Bodily distress disorder (BDD) involves presence of excessively distressing somatic symptoms to which individuals direct excessive attention despite repeated contacts with healthcare providers or even if another condition is causing the symptoms,paying excessive out of proportion attention to symptoms. BDD is more prevalent following Covid-19, but data from Asia remains sparse. Thus, this study is done to determine the prevalence of BDD among patients seeking outpatient treatment at Colombo North Teaching Hospital (CNTH), Sri Lanka.

We conducted a cross-sectional study recruiting consecutive, consenting patients attending the outpatient department (OPD) of CNTH from April to June 2025. Presence of somatic symptoms were determined by applying Bradford Somatic Inventory. Relationship of somatic symptoms to bodily distress disorder, depression or anxiety was determined according to ICD–11 criteria through clinical interviews by a senior registrar in psychiatry. In patients diagnosed with BDD lack of an adequate biological explanation for symptoms or in patients with established medical conditions contributing to symptoms, degree of attention to symptoms being excessive despite appropriate clinical examination, investigations and reassurance was confirmed by the Consultant Physician in charge of OPD.

We studied 236 patients (female 83.1%, mean age 62±11.8 years, educated up to orbelow grade eleven–83.1%, residency urban or suburban–89%). Prevalence of somatic symptoms was 94.1%. Out of those, BDD was diagnosed in 28.1%, depressive disorder in 14.3% and anxiety disorder in 7.1%. Prevalence of BDD was higher in females 29.1% compared with males 15% (Chi square 3.4,pvalue 0.06) and higher in people with education up to or below grade eleven–27.0% when compared with above grade eleven–25.0% (Chi square 0.7, p value 0.79). BDD was higher in people below 60 years (Chi square 5.6, p value 0.18) and in people residing in urban, and suburban areas (Chi square 11.0, p value 0.00). Number of comorbidities is positively correlated with BDD status. Most common two presenting symptoms were aches and pain (41.8%) and lack of energy/fatiguability (37.2%). Majority of those with BDD were on polypharmacy therapy (60.3%) and 22.2% were on analgesics.

Prevalence of BDD among this whole sample of people seeking outpatient treatment at a tertiary care hospital in Sri Lanka was 26.7%. Age below 60years, urban and suburban residency,multi-morbidity were significantly associated with BDD.

To evaluate the implementation and mental health outcomes of physical activity-based interventions within contexts specifically relevant to Wales.

We aimed to identify existing gaps in the literature, explore implications for local clinical practice, and provide a strategic solution for common mental health settings.

We sought to establish a framework for action and quality statements to embed physical activity within routine mental health care.

Prioritise action that will support the improvement of the physical health of people with severe and enduring mental health conditions, reducing the mortality gap between people who have severe and enduring mental health conditions and those that do not. This is inkeeping with aspirations of Welsh Government’s Mental Health and Wellbeing Strategy Delivery Plan 2025–2028.

We utilised a multi-faceted methodology, including a structured mapping and narrative analysis of the broader international evidence base alongside a systematic review of Wales-specific evidence.

The systematic search followed PRISMA guidelines, targeting databases such as MEDLINE, PubMed, and PsycINFO using key terms like “mental illness”, “exercise”, and “Wales”.

Grey literature sources were also analysed to capture real-world practical challenges. Articles were screened, with inclusion limited to those published after 2007 to remain consistent with modern legislative definitions.

The findings indicate that physical activity interventions significantly improve mental wellbeing across various settings in Wales, including community-based programmes, secure units, and exercise referral schemes.

Key benefits identified include reduced symptom severity for both common mental disorders and severe mental illness (SMI), improved sleep quality, and mitigation of premature mortality risks.

However, significant barriers to implementation were identified:

• Systemic Barriers: Limited funding, a shortage of qualified physical activity professionals, and insufficient training for healthcare staff.

• Individual Barriers: Low motivation, poor baseline physical health, and low self-esteem among service users.

• Environmental Barriers: The “obesogenic” nature of secure inpatient units, which often lack the flexibility or resources to prioritize physical activity.

