Over an 18-month collaborative at CNWL, Thames Ward an acute mental health ward at St Charles Hospital in the Royal Borough of Kensington and Chelsea, aimed to reduce high-level observations by 50% and decrease the frequency of continuous observation. Baseline data showed 18 high-level observations per week and use of continuous observation every 2.5 days.

With support from an Improvement Coach and workshops, the team tested three PDSA-cycle changes: safety huddles including all staff in observation decisions, prioritising risk assessments over automatic observation for new admissions, and improving patientcommunication. Seven in-depth interviews by an Expert by Experience informed communication practices.

The project achieved a 50% reduction in high-level observations (18 instances down to 9) sustained from January–September 2025. Continuous observation frequency decreased, with up to 43 days between episodes. Violence and aggression incidents did not increase, and bank staff costs fell to £0 in September 2025.

This work demonstrates that restrictive practices can be reduced without compromising safety, highlights the importance of challenging entrenched routines, and shows that Expert by Experience involvement is central to meaningful improvement.

1. To evaluate the completeness and quality of admission clerking documentation for psychiatric inpatients on Ward F, Neath Port Talbot Hospital.

2. To identify areas for improvement to ensure compliance with national psychiatry standards.

A retrospective audit was conducted on 13 December 2024, reviewing admission clerking proformas for all 23 inpatients on Ward F. Documentation was assessed across key domains including patient identification, presenting complaint, psychiatric and medical history, forensic and substance misuse history, risk assessment, mental state and physical examinations, medication history, investigations, impression, and management plan. Audit standards were derived from the Oxford Textbook of Psychiatry, Core Competencies for a Trainee in Psychiatry, and the Royal College of Psychiatrists (CCQI) Standards for Inpatient Mental Health Services: Admission–First 12 Hours (2022).

Core components of admission clerking were well documented. All patients had recorded identification, history of presenting complaint, psychiatric history, impression, and management plan. Mental state examinations and risk assessments were completed in 22/23 cases; however, documentation predominantly focused on current risk, with limited recording of past risk (4/23) and previous admissions (8/23). Physical examinations were completed in 18/23 cases, with frequent omissions in neurological, cardiovascular, and anthropometric assessments. Substance misuse history was inconsistently documented, particularly with respect to alcohol intake and illicit drug use. Medication history was recorded in 16/23 cases, with variable documentation of dates, signatures, and electronic prescribing status. Investigations were documented in only 4/23 cases.

Although core elements of psychiatric admission clerking were generally completed, significant gaps were identified in documentation of physical health assessments, substance misuse history, past risk, investigations, and medication history. A revised admission clerking proforma has been introduced incorporating a structured clerking checklist, detailed substance misuse history (including alcohol units, smoking pack-years, and illicit drug use), and comprehensive physical examination with emphasis on neurological assessment. Re-audit following implementation is recommended to evaluate improvements in documentation quality, compliance with national standards, and patient safety.

To assess compliance with recommended standards for completion and documentation of risk assessment on admission and discharge in the psychiatry inpatient unit, and to evaluate the effect of targeted interventions on improving patient safety and continuity of care.

ET AL AUTHORS:

6. Dr. Ali Abbas Zahid - Internal Medicine PGR- aliabbaszahid004@gmail.com- Aleem Medical Collge / Gulab Devi Teaching Hospital, Lahore, Pakistan

7. Dr. Muhammad Zubair - General Practitioner-muhammadzubair1103@gmail.com

A closed-loop quality improvement audit with a repeated cross-sectional design was conducted over two months. Twenty-five consecutive patients were reviewed in each cycle (total n=50). Baseline data were collected retrospectively from clinical records, followed by implementation of interventions including staff education, display of risk-assessment checklists in the ward, and reminders during ward rounds to complete admission and discharge risk documentation. A prospective re-audit was then performed using identical standards. Criteria assessed included completion of risk assessment within 24 hours of admission, documentation in clinical notes, coverage of risk domains (risk to self, risk to others, risk from others, risk of absconding), documentation of a risk management plan, and review and update of risk assessment prior to discharge.

Admission risk assessment within 24 hours improved from 64% to 92% (absolute improvement +28%). Documentation in clinical notes increased from 84% to 96% (+12%). Assessment of risk to self improved from 84% to 96% (+12%), risk to others from 80% to 92% (+12%), risk from others from 68% to 88% (+20%), and risk of absconding from 80% to 92% (+12%). Documentation of a risk management plan increased from 72% to 88% (+16%).

