospective review of patients booked for mental health outpatientappointments in a South-West Leeds community unit was conducted using electronic patient records (Caredirector). All patients had been sent appointment letters by post. Data was collected over a 16-week period and included 95 patients, of whom 22 patients DNA.

Reminder telephone calls followed a standardised script. Cycle 1 involved the reminder telephone call seven days before appointments, over a 4-week period (35 patients). Cycle 2 involved reminder telephone calls two days before appointments, over a 5-week period (21 patients). Two telephone call attempts were made if patients did not answer.

Qualitative data on appointment awareness and additional patient comments were recorded. Attendance and demographic data were then gathered from CareDirector.

In Cycle 1, 51.4% of patients answered the reminder telephone call, compared to 61.9% in Cycle 2. The average telephone call duration was 3 minutes 29 seconds. The baseline DNA rate prior to intervention was 23.16%, reducing to 14.3% with seven-day reminders and 19.1% with two-day reminders. However, amongst patients who confirmed attendance, subsequent attendance was higher with two-day reminders (100%) than seven-day reminders (83.3%). A higher DNA rate was observed amongst males in Cycle 1 (4:1), but rates were equal across genders in Cycle 2. No clear associations were identified between non-attendance and age, ethnicity, marital status, religion or interpreter requirement.

Findings suggest that forgetting appointments contribute to non-attendance, as reminder telephone calls reduced DNA rates in community outpatient clinics.The intervention was time-efficient, supporting feasibility for routine clinical practice. This simple measure could improve patient outcomes and optimise the use of mental health service resources. Future cycles could assess text-message reminders for patients who do not answer reminder telephone calls, to see if this further reduces DNA rates.

Suicide is a significant cause of death worldwide and is prevalent among homeless individuals. However, aspects of suicide in homeless mental health patients remain under-researched. This study aims to analyse socioeconomic, clinical, and service-related characteristics of homeless mental health patients who died by suicide in England between 2012 and 2022, with a focus on age group and ethnic background.

This retrospective cohort cross-correlational study uses data from the National Confidential Inquiry into Suicide and Safety in Mental Health (NCISH). Homelessness was classified as having ‘no fixed abode’. Comparative analyses, including multivariable logistic regression, were conducted between homeless (n=324) and non-homeless patients (n=12,605). Subgroup analyses were performed within the homeless group based on age group (under 45 years and over 45 years) and ethnic background (Ethnic Minority background and White-British).

Homeless patients were more likely to be male, younger and socioeconomically disadvantaged, to have dual diagnoses of substance dependence, adjustment disorders and histories of substance misuse, self-harm and service disengagement. They were more likely to die within 24 hours of last service contact. Younger homeless patients displayed higher prevalence of substance misuse and self-harm, and for self-harm leading to service contact. Older homeless patients more often faced recent financial difficulties. Homeless patients from ethnic minority backgrounds had a higher prevalence of affective disorders, immigration-related vulnerability and a concerningly lower median age of death.

Suicide in homeless mental health patients is associated with complex socioeconomic and clinical vulnerabilities. Our findings emphasise the need for integrated, culturally sensitive and targeted suicide prevention strategies.

The re-audit aimed to assess compliance with previously implemented recommendations regarding alcohol assessment, intervention, documentation, and signposting for people with gambling disorder presenting to the Southern Gambling Service (SGS), and to evaluate improvements in practice since the initial audit.

The re-audit included all referrals received by the Southern Gambling Service (SGS) between 1 March 2025 and 30 September 2025 who completed an initial assessment.

Baseline data were analysed to stratify patients’ alcohol use risk based on their extended Alcohol Use Disorder Identification Test (AUDIT-C) and Estimated Weekly Alcohol Consumption (EWAC), collected via a digital pre-assessment tool, with escalation to a full AUDIT where indicated. Clinical assessment letters and formulations were reviewed to assess documented compliance with National Institute for Health and Care Excellence (CG115) guidance, Department of Health and Social Care guidance, and Royal College of Physicians regarding appropriate management according to their risk brackets. Outcomes included: completion of full AUDIT for those meeting criteria; delivery and documentation of brief interventions for hazardous or harmful drinking; provision of advice on avoiding abrupt reduction for those scoring ≥20; delivery and documentation of formulations on alcohol use and signposting to specialist alcohol services where appropriate.

