The psychiatric specialty of Old Age Psychiatry cares for a patient population with complex psychiatric needs, where complex medical comorbidity and increasing frailty are common. As a result, patients may die while under inpatient psychiatric care. This survey aimed to gather views from the Multidisciplinary Team (MDT) working across the Acute Old Age Psychiatry wards at the Royal Edinburgh Hospital (REH) on their experience of providing care for a dying patient. Between January 2023 and December 2024, 14 patients were cared for and died of medical causes on the inpatient wards.

In January 2025, a Microsoft Form survey asking 3 questions was constructed regarding MDT involvement in the care of a dying patient;

What do you feel is done well?

What challenges do you encounter?

Regarding challenges encountered, how do you think they could be improved/overcome/better supported?

The survey was emailed to all MDT members in the Acute Old Age Psychiatry inpatient serviceatREH. The qualitative responses were gathered and collated into a ‘word cloud’.

16 survey responses from the MDT were returned; 5 Nurses, 4 Nursing Assistants, 3 Doctors, 3 Arts Psychotherapists and 1 Pharmacist.

Regarding the aspects of care for a dying patient which were done well, the MDT highlighted; patient-centered care, proactive symptom management, patients are treated with compassion, gentleness, dignity and respect. Furthermore, collaborative MDT working, involvement of family and spiritual care and promoting a calm environment were noted.

Challenges encountered by the MDT mainly focused on logistical difficulties for initiating and managing administration of palliative medications via syringe driver in the psychiatric setting. At times, additional support from the local Community District Nursing team is required to deliver this aspect of patient care. Other difficulties reflected the challenge personally to staff in processing a patient death and considering howbest to support other patients following a death.

Recommendations from the MDT to address these challenges identified opportunities for education and training, called for additional staffing and consideration of informal MDT support check ins.

This survey highlights important views from the MDT on the experience of caring for a dying patient. In response, additional nursing staff have been trained in the implementation and management of syringe drivers to administer palliative medications and amodule inpalliative care has been added to the newly qualified nurses training programme for the Acute Old Age Psychiatry wards at REH.

This service evaluation project is aimed to assess physical health comorbidity, health monitoring, polypharmacy and health outcomes in older patients treated with clozapine.

A retrospective review of electronic records was performed for the patients above 60 years who were currently prescribed clozapine. Data collected included demographic details, diagnosis, duration of treatment with clozapine, physical health status, co-prescription of medications, and physical health monitoring, along with side effects and health outcomes during the observation period.

50 patients between the ages of 60–89 years were identified, with the majority of patients having a diagnosis of paranoid schizophrenia. Two thirds of the cohort had more than 20 years of illness, with most having been on clozapine for more than a decade.

Patients had high physical health complexities, with more than 70% of patients having >3 physical comorbidities. Polypharmacy was prevalent, with most patients prescribed >4 medications. Physical health monitoring was complete for 50% of patients in the preceding year of assessment.

Nearly 60% of patients experienced significant side effects, the most common being constipation, hypersalivation, and hypotension. Clozapine was discontinued due to toxicity, poor concordance with monitoring, and service disengagement.

Older patients treated with clozapine exhibited a high burden of physical comorbidity and polypharmacy despite being on high medication doses. Although known to mental health services for long duration their physical health monitoring remainedsuboptimal. These findings suggest the need for enhanced monitoring and surveillance for older patients on clozapine.

This audit aimed to:

Evaluate compliance with NICE and GMMH guidelines for physical health monitoring in adults with intellectual disabilities prescribed atypical antipsychotics.

- Identify gaps in current monitoring practices.

- Enhance patient safety by highlighting areas requiring improvement.Support better long-term outcomes through early detection of physical health issues.

Electronic clinical records (Paris) were reviewed using a bespoke audit tool based on NICE and GMMH protocols. Data were collected for the period February 2024–January 2025. Variables included demographic information, intellectual disability severity, diagnosis, and completion of recommended physical health checks. Data were analysed descriptively using Excel and presented graphically.

Seventy-eight patients were included (approx. 60% of the caseload). Of these, 57.5% were male and 73.08% were White British. Most were aged 18–39 years, and around half had mild intellectual disability.Compliance with routine blood monitoring ranged from 71.79% to 76.92%. In contrast, prolactin monitoring was completed in only 28.21% of patients, and ECG completion was notably low at 17.95%. These findings highlight significant variation in adherence to different components of the monitoring protocol.

