Legal herbal supplements are increasingly used as “natural” alternatives for mental health issues. Nymphaea caerulea (Blue Lotus) is promoted online as a relaxant, though its neuropsychiatric effects remain poorly understood. This short review aims to examine the available literature onNymphaea caerulea(Blue Lotus), with a focus on its pharmacology, psychoactive and neuropsychiatric properties, and to describe illustrative examples from clinical practice. The review also seeks to raise awareness of potential associations between new-onset psychotic presentations and legal herbal supplements, and identify gaps in the evidence base requiring further research and regulation.

A narrative literature search was conducted in PubMed, Google Scholar, and grey literature up to 2025 using the terms “Nymphaea caerulea”, “Blue Lotus”, “herbal psychoactive”, and “psychiatric symptoms”. Pharmacological sources and regulatory reports were also reviewed. Two brief anonymised clinical vignettes from clinical practice were also included to illustrate real-world psychiatric presentations temporally associated with Blue Lotus use.

The results of the search revealed fewer than ten publications, with only one peer-reviewed case series, which described five individuals presenting with agitation, confusion, derealisation, and anxiety following ingestion or vaping. Routine toxicology screening was negative in all cases. Two brief anonymised clinical vignettes from recent clinical practice were also included, illustrating hypomanic and psychotic presentations following Blue Lotus use.

Regulatory alerts from the UK Office for Product Safety and Standards have raised concerns around the safety of Nymphaea caerulea (Blue Lotus), particularly the lack of information on dosages, variability in psychoactive content, and concerns regarding purity standards. Pharmacological reports have described the main active compounds, including nuciferine and aporphine, which act on dopaminergic and serotonergic receptors and may induce both calming and euphoric effects. The concentration of these alkaloids may vary depending on the plant, extraction method, and storage, resulting in unpredictable clinical effects. Furthermore, nuciferine has been identified in Blue Lotus resin used in electronic-cigarette devices, confirming the presence of psychoactive compounds in products marketed for inhalation.

Nymphaea caerulea is a legally obtainable, yet psychoactive herbal supplementthat may provoke neuropsychiatric symptoms. Clinicians should inquire about herbal/“natural” supplement use in new-onset psychiatric presentations. Regulation and further research are needed.

Clozapine is an effective medication for adults with treatment-resistant schizophrenia. However, its safe prescribing and monitoring can be challenging during General Hospital admissions. An initial service evaluation conducted in 2023–2024 identified inaccurate documentation of clozapine in community records, delayed referrals to Liaison Psychiatry and inconsistent monitoring of clozapine-related risk factors. In response, quality improvement interventions were implemented, including local education, a Trust-wide clozapine policy for General Hospitals and a clozapine admission checklist. This second-cycle service evaluation aimed to assess whether these interventions improved the safety and consistency of clozapine prescribing and monitoring.

A retrospective review was conducted of patients prescribed clozapine in the community who were admitted to two General Hospitals in England between March 2024 and February 2025. There were 66 admissions involving 53 patients. Electronic records from community services, General Hospitals and Mental Health services were reviewed. Data collected included the accuracy of clozapine documentation on community records, whether referrals to Liaison Psychiatry were made and the timeliness of referral and review. Liaison Psychiatry documentation was reviewed to determine whether key clozapine-related factors were considered, including full blood count monitoring, medication concordance, smoking status, bowel function, physical health concerns, medication interactions, signs of clozapine toxicity and advice regarding plasma level monitoring.

Clozapine prescriptions were correctly documented in community records in 26% (17/66) of admissions, compared with 16% in the first cycle. On admission, 79% (52/66) of patients were referred to Liaison Psychiatry, with a reduction in mean time to referral from 41.07 hours to 32 hours. Of those referred, 87% (54/62) were reviewed within 24 hours, compared with 68% in the first cycle.

Within Liaison Psychiatry reviews, documentation rates were highest for medication concordance and physical health concerns (both 88%) and full blood count monitoring (78%). Documentation was lower for medication interactions (59%), bowel movements (50%), signs of clozapine toxicity (33%) and smoking status (19%). Advice regarding plasma level monitoring was documented in 40% of cases.

This second-cycle service evaluation demonstrates improvements in referral rates to Liaison Psychiatry, timeliness of review and the quality of Liaison Psychiatry documentation following targeted quality improvement measures. However, challenges remain in the consistent documentation of clozapine prescriptions in community records and routine assessment of smoking status and signs of toxicity. Further quality improvement initiatives and repeat evaluation cycles are recommended to support safe and consistent clozapine management in General Hospitals.

