To assess compliance with Trust Smoke-Free standards on older adult psychiatric wards, specifically: documentation of smoking status on admission; timely initiation of nicotine replacement therapy (NRT); regular multidisciplinary team (MDT) review of tobacco dependence treatment; and referral to the Trust Tobacco Dependency Team. The audit also aimed to identify potential age - or diagnosis-related inequities in assessment and treatment.

A cross-sectional baseline clinical audit was conducted across four older adult psychiatric inpatient wards. All inpatients present on 21/11/2025 were included (n=53). Data were extracted from electronic patient records (RiO), the electronic prescribing system (EPMA), and MDT documentation. Compliance was measured against four Trust Smoke-Free standards. Smoking status documentation was assessed across all admissions, while treatment, review, and referral standards were assessed in patients with documented tobacco dependence (n=6).

Smoking status was documented during admission clerking in 31% of patients (16/53). Among identified smokers, compliance with prescribing tobacco dependence treatment within 30 minutes of admission was 0%. Although 83% of smokers were eventually prescribed NRT, all prescriptions occurred more than five hours after admission, and 17% of smokers were never prescribed NRT. There was 0% compliance with regular MDT review of tobacco dependence treatment. Referral to the Tobacco Dependency Team within 24 hours occurred in only 17% of smokers.

This audit demonstrates poor baseline compliance with Smoke-Free standards on older adult psychiatric wards, particularly in the identification and timely management of tobacco dependence. The findings highlight risks of diagnostic overshadowing and avoidable behavioural disturbance in older adult psychiatry. Targeted quality improvement interventions focusing on admission clerking, MDT review, and referral pathways are required to promote equitable, person-centred care and an equal standard of care. A re-audit is planned following implementation of these interventions.

Tardive Dyskinesia (TD) is a movement disorder that typically occurs in individuals with longstanding use of dopamine receptor blocking agents; this typically includes second generation anti-psychotics, but can also include anti-emetic/anti-vertigo drugs and even other drugs. The onset of TD is often insidious with the first symptoms presenting over days to weeks and usually even months, prior to development into a full syndrome. It can only occur 3 months after the exposure to such agents for those under the age of 60 and 1 month of exposure for those aged above 60.

We present the case of a 66-year-old gentleman with a severe intellectual disability and a history of challenging behaviour. He has been previously under the care of his community learning disability service for a previous history of challenging behaviour but was re-referred on this occasion with the concerns about strange behaviour.

Staff noted and reported a intermittent abnormalities in movement and this gentleman’s case was referred to Psychiatry for follow up. These abnormalities also included difficulties in swallowing food. As part of the psychiatric evaluation the physical health of the gentleman was reviewed and the nature of the intermittent abnormalities in movement prompted a referral to the local Neurology department in order to evaluate whether there may be a form of epilepsy that this gentleman was suffering from. This gentleman was diagnosed with Tardive Dyskinesia after extensive ruling out of potential physical and mental health concerns. His treatment of Tetrabenazine was initiated and has since been tapered up to a total daily dose of 125mg per day. His symptoms have improved and with the aid of his local speech and language therapy team and dietetics team, he is able to safely eat food.

This case highlights the complexities of Tardive Dyskinesia and how these symptoms can be easily overlooked in someone with an intellectual disability. It also underscores the importance of proactive monitoring as well as regular medication review. This case further highlights the importance of a multidisciplinary approach towards the care of individuals with intellectual disabilities.

This case further highlights the need for structures screening for Tardive Dyskinesia in the ID population; particularly those receiving long-term antipsychotics. This case further lends weight to the regular use of movement assessments and reinforces the need for continued deprescribing where clinically appropriate.

Inattention and hyperactivity/impulsivity are frequently associated with intellectual disability (ID), contributing to significant behavioural dysregulation and functional impairment. Protein kinase C (PKC) has emerged as a key molecular target in the neurobiology of impulsivity, with PKC overactivity disrupting dopaminergic regulation and prefrontal cortical functioning, leading to impaired inhibition and executive dysfunction. Endoxifen, an active metabolite of Tamoxifen, is a selective PKC inhibitor that has demonstrated antimanic, anti-impulsive, and emotion-stabilising effects in adults. Emerging clinical evidence suggests benefit in behavioural dysregulation across several psychiatric conditions; however, paediatric use remains limited and largely off-label. This case report aims to evaluate the efficacy and tolerability of endoxifen for behavioural symptoms in an adolescent with ID who showed inadequate response to standard treatments.

A 14-year-old male with global developmental delay and significant speech–language impairment presented with repetitive verbal behaviours, hyperactivity, poor sitting tolerance, and frequent anger outbursts for two years. He was provisionally diagnosed with ID with behavioural impairment. Baseline BMI was 21 kg/m², and comorbid hypothyroidism was managed with replacement therapy.

Previous trials of risperidone (4 mg/day) with divalproex sodium (1500 mg/day) resulted in minimal improvement and adverse effects, including nausea, increased appetite, and weight gain. Subsequent treatment with oxcarbazepine (titrated to 1350 mg/day) and aripiprazole (10 mg/day) was complicated by hyponatremia, necessitating discontinuation of oxcarbazepine.

Following informed consent and assent, endoxifen was initiated at 8 mg/day and gradually titrated to 24 mg/day, while aripiprazole was continued at 5 mg/day. Clinical response and tolerability were monitored over 12 months.