A total of 301 referrals were received during the audit period, of which 124 referrals (41.2%) were accepted and assessed. AUDIT-C and EWAC were completed for 100% of assessed patients. Fifty-five patients (44.4%) met criteria for escalation and completed a full AUDIT. Of these, 27 patients (49.1%) scored 8 or above, indicating hazardous or harmful drinking, and 10 patients (18.2%) scored 20 or above, suggesting possible alcohol dependence. Among patients scoring ≥8, 18 (66.7%) received a documented brief intervention and 20 (74%) had an alcohol-related formulation recorded. Of those scoring ≥20, seven (70%) received documented advice on avoiding abrupt alcohol reduction and eight (80%) had a formulation addressing alcohol use. Signposting to specialist alcohol services was documented for 7 of 10 (70%) patients who met criteria.

The re-audit demonstrates substantial improvements across all areas compared with the initial audit. Full AUDIT completion improved from 0% to 100%, delivery of brief interventions from 7% → 67%, advice on safe alcohol reduction from (0% → 70%) and signposting for patients improved substantially. Maintaining current standards with improvement in documentation consistency, staff education and reinforcement of intervention thresholds can help improve these gains.

To evaluate clinical activity, patient outcomes, and staff perceptions following integration of senior clinical fellows into a nurse-led crisis team.

In August 2025, senior clinical fellows were embedded within the Royal Edinburgh Hospital’s Mental Health Assessment Service to provide in-hours medical support, previously covered ad-hoc by medics from other services.

A prospective activity log and a database of patients booked for medical follow-up after out-of-hours nursing assessment were maintained between 28th September 2025 – 21st January 2026 within the Mental Health Assessment Service. Staff feedback was obtained via an anonymous nursing survey.

Senior clinical fellows recorded 82 activities. There were 45 direct clinical contacts, mainly joint assessments with nursing staff, and indirect clinical contacts such as case discussions and GP liaison. Direct clinical contacts included both scheduled medical follow-up appointments and unscheduled reviews. The primary reasons for medical input were diagnostic clarity, risk assessment, prescribing, or Mental Health Act (MHA) decisions.

28 patients received 33 in-hours scheduled follow-ups, most commonly for suicidal ideation (n=14) or psychosis (n=10). Medication was initiated in 14 appointments (50%). Outcomes included signposting (n=10); referral to third sector services (n=5); referral to CommunityMental Health Teams (n=4) or Intensive Home Treatment Team (n=5); informal admission (n=2); admission under the MHA (n=2).

There were also unscheduled medical reviews according to clinical need. This included one patient detained by police and one further admission under the MHA.

Senior clinical fellows delivered 17 teaching and supervision sessions to nurses, foundation doctors, and students. They also formally supervised three nurses through a Clinical Assessment and Decision Making module for Advanced Nurse Practitioner training.

Seven nurses completed the survey. Prior to senior clinical fellows, reported time to access medical support for MHA assessments ranged from 30 to over 240 minutes. Post-implementation, access time ranged from immediate to under 60 minutes for all respondents. Reported benefits of senior clinical fellows included improved patient flow; reduced waiting times; enhanced confidence managing complex cases; and educational benefit. One postulated downside of senior clinical fellows was potential to disincentivise nurses to make complex decisions.

Embedding senior clinical fellows in a nurse-led crisis team generated a range of clinical activity. It was associated with service enhancements to benefit patients, including diagnostic assessments and prescribing. Access to senior medical input was streamlined, with reduced delays and more efficient use of nursing time. There were also benefits for staff development. This model may be replicable across crisis services.

Personality disorder (borderline type), previously known as Emotionally Unstable Personality Disorder (EUPD), is a complex psychiatric condition associated with unstable relationships, emotional lability and transient psychotic-like features. National Institute for Health and Care Excellence (NICE) guidelines for EUPD (CG78) advise against routine use of psychiatric medication for personality disorder symptoms, recommending pharmacological treatment only for comorbid mental illness in accordance with relevant guidance. Antipsychotics are not licensed for EUPD. Where used, prescribing should be short-term, crisis-focused, and accompanied by clear documentation and informed consent. However, national data from the Prescribing Observatory for Mental Health indicate that antipsychotic prescribing in EUPD often occurs off-licence and may continue long-term by default, with variable documentation and review. This audit evaluated antipsychotic prescribing practices for inpatients with EUPD within Sussex Partnership NHS Foundation Trust, focusing on documentation of prescribing rationale, communication with patients regarding above license and physical health monitoring.