While compliance with routine blood tests was generally good, prolactin andECG monitoring were markedly poor. Improved documentation, clearer communication with primary care, and targeted interventions are required to ensure comprehensive physical health monitoring for this vulnerable population.

Atypical antipsychotics are a class of medication used to treat psychiatric disorders involving psychosis. Alongside other side effects, they are strongly associated with increase the risk of adverse cardiovascular outcomes e.g. hyperlipidaemia and weight gain. As such, the BNF states that patients should be monitored annually for these risk factors, including weight, glucose/Hbs-648c, blood lipids and blood pressure.

To assess the monitoring of cardiovascular risk factors for vulnerable patients on atypical antipsychotics at a general practice in the West Midlands to allow interventions and modifications to be put in place. In the second cycle, the aim was to assess whether interventions and recommendations made from the first audit made a significant difference to levels of monitoring.

Searches on EMIS were conducted from a list of registered patients currently on atypical antipsychotics to assess whether weight, glucose/HbA1c, blood lipids and BP had been checked in the previous year, in accordance with BNF recommendations for monitoring. Standards set were:

• • 100% of patients will have three or more of the four CVD risk factors monitored within the past year.

• • 80% of patients in the practice monitored for each measure within the past year.

• • A statistically significant increase in overall rates of monitoring from 2024 to 2025 using Fisher’s Exact Test.

For standard 1, there was an increase from 48% to 60% of patients who met this standard from 2024 to 2025. For standard 2, none of the four measures met the criteria in either year, however three measures had increased from 2024. Standard 3 was met as the overall monitoring rate had increased from 58% in 2024 to 65% in 2025, which was a statistically significant increase using Fisher’s Exact test with a p value of 0.04.

NICE guidelines state that patients taking antipsychotics should have annual monitoring of cardiovascular risk factors due to their potential side effects. Although results show that neither of the first two standards were met in both cycles, standard 3 was met, showing a statistically significant improvement in rates of monitoring. This suggested that recommendations made from the 2024 cycle had a positive effect on rates of cardiovascular monitoring of patients on antipsychotics but that further improvements could be made. Further recommendations were made, including implementing manual monitoring reminders for patients not under the SMI checks and long-term solutions for phlebotomy access. Another re-audit will be conducted to assess the impact of these recommendations.

The intersection of open justice principles and medical ethics in forensic psychiatry presents complex challenges when courts must decide whether to anonymise judgments involving individuals with mental health conditions. Open justice ensures public accountability, maintains confidence in professional standards, and provides educational precedents. However, this must be balanced against the medical ethical principle of “primum non nocere” (first, do no harm), particularly where psychiatrists owe duties both to individual patients and to the court system.

PDS, a 29-year-old law graduate, was denied admission to the Singapore Bar following findings of collaboration during her Part A Bar examination and non-disclosure of previous academic misconduct in university. PDS sought anonymisation of her court judgment, supported by a private psychiatric assessment diagnosing Major Depressive Disorder (MDD) and Post-Traumatic Stress Disorder (PTSD) symptoms following sexual assault during university. A comprehensive forensic psychiatric assessment by the Institute of Mental Health diagnosed her with MDD of mild severity, directly precipitated by her interactions with legal authorities. Whilst acknowledging her history as a sexual assault survivor, the assessment found insufficient evidence for PTSD. The evaluation revealed that publication of her name would likely constitute a major stressor potentially causing deterioration in her mental health condition, suggesting psychiatric treatment and monitoring before any publication whilst recommending against revealing details about the sexual assault.

The case exemplifies the challenging position of forensic psychiatrists who must balance competing ethical obligations between individual patient welfare and duties to the court. The forensic assessment demonstrates a nuanced approach, distinguishing between different types of potential disclosure. Whilst recommending against publication of details regarding PDS’s sexual trauma, which appears peripheral to the core professional misconduct and would serve no legitimate public purpose, the assessment acknowledges the court’s legitimate interest in transparency about plagiarism and non-disclosure issues directly relevant to professional fitness. The psychiatrist’s recommendations represent a harm-reduction approach that would provide required mental health support whilst maintaining judicial transparency.

Ethical resolution in cases involving mental health and professional accountability may require graduated approaches rather than absolute positions. Courts can balance open justice principles with harm minimisation through careful distinction between relevant professional misconduct requiring transparency and peripheral personal information warranting protection. Forensic psychiatric assessments provide valuable frameworks for achieving proportionate outcomes that acknowledge both public interest in professional standards and individual rights to protection from disproportionate harm.