Over one year of treatment, the patient demonstrated sustained reductions in impulsivity, hyperactivity, repetitive behaviours, and anger outbursts, with notable improvements in behavioural regulation and overall family functioning. The medication was well tolerated, with no significant metabolic, neurological, or systemic adverse effects, and adherence remained satisfactory throughout follow-up.

Endoxifen showed favourable efficacy and tolerability in managing behavioural dysregulation in an adolescent with ID who was refractory or intolerant to conventional psychotropics. Targeting PKC-mediated pathways may represent a promising therapeutic strategy for impulsivity and aggression in neurodevelopmental disorders. Larger controlled studies are needed to establish safety and long-term efficacy.

REM sleep behaviour disorder (RBD) is characterised by loss of physiological REM atonia, resulting in dream-enactment behaviours that may be violent and pose significant risk to patients and bed partners. RBD may be idiopathic, secondary to neurological disease, or medication-induced. Medications, including antidepressants and sedative-hypnotics, have been implicated in precipitating or unmasking RBD, particularly in individuals with underlying neuropsychiatric vulnerability and structural brain injury.

A 60-year-old man who was diagnosed with PTSD following a severe physical assault 30 years ago. He also sustained a scalp laceration, severe bruising to his body, hearing impairment, memory problems, and anxiety problems. Documentation of prior neurological and neuroimaging follow-up was unavailable.

He presented with a six-year history of progressively worsening sleep-related behaviours. These included snoring, talking, shouting, odd sounds, nightmares, increased restlessness, abnormal nocturnal movements, falls from bed when startled, and a recent episode of violent behaviour during sleep resulting in injury to his partner. He had a longstanding psychotropic polypharmacy, including paroxetine, carbamazepine, risperidone, and zopiclone. Collateral history highlighted worsening impairment of his memory and concentration levels, and recent changes in his personality.

Physical examination revealed an abnormal gait, positive Romberg’s test and tremors of his upper limb, with involuntary tic-like movements and repetitive blinking. Cognitive assessment revealed significant deficits in memory, recall, attention and language. Due to a childhood history of petite mal epilepsy, an electroencephalogram was done and it showed no epileptiform discharges. Neuroimaging identified chronic gliotic change and encephalomalacia in the left frontal lobe, consistent with previous injury. Previous oximetry and multi-channel sleep studies excluded sleep apnoea.

Zopiclone and paroxetine were gradually discontinued, and sertraline and melatonin were initiated. Risk management involved separate sleeping arrangements. Subsequently, violent sleep-related behaviours resolved. The patient was referred to Memory Services for further neurocognitive assessment.

The combination of violent dream-enactment behaviours, associated injury to a bed partner, absence of epileptiform activity, structural frontal lobe injury and improvement following gradual withdrawal of long-term paroxetine and zopiclone supported a diagnosis of likely medication-induced RBD in the context of TBI.

This case illustrates the risks of diagnostic overshadowing in patients with established psychiatric diagnoses and highlights the importance of considering organic and iatrogenic causes when new behavioural disturbance emerges, such as violent sleep-related behaviours. This case highlights the importance of awareness of the long-term neuropsychiatric sequelae of TBI and regular medication review and rationalisation to minimise iatrogenic harm

Physical health monitoring is crucial in early psychosis patients because of enhanced risk for physical health issues due to disease and prescribed anti-psychotic treatments. Early monitoring and intervention help identify and manage these risks, improving long term outcomes and quality of life. Physical health is often neglected in mental health care, auditing ensures comprehensive, Integrated care. Addressing physical health can enhance treatment adherence, reduce hospitalizations and improve recovery rates overall.

We are proposing introduction of Lester UK tool and monitoring and intervening for physical health issues based on Lester UK recommendations only in high-risk patients identified from the case load of mid and north EIP.

High risk patients will be put into Red category

Inclusion criteria:

1. Previous cardiometabolic issues (high BP, cardiac morbidity)

2. High Lipid, HbA1c profile

3. High BMI

4. Smoking

5. Health behaviour and lifestyle changes eg. Alcohol intake Interventions and advice on daily exercise will be offered and will be according to the recommendations set by NCAP(National Clinical audit of Psychosis) adaptation of Lester UK and NAS (National Audit of Schizophrenia)

The standards will be compared with the physical health monitoring standards set by National Audit of Schizophrenia 2021 and National Clinical Audit for Psychosis 2022. 1st cycle will be Retrospective to compare local with national standards. Subsequent cycles will be concurrent. Estimated sample size is approx. 30 high risk cases.This will be reaudited every 6 months to match the standards. A target of 80 % is set to be achieved after the interventions offered.

Retrospective data was collected for first cycle of audit using Blood test results on ICE, Physical health check form on RiO notes and GP data from CHIE/GP Connect. 118 patients were audited and out of these patients 54 have been identified in high-risk zones based on 6 different categories.

Standards were compared with Physical health monitoring and intervention in National Audit of Schizophrenia and National Clinical audit of psychosis.

Monitoring and identifying risk of smoking, alcohol, illicit substance, high BMI, High blood pressure, high lipids and high blood glucose is more than required standards of 75 %.

Acceptance rate of smoking cessation (18%) is significantly below the matching standards of 75 %. This requires proactive measures to educate patients of smoking related health risks and encouraged to quit smoking.

