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.

The NHS mental health system is complex, with a wide range of community, inpatient, specialist, and population-specific services. New trainees in psychiatry, especially IMGs, often begin work with variable knowledge of available services and limited understanding of who does what across pathways. This can impact confidence, appropriate signposting, multidisciplinary working, and patient care.

The aim of this QI project was to assess baseline knowledge of NHS mental health services among IMGs and to develop a clear, accessible resource to improve understanding of service roles and pathways.

An initial survey using Microsoft Forms was distributed to IMG psychiatry trainees across West Midlands. Participants were asked how long they had worked, to rate their knowledge of NHS mental health services when they first started (on a 1–5 scale: no clue, rough idea, neutral, pretty good, excellent), and to list any services they were aware of at that time.

Quantitative data were analysed descriptively, and free-text responses were thematicallyreviewed to identify patterns in awareness and gaps in understanding. Based on the findings, a practical resource titled “Mental Health Services; Who Does What?” was developed.

Respondents reported working in NHS mental health roles for between 2 and 68 months, with a mean duration of 23 months. When asked to retrospectively rate their knowledge of NHS mental health services, out of 11 respondents, 3 selected “no clue”, 5 selected “rough idea”, 1 “neutral”, 1 “pretty good”, and 1 “excellent.”

Free-text responses revealed a wide variation in awareness. Most participants were familiar with core services such as Community Mental Health Teams, inpatient services, crisis and home treatment teams, and liaison psychiatry. Awareness of more specialist services such as assertive outreach, neuropsychiatry, perinatal, eating disorder services, forensic services, and voluntary sector support) was inconsistent and often superficial, with limited understanding of specific roles and responsibilities.

This project highlights significant variation and overall low confidence in IMG trainees' knowledge of NHS mental health services at the start of employment. The development of a concise, structured service guide directly addresses identified gaps and provides a practical tool to support induction and early learning. In the future, we will collate feedback and measure improvements in confidence and service awareness following implementation of the guide.

To evaluate compliance with the Trust standard for completion of inpatient discharge summaries within 24 hours of discharge and to identify reasons for delay.

A retrospective clinical audit was conducted across two adult inpatient psychiatric wards over a four-month period (28 May–26 September). Fifty consecutive inpatient discharges were sampled (Clark Ward n=25; Beamshaw Ward n=25). Discharge date/time was compared with the time of completion of the EPMA full discharge summary. Outcomes assessed included timeliness of completion, diagnostic accuracy, and reasons for delay.

Overall, 76% (n=38) of discharge summaries were completed within 24 hours, with 24% (n=12) delayed, falling below the Trust compliance threshold of >91%. The most common reason for delay was an unclear EPMA discharge process, where summaries were signed off but not fully finalised (n=5). Other contributing factors included staffing shortages (n=1), awaiting investigation results (e.g. CT head report; n=1), transfer to community services under a Community Treatment Order (n=1), absence of a junior doctor at the discharge meeting (n=1), and unspecified causes (n=3).

While the majority of inpatient discharge summaries were completed within the required timeframe, overall compliance did not meet Trust standards. System-related barriers–particularly ambiguity within the EPMA workflow–were the predominant contributors to delay. Targeted interventions, including reinforcing EPMA discharge processes, regular MDT-linked updates, proactive review of anticipated discharges, and visible guidance for clinicians, are recommended. These measures aim to improve efficiency, reduce avoidable delays, and achieve sustained compliance above 91%, enhancing patient safety and continuity of psychiatric care.

Personality disorders (PDs) are frequently assumed to confer poorer prognosis in substance use disorder (SUD) treatment and are often viewed as markers of higher clinical risk, reduced treatment responsiveness, and increased likelihood of relapse. These assumptions can influence clinical decision-making, expectations of recovery, and access to specialised services. However, empirical evidence supporting these beliefs remains limited and inconsistent, particularly within mandated rehabilitation systems where treatment engagement, supervision, and monitoring differ substantially from voluntary care. Data from the Middle East are especially sparse. This study aimed to examine the association between comorbid PD and post-discharge relapse following inpatient SUD treatment in Qatar and to characterise the prevalence of dual diagnosis within a mandated rehabilitation population. We hypothesised that comorbid PD would be associated with higher relapse rates following discharge.