Integrating physical activity into mental health services is essential but requires a shift in clinical culture and investment.

We propose four Quality Statements to guide leaders, emphasising collaborative design with physical activity professionals, inclusive programming for diverse needs, equitable care in secure settings, and sustainable investment in community programmes.

Effective implementation depends on moving toward a person-centred, evidence-informed approach that addresses both social and commercial determinants of health.

Dissociative identity disorder (DID) is characterised by the existence of two or more distinct identities within an individual, affecting their consciousness, behaviour, and memory. Accounting for only 1% of the psychiatric population, it is a rare and often controversial diagnosis. This case report describes the diagnosis of DID in a neurodivergent adolescent from an ethnic minority background, whose assessment was complicated by layers of complexities. Through his journey within the mental health services in England, the successes and challenges in supporting the needs of young people in similar circumstances will be discussed. All identifying details have been anonymised.

Joseph is a 14-year-old asylum seeker of Black ethnicity who arrived in the UK at age 9. Known to the mental health service from age 13 for low mood, he was reviewed following a suicide attempt by jumping from a bridge. Joseph, however, stated that it was not him but ‘Karl’ who took the leap. This behaviour was initially hypothesised to be part of autistic thinking or passivity phenomena of an emerging psychotic episode. Joseph continued to describe being in distinct personality states across various contexts, and his mother corroborated episodes of dissociation involving behavioural changes and memory disruption. A diagnosis of DID was made following multiple specialist assessments.

Joseph’s care involved multi-agency collaboration between a range of specialist teams across the public sector. The Crisis team provided a swift response and intensive follow-up during periods of escalated risks. The Outreach team, which specialises in engaging young people who are difficult to reach, built rapport with Joseph at home. Educational and social care agencies played active roles in navigating uncertainties regarding Joseph’s legal status. Engaging with a young autistic person required persistence and skill. Understanding the family’s cultural and religious backgrounds was crucial for differentiating culturally congruent experiences from those that were pathological and distressing. A key barrier to planning management from the formulation was the gaps in services and training to address such intricate presentation holistically.

While DID may not be a commonly encountered diagnosis, the context which this case brings is a familiar one: ethnic minorities constitute 18% of the UK population; autism is diagnosed in 3% of adolescents; dissociative disorders have a prevalence of 10% in the clinical population and are strongly associated with trauma. Resource allocation for training professionals to become trauma-informed, culture-aware, and neurodivergence-sensitive across mental health and non-mental health services would therefore be essential.

Autism Spectrum Disorder (ASD)-related catatonia presents a significant diagnostic and management challenge, due to the overlap between catatonic features and core autistic traits. Adolescents with ASD appear to be at increased risk of catatonic deterioration often triggered by psychosocial stressors and underlying neurobiological factors. This case describes a 16-year-old female adolescent whose catatonia was primarily driven by underlying autism, illustrating the crucial role of ASD-related mechanisms in both her deterioration and recurrence. Current literature review reveals a small number of documented adolescent catatonia cases indicating limited clinical and research consideration to this population.

A multidisciplinary treatment approach integrating pharmacological, psychological, and environmental strategies was implemented. Pharmacological management included Lorazepam (1 mg BD) targeting motor symptoms, alongside Olanzapine (5 mg ON) and Sertraline (150mg OD) to address comorbid anxiety, emotional dysregulation, and behavioural rigidity. Regular physical health monitoring remained unremarkable throughout. Additionally, the adapted for children version of the Bush Francis catatonia scaled was utilised to measure symptoms. Psychological interventions focused on anxiety reduction, restoration of independence, and development of structured daily routines. Environmentally, a low-arousal setting was prioritised with consistent 1:1 support as part of Level 3 observations. This provided containment, predictability, relational stability and reduced sensory overload. Collaborative multidisciplinary working and graded Section 17 leave facilitated a smooth transition back to the community.