Multidisciplinary Team meetings are essential to care planning, rehabilitation, and discharge. However, MDTs are often experienced differently by each service user. Each service user brings their own preferences, communication styles and expectations to the MDT setting. This quality improvement project aimed to explore their views on MDT and developed a sustainable process whereby patients' views are explored and the MDT process is adjusted to their needs and preferences.

We used the 6-step quality improvement approach and completed three Plan–Do–Study–Act cycles. Baseline insight was gathered using a structured Likert scale questionnaire to explore service users’ views and experiences of MDT meetings. Responses were rated on a five-point scale from very satisfied to very unsatisfied. The questionnaire explored aspects of MDTs including: feeling prepared for the MDT; preference for order of speaking; comfort with the number of people present; understanding who is in the meeting and their roles; having enough time to share views; comfort within the MDT environment; feeling listened to; feeling safe and respected; whether personal topics were discussed; understanding what was being said; understanding next steps; whether the MDT gave hope for recovery; and overall MDT experience.

Initial data identified five domains impacting MDT experience: preparation for the MDT, feeling listened to, having key topics discussed, environmental comfort, and understanding next steps following the MDT. Across three PDSA cycles, targeted interventions were introduced to improve service user experience of MDT meetings. Theseincluded adding the My MDT preferences tool to the Care Plan that allowed service users to express personal preferences regarding MDT format, environment, timing, and support. Another change involved improving the existing pre-MDT preparation form, and introducing a process whereby administrative staff emailed weekend staff. Another adjustment included offering a post-MDT form. Following the interventions, Likert scale scores improved in all questions. The greatest improvement was seen in feeling listened to (mean score improved from 2.0 to 1.5) and understanding next steps after the MDT (1.9 to 1.5).

A flexible and person-centred MDT process can improve service user experience. The project has been adopted into routine practice with plans for ongoing monitoring to sustain improvements. This approach is transferable to other inpatient settings aiming to strengthen service user experience in MDTs.

This audit aimed to assess current practice within NHS Borders Mental Health for Older Adults Service (MHOAS) regarding the use of neuroimaging in memory assessment clinics. Specifically, it sought to determine the proportion of patients with suspected dementia who had a documented decision and rationale regarding neuroimaging, and the proportion who underwent neuroimaging as part of their assessment. This was compared with findings from a previous audit conducted in 2014.

Patients referred to NHS Borders Older Adult teams with suspected dementia between January and March 2024 were identified from administrative referral records. A retrospective review of initial cognitive assessment letters was undertaken between February and August 2025. Data collected included whether there was documented consideration and rationale for neuroimaging, and whether neuroimaging was subsequently performed. The agreed audit standard was that all patients with suspected dementia should have a documented decision and rationale regarding neuroimaging, and that the majority should undergo imaging unless a clear clinical justification was recorded.

Fifty-one patients were included in the audit. Documented consideration of neuroimaging was present in 45 patients (88.2%), representing a substantial improvement compared with 59% in the 2014 audit. Neuroimaging was performed in 27 patients (53%), compared with 18% in 2014. Of the 24 patients who did not undergo neuroimaging, eight (33%) had already received neuroimaging within the preceding two years, and repeat imaging was deemed clinically unnecessary. In the remaining cases, the most common documented rationale for not performing neuroimaging was that the diagnosis was already clear and that imaging was unlikely to add diagnostic value or alter management.

This audit demonstrates a marked improvement over the past decade in both the documentation and utilisation of neuroimaging within the NHS Borders memory assessment clinic. Current practice is more closely aligned with national NICE and SIGN guidance, with appropriate clinical reasoning documented where neuroimaging is not performed. The findings suggest that neuroimaging is being used proportionately and appropriately, balancing guideline recommendations with principles of Realistic Medicine.

Undertaking a psychotherapy long case is part of the Core Psychiatry Training curriculum. While the value of psychological skills within psychiatry is well recognised, for many trainees starting the first psychotherapy case is an anxiety provoking task. The need for more formal teaching has been identified in previous studies. The aim of the project was to understand challenges faced by resident doctors and based on this knowledge, to improve the quality of psychotherapy training in North Central London (NCL).

NCL doctors in Core and Higher Psychiatry Training were invited to complete an anonymous survey which consisted of qualitative and quantitative questions. The feedback was used to design 2 three-hour long teaching sessions between September and October 2025. Both modules had strong focus on experiential learning which included reflecting on video recorded psychotherapy sessions and discussing observations in small groups, whilst providing only brief theoretical introduction to core psychodynamic concepts. The overall experience and effectiveness of teaching was evaluated by collecting data through formal and informal feedback.

