Young carers (YCs), estimated to comprise 2–8% of the child and young person (CYP) population in England, face numerous sociodemographic challenges that put them at increased risk of poor mental health (MH). The Covid-19 pandemic exacerbated challenges by increasing caregiving responsibilities. However, research on YCs in the pandemic era remains limited. This study is a secondary analysis of the NHS England 2020 Mental Health of Children and Young People (MHCYP) survey, investigating the characteristics, pandemic experiences, and MH outcomes of YCs aged 11–22 in England.

The NHS England MHCYP 2020 survey was a follow-up to the 2017 survey, taking place July/August 2020. The original 2017 cohort, selected through random probability sampling from the NHS Patient Register, included 9,117 CYP aged 2–19 and/or their parents. Of these, 3,570 (46%) completed the follow-up 2020 survey, now aged 5–22. The main measure of mental health in 2020 was the Strengths and Difficulties Questionnaire (SDQ), a broad measure of mental health difficulties. The 2020 survey included a range of questions about pandemic experiences, which were compared for YCs and non-YCs. Longitudinal regression analyses assessed whether YC status in 2017 predicted change in SDQ score between 2017 and 2020. Weighted analyses adjusted sequentially for baseline SDQ, demographics, and a comprehensive theoretically informed covariate set.

The analysis revealed some differences in demographic and pandemic-related variables between YCs and non-YCs. Parents of young carers were more likely to report that they could not afford food or had to use a food bank compared to parents of other young people (5.7% compared to 1.8%). Young carers were more likely than non young carers toreport that their household could not pay bills (5.5% compared to 1.8%). There was no evidence of difference in MH outcomes in 2020 as measured by the SDQ between YCs and non-YCs, nor did the longitudinal analysis indicate a greater deterioration in SDQ scores among YCs from 2017 to 2020.

These findings suggest that YCs as a group were more likely to face socioeconomic challenges during the pandemic, although we found no differences in mental health outcomes. This may reflect protective factors at play or reflect study limitations. There was considerable attrition between the 2017 and 2020 surveys, requiring weighted analysis and reducing power. Further research is warranted to explore the complex interactions between caregiving, socioeconomic factors, and MH, and to develop risk-mitigation and mental health promotion strategies.

Relapse following discharge from inpatient rehabilitation remains a major challenge in substance use disorder (SUD) care and is associated with significant clinical, social, and legal consequences. While relapse rates are well described, far less is known about the timing of relapse, particularly within mandated treatment systems where patients are referred through legal (Court) or regulatory pathways (General Persecution) and experience structured supervision and monitoring. Identifying periods of heightened vulnerability following discharge is critical for optimising aftercare strategies and allocating resources effectively. This study aimed to characterise the timing and distribution of relapse events following discharge from inpatient SUD rehabilitation in Qatar and to identify critical post-discharge periods for targeted preventive intervention within mandated treatment pathways. We hypothesised that relapse risk would be highest during the early post-discharge period.

A retrospective cohort study was conducted including 72 patients discharged from an inpatient SUD rehabilitation programmeoperating under a mandated treatment framework. All patients entered a structured aftercare pathway with routine follow-up and urine drug screening. Relapse was defined as a documented positive urine drug screen for illicit substances during follow-up. Time-to-relapse was measured from the date of discharge and tracked over a 26-week post-discharge period. Patients who did not relapse during follow-up were censored at their last negative drug screen. Kaplan–Meier survival analysis was used to estimate relapse-free survival and to describe the temporal distribution of relapse events across the follow-up period.

During the 26-week follow-up, 40.3% of patients (n=29) experienced relapse. The median time-to-relapse was 28 days, indicating that half of all relapse events occurred within the first four weeks following discharge. Relapse timing ranged from 7 to 182 days, demonstrating substantial inter-individual variability in post-discharge recovery stability. Kaplan–Meier survival curves showed the steepest decline in relapse-free survival during the first month after discharge, identifying this period as the highest-risk phase for recurrence. Beyond the initial four weeks, the hazard of relapse declined progressively over time, with fewer new relapse events observed in later follow-up.

