The primary aim was to assess the quality of recording mental capacity assessments by the Chesterfield MHLT to ensure compliance with legal and ethical obligations. The audit aimed for 100% documentation of capacity assessments during all mental health reviews. Additionally, the project targeted a minimum Grade 2 standard (moderate detail) in documenting the four functional stages of capacity for all patients, ensuring that narrative and context regarding a patient’s capacity component were thoroughly recorded.

A retrospective review of 30 randomized electronic patient records (electronic system) was conducted for the Chesterfield MHLT for cases identified between January and February 2025. Data was analysed to determine the presence of broad capacity assessments and, crucially, to evaluate the quality of documentation regarding the four functional stages: Understanding, Retaining, Weighing-up, and Communicating information. A standardized grading scale (Grade 0-3) was utilized to measure the depth of narrative and the presence of direct patient quotes in the documentation

While a broad assessment of capacity was recorded in 90% of cases, the documentation quality regarding specific domains was inadequate. Only 37% of cases explicitly documented the specific decision being assessed, such as consent to medication or admission, representing a critical gap in compliance. Furthermore, the detailed assessment of the functional stages frequently failed to meet the required standard. For the functional domains of “Understanding” and “Communicating,” 50% of cases showed no evidence (Grade 0) of documentation. Similarly, 40% of cases showed no evidence of documentation for “Weighing-up” information, highlighting a significant discrepancy between broad capacity recording and the required detailed documentation of the assessment process

This audit highlights that while capacity is often broadly recorded, the specific, detailed assessment of how patients understand, retain, weigh up information, and communicate their decisions is frequently absent or insufficient. To enhance compliance, we recommend integrating mandatory MCA forms into the core assessment template on electronic and enforcing explicit, decision-specific documentation. A re-audit is planned in six months to measure the impact of these changes on documentation quality and patient autonomy.

The primary aim of this project was to assess the current knowledge and confidence levels of medical employees regarding the management of transgender patients within the Kent and Medway Mental Health NHS Trust (KMMH). Against a background of recent legal changes and scarce guidelines, we hypothesised that despite likely clinical exposure to this demographic, staff confidence and awareness of specific policies would be low. The results are intended to drive the development of a dedicated Trust policy and training curriculum.

This project was designed as a service evaluation utilising an anonymous electronic questionnaire distributed to medical staff by the medical education team. The survey consisted of five questions addressing clinical experience, self-reported confidence, training history, and awareness of gender reassignment processes and relevant guidelines. Qualitative data were also collected through free-text comments. Data collection and analysis focused on quantifying the gap between patient contact and provider preparedness.

A total of 43 completed responses were received from over 300 medical staff. The data revealed that while the vast majority of staff (83.7%) had been involved in the care of transgender patients, confidence remained low. Only 41.9% of respondents felt “quite confident” managing these patients in a mental health setting, with 58.1% reporting they were “not confident”.

Gaps in education and governance were prominent. Eighty-six per cent (86%) of respondents stated they had received no training in the management of transgender patients. Furthermore, 60.5% were unaware of current gender reassignment processes in the United Kingdom (UK), and 79.1% were unaware of any national guidelines or hospital policies regarding healthcare for this group. Qualitative feedback supported these figures, with staff requesting specific training on pronouns, legal frameworks, and “user perspectives” from the trans community.

The audit demonstrates a significant disparity between the high frequency of clinical contact with transgender patients and the low levels of staff training and confidence. The widespread lack of awareness regarding existing guidelines indicates an urgent need for the formalisation of Trust policies and the implementation of targeted educational workshops. Improving staff knowledge is critical to mitigating risk and ensuring effective, respectful care for transgender service users.

Individuals with severe mental illness experience a disproportionate burden of oral disease. Contributory factors include medication-induced xerostomia, cognitive deficits, and impaired motivation for self-care. Studies found that they are significantly less likely to engage in preventative dental behaviours or utilize services. Inpatient admission provides an opportunity to engage our service users in promoting their oral hygiene. Hence, an audit can provide valuable insights into current practices and identify areas for improvement and highlight gaps in service provision.

The study was conducted between April to May 2025 across inpatient mental health units within Derbyshire Healthcare NHS Foundation Trust. Electronic patient records were reviewed to assess completion of the ‘Eating, Drinking and Oral Health’ questionnaire and the standardized oral health risk assessment during their admission. The audit also examined the prevalence of documented dental issues and access to dental services. A structured data collection tool was developed to capture sex, gender, ward type, documentation of oral health assessments, completion of dental screening questionnaires and risk assessments, identified oral health issues, and access to dental care during their admission. Trust inpatient policy requires all inpatients to receive a comprehensive physical health assessment including oral health examination on admission, and dental hygiene included in ongoing nursing care reviews.