33 % patients accepted NICE recommended interventions for alcohol use, below 75% standards. This requires improved motivational strategies and personalised intervention plans.

Only 6 % patients accepted advise to abstain from illicit substances. This requires motivation and encouragement for patients to refer to Inclusion services and accept advise provided.

100 % patients with high HBs-668C were referred to primary services but only 8 % patients accepted high HAB1C related NICE recommendations. Consistent monitoring and oroactivemanagement of metabolic health is required.

100 % patients from those identified with high Cholesterol/HDL ratio accepted referral to primary services but only 10 % accepted lifestyle modification advice. Ongoing patient education and encouraging for healthy lifestyle is required.

100 % of those identified with high BMI accepted NICE recommendations for healthy life style and referral to primary services. The success of interventions will depend on patient’s adherence and strategies to enhance motivation, and accessibility should be put in place.

100% patients accepted NICE recommended interventions for hypertension and referral to primary services.

INSIGHT Audit reveals gaps in meeting the standards set by NAS and NCAP for interventions although meeting standards for monitoring. While interventions are aligned with national standards, patient engagement and adherence remain major challenges that require action like patient’s education regarding physical health benefits and team’s knowledge and implementation of Lester tool recommended interventions. We have recommended the action plan for interventions before next cycle of audit.

In Northern Ireland, the prevalence of mental health disorders is estimated to be significantly higher than in England, set against a backdrop of socioeconomic deprivation. Consequently, a resilient workforce is a clinical imperative. However, postgraduate training often leaves a critical gap between theoretical knowledge of The Mental Health Order (NI) 1986 and the emotional endurance required to apply its principles in acute settings. This paper describes the development of a high-fidelity simulation designed to bridge this gap. The primary aim was to transform a morally injurious personal experience into a safe educational tool, teaching trainees to navigate the conflict between the Hippocratic instinct to treat and the strict statutory limits regarding patient autonomy.

A high-fidelity simulation was developed within the Western Health & Social Care Trust as part of a Psychiatric Emergencies Simulation Day. Grounded in Kolb’s experiential learning cycle and the author’s dual background as a Solicitor and Psychiatrist, the scenario involves a voluntary patient with Emotionally Unstable Personality Disorder (EUPD) and Type 1 Diabetes refusing insulin. The patient is fully capacitous, aware of the risk of Diabetic Ketoacidosis (DKA), yet refuses treatment due to emotional dysregulation. The simulation utilizes Bion’s theory of containment; the facilitator absorbs trainee anxiety (counter-transference) to prevent the loss of a mentalizing stance, modelling how to regulate the urge to utilize coercive measures prematurely.

The simulation exposes the visceral conflict between the right to life (ECHR Article 2) and the right to private life/autonomy (ECHR Article 8). Trainees are forced to confront the specific constraints of the MHO (NI) 1986, which precludes detention solely based on Personality Disorder. The scenario demonstrates that the threshold for overriding a competent refusal is the high bar of the Common Law doctrine of Necessity. The primary learning outcome is the realization that the hardest clinical decision is often not to treat.

This educational intervention successfully establishes that respecting legally protected autonomy, even when it risks catastrophe, exacts a heavy toll of moral distress. By integrating legal jurisprudence with psychotherapeutic principles of containment, the simulation acts as a sublimation of moral injury. It demonstrates that curriculum development must address the “faceless” demands of the law alongside the human needs of the doctor. Providing a controlled environment to bear the “unbearable weight of autonomy” is an ethical imperative for mitigating burnout and ensuring true patient-centred care.

According to NICE guideline, psychotropic medication has limited role to improve clinical outcome in EUPD patients. However, the practice of utilising psychotropic medication is increasing. The aim of this audit is to assess whether prescribing psychotropic medication in the absence of any other psychiatric co morbidities improves the clinical outcome.

The audit was completed at the Scarisbrick In-patient unit at Lancashire and South Cumbria NHS Foundation Trust. The number of hospital admission within next 1 year of starting psychotropic medication was used as the indicator for clinical outcome. Data was collected retrospectively from the electronic system from the patients’ cohort who were admitted from 01/2023-12/2023, with diagnosis of EUPD in the absence of other psychiatric comorbidities, (N=29) to assess if prescribing psychotropic medication can reduce number of hospital admission within next 1 year (between 01/24- 12/2024).

The result shows high rate of psychotropic medication used in patients with EUPD diagnosis in the absence of any other psychiatric comorbidities. 62% patients were already on antidepressants and 55% on antipsychotics prior to admission. After medication review post admission, 55% started on psychotropics, including 41% on antipsychotics, 35% on antidepressants, and 14% on mood stabilisers.

Despite being on psychotropic medications, the readmission rate within next 1 year remains high. 58.62 % (N=17) patients had re-admissions within one year of starting psychotropics. Of those, 71% (N=12)had more than one admission. 65% (N=11) of readmissions were under the Mental Health Act. For 76% (N=13) patients, admission lasted more than 2 weeks and 24% had crisis admission.

The audit focuses solely on pharmacological data. There is no mention of psychological input, crisis plans, care coordination, which is central to NICE/RCPsych recommendations.