A clinical decline was observed when Lorazepam was tapered and observation levels reduced to Level 2 (15-minute checks). Catatonic features including behavioural “stuckness,” delayed motor initiation, increased ritualistic behaviour, and reduced self-care re-emerged. Marked improvement was observed following the reintroduction of 1:1 support as part of Level 3 observations and an increased Lorazepam dose. This clear temporal association emphasises that environmental structure and sustained relational support are as critical as pharmacological treatment.

This case highlights the importance of recognising catatonia as a treatable manifestation of ASD. The clinical course established how ASD specific neurobiological vulnerabilities impacted to the initial deterioration and subsequent relapse. Recovery was dependent not only on benzodiazepine responsiveness but also on maintaining consistency, predictability, and therapeutic connection. A formulation driven, multidisciplinary approach balancing pharmacological, psychological, and environmental interventions is essential for sustaining improvement and preventing relapse in autistic adolescents with catatonia.

South Asia bears a substantial burden of developmental and psychosocial adversity among children and adolescents, yet specialist mental health resources remain scarce. Scalable, non-specialist delivered interventions have been proposed as a solution, but the breadth, characteristics, and evidentiary foundations of such interventions across developmental stages remain poorly synthesised.

This review aimed to systematically examine the existing evidence on child-centred interventions delivered by non-specialists in South Asia, including whether such interventions demonstrate successful outcomes, are predominantly preventive or promotive in focus, are developmentally targeted, and are implemented with acceptable participant retention across diverse settings.

A scoping review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidance (PRISMA). Web of Science and PubMed were searched for peer-reviewed intervention studies published from 2010 onwards. Eligible studies were clinical trials with a comparison group, conducted in South Asia, targeting infants, children, or adolescents up to 19 years, and aiming to improve developmental or wellbeing outcomes through prevention, promotion, or treatment approaches. Pharmacological studies, qualitative designs, and samples with high baseline psychiatric morbidity were excluded. Screening, full-text review, and data extraction were undertaken independently by multiple reviewers with consensus resolution.

Forty-seven studies met inclusion criteria, encompassing 57,951 participants at baseline and 49,321 at endline, with an overall attrition rate of approximately 15%. Nearly half of studies were conducted in India, followed by Bangladesh and Pakistan. Most interventions were randomised or cluster randomised trials and were delivered in schools, homes, or community settings. Non-specialists delivered 87% of interventions, including health workers, lay counsellors, peers, and teachers. Interventions predominantly focused on promotion (68%) or prevention, with only two treatment-focused trials.

Perinatal and early childhood interventions predominantly emphasised developmental stimulation (n=21), parenting practices (n=18), psychoeducation related to child health, development, nutrition, or maternal wellbeing (n=19), and responsive caregiving or maternal responsiveness (n=11). In contrast, adolescent interventions primarily targeted psychosocial wellbeing (n=8), positive youth development approaches (n=5), life skills, stress management, or resilience-focused outcomes (n=multiple studies; exact counts varied by domain).

Cognitive behavioural components were present in a minority of interventions (n=7 overall), most commonly embedded within multi-component programmes rather than delivered as stand-alone therapies. The use of standardised developmental and psychosocial outcome measures was common, with the Bayley Scales of Infant and Toddler Development (Second edition: n=6; Third edition: n=11) most frequently used for early childhood outcomes, and the Strengths and Difficulties Questionnaire (n=7) most commonly employed for child and adolescent psychosocial wellbeing.

Over the past decade, South Asia has generated a substantial and methodologically robust body of evidence demonstrating the feasibility and acceptability ofnon-specialist delivered child and adolescent developmental interventions across settings and developmental stages. However, the literature remains heavily weighted toward promotion and prevention, with notable gaps in middle childhood and treatment-focused interventions. Future research should prioritise theoretically explicit, mechanism-informed designs and address under-represented age groups to inform scalable, equitable child mental health strategies in low-resource settings.

This audit focused on the recording and reporting of patient deaths across the Acute Old Age Psychiatry wards at the Royal Edinburgh Hospital (REH), Scotland. All inpatient deaths should be reported electronically via the NHS Lothian health board ‘DATIX’ incident reporting system. A patient death is recorded as ‘expected’ or‘unexpected’. This audit aimed to identify how many patient deaths had occurred over a 2 year period and if they were appropriately reported via ‘DATIX’.