A total of 114 patients were included in this study, from acute working age (n=40), older adult (n=34), low-secure forensic (n=20), and rehabilitation ward (n=19), with a mean age of 53.6 years. 72/114 were male. Although the “Eating, Drinking and Oral Health” questionnaire was partially completed for 61.4% (n=70/114), full compliance was not achieved for any patient. Formal oral health examinations were recorded for only 10.5% (n=12/114), with the lowest rates observed in the forensic unit (0%). Notably, no patients had a completed oral health risk assessment. Of the 30 patients who presented with acute dental issues during their admission, 18 successfully accessed professional dental care, though access rates varied significantly between ward types with the service users in the forensic ward among the highest.

The audit demonstrates that current monitoring and documentation practices of oral hygiene in our local trust requires improvement. Immediate interventions should focus on increasing awareness, optimizing the accessibility of relevant assessment tools, and implementing clinical prompts to improve documentation quality. Long-term strategies must prioritize the integration of oral health into multidisciplinary care planning and the establishment of formal referral pathways with community dental providers to ensure holistic patient management.

Erotomanic delusions involve the fixed false belief that another person (often of higher social status) is in love with the individual. Although rare, erotomania is clinically significant due to its association with stalking, harassment, and, in some cases, serious violence. Risk assessment framework deficits have contributed to fragmented understanding of factors associated with violent escalation. Existing evidence is largely confined to case reports and case series, limiting systematic synthesis of clinical and contextual risk factors. This scoping review aimed to synthesise published case-level evidence on erotomania associated with stalking and/or violent behaviour. The primary objective was to identify individual, clinical, and contextual factors linked to stalking or violence in people with erotomanic delusions. Secondary objectives were to describe the nature and severity of violence and to identify gaps in the literature.

A literature search was conducted in January 2026 using six databases. Eligible publications included case reports, case series, and observational or qualitative studies describing erotomanic delusions in connection with stalking or violence. Data were extracted using Covidence capturing sociodemographic, clinical and criminological factors. Results were synthesised descriptively and reported as frequencies and percentages overall and by sex. Fifty publications comprising 87 cases were included.

The sample included 51 males (58.6%) and 36 females (41.4%), with a mean age of 36.0 years (SD 11.7). Most individuals were single, socially isolated and had unstable living arrangements. Erotomanic delusions were most commonly described in the context of a primary diagnosis of a psychotic illness (90.8%). Co-occurring delusional themes were common, particularly referential, persecutory, and grandiose delusions.

Stalking was reported in 88.5% of cases, typically involving a single object. Victims were predominantly female (64.5%) and most often professionals (e.g. clinicians, employers). Violence occurred in 49.4% of cases, with males significantly more likely to perpetrate severe violence. Common motivations included delusional beliefs of reciprocated love and perceived rejection. Criminal charges arose in over half of cases, particularly among male offenders.

Erotomania associated with stalking and violence represents a high-risk clinical and forensic phenomenon. The literature remains dominated by descriptive reports underscoring the need for structured risk assessment approaches, clearer diagnostic guidance, and targeted management strategies to prevent escalation and harm.

Autism spectrum condition (ASC) remains underdiagnosed in adults, particularly among women and individuals from marginalised and inclusion health groups. Contributing factors include masking, cultural stigma and inequities in service design. Skylight Psychiatry is an adult neurodiversity assessment service delivering NHS-commissioned and self-funded care through a hybrid diagnostic model, combining face-to-face ADOS-2 assessments with virtual clinical assessments and developmental history appointments. Although a range of reasonable adjustments and neuroaffirmative practices are embedded within the service, a formal evaluation of equality, diversity, and inclusion had not previously been undertaken.

This audit evaluates the inclusivity of an adult autism assessment service by analysing patient demographics and systematically reviewing assessment pathways, policies, and accessible information to identify strengths and areas for improvement.

A mixed-methods service audit was conducted. A voluntary demographic questionnaire was distributed to prospective referrals across two geographical cohorts, with quantitative findings compared against UK population demographics. A structured qualitative review examined policies and procedures, assessment pathways, and neuroaffirmative clinical practice and report writing. This was benchmarked against NHS inclusion health principles, NICE guidelines, and inclusive communication principles.

Quantitative findings demonstrated strong representation of women, gender-diverse individuals, and LGBTQIA+ patients compared with national averages, consistent with emerging literature on adult autism and camouflaging. Demographical representation from some ethnic minority and religious groups was lower than expected, suggesting potential cultural or systemic barriers to access. The qualitative review identified strengths in flexible, patient-centred assessment delivery and consistent neuroaffirmative approaches across appointments. Suggested areas for improvement included suggested evaluation of physical accessibility across clinic sites and consideration of the risks of digital exclusion. Findings suggested that there was some inconsistent use of inclusive language in some clinical documentation, which may be mitigated by the introduction of specific training centred around increasing inclusion and reducing potential diagnostic bias.

This audit demonstrates that a hybrid adult autism diagnostic model can support inclusive and patient-centred care when underpinned by reasonable adjustments and neuroaffirmative practice. However, disparities in access persist for some marginalised groups. It was suggested that the service should prioritise improving equality through the introduction of interventions, such as accessible correspondence, easy-read materials, and translated online content, alongside targeted workforce development. These recommendations are likely to improve access and mitigate adverse outcomes associated with delayed or missed diagnosis.

