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.

The purpose of this audit was to evaluate and improve staff awareness and confidence in signposting patients to services both within and outside the NHS. It aimed to transition from a fragmented information landscape to an integrated “one-stop-shop” directory. By centralising resources into a sustainable, living database, the project sought to bridge knowledge gaps, foster Trust-wide collaboration, and ensure patients receive tailored support across all five boroughs.

A Trust-wide baseline survey was distributed to all staff, capturing data on professional roles and geographical boroughs to identify specific resource gaps. Targeted surveys were sent to medical staff to pinpoint clinical areas and service types where signposting confidence was lowest. Both quantitative and qualitative methods were used to gather initial baseline data and further suggestions to integrate resources better. This data informed the design of a Microsoft Lists database, prioritizing the most “under-resourced” areas and ensuring the platform met the practical needs of frontline staff.

Baseline data confirmed a high demand for resources, with 71.5% of staff signposting patients at least weekly. Key barriers included unclear referral pathways (77.8%), poor service awareness (70.4%), and outdated information (59.3%). Pre-intervention, staff lacked confidence in signposting for housing (78.7%), employment (67%), and finances (57.1%), with significant unawareness regarding legal aid (89.3%) and food banks (67.9%). Internal service literacy was also low, with over half (60.7%) unaware of Trust rehabilitation services. Consequently, 60.7% of staff requested the interactive digital directory.

Post-intervention, confidence in signposting to employment, housing, and finance services all rose to above 56%. Staff reported marked increases in awareness for domestic abuse and carer support (both 93.8%), legal aid (75%), and debt advice (68.8%). While awareness of external resources improved, gaps persisted for internal rehabilitation (62.5% unaware) and forensic services (43.8% unaware). Qualitative feedback confirmed the directory successfully consolidated information, though staff recommended expanding the database through closer collaboration with community teams and social prescribers across all five boroughs.

The collaborative digital directory represents a low-cost, high-impact solution to streamline patient signposting. Future interventions will focus on expanding the project team and recruiting “resource champions” from various teams to ensure the directory remains dynamic and sustainable. This model serves as a scalable blueprint for enhancing health literacy of staff for services that exist both within and outside NHS services.

Electroconvulsive therapy (ECT) is an effective and safe treatment for severe mental illnesses yet it remains stigmatised with widespread misconceptions- even among healthcare professionals and medical students. Previous studies have reported that medical students often have limited and inaccurate knowledge about ECT, particularly regarding itsadministration and safety. The aim of our study was to explore medical students’ attitudes to ECT before they engaged with a Technology-Enhanced Learning and Teaching (TELT) resource which focused on ECT.

An online survey was sent to all medical students during their clinical placement in psychiatry to explore their knowledge and attitudes about ECT. The questionnaire was adapted from those used in other studies to explore knowledge and attitudes towards ECT. Ethical approval was obtained from the MVLS Ethics Committee as was approval from the Head of the Undergraduate Medical School.

To date, 104 students have completed the pre-teaching questionnaire. Of the respondents,57% (n=59) identified as female and 40% (n=41) identified as male.The majority of respondents (70%, n=72) reported that a friend or relative had been diagnosed with a mental health problem and 16% (n=16) reported that they themselves, had been diagnosed with a mental illness.

Just under half (47%, n=48) stated that they would consider specialising in psychiatry. Respondents reported that prior knowledge about ECT came from movies and TV (67%, n=70), the internet (53%, n=55) and medical books and journals (37%, n=38). Baseline knowledge of ECT was limited: only 64% (n=66) were aware a general anaesthetic was given and only half (51%, n=53) were aware that muscle relaxants were used. Only 33% (n=34) recognised that ECT did not cause permanent brain damage and 38% (n=40) were aware that ECT did not cause burns. Moreover, 65% (n=68) reported they would be afraid to receive ECT themselves and 59% (n=61) reported that their view of ECT had been negatively impacted by the media.

Despite respondents reporting high rates of exposure to mental health problems in family and friends and high rates of respondents considering a career in psychiatry, baseline knowledge of ECT was very limited, and appeared to be influence by the media. Misconceptions around the procedure, were relatively common with many respondents expressing fear over receiving the treatment themselves. These results highlight the need for educational resources to address misconceptions, improve knowledge and counteract the negative influence of media depictions of ECT.

