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.

Assessing risk is a fundamental skill in psychiatry, particularly for Core Trainees who are developing their skills during Out-of-Hours (OOH) shifts. However, the time pressure in these shifts often leads doctors to quickly document their admission notes without much thought for risk management. Failing to record Mental Health Act (MHA) status, leave permissions, or observation levels may create significant safety gaps and falls short of the standards set by the Mental Health (Care and Treatment) (Scotland) Act 2003. We retrospectively collected data that supported this notion and posted simple, structured posters to guide trainees in robust risk documentation. The goal was to encourage active thought processing that aligns with local risk protocols, ensuring that documentation isn't just a box-ticking exercise but a helpful guide for nursing staff. This helps empowers nurses to use their discretion in line with the admitting doctors opinion and adjust care safely as a patient's risk fluctuates on the ward.

We conducted a retrospective audit (Cycle 1, n=52) of OOH admission notes which showed only 15.4% of notes documented observation levels and 13.5% failed to mention leave status entirely. In response, we placed posters in key resident doctor work areas to act as a visual “nudge,” explicitly prompting doctors to define legal status and safety monitoring plans. A re-audit (Cycle 2, n=29) was completed one month later to see if these visual cues changed behaviour.

The second cycle showed a distinct improvement in how risk was recorded. Documentation of observation levels rose from 15.4% to 55.2%. Documentation regarding leave status also improved significantly, reaching 65.5% vs 1.9%. MHA status documentation remained roughly consistent (82.7% vs 75.9%). The rise in documenting recommended observation and leave status suggests that trainees are no longer relying on implied safety levels and are instead engaging in active risk assessment when there is a clear reminder to prompt them.

The marked increase in recording observation and leave decisions suggests that visual prompts are an effective way to remind trainees to pause and reflect on their risk assessment and how this applies to the patient’s admission journey. The posters helped convert risk assessment from an administrative afterthought into a conscious and adaptable management strategy. This simple intervention not only improves compliance but fosters a culture where active risk management is embedded into the admission process, ultimately ensuring safer handovers and better support for the nursing team.

This study aimed to computationally investigate interactions between DAT and a range of ligands across different conformational states using molecular docking and structural modelling, with the goal of identifying residues associated with ligand binding and potential conformational specificity.

Recent Cryo EM structures of DAT representing inward-facing and outward-facing conformations were obtained from the Protein Data Bank and prepared using MODELLER.Eight compounds (Amphetamine, Buproprion, Methamphetamine, Modafinil, Methylphenidate, Mephedrone, Vanoxerine and Nortriptyline) were categorised based on binding preferences. Molecular docking was performed using Cresset Flare, generating ten poses per compound, which were ranked using Lead Finder scores. The lowest-energy protein-ligand interactions were visualised with VMD and further analysed using Schrodinger Maestro and Nanome VR.

In the inward-facing conformation, conserved interacting residues across compounds included Val328, Tyr156, Phe326, and Val152. In the outward-facing conformation, conserved residues included Tyr156, Val152, Ala423, Asp79, Phe320, Phe76, Phe326, Ser149, and Ser422. Asp79 and Val328 were observed to participate in interactions that differed between conformational states.

These results identify recurring residues involved in ligand interactions with DAT and suggest conformation-dependent interaction patterns that may be relevant to transporter modulation. Future work will build on these docked complexes using molecular dynamics simulations with AI-guided analysis of protein dynamics to support drug discovery efforts aimed at the development of novel treatments for stimulant use disorder.

Driving is a complex activity that may be significantly impaired by mental illness, acute psychiatric symptoms, cognitive impairment, and the side effects of psychotropic medication. In the UK, the Driver and Vehicle Licensing Agency (DVLA) provides clear guidance regarding fitness to drive for individuals with mental health conditions. Patients are legally responsible for informing the DVLA of any condition that may affect their ability to drive; however, clinicians have a professional duty to ensure that patients are appropriately advised, and that this advice is clearly documented.

Despite this, DVLA advice is often inconsistently delivered and poorly documented in discharge summaries. This creates risks including:

• Patients unknowingly driving when unfit to do so.

• Potential harm to patients and the public.

• Medico-legal risk to clinicians and the organisation.

• Poor continuity of care for GPs and community teams.

The primary aim of this Quality Improvement Project is:

To improve the delivery and documentation of DVLA driving advice for patients discharged from a mental health inpatient unit, thereby reducing medico-legal risk and improving patient safety.

This project followed the Plan–Do–Study–Act (PDSA) framework.

PDSA Cycle

• Plan: A baseline audit was conducted to retrospectively review discharge summaries for patient discharge on 1–31 August 2025 and showed no patients had DVLA advice given or documented in their discharge summaries.

• Do: A single, targeted intervention was implemented: An additional question was added to the discharge summary template prompting clinicians to consider and document DVLA driving advice. Effecting this change needed high level hospital management approval. The quality improvement idea was presented in different management meetings including Digital delivery group, corporate delivery group and clinical oversight delivery group before this change was approved and implemented.

• Study: Following implementation, a post-intervention survey was conducted to assess the delivery and documentation of DVLA advice. It showed that all the patient discharges in January 2026 so far have DVLA advice given and documented. This is a significant improvement from the pre-intervention survey.

Act: We confirm effectiveness and consider sustain ability and wider rollout by implement the change in other clinical areas of the hospital as appropriate.