The aim of this audit is to assess compliance with physical health monitoring for patients admitted in an acute inpatient setting including weight, height, BMI, waist circumference. Also to assess if metabolic risk factors have been identified and whether appropriate risk mitigation measures were taken.

This is a retrospective audit design where electronic patient records of patients admitted in an acute inpatient unit between November 2024 and August 2025 were reviewed. Information was extracted to determine whether physical health monitoring including weight, height, BMI, waist circumference was completed at baseline (on admission), at 4 weeks, 8 weeks, 12 weeks and subsequently every 3 months. Data was only collected for the duration of the inpatient stay.

Drug charts were reviewed to see whether any changes were made to the treatment regime while inpatient. Discharge summaries were also reviewed specifically the section titled “Plan and Requested Actions” to determine any advice and follow up recommendation were made.

100 patients were admitted in the ward between November 2024 and August 2025. Waist circumference was not measured during the whole length of stay for any patient.

Base line weight was not recorded in 12 patients, height was not recorded in 14 patients. BMI was not calculated for 15 patients.4 patients were not on any psychotropic. Unclear documentation about medication for 3 patients.

37 patients were discharged/transferred before 4 week review.Among the remaining 63 patients, weight was not recorded in 21 (33.33%) patients, height was not recorded in 22 (34.9%) patients. BMI was not calculated in 23 (36.5%) patients. 2 patients didn’t have any psychotropics prescribed.

By 8 weeks, 30 patients were discharged/ transferred. Among the remaining 33 patients,weight was not recorded in 13 (39.39%) patients, height and BMI was not recorded in 14 (42.42%)patients. No psychotropics were prescribed for 1 patient

By 12 weeks, 15 patients were discharged/transferred. Among the remaining 18 patients, weight, height and BMI were not measured in 7 (38.8%) patients.

Before 3 monthly monitoring review point, 13 patients were discharged. Among the remaining 5 patients, weight was not monitored for 1 (20%) patients. 2 (40%) patients didn’t have their height and weight measured.

35 patients had documentation regarding their metabolic risk factor. No patient had clear documentation regarding action taken to mitigate these risks.

This audit shows the need for consistent weight monitoring and implementing a structured traffic-light risk category system to enable early identification and management of antipsychotic-induced weight gain.

Seclusion is highly restrictive and is a last resort to manage immediate risk of harm towards others. Therefore it requires high quality medical reviews and clear documentation to ensure patient safety.

• • To assess compliance with local trust standards for medical seclusion reviews in a inpatient mental health unit (Meadowbrook Unit, Salford, Manchester)

• • Evaluate the impact of quality improvement measures through an re-audit.

Trust policy outlines eight core review criteria: assessment of physical and psychiatric health, medication and adverse effects, observations, risks to others and to self, and the ongoing need for seclusion. This is alongside two best-practice criteria addressing harms of seclusion and steps required to end it/patient awareness.

Quality improvement measures(local teaching/presentations, communication to line managers, and a poster of trust standards in clinical areas) were implemented after an initial audit in July 2024. The re-audit was conducted in March 2025.

A retrospective audit of medical seclusion reviews was conducted using electronic clinical records within an inpatient mental health unit. Forty seclusion reviews from July–August 2024 were analysed against local trust seclusion review criteria. A re-audit of 56 seclusion reviews conducted between March and June 2025 was then undertaken to assess changes in practice.

The re-audit demonstrated higher quality seclusion reviews. No reviews met all eight criteria in 2024, but seven reviews did in 2025. The most common number of criteria met for each review increased from one criterion in 2024 (n=9) to four or five criteria in 2025 (n=12).

Documentation improved overall, including physical health (70% to 82%), psychiatric health (40% to 66%), and medication side effects (0% to 19%). Also, assessment of harms associated with ongoing seclusion improved (2% to 14%). Small declines were found in documentation of the decision to continue seclusion (97% to 91%) and steps to end seclusion or patient awareness (25% to 23%).

Limitations:

The 2024 audit had a smaller sample size (n=40) which was increased in the re-audit (n=56). The 2024 audit was also conducted shortly after a new doctors rotation. Patient sleep status(n=12), senior-led reviews (n=10), and undocumented reviews (n=3) in 2025 may have influenced findings however all reviews were included in the analysis.

The re-audit demonstrated improvement in patient safety through higher quality of documented medical seclusion reviews. There was an improvement in assessment of physical and psychiatric health, medication, and risk assessment. Minor reductions were observed in documentation of decisions to continue seclusion and steps to end seclusion/patient awareness.

Further re-audit across other trust sites should occur with measures to address undocumented reviews and asleep reviews. There should be continued integration of seclusion standards into doctor induction programmes and regular local teaching.

This re-audit shows low-cost, targeted interventions can improve patient safety and seclusion review quality which is transferable to other inpatient mental health settings.

