BMI and waist circumference should be measured on admission and then regularly for inpatients. We aimed to determine whether this was being met, and to explore staff knowledge of such monitoring.

Retrospective data was collected from Rio, the electronic records system at Bushey Fields Hospital. The fifteen most recently discharged patients from each of five wards as of April 2025 were extracted, after which six patients from each set of fifteen were selected at random. Monitoring data was then extracted by two reviewers.

A questionnaire was separately distributed amongst ward staff to assess staff knowledge of BMI and waist circumference monitoring.

30 patients were included, with ages ranging from 20 to 81, comprising 18 male and 12 female patients. 26 patients were taking an antipsychotic. Patients had a range of physical comorbidities and were taking a range of additional medications.

BMI was recorded at admission for 22 patients, at one week for 20 patients, at two weeks for 23 patients, and at three weeks for 20 patients. Waist circumference was recorded at admission for 9 patients, and at one week for 29 patients.

13 patients had an above normal BMI, but action was only taken for 4. This included lifestyle advice, provision of relevant leaflets and a referral to appropriate services.

15 staff members received the questionnaire, of which 12 responded. 100% of responders were aware of the normal BMI range, but only half knew the normal range for waist to height ratio. 92% were aware of the need for weekly monitoring for patients on antipsychotics, but only 33% were confident in recording relevant parameters on Rio.

Only 25% of responders felt confident referring patients to relevant services, and 75% felt that educational resources on the ward were inadequate.

Not all inpatients on psychiatry ward receive necessary BMI and waist circumference monitoring, and appropriate management is only initiated for a small number of patients.

Most survey responders were not confident recording relevant information on RiO or making referrals to appropriate services and felt that available educational resources were inadequate.

We have made several suggestions in light of this data, including updating electronic record, introducing posters to the ward, staff refresher workshops and the introduction of a streamlined referral pathway for dietician reviews.

Growing research indicates that attention-deficit/hyperactivity disorder (ADHD) may occur at higher rates in individuals with functional neurological disorder (FND). However, reported prevalence differs substantially across studies and FND subtypes. This systematic review and meta-analysis sought to estimate the frequency of ADHD comorbidity within FND populations.

A systematic literature search of PubMed, Embase, Web of Science, PsycINFO, and Google Scholar was conducted through October 2025. Seventy-five studies fulfilled inclusion criteria. Information was extracted regarding study design, sample characteristics, diagnostic methods, and reported ADHD prevalence. Pooled prevalence estimates were calculated using random-effects meta-analytic models.

Across 63 studies involving 115,331 participants, the pooled prevalence of ADHD among individuals with FND was 15% (95% CI: 12–19; I²=92%). Subgroup analyses indicated ADHD rates of 14% (95% CI: 10–18) in functional seizures (22 studies, n=11,117), 6% (95% CI: 1–16) in functional movement disorder (4 studies, n=166), and 27% (95% CI: 19–35) in functional tic-like behaviours (21 studies, n=1057). In studies limited to paediatric populations (33 studies, n=2141), the pooled prevalence was 16% (95% CI: 11–22).

Approximately one in six individuals with FND also meet criteria for ADHD, with particularly elevated rates observed in functional tic-like presentations and in children and adolescents. Considerable heterogeneity was present across studies. These findings underscore the importance of evaluating for ADHD during FND assessment, especially when difficulties with attention regulation or impulse control are prominent.

Clozapine-associated neutropenia occurs in approximately 3.8% of patients globally, with agranulocytosis reported in around 0.9%. Benign ethnic neutropenia (BEN), which is prevalent among Arab and African populations, complicates interpretation of haematological monitoring and may lead to unnecessary treatment interruption. Despite the high representation of BEN-susceptible ethnicities in Gulf populations, regional data on clozapine haematological safety are lacking. This study aimed to estimate the incidence of clozapine-associated neutropenia, identify clinical predictors, and evaluate the role of baseline absolute neutrophil count (ANC) in risk stratification.

A retrospective cohort study was conducted including all patients prescribed clozapine at a tertiary psychiatric hospital in the United Arab Emirates between January 2018 and July 2024. A total of 184 patients were followed over 228.1 patient-years, comprising 3,907 ANC measurements. Neutropenia was defined as ANC <2.0 × 109/L and categorised as mild (1.5–2.0), moderate (1.0–1.5), severe (0.5–1.0), or agranulocytosis (<0.5). Cox proportional hazards regression was used to identify predictors of neutropenia. Receiver operating characteristic (ROC) analysis assessed the discriminatory performance of baseline ANC.

