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

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

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

Six interrelated themes emerged.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Comparative data on restrictive practices revealed a significant disparity:

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

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

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

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

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

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

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

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

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

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

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

We set out to finish the audit loop started in 2024 at The Cove CAMHS unit. Our goal was straightforward: to prove that the fixes we put in place were actually working. Specifically, we wanted to see if tribunal reports were finally being submitted on time and if clinicians were properly documenting their conversations with the young people they treat. We also needed to ensure that our clinical standards didn’t slip during a period of systemic change, particularly with the introduction of a new digital reporting template late in the year.

We compared two years of tribunal reports side-by-side: the 2024 baseline and the 2025 re-audit. In total, we reviewed every single report produced across both years (N=28) against 27 mandatory standards from the MHA Code of Practice. The interventions we tested between the two years included a new administrative tracking system for legal deadlines and a clearer clinical pathway designed to make sure patient discussions weren’t just happening, but were being recorded accurately in the notes.

Overall compliance climbed from 94.4% to 97.1%. Our biggest success was in timeliness: we moved from a failing 64.3% to a perfect 100% submission rate. We also saw documented patient discussions more than double, jumping from 28.6% to 64.3%. However, the data revealed a new problem: a compliance dip (85.2%) directly linked to the new digital template. Because certain prompts were missing in the new software, clinicians started omitting patient strengths and detention justifications–a critical finding that highlights the hidden risks of digital transitions.

Completing this audit cycle confirms that administrative delays in tribunal reporting are solvable through better process mapping. While reaching 100% timeliness is a significant win for the ward, the 64.3% compliance in documenting patient discussions shows that clinical culture takes longer to change than administrative rules. Our discovery of a “transition gap” with the new template warns that digital updates can inadvertently sideline statutory details. We must now move beyond administrative fixes to focus on meaningful engagement, ensuring the “voice of the child” remains central to the tribunal process, regardless of the reporting format used.

Memantine is an NMDA receptor antagonist used as pro-cognitive medication across the world. In the UK, it is licensed for moderate-to-severe stages of Alzheimer’s dementia. Memantine, like other medications, is associated with side effects that could be life-threatening in certain occasions. While clinicians mainly focus on medication initiation, titration and switch-over, deprescribing remains a critical step to uphold patients’ care especially in older adults and those who are more vulnerable to side effects.

85-year-old lady with advanced mixed dementia on a psychiatric ward had a fall and a pelvic fracture. Following surgery, there was evident decline in her physical and mental health. She was nursed in bed all time and could not engage with post-operative rehabilitation. She became agitated on personal care interventions then started to present with impaired consciousness for extended periods during the day. The presentation continued to get worse to the extent that her impaired consciousness affected her diet and fluid intake and she lost significant amount of weight. Prolonged postoperative delirium was evident but there was no clear culprit to why her presentation is getting worse. Interestingly, her medication concordance was not affected for the majority of that period. It was felt that the patient could be slowly dying so we discussed the situation with palliative care team; they noticed some choreo-athetotic movements in the patient’s limbs which prompted reviewing her psychotropic medications which included Memantine 20mg. Once Memantine was discontinued, all the patient’s symptoms improved including her impaired conscious level and the abnormal limb movements.

Literature review highlighted rare associations between Memantine, such abnormal movements and impaired consciousness. This patient’s recovery from this post-operative state was lengthy and was eventually achieved after addressing “a blind spot” which was the prescribed medication Memantine. The main reason to stop Memantine was the patient’s abnormal movements but it was also responsible for the impaired conscious level. Once Memantine was discontinued, the patient’s mental and physical states changed dramatically. She became more responsive and her conscious level was back to normal. The choreo-athetotic movements were no longer visible as well.