High proportion of patients with EUPD are prescribed psychotropic medications before and during admission, despite the limited evidence supporting their effectiveness in this population. This is not consistent with NICE, which cautions againstroutine psychotropic use in EUPD in the absence of comorbidities or clear indications. Over half of patients were re-admitted to hospital within next one year of starting psychotropic medication and most had multiple re-admissions. The high re-admission rate, particularly under the MHA and with prolonged stays, raises concern about the effectiveness of psychotropic medication in reducing relapse or improving long-term outcomes in EUPD. The data appears to support NICE guidance that psychotropic medications should not be used routinely in the absence of comorbid mental illness, as their benefit in preventing relapse is questionable.

Trainees’ wellbeing is constantly becoming an area of increased interest in the recent years. The impact of the pandemic, increased workload while balancing exams, training requirements, and family and caring responsibilities can pose significant demands on trainees. Psychiatry trainees are not immune to those challenges, but furthermore, they are susceptible to challenges unique to psychiatry – such as patient suicide, working in a field that still suffers from stigma from both patients and healthcare professionals. Despite the presence of resources, wellbeing remains an area for improvement.

In our study, we sought to explore areas that impact the wellbeing of psychiatry trainees in the northwest of England; the challenges encountered and the factors that contributed both negatively and positively to health and wellbeing.

We conducted online focus groups with psychiatry trainees in different stages in their training (CT1-ST8), to explore factors affecting health and wellbeing. Each session was co-facilitated by the research team, and structured into three sections: challenges faced, unhelpful experiences, and helpful experiences. Sessions were transcribed via Microsoft Teams, with participants informed of confidentiality and anonymity, and demographic data collected via an anonymous online questionnaire. Transcripts were thematically analysed by the research team to identify key themes.

Trainees reported multiple factors negatively affecting their wellbeing, including the rotational nature of the job, significant workload, lack of rest facilities, lack of appropriate supervision, and lack of individualised support for trainees with personal vulnerabilities. Challenges were compounded by difficulties navigating administrative systems and accessing occupational health or professional support. Helpful factors included supportive and flexible supervisors, strong team relationships, good workplace integration, as well as respecting and nurturing trainees’ autonomy and sharing constructive feedback.

The quality of the trainee–supervisor relationship emerged as the most important factor influencing wellbeing, with emotionally intelligent supervisors who notice struggles and encourage reflective practice being particularly beneficial. While multiple support resources exist, they are often not tailored to individual needs or widely known; targeted training for supervisors, including guidance on supporting neurodiverse trainees, may improve accessibility and effectiveness of wellbeing support.

In Bangladesh, mental healthcare is delivered through parallel government and private psychiatric services. Both sectors play a critical role in service provision but there is limited empirical evidence comparing how these systems operate in practice from the perspective of clinicians working across both settings.

This study aimed to explore and compare clinician experiences of working in government and private psychiatric services in Bangladesh. We hypothesised that government services would be characterised by higher patient volume and resource constraints, while private services would offer more structured multidisciplinary care, greater patient autonomy, and improved continuity, albeit with increased administrative demands and financial barriers.

A qualitative thematic analysis was conducted using structured written responses from 24 multidisciplinary mental health professionals who had worked in both government and private psychiatric settings. Participants included psychiatrists, resident medical officers, psychologists, nurses, and counsellors. Responses explored workload, resource availability, multidisciplinary team (MDT) working, patient autonomy, family involvement, medication practices, psychotherapy access, stigma, risk management, admission duration, and discharge processes. Data were analysed inductively to identify recurring and contrasting themes across the two service models.

Six interrelated themes emerged.

First, patient volume and workload were markedly higher in government services, with clinicians reporting time-pressured assessments and limited follow-up, whereas private services had lower patient volumes but greater documentation and accountability requirements.

Second, resource availability differed substantially, with chronic shortages of staff, investigations, and therapeutic spaces in government settings compared to better infrastructure in private care.

Third, multidisciplinary team (MDT) working was informal or fragmented in government services but more structured and routine in private hospitals.

Fourth, patient autonomy and family involvement were constrained in government settings due to workload and system pressures, while private services allowed greater shared decision-making, though sometimes influenced by family finances.

Fifth, medication and psychotherapy practices showed guideline-based intentions in both sectors; however, polypharmacy and irregular follow-up were more common in government care, while psychotherapy access and monitoring were more consistent privately.

Finally, risk management, admission duration, and discharge planning were reactive and bed-pressure driven in government services, compared with more planned and individualised pathways in private settings.

The findings support the hypothesis that government and private psychiatric services in Bangladesh offer contrasting but complementary strengths. Government services provide accessibility and broad clinical exposure, while private services offer structure, continuity, and multidisciplinary care. Hybrid service models integrating these strengths may improve quality, equity, and sustainability of mental healthcare in similar low- and middle-income countries.

To improve inpatient understanding of liaison psychiatry, specifically the services provided by the Older Adult Mental Health Liaison Team (OA MHLT), by at least 10%, and to improve satisfaction with understanding of key OA MHLT topics among patients. Wehypothesised that a written information booklet would increase patient understanding compared with verbal explanations alone.

Liaison psychiatry is often introduced during acute physical illness, cognitive vulnerability, or heightened distress, which can limit patients’ ability to process and retain verbal information. A written resource is expected to support patient and carer understanding of the rationale for psychiatric involvement, assessment processes and interventions offered.