Twenty patients (10.9%; 95% CI 7.1–16.2%) developed neutropenia, corresponding to an incidence rate of 9.74 per 100 patient-years (95% CI 5.95–15.05). Most events were mild (n=19, 10.3%), and no cases of agranulocytosis were observed. Patients of Arab or African ethnicity had significantly higher neutropenia rates compared with other ethnic groups (16.2% vs 1.6%; odds ratio 11.5, 95% CI 1.5–87.5; p=0.001). Baseline ANC emerged as the only independent predictor of neutropenia (hazard ratio 0.15, 95% CI 0.07–0.31; p<0.001), with each unit increase associated with an 85% reduction in risk. Baseline ANC demonstrated excellent discriminatory ability (AUC 0.92, 95% CI 0.86–0.97), with an optimal threshold of 3.3 × 109/L (sensitivity 85%, specificity 87.4%). Clozapine was continued in 80% of affected patients, with no permanent discontinuations due to haematological events.

This first Middle Eastern study of clozapine haematological safety demonstrates neutropenia rates comparable to international data and no observed agranulocytosis. Baseline ANC provides excellent risk stratification, while higher neutropenia rates in Arab and African patients likely reflect benign ethnic neutropenia rather than true drug toxicity. These findings support continued clozapine treatment with appropriate monitoring and highlight the need for ethnicity-informed interpretation of haematological results in diverse populations.

No financial sponsorship was received for this project.

A clear and well-timed induction is important in helping resident doctors work safely and confidently in mental health services. Psychiatry presents specific challenges, including the use of legal frameworks, managing risk, and working within multidisciplinary teams. Feedback from doctors starting in the Trust suggested that the induction programme was variable and that some felt unprepared when beginning clinical work.

This Quality Improvement project aimed to review the current induction programme, identify gaps that affect clinical readiness and patient safety, and support improvements in how the induction is structured and delivered.

A mixed-methods survey was sent to resident doctors who had completed the Trust induction programme within the previous 12 months. The survey included rating-scale questions on coverage, usefulness, and preparedness, alongside open-ended questions about individual experiences. Quantitative responses were summarised using simple descriptive measures, and free-text responses were reviewed to identify common themes. The project followed a Plan–Do–Study–Act approach. As this work was carried out as a Quality Improvement project, formal ethical approval was not required.

Eight out of ten resident doctors across different training grades responded. Mostfelt that the induction helped them understand their role within psychiatry, but fewer felt prepared for on-call duties and seclusion reviews. Practical sessions, such as IT access, prescribing systems training, Mental Health Act teaching, and breakaway training, were viewed positively, especially when delivered early and in person. Several key areas, including discharge summaries, ward rounds, and educational meetings, were reported as not covered for some doctors. Common concerns included induction sessions being spread over several weeks, limited protected time, and starting clinical duties before completing essential systems training. These factors reduced attendance and confidence. Most respondents felt that online or recorded learning materials would support learning alongside face-to-face teaching.

The induction programme contains important psychiatry-specific content but is less effective due to delays, poor sequencing, and lack of protected time. A shorter, more focused induction period, completion of essential training before clinical duties begin, and a blended approach to teaching may improve preparedness and support safer patient care. These findings will inform a revised induction programme and a further PDSA cycle.

We intended to study the clinical outcomes and risk factors associated with patients on Community Treatment Order (CTO) and those discharged from Section 3 (S3).

The sample included adult patients admitted (n: 123) on Section 3 of the Mental Health Act in 2022; 11 of them are currently on CTO, along with a further 55 patients currently on CTO, suggesting the sample of 66 in CTO and 112 in the S3 group. Historical and previous 12-month status of clinical and risk factors, readmission rates, duration to first readmission, and total inpatient days were collected from medical records.

Sample (n: 178) consisted of 106 (59.6%) male and 72 (40.4%) female patients; with 52.8% having Caucasian ethnicity; males made up 52.1% of the Caucasian group, vs.69.2% in BME patients (P<0.05). The proportion of men was 69.7% on CTO and 53.6% on S3 (P<.05). The mean age of the groups (CTO: 46.1 ± 17.2; S3: 45.5 ± 17.4) was comparable, and there were no differences in ethnicity, employment, and accommodation status between the two groups.

The number of diagnoses and comorbidities was comparable, whereas the presence of severe mental illness was significantly higher in the CTO: 97.0% vs. S3: 81.3% (p<0.005). History of risk to self, others, neglect, arrests, custodial sentence, probation, and being on CTO or s37/41 was comparable; forensic history and convictions were significantly more in CTO.