Deprescribing is a valuable yet missed tool for improving patient outcomes. It is commonly undertaken when a medication is clearly linked to adverse effects and is often paired with prescribing alternatives. However, deprescribing is frequently overlooked when symptoms are not evidently medication-related. Implementing a proactive deprescribing process can help reduce iatrogenic harm and improve overall clinical outcomes.

The National Institute for Health and Care Excellence (NICE) and local prescribing guidance recommend that, after titration and dose stabilisation, prescribing and monitoring of Attention Deficit Hyperactivity Disorder (ADHD) medication should be carried out under shared care arrangements with primary care. In practice, shared care requests are accepted to varying degrees, thereby increasing service burden for secondary care.

We aimed to estimate the current acceptance rate of shared care requests for ADHD medications in Hull and the East Riding, explore factors influencing uptake, and recommend improvements to shared care arrangements with primary care.

A retrospective exploratory audit was conducted using electronic patient records from the Children and Young People’s Neurodevelopmental Service.

The data capture period was from 01/07/2025 to 01/09/2025. The audit included a consecutive sample of all patients identified.

The patient’s ADHD medication, shared care request, outcome, and reasons for prescription decisions, despite a shared care agreement, were recorded in an Excel spreadsheet. Data were collected retrospectively in December 2025.

Of 114 patients identified, 62 (55%) had shared care requests, 50 (45%) had none, and 2 were not medicated. Of the 62 patients who had shared care requests, 43 (69%) were accepted, 13 (21%) received no response, and 6 (10%) were declined. 4 of the 6 patients whose shared care protocol was declined are from the same General Practitioner (GP) Practice, which cited local prescribing guidelines for declining to prescribe or monitor methylphenidate. There was no clear documentation regarding prescribing decisions despite a shared care agreement in place. Prescribing commonly followed dose changes, formulation changes, or drug holidays. 2 patients were still undergoing titration.

Shared care uptake in primary care could be improved primarily by increasing the rate and timeliness of requests from secondary care, implementing systematic follow-up, and targeting engagement with GP practices that are not responding to or declining shared care. These recommendations, along with routine documentation of shared care status in clinic letters and a clear rationale for prescribing despite a shared care agreement, have been communicated to all prescribers in the service and other relevant stakeholders. A re-audit is planned to assess the impact of the implemented recommendations on improving uptake, facilitating easier access to medication, reducing service burden, and increasing capacity for new patients.

Acknowledgements

We thank:

Dr Syed S. M. H. Naqvi, Consultant Child and Adolescent Psychiatrist, for supervision and guidance.

Jo Allison, Nurse Prescriber, for data support.

Patients with severe mental illness frequently present with complex physical health comorbidities, creating significant challenges for safe inpatient management on acute psychiatric wards. Patient’s impaired capacity and behavioural disturbance can further complicate engagement with essential medical care. This case highlights the importance of integrated physical and mental health management and multidisciplinary team collaboration in achieving positive outcomes.

X is a 46-year-old female with a diagnosis of Schizoaffective disorder and poorly controlled Type I Diabetes. She presented with a progressive deterioration in mental state following discontinuation of Clozapine and Lithium. Intermittent refusal of BG monitoring, erratic and unhealthy dietary habits, and variable cooperation with insulin administration led to significant glycaemic instability, requiring coordinated Multidisciplinary team (MDT) input to ensure patient safety. Patient was transitioned to Paliperidone depot injection due to the favourable metabolic profile.

A coordinated MDT approach was implemented. Nursing staff adhered to a structured rapid-acting insulin management plan, administering additional doses in response to BG readings. A Freestyle Libre continuous glucose monitoring sensor was introduced, with staff educating the patient, helping to set up alerts for hypo- and hyperglycaemia. Dietitian’s input was provided, alongside liaison with hospital catering services to facilitate healthier food substitutions.

As a result the patient’s glycaemic control improved markedly, with reduced BG fluctuations and decreased need for additional rapid-acting insulin. This improvement was reflected in a significant reduction in HbA1c from 92 mmol/mol (21/11/25) to 69 mmol/mol (14/01/26) within less than 3 months. The patient demonstrated sustained behavioural change, discontinuing takeaway food and adopting healthier eating habits.