Structured risk assessment is a core component of safe community mental health practice. Within NHS Greater Glasgow and Clyde, the Clinical Risk Assessment Framework for Teams (CRAFT) is used to document and review clinical risk for patients open to Community Mental Health Teams (CMHTs). Local guidance requires that CRAFT is updated at least annually, or sooner if risk changes. This audit aimed to assess compliance with annual CRAFT review within an elderly CMHT, identify factors contributing to non-compliance, and evaluate the impact of targeted interventions through a re-audit cycle.

A retrospective two-cycle clinical audit was undertaken using electronic health records (EMIS). In cycle one, we reviewed all outpatients in medical clinics from 16 December 2024 to 14 March 2025, and nurse-led clinics from mid-February 2025 to mid-March 2025. We excluded patients who did not attend, inpatients, and those no longer open to the team. For each included patient, EMIS was searched for a CRAFT dated within the previous 12 months (i.e., dated March 2024 or later) and compliance was recorded as yes/no. Following cycle one, findings were presented and discussed in the community multidisciplinary team meeting, and an email was circulated to clinicians with updated guidance on CRAFT completion and method for identifying the date of the most recent CRAFT by searching with the keywords. Cycle two was completed three months later using medical clinics from mid-April to mid-July 2025, and nurse-led clinics from mid-June to mid-July 2025, applying the same inclusion/exclusion criteria and outcome measures.

In the first audit, 132 eligible outpatients were reviewed. 108/132 had a CRAFT updated within the preceding year, giving an overall compliance rate of 81.8%. There was 77.6 % (83/107) compliance within the medical team and 100% (25/25) within the nursing team. The plausible contributors to non-compliance were time pressure in medical clinics and the absence of automated prompts within EMIS. In cycle two, medical clinic compliance improved to 83.6% (102/122). Nurse-led clinics maintained a high compliance rate of 95% (38/40). Overall compliance increased to 86.4% in the re-audit.

Compliance with annual CRAFT review in this elderly CMHT was high but not universal. A simple intervention, consisting of multidisciplinary feedback with practical guidance on screening for last CRAFT update, was associated with measurable improvement. Introducing electronic prompts and continuing periodic re-audit may help sustain gains and standardize accessible risk documentation across the team.

Effective handovers are crucial for patient safety and continuity of care in psychiatry. The Excel-based handover format used across three South Glasgow-linked hospitals (Dykebar, Leverndale and Inverclyde) frequently contained unresolved or outdated tasks, and did not clearly indicate urgency or ownership. Previous audits highlighted inefficiencies in this system, revealing an opportunity for innovation. We aimed to introduce a new Microsoft Teams handover, to improve clarity and efficiency and support safe on-call working across all three sites.

Between December 2024 and March 2025, feedback was collected from resident doctors across three South Glasgow psychiatric hospitals via anonymised Likert scale and free-text surveys, to explore their experiences with the Excel handover and openness towards trialling a new Teams format. The handover was created using Planner software, utilising tabsand columns to organise wards. Advice was sought from Information Governance regarding use of patient data, and subsequently implemented: the system was made private with closely managed access, and a retention period was applied via automated workflows to transfer completed tasks onto a private Excel sheet every three months, to be stored locally for audit trail. Clinical directors and residents received demonstrations and tutorials, and approved of the launch. The Teams system was implemented across all three sites in April 2025. Post-intervention feedback was collected in May 2025 to gauge opinions on the new handover; following this, the system remained in use and was later replicated at other Glasgow hospitals with our guidance on setup and workflow.

All eight participants in the preliminary survey indicated they found the Excel handover had become inefficient and unclear, and were interested in trialling the new system. Following launch of the Teams handover, all 15 respondents agreed it brought improved usability, clarity, and clinical efficiency. Comments acknowledged the clean interface and the ability to check tasks off, assign due-dates, and schedule repeating tasks ahead of time. Later in 2025, resident doctors in North Glasgow reached out and successfully adapted this project at Gartnavel and Stobhill hospitals, demonstrating positive change across multiple areas of the health board.

The findings provide evidence of improved satisfaction with the on-call handover since our introduction of the Teams interface. It is suggested that resident doctors value clarity and efficiency for smooth, safe team-working. The small sample size and single-region implementation limit generalisability, but feedback shows the project has brought a positive change to clinical work and has now been implemented at multiple hospitals.