There is a significant and rapidly widening chasm between the demand for Old Age Psychiatry and what the current workforce can deliver.

We aimed to review the changing burden of psychiatric disease in the 55–65 age group to help predict future needs, the current workforce providing this care and the training providing this in the future.

We have collected data regarding the rate of complex psychiatric diagnoses in 55–65 and 65 and older people in South London and Maudsley and Cambridge and Peterborough, building on previous work using anonymised data sets.

We reviewed data collected by the Royal College of Psychiatrists regarding numbers of older adult psychiatric posts and training rates to older adult posts across the country. Various existing data was compiled to show past demographic changes and future expectations in training.

The Older Adult UK cohort is growing, with a large cohort currently aged 55–65 soon to enter the over 65 age band. This group is projected to show increased complex psychiatric comorbidity which Older Adults services are poorly equipped to address. This will be an additional complication to the already complex medicalcomorbidity expected in Older Adult populations. This pattern of increasing psychiatric and medical comorbidity is only set to increase as prevalence of psychiatric disorders rises in the UK population.

Meanwhile, consultant provision in Old Age psychiatry is currently insufficient. RCPsych data demonstrates that 28.8% of Old Age psychiatry consultant posts in the UK are currently vacant or filled by locum doctors. Adjusted for population, the number of old age psychiatry consultants in England has been trending downwards over the last decade, with similar trends in the devolved nations. This is despite previous workforce projections from the Royal College which anticipate that the number of Old Age psychiatry consultant posts needs to double. Our collected data shows retirement rates have remained relatively static, implicating the major contributor to the current workforce shortfall is the consistent underfilling ofOld Age psychiatry specialty training posts.

Our review of RCPsych census data shows that Older Adult training posts have been consistently underfilled across the country. The average fill rate across the last decade for Older Adult posts sits at 49% nationally with high inter-regional differences, contributing to over 300 posts not being filled across the decade.

Without corrective action, Old Age psychiatry services are at risk of deteriorating,becoming increasingly unsafe and unable to accommodate the vulnerable populations they serve.

To address this the Older Adults Faculty at the Royal College is working to highlight these current and projected shortfalls and review the contributing factors to develop a new workforce plan.

Anxiety and depression are prevalent among medical students worldwide, especially in low- and middle-income countries like Pakistan, where mental health stigma remains a significant challenge. This study aimed to develop an explainable machine learning-based screening tool for anxiety and depression using non-stigmatizing lifestyle and sociodemographic factors in academic settings. We hypothesized that explainable machine learning models can use non-stigmatizing lifestyle and sociodemographic factors to screen for anxiety and depression in medical students.

A cross-sectional survey was conducted among 1,630 undergraduate medical students in Islamabad, Pakistan. Participation was voluntary; informed consent was taken and confidentiality assured. The study protocol was reviewed and approved by the institutional ethics committee (Approval No. 00009 IHSA/P\D-2022). Data collection was guided by extensive stakeholder engagement involving students, faculty, and mental health professionals to ensure contextual relevance and acceptability. Sociodemographic variables (e.g., age, gender, year of study, socioeconomic indicators) and lifestyle factors (e.g., sleep patterns, physical activity, academic workload, and social factors) were collected. Anxiety and depression were assessed using validated self-report instruments (GAD-7 and PHQ-9).

Following data cleaning, imputation, and encoding, the dataset was split into training (80%) and testing (20%) subsets. Separate Random Forest classification models were developed for anxiety and depression due to their capacity to model complex, non-linear relationships. Hyperparameters were optimized using cross-validation. Model performance was evaluated using accuracy, sensitivity, specificity, and AUC-ROC. Explainability was enhanced through SHapley Additive exPlanations (SHAP), enabling both global and class-specific interpretation of predictors.

The study reported that the prevalence of depression and anxiety was 57.8% and 46.4%, respectively. The anxiety model achieved 84.36% accuracy, while the depression model achieved 81% on the test dataset. SHAP analysis identified academic performance, sleep patterns, and physical activity as the strongest predictors of anxiety and depression, demonstrating non-linear and context-specific relationships. The anxiety model showed comparatively stronger performance, potentially reflecting differences in symptom structure and their associations with lifestyle variables.