This time-to-event analysis demonstrates that the first four weeks following discharge constitute a critical vulnerability window for relapse among patients undergoing mandated inpatient SUD rehabilitation. Findings support prioritising intensive early aftercare, enhanced monitoring, and rapid-response interventions during the immediate post-discharge phase. Targeting this high-risk period within mandated treatment pathways may reduce early relapse and improve longer term recovery outcomes.

Tic disorders are the most common movement disorder of childhood with a lifetime prevalence rate of 5% for transient tic disorders and 0.7% for Tourette syndrome. 20% of school-aged children may be affected by tics at some point. Most tic disorders are transient and do not require treatment. Chronic tic disorders if causing distress to the young person would require treatment.

Management of tic disorders requires a multidisciplinary approach with paediatricians, psychologists and psychiatrists working together depending on comorbidities. General practitioners are often unclear about the most appropriate service to refer young people to, causing delay in young people accessing the right support. This led to discussions about creating a pathway for children and adolescents with tic disorder in the community setting.

Aims were to create a referral pathway for children and young people with tic disorders in North Staffordshire; to provide a seamless service for young people, by developing a referral system with clear guidance to genera practitioners so that young people can access the right support in a timely fashion.

A working group was formed with Paediatricians (3 and 4) from University Hospital of North Midlands and a Psychiatrist (1) and Psychologist (2) from the CAMHS services. A general practitioner (5) who represented ICB was also part of the working group.

The group met regularly in 2023 and created a pathway which enabled the general practitioners to refer to the most appropriate team. A referral form was also created to guide the referring clinician. This was presented to a group of general practitioners and amendments were made accordingly. The pathway was approved by the ICB and implemented in March 2024.

Introduction of the tic disorder pathway helped primary care colleagues to make referrals to the right team and helped reduce waiting times.

Creation of this pathway helped primary care clinicians to assess and refer young people without referrals being redirected to different teams. This has reduced the time from referral to treatment for young people with movement disorders. The development of the pathway has positively impacted on working relationships between primary and secondary care colleagues.

Obsessive–compulsive disorder (OCD) is a chronic psychiatric illness associated with marked functional impairment and reduced quality of life (QoL).Although the adverse impact of OCD on QoL is well established,local data is limited.In light of limited relevant local literature, we planned our research to build a scientific database related to effect on quality of life in OCD patients due to several different types of obsessions and to establish which type of obsessions are more prevalent and affect more.

This cross-sectional study was conducted over a period of six months at the Department of Psychiatry and Behavioural Sciences, Allied Hospital II, Faisalabad, after approval from the Ethical Review Committee of Faisalabad Medical University. A total of 180 participants were recruited using probability consecutive sampling from the outpatient and inpatient services. Adults aged 18 years and above diagnosed with OCD according to DSM–5 criteria were included, while individuals with neurological disorders, significant cognitive impairment, acute psychiatric crises, or major comorbid psychiatric disorders were excluded. Written informed consent was obtained from all participants. Diagnosis and categorization of obsession types were established through structured clinical interviews based on DSM–5 criteria, and relevant data were recorded on a structured proforma. Data were analysed using SPSS version 25, with descriptive statistics calculated for demographic and clinical variables; differences in quality of life across obsession categories were assessed using analysis of variance (ANOVA), and simple linear regression analysis was performed to evaluate predictors of quality of life.

Of the 180 people who took part, 109 (60.6%) reported a poor quality of life, and 71 (39.4%) had a normal quality of life. There were 30 people in each group for each category of preoccupation. There was no statistically significant correlation between types of obsessions and quality of life (χ²=3.466, p=0.629). Nonetheless, QOL exhibited strong correlations with gender (p=0.038), employment status (p=0.022), disease duration (p=0.002), familial history (p=0.010), and OCD severity (p<0.001). A stronger link existed between worse quality of life and higher intensity and longer duration of illness.

Patients with OCD have a significant deterioration in their quality of life. The specific type of preoccupation does not directly influence quality of life; rather, clinical considerations, especially the severity of OCD and the length of the illness, are pivotal. These results underscore the significance of prompt diagnosis, thorough management, and severity-oriented interventions to enhance the overall well-being of individuals with OCD.

Gambling-related harm is under-recognised in patients receiving opioid substitution treatment (OST). This study aimed to determine the prevalence and severity of gambling harm in an OST outpatient population, explore associations with concurrent substance use (cocaine, cannabis, illicit benzodiazepines), and assess the feasibility of routine screening in clinical practice.