To evaluate the impact of AI use on psychotherapy training for “core trainee” psychiatry residents. Psychotherapy training for residents includes theory-based teaching, courses, Balint groups, and completion of two psychotherapy cases across different modalities, all supervised by experienced psychotherapists. This includes anonymised case summaries, including a formulation.

A short questionnaire about AI use was sent to core training psychiatry residents working in CWPT via email, asking about their use of AI in psychotherapy training. The data is both quantitative and qualitative, summarising emerging themes. A similar survey was done for England-based psychotherapy tutors and is reported in a separate poster.

14 out of 32 residents completed the questionnaire. 85.7% of responders reported they don’t have experience of using AI in psychotherapy training or teaching. Those who used it reported using it for questions about psychotherapy, advice on how to discuss certain topics, and to “consolidate summaries and formulations” or “to write up sessions”.

When combining the “yes” and “maybe” responses, most residents supported using AI for teaching psychotherapy concepts, assisting with scribing, and producing formulations (57.14%, 71.42%, and 71.42%, respectively). 28.57% did not support the use of AI-assisted formulation.

28.57% of residents expressed concerns about confidentiality, 35.71% mentioned concerns about a “lack of contextual or emotional understanding” by AI. 14.28% had concerns about AI replacing therapists in the future or about inputting data into AI models, which could facilitate this. 14.28% mentioned that the responses generated can be inaccurate.

When asked about the “best use” of AI 42.85% listed explaining or breaking down concepts (teaching). 14.28% suggested its use for scribing.

Most respondents didn’t use AI in psychotherapy training or teaching. There is however significant support for its use for teaching, scribing and formulations. The residents expressed relevant concerns about the data protection and about AI lacking an in-depth understanding about emotions and context if being used in patient care.

A significant part of psychotherapy learning involves reflections about the sessions, facilitated by writing session summaries and supervision. The case formulation is a key part of the shared understanding, between resident, patient and the supervisor. AI being used to replace the process can negatively impact learning. Agreed guidance on best practice for the use of AI in psychotherapy training could assist residents in learning psychotherapy concepts and understanding potential pitfalls with AI use.

GAP is the largest psychiatric specialty, but most treatment evidence is generated in other populations, or excludes participants with severe conditions, comorbidities and treatment-resistance–essentially omitting most GAP inpatients. Consequently, the published evidence may have limited relevance.

Aimswere to characteriseGAP inpatients–diagnoses, severity, treatment-resistance, comorbidities, and legal status–to benchmark and inform the development of a framework to meta-analyse publications to test how accurately they reflect real-world practice.

We characterised consecutive admissions to a GAP ward using the measures usually employed in psychiatric publications. Data included demographics, Brief Psychiatric Rating Scale (BPRS), Inventory of Depressive Symptomatology (IDS-SR), Personality Disorder Severity (PDS-ICD-11), Generalised Anxiety Disorder scale (GAD-7), Substance Use scale (TAPS), and medical abnormalities and comorbidities.

N=65 (‘GAP-65’, 11 declined/could not be consented). Psychosis Group N=32: 60% treatment-resistant (clozapine protocol), severe psychosis (BPRS mean 58.2), very severe depression (IDS-SR mean 39.4), smoking, alcohol, and cardiometabolic disease frequent. Bipolar Mania Group N=5: Severe mania (YMRS mean 39.6), 60% obese, 50% hypertensive, and frequent metabolic abnormalities (DM II, prolactin elevation). Bipolar Depression Group N=2: All treatment-resistant (Massachusetts General Hospital Staging), 50% DM II and hypertensive. Unipolar Depression Group N=9: Very severe depression (IDS-SR mean 50.6), 57.1% treatment-resistant, 38% obese, 71% hypertensive, and high rates of cardiometabolic and respiratory illness. Axis II Group N=15: 80% PD, 93.3% suicidal ideation, physical comorbidities less common but mean BMI 30.2.

When these features are operationalised, an extremely low proportion of GAP inpatients would meet criteria for recruitment into even exemplars of contemporary academic psychiatry e.g. 1) translational neuroscience; Rupprechter et al., Brain (2020) (£4.7M, N=475)–92% participants were in the healthy or mild depression range and treatment-resistant patients were excluded c.f. GAP-65 who were all severely ill and mostly treatment-resistant. 2) treatment trials; Jog et al., JAMA Netw Open (2025) (highlighted by evidencealerts.com, including for clinical relevance)–participants were in the moderate depression range, treatment-resistant patients were excluded, and the reduction in depression scores following transcranial direct current stimulation would not move pertinent GAP-65 patients out of the severe range of illness.

