This QI project aimed to implement the NHS England Culture of Care framework on Severn Ward, a forensic PICU and National pilot site.

Objectives were to:

(1) To reduce restrictive practices

(2) Enhance patient and staff experience through Culture of Care principles and lived experience.

(3) Improve the therapeutic environment and relational safety.

Between January 2024 and December 2025, a structured multidisciplinary QI approach was implemented using co-production and PDSA cycles. Patient voice was central to the project through ward representatives, discussions and recovery suppers, and co-led morning meetings to shape daily activity choices and ward expectations.

Key interventions included:

• De-escalation space/sensory room being set up.

• New Gold, Silver, Bronze sharps system to support proportionate safety measures.

• Expanded therapeutic activity programme (gardening, art therapy, drum circle, breakfast club).

• Allowing community leaves pathways from PICU (removing blanket restriction on leaves).

• Access to mobile phones.

• Environmental improvements: new examination room, new ward gym, moving CTM to a more welcoming room with windows, increased courtyard access, opening up dining room.

• Staff induction leaflet promoting wellbeing and relational safety.

• Embedding Autism Informed Care principles (sensory regulation, communication needs, SALT involvement).

Due to the patient cohort, qualitative feedback from patients and staff was prioritised over quantitative data. Patient and staff interviews and questionnaires were completed, patients on Rehabilitation wards with prior experience of the ICU acted as Expert by experience with regards the changes they would like to see in the PICU setting.

Service users consistently reported feeling more heard, respected, and involved, especially through co-leading morning meetings. This improved transparency and shared ownership of ward life. Patients described increased privacy and freedom of movement, reduced boredom and more meaningful activity engagement. The new ward gym also helped in patients having better access to physical exercise to regulate their emotions and taking care of their physical health.

Staff reported a calmer atmosphere which is less reliant on blanket restrictions. They also felt more confident in applying Trauma-Informed and Autism-Informed approaches. The de-escalation room became a valued early intervention tool. Environmental improvements enhanced dignity and therapeutic interaction. Staff also noted improved team cohesion and clearer shared values.

Organisational barriers slowed completion of some interventions.

Qualitative evidence from staff and patients strongly indicates positive cultural change despite variability in patient acuity. Sustained progress will require continuedorganisational support and ongoing PDSA cycles to keep Culture of Care at the centre of patient care.

Mental health concerns related to menstruation, the perinatal period, and perimenopause are under-researched healthcare priorities, as identified by the Royal College of Obstetrics and Gynaecology. The links between reproductive life events and psychiatric symptoms are overlooked, particularly in people with chronic mental illnesses.

We aimed to assess whether female reproductive health is being routinely appraised by clinicians caring for inpatients in the Royal Edinburgh Hospital and Associated Services (REAS). Our secondary aim was to identify areas for improvement and consider changes to aid clinician awareness, documentation, and onward referrals.

We conducted an evaluation to review clerking, ward round, and progress notes using Lothian TrakCare electronic health records. Ten female patients from each of the eight REAS wards (CAMHS, two General Adult Psychiatry wards, Forensics, Mother and Baby Unit, Eating Disorder Unit, Rehabilitation Wards, Old Age Psychiatry) admitted before 31/07/25, were retrospectively included (N=80). Keyword searches were performed for the terms: “menstruation”, “contraception”, “perinatal issues” and “pregnancy status”, “menopause” and “HRT” (Hormone Replacement Therapy); and a score was assigned (1 mention; 0 no mention). Free text from electronic health records was captured and underwent further thematic analysis.

Overall, the documentation of female reproductive health factors was uncommon. Only 20% (N=4/20) of General Adult Psychiatry patients were asked about menstruation and contraception, compared to 70% (N=7/10) in Rehabilitation wards. Issues tended to be raised by patients and not proactively solicited. Conversations regarding menstruation were documented in 100% (N=10/10) and 80% (N=8/10) of Eating Disorder Unit and CAMHS unit notes respectively. This was due to targeted questioning about amenorrhoea and low BMI. Menopausal and HRT documentation was minimal with 17% (N=6/36) and 8% (N=3/36) respectively (inclusion criterion: age ≥ 45).

This service evaluation found minimal documentation of female reproductive health across psychiatric inpatient units. Notable areas of increased documentation include the Rehabilitation wards, Eating Disorder Unit, and CAMHS unit. Our next steps are to engage service users on how they prefer to be asked about reproductive health; to survey relevant clinicians on reproductive health knowledge and confidence; and to implement educational interventions to improve clinician practice.

Disclosure: This project was previously submitted as an abstract for presentation at PsyQIatry: Ideas, Innovation, and Impact in Psychiatry, March 2026.