In January 2025 retrospective data was gathered for the review period from January 2023 to December 2024.

Following a patient death, a physical Medical Certificate of Cause of Death (MCCD) was issued by medical staff. The MCCD log books are held on the Acute Old Age Psychiatry wards at REH. Each log book entry was reviewed and the number of deaths were recorded.

Electronic data from the ‘DATIX’ reporting system was gathered by the Assurance and Improvement Team for the REH, who are involved in the review of Significant Adverse Events.

The information from the MCCD log books and ‘DATIX’ system were cross-referenced.

A total of 14 patients died whilst an inpatient during the review period. These were all due to a primary medical condition and not primarily resulting from a psychiatric disorder.13 MCCD were issued. 1 MCCD could not be issued due to legal reasons. The patient deaths occurred on 3 of the 4 wards.

‘DATIX’ data identified that 7 deaths were reported; all 3 ‘unexpected’ deaths and 4 ‘expected’ deaths.

Therefore, 50% of the patient deaths occurring on the Acute Old Age Psychiatry wards at REH were not reported via the ‘DATIX’ incident reporting system.

This audit identified the number of patient deaths that occurred during the 2 year review period on the Acute Old Age Psychiatry wards at REH and elucidated that not all patient deaths were being reported to the ‘DATIX’ incident system. In particular, ‘expected’ deaths were not reported consistently. This meant data held by the Assurance and Improvement Team was not accurate and highlighted that clinical teams were not aware of the need to report every inpatient death. Following this audit, issuing of the MCCD at REH became electronic. Senior management also ensured all clinical teams were informed of the requirement to report all deaths via ‘DATIX’. Future audit is required.

This clinical audit aimed to assess and quantify patient wait times across all localities within the TEWV Trust, benchmarking these durations against Trust and National averages. Timely care for individuals with dementia is critical, not only for patients and their families but also for broader community health outcomes. Early diagnosis is essential for providing customized support, facilitating effective treatment options, enabling proactive planning, and preventing crises. Reducing the wait time between referral to a Memory Assessment Service (MAS) and the subsequent diagnosis and care plan is crucial, as delays can significantly burden the NHS and adversely affect the long-term mental health of patients and their caregivers. According to the National Audit of Dementia for 2023/2024, wait times have risen sharply from 124 days in 2021 to 151 days, with only 10% of patients obtaining a diagnosis within six weeks of referral.

The audit was conducted over a four-week period from September 28 to October 28, 2024. A random sampling method was employed to select 149 patients referred to 15 memory services throughout the TEWV Trust. Data were collected through the analysis of referral letters, initial assessments, diagnostic appointments, case notes, and correspondence from CITO. Analysis was performed using a custom tool developed in Excel.

The analysis yielded average access times, diagnostic wait times, and overall wait times ranging from 30 to 207 days, 3 to 147 days, and 92 to 323 days, respectively. Notably, none of the Mental Health Service for Older People (MHSOP) services within the TEWV Trust met the national benchmark for overall wait times of six weeks. Furthermore, only 25% of the services succeeded in providing a diagnosis within the 6 to 18-week timeframe, while the remaining 75% experienced wait times extending to 18-52 weeks. A comparative analysis revealed that the average wait times (access, diagnostic, and overall) within the Trust exceeded those of the National averages.

The audit underscored substantial discrepancies between the various memory services’ performance and the National recommendations of a six-week wait. Among the services assessed, only one was marginally compliant with a 92-day mark, falling short of the National benchmark of 42 days. This evaluation not only identified critical challenges faced by the services but also presented a series of recommendations to address these gaps.

Tees, Esk and Wear Valley’s Eating Disorder teams recognised a lack of guidance to inform the introduction of exercise in young people with eating disorders. An MDT group reviewed evidence and international guidelines to inform the drafting of a decision-making tool in line with national risk assessment frameworks.