A retrospective review of clinical records was conducted across all working-age adult inpatient wards within the Trust. Data were collected as cross-sectional snapshots at three time points, each one month apart. Inpatients aged 18-65 years with a documented diagnosis of EUPD were included. Patients with primary psychotic disorder and out-of-area admissions were excluded. Where diagnostic ambiguity existed, a senior psychiatrist reviewed clinical notes to determine eligibility on a case-by-case basis. Outcomes were assessed against NICE and local Trust guidelines using descriptive statistics.

Of 508 records reviewed, 52 patients met the inclusion criteria. Antipsychotics were prescribed in 86.5% (45/52) of patients, with 20% (9/45) initiated during admission and 8.9% (4/45) receiving polypharmacy. None of the antipsychotics initiated were documented as time-limited. Documentation of communication regarding off-licence prescribing was present in only 6.6% (3/45) of cases. Physical health monitoring was inconsistently completed: body mass index was tracked in 80.7% (42/52) patients, HbA1c in 21.1% (11/52), electrocardiogram in 48.1% (25/52), blood pressure in 98.1% (51/52), prolactin in 42.3% (25/52), and cholesterol in 53.8% (28/52). Random glucose was requested instead of HbA1c in 42.3% (22/52) of cases, contrary to Trust guidelines.

Antipsychotic prescribing for EUPD inpatients frequently deviated from guideline recommendations, with significant gaps in documentation, consent recording, and physical health monitoring. These findings highlight the need for improved adherence to guidance, clearer documentation standards, and structured monitoring pathways to enhance patient safety and quality of care.

Autistic adults are at increased risk of mental health crises, yet their representation within crisis services and staff preparedness remain under-researched. This study aimed to determine the prevalence of diagnosed and suspected autism spectrum disorder (ASD) among referrals to a Crisis Resolution and Home Treatment Team (CRHTT), describe associated crisis presentations, and assess staff training experiences and knowledge.

A retrospective observational service evaluation was conducted within a crisis team in Sheffield, UK. A random sample of 400 adult referrals was selected from 2397 referrals. Demographic data, ASD diagnostic status, and presenting complaints were extracted from electronic records. Staff knowledge and training were assessed using an adapted National Autism Implementation Team questionnaire. Quantitative data were analysed descriptively and compared with population prevalence estimates; qualitative free-text responses were analysed thematically.

Among the 400 referrals, 10.5% had a formal ASD diagnosis and 11.3% were suspected cases, yielding a combined prevalence of 21.8%, over nine times higher than general population estimates. Common crisis presentations included suicidal thoughts or behaviours (41%), acute psychotic episodes (24%), and worsening psychiatric comorbidities (18%). One-third of suspected ASD cases had not been referred for diagnostic assessment. Forty percent of staff reported no ASD-specific training, and only 10% rated their knowledge as full. Qualitative findings highlighted insufficient, overly generic training and low confidence in managing autistic adults in crisis.

Autistic adults are substantially overrepresented in mental health crisis services, yet diagnostic delays and limited staff training persist. Improving autism-specific training, strengthening diagnostic referral pathways, and adopting more proactive models of care are essential to enhance crisis support and reduce repeated emergency presentations among autistic adults.

Involvement in Quality Improvement (QI) is an important component of Core Psychiatry Training. The Psychiatry Silver Guide states that trainees should be supported to be involved in one QI project and/or audit per year. We have seen our resident doctors face significant barriers in engaging with QI activities at South West London and St George’s Mental Health NHS Trust (SWLSTG). The Quality Improvement and Innovation (QII) Team coach and track the impact of QI projects at SWLSTG. Since 2023, the QII team have aimed to increase the number of resident doctors involved in QI projects overseen by the QII team.

Since 2023, we have tested 4 change ideas to increase the number of resident doctors involved in QI projects with oversight from the QII team.

Firstly, a cohort programme was designed to coach a group of resident doctors through a joint project with integrated QI training. The pilot of ‘Streamline QI’ began in early 2023 and included bespoke QI teaching and the coaching of participants through a group project. Subsequent cycles in 2024 and 2025 refined the model.

Additional change ideas tested included creating a SpR Special Interest role to support resident doctors, the targeted advertisement of QI training to doctors and the circulation of a trust criteria for QI project endorsement.

We used registration of QI projects with the QII team and repeated surveys of involvement to measure improvement.