OA MHLT staff (n=10) completed a questionnaire to identify high-priority topics for inclusion in a patient information booklet. Inpatients (n=10) were asked how well informed they felt about OA MHLT related topics (including assessment and interventions, psychological support, legal frameworks such as the Mental Health Act and Deprivation of Liberty Safeguards (DoLS), discharge pathways and crisis support) and their satisfaction with their understanding overall (0–5 Likert scale). A patient information booklet was created based on questionnaire findings and distributed to inpatients, after which the patient and staff questionnaire was repeated.

Before booklet distribution, mean staff-rated satisfaction with patient understanding of OA MHLT topics was 1.86/5 and mean patient-rated satisfaction with their understanding was 2.00/5. After booklet distribution, mean staff-rated satisfaction increased to just under 4.6/5 and mean patient-rated satisfaction increased to 4.4/5, exceeding the project aim of ≥10% improvement.

A co-designed OA MHLT patient information booklet was associated with substantially improved staff-rated and patient-rated satisfaction with patient understanding of key liaison psychiatry topics in a small inpatient sample. Further work should evaluatesustainability over time and test the booklet with larger numbers of inpatients. The booklet is due to receive further feedback and final modifications via the service user and carer advisory group.

To assess whether information recorded on T2B and T3B treatment forms accurately corresponds to medications prescribed to patients by Community Mental Health Teams (CMHT) or General Practitioners (GPs). The hypothesis was that discrepancies may exist due to the absence of inpatient safeguards in community settings.

Under the Mental Health (Care and Treatment) (Scotland) Act 2003, patients on compulsory treatment for more than two months require T2B or T3B forms. T2B for consented treatment and T3B for treatment approved by a Designated Medical Practitioner (DMP). These forms protect patient rights and must be completed accurately. Guidance is provided by the Mental Welfare Commission through publications such as Consent to Treatment (2017) and Medical Treatment under Part 16 (2021), with an updated consent guide published in October 2025 (postdating this audit).

T2B forms should specify exact medications while T3B may list broader drug classes. Inpatient settings have safeguards like electronic records alerts, dispensing checks, and MDT oversight. These are absent in community care, where CMHTs request medication changes via GPs and do not dispense most medications directly. If patients are reviewed by clinicians other than their Responsible Medical Officer (RMO), there is a risk of unauthorized treatment.

The audit reviewed all patients on T2B and T3B forms under NHSGGC Adult CMHTs (Renfrewshire, Inverclyde, South Glasgow, North East Glasgow, and North West Glasgow HSCPs) with Caldicott approval. A checklist assessed whether forms were in date, uploaded to EMIS (electronic records), included consent (for T2B), referenced in clinicletters, and matched ECS (GP Emergency Care Summary) records.

Medical records provided listing of patients on Compulsory Treatment Orders (CTO) and treatment forms. Separate audits for each site were conducted by core trainees and reviewed by Dr Mai Elsawaf who combined a report. Data access occurred between June and October 2025, though timing varied between teams, a noted limitation.

A total of 558 patients were included (491 General Adult, 36 Forensic, 8 Learning Disability, 23 Older Adults). Most forms were for CCTO (Community Compulsory Treatment Order) patients, aligning with the audit’s scope. T3B forms were more common than T2B, reflecting treatment as a key reason for CCTO. Compliance was high, with 99.8% of forms and consent uploaded to EMIS.

However, only 85% of clinic letters mentioned treatment orders, and just 14% referenced treatment forms, limiting information sharing with GPs and emergency teams. Medication alignment was strong (90%), with discrepancies due to additional psychotropics. ECS correspondence was lower (80%), with missing or incorrect entries posing risks, especially for clozapine, which was absent in two cases. Other mismatches were due to dose adjustments not reflected in forms. Best practice includes reissuing updated forms or using dose ranges and alternative plans on T3B forms.

The audit showed 90% correspondence between treatment forms and prescribed medications, with main discrepancies from additional medications and poor documentation in clinic letters. Actions taken included contacting relevant teams with discrepancies and changing the format of the clinic letters to include information on treatment forms. Recommendations include re-circulating guidance, adding EMIS alerts, considering inclusion of treatment form details in clinic letters, and re-auditing in 12 months.

Antipsychotic medications are commonly prescribed for psychotic illness, bipolar affective disorder and treatment-resistant depression. They are associated with significant physical health risks, including metabolic syndrome, cardiovascular complications, and extrapyramidal side effects. The National Institute for Health and Care Excellence (NICE) recommends comprehensive physical health monitoring at baseline, three months, and twelve months following initiation of antipsychotic treatment. Recommended physical health parameters include blood tests, body mass index (BMI) or body weight, blood pressure, heart rate, electrocardiogram (ECG) for certain antipsychotics, and side-effect profiles.

Antipsychotic medications can be safely prescribed to patients in the perinatal period, however, it is necessary to monitor their physical health. This project aimed to evaluate adherence to the aforementioned NICE guidelines, for all patients prescribed antipsychotic medications within a perinatal mental health community service (PMHCS).

A retrospective review of all patients under the PMHCS caseload as of 1 August 2025 was conducted (n=388). Electronic case notes were reviewed to identify patients prescribed antipsychotic medication. Data collected included diagnosis, medication prescribed, duration of treatment and completion of recommended physical health monitoring in comparison to NICE guidance.