Discharge-related safety showed the greatest improvement. Review of risk assessment prior to discharge improved from 40% to 84% (+44%), and updating of risk assessment before discharge improved from 40% to 80% (+40%). Overall, post-intervention compliance was high across all admission and discharge standards, with the largest absolute gains seen in safeguarding assessments and discharge safety processes.

This closed-loop audit demonstrates that simple, low-cost interventions led to substantial absolute improvements (12–44 percentage points) in multiple components of risk assessment, particularly in safeguarding domains and discharge risk review, which are critical for preventing post-discharge adverse events. Although post-intervention compliance was high, gaps remain in achieving universal documentation of risk management plans and discharge updates. Embedding standardized admission and discharge proformas and continued staff reinforcement are recommended to sustain and further improve patient safety practices.

To examine how musicians express mood states through music and how these expressions are interpreted by media narratives, and how cultural analysis can be used as an educational tool to enhance psychiatric understanding of mental state, stigma and patient engagement.

A qualitative analysis was conducted using a comparative cultural analysis approach. Publicly available materials related to four artists (Amy Winehouse, Kurt Cobain, Stormzy and Florence Welch) were used. These artists were selected to reflect variation across genres, eras, genders and cultural contexts. Materials, such as song lyrics, interviews and media reporting, were thematically analysed using the Braun and Clarke framework. Patterns in emotional expression, representations of mental distress, and media framing were found. Identified themes were mapped to core psychiatric training domains, including mental state variations, stigma and culturally informed care. As no primary clinical data were collected and all materials were in the public domain, ethical approval was not required.

Three consistent themes were identified. First, musicians frequently expressed emotional distress and vulnerability using metaphors, tone and narrative rather than explicit clinical language. This suggests music can provide insight into subjective emotional states and serves as a tool for understanding the meaning and the context of an experience or emotion. Second, media portrayals often simplified or moralised these expressions, particularly in relation to substance abuse, reinforcing stigma and overshadowing the complexity of co-occurring mental health challenges. Third, disparities were observed in how distress was framed, dependent on gender, race and genre, with some artists’ experiences pathologised to a greater extent, whilst others were relatively contextualised or minimised. These findings demonstrate how cultural material can be used in education to show the limitations of symptom-only interpretation and the importance of contextual formulation – including social environment, occupational pressures and media influence. This pedagogical approach aligns with the RCPsych curriculum by enhancing reflective practice and improving cultural competence, pivotal for managing complex presentations in diverse populations.

Music and media analysis offers a potentially useful framework to augment psychiatric training by highlighting how emotional distress is expressed, interpreted and socially constructed. While music cannot be used to diagnose mental illness, it can enhance engagement and facilitate conversations around stigma, identity and help-seeking. Incorporating culturally relevant case analyses through simulated formulation workshops into education may improve recognition of non-verbal expressions of distress, encourage reflective engagement with stigma and media narratives, and promote culturally informed practices.

Postgraduate psychiatry training varies globally in clinical competencies, patient exposure, trainee autonomy, and teaching methods. Teaching webinars can address gaps in training needs by facilitating knowledge and skills development, especially in low and middle-income countries. Having completed undergraduate medical training in developing countries and currently practicing psychiatry in the UK, the authors drew upon their direct experience of differing training structures to develop a webinar series. This series was delivered in collaboration with the British Pakistani Psychiatric Association (BPPA) to share key UK training curricula skills and workplace practices with international psychiatry resident doctors with an aim to further develop their clinical practice and improve patient care.

Seven interactive sessions covered reflective practice and Balint group principles, trauma-informed psychiatry, CBT frameworks, clinical skills (capacity and risk assessments) and ethical considerations of patient confidentiality and consent, designing research, audits, and quality improvement projects, and UK psychiatry career pathways, were delivered by UK-based doctors. Within one week of advertising through BPPA networks, 90 doctors from 19 countries applied (52.2% non-training, 47.8% trainees). Fifty participants were shortlisted based on expressions of interest. Post-series feedback was collected.

The survey response rate was 44%. The series received a mean rating of 4.59/5, with speaker line-up rated 4.55/5, accessibility 4.23/5, and topic relevance 4.68/5. Qualitative feedback reported sessions as highly informative, diverse in topic range, clinically relevant, and presenting concepts that were new to many participants, like Balint groups. Participants recommended more detailed sessions, increased case-based learning, pre-session access to slides and post-session recordings, and more focus on NHS-specific practices versus other healthcare systems. There was strong interest in future sessions with longer duration and increased frequency.