This study evaluated the efficacy of an immersive Acceptance and Commitment Therapy (ACT)-based intervention in reducing subclinical depressive, anxiety, and obsessive–compulsive symptoms in medical students at Cardiff University.

A quantitative within-subjects repeated-measures design was employed using a single-group pretest–post-test approach. Participants completed baseline measures of obsessive–compulsive (OCI-R), anxiety (GAD-7), and depressive (PHQ-9) symptoms prior to engaging with the immersive ACT intervention, and the same measures were repeated post-intervention. Participants were recruited via the medical school’s student support unit and through advertising across all years of the undergraduate medical programme.

Seventeen participants completed all study components. No significant pre–postdifferences were observed on the total OCI-R, GAD-7, or PHQ-9 scores. However, subscale analyses revealed a significant reduction in the neutralising dimension of the OCI-R following the intervention (z=−1.941, p <0.05). Post-intervention differences were also identified between participants with high versus low depressive symptoms (PHQ-9), specifically in obsessional symptoms (z=−2.298, p <0.05). In addition, participants with high versus low anxiety scores (GAD-7) demonstrated a significant reduction in ordering symptoms post-intervention (z=−2.179, p=0.029).

Although no significant changes were observed on overall measures of obsessive–compulsive, anxiety, or depressive symptoms, targeted reductions were evident in specific symptom dimensions following the immersive ACT-based intervention. These findings suggest potential symptom-specific benefits for medical students with elevated obsessive–compulsive, depressive, and anxiety traits. While limited by a small, subclinical sample, the results support further investigation of immersive ACT interventions in larger and clinical populations.

This audit aimed to review patterns of psychotropic prescribing within a community LD psychiatry service in Caerphilly, focusing on medication type, dosage, documented clinical indication, and trends in medication change over time.

Psychotropic medications play a central role in the management of mental health conditions among individuals with Learning Disability. However, their use in this population requires careful consideration due to increased vulnerability to adverse effects, polypharmacy, and challenges in monitoring efficacy and safety. National guidelines, including those from NICE and the Royal College of Psychiatrists, emphasize the importance of regular review, clear documentation of indications, and adherence to best practice standards to minimize inappropriate prescribing.

A retrospective review of clinic and home visit letters for all patients seen by the community LD psychiatry service during the audit period was undertaken. Data were collected by 3 doctors on level of LD, presence of autism spectrum disorder (ASD) or attention deficit hyperactivity disorder (ADHD), psychiatric diagnoses, psychotropic medications prescribed, antipsychotic dose expressed as a percentage of the British National Formulary (BNF) maximum, and medication changes over the audit period.

A total of 117 patients were included. 114 (97.4%) were prescribed at least one psychotropic medication. 77 patients (65.8%) were prescribed antipsychotics, mostcommonly risperidone (n=37). Antipsychotic doses ranged from 1.5% to 100% of the BNF maximum, with 47 patients (61.0%) prescribed doses at or below 25% of the maximum.

A clear mental health diagnosis supporting antipsychotic use was documented in 23 of 77 patients (29.9%), while behaviours that challenge were documented in a further 15 patients (19.5%). No clear indication for antipsychotic prescribing was recorded in the remaining 39 patients (50.6%). Antidepressants were prescribed to 44 patients; anxiety or depressive disorders were documented in 16 patients (36.4%), while 8 patients (18.2%) had no documented indication.

Over the audit period, psychotropic medication remained unchanged in 57 patients (48.7%), increased in 27 patients (23.1%), reduced in 23 patients (19.7%), and switched or cross-titrated in 6 patients (5.1%).

This audit demonstrates high rates of psychotropic prescribing within a community LD caseload, with substantial gaps in documentation of clinical indication, particularly for antipsychotic and antidepressant use. Although some medication reduction occurred, increases were more common than reductions. Improved documentation, structured medication review processes, and multidisciplinary approaches are required to support safe prescribing and align practice with national guidance.

Tier 4 CAMHS general adolescent inpatient services are required to monitor clinical outcomes using measures including CGAS, collected on admission and at discharge. This audit aims to evaluate the completeness of CGAS recording at admission and discharge, and describe CGAS distribution for young people admitted to a general adolescent inpatient unit over a nine-month period.

Data was collected over a nine-month period (30/01/2025 to 30/09/2025), giving n=50 admissions for analysis. Inclusion criteria was all completed admissions within the audit period, and exclusion criteria was any entries where the episode was incomplete or duplicated. For each admission, presence/absence of CGAS at admission, presence/absence of CGAS at discharge, CGAS score at admission (banded into 10-point ranges), and CGAS score at discharge (similarly banded) were extracted from patients’ admission forms and discharge summaries on MORSE healthcare electronic data.