Of the 92 patients (24%) prescribed antipsychotic medication, 53 (58%) had medication initiated by PMHCS. The most common diagnosis was Bipolar Affective Disorder (34%) and quetiapine was the most commonly prescribed antipsychotic medication (51%).

Just over half of the cohort had baseline monitoring recorded (n=47, 51%) but certain parameters were commonly omitted; only 20% had Hbs-392c recorded and 34% had a blood pressure recorded. A total of 75 patients had been taking an antipsychotic medication for over three months, of which 31 (41%) had physical health monitoring to reflect this. There were 57 patients who had taken an antipsychotic medication for at least one year and amongst them, 31 (54%) had physical health monitoring.

Our results demonstrated that despite NICE guidance outlining the required monitoring, it was uncommon for patients within this cohort to have the necessary investigations recorded at the required intervals. To address this, the team devised a structured antipsychotic monitoring strategy that included patient education, dissemination of patient information leaflets on physical health monitoring, distribution of monitoring equipment amongst staff, staff training, and recruitment of dedicated physical health nurses. Designated physical health clinic days and systematic data recording were planned to improve monitoring. A re-audit is planned to evaluate the impact of these interventions on compliance with physical health monitoring standards.

This Quality Improvement Project (QIP) aims to evaluate the awareness of wellbeing resources among Core and Higher Psychiatry Resident doctors at Kent and Medway Mental Health NHS Trust. Additionally, it explores barriers to accessing these resources and identifies preferred methods for the delivery of future wellbeing initiatives.

A collaborative initiative was established between the Medical Education department, the Trust’s Health and Wellbeing team, and resident doctor representatives.

A survey, adapted from a previous QIP, was developed to collect demographic data and training details. It utilized 5-point Likert scales, multiple choice and open-ended questions. The survey was hosted on LimeSurvey and distributed via email to all Core and Higher trainees over a two-month period (October–November 2025).

Twenty-three residents completed the survey. The cohort was predominantly aged 26–35 (87%), female (70%), International Medical Graduates (IMG) (83%), and at Core training level (57%).

Regarding baseline awareness, residents were most familiar with mental wellbeing resources (57%), followed by financial wellbeing and work-life balance (both 35%). Awareness of specific providers included community organizations/charities (43%), local staff wellbeing support (35%), and British Medical Association wellbeing services (35%). While 83% had engaged in a wellbeing conversation with a senior clinician, 91% had not utilized the existing wellbeing resource pack, and 83% had not accessed any formal support services. Participants identified mental wellbeing and work-life balance (both 57%) as the primary areas for future support. Preferred delivery methods included in-person events (78%), email (65%), and induction presentations (43%).

Upon comparing awareness of wellbeing resources, perceived provision of information, and perceived sufficiency of wellbeing offers among groups, we found that Specialty Trainees consistently reported higher mean scores than Core Trainees across all outcome measures; non-IMG doctors reported higher mean scores than IMG doctors across all outcomes; White respondents reported the highest mean scores across all outcomes, while Asian and mixed ethnicity respondents reported lower average awareness and satisfaction.

Qualitative analysis identified “email fatigue”, clinical workload, information access and perceived lack of relevance as significant barriers to engagement.

This project highlights a significant gap between resource availability and trainee utilization. While awareness of mental health support exists, practical barriers such as workload and information overload hinder engagement. The next phase of this QIP will focus on implementing targeted, in-person interventions and streamlining communication to better meet the specific needs of resident doctors.

To assess the appropriate use of FP-10 prescriptions against the NICE-BNF and Trust Guidelines.

This was a retrospective audit, and reaudit to include all FP-10 prescriptions written for the patients coming under the Community mental health teams in Halton (that is Assessment and HTT, Recovery Team, EIP, LLAMS and CAMHS).The sample was identified from Appendix 3 data sheets,RiOnotes, Clinical documents.The data were extracted from Data from existing databases, electronic systems and case notes.The total size of the population was 23 for the initial audit and 97 for the re-audit.The sample time period for the initial audit was 01/01/2022 till 25/07/2022 and reaudit was from 07/07/2024 to 07/08/2024. The sample selection was all consecutive FP 10 prescriptions used during the time period.

Initial audit had 97% overall compliance level but the criteria on completing appendix 3 for the completed FP-10s and scanning or documenting the FP-10s to patient records were met with a moderate compliance level of 83% and 87% respectively.

Action plan following the audit was to include a column in Appendix 3 to identify NHS numbers of the patients given FP-10s and to insert an information sheet to FP-10 bundle with guidance on recording details.

In both audits 100% compliance was met for storing the FP-10s and managing them securely and Prescription writing guidelines were followed according to NICE- BNF standards. This was not a prescribing audit and the doses and appropriateness of medication were not audited

Following the action plan in the re-audit the compliance level was met at 99% with the above-mentioned criteria improving compliance to 100% and 97% respectively.

In both audits the FP-10s were given to prescribe psychotropics only and were written according to NICE-BNF guidance.

In both audits the FP-10s were stored and managed according to the local trust guidance.

The recording of FP-10 details improved following the simple intervention of including a prompt sheet with the prescriptions.

A secondary outcome was that the procedure for management of FP10s in the community has been reviewed and rewritten.

Liaison psychiatry plays a key role in managing mental health presentations within acute hospital settings. However, variation in referral patterns and service utilisation may impact effectiveness and resource planning. This service evaluation aimed to examine the frequency, reasons, demographics, referral sources, and outcomes of referrals to liaison psychiatry services across multiple acute hospitals within a large NHS mental health trust, and to identify potential gaps in current service provision.

