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.

To understand what leads young people to come to Sheffield Children’s Hospital for their mental health, and the barriers to discharge home. This may help guide the service in reducing the number of long admissions and their length of stay. For example, we may be able to identify at risk groups and give appropriate support before and during admission.

We gathered data showing admissions to the STAR team (Supportive Treatment and Recovery Team) from 2022-2024 and identified patients with a prolonged (>21 days) stay. Within their electronic record, notes were reviewed to identify: patient demographics, frequency of stays (related to mental health), length of stays (related to mental health), risk to self or others, involvement of other services or consideration of Tier 4 input, issues with sleep, school, substances, possible/confirmed neurodiversity.

Out of 753 patients identified in 2022-2024, 20 patients met the criteria for a prolonged admission. There was an even split by sex, with a mean age of 13.5 years. We identified demographic traits within the cohort having prolonged admissions.

Overall, it seems certain factors might increase the risk of a prolonged mental health admission, such as safeguarding concerns and violence and absconding risk. Using the risk factors identified, we have created an admissions tool. The aim is for this to allow professionals to score the amount of risk factors, and if meeting a certain threshold, trigger a case conference. This may help at the early stages to reduced potential frequent or prolonged admissions for a young person.

Essex partnership university Trust (EPUT) policy on Discharge and Transfer Clinical Guidelines (CG24) aims to provide a clear pathway for the transfer and discharge of all patients of EPUT from and within Mental Health, Learning Disability, Secure Services and Community Health Services. It also aims to ensure that a patient’s transition between areas of EPUT services and transfer outside of EPUT services is carried out timely, effectively and safely.

The aim of audit is to to evaluate if EPUT Policy on Discharge and Transfer Clinical guidelines CG24 was being followed in an inclusive inpatient setting.

Data was collected retrospectively on all discharges from 6 acute inpatient wards within the Mid locality of EPUT; in the Linden Centre, Chelmsford.Inpatient wards that were included were General Adult (Galleywood, Finchingfield, Topaz), Older Adult (Ruby), Perinatal Specialist (Rainbow) and Psychiatric Intensive Care Unit (Christopher Unit) using a custom built audit tool. All discharges in a 3-month period (from June 2025 to August 2025) were included. This information was gathered from the electronic record (PARIS) with sample size of 91 discharges.

1. 1. Copy of the brief discharge summary given to patient: 100%

2. 2. Copy of detailed discharge summary scanned onto electronic medical records: 98%.

3. 3. GP to receive brief summary about admission, treatment required and medications within 24 hours of patient leaving the ward: 86%

4. 4. Copy of brief discharge summary scanned onto electronic medical records: 86%

5. 5. GP to receive detailed discharge summary within 5 working days of patient leaving the ward: 81%

6. 6. Copy of the more detailed discharge summary sent to patient: 0%

This re-audit has highlighted good compliance with providing the brief summary to the patient directly and scanning detailed discharge summary onto electronic medical records. There is a slight decline in sending both the brief summary to the GP within 24 hours, and with sending the detailed summary to the GP within 5 days following discharge compared to previous audit cycle with 81 discharges (data collected February 2024 – April 2024).

Areas of Good Practice:

Wards were generally compliant at uploading detailed discharge summaries to the EPR (98%).

Nurses continued to provide patients with a copy of brief discharge summary. (100%)

All wards apart from Rainbow (Mother and baby unit) are using E discharge summary.

Areas for Improvement:

There was slight decline in sharing of the brief and detailed discharge summaries with the GP, and poor compliance in sharing detailed discharge summaries with patients.

Delayed discharges arise from multiple factors and are linked with poor health outcomes, increased systemic pressures and a higher financial burden. To tackle these problems, a simple screening system (The Holistic Concern Score, HCS) was developed to identify the nature and degree of case complexity, signpost discharge barriers and enable early parallel working between allied health services.

The scale was developed using pooled data over the longest-admitted patients to determine reasons for protracted stays. The two major phases of the project involved the development of the score, and subsequently a combined retrospective application to a case sample to review its efficacy and learning.

Ten factors were identified and placed into a novel scale with factors identified as either natural (for example treatment resistance, lack of capacity) or systemic (accommodation delays, funding problems). A preliminary complexity thresholdwas calculated to determine cut-off points for identifying cases for early escalation to senior management.

The same thirty cases were re-analysed approximately 3 months later to assess efficacy of the score in predicting admission duration.

The scale shows moderate strength in predicting length of inpatient stay and characterises discrete clusters of compounding issues signifying the need for assertive multidisciplinary management. The use of this scale at admission has led to improved holistic management of cases and provided clear therapeutic benefits, with the potential to reduce delayed discharge, improve health outcomes and relieve systemic and financial pressures.