1) A multidisciplinary team assembled monthly, including physical and mental health clinicians and dieticians, to develop and refine guidelines.

2) A literature search was conducted to seek up to date best practice globally.

3) The impact and utility of the framework was assessed through pre-and post-guideline questionnaires distributed to the Eating Disorder Team.

4) Artificial Intelligence assisted Thematic Analysis explored pre-and post-guideline responses.

Thematic Analysis highlighted:

1. Guidance and decision tree were seen as helpful and providing more structure. There were still some requests for improved communication and shared application.

2. Some variation in decision making exists post guidelines, but several team members noted improved consistency with guidance/decision tools. Some pockets of inconsistency remain.

3. Greater reflection on balance of risk. Some felt the team were still overly cautious in the reintroduction of exercise, but others noted guidance enabled positive risk-taking for young people.

4. Confidence generally higher in this area within the team. Respondents highlighted MDT strength and guidance as supportive tools. Some newer staff still unsure around advice in this area.

Themes emergent from pre-and post-draft guideline questionnaires reflected those identified in wider clinical studies around the management of exercise in Eating Disorder interventions. Teams believed exercise was crucial to recovery, bringing benefits to mental and physical health, providing connection with past activities that previously brought enjoyment. The introduction of new clinical guidelines were felt to enable positive risk taking whilst improving consistency and confidence within the MDT.

Current DVLA guidelines advice that patients admitted to hospital for serious mental health conditions should not drive for 3 months following stabilisation and should inform the DVLA of their mental status. This closed loop audit, completed on a Working-Age Adult ward, evaluated current practice and introduced an intervention with subsequent re-evaluation.

A baseline audit was conducted (n=12) which demonstrated that driving status was explored 25% of the time, and of these 67% were given DVLA advice and 67% were told to inform the DVLA. It was concluded that driving status was not routinely involved in MDT discussions, with a clear scope of change. Therefore, an intervention was introduced – the addition of a “driving status” to the electronic ward round template to standardise screening during ward reviews. A prospective re-audit during a 10-week period of 20 patients was then completed. The aims were to implement a sustainable change to improve on current practice and to re-audit to assess impact of intervention. Measured parameters were driving status exploration, advice given regarding driving and was advice to contact DVLA provided.

Following re-auditing, driving status exploration had improved to 85%.Furthermore, of that cohort that drove, 86% were given the relevant DVLA advice regarding whether they could drive or not, an increase from 67% at baseline. Of that cohort that drove 71% were advised to contact the DVLA, as opposed to 67% at baseline. These results suggest that the electronic ward round template intervention introduced did significantly improve the exploration of driving status, and that in this cohort the providing of relevant DVLA advice was improved.

Some of the strengths of the audit included its closed-loop design, which allowed for an evaluation of the intervention introduced. There was also an increase in sample size from the baseline audit to the re-audit. Additionally, the simplicity of the intervention allowed for a sustainable change in practice. Limitations of the audit included the sample size, which reflected a single ward in the hospital and as a result may not generalise across other services. Further actions included introductions of posters on the ward, qualitative information gathering of MDT awareness and expansion of audit into other wards in the hospital.

Harmful and dependent alcohol use frequently co-occurs with psychiatric disorders and is more prevalent amongst psychiatric inpatients than in the general population. Patients admitted to general adult psychiatric wards are at increased risk of alcohol withdrawal.Early identification of alcohol misuse at admission is essential to guide appropriate investigation, monitoring, pharmacological management, and referral to specialist alcohol services.

This re-audit of assessment and management of alcohol misuse in a general adult psychiatric inpatient setting in Mersey Care NHS Foundation Trust follows the original audit conducted in 2021 and re-audit in 2022 and evaluated whether assessment and management of harmful or dependent alcohol use, as defined by ICD-11 criteria, had improved since previous audits and assess effectiveness of previous recommendations implemented.Key areas reviewed were documentation of alcohol history, identification of alcohol misuse, monitoring for withdrawal, prescription of evidence-based treatments, appropriate investigations, and referral to community alcohol services.