We concluded that explainable machine learning models based on non-stigmatizing data can effectively support mental health screening among medical students. This approach offers a scalable, ethically transparent decision-support tool to inform targeted preventive interventions, such as sleep hygiene initiatives and workload management, advancing precision mental health in resource-constrained educational settings.

Effective communication between secondary and primary care is fundamental to patient safety and continuity of care. While the GMC and RCPsych emphasize high-quality correspondence, there is a lack of strictly mandated national timeframes for non-urgent outpatient letters. In line with the NHS Standard Contract, our Trust (NHFT) utilizes a 24-hour benchmark for clinic entry completion and a 7-day standard for issuing GP letters. This audit aimed to evaluate compliance with these standards across the North and South Community Mental Health Teams (CMHTs). The Set standard was that 100% of clinic outcomes and clinic letters should be completed within Trust’s time standards of 24 hours and 7 days, respectively.

A retrospective audit was conducted over a six-week period (24 March–2 May 2025). Data was collected from SystmOne (Trust’s Electronic record system) for 176 clinics across various localities.

Primarily, the timeframe within which clinic outcomes were completed was evaluated against standards. Secondarily, the same was done for Clinic letter completion timeframe. The final compliance rates were compared between the North and South teams, to assess for any variability.

Of the 176 clinics audited (North: 62; South: 114), overall compliance was high, although it was below the target of 100%.

• • Clinic Entries (<24 hours): South CMHTs achieved 99% compliance, while North CMHTs achieved 94%.

• • Clinic Letters (<7 days): South CMHTs demonstrated excellent timeliness at 99%. However, North, 92% of letters met the 7-day target. In the North locality, 8% of letters were overdue or missing, with some delays extending up to 31 days. Conversely, the South locality had only one missing letter and one overdue letter, representing less than 1% of the sample.

The overall compliance was below set standards. Identified factors included missing letters and significant delays (>30 days). The clinicians involved were not aware of the undergoing audit.

In addition to the short duration, the audit didn’t account for the total number of appointments, patient non-attendance and administrative capacity.

We recommend that the findings are presented to regional academic teaching program, a survey to identify administrative capacity issues, a longer re-audit duration of 12 weeks, inclusion of the newly implemented Local Area Partnership (LAP) transformation model, as well as addressing the identified limitations. Going a further step, we recommend the addition of consenting patients as recipients according to the new clinic-letter standard.

Social media use is nearly universal among adolescents, yet its relationship with mental health remains contested. Much public and policy debate focuses on total time spent on social media, despite emerging evidence that qualitative aspects of use may be more relevant. Clarifying which dimensions of social media use are most strongly associated with mental health outcomes is essential for informing school, clinical, and policy interventions.

This review aimed to synthesise evidence on the association between social media use and mental health outcomes in secondary school students (approximately ages 11–18). We hypothesised that (1) problematic social media use would show stronger and more consistent associations with adverse mental health outcomes than time-based measures, and (2) contextual and experiential patterns of use would be more informative than frequency or duration alone.

A rapid systematic review was conducted using a structured web-based search strategy to identify peer-reviewed systematic reviews, meta-analyses, and high-quality longitudinal or quasi-experimental studies examining social media use and mental health outcomes in adolescents attending secondary school. Eligible outcomes included depressive symptoms, anxiety symptoms, psychological distress, wellbeing, sleep disturbance, and self-harm-related outcomes. Social media exposure measures were categorised as time/frequency of use, problematic social media use (defined as compulsive or impairment-associated use), and patterns or experiences of use (e.g. active versus passive engagement, social comparison, feedback sensitivity). Findings were synthesised narratively by exposure category and outcome domain.

Across included evidence syntheses and longitudinal studies, associations between time spent on social media and mental health outcomes were generally small and inconsistent, with substantial susceptibility to confounding and reverse causality. In contrast, problematic social media use demonstrated more robust and consistent associations with depressive symptoms, anxiety symptoms, and psychological distress. Evidence examining patterns and experiences of use suggested that mechanisms such as social comparison, sleepdisruption, and emotional reactivity to online feedback may partially explain observed associations. Evidence evaluating school-based restriction policies alone showed limited and mixed effects on mental health outcomes.