A total of 14 responses to the initial survey were received. 50% of respondents hadalready completed a long case, 29% were seeing a patient, 21% were preparing to start by attending a supervision group.

Qualitative analysis showed themes of being underprepared and having not enough formal teaching before seeing a long case. Doctors who were about to start the long case wanted more theoretical teaching, while the ones who had already completed the long case put emphasis on the value of learning through experience e.g. in Balint and supervision groups. All trainees who had already started or completed the long case found the experience very useful or useful (73% and 27% respectively) in helping them to understand psychodynamic concepts better.

Psychotherapy teaching modules were very well attended. First and second teaching session formal feedback was overwhelmingly positive with 40 and 32 responses rating teaching as good (15% and 28%) or excellent (83% and 72%), respectively. Respondents particularly emphasised the usefulness of interactive elements of the teaching, seeing psychotherapy in action through the video material and the discussions in small groups.

While Core Psychiatry Training curriculum provides little guidance on provision of psychotherapy teaching, our project highlighted the usefulness of interactive and experiential teaching methods, which was evidenced by the initial survey results, high teaching attendance rates and very positive formal and informal feedback.

To understand what leads young people to come to Sheffield Children’s Hospital for their mental health, and the barriers to discharge home. This may help guide the service in reducing the number of long admissions and their length of stay. For example, we may be able to identify at risk groups and give appropriate support before and during admission.

We gathered data showing admissions to the STAR team (Supportive Treatment and Recovery Team) from 2022-2024 and identified patients with a prolonged (>21 days) stay. Within their electronic record, notes were reviewed to identify: patient demographics, frequency of stays (related to mental health), length of stays (related to mental health), risk to self or others, involvement of other services or consideration of Tier 4 input, issues with sleep, school, substances, possible/confirmed neurodiversity.

Out of 753 patients identified in 2022-2024, 20 patients met the criteria for a prolonged admission. There was an even split by sex, with a mean age of 13.5 years. We identified demographic traits within the cohort having prolonged admissions.

Overall, it seems certain factors might increase the risk of a prolonged mental health admission, such as safeguarding concerns and violence and absconding risk. Using the risk factors identified, we have created an admissions tool. The aim is for this to allow professionals to score the amount of risk factors, and if meeting a certain threshold, trigger a case conference. This may help at the early stages to reduced potential frequent or prolonged admissions for a young person.

Essex partnership university Trust (EPUT) policy on Discharge and Transfer Clinical Guidelines (CG24) aims to provide a clear pathway for the transfer and discharge of all patients of EPUT from and within Mental Health, Learning Disability, Secure Services and Community Health Services. It also aims to ensure that a patient’s transition between areas of EPUT services and transfer outside of EPUT services is carried out timely, effectively and safely.

The aim of audit is to to evaluate if EPUT Policy on Discharge and Transfer Clinical guidelines CG24 was being followed in an inclusive inpatient setting.

Data was collected retrospectively on all discharges from 6 acute inpatient wards within the Mid locality of EPUT; in the Linden Centre, Chelmsford.Inpatient wards that were included were General Adult (Galleywood, Finchingfield, Topaz), Older Adult (Ruby), Perinatal Specialist (Rainbow) and Psychiatric Intensive Care Unit (Christopher Unit) using a custom built audit tool. All discharges in a 3-month period (from June 2025 to August 2025) were included. This information was gathered from the electronic record (PARIS) with sample size of 91 discharges.

1. 1. Copy of the brief discharge summary given to patient: 100%

2. 2. Copy of detailed discharge summary scanned onto electronic medical records: 98%.

3. 3. GP to receive brief summary about admission, treatment required and medications within 24 hours of patient leaving the ward: 86%

4. 4. Copy of brief discharge summary scanned onto electronic medical records: 86%

5. 5. GP to receive detailed discharge summary within 5 working days of patient leaving the ward: 81%

6. 6. Copy of the more detailed discharge summary sent to patient: 0%

This re-audit has highlighted good compliance with providing the brief summary to the patient directly and scanning detailed discharge summary onto electronic medical records. There is a slight decline in sending both the brief summary to the GP within 24 hours, and with sending the detailed summary to the GP within 5 days following discharge compared to previous audit cycle with 81 discharges (data collected February 2024 – April 2024).

Areas of Good Practice:

Wards were generally compliant at uploading detailed discharge summaries to the EPR (98%).

Nurses continued to provide patients with a copy of brief discharge summary. (100%)

All wards apart from Rainbow (Mother and baby unit) are using E discharge summary.