Duration from index discharge to readmission was considerably longer in CTO (439.2 ± 471.4) vs S3 (265.5 ± 281.2), which approached statistical significance (p: 0.059). The duration of first readmission and the nature of readmission (informal or formal) were comparable between the groups. Significantly more patients in CTO had depot and oral antipsychotics, and fewer had antidepressants compared to S3; whereas prescriptions of high-dose antipsychotics, more than one antipsychotic, mood stabilisers, and hypnotic drugs were comparable.

In the previous 12-month period, risk to self, to others, self-neglect, opiate use, psychotic symptoms, impaired or absent insight, poor engagement, and poor concordance were all significantly higher in CTO patients compared to those discharged from S3.

There were considerable differences in a few areas of the CTO and S3 patient profile, e.g. forensic history, past convictions, and treatment with depot and antipsychotics. There were many clinical and risk-related factors in the previous 12 months, validating continuation of CTO in a proportion of patients. Future studies should consider differences in symptomatic presentations, functioning and patient-reported outcomes.

Population ageing in India is accelerating, accompanied by a rising burden of neurocognitive disorders that contribute substantially to disability, healthcare utilisation, and loss of independence. Cognitive impairment (CI), particularly in its mild and early stages, remains under-detected in low- and middle-income settings due to limited screening, low literacy levels, and restricted access to specialist services. Rural and socioeconomically disadvantaged populations are especially vulnerable, yet robust multicentric data from South India remain scarce. This study aimed to estimate the prevalence of cognitive impairment across specific cognitive domains among older adults in South India and to examine its association with socio-demographic and clinical variables.

A multicentric cross-sectional survey was conducted across selected centres in South India, enrolling 122 participants aged 60 years and above. Data were collected from medical outpatient clinic attendees, using a structured proforma capturing age, gender, education, employment status, socioeconomic status (SES), medical comorbidities, and alcohol/substance use. Cognitive functioning was assessed using the Montreal Cognitive Assessment (MoCA), a validated and widely used screening instrument for detecting cognitive impairment. Cognitive impairment was categorised into mild, moderate and severe, based on established cut-offs. Statistical analyses were performed to identify significant correlates of cognitive impairment.

The study population was predominantly male (68.9%), below 65 years of age (58.2%), and residing in rural areas (79.5%). The overall prevalence of cognitive impairment was strikingly high at 77.9%. Of those identified with impairment, 59.8% had mild cognitive impairment, indicating a substantial burden of potentially reversible or modifiable cognitive decline. Cognitive impairment showed significant associations with increasing age, lower educational attainment, unemployment or engagement in unskilled labour, and lower socioeconomic status. In contrast, no statistically significant associations were observed with gender, rural versus urban residence, medical comorbidities, or alcohol/substance use.

This study demonstrates a markedly high prevalence of cognitive impairment among older adults in South India, with a large proportion experiencing early or mild cognitive deficits that are likely undetected in routine care. The strong association with social and educational disadvantage highlights cognitive impairment as not only a medical condition but also a social determinant, driving health inequity. These findings emphasise the urgent need to integrate routine cognitive screening into primary healthcare and geriatric services. Early identification and timely intervention may help delay progression, reduce disability, and preserve functional independence, thereby improving quality of life for India’s rapidly ageing population.

Estimate associations of domestic violence (DV; physical, sexual, emotional, financial) with Emergency Department (ED) attendance for self-harm in women using mental health services.

We analysed data from the Clinical Record Interactive Search (CRIS),an electronic health record database (EHR) from South London, of women who used South London and Maudsley (SLaM) NHS Trust mental health services. We used a previously developed and validated natural language processing (NLP) algorithm to ascertain identification of DV types occurring within the first year of care and at any time. ED attendances for self-harm were gathered from hospital episodes statistics (HES) data linked tothe EHR database. We adjusted for variables relating to DV and self-harm such as age, ethnicity and psychiatric diagnosis to estimate associations of DV types with ED attendances for self-harm.

Between 2007 and 2020, 240,180 women used services. Missing data was excluded, data from 79,025 women were analysed. Overall, 2670 (3.4%) of women had ED self-harm attendance. The most common DV types recorded at any time were physical (28.8%) and emotional (13.7%). Sexual DV had the strongest association with self-harm. After adjusting for factors that can affect self-harm and DV, the strongest association was for physical DV. The strongest association in the first 12 months after referral was for financial DV.