Our results highlight a critical gap in psychiatric research: Studies that are highly cited and influential do not adequately represent the severity and complexity of typical GAP inpatients. Correspondingly, we propose a systematic review and meta-analysis of clinically important features of GAP inpatients to evaluate the extent to which psychiatric research represents real-world practice.

The aim of this auditis to assess the adequacy of on-call room facilities and their impact on resident doctors’ rest and recovery during shifts. It also sought to evaluate the challenges and safety risks associated with driving long distances during and after on-call duties.

Data were collected through direct observation and surveys completed by participating resident doctors. The audit assessed cleanliness, availability of rest facilities, access to kitchen and bathroom amenities, and perceived impact on fatigue and driving safety. Driving distances between the hospital and doctors’ homes were recorded and analysed. Surveys also explored how often doctors felt tired when driving after on-call shifts and their perceived ability to drive home safely. Data were collected from seven resident doctors covering shifts between 17 August 2024 and 20 September 2024.

The audit identified significant deficiencies in on-call room conditions. Rooms were frequently unclean, infested with insects, and lacked basic hygiene measures such as bed linen. Many rooms were used as day offices, limiting opportunities for rest. Additional issues included lack of water access in kitchen areas and poor lighting. These conditions were associated with increased fatigue and stress among resident doctors.

Driving analysis showed a total of 626.3 miles driven during recorded journeys, with 247.4 miles driven when returning home after on-call shifts. Survey responses indicated high levels of fatigue related to driving: doctors reported feeling occasionally tired on 6 shifts, frequently tired on 17 shifts, and very frequently tired on 15 shifts. Regarding the ability to drive home, responses were “Yes” for 18 shifts, “No” for 4 shifts, and “Maybe” for 16 shifts.

The findings underscore the need to enhance on-call room facilities to ensure adequate rest and mitigate fatigue-related risks. Improvements should align with BMA guidance, including provision of dedicated, hygienic rest areas that are not used for clinical work. Addressing long driving distances and post-shift commuting risks is also crucial to enhancing resident doctors’ safety and well-being.

Cultural psychiatry explores the impact of social and cultural context on mental health and illness. Given new urgency by global anti-racism campaigns, cultural psychiatry teaching has been increasingly prioritised in recent years. However, there is currently little evidence on how cultural psychiatry training is being implemented in practice. By comparing different approaches, this research provides guidance on the benefits and limitations of different formats for teaching cultural psychiatry.

Four case studies of UK teaching programmes are compared, selected to reflect national variation and diversity of approach. The case studies differ in audience, form andstructure; on whether they were online or in-person; on whether they were mandatory or informal; and in their use of resources.

All groups emphasised the importance of psychological safety when facilitating challenging conversations. Informal sessions were associated with more open conversations; limitations included variable attendance, inadequate organisational time, problems inviting external speakers, and difficulties creating a safe frame. Online spaces were more accessible; but with concerns around engagement, safety and the ability to challenge insensitive comments. Sessions with external speakers brought alternate perspectives, but needed careful management to avoid insensitivity. Consideration was given to whether race and ethnicity were prioritised over other elements of culture such as sexuality, gender, religion and class.

Bringing cultural psychiatry into the curriculum offers the potential to improve both patient care and clinician wellbeing. Lessons learned from these case studies can guide mental health and teaching organisations seeking to implement similar courses.

A community engagement programme can improve individuals’ mental health literacy and create awareness about mental health in communities. The conference aimed to reduce mental health stigma and improve mental health outcomes in the community.

The impact of the conference was mapped out by applying Theory of Change. They are input, which are resources including financial sponsorship and institutional support; expertise from leading psychiatrists in the UK, psychologists, researchers, practitioners, and individuals with lived experiences from a South Asian background. Keynotes were given by Professors Dinesh Bhugra, Nusrat Husain, and Subodh Dave. Engagement tools include a survey (N=42), sticky note messages (N=41), a data map, and a website (https://samhstigma.my.canva.site). Activities included 15 presentations, both in person and online. Outputs included hybrid delivery and participation (62 in-person, 13 online), recording of the conference, and a booklet with presenters’ profiles and a summary of their presentation.