Areas for Improvement:

There was slight decline in sharing of the brief and detailed discharge summaries with the GP, and poor compliance in sharing detailed discharge summaries with patients.

Delayed discharges arise from multiple factors and are linked with poor health outcomes, increased systemic pressures and a higher financial burden. To tackle these problems, a simple screening system (The Holistic Concern Score, HCS) was developed to identify the nature and degree of case complexity, signpost discharge barriers and enable early parallel working between allied health services.

The scale was developed using pooled data over the longest-admitted patients to determine reasons for protracted stays. The two major phases of the project involved the development of the score, and subsequently a combined retrospective application to a case sample to review its efficacy and learning.

Ten factors were identified and placed into a novel scale with factors identified as either natural (for example treatment resistance, lack of capacity) or systemic (accommodation delays, funding problems). A preliminary complexity thresholdwas calculated to determine cut-off points for identifying cases for early escalation to senior management.

The same thirty cases were re-analysed approximately 3 months later to assess efficacy of the score in predicting admission duration.

The scale shows moderate strength in predicting length of inpatient stay and characterises discrete clusters of compounding issues signifying the need for assertive multidisciplinary management. The use of this scale at admission has led to improved holistic management of cases and provided clear therapeutic benefits, with the potential to reduce delayed discharge, improve health outcomes and relieve systemic and financial pressures.

Further work will be needed to refine the scale but it presents promise within any inpatient service pathway as a directive, prescriptive and effective approach to case management on multiple levels.

To improve access to the young person psychotherapy service by adapting intake requirements. National data indicates that there is an impact of ethnicity on accessing therapies. Our aims are to improve attendance of the initial pre-assessment consultation (PAC) appointments, but also to see if there is an improvement to PCREF diversity. To support the AYAS team in achieving the existing 4-week KPI target between referral and appointment by reducing DNAs and cancellations.

1) Data was collected during the period between April 2024–June 2025 on patients who either did not attend (DNA) or cancelled their initial pre-assessment consultation (PAC) appointments. Patient records were reviewed to understand the most common reasons why patients were unable to attend their appointments.

2) Stakeholder engagement was also sought by collecting opinions from staff members involved in the opt-in process.

3) Using the above data and feedback, a new opt-in template was developed that was user friendly, age appropriate, and helpful for booking appointments, thus improving the experience for patients and staff.

4) Following its implementation, data was collected on whether the new process was effective in achieving our initial aims and objectives. Continued feedback will be sought from patients and staff members to inform a new cycle of quality improvement in the future.

Data collected in the 14 months between April 2024–June 2025 found 21 DNAs and cancellations. The most common reason given for cancellations and DNAs was because their appointment clashed with college, work or other commitments (10). This was followed by being given too short notice (5) and sickness (4). Of the 304 appointments offered in 2024–2025, there were 42 first-appointment DNAs. Of these, the most common ethnicities were White British (10), White Other (6) and Black African (6). There was an improvement in the time it took for patients to respond once an opt-in was offered, which was supported by feedback from staff members involved in the opt-in process.

The new opt-in process for the Adolescent and Young Adult Service (AYAS) has demonstrated promising results in improving the rates of response for patients offered an opt-in to attend the pre-assessment consultation (PAC). Previous data suggests that there is no impact of diversity on attendance. Ongoing data collection is required to assess its longer-term impact on the service.

ADHD is treated in CAMHS and may involve non-pharmacological treatments, suchas behavioural therapy. It may also involve pharmacological treatments, such as methylphenidate, lisdexamfetamine, atomoxetine, and guanfacine. Medication side effects include hypertension, weight loss, arrhythmias, and loss of appetite, all of which are detrimental to childhood development. The aim of this closed-loop audit was to improve Attention Deficit Hyperactivity Disorder (ADHD) monitoring within the Child & Adolescent Mental Health Services (CAMHS) in West Glasgow. Patients’ height, weight, blood pressure, and heart rate, along with respective centiles and growth charts, were assessed in accordance with NICE guidelines.

In the initial audit, a retrospective data search using electronic health records identified a sample of 33 patients under 18 with a diagnosis of ADHD who took ADHD medication within the previous 6 months. The results of this initial audit were presented at a local department meeting. Posters of the NICE guidelines were then distributed. The same methods as the initial audit were used to identify 45 patients on ADHD medication for the follow-up cycle to assess improvement in monitoring.

In the initial audit, 97% of the 33 patients had their height and weight recorded, and 100% had their blood pressure and heart rate recorded. 85% of patients had their height centile, weight centile, and growth charts recorded. 10% of patients had blood pressure centiles recorded, and 0% had heart rate centiles recorded. In the second cycle, 100% of the 45 patients had their height, height centiles, weight, weight centiles, heart rate, blood pressure, and growth charts recorded. 2% of patients had blood pressure centiles recorded, and 0% had heart rate centiles recorded.