*Vikki Argent, Ariana Axiaq, Jo Brown, Michelle Cooper, Flora Flinn, Jenny Green, Katie Halton, Francesca Moss-Lawton, Shani Ross, Penny Shutt, Rob Waller.

Investing in workforce development is a core tenet of delivering high quality, safe and effective mental health care, particularly when supporting individuals with long-term and complex needs. Further to preliminary piloting and evaluating of a novel training package to support clinical staff to deliver values-led, recovery orientated rehabilitation, we have revised the package and commenced a wider evaluation. The aim of this study was to deliver a revised module to a wider audience and analyse its impact on participants using quantitative and qualitative methods.

The “Collaborating Towards Recovery” module was offered to staff working in mental health services across the North West of England. This module was selected as the content is focused more on general principles of recovery orientated mental health care,rather than being solely focused on rehabilitation. Participants were recruited via expressions of interest through established practice networks.

Data was collected through pre-and post-training questionnaires, alongside a focus group facilitated 6 weeks post-training. All questionnaires were anonymous and completion of both questionnaires and attendance at the focus group was optional.

Qualitative data was collated, and a reflexive thematic analysis was undertaken to identify key themes.

Of the n=12 participants who completed the post-training questionnaire, the majority identified their role as clinical, with a small number of participants stating their role was operational (n=1) or lived experience (n=1). Self-rated knowledge and understanding of recovery approaches increased from an average of 6.4/10 (median=7) to 8.7/10 (median=9) on completion of the training module. Overall, 100% of post-training respondents felt the training was relevant to them, alongside 100% of respondents reporting feeling they could put the themes discussed into practice.

Thematic analysis of the qualitative data identified six key themes: (1) shaping new perspectives, (2) learning through connection, (3) flexible facilitation, (4) balance of philosophy and practice, (5) reframing needs and holding hope and (6) hearing lived experience voices.

The data reflects that participants, overall, had a positive experience of participating in the training. Not only did the training enhance self-rated knowledge and understanding of recovery, but feedback reflecting the value of connection, inclusion of lived experience voices and fostering and holding hope gives evidence that recognises the overallvalue of the training module. Feedback also reflects areas for improvement or further evaluation, including the amount of content delivered, alongside further considerations for the practical application of the principles in different areas of practice.

Mental health issues in Arab countries, including Oman, have been traditionally stigmatized, leading to increased non-adherence to prescribed medications. This study aims to explore gender differences in medication adherence among patients with mental illness in Oman, highlighting the impact of social factors on treatment compliance.

A cross-sectional study was conducted at Al Masarra Hospital in Muscat between October 2020 and May 2021. Using convenience sampling, 302 participants aged 18 and older, receiving follow-up care for documented mental health disorders, were recruited. The Medication Adherence Rating Scale (MARS) was employed to assess adherence levels and collect demographic data.

The study included 302 participants, predominantly aged 26–45 years (59.61%). Male patients had a mean medication adherence score of 5.75 (SD=2.550), compared to 5.67 (SD=2.347) for females. An independent samples t-test revealed a statistically significant difference, with a t-value of−2.027 (p=0.044), suggesting that gender influenced adherence rates. ANCOVA showed that marital status (F(1, 295)=5.321, p=0.021) and patient insight (F(1, 295)=7.456, p=0.007) significantly predicted adherence, whereas no significant effect of gender was observed.

This study highlights the complexity of medication adherence in mental health care, emphasizing the need for tailored interventions that consider gender dynamics and social support systems. By addressing these factors, mental health services can improve adherence rates and overall patient outcomes in Oman.

To evaluate the Institute of Mental Health's (IMH) clinical governance and quality processes following an independent review of systems related to care lapses, and to implement standardised root cause analysis (RCA) processes to improve patient safety outcomes.

An independent review of IMH's clinical service delivery model and governance processes was conducted, examining Serious Reportable Events (SRE) and Sentinel Events (SE) from January 2017 to October 2023. A two-pronged approach was employed: an independent-led review by the National Healthcare Group and an internal self-review. Further in-depth analyses of selected incidents were conducted by subject matter experts using selection criteria based on recency, incident type, severity of harm, and findings. Root causes and recommendations were assessed using the New South Wales Root Cause AnalysisReview Committee's Classification of Recommendations. Following identification of governance deficiencies, a comprehensive change management process was implemented incorporating six key strategies: educate, engage, empower, evaluate, encourage, and escalate. A standardised RCA process utilising the Human Factors Analysis and Classification System (HFACS) framework was adopted, with establishment of the SRE-SE Oversight Panel in October 2024 to ensure oversight and consistent quality of the RCAs.