A cross-sectional service evaluation was conducted in an NHS addictions psychiatry outpatient service. Adults aged ≥18 years receiving methadone or buprenorphine were opportunistically screened during routine appointments, excluding those unable to engage due to acute intoxication, severe withdrawal, cognitive impairment, or acute psychiatric instability. Gambling-related harm was assessed using the Problem Gambling Severity Index (PGSI). Demographic data, opioid substitution treatment type, concurrent substance use, and psychiatric comorbidities were extracted from clinical records and patient self-report. Data were anonymised and analysed descriptively, with exploratory comparisons between patients with and without gambling-related harm.

A total of 62 patients were screened. Eighteen patients (29%) scored ≥3 on the Problem Gambling Severity Index (PGSI), indicating moderate-risk or problem gambling, while nine patients (14%) met criteria for problem gambling (PGSI ≥8). Gambling-related harm was more frequently observed among patients reporting concurrent cocaine use and illicit benzodiazepine use. The majority (82%) of patients with moderate or severe gambling harm had no prior documentation of gambling difficulties in their clinical records, suggesting significant under-recognition. Screening was feasible, added minimal time to routine assessments, and prompted clinically relevant discussions around financial stress and relapse risk.

Gambling-related harm appears common yet under-identified among patients receiving OST in addiction psychiatry outpatient services. Routine screening using brief validated tools such as the PGSI is feasible and may enhance holistic assessment and care planning. Integrating gambling harm assessment into standard addiction reviews may help address unmet clinical need and improve outcomes in this complex patient group.

To quantify anticholinergic burden among older adults newly referred to the Central Aberdeenshire Community Mental Health Team (CMHT) between February 2024 and February 2025, and to evaluate whether clinicians documented interventions to review or mitigate anticholinergic medications when the burden was clinically significant.

This quality improvement project reviewed all general practitioner referrals to the Central Aberdeenshire CMHT during the study period. Of 241 referrals, 30 deceased patients were excluded, leaving 211 patient records for analysis. Prescribed medications were reviewed and anticholinergic burden was calculated using both the German Anticholinergic Burden Score and the Anticholinergic Cognitive Burden (ACB) Scale; where discrepanciesoccurred, the higher score was used to prioritise patient safety. An ACB score ≥3 was considered clinically significant. For these patients, clinical records were examined to identify documented interventions, categorised as switching to less anticholinergic alternatives, suggesting a medical review, deprescribing, or dose adjustment/reduction.

Among the 211 patients (age range 61–101 years), 73% were prescribed at least one anticholinergic medication and 32.7% (N=69) had a clinically significant anticholinergic burden (ACB ≥3), with scores ranging from 0 to 11. Anticholinergic burden was strongly associated with polypharmacy: 63.9% of patients prescribed eight or more medications had an ACB ≥3, compared with 11.8% of those on fewer than five medications. High-burden medications most frequently prescribed included quetiapine, amitriptyline, and solifenacin.

Despite the prevalence of significant anticholinergic burden, 75.4% of affected patients had no documented intervention. Interventions included deprescribing (8.7%), dose adjustment or reduction (8.7%), suggesting a medical review (4.4%), and switching to a less anticholinergic alternative (2.9%).

Clinically significant anticholinergic burden remains common among older adults referred to CMHT services and is closely linked to polypharmacy. However, documented clinical interventions have declined compared with previous local audits, indicating a widening gap between risk identification and active management. Embedding routine anticholinergic burden calculation into assessments, prompting systematic medication review for patients with ACB ≥3, and supporting clinicians with targeted education may improve patient safety. A re-audit is planned to evaluate the impact of these interventions.

Weight-loss medications such as tirzepatide are increasingly prescribed, yet their potential psychiatric effects remain under-recognised. This case explores diagnostic uncertainty between personality pathology and hypomania following significant weight loss and exposure to tirzepatide in an individual with pre-existing narcissistic personality traits. The aim was to examine whether behavioural escalation represented an exacerbation of personality traits alone or a superimposed affective episode temporally associated with medication use.