In February 2025, 45 resident doctors were surveyed. 42% of respondents were not involved in QI projects. Of the respondents involved in QI projects, 65% were involved in projects without QII team involvement and 35% had QII oversight. The QII caseload of registered QI projects was reviewed and revealed that 0 resident doctor projects were actively progressing.

In January 2026, a repeat survey of 25 resident doctors showed 40% had not been involved in QI projects. Of the respondents involved in QI projects, 100% had QII oversight. This represents an improvement of 65%. The QII caseload had 8 active resident doctor projects and 9 enrolled in Streamline QI.

Feedback from all three cohorts of Streamline QI has been unanimously positive.

Here we have shown that a multi-dimensional approach can engage resident doctors in QI. Future change ideas to test will include a monthly ‘QI project idea’ clinic for resident doctors and delivering QI training to resident doctors on induction.

Superficial siderosis of the central nervous system is a rare progressive disorder caused by chronic deposition of haemosiderin in the superficial layers of the brain and spinal cord, often following recurrent subarachnoid bleeding. The cerebellum and hindbrain structures are particularly vulnerable to iron-related toxicity. Although classically characterised by ataxia, dysarthria, and gait disturbance, cognitive impairment is increasingly recognised as part of its presentation. This overlap can obscure diagnosis, especially when patients first present to memory services with primarily cognitive complaints.

A 75-year-old woman was referred to the memory clinic with a one-year history of worsening forgetfulness, difficulty recalling recent events, and episodes of disorientation. Her family reported rapid decline in her functional abilities, and she had become dependent on her son for daily organisation. She appeared anxious during cognitive testing and showed impaired short-term memory, word-finding difficulty, and repetitive speech, although reading and writing remained intact.

Initially, her presentation resembled a primary cognitive disorder. However, neurological examination revealed significant abnormalities, including difficulty following complex commands, tongue and limb apraxia, bilateral dysdiadochokinesia, and impaired tandem walking. Although there were no cranial nerve deficits or nystagmus, prominent cerebellar signs prompted neuroimaging. MRI demonstrated severe superficial siderosis symmetrically affecting the infratentorial region with lesser supratentorial involvement.

Her cognitive and neurological function deteriorated despite anti-dementia medication. A neurology opinion was sought, and she required multidisciplinary involvement, including speech and language therapy for dysphagia and fallsprevention support. As the condition progressed, she developed leftsided weakness, an upgoing plantar response, and reduced ankle reflexes. Chelation therapy with deferiprone was considered but not pursued due to advanced cognitive impairment, marked ataxia, and limited potential for benefit.

This case highlights an important diagnostic challenge for memoryassessment clinicians: superficial siderosis can initially present as a cognitive disorder, even though the underlying pathology is neurological. Without thorough neurological examination, such cases may be misdiagnosed as dementia, particularly when dysarthria and inconsistent cognitive testing obscure the picture. Dysarthria limits verbal responses, reduces the validity of cognitive scores, and can exaggerate perceived deficits. The patient’s apraxia, coordination abnormalities, and gait disturbance indicated a broader process inconsistent with typical neurodegenerative dementia. Early recognition is essential, not because curative therapy exists, but to guide appropriate imaging, avoid unnecessary treatments, initiate timely multidisciplinary care, and prepare families for progressive decline.

Cognitiveled presentations of superficial siderosis are uncommon but clinically important. This case highlights the value of thorough neurological assessment in memory services, particularly when cognitive symptoms present with atypical neurological features.

The Triangle of Care (ToC) is a national framework, developed by the Carers Trust, comprising six standards to ensure carers are identified, supported and included in mental health care, which is especially pertinent for Crisis Resolution and Home Treatment (CRHT) “limited-contact” services.

Undertaking this Triangle of Care audit within CRHT is crucial because, in a short-term, high-intensity, limited-contact crisis setting, it checks whether carers are identified, supported and meaningfully involved (notably around consent and discharge planning), assures compliance with Trust policy and the Health and Care Act 2022 duty to involve carers, and drives a targeted action plan with scheduled re-audit to secure measurable improvements.

We hypothesised that compliance would be high for staff training and availability of carer information/support, but lower for documentation-dependent items such as consent and recording carers’ special circumstances.

Retrospective review of 30 cases over 6–8 weeks (July–September 2025), excluding instances where no carer was identified despite reasonable enquiry.

Data sources included electronic case notes (carer identification, consent, documentation, discharge planning), staff training records, qualitylead feedback, and local policy/pack review.