The feedback highlighted significant demand for accessible, high-quality psychiatric education. Topics like reflective practice and trauma-informed care, not universally integrated into existing curricula, generated particular interest. The positive response has motivated the authors to deliver similar initiatives for wider cohorts, incorporating participant feedback to enhance accessibility and educational impact. Such programmes offer structured educational platforms for early-career psychiatrists globally to access skills-focused learning opportunities, while facilitating cross-cultural exchange of psychiatric expertise. While traditional psychiatric education often overlooks cultural nuances in patient care, international collaboration among psychiatrists can improve patient outcomes and reinforce healthcare systems by fostering both cultural competence and cultural humility.

Systematic monitoring of antipsychotic side effects is essential for medication adherence and relapse prevention. To audit compliance with recommended GASS monitoring for patients receiving depot antipsychotic injections in a community mental health team (CMHT). Local Trust and NICE guidelines recommend use of validated rating scales such as the Glasgow Antipsychotic Side-Effect Scale (GASS), with completion at one month after initiating depot antipsychotics and at least every six months thereafter

Using a retrospective review, 20 randomly selected patients receiving depot antipsychotics at Swale CMHT were assessed. Electronic notes (Rio) and uploaded specialist assessment forms were examined to determine whether GASS assessments were completed at the minimum six-monthly interval. Initial one-month post-initiation GASS assessments were excluded as most service users had commenced treatment prior to the first audit cycle.

The 1st cycle of the audit was conducted from Nov 1st 2023 to Jan 30th2024 and six-month GASS monitoring were reviewed between Jan 2022 till Oct 2023. The 2nd cycle of the audit was done between 15thJan 2025 to March 30thand six-month GASS monitoring were reviewed between Jan 2024 till Dec 2024.

In the first audit cycle, only 5% (1/20) of service users had GASS assessments completed at the recommended six-monthly interval. Following staffing improvements, including new pharmacy team joining and increased awareness of guidelines, the re-audit demonstrated substantial improvement: 75% (15/20) of service users received GASS assessments every six months. Reasons for missed assessments were often undocumented.

The initial audit cycle identified a significant deficit in the objective monitoring of antipsychotic side effects using the Glasgow Antipsychotic Side-effect Scale (GASS). Following the implementation of increased awareness, and optimized staffing levels, the second cycle demonstrated a marked improvement in compliance. However, documentation gaps and patient refusals persist. These findings highlight the need for further targeted interventions to ensure full adherence to Trust clinical guidelines.

Risperidone is associated with a high risk of antipsychotic induced hyperprolactinaemia, and routine biochemical monitoring is recommended. This audit aimed to assess adherence to local hospital guidelines on prolactin monitoring for adult outpatients prescribed risperidone, which align with the National Institute for Health and Clinical Excellence (NICE) Guideline CG178 at the Behavioural Sciences Institute (BSI) in Al Ain,United Arab Emirates, and to identify priorities for improving monitoring and documentation.

We conducted a retrospective audit of adult patients (≥18 years) initiated on risperidone and followed in BSI outpatient clinics between 2023 and 2025. We reviewed electronic case notes and lab records. The inclusion criteria were at least six months of risperidone treatment and follow-up at BSI. Exclusions included short-term use (<6 months), death, loss to follow-up, or starting risperidone elsewhere. Audit standards were based on Al Ain hospital guidance: (1) baseline prolactin measurement before antipsychotic treatment, and (2) repeat prolactin at 4–6 months. For each patient, we recorded age, sex, diagnosis, and whether prolactin tests were done, with reasons noted if not. Data were analysed as counts and percentages.

Of 240 patients on risperidone during the audit, 159 were excluded (115 treated for less than six months, 24 lost to follow-up, 18 transferred, 2 died), leaving 81 for analysis. The sample included 53 males (65.4%) and 28 females (34.6%), aged 18–94 (mean 45.8). The most common diagnoses were schizophrenia spectrum and other psychotic disorders (55.6%), followed by developmental disorders including autism and intellectual disability (14.8%), major depression (11.1%), neurocognitive disorders (8.6%), bipolar disorder (4.9%), obsessive–compulsive disorder (2.5%), and single cases of adjustment disorder and cerebral palsy (1.2% each). Baseline prolactin was measured in 12 patients (14.8%), 69 (85.2%) had none, with a recorded reason in only one case (1.2%). At 4–6 months, prolactin was checked in 11 patients (13.6%), with reasons documented in 3 (3.7%).