CGAS was recorded on admission for 39/50 admissions. The admission CGAS completion rate of 78.0% did not meet the local target of ≥90%. CGAS was recorded on discharge for 29/50 admissions. The discharge CGAS completion rate of 58.0% was well below the local target of ≥90%. 56% had admission CGAS scores in the 31–40 band, indicating marked impairment in functioning. 16% scored 21–30, and 4% scored 11–20, reflecting very severe impairment. By discharge, a greater proportion of young people had scores in the 41–50 and 51–60 bands, and a small number reached 61–70 and 71–80, suggesting improvement in functioning for those with recorded scores. However, because discharge CGAS was missing or “TBD” for almost half of the sample, these figures may over-represent young people whose episodes were more complete or stable at discharge.

Where recorded, CGAS distributions indicate clinically meaningful improvement in functioning from admission to discharge, but missing discharge data in 21/50 cases weakens the ability to demonstrate outcomes for the whole cohort. Going forward, the Information Officer will routinely check discharge summaries (where no CGAS score is included, the author will be contacted) and the Medical Secretary will only accept discharge summaries that include a completed CGAS, querying any summaries where this is missing. A re-audit will be undertaken for all eligible admissions from 10/2025 to 02/26, using the same criteria and targets to assess whether CGAS completion at admission and discharge has improved towards or beyond the ≥90% threshold.

To improve the accuracy and efficiency of NEWS monitoring by assessing flexibility for parameter recalibration and standardising documentation practices by March 2026.

To ensure NEWS parameters are safely and accurately adjusted for patients with atypical baselines (e.g. on psychotropics), in line with TEWV policy.

PDSA Cycle 1 – Completed November 2025

Plan: To understand current NEWS monitoring practice and identify gaps related to accuracy, recalibration flexibility, and efficiency. This was following discussion with colleagues currently working with the secure inpatient services.

Specific objectives:

• • Assess how frequently NEWS scores are documented electronically and on paper.

• • Determine whether ward systems allow recalibration of NEWS parameters.

• • Identify whether NEWS charts are being used for non-NEWS purposes.

• • Compare practice against TEWV NEWS Policy and NICE guidance.

The expected outcome was to highlight inconsistencies and identify initial improvement opportunities.

Do:

• • Collected data from five forensic wards using a structured yes/no/na audit tool.

Obtained data on:

1. Electronic NEWS recording.

2. Paper NEWS recording.

3. Ability to adjust/recalibrate parameters.

4. Misuse of charts.

• Converted findings to percentage compliance to allow cross-ward comparison.

Study: Key findings from Cycle 1:

• • 72% of wards recorded NEWS electronically.

• • 80% recorded NEWS on paper, showing duplication.

• • 0% electronic recalibration available.

• • 100% of paper charts allowed manual parameter adjustment.

• • 28% of wards used paper charts for non-NEWS tasks.

• • 0% misused electronic charts.

Interpretation:

• • There is a reliance on paper charts for flexibility.

• • The electronic system is inflexible, which may affect clinical accuracy.

• • Documentation duplication results in inefficiency and possible errors.

• • Paper misuse indicates lack of standardisation.

Act: Based on Cycle 1, the project team decided to:

• • Present and disseminate findings to the ward teams and managers.

• • Develop guidance on when and how to adjust NEWS parameters for atypical baselines.

• • Explore options with digital teams for electronic NEWS customisation.

• • Plan staff education on appropriate chart use.

• • Prepare tests of change for Cycle 2.

These findings shaped the next phase of improvement work.

• • 72% of wards recorded NEWS electronically.

• • 80% recorded NEWS on paper, showing duplication.

• • 0% electronic recalibration available.

• • 100% of paper charts allowed manual parameter adjustment.

• • 28% of wards used paper charts for non-NEWS tasks.

• • 0% misused electronic charts.

Summary of Wastes: Duplication of documentation, inability to recalibrate electronically, misuse of paper charts, risk of inaccurate scoring, and reliance on inefficient workarounds all contribute to waste in time, motion, accuracy, and staff expertise.

The data show good overall compliance with NEWS recording but significant limitations in electronic flexibility and non-standardisation of paper chart use.

To align with TEWV policy and NICE guidance, a structured recalibration approach and system improvements are required.

The ADHD service in the London Borough of Redbridge has a waiting list over nearly 600 patients. However, it was noticed that many patients were being booked in for assessments inappropriately, including patients who lived out of borough, who already had a diagnosis or who were seeking a medication review. It was decided to audit the waiting list to see if all remaining patients were suitable to be booked for assessment.

The entire waiting list of 559 patients was screened manually and compared with our electronic patient record system Rio. Client demographics were checked to ensure they currently reside in Redbridge. Referral information was screened to ensure clients were referred for a diagnostic assessment. The list was also screened for duplicate patients. Theexpected standard was that 100% of patients on the waiting list were suitable for an ADHD assessment.