There was a significant increase in the monitoring of height, height centiles,weight, weight centiles, heart rate, blood pressure, and growth charts in the second cycle compared with the first cycle. However, blood pressure and heart rate centiles still did not meet NICE guidelines. This was clinically significant due to the variance in heart rate and blood pressure in children. The electronic health system’s inability to convert raw figures of blood pressure and heart rate to percentiles likely impacted the ability to monitor these specific percentiles.

To develop a peer group of clinical academic residents in the West Midlands Deanery.

The SPARK project (Supporting Psychiatric Academic Research for Knowledge) began in 2024 in the West Midlands Deanery to support resident doctors to achieve the research requirements of the higher training curriculum. From this work it became apparent that a smaller cohort of academicallyfocussed residents wanted support with applications and their additional training needs.

We started a series of meetings for clinical academic residents and doctors interested in academic psychiatry careers working in the West Midlands. We held our first hybrid meeting in October 2025 at the University of Birmingham. This consisted of a hot networking lunch, a career talk from clinical Associate Prof Dr Ben Perry, a talk on theclinical academic training pathway and time for networking. We created a WhatsApp group where we share funding and job opportunities as they arise.

A second meeting is booked for March 2026 and will feature a career journey talk from Prof Femi Oyebode. This will be held at the University of Warwick so residents get exposed to different universities in the Midlands.

At the first meeting we measured pre-and post-session awareness of, and interest in, clinical academic careers.

21 participants recorded their attendance at the first SPARK 2 meeting, 16 in person and five online. The attendees were a mix of ACFs, core trainees, higher trainees, a foundation doctor, a clinical research fellow, an SAS doctor and a medical student.

Participants were asked to respond to the statement “I know what a clinical academic is and what they do”; 58% responded “Agree” or “Strongly agree” pre-session, 100% responded “Agree” or “Strongly agree” post-session. Participants were asked to respond to the statement “I understand the typical training and career pathway for a clinical academic”; 41% responded “Agree” or “Strongly agree” pre-session, 100% responded “Agree” or “Strongly agree” post-session. After the session 100% of participants responded “Agree” or “Strongly agree” with the statement “The seminar improved my understanding of clinical academia”.

One resident stated afterwards “That event really was pivotal” to his subsequent appointment as an ACF.

SPARK 2 is a quality improvement project in the West Midlands to support clinical academic residents in the region. We run meetings and have created a WhatsAppgroup to allow for networking and the sharing of knowledge and resources.

Menopause is increasingly recognised as a contributor to mental health presentations. There is a lack of confidence amongst clinicians in investigating and managing menopause in psychiatric patients; up to 41% of psychiatrists reporting feeling “not confident at all” in responding to the hormonal health of female service users. We aimed to evaluate the acceptability and efficacy of a specialist service for menopause and menstrual disorders amongst patients in secondary mental health care.

We devised and ran a Menopause and Menstrual Health Clinic offering email advice, case discussions, and assessments. The clinic is staffed by a consultant with special interest in the field, admin, and with MDT discussion input from Community Gynaecology. We have administered tailored teaching sessions to clinical services across the trust. Pre- and post-intervention survey data has been taken from service users, clinicians, and teaching recipients.

Initial feedback from teaching sessions shows improvement in knowledge and confidence (both 100%, n=12) and a positive impact on clinical practice (100%, n=10).

In the first eight months of operation, the clinic received 43 referrals from 37 referrers across primary and secondary care services. Early quantitative and qualitative feedback from patients and clinicians is positive. 100% of clinicians (n=9) who have responded to date find the clinic has improved the care they offer their patients, naming the “expert advice”, “comprehensive feedback”, and holistic reviews offered as key components of the clinic’s efficacy. 100% of clinicians and patients surveyed found the clinic easy to refer to or attend.Six-monthly follow ups from initial reviews are ongoing, but 100% (n=3) of patients surveyed to date have found treatment changes advised by the clinic to have had a positive impact on their mental health.

Preliminary data suggests the clinic is beneficial to clinicians and patients, with strengths including discussion of novel treatment options, holistic assessment of needs, and open dialogue between professionals regarding hormonal symptomatology and management. Delivering teaching sessions for colleagues to introduce a hormonal lens to formulation and management plans further extends the reach and effectiveness of the clinic. Ongoing work is needed to embed this awareness in routine psychiatric practice, through the expansion of teaching provision and increasing the profile of the clinic’s criteria and referral process. Future research should consider the need to embed consideration of hormonal status into mental health assessments, as a step towards addressing inequitable health outcomes for women.”