The review identified inadequately robust clinical and quality governance processes. Previous RCA investigations were sub-optimal, resulting in weak recommendations and reactive responses that missed opportunities for systems-level improvement. Prior to HFACS implementation, majority of recommendations in 2022 and 2023 were classified as 'weak', relying heavily on memory and vigilance. Post-implementation, there was an increase in robust, system-level recommendations requiring greater senior management involvement. However, approval processes initially extended to 373 days, failing to meet the 60-day requirement stipulated by the Ministry of Health. Following establishment of the SRE-SE Oversight Panel, approval times reduced from an average of 145 days to 50 days by April 2025. Despite improved recommendation quality, there was a decrease in the percentage of recommendations implemented within stipulated timeframes, attributed to the increased complexity of system-level interventions.

The implementation of standardised RCA processes using HFACS successfully improved the quality and robustness of safety recommendations at IMH. However, stronger system-level recommendations require greater resources and extended implementation timelines. Continuous improvement through iterative Plan–Do–Study–Act cycles, stakeholder engagement, and appropriate escalation processes are essential for drivingsustainable change in psychiatric healthcare quality and safety initiatives.

Elderly patients in psychiatric settings are particularly vulnerable to falls, a risk exacerbated by the side effects of psychotropic medications. The cumulative effect of thesedrugs, known as the Anticholinergic Cognitive Burden (ACB), can cause dizziness, confusion, and impaired balance. Prior to this project, ACB scores were not routinely calculated or used to guide medication reviews on our older adult inpatient ward.

The primary aim was to reduce the risk of falls by implementing routine monitoring of ACB scores and ensuring weekly medication reviews. The hypothesis was that increasing awareness of a patient's anticholinergic load would lead to proactive deprescribing and a reduction in the average ACB score by the time of discharge.

We conducted a Quality Improvement Project on Jasmine Ward, an inpatient ward for elder females. Data was collected retrospectively from electronic patient records. Cycle 1 (n=37) established baseline practice. Cycle 2 (n=36) involved the introduction of a protocol requiring weekly multidisciplinary reviews for patients with an ACB score >3. The intervention focused on prompting clinicians to consider deprescribing high-burden medications.

The documentation of medication reviews improved from 54.5% in Cycle 1 to 83.3% in Cycle 2. Similarly, documented consideration of deprescribing increased from 39.3% to 50.0%.

Most notably, the intervention reversed the trend of accumulating drug burden. In Cycle 1, the average ACB score increased during the hospital stay (Admission: 3.17 to Discharge: 3.30). In Cycle 2, the average ACB score decreased during the stay (Admission: 3.46 to Discharge: 3.22). The incidence of falls remained comparable between cycles (21.6% vs 25.0%), suggesting that while drug burden was successfully reduced, the impact on fall rates may be a lagging indicator or influenced by the small sample size.

Systematic monitoring of ACB scores is an effective strategy to drive deprescribing and reduce the pharmaceutical burden on elderly psychiatric inpatients. While the reduction in ACB scores did not immediately correlate with a drop in fall rates within the short study period, the improved documentation and the successful reduction of anticholinergic burden represent a crucial step towards improving long-term patient safety and cognitive health.

The Eating Disorder Online Activity Questionnaire was developed within a specialist Community Eating Disorder Service (CEDS) to explore online activity of Children and Young People presenting with eating disorders. The authors proposed a research project to evaluate its psychometric properties in adolescents receiving care from CEDS. Despite this being a low-risk observational study with no funding requirements, the research team have encountered several challenges resulting in significant delays to the planned timeline. This study aims to present practice-based reflections on the barriers to conducting low-risk research studies within the NHS.

A literature search was conducted to review current evidence relevant to NHS research processes. Journal articles and policy documents were synthesised to highlight barriers and facilitators for conducting research in the NHS. Authors used Gibbs reflective cycle to reflect on key challenges which contributed to a twelve-month timeline from first developing their research proposal to sponsorship application.

Authors categorised factors which led to the delay and then used these categories to create an analysis and draw conclusions. Analysis and conclusions were linked back to the results from the literature search. Final conclusions and background literature were used to inform recommendations for research policy.

Delays reflect major structural challenges within NHS research processes. Research teams face several systemic challenges, even for small-scale, low-risk studies. Key issues include a lack of clear and accessible guidance, complex and inconsistent application processes, and under-resourced Research and Innovations (R&I) departments. Organisations were reluctant to agree to sponsorship of an unfunded study despite low risks associated and costs being accounted for within the practitioners training scheme. Sponsorship applications added a high administrative burden and were inconsistent across different organisations.

Small-scale research projects are integral to the national ambition to increase research active organisations and allow early access to treatment, improve patient outcomes and increase staff satisfaction. Despite this, low risk studies face significant challenges and are routinely de-prioritised by sponsorship organisations due to lack of funding. In the case study, these delays had implications for academic progression within the team and it was reflected that these issues are likely to discourage practitioners balancing clinical and academic responsibilities from taking part in research.