408/559 patients (73%) were deemed as suitable for assessment based on the criteria of living in Redbridge and requiring an ADHD assessment. 151 patients (27%) were unsuitable for a variety of reasons, including residing outside the borough, having moved since being referred, patients who were referred for medication review and patients who had not returned screening questionnaires. There were a significant number of duplicates, with 37 patients being on the list twice, and one patient three times. After removal of these 151 patients, the remaining 408 patients were reaudited to the same standard, with 398/408 (98%) of patients being suitable for assessment. The remaining 10 were subsequently removed. The removal of so many patients had the effect of reducing the waiting time for ADHD assessment in Redbridge by approximately 5–6 months.

The audit revealed flaws with the waiting list and the screening system. Many patients were referred multiple times without this being noticed. There was no screening of the referral to assess which intervention the patient required (i.e. medication review, yearly review or new assessment), with all patients being added to the same list. Patient addresses were not scrutinised and there was no means of being alerted when patients had moved out of borough. These flaws resulted in an increased waiting time for ADHD assessment, and many patients being booked erroneously, wasting clinical and patient time. Measures to prevent this have been implemented, including cross-referencing of new referrals with the waiting list, regular screening of the waiting list by the consultant, and administrative staff checking patient addresses before offering appointments.

During a routine presentation of a ‘mental state examination’ (MSE) within clinical supervision, we noted a hesitancy to describe a patient’s appearance with regards to their race and ethnicity, in a manner routinely taught during training. Our aim was to critically engage with relevant literature to inform our understanding of whether teaching the routine inclusion of race and ethnic descriptors within the MSE should be challenged.

We conducted a review of relevant literature. Six articles were included (full references available).

Limitations within diagnostic formulation: Race, associated with physical characteristics, and ethnicity, associated with descent and cultural factors, are poorly defined, Racial categories do not robustly represent biological predisposition to mental illness. Ethnicity might be considered a ‘shortcut’ to understanding an individual’s sociocultural predisposition to mental illness, however this is shaped by broader societal influences across the lifespan.

Risks of stereotyping: Despite a decline in stereotyping of patients by psychiatrists, racial stereotyping, whether arising from conscious or unconscious biases, remains an issue. Such stereotyping can lead to inaccurate assumptions which may contribute to disparities in diagnosis and healthcare delivery.

Impact of racial/ethnic mis-assignment: Visual assessments of race/ethnicity, based on offhand observations, risk mis-assignment. There is evidence from non-clinical settings that this has a negative impact on sense of identity and mental health. In a specialty where patients often have a complex sense of their own identity, this may cause additional unintended harm. A positive view of one’s ‘self’ is important to recovery; conversely invalidation of a patient’s ‘knowledge of self’ may contribute to epistemic injustice. Being mis-labelled by professionals may also reinforce mistrust of mental health services by some ethnic minorities, contributing to perpetuation of inequalities in accessing care.

Risks of ‘colour blind’ practice: Recognising and understanding an individual’s ethnicity may validate a patient’s sense of identity and is vital for providing holistic care. Recording, recognising and researching race and ethnicity is crucial to better understand and address health disparities within mental health.

Understanding patients’ ethnic and cultural identities is crucial to appreciate and respond to their mental health difficulties. However, we challenge teaching the routine inclusion of race and ethnic descriptors within the ‘mental state examination’. It has little value in supporting formulation and treatment planning, and may contribute towards damaging stereotyping and mis-assignment. Teaching psychiatric trainees to engage in conversations around patients’ heritage and to incorporate relevant aspects within their formulation and treatment is crucial.

Working with carers alongside service users improves clinical outcomes, service user experience, and reduces risks of suicide and self-harm. Caring significantly impacts carers' physical and mental health, yet carers often feel unsupported. This project was conducted in a specialist community rehabilitation team in Sheffield supporting 50 service users with significant support needs. The aims of the project were to improve carer engagement and support, and to identify gaps in carer recording.

A survey based on the Royal College of Psychiatrists standards for community rehabilitation services was distributed electronically to a total of 58 friends, families and carers of current service users. Alongside this an audit of Electronic Patient Records (EPR) was conducted to identify formally recorded carers. This took place in March 2025. The results of this survey and audit were then used to implement changes within the service.

The audit revealed that only 3 out of 50 service users (6%) had formally identified carers recorded, totalling 6 carers. Many more friends and family were recorded without carer status identified.

The response rate of the survey was 24% (14/58). All 14 respondents identified as carers when presented with a definition of a carer as described by Carers UK, suggesting significant under-recording of carers. Carer feedback was generally positive: 93% had emergency contact information, 78% felt well supported by the team, 71% had been offered individual time with team members, and 64% felt involved in care decisions. Areas for development included information around available carers groups, with only 50% being aware these existed, and only 14% of carers being provided with written information about the team.

A bimonthly family, friends, and carers support group was established jointly with the inpatient rehabilitation service. Attendees have given positive feedback regarding this. The written carers pack was reviewed. The team’s view of who constituted a carer was broadened–due to limitations with the EPR carer status wasn’t easily formally recorded, but any family and friends involved in care were considered carers.

This project highlighted gaps in the identification and recording of carers under the community team, despite good levels of carer engagement. The major implemented change was that of a carers group, which was well-received.