A retrospective audit of all patients on eight general adult inpatient wards in the Trust was conducted on 22ndof April 2025. The electronic patient record and prescription chart for each patient were reviewed. Patients with no documented history of alcohol misuse were excluded from monitoring for and management of withdrawal. Audit standards were based on the Trust’s alcohol detoxification policy and NICE guidance.

The total sample was 130 inpatients - 52% male, 48% female.55% of patients had an alcohol history documented on admission.28% of patients had a prior history of alcohol misuse but only 28% of these had their average weekly alcohol intake recorded.Among patients with identified alcohol misuse, a CIWA score was documented within 24 hours in 17% - an improvement from 1% in 2021 and 4% in 2022. Prescribing of withdrawal-related medications remained inconsistent - 14% were initiated on Chlordiazepoxide, 25% on Thiamine, and 3% on Vitamin B Compound Strong within 24 hours of admission.Relevantblood tests - gamma GT level - 31% and Mg2+ - 25% were incompletely performed. No patients were offered referral to community alcohol services, a deterioration compared with previous audits.

Despite modest improvements in CIWA documentation, significant gaps remain in assessment and management of alcohol misuse in general adult inpatients.Inconsistent clerking practices, limited use of structured proformas, and poor referral rates to community alcohol services represent missed opportunities to reduce withdrawal-related morbidity and support long-term recovery.Increased use of clerking proformas and targeted education on alcohol withdrawal management were recommended.

Doctors working in stand-alone mental health hospitals frequently need to refer patients to acute and specialist services to manage physical health problems. These referrals can involve multiple acute hospital trusts, resulting in unclear and inconsistent referral pathways. Resident doctors who rotate regularly between placements may in particular be unfamiliar with local pathways, which can lead to inefficiencies and impact quality of patient care. The aim of this quality improvement project was to assess and improve doctors’ confidence in making appropriate referral pathways by developing and implementing a referral guidance resource. It was hypothesised that compiling a comprehensive referral guidance resource would improve doctors’ self-reported confidence.

This quality improvement project was carried out at Atherleigh Park Hospital using two Plan–Do–Study–Act cycles. Two cohorts of doctors participated (Cycle 1: n=10; Cycle 2: n=6). Baseline confidence in identifying referral pathways was assessed using a questionnaire with a five-point Likert scale (1=not at all confident, 5=very confident). A referral guidance resource outlining commonly required specialty referral pathways was developed and implemented. Following implementation, participants completed a repeat questionnaire assessing confidence, resource usage, ease of access, and included opportunity for qualitative feedback.

Baseline confidence varied across both cohorts. Following the introduction of the referral guidance resource, 100% of respondents reported having used the resource whilst 94% reported knowing where to find it. All respondents also reported an improvement in confidence in identifying appropriate referral pathways. Post-intervention confidence scores across both cohorts ranged from 4 to 5, with a mean score of 4.5 out of 5. Ongoinguncertainty in specific specialties, such as referrals to respiratory medicine, venous thromboembolism clinic, and referrals outside the main acute hospital trust affiliated with the mental health hospital were identified through qualitative feedback. The findings have informed priorities for further development of the resource.

The introduction of a referral guidance resource was associated with improved self-reported confidence. There was high uptake of the resource among doctors at a stand-alone mental health hospital. The findings support the hypothesis that a structured referral resource can improve clinician confidence and show the capacity to contribute to meaningful local service improvement. Further work will focus on expanding specialty coverage within the resource, which has already been incorporated into the resident doctor induction sessions at the hospital with the aim to expand its impact.

Improve identification of patients with restricted eating, standardise the assessment and weight monitoring of patients with restricted eating and improve monitoring for at-risk young people.

This project followed a Plan–Do–Study–Act cycle. The Reading West CAMHScommunity patient list was analysed to gain a baseline measurement of:

• The consistency in identification of patients with restricted eating.

• The effectiveness of weight monitoring being undertaken for the patients on the team caseload.

An anonymous survey was sent to the multidisciplinary team to analyse perceived barriers to identifying patients with restricted eating and gather perspectives.