A man in his late 40s with established Narcissistic Personality traits and no prior history of mood disorder was assessed following escalating behavioural concerns in the workplace. Prior to medication exposure, occupational functioning was stable, though interpersonal behaviour was characterised by inconsistency, criticality, and sensitivity to perceived errors in others.

Tirzepatide was initiated for weight loss at a starting dose of 2.5 mg and gradually escalated to 10 mg. Over approximately six months, the patient experienced rapid weight loss of 20 kg. Over the last three months of the treatment, marked behavioural changes were observed, including reduced need for sleep, increased energy, heightened grandiosity beyond baseline, impulsive decision-making, disinhibition, and poor insight into the impact of his actions on colleagues.

He demonstrated abrupt rule-breaking behaviour, including suspending colleagues without completing appropriate investigations or following established procedures, causing significant distress within the workplace. Symptoms were escalating rather than static. There were no psychotic symptoms, substance misuse, or alternative medical explanations identified.

The primary diagnostic considerations included exacerbation of narcissistic personality traits, hypomania, and medication-associated affective destabilisation. Several features supported hypomania over personality traits alone, including a clear change from baseline functioning, reduced sleep, increased goal-directed activity, behavioural disinhibition, and a marked reduction in insight. The temporal association with tirzepatide initiation and rapid weight loss raised the possibility of medication-related affective change in a psychologically vulnerable individual, despite no prior bipolar diagnosis.

This case highlights the diagnostic complexity of distinguishing personality pathology from emergent mood disorder in the context of metabolic pharmacotherapy. Clinicians should remain vigilant for affective destabilisation in patients prescribed GLP-1–based weight-loss agents, particularly those with underlying personality vulnerabilities. Careful longitudinal assessment is essential before attributing behavioural change solely to personality traits.

Many people with eating disorders experience body image disturbance, and there is evidence to suggest that body image difficulties not effectively addressed through eating disorder treatment can contribute to later relapse. Virtual reality (VR) interventions designed to target body image difficulties associated with eating disorders have begun to demonstrate promising evidence of efficacy. However, little is known about the perspectives of people with eating disorders and those who care for them around such interventions. This study aims to explore stakeholders’ views of factors that could impede or support use of such interventions.

Eleven young people with lived or living experience of eating disorders (PWLE), four parents/carers of people with eating disorders, and five clinicians with experience of treating eating disorders took part in semi-structured interviews or focus groups. Qualitative data was coded inductively and analysed using reflexive thematic analysis. Themes and subthemes were iteratively refined through discussions between the authors.

Five themes were generated. These were getting the timing right: highlighting the importance of timing within a person’s treatment journey, with suggestions for optimal timing; tailoring the intervention to the individual: all stakeholders agreed that individualisation to the person accessing treatment was critical; thoughtfully empowering agency: participants suggested that a degree of control over most aspects of the intervention would be helpful, with some key caveats; providing the right support: suggestions were made about both the necessity of support, and what this support might look like; and an overarching theme of on balance is it worth while? This overarching theme involved participants carefully weighing up the risks and benefits of using such an intervention. It included three subthemes: hope of efficacy; fear of difficulty; and desperate belief in necessity.

PWLE, parents and carers and clinicians shared valuable, detailed insights into how they view body image interventions in VR, the key challenging areas and suggestions for how they could be done well. They highlighted that getting these aspects right may make such an intervention on balance worthwhile. Ongoing co-production in order to optimise these components of the intervention should be utilised in the development of VR body image interventions, as they will likely make the difference as to whether people will choose to try them and whether they will be effective.

Sub-optimal prescribing of anti-dementia medications may compromise the cognition of patients with dementia. The aim of this audit was to assess the prescribing of anti-dementia medications, including Donepezil, Rivastigmine and Memantine, for patients diagnosed with dementia against local and national guidelines in relation to three domains: appropriate indication for dementia subtype, optimal dosage titration and recommended physical health monitoring. The target was to achieve a minimum of 90% adherence to guidelines for each domain.