A retrospective cohort analysis was conducted using medical records of patients discharged from an inpatient SUD rehabilitation programme operating under a mandated treatment framework. The cohort comprised 72 patients who completed inpatient treatment and entered structured post-discharge monitoring. Patients were categorised according to the presence (n=19, 26.4%) or absence (n=53, 73.6%) of a diagnosed personality disorder documented during admission. Relapse was defined using clinically relevant real-world indicators, including documented positive urine drug screening, self-disclosed substance use during follow-up, or failure to attend scheduled drug testing. Relapse outcomes were compared between groups using chi-squared testing to assess the association between PD status and early post-discharge relapse.

Comorbid PD was identified in over one-quarter of the cohort, demonstrating a substantial burden of dual diagnosis within mandated rehabilitation settings. Relapse occurred in 36.8% of patients with comorbid PD (n=7) compared with 41.5% of patients without PD (n=22). The difference in relapse rates between groups was not statistically significant (χ²=0.0069; p=0.9336). Contrary to prevailing assumptions, relapse rates were numerically higher among patients without PD, although this difference was small and clinically modest. Overall, PD status did not meaningfully differentiate short-term relapse risk following discharge in this cohort.

This study represents one of the first regional evaluations examining relapse outcomes by PD status within a mandated SUD rehabilitation context. Findings challenge assumptions that comorbid PD necessarily predicts poorer early recovery or higher relapse risk. Results support the feasibility of managing dual diagnosis patients within standard addiction treatment pathways when comprehensive assessment, structured monitoring, and integrated care are in place. Larger prospective studies are required to explore the impact of specific PD subtypes and longer-term outcomes.

Undergraduate psychiatry education is traditionally centred on inpatient services and secondary care experiences, despite the majority of mental health support occurring within communities. This imbalance risks reinforcing medicalised understandings of mental ill health and limits student exposure to preventative, psychosocial, and lived-experience led approaches. With evidence that many doctors practise in the regions where they train, there is a clear educational and workforce imperative to embed community engagement early in medical training. This project aimed to develop and evaluate a novel community-based placement at Middle Street Resource Centre, a charitable organisation providing mental health support and wellbeing services, with community, inclusion, and lived experience embedded at the core of medical education.

Medical students undertook a structured placement within Middle Street Resource Centre, a non-profit, open-access community hub providing psychosocial support without referral. Students embedded within the centre, participating in a range of existing community activities including music sessions, discussion groups, and social café spaces. In addition, the medical education team facilitated structured group sessions on bipolar disorder, mindfulness, and eating disorders which students actively participated in and co-designed. Evaluation was qualitative, drawing on detailed reflective accounts written by students following their placement experience.

Student reflections highlighted profound learning that extended beyond traditional clinical outcomes. Exposure to a non-judgemental, inclusive environment challenged students’ assumptions about mental illness and disability, strengthening empathy and reflective practice. Engagement with community members illustrated the importance of socialconnection, creativity, and belonging in mental wellbeing, and reinforced the preventative role of community services. Students reported increased confidence in communicating sensitively, adapting language to diverse populations, and appreciating the impact of stigma and diagnostic terminology. Observing and learning from staff and volunteers with lived experience further deepened understanding of relational, trust-based support, contrasting with more hierarchical clinical models. Many students described the placement as transformative, shaping how they intended to practise psychiatry and medicine more broadly.

Embedding medical students within community mental health hubs offers powerful educational value and complements traditional psychiatric training. This placement demonstrates a scalable, innovative model that prioritises prevention, inclusion, and lived experience, while fostering empathy, communication skills, and community connection. As we expand such placements across further community hubs, we recognise the potential to strengthen psychiatry education, support workforce sustainability, and place community at the heart of future mental health care.

Late-onset treatment resistant psychosis with catatonia poses a significant diagnostic challenge, particularly where neurological and psychiatric features overlap.

Anti-n-Methyl-D-aspartate receptor {NMDAR} antibody-associated syndromes may present predominantly with psychiatric symptoms and delayed or fluctuating seropositivity further complicates diagnosis.