Symptom severity, measured using the Brief Psychiatric Rating Scale (BPRS), reduced from 52 to 29, representing 44 % demonstrating a substantial reduction in psychotic, affective, and behavioural symptoms.

Occupational therapy task observation scale (OTTOS) total score increased from 61/200 to 190/200, representing 64.5% increase, indicating a substantial improvement in both task performance and overall functional behaviour.

GAP (global assessment of progress) score improved from 40/70 on admission to 59/70, representing an absolute increase of 19 points and reflecting a 27% improvement across the different domains, highlighting a marked improvement in clinical stability and functional engagement.

Integrated physical and mental health care is essential for patients with severe mental illness and complex comorbidities. This case demonstrates that even during acute psychiatric deterioration, effective management of complex physical health conditions is achievable through structured care plans, consistent nursing input, and strong multidisciplinary team collaboration.

This systematic review investigates the psychological phenomenon of Cancel Culture Induced Anxiety (CCIA) among Generation Z individuals aged 16–25. The primary aims are to synthesise empirical evidence from existing literature and develop an integrated conceptual model mapping the causes, pathways, and psychological effects of this condition.

A systematic review was conducted in accordance with PRISMA guidelines and the Cochrane Method. Comprehensive literature searches were performed across PsychINFO,PubMed, and Scopus to identify peer-reviewed, primary empirical studies. Ten studies were selected for inclusion based on a predefined Population, Exposure, Outcome (PEO) framework. Quality Assessment was then performed using Critical Appraisal Skills Programme (CASP) checklists. Finally, evidence was synthesised using the Temporal Need Threat Model, context collapse, and networked publics as theoretical foundations.

Findings indicate that CCIA manifests primarily as acute social anxiety, which frequently escalates to clinical depression, diminished self-esteem, and in severe cases, suicidal ideation. Key behavioural outcomes include avoidance, self-censorship, and both internal and external conformity. These effects are sustained through psychological mechanisms such as rejection sensitivity and rumination. The review establishes that CCIA is driven by simultaneous threats to four fundamental human needs: belonging, self-esteem, control and meaningful existence. Social media, shaped by the dynamics of context collapse, emerges as the dominant environment for CCIA, though its severity is mediated by cultural, socio-economic, and individual predisposing and protective factors. The identified coping strategies are predominantly reactive and individualised, highlighting a significant gap for systemic and preventative interventions.

The proposed conceptual model establishes a vital foundation for understanding CCIA across diverse cultural and social contexts. It offers practical guidance for psychiatrists and mental health professionals in designing targeted clinical interventions and institutional policies. Future research should employ longitudinal and mixed-method approaches to validate the model and inform preventative strategies, addressing CCIA as a systemic feature of the digital age.

Risperidone is prescribed to children and adolescents for psychotic conditions when non-drug interventions are insufficient. It carries a significant risk of hyperprolactinaemia, which may adversely affect growth, pubertal development, and bone health. This audit assessed adherence to local hospital guidelines on prolactin monitoring for child and adolescent patients on risperidone, which align with the National Institute for Health and Clinical Excellence (NICE) Guideline CG155, at the Behavioural Sciences Institute (BSI) in Al Ain, United Arab Emirates (UAE).

A retrospective clinical audit was conducted at the BSI, Al Ain Hospital. Electronic medical records were reviewed for patients aged 18 years or younger who were initiated on risperidone from January 2023 onwards and maintained on treatment for at leastsix months. Data were collected between April and July 2025. Patients who discontinued risperidone within six months or had incomplete follow-up were excluded. Audit standards were based on local hospital protocols aligned with national guidelines, focusing on documentation of prolactin measurements at baseline, 12 weeks, and six months after treatment initiation. Data were analysed descriptively and reported as frequencies and percentages.