Adherence to local prolactin monitoring for adults on risperidone at BSI was very low, with poor documentation of reasons for missed tests. Given the potential clinical consequences of unrecognised hyperprolactinaemia, these findings highlight an important patient safety gap. Targeted interventions like staff education, electronic reminders, and clearer documentation expectations are needed, along with a re-audit to assess progress.

No financial sponsorship was received for this project.

To audit, and then work with the MDT to identify ways to improve compliance with Perinatal Quality Network (PQN) standards. The standards were regarding pharmacological management, including the requirements when starting new medication, and weekly reviews for regular medication and PRN usage. The agreed measure is the percentage of time that these medications are monitored and this is recorded appropriately. As per the PQN, the acceptable level would be 90% plus in order to meet Sustainable Service Accreditation.

A month of records were examined for six patients including MDT minutes,reviews and the prescribing interface. Data was collected to review whether monitoring, therapeutic response and discussions about medication met the PQN standards. After this cycle, the MDT met to implement changes to the weekly review and ward documentation to improve compliance. A further month of records following this change were examined.

Following changes, monitoring compliance increased. Therapeutic response monitoring for regular medication improved from 69.1% in cycle 1 to 93.6% in cycle 2, safety assessment from 44.9% to 92%, side-effect discussions rising from 22.4% to 98% and adherence recording going from 78.5% to 96%. No new medication reviews were conducted during cycle 1, so there was no baseline data, however treatment goal, risks and benefits were discussed in all reviews in cycle 2. Timescale however was not specified in any of the three reviews. Changes to PRN monitoring were also seen with weekly reviews conducted 36.7% of the time in cycle 1, increasing to 67.5% in cycle 2.

Discussion and involvement of the MDT to understand need for monitoring and aim of accreditation led to positive changes in pharmacological management, contributing to sustainable principles. The use of the PQN Quality standards to help guide MDT discussion and patient reviews has been successful in ensuring best-quality care is provided.

We aimed to evaluate the number and circumstances of falls in our 6-bed older adult ward and our 12-bed dementia specialist unit.

Records were reviewed if the patient had falls ≥2 during admission. Data was collected in October and December from our records and our incident reporting system. Education sessions were held between audit cycles and medications reviewed using STOP-STARTT criteria after ward rounds.

From initial audit (n=12) to repeat audit (n=10) falls were approximately similar, 25 and 22 respectively. PRN use associated with the falls were 32% in October and 45% in December, and number of patients with ACB score of 3+ was 7 and 6 respectively. Physical observations taken post-fall increased from 44% to 82%, but incident reporting decreased from 84% to 36%. In the initial audit one patient accounted for 36% of the falls with 3 having not fallen, and in repeat audit 2 patients accounted for 77% of falls, with 6 having not fallen.

All patients had received MDT input with falls bundles and care plans andregular physiotherapy review. Pre-existing extensive falls protocols are well-adhered by staff and the majority of ACB burden is due to necessary medications for stress and distress which limits ability to reduce falls risk. We identified there is ongoing scope for medication reconciliation, and there is a follow-up QIP starting to evaluate de-prescribing medication in this high-risk cohort with geriatrician advice.

We evaluated the adequacy of Mother & Baby Unit (MBU) provision for the population of Wales. Primary objectives included assessing historical patterns of patient referrals and admissions, identifying peak demand trends, and projecting future requirements. Additionally, we utilised capacity modelling to evaluate service scenarios and recommend innovations to reduce admission delays.

We analysed retrospective data on admissions and activity from November 2021 to January 2025. Demand was estimated using epidemiology and live birth statistics from 2023. Travel distances and times were modelled using Google Maps car journey calculations. Furthermore, we in corporated qualitative insights from a Lived Experience Group to define service standards, such as the preferred maximum travel time of one hour.

Working with Cardiff University’s School of Mathematics we developed large language models against scenario analysis.

Our programme has utilised mathematical modelling techniques specifically queuing theory, discrete event simulation (DES), and mathematical programming to ultimately address keychallenges in mental health services – lever aging mathematical modelling for more effective and responsive mental health services.