Recommendations:

A standardised application process across trusts and organisations to improve transparency and reduce administrative burden on practitioners.

A simplified, streamlined process for small-scale, low-risk studies which do not present significant financial costs or ethical considerations.

Clozapine remains the only licensed treatment for patients with treatment-resistant schizophrenia and is highly effective, but its use is limited by potentially serious adverse effects such as clozapine-associated myocarditis, as has been highlighted by the recent position statement by the RCPsych. The risk of myocarditis is greatest within the first 6–8 weeks of treatment, during which early detection relies on monitoring inflammatory markers and cardiac biomarkers, particularly CRP and troponin.

Evidence-based monitoring for myocarditis is guided by the Ronaldson et al. algorithm, which is adopted by the Maudsley Prescribing Guidelines and supported by ZTAS, recommending weekly troponin and CRP monitoring during the first four weeks of titration. However, under local protocols normal reference ranges are often based on acute cardiac pathways, meaning that mildly raised troponin levels often prompt additional testing, leading to unnecessary investigations and resource use.

This audit evaluated adherence to guideline-recommended monitoring of troponin and CRP during clozapine initiation or re-titration on inpatient general adult psychiatry wards. It also assessed the management of abnormal results and examined whether troponin testing was over-utilised when not clinically indicated.

A retrospective audit was conducted at Swallownest Court (RDaSH NHS Foundation Trust), reviewing all patients who commenced or retitrated clozapine between 1 July and 30 November 2025. Data were extracted from electronic records, including baseline investigations, weekly troponin and CRP results, and clinical responses to abnormal findings. Practice was compared against Maudsley and Ronaldson monitoring standards.

Ten patients were included. Baseline troponin and CRP were documented in 80% and baseline ECG in 90%. Five patients (50%) developed mildly elevated troponin levels (>3 ng/L, but <13ng/L), none of which exceeded myocarditis-specific thresholds (greater than 2×ULN) or were associated with clinical symptoms. Nevertheless, 80% of these cases underwent repeat troponin testing. CRP elevations occurred in four patients; two were attributed to non-cardiac causes. No cases of suspected myocarditis were identified. Findings indicate that repeat troponin tests were frequently triggered by ACS-based reference values rather than guideline-recommended myocarditis thresholds.

Monitoring during clozapine titration is generally well conducted; however, troponin testing is commonly repeated in response to mild, clinically insignificant elevations, leading to unnecessary investigations. Recommendations have been made to align local practice with the Ronaldson and Maudsley protocols, incorporating locally agreedbiochemistry reference ranges. These will be implemented following inclusion in local policy, with re-audit planned to assess their impact on monitoring practice and patient safety.

Multidrug-resistant tuberculosis (MDR-TB) is associated with prolonged treatment, significant psychosocial stressors, and poor treatment outcomes. Depression is a common but under-recognised comorbidity in this population and may negatively affect adherence and recovery. This study aimed to determine the prevalence of depression among patients with MDR-TB and to identify socio-demographic and clinical factors associated with depression. We hypothesised that depression would be highly prevalent among MDR-TB patients and associated with financial stress, family problems, longer treatment duration, and increasingage.

A descriptive cross-sectional study was conducted at a tertiary care hospital in Karachi, Pakistan. A total of 107 adult patients diagnosed with MDR-TB were recruited using non-probability consecutive sampling. Patients who had been receiving anti-tuberculosis treatment for more than two months were included. Pregnant patients, those receiving psychiatric treatment for conditions other than depression, and those unwilling to participate were excluded. Depression was assessed using the Patient Health Questionnaire-9 (PHQ-9). A score greater than 4 was considered indicative of depressive symptoms. Data were collected on age, gender, education, employment status, duration of treatment, financial difficulties, and family problems related to the TB diagnosis. Statistical analysis was performed using SPSS version 20. Associations between depression and potential determinants were analysed using the Chi-square test, with a p-value of ≤0.05 considered statistically significant.

The mean age of participants was 32.1 ± 6.2 years, with a predominance of male patients (69.2%). Depression was identified in 52 patients (48.6%). Depression was significantly associated with increasing age (p=0.001), financial difficulties (p=0.01), family problems (p=0.01), and longer duration of MDR-TB treatment (p=0.01). Patients undergoing treatment for more than eight months demonstrated the highest prevalence of depressive symptoms. No significant associations were observed with gender, education level,or employment status.