Of 52 cases reviewed, 49 met the inclusion criteria. The sample comprised 42 males (86%), with ages ranging from 3 to 17 years (mean 9.6 years). The majority of patients (96%) had diagnoses of psychosis associated with neurodevelopmental conditions, including attention-deficit hyperactivity disorder, autism spectrum disorder, or intellectual disability. Baseline prolactin monitoring was performed more frequently than follow-up monitoring. Prolactin measurement at 12 weeks was documented in 12% of patients, with reasons recorded for non-monitoring in 8% of cases. Monitoring at the six-month interval was more commonly completed, although a substantial proportion of patients did not undergo recommended testing at this time point.

This audit identified partial adherence to prolactin monitoring guidelines in children and adolescents prescribed risperidone at a tertiary mental health service. While baseline and six-month monitoring were more frequently completed, monitoring at the 12-week interval and documentation of reasons for missed tests were suboptimal. These findings highlight the need for targeted quality-improvement strategies, including electronic reminders, staff education, and improved documentation practices, to ensure safer prescribing and early detection of antipsychotic-induced hyperprolactinaemia in this vulnerable population.

No financial sponsorship has been received for this project.

Depression is estimated to affect approximately 10% of patients in primary care. Timely follow-up is crucial for monitoring symptom progression, assessing suicide risk, and evaluating treatment response. NICE (2022) recommend review within 2–4 weeks of diagnosis, or within 1 week if suicide risk is identified, while the Quality and Outcomes Framework (QOF) provide a broader window of 10–56 days. Despite the integral role of primary care in the management of depression, adherence to these standards varies widely across UK practices, putting patients at risk of clinical deterioration and suicide.

Assessing compliance with NICE guidelines for depression can identify gaps and guide strategies to improve patient safety and clinical outcomes. This audit therefore evaluated adherence to NICE guidelines in a South London GP practice, with a focus on review timing and documentation of suicide risk assessment.

1. To determine the proportion of patients with newly diagnosed depression who received a follow-up review within 2–4 weeks

2. To assess documentation of suicidal risk assessment and subsequent follow-up.

A retrospective audit of EMIS records identified all patients diagnosed with “Depression” or “Mixed depressive and anxiety disorder” from January and May 2024 (n=70). Fourteen patients were excluded as the 4-week review window had not yet elapsed, leaving 56 patients for analysis. Data were collected across nine parameters, including review timing, suicide risk documentation, treatment initiation, comorbidities, and referrals to specialist or psychological services.

The sample included 56 patients (59% female, mean age of 39.6 years). A notable 59% of patients had no documented review, with nearly half having recorded comorbidities. Only 41% had a documented review (n=23), with just 25% (n=14) being reviewed within the NICE recommended 2–4-week timeframe, while 39% met the QOF target of 10-56 days. Suicide risk assessment was documented in 91% of cases; however, 27% of patients reporting suicidal ideation had no documented referral to specialist or psychological services.

Adherence to NICE-recommended follow up for depression in primary care was low, with significant gaps in referral for patients with suicidal ideation, posing concerns regarding patient safety. Targeted strategies such as staff training on guideline compliance, automated follow-up prompts within EMIS, and integration of mental health reviews within multimorbidity consultations may improve compliance and support safer depression management. Ongoing monitoring and larger multi-site audits are needed to guide quality improvement in depression management on a broader scale.

Timely and accurate admission clerking is essential for safe and effective care in inpatient psychiatric settings. In our adult acute inpatient psychiatric unit, admission clerking was frequently delayed and inconsistently completed, increasing risks to patient safety, delaying treatment initiation, and impairing multidisciplinary communication. This quality improvement (QI) project aimed to improve the timeliness and completeness of admission clerking by ensuring completion within 72 hours of admission and achieving at least 70% documentation completeness by December 2025.