Women with a history of DV are more likely to use mental health services. Associations between DV types with self-harm are unexplored. Women accessing services who experience DV are more likely to attend hospital due to self-harm than those not experiencing DV. Physical and emotional DV were the most common types. There were associations between self-harm and most DV types. These findings can inform interventions and service improvements.

We aimed to improve the safety, reliability and confidentiality of the medical handover process at Broadmoor, a high-secure forensic hospital. The existing system relied on a mass email sent at the end of on-call shift containing clinical updates, seclusion information and outstanding tasks. We identified key risks: outdated patient lists, missed seclusion reviews, task not reaching the on-call doctor, poor structure and routine sharing of patient full names across a broad distribution list. In a high-secure forensic setting, where patients have complex comorbidities and legal restrictions, communication failures carry heightened clinical and governance risk.

Rather than modifying the email format alone we aimed to redesign the entire handover processto ensure up-to-date information, improve accountability, enhance data security and promote combined verbal and written handover.

We conducted a Quality Improvement Project using feedback and systemic redesign, we surveyed all regular recipients of the handover email (resident doctors, consultants, site management and physical health nurses). The baseline results showed low satisfaction with the handover email, with 73% reporting dissatisfaction to extreme dissatisfaction, citing safety, accuracy, layout and confidentiality concerns.

Our intervention replaced free-text email handover with a structured process. We introduced an Excel template stored in a secure shared drive which is attached to the email, separate tables were created for acute issues, monitoring needs, seclusion status and tasks. Full patient names were removed and replaced with the initials and hospital numbers. We also introduced a requirement of both verbal and writtenhandover and added a step for the on-call doctor toconfirm seclusion status with site management by the end of their shift. We also reviewed all patient lists for regular monitoring to remove outdated patients. The new process was introduced via hospital-wide presentation.

Post-implementation feedback showed marked improvement, up to 80% of responders reported satisfaction to extreme satisfactionacross domains compared to the baseline dissatisfaction. Staff reported clear structure, more reliable seclusion information, fewer missed tasks and improved confidentiality. The combination of structured documentation and verbal handover reduce reliance on memory during busy shifts and improved multidisciplinary communication. Removal of outdated patients increased clinical relevance of the handover list.

System redesign of the medical handover improved safety, clarity and information governance in a high-secure forensic setting.Structured templates, verbal reinforcement and reduced identifiable patients’ data created a more reliable process.

This low-cost interventiondemonstrated how addressing system factors can strengthen communication, accountability and patient safety across acute and secure psychiatric services.

Complex psychosis, characterised by severe, treatment-resistant psychosis with associated functional impairment, is one of the most challenging conditions to manage in psychiatric practice. Evidence-based guidelines recommend clozapine for treatment-resistant psychosis, though in practice less than 1/3 of potentially eligible patients receive clozapine in a timely manner. The Complex Psychosis Service (CPS) was established in Kent in 2022, with the goal of providing a specialist multi-disciplinary opinion to clinicians for the management of patients with complex psychosis.

This paper aims to describe our model for developing and implementing this new consultation service for complex psychosis in Kent and Medway Mental Health NHS Trust. We aim to describe the clinical characteristics of individuals referred to CPS, treatment recommendations made, rates of uptake, and staff experiences of the service.

Retrospective data was collected on the number of referrals to CPS from its inception in December 2022 to September 2024. Data was collected on several measures including primary psychiatric diagnosis, comorbid mental disorders and prior antipsychotic treatment, including whether clozapine had been trialled in the past. Questionnaire data was collected from referrers, and qualitative experiences explored through semi-structured interviews with six referrers and discussions with the CPS team.

62 referrals were made to CPS during this time period. The most common primary diagnoses were treatment-resistant schizophrenia (n=29) and schizoaffective disorder (n=19), and 26 had another comorbid mental disorder, most frequently mood disorder (n=7) and personality disorder (n=5). Patients had a mean of 5.7 prior inpatient admissions and average of 6.2 antipsychotic trials. 18 patients had never tried clozapine despite treatment-resistance. CPS recommendations proposed trials of clozapine (n=12), augmentation with other psychotropics (n=16), ECT augmenting clozapine (n=5), and non-pharmacological interventions including psychology and occupational therapy.

56% of referrers implemented the recommendations and 90% reported high levels of satisfaction with the service provided by CPS. However, some referrers felt limited by CPS often not reviewing patients face-to-face. Qualitative data indicated that referrers valued the specialist input and expertise, and Psychiatry trainee doctors felt that working in CPS offered a rich educational experience.