The aim of the project was to formalise and structure reciprocal communication between GPs and Queen’s Park and Paddington community mental health hub (QPP CMHH), with the hope of streamlining mental health care, supporting GP colleagues with mental health management, and to improve the quality of referrals.

Three GP surgeries were selected on the basis that they constituted 80% of the referrals to QPP CMHH. A7-item questionnaire (consisting of 5 rating-scale questions, ranging from dissatisfied to very satisfied, and 2 free-text questions) was sent to the GPs at these practices. Both virtual and paper copies were used. GPs were then given access to a spreadsheet that allowed them to book in for patients that they wished to discuss with CMHH, where they provided patient details and the clinical question. Virtual meetings were held every 2 weeks to discuss the cases and for the GPs to receive advice.

A total of 15 pre-intervention questionnaires were returned, from 3 GP surgeries. A total of 13 post-intervention questionnaires were returned, from 1 GP surgery. There was overall improvement in the GP-CMHH relationship, with the greatest improvement seen in the domain ‘communications were being sent via the correct channels’.

Limitations include long-term sustainability, which depends heavily on the commitment and input of more permanent, often senior staff. Suggested areas for improvement included a bypass telephone number to expedite access to QPP professionals for better support for duty GPs, and integrating the discussion referral process into SystmOne, the software that both GP surgeries and CMHT use. Suggested next steps is to widen access to additional GP surgeries.

The aims of this audit are to assess compliance with local audit standards for: (1) documentation of driving status at initial assessment; (2) documentation of DVLA notification advice; and (3) documentation and follow-up of driving safety advice aligned with DVLA/regional guidance because young people with eating disorders (EDs) may experience physical and cognitive impairment (e.g., blackouts, hypotension, hypoglycaemia) that can compromise driving safety. UK Driver and Vehicle Licensing Agency (DVLA) guidance requires individuals to notify DVLA if an ED affects fitness to drive. Yet, no CAMHS-specific local process existed to guide systematic assessment and documentation of the risk that young people pose from driving, to ultimately maintain patient and public safety.

A retrospective electronic case-note review was undertaken within the North Yorkshire & York CAMHS ED Service. All patients aged ≥15 years 9 months up to October 2024 were screened (n=65); 48 met the inclusion criteria. An agreed proforma captured driving status documentation; presence and content of driving safety advice; how this aligned with DVLA/ NHS guidance; follow-up advice at specified intervals; and explicit documentation of DVLA notification advice.

No cases documented driving status at initial assessment (0/48). Any documented driving safety advice was present in 33.3% (16/48) of cases. Among those with documented advice (n=16), follow-up driving advice was recorded in 93.8% (15/16), and 100% had documented advice aligned with DVLA/NHS guidance (16/16). Explicit documentation that the patient should notify DVLA was present in 43.8% (7/16). The key areas for improvement were the lack of risk assessment regarding driving; documentation at initial assessment; and inconsistent DVLA notification advice.

This audit identified that the ED service was not adequately assessing the driving status of young people with ED and/or providing the necessary advice, which could have implications for patient safety. Where advice was documented, quality and follow-up were high, suggesting that introducing structured prompts would be beneficial.

A revised initial assessment pro forma incorporating a structured “Driving Status & Advice” section and visual reminders (a clinic poster) has been implemented; a co-produced CAMHS-specific ED and Driving patient leaflet and an updated follow-up review template are in progress. The second cycle will evaluate the impact of the changes and the standardisation of DVLA-related documentation across the pathway.

As guided by the General Medical Council and the Royal College of Psychiatrists, the inclusion of experts by experience is a required component of British undergraduate medical education and postgraduate psychiatry training. However, this has not been formally applied to the training of Mental Health Tribunal (MHT) and Special Educational Needs and Disability (SEND) Tribunal members who are advised on reasonable adjustments for patients and appellants through the Equal Treatment Bench Book, including guidance on Autism Spectrum Disorder (ASD).

This study aims to evaluate the impact of expert-patient input on tribunal members’ understanding of ASD following a dedicated training programme. We hypothesise that the training day will increase participants’ confidence regarding reasonable adjustments for patients with ASD and will be perceived as novel and valuable.

A multidisciplinary training day was delivered to MHT and SEND Tribunal members in England, jointly by clinicians and experts by experience. The training offered a multimodal overview of ASD and its treatment, and how reasonable adjustments can be made in tribunal hearings.