Further work will be needed to refine the scale but it presents promise within any inpatient service pathway as a directive, prescriptive and effective approach to case management on multiple levels.

To improve access to the young person psychotherapy service by adapting intake requirements. National data indicates that there is an impact of ethnicity on accessing therapies. Our aims are to improve attendance of the initial pre-assessment consultation (PAC) appointments, but also to see if there is an improvement to PCREF diversity. To support the AYAS team in achieving the existing 4-week KPI target between referral and appointment by reducing DNAs and cancellations.

1) Data was collected during the period between April 2024–June 2025 on patients who either did not attend (DNA) or cancelled their initial pre-assessment consultation (PAC) appointments. Patient records were reviewed to understand the most common reasons why patients were unable to attend their appointments.

2) Stakeholder engagement was also sought by collecting opinions from staff members involved in the opt-in process.

3) Using the above data and feedback, a new opt-in template was developed that was user friendly, age appropriate, and helpful for booking appointments, thus improving the experience for patients and staff.

4) Following its implementation, data was collected on whether the new process was effective in achieving our initial aims and objectives. Continued feedback will be sought from patients and staff members to inform a new cycle of quality improvement in the future.

Data collected in the 14 months between April 2024–June 2025 found 21 DNAs and cancellations. The most common reason given for cancellations and DNAs was because their appointment clashed with college, work or other commitments (10). This was followed by being given too short notice (5) and sickness (4). Of the 304 appointments offered in 2024–2025, there were 42 first-appointment DNAs. Of these, the most common ethnicities were White British (10), White Other (6) and Black African (6). There was an improvement in the time it took for patients to respond once an opt-in was offered, which was supported by feedback from staff members involved in the opt-in process.

The new opt-in process for the Adolescent and Young Adult Service (AYAS) has demonstrated promising results in improving the rates of response for patients offered an opt-in to attend the pre-assessment consultation (PAC). Previous data suggests that there is no impact of diversity on attendance. Ongoing data collection is required to assess its longer-term impact on the service.

ADHD is treated in CAMHS and may involve non-pharmacological treatments, suchas behavioural therapy. It may also involve pharmacological treatments, such as methylphenidate, lisdexamfetamine, atomoxetine, and guanfacine. Medication side effects include hypertension, weight loss, arrhythmias, and loss of appetite, all of which are detrimental to childhood development. The aim of this closed-loop audit was to improve Attention Deficit Hyperactivity Disorder (ADHD) monitoring within the Child & Adolescent Mental Health Services (CAMHS) in West Glasgow. Patients’ height, weight, blood pressure, and heart rate, along with respective centiles and growth charts, were assessed in accordance with NICE guidelines.

In the initial audit, a retrospective data search using electronic health records identified a sample of 33 patients under 18 with a diagnosis of ADHD who took ADHD medication within the previous 6 months. The results of this initial audit were presented at a local department meeting. Posters of the NICE guidelines were then distributed. The same methods as the initial audit were used to identify 45 patients on ADHD medication for the follow-up cycle to assess improvement in monitoring.

In the initial audit, 97% of the 33 patients had their height and weight recorded, and 100% had their blood pressure and heart rate recorded. 85% of patients had their height centile, weight centile, and growth charts recorded. 10% of patients had blood pressure centiles recorded, and 0% had heart rate centiles recorded. In the second cycle, 100% of the 45 patients had their height, height centiles, weight, weight centiles, heart rate, blood pressure, and growth charts recorded. 2% of patients had blood pressure centiles recorded, and 0% had heart rate centiles recorded.

There was a significant increase in the monitoring of height, height centiles,weight, weight centiles, heart rate, blood pressure, and growth charts in the second cycle compared with the first cycle. However, blood pressure and heart rate centiles still did not meet NICE guidelines. This was clinically significant due to the variance in heart rate and blood pressure in children. The electronic health system’s inability to convert raw figures of blood pressure and heart rate to percentiles likely impacted the ability to monitor these specific percentiles.

To develop a peer group of clinical academic residents in the West Midlands Deanery.

The SPARK project (Supporting Psychiatric Academic Research for Knowledge) began in 2024 in the West Midlands Deanery to support resident doctors to achieve the research requirements of the higher training curriculum. From this work it became apparent that a smaller cohort of academicallyfocussed residents wanted support with applications and their additional training needs.

We started a series of meetings for clinical academic residents and doctors interested in academic psychiatry careers working in the West Midlands. We held our first hybrid meeting in October 2025 at the University of Birmingham. This consisted of a hot networking lunch, a career talk from clinical Associate Prof Dr Ben Perry, a talk on theclinical academic training pathway and time for networking. We created a WhatsApp group where we share funding and job opportunities as they arise.