Individuals referred to CPS primarily had schizophrenia-spectrum illness with treatment-resistance, with significant burden from untreated symptoms. Input from the CPS multi-disciplinary team was well-received by referrers, and there were high levels of satisfaction both from referrers and CPS clinicians. Future directions to expand CPS would include specialist psychology input, and potentially inpatient beds on a specialist unit to increase the uptake of treatment recommendations.

To investigate relationships between diabetes, diabetes duration, and psychiatric difficulties using data from a nationwide survey and to examine associations between psychiatric difficulties and physician diagnosis, treatment status, and glycaemic control in diabetes patients by performing subgroup analyses.

Data from the 2022 Korea National Health and Nutrition Examination Survey were analysed. A representative sample of 4,475 adults aged 19 years or older was obtained using stratified, multistage, clustered sampling. Psychiatric difficulties were assessed using PHQ-9 for depression, GAD-7 for anxiety, and face-to-face interviews for suicidality. Diabetes patients were categorized by diabetes duration (<5, 5−9, 10−14, and ≥15 years). Statistical models were adjusted for demographic and clinical covariates.

Diabetes patients were significantly more likely to experience depression than controls (aOR=1.818). Those with a diabetes duration of ≥15 years showed significant associations with depression (aOR=2.830), suicidal ideation (aOR=2.496), and suicidal plans (aOR=4.604). Such associations were not found in shorter duration groups. Subgroup analyses revealed links between suicidal ideation and being diagnosed by a physician or receiving treatment. No significant associations were found between glycaemic control and psychiatric difficulties.

Depression was more prevalent in diabetes patients than in controls. A diabetes duration of ≥15 years was significantly linked to higher rates of depression and suicidality. Routine psychiatric screenings after 15 years of diabetes duration could enhance public health strategies. Addressing societal stigma and alleviating burdens of diabetes management might improve mental health outcomes.

Medical students experience higher rates of mental health problems compared with the wider student population. Stigma and fitness-to-practise concerns can deter help-seeking, with students often turning to peers. Mental Health First Aid (MHFA) is a psycho-educational programme developed for the general public, designed to support recognition of mental health difficulties and responses to people in distress. We present an innovative, co-constructed mixed-methods study exploring medical students’ experiences of MHFA training,delivered as a student-selected component within a medical school curriculum. We aimed to explore the motivators, enablers and barriers to student engagement, and students’ perceptions of the value and relevance of MHFA in relation to mental health knowledge, self-care, help-seeking and supporting others. The study also sought to inform the development of a bespoke course tailored to the needs of medical students.

MHFA was delivered in four half-day face-to-face sessions to Year 1 and 2 medical students at Kent and Medway Medical School. Data were collected via post-session questionnaires, in addition to post-course student-led focus groups and optional semi-structured individual interviews. Questionnaire data were analysed using descriptive statistics, and qualitative data were analysed thematically.

Twenty-five students participated; 21 attended all four sessions (range was 21–25 students). In post-session questionnaires, students rated MHFA content positively in relation to self-care and supporting others, and noted areas of overlap with the medical curriculum, including psychosis, suicide and communication skills. Analysis of qualitative data from four focus groups (n=22) and nine individual interviews identified common themes. Students described generally positive experiences of MHFA training and valued having an adaptable framework for guiding conversations about mental health in professional and personal contexts. An additional theme related to suggestions for adapting the course to better suit the needs of medical students. These included a faster-paced format, case scenarios that more closely reflected medical student experiences, greater integration of skills practice, and increased focus on issues specific to medical students, such as disclosure of mental illness and fitness to practise, exam-related anxiety, and inclusion of doctors’ lived experience of mental illness.

MHFA training was generally experienced positively by medical students and perceived as relevant to self-care and supporting others. Students also identified limitations in how well the course aligned with the specific contexts and pressures of medical training. Together, these findings support the development of a bespoke mental health support course for medical students, building on MHFA approaches while addressing discipline-specific needs.

This study aimed to estimate the proportion meeting Rome III criteria for functional gastrointestinal disorders (FGIDs) and examine associations with suicidal ideation, depression, anxiety, and perceived stress in child and adolescent psychiatric outpatients, including subgroup analyses by irritable bowel syndrome (IBS), functional constipation (FC), and subtype complexity (single vs. multiple).