This retrospective clinical audit was based at the Forget Me Not Unit, a specialist dementia intensive care unit in Worthing. The first audit cycle collected data from twenty patients discharged between February and May 2025. Data obtained from electronic medical records included dementia subtype and severity, pre-admission and inpatient-initiated anti-dementia medications, titration regimes, pulse checks and renal function profiles. Results were compared against Trust and Maudsley prescribing guidelines which served as standards. An action plan was subsequently implemented which included raising staff awareness of the audit, disseminating its results and placing visible audit reminders on ward lists. A second cycle was commenced in November 2025 to February 2026 which examined the data of twenty discharged patients following implementation of the action plan.

In the first cycle, thirteen out of twenty patients were prescribed pre-admission anti-dementia medications (65%) whilst seven out of twenty patients were candidates for an inpatient-initiated anti-dementia medication given their dementia subtype (35%). Six of these patients were offered an anti-dementia prescription of which five were clearly indicated (83%). All prescriptions were titrated according to guidelines but recommended physical health monitoring was only completed for five patients (83%). Similar results were demonstrated in the second cycle. Eleven patients were prescribed an anti-dementia medication prior to their admission (55%), six patients were candidates for an anti-dementiamedication (30%) but only four patients were prescribed an indicated drug during their admission (67%). However, all inpatient-initiated anti-dementia medications were titrated and monitored according to standards.

Anti-dementia medications are licensed treatments for dementia but may be underutilised as evidenced by this audit. Although the target was achieved by the second cycle in two out of three domains, the indication of anti-dementia prescriptions was not fully adhered to against guidelines. Further audit cycles and tailored action plans could raise the standards of anti-dementia prescriptions and thereby improve patient safety and care.

This audit aimed to determine the proportion of adults with Intellectual Disability (ID) residing at ‘Dar tal-Providenza’ residence, who had undergone genetic testing confirming a genetic diagnosis, assess documentation of genetic testing discussions or referrals, and evaluate alignment of current practice with national and international guidelines for genetic testing in neurodevelopmental disorders.

All adults under the care of the ID team with a documented diagnosis of ID and/or Autism Spectrum Disorder (ASD) were included. Electronic Patient Records were reviewed for demographic data, primary diagnoses, documentation of genetic testing or referral to genetics services, discussions with patients or carers, and documentation of results and follow-up actions in accordance with National Institute for Health and Care Excellence (NICE) and European Society of Human Genetics (ESHG) guidelines.

The cohort consisted of 80 adults aged ≥18 years, with a mean age of 50.4 years and a gender distribution of 49 males and 31 females. Most individuals had multiple co-existing neurodevelopmental, neurological, genetic, and mental health diagnoses. ID severity was mild–moderate in 23.75% (n=19), moderate–severe in 57.5% (n=46), and unspecified in 18.75% (n=15). An associated genetic syndrome was identified in 16.25% (n=13).

ASD was the second most common diagnosis (22.5%, n=18) and a frequent comorbidity with ID (16.25%, n=13). Other diagnoses included cerebral palsy (13.75%, n=11), trisomy 21 (11.25%, n=9), epilepsy (6.25%, n=5), Fragile X syndrome, Cri-du-Chat syndrome, and Peters-plus syndrome (each 1.25%, n=1). Challenging behaviour co-occurred in 8.75% (n=7). Mental health comorbidity was common, including bipolar affective disorder (6.25%, n=5), emotionally unstable personality disorder, post-traumatic stress disorder, schizoaffective disorder, anxiety disorder, and psychotic depression (each 1.25%, n=1).

Only 6 patients (7.5%) had a documented genetics referral, with genetic testing discussed in one case (1.25%). Among those referred, five had confirmed diagnoses, one was awaiting results, and no follow-up plans were documented.

This audit identified a highly complex cohort with extensive neurodevelopmental and mental health needs. Despite meeting NICE and ESHG criteria, genetics referral was low (7.5%) with minimal documented discussion or follow-up, highlighting the need for further training and collaboration between the Psychiatry and Genetics Department in Malta.

Background

Electroconvulsive Therapy (ECT) is among the most effective treatments for severe and life-threatening psychiatric illness, yet its use in medically complex patients demands refined clinical judgment.

With rising multimorbidity and increasing prevalence of implanted medical devices, clinicians are more frequently required to balance urgency against evolving physical risk.

This presentation introduces the concept of the therapeutic pause; not as delay, but as an active, patient-centered safety strategy, demonstrating how structured reflection and multidisciplinary collaboration can transform high-risk uncertainty into safe, timely intervention.