A QI methodology using Plan–Do–Study–Act (PDSA) cycles was employed. Afishbone diagram and driver diagram were developed to identify contributory factors and guide interventions. Baseline data were collected to assess current performance and identify priority areas for improvement. Two change ideas were tested. The first involved extending the target timeframe for admission clerking completion to within 72 hours of admission, which was clearly communicated to all medical staff. The second involved introducing a standardized admission clerking template to ensure consistent documentation of key domains, including mental state examination, risk assessment, physical health, and social history. Data on timeliness and completeness of admission clerking were collected and reviewed across sequential PDSA cycles.

Following implementation of the first intervention, the initial PDSA cycle demonstrated a significant qualitative improvement in admission clerking completion rates, although quantitative variability in documentation quality remained. During the second PDSA cycle, the extended 72-hour target was retained and combined with the standardized clerking template. Over the final twelve weeks of data collection, this combined approach resulted in a sustained improvement in both timeliness and completeness, achieving a 100% admission clerking completion rate.

Clearly defined timeframes combined with standardized documentation tools can significantly improve the quality, timeliness, and sustainability of admission clerking in inpatient psychiatric settings. Plans are underway to scale this intervention across the wider trust and continue data collection to evaluate long-term impact and sustainability.

Obesity and eating disorders (EDs) are associated with high morbidity, mortality, and limited long-term treatment efficacy. Virtual reality (VR) interventions are increasingly used in these conditions, yet their effects on objective biomarker outcomes have not been systematically evaluated. This review aimed to synthesize and critically appraise evidence on the effects of immersive VR interventions on clinical and biomarker outcomes in obesity and EDs.

A systematic review was conducted following PRISMA 2020 guidelines. PubMed, Web of Science, and PsycINFO were searched from inception to April 2025. Eligible studies evaluated immersive VR interventions targeting obesity or EDs and reported at least one biomarker outcome, including anthropometric, physiological/autonomic, endocrine/metabolic, or neurocognitive measures. Randomized controlled trials (RCTs), non-randomized trials, and observational studies were included. Risk of bias was assessed using Joanna Briggs Institute tools. Random-effects meta-analyses were conducted when three or more RCTs reported comparable outcomes; otherwise, a structured narrative synthesis was conducted.

Twenty-three studies (N=1,413; obesity=11, EDs=12) were included. ED populations comprised individuals with anorexia nervosa, bulimia nervosa, and binge-eating disorder.

Obesity: VR-enhanced cognitive–behavioural therapy (VR-CBT) promoted sustained weight loss, whereas VR-based exercise interventions produced short-term reductions in BMI and body weight. Meta-analysis of four RCTs revealed a significant pooled effect of VR versus control on anthropometric outcomes (Hedges’ g=−0.35, 95% CI [−0.61,−0.09], p=0.009; I²=0%), with stronger effects for VR-CBT. Long-term follow-up (6–12 months) confirmed sustained benefits (g=−0.39, 95% CI [−0.73,−0.05]). Within-group pre–post analyses consistently showed reductions in BMI and weight (g=−0.56).

Eating Disorders: VR-CBT consistently reduced body image disturbance and fear of weight gain, while VR cue-exposure therapy decreased binge-eating and purging behaviours. Eye-tracking measures revealed attentional biases toward disorder-relevant cues. Autonomic markers (heart rate, heart rate variability, skin conductance), endocrine biomarkers (cortisol, α-amylase, leptin), and enzymatic measures confirmed that VR reliably elicited measurable psychophysiological responses.

Immersive VR interventions show promise for improving clinical outcomes and eliciting measurable biomarker changes in obesity and EDs. Evidence supports VR-CBT for sustained anthropometric improvements and highlights VR’s potential for investigating autonomic and neurocognitive mechanisms. Larger, biomarker-integrated RCTs are needed to confirm efficacy and inform personalized, mechanism-driven treatment approaches.