We recruited 137 outpatients aged 12–18 years (2021–2023). FGIDs wereclassified with the Questionnaire on Pediatric Gastrointestinal Symptoms–Rome III (QPGS-Rome III). Beck Scale for Suicide Ideation (BSS), item Center for Epidemiological Studies–Depression Scale for Children (CES-DC), self-report version of the Screen for Child Anxiety Related Emotional Disorders (SCARED), and Perceived Stress Scale (PSS) assessed psychosocial burden. Group differences used standard comparisons (two-sided p<0.05).

Overall, 69.3% met Rome III criteria for ≥1 FGID subtype. Compared with the non-FGID group, the FGID group had higher scores on BSS (p=0.048), CES-DC (p=0.035), SCARED (p<0.001), and PSS (p=0.003). In three-group comparisons (non/single/multiple), CES-DC, SCARED, and PSS differed significantly, with single and multiple FGID groups exceeding non-FGID. In subgroup analyses, IBS-related groups showed higher anxiety and stress than non-FGID, whereas the single FC subtype did not differ significantly.

Among child and adolescent psychiatric outpatients, the proportion meeting the Rome III criteria for FGIDs was high and was significantly associated with psychological burden. These findings support integrating gastrointestinal symptom screening with mental health assessments at intake, with risk-stratified management for IBS-related presentations.

There is growing awareness of the complex bidirectional interactions between hormonal and mental health, with fluctuations across the menstrual cycle, perimenopause and menopause influencing the onset, severity and course of psychiatric illness. Despite this, reproductive health is often poorly assessed and documented in psychiatric inpatient settings. An initial audit across multiple inpatient wards demonstrated a substantial deficit in theidentification and documentation of reproductive health information. Our trust policy recommends that women are asked within 24 hours of admission about menstrual problems, menopause and breastfeeding; however, discussing these sensitive issues is often inappropriate or overlooked during acute psychiatric admissions. In this ongoing quality improvement project (QIP) we aim to increase awareness and detection of women’s health problems in female psychiatric inpatients using a trauma-informed approach led by trained nursing staff. We hypothesised that shifting responsibility from early medical clerking to appropriately timed nurse-led conversations would be more acceptable and feasible, while improving identification of clinically relevant issues.

The QIP intervention was initiated on a single 15-bed female acute psychiatric ward. Nurses with additional training in women’s health were designated as Women’s Health Champions (WHCs). Their role included offering one-to-one conversations with service users when clinically appropriate, running twice-monthly educational groups, providing written information on the ward and escalating concerns to the medical team. The first Plan–Do–Study–Act (PDSA) cycle focused on assessing feasibility and uptake of one-to-one conversations over a three-week period, alongside qualitative identification of implementation challenges.

During the first QIP cycle, 7 of 15 service users were deemed well enough to participate in a one-to-one women’s health conversation. Three service users were offered a conversation over three weeks; two engaged in brief discussions. Barriers identified included limited nursing time, fluctuating mental state of service users and uncertainty around documentation and information-sharing. Key process issues to be addressed in future cycles: the need for thorough documentation to avoid missing ‘red flags’; obtaining explicit consentto share information with the medical team, and documenting whether a service user is well enough to participate.

Early findings suggest that a nurse-led, trauma-informed model for addressing women’s health in psychiatric inpatients is feasible but constrained by acuity and resource limitations. While uptake was limited, the project identified clear, actionable system changes to support safer and more consistent practice. These results support revising existing policy to prioritise timing, consent and documentation rather than rigid early-admission targets.

The aim of this quality improvement project was to optimise existing General Practitioner (GP) mental health hub meeting structures for better efficiency, implementing new hub meetings in non-participating surgeries within the primary care network and establishing a framework for satellite psychiatry clinics in GP surgeries.

The target population consisted of general practitioners in 6 GP surgeries within the North and East Cornwall Primary Care Network (PCN). Between October to November 2024, a structured 12-point electronic survey was distributed to 34 general practitioners to capture both quantitative trends and qualitative feedback. The survey focused on five domains of Community Mental Health Team (CMHT) input into primary care including feasibility, demand, barriers to engagement, logistical preferences (face to face vs virtual) and clinical scope. A reminder email was sent after 4 weeks.