Nearly half of patients with MDR-TB in this study experienced depressive symptoms, highlighting a substantial mental health burden in this population. Financial stress,family difficulties, prolonged treatment duration, and increasing age were key determinants of depression. These findings underscore the importance of routine mental health screening and integrated psychosocial support within MDR-TB treatment programmes to improve adherence, treatment outcomes, and overall quality of life.

Healthcare professionals (HCPs) face significant mental health challenges, yet barrierssuch as stigma, fear of professional repercussions, and systemic issues hinder help-seeking. At present, there is little evidence on how help-seeking in HCPs can be facilitated. Given the widespread prevalence and serious consequences of mental health difficulties among HCPs, this study aimed to explore the barriers and facilitators that help or hinder HCPs accessing and utilising mental health support and wellbeing provision within a mental health National Health Service (NHS) Foundation Trust. A further aim was to develop recommendations, informed by participants’ accounts and existing literature, to encourage uptake of mental health support and wellbeing provision and foster a culture of wellbeing across healthcare organisations.

Three focus groups were conducted with healthcare professionals (doctors and nurses) employed by a mental health NHS trust. Participants represented a range of roles, backgrounds, and genders. Focus group transcripts were analysed using Reflexive Thematic Analysis, following a six-phase, non-linear process. Analysis identified key workplace stressors, coping strategies, and mitigating factors that shaped whether and how participants engaged with wellbeing support. Recommendations were developed from participants’ accounts and extrapolated in the context of existing literature.

Analysis generated three overarching thematic domains: (1) workplace stressors, (2) coping strategies, and (3) mitigating factors influencing help-seeking. Core stressors included overwhelming workloads, exposure to clinical risk and responsibility for patient safety, operational pressures, and the impact of serious incidents and investigations. Coping strategies ranged from individual approaches (e.g. hobbies, informal support) to organisational supports (e.g. supervision, flexible working, counselling). Barriers to help-seeking were primarily organisational and relational, including limited awareness andaccessibility of services, cultures emphasising resilience and self-sacrifice, and trust- and manager-related dynamics that shaped perceptions of safety, authenticity, and confidentiality. Key recommendations focused on addressing system-level stressors, strengthening wellbeing-focused managerial training, and improving the accessibility, credibility, and authenticity of wellbeing services.

These findings demonstrate that help-seeking among HCPs is shaped less by individual reluctance and more by organisational culture, leadership practices, and system-level pressures. Addressing these factors may reduce burnout, encourage timely help-seeking, and enhance patient care. The study provides practical, transferable guidance for healthcare organisations seeking to develop effective interventions to support healthcare professionals’ wellbeing in the workplace.

Psychoeducation is a core component of recovery-focused inpatient mental health care, supporting service users to better understand their illness, treatment, and legal framework. The Whole Mind Group was developed to provide structured, accessible psychoeducation delivered collaboratively by a multidisciplinary team (MDT) within an inpatient setting.

The aim of the Whole Mind Group was to enhance patients’ understanding of their mental health, medication, legal status, and wellbeing through interactive, MDT-led psychoeducational sessions, and to evaluate participant satisfaction with the knowledge gained, its applicability, and group facilitation.

The Whole Mind Group was delivered weekly on Mondays from 2:30 pm to 3:30 pm over a 16-week period, running from 12 May 2025 to August 2025, with two repeat cycles of six core topics: understanding medication, stress and trauma, affective disorders, psychosis, section and rights, and substance misuse. The group was open to patients acrossthree wards at Cygnet Churchill Hospital (two acute male wards and one male rehabilitation ward). Sessions were facilitated by the MDT, including consultant psychiatrist, occupational therapist, psychologist, mental health act lead, and assistant psychologists.Delivery was interactive, with emphasis on participation, shared learning, and maintaining a psychologically safe environment. Feedback was collected at the end of each session using a standardised questionnaire based on a 7-point Likert scale assessing satisfaction with practical knowledge received, ability to apply knowledge, and facilitation of the psychology group.

Participant feedback was analysed using a 7-point Likert scale (1–7) across three domains: knowledge, application of knowledge, and group facilitation. Mean scores were converted to percentages to support interpretation.

Overall scores were high across all domains. Knowledge and group facilitation both achieved a mean score of 6.04/7 (86.3%), while application of knowledge achieved a mean score of 5.46/7 (78%).

Across individual sessions, Understanding Affective Disorders received the highest overall score with a mean total of 19.33/21 (92%). The lowest overall score was recorded for Understanding Your Medication, with a mean total score of 15.18/21 (72.3%).

The overall mean total score across all sessions was 17.54/21, indicating consistently positive participant feedback regarding knowledge gain, applicability, and facilitation of the Whole Mind psychoeducation group.

The Whole Mind Group demonstrates the value of structured, MDT-led psychoeducation within inpatient mental health services. The consistently positive feedback indicates that the group was well-received and supports its ongoing use as a collaborative, recovery-focused intervention promoting understanding, engagement, and shared learning among service users.