• • Incidence and Admissions: Between 2021 and 2024, 164 mothers from NHS Wales were admitted to MBUs, a figure consistent with clinical projections.

• • Service Provision: 81% of admissions were to Uned Gobaith (the only NHS MBU in Wales), which has a 6-bed capacity and is frequently at full occupancy. The remaining 19% of mothers were admitted to units in England.

• • Accessibility: While 73% of Welsh mothers travelled less than one hour for treatment, significant regional inequalities exist. Mothers from Betsi Cadwaladr University Health Board travelled the furthest, with an average time of 1 hour 45 minutes.

• • Economic Impact: MBU beds are high-cost interventions, with an annual occupancy cost per bed of £350,000–£400,000.

• • Current Welsh MBU provision is operating at capacity, often necessitating out-of-area placements.

• • To eliminate delays, South Wales requires access to 8–9 beds (up from 6), and North Wales requires 2–3 beds.

• • The opening of Seren Lodge in Chester (Autumn 2025) is projected to increase the percentage of North Wales mothers travelling less than one hour from 13% to 69%.

• • Future planning must balance inpatient bed expansion with investment in community services to reduce admission needs.

• • Mathematical modelling, which has proven effective across various industries, offers a toolbox to help optimising mental health services by improving resource allocation, staff scheduling, and patient care pathways.

The number of adult patients diagnosed with ADHD has continued to rise rapidly such that mental health services have experienced increasing delays in providing treatment. We introduced a new process in our adult CMHT to address rising demand and improve initiation and shared-care monitoring of ADHD drug treatment.

We reallocated staff resources to create a dedicated ADHD clinic and collected data at baseline, 3 months and 6 months on the number of patients at the different stages of the process (waiting for initiation, initiation of treatment, monitoring of treatment), allocation of keyworker, recording of diagnosis. In addition, we measured time intervals between adding to the waiting list, initiating treatment and transition to shared-care monitoring. For patients under monitoring, we recorded the compliance with NICE standards for clinical review and for physical monitoring.

The number of patients with a diagnosis of ADHD wanting treatment within our service increased from 267 to 327 over 6 months (representing about 0.4% of the working age population and an increase of 22% over 6 months). With the new process, the number of patients allocated to a keyworker and with a diagnosis recorded increased to 99.7% and 99.1% respectively. The number moving from waiting to initiation phase increased substantially. Consequently, the proportion waiting for initiation fell from 17.2% to 12.5%, while the proportion in the initiation phase rose from 12.7% to 20.8%. The proportion of monitoring patients offered a review remained high (>90%), but not universal. Compliance with physical health monitoring every 12 months improved substantially, but less so for every 6 months. For annual blood pressure monitoring, compliance increased from 62.0% to 90.4% and for annual weight monitoring, the corresponding increase was from 56.7% to 80.3%. Thelongest wait for initiation reduced from 330 days to 125 days, and the median initiation phase duration decreased from 92 days to 62 days. Over the same period, the number of shared-care requests accepted by GPs increased substantially.

The overall aims of the quality improvement project have been largely met at 6 months. Key challenges included reducing waiting times for medication initiation and accelerating transition to shared care, while maintaining NICE-compliant monitoring for established patients. We prioritised reducing initiation delays and ensuring monitoring reviews at least 12 monthly. We plan to continue the project by reducing the frequency of audit and introducing reporting on outcome measures.

Antipsychotics (APs) may cause significant adverse events (AEs) resulting in treatment discontinuation and relapse. Xanomeline/trospium chloride (KarXT), a dual M1/M4 muscarinic receptor agonist combined with a peripheral pan muscarinic receptor antagonist, has a favourable side-effect profile, potentially lowering the risk of cardiometabolic and extrapyramidal AEs. Healthcare providers may benefit from clinical data and guidance on switching patients from traditional APs to KarXT.

This 8-week, multicenter, randomized, open-label, outpatient trial assessed efficacy and safety of a switch from atypical APs to KarXT monotherapy in adults with schizophrenia based on criteria from the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Participants were randomized 1:1 to 2 treatment groups: slower transition from AP to KarXT over 4 weeks (25% reduction in AP dose/week) or faster transition from AP to KarXT over 2 weeks (50% reduction in AP dose/week). Participants in both treatment groups followed the same titration schedule, initiating KarXT at 50 mg/20 mg twice daily for 1 week and uptitrating to a target maintenance dosage of 125 mg/30 mg over 8 weeks. The primary endpoint was all-cause discontinuation of KarXT. Secondary endpoints included change from baseline to week 8 in Positive and Negative Syndrome Scale (PANSS), Clinical Global Impressions-Severity (CGI-S), and Personal and Social Performance (PSP) scores. Safety endpoints included KarXT AE-related discontinuations and AE incidence.