The aim is to highlight how deliberate pauses at critical decision points can improve both clinical outcomes and patient safety.

Case Reports

Two urgent liaison psychiatry referrals for ECT are presented.

Case 1 involved a 72-year-old man with schizophrenia and mild learning disability, admitted with catatonia, severe self-neglect, and nutritional failure requiring nasogastric feeding. He had a proximal deep vein thrombosis (DVT) diagnosed three weeks earlier and hyperkalaemia, raising concern about embolic risk and physiological stress during ECT.

Case 2 involved a 62-year-old woman with psychotic depression and catatonia, who had an implanted spinal cord stimulator (SCS) for chronic pain, creating potential risks of electrical interference and device damage.

In both cases, ECT urgency was balanced against medical risk using targeted investigations, literature review, consultation with the ECT Accreditation Service (ECTAS) Knowledge Hub, and early multidisciplinary input.

In Case 1, repeat Doppler imaging confirmed resolution of the proximal DVT and electrolyte abnormalities were corrected, allowing ECT to commence three days later. By the third and fourth treatments, the patient showed striking recovery: spontaneous speech, independent mobility, recognition of staff, and restoration of oral intake, facilitating discharge after completing the course.

For Case 2, collaboration with pain specialists and device manufacturers enabled safe deactivation, monitored ECT delivery, and post-treatment device integrity checks, followed by clear improvement in psychomotor function, affect, and nutritional status.

These cases demonstrate that ECT risk is rarely absolute; it is dynamic and often modifiable. In both cases, pausing prevented both premature exposure to harm and unnecessary therapeutic delay.

Pausing before ECT is not clinical indecision; it is clinical leadership. Individualized assessment, proactive multidisciplinary collaboration, and informed use of national guidance allow clinicians to navigate the interface between psychiatric urgency and physical vulnerability.

As ECT increasingly serves patients with complex comorbidity, reflective practice must replace routine automation. Thoughtful pauses protect patients, strengthen decision-making, and ultimately enable ECT to deliver its life-saving potential.

In complex ECT, the safest action may begin with a pause.

Effective communication and comprehensive history taking are core competencies in undergraduate medical education. Emerging digital technologies, including generative artificial intelligence (GenAI), offer novel opportunities to enhance experiential learning in this domain. This service evaluation explored the educational value of a GenAI-simulated virtual patient presenting with psychosis, integrated into psychiatry communication skillsteaching at Cardiff University School of Medicine. The primary aim was to assess student perceptions of the simulation as a learning tool.

A mixed-methods service evaluation design was employed. Quantitative and qualitative data were collected using pre- and post-intervention questionnaires assessing self-reported confidence in communication, history taking, and risk assessment, alongside usability and accessibility. Participants engaged with an AI-simulated virtual patient on the SimFlow.AI platform, receiving pre-task information and automated post-task feedback on performance. The simulation involved an acute psychotic presentation, requiring participants to conduct a psychiatric history and risk assessment. Participants were recruited from Years 2 through to 5 of the undergraduate medical programme at Cardiff University. The AI simulation was also embedded in a Year 2 unit of study to support students’ self-directed practice of communication skills.

Twenty participants completed all study components, including full engagement with the AI simulation and pre- and post-intervention questionnaires. Self-reported confidence in history taking and risk assessment increased significantly following exposure to the AI-simulated virtual patient (z=−3.750, p<0.001), with significant improvements observed across both junior and senior cohorts. All participants reported that the simulation facilitated clinically relevant skills practice, with 94% indicating that the platform helped them identify strengths and areas for improvement in their communication skills. Perceived authenticity was high, with 94% rating the AI responses as realistic and clinically plausible. All participants endorsed the platform as a useful adjunct to existing communication skills teaching. Where the AI simulation was embedded within a Year 2 unit of study, 74% of 93 respondents rated the AI virtual patient encounter as useful in practicing psychiatric history taking during self-directed learning time.

AI-simulated psychosis consultations appear to offer psychologically safe, accessible, and practical opportunities for communication skills rehearsal and reflective learning. Students supported the integration of AI simulations as a supplementary educational resource (particularly for OSCE/ISCE preparation) while emphasising that such tools should complement rather than replace patient actors.

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.