The national recruitment process for higher psychiatry training in the UK includes a self-assessment section that recognises applicants’ experience and achievements outside of their usual work. Evidence is uploaded by applicants then reviewed by verifiers using a standardised scoring system. The total awarded score ultimately influences applicants’ priority ranking when training offers are allocated. The aim of this study is to identify trends in self-assessment scoring inaccuracies and explore the reasons for these. This will inform future improvements to the self-assessment process and scoring guidance.

Anonymised data was provided by the National Psychiatry Recruitment Office for all applicants to higher psychiatry training in February and August 2025. Counts were summarised overall and by group using descriptive statistics. Thematic analysis was conducted to explore reasons for scoring adjustments and appeals across the ten assessed domains. Coding was cross-checked by a second researcher to enhance validity.

There were 1,025 applicants across the two recruitment rounds, with 76% having completed core psychiatry training or being in their final year of training. Fifty-nine per cent of applicants were non-UK graduates. The findings highlighted frequent errors in both applicants’ evidence submissions and in verifiers’ reviews. Common applicant error themes included submitting inappropriate, excessive, or incomplete evidence, misunderstanding current guidance, and incorrect domain allocation. Upheld appeals highlighted several instances of incorrect verifier scoring due to misinterpretation of submitted evidence and verification guidance. This resulted in frequent misalignment between candidates’ self-assessments and verifiers’ scoring, with 16% of applicants appealing their scores. Most scoring errors were identified in domains 6 (Clinical Governance, Audit and Quality Improvement as a postgraduate), 8 (Teaching), and 10 (Presentations and Poster Presentations). Scoring errors disproportionately affected applicants with non-UK qualifications and those submitting evidence obtained abroad as documents often did not conform to UK formats, contributing to scoring misalignment.

These findings highlight several challenges in translating applicants’ achievements into standardised scores in the current Higher Psychiatry Training recruitment process. Frequent scoring errors by both applicants and verifiers indicate that the current guidance may lack sufficient clarity, particularly regarding evidence requirements, domain boundaries and scoring thresholds. There is a need to develop the applicant and verifier guidance to include clearer definitions, descriptions, and examples to reduce error rates and improve equity and consistency in portfolio scoring.

High dose antipsychotic therapy (HDAT) is associated with an increased incidence of physical health complications, typically cardiac and metabolic, due to the dose dependent side effect profile of antipsychotic medication.

Since the migration to a fully electronic health record (EHR), Epic, in November 2024 there has not been a streamlined or consistent approach to the completion of physical health monitoring within this patient cohort in our Community Mental Health Team.

This project aimed to evaluate and improve adherence to HDAT monitoring guidelines to reduce the risk of HDAT-related physical health complications.

We screened our caseload of 896 patients and conducted a baseline audit in January 2026 against National Institute for Clinical Excellence (NICE) Clinical KnowledgeSummary (CKS) standards for antipsychotic monitoring (revised January 2026), with a target of 100% compliance.

We also measured the use of two functions of Epic, the ‘FYI Flag’ which is visible on the opening screen of each patient’s electronic chart and the ‘Therapy Plan’ which creates orders for appointments and specified investigations at defined intervals.

We then implemented change by ensuring all patients had an ‘FYI Flag’ for HDAT and an active HDAT ‘Therapy Plan’.

19 patients (2% of the caseload) were currently prescribed HDAT.

At baseline (January 2026), compliance with monitoring was 26%. 21% of patients had an FYI flag on their chart and 26% had HDAT therapy plans in place.

On reaudit (February 2026), compliance with monitoring was 58%. 100% of patients had an FYI flag on their chart and 100% had HDAT therapy plans in place.

Of the 42% of patients who had incomplete or outdated monitoring, 100% had an appointment scheduled for investigations to be completed. The majority of appointments were generated from the recently implemented therapy plans.

The most common reason for incomplete monitoring was investigations falling outside the recommended timeframe. The most commonly omitted components of an otherwise up-to-date set were prolactin and ECG completion.

Adherence to HDAT monitoring guidelines was initially poor but improved substantially over a short period following targeted digital interventions.

This project demonstrates how the use of EHR functionality can efficiently improve patient care. We are optimistic that the rate of monitoring will continue to rise through the implementation of ‘Therapy Plans’ which electronically generate prompts for investigation completion and appointment booking.

We plan to continue this project with ongoing Plan–Do–Study–Act cycles to reach our target of 100% and demonstrate sustained improvement.

This service evaluation aimed to assess how consistently overdose risk factors are recorded in routine outpatient clinical records, identify gaps in documentation, and explore patient characteristics associated with missing or incomplete risk assessments.