Clozapine is the only evidence-based medication for treatment-resistant schizophrenia and is associated with reductions in relapse, suicide risk, and all-cause mortality.Nevertheless, its use is restricted by concerns about adverse effects, particularly neutropenia and agranulocytosis, which often result in permanent discontinuation under current UK monitoring rules.

Emerging evidence and regulatory changes, particularly in the United States and Europe, suggest that Clozapine re-challenge may be safe in selected patients following careful individualised risk–benefit assessment. However, Clozapine re-challenge remains uncommon in the UK.

We completed a retrospective case series of patients who underwent Clozapine re-challenge within TEWV NHS Trust.Using CPMS data and clinical records, patients who stopped Clozapine due to neutropenia between 1994 and 2024 were identified. We then checked the data of patients who were re-challenged with Clozapine in detail. Extracted data included demographic characteristics, severity and duration of neutropenic episodes, time to neutropenia following Clozapine initiation, interval between discontinuation and re-challenge, re-challenge strategies (including use of lithium and/or G-CSF) and clinical outcomes.

Successful re-challenge was defined as continued Clozapine treatment without recurrent red blood results requiring permanent discontinuation.

We found that thirteen (46%)out of twenty-eight patientswho discontinued Clozapine due to neutropenia underwent re-challenge.

Eight patients (61.5%) were successfully re-challenged and maintained on Clozapine.

Five re-challenges were unsuccessful and three of which were associated with recurrent severe neutropenia.

No fatalities occurred following Clozapine re-challenge.

Most cases of Clozapine re-challenge were undertaken using Clozapine alone, without adding lithium or G-CSF.

With the exception of two cases, all index neutropenic events occurred beyond the first year of Clozapine treatment, ranging from 17 months to 20 years.

Neither the severity nor the timing of the initial neutropenic episode reliably predicted the rechallenge outcome.

Clozapine re-challenge was successful in a majority of patients, with no deaths observed. Neither severity nor timing of the index neutropenic episode reliably predicted the re-challenge outcome. Therefore,Clozapine re-challenge should be cautiously considered in selected patients, particularly where no effective alternatives exist.

These findings highlight the need for a more flexible and evidence based guidance for Clozapine monitoring and re-challenge.

Individuals with severe and enduring mental illness (SMI) are at greater risk of poor physical health than the general population and have a higher premature mortality rate.Average life expectancy of individuals with SMI is ~15 - 20 years shorter than the general population, often due to physical disease.A significant contributor is underperformance of physical examination, assessment and intervention.NICE Clinical Guidelines and Mersey Care NHS Foundation Trust guidelines state that, following admission to a mental health inpatient unit, a patient should have a physical examination and assessment completed within 24 hours.

This audit assessed if the following were completed within 24 hours of admission to the Trust’s general adult inpatient wards: FBC; U and Es; LFTs; TFTs; bone profile; Vitamin B12 level, serum folate level; serum prolactin level; Hbs-656c level; random serum total cholesterol level; ECG; urine dipstick, urine pregnancy test in females of childbearing potential; and QRISK score in relevant patients.

A retrospective audit was conducted, with the sample comprising all patients on 12 of the Trust’s general adult inpatient wards on a specific date in December 2025.An audit tool was designed with standards based on NICE Clinical Guidelines and the Trust’s physical health policy and completed for each patient using the patient’s electronic patient record.

129 of the 200 patients were male, 71 female (3 patients were born biologically male but transitioned to female).Age of patients ranged from 18 to 73 years.Within 24 hours of admission the following were completed: FBC - 46%; U and Es - 45%;LFTs - 44%; TFTs - 40%; bone profile - 44%; Vitamin B12 level - 38%; serum folate level - 37%; serum prolactin level - 33%; Hbs-656c level - 39%; and random serum total cholesterol level - 43%.47% of patients had an ECG done.28% had a urine dipstick; 23% of female patients of childbearing potential had a urine pregnancy test.2% of applicable patients had a QRISK score.

Admission to the ward presents an opportunity to “screen and intervene” in a patient population with poorer physical health than the general population and who are less likely to engage in physical health monitoring in the community.An ECG is required if psychotropic medication is initiated or changed. There is a need for greater awareness from both medical and nursing staff on the importance of relevant physical health investigations being completed following admission to the ward.

The aim of this service evaluation was to assess baseline mental health awareness, openness to discussing mental health issues, recent experiences and perceived barriers to seeking help among construction workers, and to identify preferred workplace interventions to inform targeted mental health support initiatives.