A threecase pilot established interrater consistency; a subsample was checked by a senior colleague and carer lead for validation, in line with standard audit methodology.

Overall compliance across ToC standards was 77% (Green/Amber).

By individual standards:

• • S1 Identification 55%

• • S2 Staff training 100%

• • S3 Confidentiality/information sharing 50%

• • S4 Defined carer roles 67%

• • S5 Carer introduction & information 90%

• • S6 Range of carer support 100%.

Sub-items illustrating key gaps included:

• • Recording special circumstances 27%

• • Documented consent/limits 54%

• • Routine discussions on sharing information 45%

• • Revisiting non-disclosure 33%

• • Offering support when disclosure declined 0%

• • Carer involvement in discharge planning 50%

Strengths included universal carer-awareness training, an accessible introduction/information pack (including cultural/language considerations), and comprehensive signposting to support.

Findings support the hypothesis: the CRHT team showed strong performance for staff training and information/support availability. There is much needed for improvement in consent processes, systematic recording of carer special circumstances, and consolidation of local carer-champion arrangements. These improvements would be an essential element in enhancing care for high-risk patients. Supporting wider organisational objectives to promote recovery in the community.

An action plan is in development to enhance service user and carer experience with a re-audit scheduled for 2026.

This audit aimed to determine clinician adherence in Leeds and York Partnership NHS Foundation Trust’s (LYPFT) Older People’s Service (OPS) North as part of the Community Mental Health Team (CMHT), for the NICE guidance regarding:

1. Provision of advice for people with depression for regular physical activity to enhance patients’ sense of wellbeing with potential for added benefits for outdoor activity.

2. Advising people with depression that maintaining a healthy lifestyle by, for example, eating a healthy diet, avoiding excess alcohol, and maintaining a healthy sleeping pattern, can also improve their sense of wellbeing.

The first 200 consecutive contacts by service users with the service from 1st July 2024 onwards were analysed. Seventy-six separate service users were identified. After excluding those without a depressive disorder noted, frail service users, and those who were exclusively seen by a psychologist within the defined study period – first contact from 1st July 2024 up to one month later – 31 service users formed the final sample. Records were then searched to identify clinicians’ interactions with the service user and whether there was evidence of following the NICE guidelines for the provision of advice to improve patients’ sense of wellbeing.

Of the 31 patients in the final analysis, the NICE guidelines regarding the provision of advice for regular physical activity to enhance a sense of wellbeing were followed in 35% of cases (11 service users) with there being no documented evidence of such advice for the remaining 20 (65%) service users. Eighteen service users (58%) had no documented evidence of the provision of advice for maintaining a healthy lifestyle but 13 service users (42%) did. When analysing by staff group, compared to Care Coordinators and Health Support Workers, Doctors performed worst with regards to evidence of providing advice for behaviours to enhance wellbeing.

This audit demonstrated that documentation of LYPFT CMHT OPS North clinicians’ advice to patients with depression that wellbeing can be improved by engaging in regular physical activity, and by maintaining healthy lifestyle habits is absent in the majority of cases (65% and 58% respectively). Following the audit, an action plan was created to improve adherence to the guidelines. This included staff education and creation of a patient information leaflet. A re-audit is planned to analyse whether the action plan has led to improvement.

Alcohol withdrawal can potentially result in a life-threatening condition. This requires early recognition, prompt assessment and treatment. The National and Humber Trust guidelines emphasise use of validated tools such as Severity of Alcohol Dependence Questionnaire (SADQ) and Clinical Institute Withdrawal Assessment for Alcohol–Revised (CIWA–Ar) to guide treatment decisions.

An incident of alcohol withdrawal in the 136 suites, in which the patient’s symptoms were not recognised early and treatment was inadequate, alongside the presence of new staff within the team and informal discussions with staff, highlighted variability in staff knowledge regarding assessment tools and the treatment pathway.

The aim of the project was to improve staff confidence and knowledge in assessing and managing alcohol withdrawal in line with Trust Guidelines as measured by the pre-and post-intervention questionnaire.

The project followed the PDSA cycle of Quality Improvement:

Plan: Improve staff knowledge and confidence in managing alcohol withdrawal.

Do: We conducted a teaching session with staff on alcohol withdrawal symptoms, assessment tools and how they are used and required treatment.

We also created a flowchart to summarise the diagnosis and treatment of alcohol withdrawal. These flowcharts were pasted in suite 136 for staff to use as quick reference.