A response rate of 35% was achieved. Out of 6 GP surgeries, 5 had pre-existing GP hub meetings. Two GPs (out of a total of 12 respondents) reported that they did not need a GPHub meeting. 33% of respondents preferred a combination of virtual and face to face meetings, 25% preferred these meetings to be held at the GP surgery and 17% preferred alternating between the GP surgery and CMHT base. Of GP surgeries that had existing hub meetings, 58% preferred the meetings to be monthly for 1 hour each time. Common mental health issues encountered by general practitioners in their settings were mood disorders (24%), anxiety disorder (22%), substance and alcohol misuse (20%), trauma-related experiences/post-traumatic stress disorder PTSD (17%), and psychosis (2%). When offered the option, 67% expressed a wish to have a satellite clinic with a psychiatrist at the GP surgery.

This QI project successfully standardized and expanded the collaboration between the CMHT and GPs in this patch of East Cornwall. By aligning meeting frequency and content with GP preferences, all 6 GP surgeries now participate in either monthly or 3-monthly GP hub meetings. Face to face GP hub meetings are now established in all but one of the surgeries. The demand for closer integration has resulted in the successful establishment of psychiatric satellite clinics in two surgeries, with plans to establish these in all six surgeries.

Patients are referred into the Community Treatment Team (CTT) on a daily basis. Referrals are discussed in a daily MDT and a decision is made on whether the patient is accepted into the service for a formal assessment and provision of care, signposted to a more suitable service, or discharged with advice to the referrer.

Our service currently does not have a standardised format for referrals, and variations in information provided often result in delays pending further information gathering/triage.

The aim of this project is to standardise referrals from Primary Care to the CTT by designing a proforma that will be circulated to GP surgeries. In order to justify our intervention, we first quantified the magnitude of the burden using the current referral system by reviewing referrals from a high volume supplier of referrals, identifying the cases that required further triage and quantifying the amount of delay caused.

Retrospective review of all referrals from a single GP surgery over the month of October 2025. Original referral and MDT outcome obtained from Electronic Patient Records. Data collected on anonymised spreadsheet. Data analysis and graphical representations performed on MS excel.

Total 22 referrals. Sources of the referrals were 68% from GPs, 23% from Primary Care Psychology, 4.5% from EIP and 4.5% from inpatient services. It took on average 2.1 days (0-6 days) for the MDT to review referrals.

Outcome of referrals: 37% of referrals were accepted into the service, 27% were discharged with advice/signposting, 18% required further triage, 9% were referred onwards to relevant services and 9% were listed for discussion with Primary Care Psychology.

The common reasons for requiring triage were unclear risk (50%), unclear consent status (12.5%), unclear patient expectations (12.5%), unclear substance misuse (12.5%) and unclear current mental state (12.5%). Of those requiring triage, 75% were discharged post triage and 25% were accepted for full assessment. Triaging added an extra 4-15 days to a final MDT outcome.

The results demonstrated that 18% of referrals were missing crucial information for a streamlined MDT outcome, and as a result causing delays for patients and additional burden on a stretched service. We have designed a referral proforma, based on the commonly used SBAR format, that includes prompts for risks, consent status and patient expectations. The new referral proforma is now being piloted in a selected number of GP surgeries and the impact will be re-measured using the same metrics as above.

There are growing concerns of disparities in mental health care, with suggestions of discrepancies in the use of seclusion across patients from different backgrounds. The aim of this project was to evaluate the use of short-term seclusion (STS) and long-term segregation (LTS) across patient ethnicity alongside other demographics in Broadmoor High Secure Hospital (HSH).

This quantitative study analysed STS and LTS episodes from July 2022 to July 2025 alongside various demographics. STS consisted of 183 patients and 1,614 seclusions, LTS of 128 patients and 220 segregations.

STS:

Correlational analysis found significant relationships for admission length in duration and frequency, with longer stay patients experiencing more episodes and higher durations. Correlational analysis also identified significant relationships for patient age in duration and frequency, with older patients experiencing more episodes and higher durations. BMI significantly correlated with frequency of episodes, with higher BMI experiencing more episodes.

Inferential analysis found significant differences in frequency and duration based on where a patient was transferred from, with patients from prison experiencing higher frequency and duration than patients from medium secure units (MSU).

Significant differences were found based on index offence, with terrorist offenders experiencing higher frequencies and durations relative to patients with multiple offences or an offence of violence against the person. Patients with an alleged offence had higher durations of STS than those with multiple offences or violence against the person.

No significant differences were found between patient ethnic groups, diagnosis or religion.

LTS:

Correlational analysis identified a significant positive relationship between duration and admission length, with longer stay patients having longer durations. Additionally, a significant positive correlation was found between duration and BMI, with higher BMI relating to higher duration.