An anonymous survey was conducted at a single construction site. Participants completed a questionnaire assessing mental health training exposure, confidence in recognising mental health issues in themselves and in others, openness to talking about mental health problems, awareness of mental health support services, perceived barriers to seeking help, recent mental health experiences and preferred support interventions. Responses were analysed using descriptive statistics.

The survey was completed by 18 construction workers at a single site. Only 56% had received a form of mental-health training. Awareness of support services was variable with 72% knowing about Samaritans, while 56% were aware of the NHS urgent mental-health helpline and the Construction Industry Helpline. Stress at work was reported by 78% of respondents, and approximately 66% experienced low mood, anxiety or sleep disturbance. The most common barriers to seeking help were the belief that others would not care (39%) and stigma or taboo (33%). Preferred interventions included supervisor mental-health training (50%), short educational mental health talks (44%) and mental health champion programmes(39%).

A significant number of construction workers in this survey reported recent experiences with stress, depression and anxiety, alongside gaps in mental health training and awareness of available support. Stigma and belief that others would not care were identified barriers to seeking help, reinforcing the impact that culture and society plays on these perceived barriers. Participants favoured practical, workplace based interventions, particularly supervisor training, brief educational sessions and peer support initiatives. These findings support the implementation of targeted on-site mental health initiatives to improve engagement and accessibility of support within this high-risk occupational group.

A peer-led video intervention aimed at boosting trainee confidence in handling psychiatry on call tasks.

Assess what trainees are most worried about before starting out their psychiatry on-calls.

Assess baseline trainee confidence of handling on call tasks.

Design a targeted video intervention aimed at junior resident doctors (both core and foundation trainees) to boost confidence in handling their on-call requirement and assess its impact on trainee confidence.

We produced an eight-minute introductory tutorial video for core and foundation trainees for their first on calls at Kendray Hospital in Barnsley, to improve their confidence on handling on-call tasks. This video covered key areas of common tasks such as how to clerk a new patient, how to complete a section 5(2) form or a seclusion review. Kendray Hospital specific information such as where to find the on-call pager, and on-call rooms was also included. Microsoft video editing software (Clipchamp) was used for video editing. A survey was sent to assess trainee confidence before and after watching the video. They were asked to rate their confidence on different aspects of on-call tasks on a Likert scale from 1–5.

50% of core and foundation trainees (5/10) responded. Trainees demonstrated an increase in mean confidence scores (on a scale of 1–5) in a few areas. There was a +0.6 in managing agitated patients, +0.6 points increase in confidence of when and how to request section 17 leave, +0.4 increase in confidence on how to complete section 5(2) paperwork. Confidence increased by +0.2 on knowledge of how to access the on-call room. Areas that showed no improvement in confidence where how to handover during shift changes; how carry out a seclusion review, where to locate the on-call pager or how to contact seniors when on call. Trainees demonstrated high confidence in these areas showing that these areas are well covered in other parts of induction into a new rotation.

A peer-led video intervention that offers trust-specific advice can be a small cost-effective way to boost trainee confidence in carrying out on-call tasks. Benefits can beincreased by embedding the video into the official Barnsley trainee’s induction programme to ensure that every new cohort of new trainees have access to it. It is also recommended that the trust include the video in the trust intranet to allow trainees to have access to it any time they need a refresher.

(1) Quantify adherence to British National Formulary (BNF) dose limits; (2) Measure polypharmacy prevalence and rationale documentation; (3) Assess as required (PRN) governance (instruction clarity, review frequency, benzodiazepine duration); and (4) Compare high-dose antipsychotic therapy (HDAT) form completion between cycles.

Retrospective analysis of electronic health records (EHR) exported to standardised spreadsheets. Polypharmacy defined as being more than 2 medications of the same class. Doses were expressed as %BNF maximum across six medication classes: >100% denoted high-dose prescribing. PRN indicators captured instruction presence, review status, and benzodiazepine duration ≤4 weeks. Analyses were performed programmatically on two audit cycles.

BNF adherence worsened: patients exceeding BNF maxima decreased from 1% (Cycle 1) to 2.9% (Cycle 2).

Polypharmacy increased from 5.6% to 10.4%; (e.g., switching medications/complex illness/patient preference) likely contributed, but the rise suggests persistent clinical complexity.

PRN governance was mixed: “PRN not reviewed” improved from 1.9% to 1.45%, while “PRN instruction missing” rose from 1.1% to 2.1%.

Benzodiazepine PRN >4 weeks increased from 0.26% to 2.70%, indicating a stewardship gap.

HDAT documentation remained suboptimal but improved: 1/378 (0.002%) forms completed in Cycle 1 vs 3/482 (0.62%) in Cycle 2.