We describe a patient in early 60s with no prior psychiatry history who developed a severe, relapsing neuropsychiatric illness a few years ago. Patient presented initially with depressive symptoms, health anxiety, weight loss and insomnia, followed by psychosis characterised by auditory hallucinations, nihilistic and homicidal delusions, behavioural disinhibition, and prominent catatonic features including mutism, psychomotor retardation, posturing and reduced responsiveness.

Over several years, patient underwent multiple prolonged hospital admissions under the Mental Health Act. The illness proved highly treatment resistant with limited or transient response to multiple antidepressants, antipsychotics, mood stabilisers, benzodiazepines and several courses of electroconvulsive therapy.

Lorazepam resulted in partially, short lived improvement in catatonic symptoms. Clozapine was discontinued as patient developed constipation. Between episodes, only brief periods of partial recovery were observed, with no sustained return to baseline functioning.

Extensive medical and neurological investigations were undertaken, including repeated MRI and CT brain imaging, EEG, Lumbar puncture, PET and DAT scan, and comprehensive autoimmune and paraneoplastic screening. Initial antibody testing for autoimmune psychosis was negative, however, subsequent repeated testing showed serum NMDR antibodies. Cerebrospinal fluid antibodies were negative.

Trials of corticosteroids and dopaminergic therapy were undertaken amid evolving differential and working diagnoses, including limbic encephalitis, Parkinsonian syndromes, dementia with Lewy Bodies and functional neurological disorder.

This case highlights the complexity of late onset psychosis with catatonia and the diagnostic uncertainty surrounding fluctuating NMDR antibody positivity and other neurological symptomology. It underscores the need for close collaboration between Psychiatry and Neurology, cautious interpretation or results, reassessments and revisiting the differential and working diagnoses over time.

Persistent, treatment resistant catatonia in adults should prompt ongoing consideration of autoimmune and neurological differentials, despite inconclusive initial investigations. This case illustrates the challenges of diagnosis and management at the interface of Psychiatry and Neurology.

The gastrointestinal histopathobiome has major potential clinical implications for Psychiatry. However, the complexity and relatively nascent nature of this research means that its direct clinical relevance is presently unclear. The aim of this study was to obtain a snapshot of current attitudes towards this field amongst psychiatric medical staff.

Through an anonymous survey sent to psychiatric medical staff working within Ayrshire and Arran in February 2026, contemporary, qualitative data were gathered across four domains:

1. Current medical grade of the doctor

2. To what extent the doctors were likely to specifically seek out information pertaining to the patient’s gastrointestinal tract.

3. To what extent the doctors were likely to incorporate knowledge relating to the histopathobiome into their management plans.

4. The perceived relevance of, and interest in, this field.

Likert scales were used to collect responses, apart from the final question which required either a “yes” or “no”.

Seven responses were obtained, representing the views of three consultants, one registrar, one specialty doctor and two core trainees. FY2s and clinical fellows did not respond.

57% were “very unlikely” to enquire about the gastrointestinal system, and 57% were “unlikely” or “very unlikely” to ask about diet. Results were evenly spread with regard to seeking out gastrointestinal investigations or histology reports.

57% reported having, on occasion, either offered advice or referred to dietetics, specifically to improve the gut microbiome, however do not often feel this is relevant. 86% reported that they would either “probably” or “definitely not” feel comfortable taking a history or advising in this regard.

29% felt this research is currently clinically relevant in Psychiatry, compared with 71% who did not (43% felt it might be in the future but that it is not at present). 86% would be interested in learning more about this topic.

There were no emerging patterns across grade, however, the small sample size is of relevance here.

Findings suggest that this emerging research is not yet deemed clinically useful by Psychiatric staff within the health board. However, there is an awareness of it, and are adiness to learn more. Given the lack of current best practice regarding the gastrointestinal histopathobiome in psychiatric management, the findings are likely appropriate.

Menstrual and menopausal health significantly influences mental health, with hormonal fluctuations affecting mood regulation, emotional stability, cognition, and vulnerability to psychiatric relapse. Psychiatric medications, especially antipsychotics associated with hyperprolactinaemia, can further disrupt menstrual cycles, contributing to distress, reduced quality of life, and treatment non-adherence. Despite this, menstrual health assessment is often absent from routine psychiatric review. Systematic screening during admission is therefore essential to identify treatable contributors to mental state deterioration and to deliver truly holistic care. Our aim was to evaluate how frequently menstrual and menopausal health was assessed on all inpatient psychiatric female wards at Lambeth Hospital (South London and Maudsley Trust), and to measure the impact of targeted interventions on improving active screening rates.