Study: Post-intervention results showed improved staff knowledge and confidence. Flowcharts were frequently used as quick reference points, and lectures enhanced understanding of assessment and management.

Act: Continue teaching and display of flowcharts. Future cycles may focus on evaluating clinical outcomes of alcohol withdrawal management.

The results showed that the intervention carried out led to significant improvement in staff knowledge of alcohol withdrawal assessment tools, treatment pathways, and guideline access.

The project showed that combining lectures and visible flowcharts effectively improved staff knowledge and confidence in managing alcohol withdrawal. Ongoing reinforcement and feedback are essential to ensure that improved knowledge translates to consistent practice.

This project helps staff to manage alcohol withdrawal more efficiently thereby saving time. It also helps to optimise use of resources. Early recognition and treatment initiation helps to prevent complication thereby cost saving.

To evaluate the implementation of autism and ADHD assessments within the Swansea Bay community perinatal team and mother and baby inpatient unit in South Wales, focusing on service outcomes and patient and staff experiences.

Perinatal inpatients and outpatients assessed for ADHD or autism from Feb 2024–Aug 2025 were identified. Assessment outcomes were captured, and all 22 patients were invited to provide feedback on experience and impact. MDT members from inpatient andcommunity perinatal services also provided perspectives. Thematic analysis was applied to all responses.

Quantitative: Of 867 screened perinatal cases, 22 underwent assessment (7 inpatients, 15 outpatients). Among inpatients, 6 met diagnostic thresholds (4 autism, 2 ADHD); all 15 outpatients met thresholds (13 autism, 2 ADHD).

Qualitative: Feedback from 12 staff members highlighted that diagnosis improved patient self-advocacy and family relationships but reported gaps in post-diagnostic support, leaving patients to interpret their diagnosis independently. Staff also noted the need to adapt practice and interventions for neurodivergent patients. Feedback also highlighted the need for internal gatekeeping to prevent oversaturation of the service and to avoid the service being used solely as an alternate pathway for quicker ADHD/autism diagnosis. Patient feedback (n=11) described benefits of validation, self-understanding, and stronger family relationships, praising the compassionate and personalised care received. Two patients highlighted the need for structured aftercare and follow-up.

Findings suggest a particular need for neurodivergence assessments during the perinatal period. Patient and staff feedback consistently reported improved self-understanding and family relationships but highlighted post-diagnostic gaps in support and aftercare, underlining areas for service improvement. This evaluation has highlighted the need for further development of the pathway for neurodivergence within the perinatal population ensuring the service provided is sustainable and adapted to meet patients’ needs.

Monitoring mental state and risk is central to psychiatric inpatient care. The narrative nature of the Mental State Examination (MSE), although essential for clinical decision-making, limits rapid detection of trends and communication of change across teams. Existingrating scales are often diagnosis-specific, time-consuming, or clinician-restricted, reducing feasibility for routine ward use.

MINDY is a brief, structured tool designed for repeated inpatient assessment to capture mental-state disturbance and risk in a reproducible format.

This study aimed to evaluate whether repeated MINDY assessments meaningfully reflect clinical change in mental state and risk during psychiatric admissions.

We hypothesised that MINDY scores and risk classifications would show clinically coherent variation over time and align with changes documented in nursing notes.

This ward-based service-evaluation and retrospective case-note review was conducted on an adult psychiatric inpatient ward. Three resident doctors completed daily MINDY assessments for inpatients under a single consultant team over a randomly selected two-week period.

MINDY outputs were compared with concurrent nursing documentation. Data were anonymised and handled in accordance with NHS information-governance and General Data Protection Regulation requirements. Analyses were undertaken by an independent medical student with no prior clinical involvement.

The case-record analysis focused on MINDY’s capacity to track clinical change over time. Documentation completeness, inter-rater reliability and predictive validity were not assessed.

On days with both MINDY and nursing documentation available, suicide or self-harm risk was recorded on six occasions, all classified by MINDY as Risk-Group C (100% sensitivity and negative predictive value). Specificity was 87.5%, with three Risk-Group C classifications on days without documented risk. Agreement between Risk-Group C and nursing-documented risk was substantial (κ=0.74). Documented risk was significantly more frequent on Risk-Group C days than others (66.7% vs 0%), with a large effect size (h=1.91; p=0.00014).