A retrospective observational service evaluation was conducted using routinely collected electronic health record data for all referrals to liaison psychiatry services across seven acute hospital sites over a twelve-month period. Data extracted included patient demographics (age, gender, ethnicity), referring departments, reasons for referral, and outcomes following assessment by liaison psychiatry teams. Descriptive analyses were performed to explore referral volumes, site-level variation, demographic patterns, and intervention outcomes.

A total of 32,209 referrals were analysed across the seven hospital sites. Emergency Departments accounted for the majority of referrals at all sites (approximately 67–85%). The most common reasons for referral were suicidal thoughts (42%), followed by low mood (23.4%) and self-harm/overdose (18.5%). Significant variation was observed in referral rates per population across sites, with some hospitals demonstrating substantially higher activity than others. Referrals predominantly involved working-age adults, while those under 20 years and older adults were proportionally lower at several sites. Ethnicity data revealed a predominantly White British referral population, though substantial missing data limited interpretation at some locations. The most frequent outcome was discharge with GP follow-up (38%), while smaller proportions were referred to community mental health teams, home treatment teams, or admitted to psychiatric wards.

This multi-site service evaluation demonstrates that liaison psychiatry services across acute hospitals are predominantly accessed via Emergency Departments, with suicidal ideation and mood-related concerns representing the most common referral reasons. Marked variation in referral volumes, demographic representation, and outcomes across sites suggests differences in service utilisation, integration, and potentially unmet need. Data quality issues, particularly around ethnicity and outcome coding, were identified. These findings highlight opportunities for improving referral pathways, strengthening liaison integration beyond Emergency Departments, and enhancing data recording to support future service planning, workforce allocation, and targeted quality improvement initiatives.

Despite growing recognition of disparities in the diagnosis and treatment of adult attention deficit hyperactive disorder (ADHD), few studies have examined how gender intersects with rural healthcare contexts to shape diagnostic pathways. This gap is particularly concerning given that rural healthcare settings face structural constraints such as limited access to specialized mental health services that may further exacerbate diagnostic inequities, especially for gender-diverse populations. The aims of this study were to explore ADHD subtype distribution among adults attending a rural outpatient clinic, examine demographic and psychosocial correlates of subtype, and assess gender-based variation in these associations using the Gender-Based Analysis Plus (GBA+) framework.

This is a retrospective cross-sectional study of adults diagnosed with ADHD in an outpatient mental health clinic in rural Northern British Columbia, Canada. ADHD subtypes were classified using two standardized diagnostic assessments: the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM–5), and the Diagnostic Interview for ADHD in Adults, version 5 (DIVA–5). Sociodemographic characteristics, psychosocial factors, comorbidities, and medication use were extracted from clinical records. Associations between ADHD subtype and key variables were examined using both descriptive and inferential statistics. Gender-stratified analyses were performed to explore the relationships between ADHD subtype and psychosocial factors, with a focus on treatment patterns and functional indicators relevant to rural health service delivery.

The sample consisted of 660 adults age range between 20 and 75 years (mean age=38 years). The combined presentation was the most prevalent ADHD subtype (67%),followed by the predominantly inattentive presentation (30%); the hyperactive/impulsive presentation was uncommon (3%). ADHD subtype distribution did not differ significantly by gender. The association between ADHD diagnosis subtype and gender was not statistically significant, χ²(4, N=660)=1.10, p=0.894. Employment status also did not differ significantly by ADHD subtype (χ² (2)=4.48, p=0.107), indicating similar employment distributions across combined, inattentive, and hyperactive/impulsive ADHD presentations. In contrast, medication use differed significantly by ADHD subtype (χ² (2)=12.75, p=0.002), with higher rates of pharmacological treatment among individuals with combined presentations.

These findings support adult ADHD guidelines that prioritize comprehensive assessment and individualized care rather than gender-based assumptions. In rural mental health systems, aligning practice with standardized diagnosis, subtype-informed treatment planning, and structured follow-up may strengthen equity, consistency, and continuity in adult ADHD care delivery.

Older adults experiencing acute mental health crises often face prolonged inpatient stays due to multimorbidity and complex psychosocial needs. The shift from hospital care to supporting people to recover in their own homes, with the right support in place, was the basis for the introduction of the Functional Intensive Response & Response Team (FIRST).

The South-East Essex FIRST (SE FIRST), a virtual ward, which commenced operations in June 2023, was one of three teams set up to provide these services across our trust. It is a multidisciplinary service catering for older adults aged ≥70 years, with flexibility to accommodate 65–69-year-olds with significant frailty. Its objectives were to intervene early, act as a gatekeeper for informal psychiatric hospital admissions, and support timely hospital discharge.

This service evaluation reviewed all referrals from June 2023 to June 2025. Approval was obtained from the Research Team, and data governance principles were adhered to.

Information was extracted from referral records supplemented by the electronic systems. This included socio-demographic, clinical, and referral variables, which were analysed using descriptive statistics.