A focus group was organised involving clinical psychology, psychotherapy and medical teams to examine these barriers and to generate potential interventions.

Based on these findings, changes were implemented in the team, with the intention to expand to other localities if shown to be effective.

Interventions:

• Development of a standardised protocol for documenting weight.

• Addition of screening questions for restricted eating to the proforma for initial assessments of young people.

• Education for the MDT on the risks associated with restricted eating and the importance of early identification and consistent monitoring.

These interventions were disseminated across the team using established channels.

Of the 49 patients on the treatment list, 19 (39%) had documented evidence of restricted eating. Of these, 7 (37%) had adequate weight monitoring and documentation.

Reviews of the notes of these patients found that weight was not always documented, and if it was it was not in a standardised format.

Survey responses highlighted recurring themes including a lack of training and confidence in identifying restricted eating, concerns about the impact of monitoring on therapeutic relationships and the absence of a local protocol. Additional concerns were raised regarding escalation pathways and clinical responsibility.

The preliminary findings indicate that patients with restricted eating make a significant proportion of the caseload, however monitoring of these patients and documentation is not standardised. This indicates missed opportunities to identify and monitor these at-risk patients.

Several barriers to the identification and efficient weight monitoring of at-risk patients were found. These included staff training and confidence and poor standardisation of practice.

We anticipate improved consistency in weight monitoring and identification of high-risk patients with the implemented changes. Repeat analysis will be needed to confirm the post-intervention effect.

Further work will include the development of robust monitoring protocols, establishment of clear escalation pathways and implementation of defined clinical responses for young people identified as high risk.

Autistic and other neurodivergent people experience substantial health inequalities, including poorer mental health outcomes, barriers to accessing care, and premature mortality (autistic people are 7 times more likely to attempt suicide than non-autistic people). These preventable outcomes reflect systemic inequities rather than autism itself. There is, therefore, need for a radical new approach to ward-, service- and organisational-level change to address this profound, unmet need within mental healthcare systems.

Aim: to create a novel Trust-wide Neurodivergence Specialist Advisor role within Essex Partnership University NHS Foundation Trust (EPUT), to improve quality, safety and across all services and age groups through co-produced partnership working to drive professional development, system transformation and an essential cultural shift around all neurodivergence.

This service-development initiative involved partnership working between an Autistic/ADHD psychiatrist and a lived-experience expert, grounded in participatory and co-production principles. Activity domains will include: bespoke patient and service clinical consultations; supporting Patient Safety Incident Investigations, Inquest, LeDeR panels, and Prevention of Future Death processes to turn learning into transformational change;delivery of co-produced training addressing workforce knowledge gaps (e.g. National Autism Trainer Programme – additional and complementary to Oliver McGowan Mandatory Training); service development aligned with organisational governance quality priorities; and collaborative partnership working with local authority and system partners to address interface gaps where neurodivergent people are excluded from support and care pathways.

Significant drive leading to the successful implementation of this new frameworkand advisory role is an outcome of sustained lived-experience advocacy and campaigning, reflecting the influence, expertise, and leadership of the co-authoring lived-experience partner, reinforcing the value and principles of participatory and co-production in healthcare design.Experiential knowledge is essential to shaping equitable systems, not as an adjunct perspective.

Structured evaluation is planned at six months, including audit of activity and service impact (including patient safety data), thematic analyses, and review through executive governance processes as defined by EPUT’s “Working with Neurodivergence” group. This will explore perceived accessibility, workforce ability and confidence, system responsiveness, and identification of previously unrecognised gaps across service pathways. Findings will inform iterative refinement of the role and contribute to organisational learning regarding scalable neurodivergence-informed service transformation.

Embedding neurodivergence expertise and lived experience at organisational level represents a scalable approach to addressing structural inequities in mental healthcare for neurodivergent people. This model emphasises transformational co-production, workforce development, and cross-system collaboration as mechanisms. Early implementation insights will guide wider adoption and contribute to improving outcomes for neurodivergent populations.