Fifty-three participants were enrolled in the slower transition group and 52 in the faster transition group; 86% of participants completed 8 weeks of treatment, with discontinuation rates of 15.1% (n=8) and 13.5% (n=7) in the slower and faster transition groups, respectively. No participant discontinued due to lack of efficacy. Mean changes in PANSS total scores from baseline to week 8 were −4.2 (slower transition group) and −3.1 (faster transition group). Mean change in CGI-S score was −0.2 in both transition groups. From baseline to week 8, mean PSP scores increased by 1.1 and 0.7 in the slower and faster transition groups, respectively. Forty-nine per cent of participants had ≥1 treatment-emergent AE (TEAE); none were serious. In the slower and faster transition groups, 1 (1.9%) and 2 (3.8%) participants, respectively, discontinued treatment early due to TEAEs.

Both slower and faster transitions from stable AP treatment to KarXT were generally safe and effective, suggesting that either transition method may be considered. These results aid clinical decision-making, providing healthcare providers with evidence-based guidance on how to switch to KarXT from oral atypical APs.

Achieving sustainable community reintegration for autistic adults within specialist inpatient rehabilitation environments necessitates comprehensive, evidence-informed assessment of functional capabilities and adaptive competencies. Autism-specific tertiary rehabilitation units serve a fundamental purpose in cultivating independence, augmenting adaptive repertoires, and ameliorating maladaptive presentations that constitute barriers to successful discharge. This systematic audit investigated the degree to which service users within two Autism Specialist Rehabilitation Wards at Cygnet Harrow Hospital–Springs Centre and Springs Wing–exhibit requisite capabilities for community placement. The principal hypothesis posited that whilst service users would demonstrate substantive advancement across multiple functional trajectories, enduring impediments within domains critical to autonomous functioning would persist, thereby warranting intensified, person-centred therapeutic intervention.

A comprehensive multidisciplinary audit framework was implemented through collaborative administration by clinical professionals representing occupational therapy, clinical psychology, therapeutic activities coordination, and physical health disciplines. The assessment instrument encompassed 18 clinically validated domains fundamental to rehabilitation progression and discharge preparedness, incorporating activities of daily living, communicative functioning, sensory modulation, adaptive coping mechanisms, affective regulation, interpersonal competence, physical wellbeing, volitional capacity, and overarching integration readiness. Domain-specific ratings were derived through systematic clinical observation, longitudinal therapeutic engagement analysis, and functional performance evaluation, thereby facilitating comprehensive characterisation of individual capabilities and therapeutic needs.

Analytical review identified considerable proficiency across approximately 11 assessed domains, with service users exhibiting sustained progression in self-care competencies, functional communication capacities, emotional self-regulation, therapeutic alliance formation, and diminution of anxiety-driven behavioural manifestations. These therapeutic gains substantiate the efficacy of structured rehabilitative programming and underscore the stabilising influence of coordinated intervention. Conversely, pronounced deficits persisted across six critical areas: capacity for informed autonomous decision-making, behavioural adaptation under stress, social-cognitive competence, preparedness for transition, and proprioceptive awareness alongside motor planning. These domains constitute fundamental prerequisites for discharge viability and emerged as prevalent obstacles throughout the patient cohort.

This audit elucidates that whilst individuals receiving care within autism-specific rehabilitation settings demonstrate meaningful advancement across foundational capabilities, persistent limitations in social cognition, behavioural regulation, and executive decision-making continue to represent significant impediments to placement. Findings illuminate the inherent complexity of preparing autistic adults–particularly those presenting with comorbid intellectual disabilities or challenging behavioural phenotypes–for autonomous living. Outcomes will directly inform collaborative care planning, shape service enhancement initiatives, and facilitate implementation of bespoke therapeutic pathways specifically targeting readiness competencies. Through systematic addressing of identified challenges via empiricallysupported interventions, services can optimise rehabilitative trajectories and substantially enhance prospects for safe, enduring reintegration.