In total 309 unique referrals were received, out of which 21 (6.8%) individuals required multiple episodes of care over the period. The majority were female (64.7%), with a mean age of 77.2(±7.0) years. Over three-quarters (76.1%) had a prior psychiatric diagnosis, with mood disorders (41.1%) and organic disorders (19.1%) being the most prevalent. Most referrals originated from Mental Health Liaison Teams (36.2%) and Older Adults CMHT (34.3%). Mental health deterioration was the leading reason for referral (74.1%) followed by post-discharge support (23.3%). Following a two-clinician assessment and multidisciplinary discussion, nearly a third (30.7%) were not considered suitable for FIRST with signposting to appropriate services, 100 (32.4%) were accepted for home treatment, of which 73 were successfully managed with a mean duration of 33.9 (±50.8) days. This translated to an overall admission avoidance rate of approximately 24%. For those whose admission was unavoidable (n=62), they were considered too risky to be managed in the community. Feedback, though limited (16%), was overwhelmingly positive, highlighting professionalism, kindness, and responsiveness which exemplifies our trust motto of ‘We care, we learn, we empower’.

SE FIRST has demonstrated effectiveness in delivering safe, person-centred crisis care for older adults, reducing admissions rates or duration and promoting continuity of care. Future priorities would include strengthening data systems and implementing structured indicators such as tracking admission avoidance rates, quantifying bed-days saved and optimizing service delivery.

This study aimed to quantify the clinical performance of the Tryweryn ward (PICU) in Heddfan Psychiatric Unit, Wrexham, North Wales against the data available nationally in the 2021 National Survey of PICUs. Our objective was also to evaluate how unit infrastructure; specifically, the presence or absence of a dedicated on-unit seclusion suite affects the frequency of restrictive physical interventions (RPI) in the two PICUs in North Wales (Tryweryn ward with no seclusion suite and Taliesin ward with a dedicated seclusion suite).

A retrospective analysis was conducted on admission data over an 18-month period (N=190) at Tryweryn ward (PICU) in Wrexham. Data collected was on gender, legal status, diagnosis, and length of stay (LoS) and discharge/transfer destination. These were compared to nationally available data in previously published literature from PICUs in England. Additionally, a 13-month data (August 2024–August 2025) compared the number of restrictive physical intervention episodes in Tryweryn ward PICU with no seclusion suite versus such episodes in Taliesin Ward (PICU with dedicated seclusion suite).

Tryweryn Ward PICU data demonstrated high alignment with nationally available data for mean LoS (36.55 days vs. national 36.57 days) and primary diagnosis, with 58% of patients admitted in psychotic crisis. Gender distribution showed a higher female representation (37%) compared to the 20% national average. Legal acuity was high, with 88% of patients detained under Section 2 or 3 of the Mental Health Act.

Comparative data on restrictive practices revealed a significant disparity:

• • Seclusion: The PICU with dedicated seclusion suite (Taliesin Ward) recorded 22 such episodes, whereas the unit without (Tryweryn) recorded only 2, utilizing off-unit Section 136 suites or transfers out of the unit for such a need.

• • RPI: The ward with seclusion suite recorded 352 total RPI incidents versus Tryweryn ward incidents (139 incidents).

• • Monthly Variation: In the final month of the data collection, RPI incident number peaked at 82 incidents in the PICU with seclusion, compared to 7 in the PICU without.

Our PICU with no seclusion suite facility in North Wales effectively mirrors the nationally available data regarding intensive care psychiatric practice. The utility of seclusion suites remains debatable on the issue whether such suites contribute to any reduction in restrictive physical intervention practices or not.

The aim of this Quality Improvement (QI) project was to standardize the use of Opiate substitution therapy (OST) in Brent, London to improve patient experience, streamline supervision level and reduce money spent on supervision.

Patients were initially provided with supervised prescription of OST with aim to progress to lower supervision as they demonstrate adherence and stability. There were some inconsistencies in supervision level leading to certain patients remaining on unnecessary high levels of supervision. Pharmacy time and resources were diverted to supervise patients who no longer required this level of monitoring. A structured questionnaire with guidance in accordance with Orange guidelines and Trust Policy was developed as part of a QI Project to streamline the process.

The QI Project ran from October 2024 to August 2025 (8 months) and employed a Plan–Do–Study–Act(PDSA) approach and completed one PDSA Cycle.

Interventions included development of unified OST Supervision Questionnaire (countersigned by a prescriber), staff training and presentation about guidelines to reduce the supervision. Data on patient satisfaction, supervision cost and number of patients and level of supervision was collected quarterly.

Implementation of standardized OST Protocol resulted in a measurable increase in patient satisfaction. However, the project also identified an increase in pharmacy costs, specifically related to supervision. This rise was attributed to enrolment of a large cohort of new patients during April and May which temporarily increased supervision needs.

Baseline data showed 44.8% patients on supervised dose of OST (buprenorphine & methadone) which increased to 45.7% in March and further to 47.3% in July. This increase was mainly seen due to new clients enrolling and as part of new Guidance–patients needed to be on 2 months supervised dose before any reduction to this regimen could be made.

The QI Project ran for 8 months successfully standardizing the approach to OST supervision in Brent, London. It led to enhanced patient satisfaction and increase in follow-up by patients. Though supervision cost and number of patients on supervised doses increased by small percentage which was contributed to the surge of new patient enrolment. The questionnaire provided a great therapeutic tool to key workers to engage in an open conversation around supervision level. The overall outcome suggested that standardizing OST Process was beneficial and sustainable with regular staff training and case discussion with line managers.