Graphical longitudinal plots showed clinically interpretable trajectories. Patients discharged during the intervention recorded sustained low risk and scores, concordant with nursing notes, while those remaining on the ward showed fluctuating scores and shifting risk zones reflecting variable clinical courses.

MINDY’s Risk-Group classification identified nursing-documented suicide and self-harm risk with perfect sensitivity and substantial agreement. Longitudinal visualisation demonstrated clinically meaningful trajectories associated with discharge and ongoing admission.

The findings support MINDY as a practical, structured tool for tracking inpatient change and guiding discharge decisions, though further refinement of risk stratification is needed.

Burnout among psychiatry inpatient staff is often attributed to challenging patient behaviour; however, organisational conditions may play an equally important role. Staffing adequacy and organisational responses following incidents represent potentially modifiable determinants of staff wellbeing. Therefore, we aim to examine associations between perceived staffing adequacy, post-incident support, and burnout among psychiatry inpatient staff.

A cross-sectional survey was completed by inpatient psychiatry staff (n=115). Burnout was assessed using a validated 7-item composite scale (α;=0.915). Organisational factors were measured using Likert-scale items assessing perceived adequacy of staffing levels to manage risk safely and perceived support from the organisation following incidents. Multivariable linear regression models were constructed adjusting for professional role group, years working in psychiatry, and work pattern. Effect modification by post-incident support was tested using interaction terms. All statistical analyses were performed using IBM SPSS Statistics.

Lower perceived staffing adequacy was strongly associated with higher burnout in univariable analysis (β=−0.41, p < 0.001), explaining 16.9% of variance in burnout scores. This association remained robust after adjustment for staff characteristics (adjusted B=−0.30, 95% CI −0.45 to −0.16; p < 0.001). Higher perceived post-incident support was independently associated with lower burnout (adjusted B=−0.35, 95% CI −0.49 to −0.20; p < 0.001). There was no evidence that post-incident support modified the association between workplace stressors and burnout (interaction p=0.23).

Perceived staffing inadequacy is a major organisational determinant of burnout among psychiatry inpatient staff. While post-incident support is associated with lower burnout overall, structural factors such as staffing levels appear to play a central role. Interventions aimed at improving staff wellbeing should prioritise workforce capacity alongside supportive organisational practices.

To assess medical students’ attitudes towards mental health and psychiatry across three domains:

Psychiatry as a medical specialty.

Mental health patients.

Stigma in mental health.

Medical students on placement in the Northern Trust and in the South-Eastern Trust (NI) were sent a survey to complete. The survey contained demographic data as well as 15 statements attached to a 5-point Likert scale, for students to select strongly agree, agree, neither agree nor disagree, disagree, or strongly disagree. Completed surveys were collected via a third party and forwarded to me for review, ensuring anonymity.

17 students completed the survey in full and their responses were analysed. Some statements had very consistent responses which produced a strong theme, as follows:

• 100% agree/strongly agree that ‘all medical students should complete a placement in psychiatry’.

• 100% disagree/strongly disagree that ‘psychiatrists are not real doctors’.

• 100% disagree/strongly disagree that ‘psychiatrists are less credible than doctors in other specialties’.

• 88% agree that ‘mental health conditions can be effectively treated’ – with 12% neither agreeing nor disagreeing. No students strongly agreed.

By contrast, a number of statements yielded a wide variety of responses with no clear theme, as follows:

• All five responses were selected (in various numbers) for the statement, ‘medical professionals treat patients with mental illness differently to those with physical illness’.

• All five responses were also selected for ‘patients with mental illness receive poorer care than those with physical illness’.

• All five responses were selected for “I worry that seeking help for my own mental health might negatively impact on my future career’.

• For the statement, ‘I would feel uncomfortable being alone with a patient who has a serious mental health issue’, 41% disagreed while 47% agreed/strongly agreed.

Some clear, consistent themes have emerged from the surveys. There is general respect for psychiatry as a specialty, with all students agreeing on psychiatry placements being necessary, and psychiatrists being credible, ‘real doctors’. This may stand against the stigma experienced by psychiatrists.

Almost all students agree mental health conditions are effectively treatable (88%) – however zero students strongly agreed.

Some issues remain divisive for students: how mental health patients are treated, how comfortable they would feel seeking help for mental illness, or being left alone with a mental health patient.

This study had a small sample size (n=17), and would benefit from both more responses, as well as focus groups to gather qualitative data.