The re-audit demonstrates worsening of BNF dose exceedance and a modest improvement in PRN review, evidencing strengthened prescribing safety processes. Nevertheless, polypharmacy increased, and benzodiazepine PRN durations lengthened, while HDAT form completion remains low. Priorities are: (i) embedding EHR “hard-stops” for >100% BNF doses and missing PRN instructions; (ii) automated four-week PRN benzodiazepine review prompts with default taper plans; (iii) a structured polypharmacy pro-forma recording indication, expected benefit, and review date; and (iv) targeted HDAT training plus mandatory electronic prompts for form completion. A third-cycle re-audit using identical denominators is recommended to verify sustained improvement and close remaining governance gaps

Rapid cognitive decline in later life often prompts urgent assessment for neurodegenerative dementia. However, severe depression and anxiety can produce profound but potentially reversible cognitive impairment, frequently described as depressive pseudodementia. Presentations characterised by abrupt onset, marked functional impairment, prominent subjective memory complaints, preserved insight, and disproportionate distress should raise suspicion for affective pathology. Failure to recognise reversible causes can lead to misdiagnosis, unnecessary investigations, and distress for patients and families.

Mr X is a 71-year-old White British retired man who presented with a two-week history of rapidly progressive cognitive and functional decline. He reported severe memory impairment, including inability to recall his date of birth or home address. He became unable to perform basic activities of daily living, forgetting how to make a cup of tea, operate household appliances, manage finances or shop independently. He frequently lost track of tasks midway and described episodes of intending to shower but later realising he had not done so.

He had recently commenced tirzepatide (Mounjaro) for weight loss, raising family concern about potential cognitive effects. Six-CIT score was 24/28. Blood investigations, including thyroid function, vitamin levels, and routine metabolic screening, as well as CT brain imaging, were unremarkable. He was referred to memory services for assessment.

During further reviews with the secondary care team, it was evident that affective symptoms were prominent. He was intensely anxious, preoccupied with fears of dementia, and distressed about becoming dependent or forgetting his family. He described low mood, anhedonia, early morning waking, appetite disturbance, and longstanding passive suicidal ideation. DASS-21 scores indicated severe depression, anxiety, and stress. Cognitive symptoms fluctuated in parallel with anxiety. Treatment with sertraline, alongside biopsychosocial support, led to early improvement in mood, confidence, and cognitive clarity.

The abrupt onset, fluctuating deficits, preserved insight, and overwhelming affective distress were inconsistent with neurodegenerative dementia. Anxiety-driven hypervigilance likely perpetuated impairment. Memory assessments conducted during severe mood and anxiety disturbance may be misleading. Treating underlying mood and anxiety through pharmacological and non-pharmacological interventions can substantially improve cognitive function.

This case highlights the importance of recognising late-life depression and anxiety as reversible mimics of dementia. Clinicians should routinely screen for reversible causes of cognitive impairment, including depression, nutritional deficiencies, hypothyroidism, medication effects, infection, alcohol misuse, and electrolyte disturbances, to avoid misdiagnosis and support recovery.

The presence of weight bias in clinical professionals’ perceptions of eating disorders has been highlighted in previous research. This can cause patients to feel dismissed, leading to a poor clinician–patient relationship, and can delay referral for patients in need of urgent treatment.

This study will explore how medical students perceive the severity and therefore priority for referral to secondary care of various eating disorder presentations, in order to assess how early into a medical career this weight bias is learned. This will be done through a survey asking participants to rank 8 fictional patient cases in the order of priority for referral that they deem most appropriate. The cases range in BMI, with some having a lower BMI with less clinically urgent signs, and some having a higher BMI with more clinically urgent signs.

The aim is to determine the extent of weight bias in the medical student population by comparing their rankings to an eating disorder consultant’s ranking which will highlight any tendencies of participants to rank patients with a lower BMI as higher priority regardless of other clinical signs. There are also demographic questions in order to evaluate how gender and year of study impact perceptions. The results will be presented to the medical school to inform future teaching practices and therefore improve future patient care.

The study will use purposive sampling of Queen's University Belfast medical students from years 1 to 5. The target sample size is around 50, based on a one-sample t-testdesign. Exclusion criteria are as follows; under the age of 18, personal experience of an eating disorder. The latter is to protect potentially vulnerable students, and to ensure that the data is based solely on medical school teaching practices.

Analysis will be done via a t-test, to evaluate any significant differences between the students’ and the consultant’s rankings, and between different genders and year groups. There will also be qualitative interpretation of any justifications or comments left in the free text question.

The study is in progress so there are currently no results, but it is expected to have finished by the International Congress therefore results should be available to present.

In conclusion, weight bias in eating disorder care has a significant impact on patient satisfaction and safety, and undergraduate training provides an opportunity to reduce the stigma that future doctors carry with them into practice. This study aims to improve that training.