Overall, the intervention was associated with improved compliance with DVLA guidance and safer discharge practice.

While this project has revolutionised how discharge summary is being written in the Trust by introducing a single and concise way of documenting DVLA advice, a more robust intervention could have been more appropriate, for example creating a different form specifically for DVLA advice on electronic medical records. But this would, however, need management financial approval and more paperwork for clinicians.

• • To ensure the Southwest Crisis Function Team (in HPFT) manages non-cognitive symptoms of dementia as per NICE guidelines, and provides appropriate non-pharmacological and pharmacological management options.

• • If not possible, identify reasons and challenges, and suggest methods for improvement, which could be implemented and re-audited.

1. All referrals received by CFT in a 12-month period were obtained through the SPIKE database.

2. 48-hour referrals and wrong referrals were excluded.

3. Only service users with a diagnosis of dementia AND were presenting with agitation, aggression, distress or psychosis were included. This information was obtained through PARIS.

4. Service users’ case notes were reviewed to ascertain whether they or their carers:

○ Had a structural assessment and had been offered psychosocial and environmental interventions as initial and ongoing management to reduce distress for service users.

• Had been offered antipsychotics and:

• If they were at the time at risk of harming themselves or others, or were experiencing agitation, hallucinations or delusions that are causing them severe distress.

• If they had discussions about risks and benefits of antipsychotics.

• Had been started on the lowest effective dose possible and were recommended to be reassessed by the prescriber.

1. In 2023, a total of 247 new Service Users (SU) were referred to CFT. After excluding 48-hour follow up referrals and inappropriate referrals, A total of 55 referrals were for SUs who were diagnosed with dementia and were presenting with agitation, aggression, distress, or psychosis. 12 out of the 55 referrals were for 6 SUs who were referred twice at different times during the year.

2. 100% (55/55) of the included referrals received a structural assessment to 1- explore possible reasons for their distress, and 2- check for and address clinical or environmental causes. 100% (55/55) were also offered psychosocial and environmental interventions as initial and ongoing management to reduce distress for SUs.

3. In 12/55 referrals, SUs were already on antipsychotics. In 7/55 referrals, SUs could not be managed without a new prescription of antipsychotics.

4. In these 7 referrals (12.7% of total eligible SUs), SUs received new prescriptions of antipsychotics as a pharmacological intervention and in all 7 referrals, the SUs were at risk of harming self or othersorwere experiencing agitation, hallucinations or delusions that are causing them severe distress.

5. 100% of the 7 referrals showed that SUs were started on the lowest effective dose of the prescribed antipsychotic.

6. However, out of the 7 referrals that received new prescriptions of antipsychotics, none of them (0%) had documentation on PARIS about discussions of risk and benefits of antipsychotics.

7. Finally, when looking at all the referrals where antipsychotics were used (19 referrals in total), there was clear documentation on PARIS about reassessment or a recommendation for reassessment of antipsychotic after 6 weeks in 4/19 referrals (21%).

• • 100% of referred SUs received a comprehensive, structural assessment.

• • The team offered psychosocial and environmental interventions to all SUs who were eligible.

• • The team offered antipsychotics only when necessary, in a small percentage of cases(12.7%), and followed NICE guidelines for initial doses and service user eligibility.

• • However, no documentation in any of the service user’s case notes mentioned discussions about risk and benefits of antipsychotics and only 21% had recommendations for reassessment of the antipsychotics within 6 weeks.

This quality improvement project sought to design and implement a new handover system for mental health hospitals in North Glasgow. The new system aimed to improve ease of access and editing, alongside reducing the frequency of missed tasks for resident doctors.

Resident doctors across Gartnavel Royal Hospital and Stobhill Hospital were surveyed (cycle 1) between 06/06/25 and 13/06/2025 regarding their opinions on their respective existing Microsoft Excel handover systems, as well as the frequency of missedtasks and their willingness to try a new system. A new system was designed for each hospital using the Planner task management software on Microsoft Teams, adapted from a similar successful pilot in South Glasgow. Training sessions were delivered over June and July 2025, and the new systems were implemented on 18/07/2025. Resident doctors were surveyed again (cycle 2) between 04/08/2025 and 12/08/2025 regarding their opinions on the new system, any missed tasks and whether they wished to keep the new system or revert to the previous one. Adjustments to systems were made as per respondents’ wishes. Guidance posters were displayed in each hospital between October 2025 and January 2026 to aid using the systems, and the doctors were surveyed once again (cycle 3) between 28/01/2026 and 04/02/2026 using the same questions.

Please note “easy” will be used where respondents rated the system easy or very easy. There were a total of 10 respondents in cycle 1: 70% found the now-previous system easy to access, only 50% found it easy to edit and 40% found they had missed tasks. Only 10% were opposed to trialling a new system. In cycle 2, there were a total of 22 respondents: 73% found the new system easy to access, 81% found it easy to edit and only 18% had missed tasks. 73% wished to keep the new system. In cycle 3, preliminary results show 10 respondents thus far: 100% found the new system easy to access and edit, only 10% had missed tasks and 100% wished to keep the new system. The system is now part of Standard Operating Procedure in North Glasgow.

A new digital handover system replaced previous systems for each North Glasgow mental health hospital. The new system improved ease of access and editing as well as reducing the frequency of missed tasks for resident doctors. Displaying guidance posters further improved each of these categories and all doctors wished to keep the new system.