• • To collect a database of all patients with ADHD in the adult mental health community team.

• • Investigate current compliance with following NICE guidelines on physical health monitoring for patients with ADHD taking medication.

• • Ensure all patients on medications were under the care of the Physical Health Monitoring Team (PHMT) who undertake the monitoring.

• • Make recommendations for improvement in care where guidelines are not being adhered to.

A database was compiled with patients suffering from ADHD and those on medications were noted.

The following criteria from the NICE guidelines on ADHD management were included:

• • Baseline observations (heart rate (HR), blood pressure (BP), height, weight) – we reviewed this for those patients who had commenced ADHD medications less than one year ago.

• • 6 monthly weight

• • 6 monthly HR and BP

• • 6 monthly psychiatry review

• • Assessment for side effects at review – This includes cardiovascular issues, emerging tics / abnormal movements, sexual dysfunction, seizures, sleep, worsening behaviour

• • 21/31 patients with confirmed ADHD were being medicated for same.

• • 10/21 medicated patients were not under the care of the PHMT nor did they have a key worker.

• • Medications included forms of methylphenidate or lisdexamfetamine and/or both:9/21 (43%) Concerta XL, 5/21 (24%) Equasym XL, Lisdexamfetamine 6/21 (29%), methylphenidate 3/21 (14%).

• • 9/21 (43%) did not receive appropriate baseline observations.

• • 14/21 (67%) did not have a 6 monthly weight documented.

• • 15/21 (71%) did not have 6 monthly HR/BP checks

• • 8/21 (38%) did not have a 6-month psychiatry review.

• • Regarding assessment for side-effects, on reviewing clinical letters, 1/21 (5%) of letters did not document any discussion regarding side effects. Variation in side effects discussed was evident with 10/21 (48%) documenting general side effects such as sleep and 8/21 (38%) documenting more specific side effects such as tics or sexual dysfunction.

This audit highlighted that ADHD monitoring was being neglected in a large percentage of patients on our ADHD database and variation in documentation regarding side effects.

• • Review led to the following improvements being made:

• • We developed an identifiable case load of patients with ADHD which is helpful for future audit and monitoring.

• • Patients were referred to the PHMT for follow up of monitoring, helping to improve the likelihood that NICE guidelines will be adhered to.

• • A reflection on the need for more specific documentation regarding monitoring of side effects in clinical letters.

Lithium is an effective mood stabilizer for older adults but carries increased risks due to age-related physiological changes, comorbidities, and reduced renal function. Regular monitoring of lithium levels, renal and thyroid function, and electrolytes is essential to prevent toxicity, ensure safe dosing, and optimize treatment outcomes.

This audit aimed to evaluate lithium monitoring practices within psychiatry of old age services in Mental Health Services for Older Persons. It focused on the monitoring of lithium levels and relevant blood tests, as well as the completion of comprehensive lithium assessments to ensure safe and effective use in older adults keeping in view of the vulnerability of this age group.

A retrospective review of all lithium patients attending the service was conducted, assessing lithium evaluations, documentation, monitoring of side effects, and adherence to recommended blood monitoring standards following NICE and Maudesley guidelines.

In Cycle 1, deficiencies were noted in documenting side effects, medication interactions, and regular monitoring of eGFR and physical health. In response, Cycle 2 introduced a service development project with structured monitoring tools. Lithium flowsheets were implemented to record blood tests every three months, and lithium stickers were used by nursing staff to document results in clinical notes. A two-page clinical assessment form, incorporating tick-boxes for side effects, interactions, and patient education, ensured all areas were systematically addressed. A GP template was also developed to prompt timely blood tests.

These interventions resulted in significant improvements in lithium monitoring and documentation. Additionally, a formal lithium policy was established within the North Dublin Mental Health Services for Older People Community Mental Health Team, supporting consistent and safe practice.

Overall, the implementation of structured monitoring tools and policy measures enhanced adherence to recommended blood tests, improved documentation of side effects, and strengthened patient education. These initiatives have collectively improved the quality, safety, and effectiveness of lithium prescribing in older adults.