To evaluate the session, data was collected via online post-session feedback questionnaires. Items were selected to assess participants’ confidence with regard to the training’s learning outcomes, the perceived novelty and value of expert-by-experience involvement, and participants’ willingness to receive a follow-up email six weeks post-training to support consideration of reasonable adjustments.

The training programme was attended by 54 MHT and SEND Tribunal members, of which 24 were judges, 13 were consultant psychiatrists, and 17 were other specialists involved in the care of patients with ASD.

Ninety-four per cent of respondents reported feeling confident after the training session, an increase from retrospectively reported pre-session confidence of 50% (n=18). Over half had no prior exposure to expert-by-experience training (55%, n=47), while a large majority thought MHT and SEND tribunal training should include more input from experts by experience (89%, n=46). 68% of participants (n=45) opted to receive an email six weeks post-training to be prompted to continue to make reasonable adjustments for patients with ASD.

The findings reinforce the effectiveness of expert-by-experience input and highlight its lack of incorporation to date in tribunal training. The willingness of participants to receive a follow-up email six weeks post-training suggests an openness to reflection. Further work should explore how such involvement can be sustainably embedded within tribunal training to support awareness of mental health conditions, including ASD, and the implementation of reasonable adjustments in hearings.

1. To improve carer contact and involvement in Emergency Department (ED) assessments within Devon Partnership Trust (DPT) liaison teams, in line with Psychiatric Liaison Accreditation Network (PLAN) standards, NICE guidance on suicide and safety planning, and the Triangle of Care.

2. To increase carer contact during emergency assessments, and completion of the associated information-sharing form to 90% target.

We began with a baseline audit of 60 emergency assessments in September 2024 across three DPT liaison teams (Torbay, Exeter, and North Devon), using carer-related standards from PLAN and NICE. This revealed carers were not routinely contacted, the information-sharing form infrequently completed, and existing guidance was not consistently followed.

A Quality Improvement project team, including a carer representative, was formed to address these issues–initially focusing on increasing routine carer contact and appropriate documentation. A qualitative survey of team members identified key barriers, which then formed a driver diagram and change ideas implemented from October 2025. Workplace culture change around carer contact emerged as a central priority. A monthly rolling audit of 5 patients per team was implemented to monitor progress.

Initial SPC chart data indicated changes remained within normal variability, particularly in documentation rates. As a result, we maintained focus on early project targets rather than progressing on to the next targets. Nonetheless, recent data shows a positive trend, with updated data to be presented in our poster.

Carer involvement in ED assessments is essential for enhancing assessment quality and patient safety, and is supported by PLAN, NICE, and the Triangle of Care. However, achieving consistent change is complex, particularly in shifting workplace culture. Our ongoing strategies are beginning to show success, and the project will continue until September 2026.

This audit evaluated antipsychotic prescribing practices for behavioural management in Child and Adolescent Mental Health Services (CAMHS) against National Institute for Health and Care Excellence (NICE) guidelines and local protocols. We hypothesised that prescribing indications would be guideline-compliant, while adherence to physical health monitoring would be lower in community settings compared to inpatient units. We further anticipated that the use of standardised outcome measures would be suboptimal across both services.

A retrospective clinical audit was conducted on the electronic health records of 26 patients prescribed antipsychotics for behavioural management (13 from the Red Kite View inpatient unit; 13 from Leeds Community Healthcare community CAMHS). Data were collected between February 2023 and February 2025. Practice was measured against standards derived from NICE guidelines (NG11, CG155, CG170), the Maudsley Prescribing Guidelines, and local Trust protocols. Criteria included appropriateness of indication, specialist initiation, baseline and ongoing physical health monitoring, and the use of standardised outcome measures.

Compliance with indication and dosing guidelines was high, with 100% of cases documenting appropriate indications across both services. Specialist initiation was common (100% inpatient; 85% community). Documentation that psychological interventions were attempted prior to medication was lower in community settings (54%) compared with inpatient services (77%).

Significant deficits were identified in monitoring and outcome measurement. Standardised behavioural rating scales were not used in any cases across either setting (0%). Baseline movement disorder assessments were absent in community services (0%) and inconsistent in inpatient care (54%). Marked disparities were observed in baseline safety blood tests (full blood count, urea and electrolytes, liver function tests), completed in 92% of inpatient cases versus 38% in the community. Ongoing community monitoring demonstrated critical gaps, including 0% adherence to recommended weekly weight monitoring during titration and 0% completion of six-month liver function tests.