Findings support the hypothesis that problematic and impairment-related social media use, rather than total time spent, is most consistently associated with poorer mental health in secondary school students. Interventions and assessments should prioritise loss of control, sleep disruption, and emotional impact of use rather than focusing solely on duration. Stronger causal inference will require future studies using objective exposure measures and experimental designs.

This comprehensive Trustwide Reaudit aimed to evaluate patterns of psychotropic and sleepmedication prescribing within the CAMHS service at Black Country Healthcare NHS Foundation Trust for children diagnosed with Autism Spectrum Disorder (ASD). It comparedthe current practice against NICE guidelines. The key objectives were to identify variations in prescribing practices across different localities within the Trust and to assess both the improvements achieved and the remaining gaps when comparing the initial audit with the reaudit.

A detailed retrospective review was carried out on 137 randomly selected cases involving children diagnosed with ASD who had been prescribed psychotropic or sleep medications. Comprehensive examination of patient records, including progress notes and clinic letters, enabled the collection of robust and meaningful data. To minimise bias, cases from each locality were evaluated by clinicians from different areas within the Trust. The assessment focused on comparing prescribing practices against NICE guidelines, and all stages of the process were conducted in accordance with strict ethical standards

Across the cohort of 137 children diagnosed with ASD, several areas of clinical practice showed clear improvement compared with the initial audit as follows. The proportion of children receiving alternative interventions before starting medication increased from 44% to 60%, and documentation of consent rose markedly from 62% to 93%. Specialists continued to initiate psychotropic medications at the minimum effective dose, and timely followup within 3–4 weeks improved from 70% to 75%. Recording of side effects also increased, moving from 61% to 70%, while documentation of prescribing indications rose from 83% to 93%, reflecting stronger clinical rationale and overall enhancement in practice standards in the Re-Audit.

The Reaudit showed marked progress in several key areas, including consent procedures, the use of prior interventions, followup practices, and overall documentation,when compared with the initial audit. However, despite these improvements, the findings revealed inconsistencies in some areas in adherence to NICE guidelines. To address these gaps in the future, recommendations were made to strengthen collaboration with supporting agencies to increase the use of nonpharmacological interventions before medication is considered. Additional recommendations included implementing trustwide clinic letter templates to standardise documentation of indications, side effects, and consent, and to establish consistent followup intervals for reviewing medication side effects. These steps were viewed as essential for ensuring safe, effective, and highquality patient care.

To investigate substance use patterns among older adults engaged with Bolton Addiction Service, with a particular focus on their physical health needs and service provision.

• • To determine the prevalence of physicalcomorbidities among this population.

• • To evaluate the frequency and adequacy of physical health monitoring provided to older service users.

• • To assess whether current service provision meets the specific needs of older adults and to develop recommendations for service improvement.

We employed a retrospective design, drawing on clinical records from the Bolton Addiction Service (Paris and GM care records). 65 years was the operational cut-off for defining “old age”. 33 records were accessed for their:

–Sociodemographic characteristics and social circumstances.

–Substance use and treatment history.

–Clinical profile: presence of comorbid medical conditions and concurrent medications.

–Investigations: whether any diagnostic or monitoring investigations were recorded, and the time elapsed since the most recent investigation.

–Cognitive status: evidence of cognitive decline documented in clinical notes.

The project highlighted significant physical and social vulnerabilities among older adults receiving treatment for substance misuse, with over halfliving alone and almost all of them relying on pension or benefits.

• • Opioid misuse is the predominant issue(73%), with 79% of these having a history of injecting, although only a small proportion (8%) continue to inject. 91.6% of those with opioid misuse are on methadone.

• • Two thirds have been in treatment for more than five years,many(39%) for over two decades. Those with shorter treatment histories are largely individuals with alcohol misuse, who receive psychosocial interventions rather than medication.

• • Nearly all patients have multiple medical comorbidities, most commonly cardiovascular disease, and all are prescribed several medications.

• • Cognitive impairment is documented in one fifth of the cohort, including three cases of confirmed dementia.