Catatonia is a syndrome characterised by decreased, increased, or abnormal psychomotor activity and is seen in conditions such as schizophrenia, and depression. Global meta-analysis carried out in 2017 found mean catatonia prevalence to be 9.0%. This case involves an adolescent patient treated for catatonia.

A 15-year-old boy with a background of severe dyspraxia but otherwise normal development and no prior health problems was admitted to an adolescent mental health unit due to rapid cognitive, motor, functional, and psychological decline, suggestive of catatonia. A paediatric immunology work up found no organic or autoimmune cause. An MRI head was unremarkable. A lorazepam challenge produced transient improvement. Due to persistent severe catatonia with emerging psychotic symptoms, an eight-session course of ECT was initiated under an STDC, later converted to a hospital CTO. Gradual recovery was observed, with Bush–Francis Catatonia Rating Scale scores reducing from 16 to 0. The patient regained normal motor coordination and speech, with improved emotional regulation and social interaction. Residual psychotic symptoms were mild, with preserved insight. Discharge plans included medication review, movement from inpatient to community, phased return to school, and gradual home passes. The patient was discharged from inpatient care after a 2.5 month stay.

Adolescent catatonia is frequently under-recognised and misattributed to neurological or functional disorders, leading to delays in effective treatment. This case is notable due to the rapid progression and severity of symptoms, with prominent motor, cognitive, and autonomic features closely mimicking organic pathology. Although benzodiazepines are recommended as first-line treatment, response in paediatric populations is often incomplete. This patient demonstrated partial improvement which necessitated escalation, illustrating the importance of early consideration of ECT, which is supported by growing evidence as safe and highly effective intervention for severe, or treatment-resistant paediatric catatonia, with reported response rates exceeding 70%. Additionally, the case highlights the ethical and legal complexities of compulsory treatment in young people, demonstrating how proportionate use of legislation can facilitate recovery and restoration of autonomy.

Catatonia in adolescents is serious but highly treatable. Early recognition and escalation of treatment reduce morbidity and risk. Benzodiazepines are first-line, but clinicians should maintain a low threshold for ECT in cases of partial response or high clinical risk, given its safety and efficacy in young people. Treatment guided by clinical presentation can result in full functional recovery and improved outcomes.

Due to their higher acquisition costs, long-acting injectable (LAI) antipsychotics are often seen as more expensive substitutes for oral antipsychotics (OAs). However, Schizophrenia is a chronic and relapsing- remitting illness; non-compliance to oral therapy frequently results in hospitalisation and emergency care, which are significant contributors to overall healthcare expenses. Therefore, rather than concentrating solely on pharmacies, evaluating treatment value necessitates a total cost of care (TCOC) perspective.

Aims were to determine, using economic data, whether the higher costs of LAI antipsychotics result in an overall increased healthcare cost when compared to oral antipsychotics in adults with Schizophrenia.

Our data sources for the study included administrative claims databases (Medicaid and commercial), cost-effectiveness models, mirror-image (pre-post) studies, national health system cohorts, systematic reviews and meta-analyses. We conducted a structured narrative evidence synthesis from the above data.

We focused on real-world economic and pharmacoeconomic studies comparing LAI antipsychotics with OAs. The total healthcare costs and/or component costs (pharmacy, inpatient, emergency department, and outpatient) were reported in the studies. Results were analysed directionally rather than pooling them statistically, due to heterogeneity in settings,currencies, and time horizons.

It was noted that across US, European, and Asian studies, LAIs consistently demonstrated lower inpatient and emergency department costs but higher pharmacy costs in comparison to OA’s.

Several pre-post analyses revealed a reduction in hospitalisation costs after LAI initiation. However, few claims-based and meta-analytic studies reported no statistically significant difference in total healthcare costs between LAIs and oral therapy.

Cost-effectiveness models indicated that LAIs may be cost-effective over multi-year horizons, despite similar or slightly higher total costs, driven by improved compliance and reduced relapse rates.

The findings demonstrate a robust “cost-offset effect”, in which the higher upfront medication costs of LAIs are balanced by the downstream savings from avoided hospitalisations.

The generalisability of this pattern for stakeholders and policy/decision-makers was supported by the fact that it was consistent across healthcare systems, study designs, and LAI molecules.

LAI antipsychotics do not significantly raise overall healthcare costs and may be economically beneficial by lowering expensive relapse-related care, though they may appear to be raising pharmacy expenditures initially. Treatment evaluations for schizophrenia should focus on the overall cost of care rather than just the cost of the medication.