A retrospective service evaluation was conducted in an addictions psychiatry outpatient clinic. Adults aged ≥18 years receiving methadone or buprenorphine during a six-month period were included. Patients were excluded if they had transferred care during this period or had incomplete medical records. Clinical notes and pharmacy records were reviewed to extract information on overdose risk factors, including polysubstance use, previous overdose, co-prescribed benzodiazepines, psychiatric comorbidities, and naloxone provision. Demographic information and substance use patterns were also collected. Data were analysed descriptively to summarise documentation rates, and exploratory comparisons were made between patients with and without recorded overdose risk factors

A total of 110 patients were included (methadone n=68, buprenorphine n=42). Overdose risk factors were documented in 61 patients (55%), leaving 45% without recorded risk assessment. Naloxone provision was documented in only 44 patients (40% of total), including 12 patients with known polysubstance use who had no recorded naloxone offer. Polysubstance use was present in 48 patients (44%), and these individuals were more likely to have risk factors documented (65% vs 48%), although a substantial proportion remained undocumented. Patients with co-occurring psychiatric diagnoses were also more likely to have documented overdose risk, but documentation consistency varied widely. The review demonstrated that systematic evaluation of overdose risk documentation is feasible within routine outpatient records and can identify gaps that may compromise patient safety.

Overdose risk is inconsistently documented in OST outpatient settings, despite high prevalence of polysubstance use and psychiatric comorbidity. Gaps in documentation, including missed naloxone provision, highlight the need for structured protocols and staff training to ensure that high-risk patients are identified and receive appropriate harm reduction interventions. Implementing routine overdose risk assessments within clinical workflows is feasible and may improve safety, patient outcomes, and overall quality of care.

In pharmacokinetic studies of xanomeline and trospium chloride (KarXT), dosing with food reduced trospium bioavailability, potentially impacting tolerability. This study was designed to demonstrate taking KarXT with food after a slow up-titration is safe and tolerable.

In pharmacokinetic studies of xanomeline and trospium chloride (KarXT), dosing with food reduced trospium bioavailability, potentially impacting tolerability. This study was designed to demonstrate taking KarXT with food after a slow up-titration is safe and tolerable.

During periods 1 and 2, 64.2% and 39.0% of participants reported ≥1 treatment-emergent adverse event (TEAE), respectively. The most common TEAEs (≥5%) in period 1 were nausea (22.5%), dyspepsia (15.6%), headache (15.0%), constipation (12.7%), and vomiting (11.6%); the incidence of all new onset TEAEs was less in period 2 when taken with food. All TEAEs were mild or moderate in intensity; none were serious. PANSS total score decreased over periods 1 and 2; Clinical Global Impression-Severity score decreased over period 1 with no further change over period 2. Dose-normalized area under the curve and maximum plasma concentration of trospium pooled from cohorts 1 and 2 decreased by 36% and 43%, respectively, when taken with food versus fasting. No clinically significant differences were observed in xanomeline exposure.

After slow uptitration on an empty stomach, there was no increase in the incidence or severity of TEAEs when taking KarXT with food; efficacy was maintained.

Consistent and comprehensive documentation is essential for patient safety, continuity and appropriateness of care, and effective communication on psychiatric inpatient wards. The Mental State Examination (MSE) remains the cornerstone of psychiatric assessment; however, routine nursing documentation often varies in structure, emphasis, and completeness. In other clinical settings, structured documentation tools have shown improved consistency and adherence to best-practice standards. Within psychiatric services, there is limited evidence examining whether routine nursing notes consistently capture the breadth of the MSE.

This case-note review focuses on documentation quality using MINDY, a structured mental state framework developed to support systematic inpatient assessment.

We aimed to compare the completeness and consistency of routine nursing inpatient psychiatric documentation with contemporaneous assessments completed using the MINDY framework.

We hypothesised that the former do not consistently show all core domains of the MSE and that MINDY provides a more comprehensive representation of the patient’s overall mental state.

We designed this as a service evaluation and case-note review on an acute adult psychiatric inpatient unit. During a two-week period, selected randomly, three different resident doctors assessed all patients under a single consultant using the MINDY tool. We obtained corresponding nursing documentation for this period and compared these sources of information, only including days when both were available.

An independent medical student, not involved in patient care, performed the comparative analysis.

All records were anonymised prior to analysis. Local NHS information-governance procedures and General Data Protection Regulation (GDPR) were followed.

Routine nursing documentation demonstrated a median MSE-domain completeness of 40% across patients, with consistent focus on behaviour, activity, mood and cognition but near-complete omission of speech, thought process and insight.

In contrast, the MINDY framework structurally mandates assessment of nine of ten classical MSE domains, yielding a median completeness of 90% per assessment. The median difference in domain coverage was therefore 50 percentage-points. The magnitude of this effect was very large (Cohen’s h=1.13), and the difference was highly statistically significant on two-proportion testing (p < 0.001).

Compared with routine narrative nursing documentation, MINDY more than doubled the breadth of mental-state recording, increasing median MSE-domain coverage from 40% to 90%. The size of this improvement was extremely large and statistically robust, supporting MINDY’s role as a powerful standardisation intervention rather than merely a symptom-rating scale.

These findings indicate that structured daily use of MINDY could enhance multidisciplinary communication and reduce systematic omission of key psychopathological domains on acute wards.