• • Despite this high level of clinical complexity, more than half have not received a medical review in the past year, eight had no physical health investigations, and only one patient underwent an ECG.

Older adults with substance misuse have substantial physical health needs that are not fully met by the current service. Enhancing the frequency of medical reviews and physical health investigations, particularly ECG monitoring, is recommended. It was also suggested that doctors include discussion about methadone dose reduction or change to buprenorphine as part of older adults’ medical reviews.

The Thames Valley Child & Adolescent Psychiatry training scheme is one of the smallest UK schemes for the specialty. The previous academic programme consisted of small local group teaching. However, over time, it became increasingly difficult to fill the programme from a limited pool. Alongside this, with more virtual teaching affecting the teaching (positively and negatively), the feedback from residents indicated a clear need for action. Hence a decision was taken to join with three London programmes that were successfully running a combined academic programme. Considering the potential impact of merging with a large group conducted virtually, we identified a need to start with a one-year pilot, and monitor the quality, accessibility and learning impact of this.

We consulted with the residents on joining the virtual programme, and started collating feedback after every session with an online form. The feedback was reviewed at the end of every term and discussed with resident representatives present. We also obtained feedback from our resident group on the quality of the academic teaching at the end of the pilot to support our decision on whether to continue.

Sessional feedback has helped gauge quality of speakers and shape future sessions. The overall feedback at the end of the pilot showed an overwhelmingly positive response.75% of the cohort responded, with everyone rating the main speaker sessions as good or excellent. Resident-led sessions were also rated positively, although comments reflected the difficulty of engaging in discussions virtually when presenting cases or journal clubs. The advantages of joining programmes included the content quality, breadth of topics, and convenience. Disadvantages included less face-face contact and reduced interactivity. Suggestions to mitigate included more in-person sessions, and access to recordings. Most people value small group teaching as a learning approach and also highly rated an in-person day in Oxford.

We conclude overall that joining of academic programmes has been a success for our scheme. We have also been able to positively contribute to the larger scheme by bringing in a structured feedback process to the programme. However, we also highlight some ongoing challenges in delivering academic programmes moving forwards. Important questions remain about future development of academic programmes: will more schemes need to merge to sustain their viability if they face similar challenges – should there be a national programme for each specialty? What are the risks of this, and how can we maintain the important identity of smaller schemes?

Various psychotropic medications have an impact on serum prolactin levels. Measurement of prolactin is therefore an important step in patient management. Clear documentation of prolactin levels and subsequent action plan will help to minimise the risk of missed prolactin results.

Screening of clinical records in an acute inpatient ward was undertaken to assess compliance with prolactin blood test measurement and recording of subsequent action plan. It was found that 55% of the inpatients had this completed. This led to a quality improvement project where a root cause analysis was undertaken. As part of the process survey wascompleted by medical teams caring for the inpatients to identify barriers to testing and documentation.

As per survey barriers to prolactin testing included human error such as forgetting to add prolactin to blood form, infrequent phlebotomy staff visits, lack of awareness of monitoring requirements and unclear responsibility for requesting tests. On the other hand, limited access to prolactin management guidelines, lack of standardized documentation template and time constraints during ward review were barriers to documentation of action plan. Based on these findings, the following interventions were implemented. Written reminders were placed on wards, meeting held with phlebotomy services to clarify visit schedule and collaboration withelectronic records team to add a dedicated section on capturing blood test and subsequent action plan within clinical records.

Following the introduction of written reminders on the ward, a modest improvement was observed in compliance with prolactin blood test monitoring. Relatively bigger improvement was noted in the documentation of associated action plans.

Electronic records team is set to make changes to clinical records by adding a section dedicated to capturing blood results and its action plan by January 2026. This intervention is anticipated to lead to further improvements in both monitoring and documentation compliance.

In summary the project identified various barriers contributing to poor prolactin monitoring and documentation of subsequent action plan in inpatient wards. Targeted intervention of written reminders led to modest improvement. Incorporating prolactinmonitoring within electronic clinical record from January 2026 is anticipated to achieve greater improvement.

Recommendations: Trust to consider blood stamps to improve compliance with complete set of admission bloods.