Short-term outcomes include increased mental health literacy, awareness of the cultural dimension of stigma, attitudinal shift, and strengthened professional networking. Some medium-term outcomes included greater collaboration between institutions and the community, integration of lived experience voices into future research and practice, through ripple effects of awareness, increased help-seeking behaviour, and encouraging culturally sensitive approaches being adopted in clinical settings. Long-term outcomes included, at a personal, community, and institutional level, reducing stigma, access to mental health services improved for South Asians.

“Nothing About Us Without Us” can further strengthen the Theory of Change framework applied to the community engagement program. It aligns with the critical long-term impact, which is empowerment and inclusion. It makes community engagement more effective and relatable as it enhances credibility and authenticity. The principle suggests that people who are directly affected by an issue must be actively involved in making decisions, policies, and programmes about that particular issue. Bilateral learning is another principle that is integrated into the programme. It involves creating a two-way exchange of knowledge between the community and professionals, including psychiatrists, counselling therapists, advocates, and researchers. The community gains information about evidence-based strategies for mental health care.

In the future, community members can be included in co-designing the agenda for community engagement programmes. The conference format can further be made interactive by including a panel discussion where queries from the community are clarified by mentalhealth professionals, conducting a workshop on shared problem-solving, storytelling, and allocating time for questions and answers with people with lived experience, alongside reflections from the professionals.

To compare UK Assertive Outreach Teams (AOT) and Vancouver Assertive Community Treatment (ACT) with respect to core model components, multidisciplinary team (MDT) delivery, crisis response, safety management, and interagency working. The evaluation also aimed to identify shared principles and locally specific adaptations, including police integration within the Vancouver model.

A descriptive, comparative service evaluation was conducted using a structured side-by-side framework across predefined domains: service context, implementation/operation, staffing/roles, and distinctive operational features. A scoping review and targeted grey-literature review identified established ACT components and local descriptions of intensive/assertive community care, including NHS England guidance and published descriptions of the Vancouver ACT model. Data were extracted into a comparison matrix (population focus, MDT composition, contact intensity, crisis/safety processes, and interagency interfaces) and synthesised narratively to describe similarities and differences.

Both services reflect core ACT principles reported in the literature, including MDT-based delivery and intensive, community-based support for people with severe mental illness and complex needs. NHS England guidance describes intensive and assertive community mental health care as a distinct, high-support form of community provision, consistent with the aims of assertive/outreach-style models. A key difference is Vancouver ACT’s formal integration of law enforcement, with designated Vancouver Police Department officers embedded within the team to enable coordinated responses. This embedded-police element represents a distinct approach to crisis intervention and safety management compared with standard UK community configurations described in national guidance.

UK AOT-style services and Vancouver ACT share a common basis of MDT, high-intensity community care, but differ in how safety functions and interagency crisis working are structurally embedded. Further evaluation should compare outcomes (engagement, admissions, safety events, patient experience) and process measures (response times, multi-agency coordination) to determine benefits, risks, and acceptability across settings.

High Dose Antipsychotic Therapy (HDAT) is defined as prescribing a single antipsychotic above the British National Formulary (BNF) maximum or a combinedpercentage dose of two or more antipsychotics exceeding this limit.HDAT is off-label and associated with increased morbidity and mortality, requiring documented clinical justification and risk–benefit discussion.This audit evaluated HDAT prevalence, adherence to Trust monitoring standards and reported side effects among adults prescribed antipsychotics in inpatient and community settings.

A cross-sectional audit was conducted between May and August 2025 of adults aged 18–65 years receiving antipsychotic therapy.All patients in nine inpatient psychiatric wards and a random sample of patients from two Community Mental Health Teams and one Early Intervention in Psychosis service were audited.Prescription charts, clinic letters and medical records were reviewed to assess prescribing patterns, HDAT prevalence, compliance with Trust monitoring standards, patient demographics, psychiatric diagnosis, treatment duration, and medication side effects.