The findings support the hypothesis: while clinical decision-making around antipsychotic initiation is largely guideline-compliant, substantial systemic gaps exist in physical health monitoring, particularly in community CAMHS. Furthermore, the universal absence of standardised outcome measures limits the objective assessment of benefit. Targeted interventions are required, including strengthened community physical health monitoring pathways, mandatory baseline movement disorder assessments, and the routine use of standardised behavioural outcome tools.

The aim of the project is to explore resident doctors’ experience of workplace-based violence within Central and Northwest London NHS Foundation Trust. These findings will help:

1) To identify barriers to reporting incidents.

2) To improve access to wellbeing support provided to resident doctors.

3) To update serious incident policy for resident doctors.

Both qualitative and quantitative surveys were conducted among all the resident doctors in Central and Northwest London NHS Foundation Trust.

Quantitative Survey: Between January and February 2025, Resident Doctors within Central and Northwest London NHS Trust were invited to complete a 13-item quantitative survey. 34 responses were received.

Qualitative Interviews: Following responses from quantitative surveys, seven resident doctors who reported workplace-based violence through Datix agreed to participate in semi-structured qualitative interviews, consisting of 13 questions. All the interviews were conducted through Microsoft teams and transcribed. Interview responses were analysed through thematic analysis to identify common themes and subthemes of individual perception and reflection on their experience of violence.

Quantitative Survey:

34 resident doctors from different grades (foundation year doctors, GP trainees, core trainees, and higher trainees) across five different boroughs responded to quantitative surveys. Of these, five core trainees, three higher trainees, two foundation year trainees and two GP trainees reported the violence.

These resident doctors who experience violence are 40% from inpatient units and 60% from community clinics. Physical and non-physical violence are most common types of violence that resident doctors experienced. Only 7 out of 20 resident doctors who experienced workplace violence reported the incident through the incident reporting system called Datix.

Qualitative Survey:

Seven resident doctors participated in interviews exploring their experience of workplace-based violence. Participants include one higher trainee, one GP trainee and five core trainees. Participants highlighted there were significant impacts of violence or aggression on emotional wellbeing as well as professionally on career commitment. A common theme emerging from the semi-structured interviews was that resident doctors who experienced physical violence were preceded by non-physical or verbal violence.

Resident doctors experiencing workplace violence and aggression in the NHS is common across different specialities, among which unfortunately psychiatry resident doctors experience the most.

In addition, resident doctors in training do not have always access to the help and support that they need following these incidents. Quantitative survey and Qualitative thematic analysis of this project call for Improved access to various wellbeing resources and Individual support for all resident doctors who experience workplace-based violence.

The aim of this initiative was to provide a structured, high-quality psychiatry teaching programme to support our Trust’s nurses’ Continuous Professional Development (CPD) and revalidation. This programme sought to further improve nurses’ clinical knowledge, prescribing skills and legal understanding.

Since February 2025, monthly afternoon educational sessions were delivered face to face at Harplands Hospital, by experienced doctors, and open to all nursing staff, especially those pursuing higher education. Each session covers two clinically relevant topics, including psychosis, bipolar affective disorder, psychopharmacology, eating disorders, ADHD and medication monitoring. Attendees were encouraged to participate and to promote engagement and consolidate newly acquired knowledge, a Kahoot quiz was used each session.

Feedback was collected from attendees following each session. This questionnaire asked whether participants found the teaching helpful, whether the content was pitched at an appropriate level, asking for topic suggestions to cover in future CPD sessions, and what did they enjoy most about that day’s teaching. Open-text qualitative feedback is regularly analysed to determine quality of teaching and shape future topics.

Feedback has been consistently positive. The vast majority of nurses reported the sessions to be helpful and pitched at an appropriate level for their job role. Teaching was described as engaging, relevant, interactive, and supportive of their CPD and revalidation needs. Use of Kahoot and the enthusiasm of the teachers were frequently noted as being valued.

Analysis of feedback showed a recurrent theme among request including ADHD, ECG and blood test interpretation, clozapine monitoring, refeeding syndrome, mood disorders, and commoncomorbid physical health conditions. This feedback shaped subsequent teaching sessions, ensuring the programme continued to be response and learner-centred.

The feedback from this monthly psychiatry teaching programme has successfully provided medical education to support with nursing CPD and revalidation requirements. Engagement has always been high and consistently positive feedback demonstrated the value of the programme in enhancing nurses’ knowledge, confidence, and clinical practice. Subsequently, our Trust is exploring protected teaching time for our nursing colleagues further reflecting the Trust’s commitment to continued professional development and patient care. Future plans including expanding bespoke sessions tailored to service needs and inviting novel speakers with specialist knowledge.