A second meeting is booked for March 2026 and will feature a career journey talk from Prof Femi Oyebode. This will be held at the University of Warwick so residents get exposed to different universities in the Midlands.

At the first meeting we measured pre-and post-session awareness of, and interest in, clinical academic careers.

21 participants recorded their attendance at the first SPARK 2 meeting, 16 in person and five online. The attendees were a mix of ACFs, core trainees, higher trainees, a foundation doctor, a clinical research fellow, an SAS doctor and a medical student.

Participants were asked to respond to the statement “I know what a clinical academic is and what they do”; 58% responded “Agree” or “Strongly agree” pre-session, 100% responded “Agree” or “Strongly agree” post-session. Participants were asked to respond to the statement “I understand the typical training and career pathway for a clinical academic”; 41% responded “Agree” or “Strongly agree” pre-session, 100% responded “Agree” or “Strongly agree” post-session. After the session 100% of participants responded “Agree” or “Strongly agree” with the statement “The seminar improved my understanding of clinical academia”.

One resident stated afterwards “That event really was pivotal” to his subsequent appointment as an ACF.

SPARK 2 is a quality improvement project in the West Midlands to support clinical academic residents in the region. We run meetings and have created a WhatsAppgroup to allow for networking and the sharing of knowledge and resources.

Menopause is increasingly recognised as a contributor to mental health presentations. There is a lack of confidence amongst clinicians in investigating and managing menopause in psychiatric patients; up to 41% of psychiatrists reporting feeling “not confident at all” in responding to the hormonal health of female service users. We aimed to evaluate the acceptability and efficacy of a specialist service for menopause and menstrual disorders amongst patients in secondary mental health care.

We devised and ran a Menopause and Menstrual Health Clinic offering email advice, case discussions, and assessments. The clinic is staffed by a consultant with special interest in the field, admin, and with MDT discussion input from Community Gynaecology. We have administered tailored teaching sessions to clinical services across the trust. Pre- and post-intervention survey data has been taken from service users, clinicians, and teaching recipients.

Initial feedback from teaching sessions shows improvement in knowledge and confidence (both 100%, n=12) and a positive impact on clinical practice (100%, n=10).

In the first eight months of operation, the clinic received 43 referrals from 37 referrers across primary and secondary care services. Early quantitative and qualitative feedback from patients and clinicians is positive. 100% of clinicians (n=9) who have responded to date find the clinic has improved the care they offer their patients, naming the “expert advice”, “comprehensive feedback”, and holistic reviews offered as key components of the clinic’s efficacy. 100% of clinicians and patients surveyed found the clinic easy to refer to or attend.Six-monthly follow ups from initial reviews are ongoing, but 100% (n=3) of patients surveyed to date have found treatment changes advised by the clinic to have had a positive impact on their mental health.

Preliminary data suggests the clinic is beneficial to clinicians and patients, with strengths including discussion of novel treatment options, holistic assessment of needs, and open dialogue between professionals regarding hormonal symptomatology and management. Delivering teaching sessions for colleagues to introduce a hormonal lens to formulation and management plans further extends the reach and effectiveness of the clinic. Ongoing work is needed to embed this awareness in routine psychiatric practice, through the expansion of teaching provision and increasing the profile of the clinic’s criteria and referral process. Future research should consider the need to embed consideration of hormonal status into mental health assessments, as a step towards addressing inequitable health outcomes for women.”

The aim of the project was to formalise and structure reciprocal communication between GPs and Queen’s Park and Paddington community mental health hub (QPP CMHH), with the hope of streamlining mental health care, supporting GP colleagues with mental health management, and to improve the quality of referrals.

Three GP surgeries were selected on the basis that they constituted 80% of the referrals to QPP CMHH. A7-item questionnaire (consisting of 5 rating-scale questions, ranging from dissatisfied to very satisfied, and 2 free-text questions) was sent to the GPs at these practices. Both virtual and paper copies were used. GPs were then given access to a spreadsheet that allowed them to book in for patients that they wished to discuss with CMHH, where they provided patient details and the clinical question. Virtual meetings were held every 2 weeks to discuss the cases and for the GPs to receive advice.

A total of 15 pre-intervention questionnaires were returned, from 3 GP surgeries. A total of 13 post-intervention questionnaires were returned, from 1 GP surgery. There was overall improvement in the GP-CMHH relationship, with the greatest improvement seen in the domain ‘communications were being sent via the correct channels’.

Limitations include long-term sustainability, which depends heavily on the commitment and input of more permanent, often senior staff. Suggested areas for improvement included a bypass telephone number to expedite access to QPP professionals for better support for duty GPs, and integrating the discussion referral process into SystmOne, the software that both GP surgeries and CMHT use. Suggested next steps is to widen access to additional GP surgeries.