A total of 337 patients were audited (n=142 female, 42.1%; n=195 male, 57.9%), mean age 41 years. Most identified as White (76.9%), with 19.0% Black or Asian and 4.2% unknown ethnicity. The majority (72.7%) were prescribed at least one additional psychotropic medication and 18.1% reported side effects, predominantly extrapyramidal symptoms (52.5%), weight gain (24.6%), and sedation (23%).Thirteen patients (3.9%) met HDAT criteria, primarily in inpatient settings (n=11); mean age 43 years.Most were male (84.6%), White (92.3%) and diagnosed with schizophrenia (84.6%).Over half (69.2%) received two antipsychotics, whilst 30.7% were prescribed a single antipsychotic above BNF limits.HDAT monitoring was fully compliant in 38.5% of cases, partially in 23.0%, and incomplete in 30.8%.Fewer HDAT patients reported medication side effects (15.4%).In the overall, sample, 32.6% had received antipsychotic treatment for over 12 months, rising to 46.2%among those on HDAT.

HDAT was infrequent, largely confined to inpatient settings and typically associated with antipsychotic polypharmacy and co-administered psychotropics.White men were more likely to receive HDAT, despite a broadly balanced gender distribution overall. Frequent side effects, relatively young cohort and known risks of HDAT highlights the importance of adherence to Trust monitoring standards, which was achieved in fewer than half of cases. The low rate of side effects among patients receiving HDAT likely reflects under-recognition or under-reporting rather than true tolerability, particularly in the context of polypharmacy and long-term treatment.These findings support the need for targeted clinician education and improved systems to promote safer HDAT practice.

Anorexia nervosa (AN) is associated with high morbidity and mortality and significant barriers to recovery, including food-related anxiety and avoidance behaviours. Virtual reality (VR) interventions offer immersive, safe exposure to feared stimuli and may enhance engagement with treatment. The OASIS feasibility study aimed to evaluate the acceptability, feasibility, and preliminary effectiveness of a VR-based, AI-personalized adjunct to treatment as usual (TAU) in adults with AN.

This is a single-site feasibility study conducted at South London and Maudsley NHS Foundation Trust (SLaM). Up to 45 adults with AN from inpatient, day-care, and outpatient services will participate in a one-week VR intervention alongside TAU. The OASIS app, delivered via Pico 4 headset, will provide personalized sessions including psychoeducation, graded food exposure, motivational support from a virtual companion, and relaxation exercises. Primary outcomes will include recruitment, adherence, retention, and acceptability. Secondary outcomes will include anxiety, relaxation, BMI, and qualitative feedback from focus groups with patients, carers, and clinicians. Data will be analysed descriptively, and thematic analysis will be applied to qualitative data.

The OASIS study will provide evidence on the feasibility and acceptability of a VR-based intervention for adults with AN and will inform the design of a future randomized controlled trial. Insights from patient, carer, and clinician feedback will guide refinement of the intervention and identify barriers and facilitators to implementation in routine clinical care.

To assess the effectiveness of the STOMP pathway in supporting the reduction of psychotropic medication prescribing among people with learning disabilities.

Adults with learning disabilities under the care of the Community Learning Disability Team who were prescribed one or more psychotropic medications were considered. Reviewed data from January 2024 to April 2025 and sources included Electronic health records, STOMP review templates, MDT notes. There were 30 participants in the sample.

The audit demonstrated a high level of compliance across most criteria relating to psychotropic medication use. Documentation of the clinical rationale for psychotropic useachieved full compliance (100%). Medication reviews within the previous 12 months were completed for the majority of individuals (93%). Non-pharmacological interventions were documented in 87% of cases, indicating good but not universal adherence. Evidence of involvement of the person and/or their carer in decision-making was present in 90% of records. However, documentation of attempted or completed reduction in psychotropic medication was comparatively lower (70%), highlighting an area for potential improvement.

The audit shows that the STOMP pathway has had a positive impact on reducing unnecessary psychotropic prescribing in people with learning disabilities. Continued focus on structured reviews, non-drug alternatives, and stakeholder involvement will help sustain this progress.

To assess how many patients were seen within the 15 working days from referral to first appointment within North Leeds OPS CMHT in line with LYPFT guidance and whether electronic documentation and letter to GP were completed in a timely manner. A re-audit was completed after interventions were implemented to assess the effectiveness of these. The interventions implemented were: including resident doctors in the gatekeeping assessment rota; reminder of need to document reasons for delay in assessment in referrals meeting or subsequent contacts and implementing a record of patients not accepted for follow up after assessment with reminders to be sent to assessing staff of need to complete letter within 2 weeks by administration team.

A review of all referrals to North Leeds OPS CMHT was completed from August to October 2024 and subsequently from August to October 2025. Each patient’s notes were reviewed to extract the outcome of referral. If accepted for assessment; referral date, first appointment date, date of electronic documentation and date of letter to GP sent were extracted. The time intervals between referral and each outcome were subsequently calculated utilising microsoft excel.