Inferential analysis found significant differences in duration between ethnic groups, with the Asian group experiencing lower durations than the Black, Mixed and White groups. A significant difference was found in duration based on where patients were transferred from, with those from prison experiencing higher durations than patients from MSU or HSH.

No significant differences were found between diagnosis, religion, index offence or age.

The implementation of STS significantly differed based on admission length, age, BMI, where a patient was transferred from and index offence. LTS differed significantly based on patient ethnic group, admission length, where a patient was transferred from and BMI. An ongoing qualitative study aims to further elucidate these differences through staff and patient perspectives to enable clinical and research recommendations.

There is limited research exploring healthcare workers’ (HCWs) attitudes toward individuals with mental illness within mental health settings in the Arabian Gulf countries. Given their central role in patient care, understanding HCWs’ perceptions is vital for improving mental health services. Oman’s universal healthcare system provides free access, and psychiatric care is delivered through a tiered referral structure from primary to tertiary facilities.

This study aimed to (1) assess HCWs’ attitudes toward people with mental illness (PWMI) in a tertiary psychiatric hospital in Oman and (2) evaluate the reliability and construct validity of the Community Attitudes toward the Mentally Ill (CAMI) scale in this context.

A cross-sectional survey was conducted from March to August 2020 among HCWs at a tertiary psychiatric hospital. 315 HCWs of various nationalities completed the survey (response rate=55%). The survey included socio-demographic data and the CAMI scale, which measures attitudes across four subscales: Authoritarianism, Benevolence, Social Restrictiveness, and Community Mental Health Ideology. Data analysis included t-tests, ANOVA, regression, and Confirmatory Factor Analysis (CFA) using SPSS and AMOS software.

Presently used 30-item CAMI scale showed an acceptable internal consistency (Cronbach’s alpha: 0.62–0.91) and acceptable model fit in CFA. Authoritarian and socially restrictive attitudes were more prevalent among Omani nationals, HCWs with longer psychiatric tenure, and workers with personal histories of mental illness. In contrast, benevolence and positive community mental health attitudes were linked to Omani nationality, psychiatric experience, working by desire, and personal mental health experiences. Furthermore, male participants exhibited lower stigma levels than females.

Findings highlight the role of culture, work experience, and personal history of mental illness in shaping HCWs’ attitudes toward PWMI. The validated CAMI scale supports future research and targeted intervention development. Culturally sensitive education programmes are essential to reduce stigma levels and encourage inclusive mental healthcare in Oman.

To identify themes that underlie fractures in the relationship between doctors and nurses in the trust and recommend interventions to help improve the situation.

Incident reports relating to difficult working relationship between resident doctors and nurses over 12 months were examined. The recurrent themes were identified, and thematic analysis was done to group them according to locality and main issues involved. Locality of focus was The Harbour inpatient complex.

Questionnaires were administered to nursing staff on duty on the Harbour inpatient units to resident doctors who had been on call at The Harbour in the previous 12 months. The answers were analysed, and the most common themes were identified and developed into recommendations.

A total of 18 incident reports were received in the trust in the year under review which involved doctors making reports about nurses and/or vice-versa.

The themes identified were:

(A) Issues with communication such as aggressive tone, poor bedside manner.

(B) Doctors being unavailable or non-contactable such as busy with other duties, asleep.

(C) Issues with clinical decision-making such as disagreeing over patient management decisions.

(D) Poor handover such as lacking important information, requests to review considered inappropriate for an on-call situation.

Nursing questionnaire results: 21 respondents raised similar issues as above (7 respondents raised Issue A, 9 issue B, 6 issue C and 4 respondents had other issues).

Doctors’ questionnaire results: 10 respondents raised issue C, 8 raised issue D, 2 raised all issues and 2 had other issues.

Recommendations made include:

• • Nurses’ Training in handover to be in the SBAR format – Situation, Background, Assessment and Recommendation, teaching given on how to escalate differences in clinical opinion to senior medics on call.

• • Doctors advised on how to manage night shifts as regards rest times, discuss requests to review and how to be more visible on the wards.

Follow-up work is currently on-going to determine the impact of the recommendations. Preliminary reports show a reduction in the number of incident reports relating to fractious working relationship between doctors and nurses.

There is potential for friction in any working relationship, particularly in the context of a highly pressurised working environment such as acute mental health units, probably worsened by understaffing, presence of bank staff who may be unfamiliar with the patients and other interpersonal factors.

We conclude that relatively simple interventions such as handover training, shift management and education on proper use of incident reporting systems may help alleviate such fractures and improve working relationship.