For the 2024 cycle the following results were found: 80 referrals were received with 30 referrals accepted for assessment; 70% were seen within 15 working days; 33% had reason for delay documented; all had electronic documentation; 73% had electronic documentation within 24 hours; 87% had letters to GP sent and 33% had GP letter sent within 2 weeks.

For the 2025 cycle the following results were found: 100 referrals were received with 39 referrals accepted for assessment; 87% were seen within 15 working days; 40% had reason for delay documented; 97% had electronic documentation; 61% had electronic documentation within 24 hours; 79% had letters to GP sent and 41% had a GP letter sent within 2 weeks.

Despite an increase in service demands there was an improvement in the number of patients seen within 15 working days with this now sitting above the trust set standard of 80% demonstrating the impact of inclusion of more MDT members for gatekeeping assessments. There were mixed results with regards to timeliness of documentation, this was likely a result of interventions being implemented at a time of greater service pressure resulting in prioritisation of direct patient care above documentation.

To reduce the time resident doctors spend requesting blood tests on an acute psychiatric inpatient ward by introducing pre-printed patient identification (ID) stickers.

Baseline timings for routine hand-written blood requests were recorded on an acute male inpatient psychiatric unit in Leeds. Using a fish bone analysis, root causes of inefficiency were identified. A PDSA cycle tested the intervention: ward administrators printed 2 pages of patient ID stickers for all new admissions which were then stored in the MDT room for use on blood request forms and bottles. A one-point lesson and step-by-step guide were distributed to all resident doctors and displayed in the doctor's office to support sustainability during staff rotation.

Mean time to request routine blood tests decreased from 7 minutes on average to 2.3 minutes after introducing patient stickers–an approximate 67% reduction–saving 3 hours 15 minutes per month across 28 routine requests on just 1 acute inpatient ward. Informal feedback indicated improved efficiency and a reduction in errors on request forms after introducing the ID labels. The process has been adopted locally and presented at the Adult Acute Inpatient Clinical Improvement Forum, where colleagues supported trust-wide roll-out.

Pre-printed patient ID stickers reduced time and errors in blood requesting on an acute psychiatric ward. The intervention is low cost, sustainable and suitable for scaling across inpatient services.

In England, access to acute psychiatric care is increasingly affected by limited inpatient capacity, which can lead to lengthy waits in emergency departments. Emergency departments often become the default place of care for patients in acute mental health crisis while awaiting psychiatric assessment or admission. This creates strain for clinicians delivering emergency mental health care, particularly out of hours, and can lead to uncertainty and moral distress. For patients, these friction points occur when they are most unwell, shaping their experiences of care at times of acute distress and vulnerability.

We aim to explore and compare potential routes of access into acute psychiatric care across England and Germany. We are using a narrative service-mapping approach, focusing on the patient journey and the experience of psychiatry trainees, who are often responsible for out-of-hours assessment and decision making. We are hoping to stimulate reflection, discussion and generate learning across different but comparable systems.

We undertook a comparative narrative service-mapping exercise based on a hypothetical patient presenting in acute mental health crisis. Using the same clinical scenario, we mapped likely pathways through community, emergency and inpatient psychiatric settings in England and Germany. Mapping was informed by clinicians’ experience of working within these systems. We worked with middle-grade and higher trainee psychiatrists involved in delivering acute and out-of-hours care in these three countries. The exercise focuses on access routes, transitions between services and areas of system pressure. Narrative elements are used to reflect how these pathways may be experienced by both the patient and the clinician providing care.

Across both systems, difficulties accessing care and fragmented transitions between services, were identified as sources of distress for patients and pressure for clinicians. Emergency departments emerged as settings of prolonged waiting. Differences were noted in routes to admission, gatekeeping processes and alternatives to inpatient care. These structural features shape doctors experience, including responsibility for decision-making under pressure, risk management and exposure to moral distress.

This comparative narrative mapping highlights how the organisation of acute psychiatric services influences patient journeys and clinician experience. By foregrounding experience and reflective clinical narratives, this work aims to support discussion about shared challenges, system pressures, and potential learning across European systems. This work reflects the perspective of clinicians, using a hypothetical scenario. It is not intended to represent all patient experiences or to provide quantitative comparison between systems.