Baseline audit: review of clinical documentation for all patients admitted during the audit period on the wards was reviewed. Screening was categorised as:

Active screening: clinicians directly asked about menstrual or menopausal status and symptoms.

Incidental screening: information volunteered or noted indirectly.

Interventions included staff training, patient information materials, and updated clerking prompts.

A reaudit 5 months later assessed the same parameters.

Baseline:

• • 3/44 (7%) patients actively screened.

• • 8/44 (18%) patients had appropriate menstrual health intervention.

• • Menstrual status was unknown for the majority of patients, and menstrual-related interventions were rare.

Re-audit:

• • 28/45 (62%) patients actively screened.

• • 33/45 (73%)patients had appropriate menstrual health intervention.

This represents a significant improvement on both wards. Menstrual symptoms such as dysmenorrhoea, menorrhagia, peri-menopausal changes, and amenorrhoea were more consistently identified, leading to appropriate interventions. Interventions included appropriate counselling, products and patient information leaflet.

Our project shows that routine menstrual and menopausal health screening in psychiatric inpatient care is feasible, clinically meaningful, and substantially improved through simple service-level interventions. Embedding structured questions into admission processes enhances safe prescribing and promotes person-centred care. This project demonstrates that menstrual health assessment should be a standard component of psychiatric inpatient practice.

Psychological safety and commitment to excellence are both critical in effective problem solving within healthcare. In the MMSPS MDTs were conducted virtually and there was a lack of consistency in chairing. We noticed tension in discussions and an avoidance of bringing cases to MDT. We explored the reasons for this with the aim of improving the quality of our MDTs leading to better patient care.

We formed a small working group of the Team Manager, Lead Psychologist and aConsultant Psychiatrist. We conducted a brief ten question survey of all staff in the MMSPS, gathering their views on their experience of and the effectiveness of MDTs. This included yes/no and free text responses. Responses were anonymous and reviewed by the working group only.

We had a high response rate of 69% across a range of professions indicating staff were engaged in this project. 38% of respondents did not feel MDTs were effective in their current format. 54% preferred face to face meetings over virtual. A third did not feel confident speaking during MDTs. Qualitative themes included feelings of conflict, feeling unsupported, contributions not feeling valued, ineffective use of MDT time and unstructured presentations.

We identified that key areas for improvement were psychological safety and MDT structure and implemented multiple strategies to improve these areas. We designed an MDT document including 8 points of “shared understanding” (ground rules) agreed on by the whole team, guidance on which cases to bring to MDT and on the role of the chair. We designed a tool for structuring presentations. We implemented a hybrid model giving the choice of face to face or virtual attendance and agreed the leadership team would chair meetings. We held a launch presentation to introduce the new concept to the team, including sharing a video on psychological safety, and we set a date for re-launch of the MDT.

Feedback from staff members has been overwhelmingly positive. The majority of staff prefer to attend face to face. There has been a notable reduction in conflict within meetings, an improved feeling of safety and improved structure and timekeeping. We are repeating the survey shortly to gather formal feedback on the new process. These strategiescould be replicated by other mental health teams hoping to implement a more psychologically safe approach to MDTs.

Social media use has become an essential part of children’s, adolescents’ and young adults’ lives, which has raised concerns about its impact on body image and disordered eating. Although previous reports, which include the Royal College of Psychiatrists’ CR225, have identified these associations, the psychological mechanisms, protective factors, and potential benefits of social media use remain poorly understood. This scoping review systematically reviews global literature from the past six years on the relationship between social media use, body image, and eating disorder symptoms in individuals aged ≤25 years.

This scoping review synthesizes peer-reviewed research published from January 2019 to December 2025, focusing on associations among social media use, body image, and eating disorder symptoms in individuals aged 25 years or younger. Literature searches were conducted in PsycINFO, PubMed, EMBASE, and Medline. Study quality was assessed using PRISMA guidelines, the Mixed Methods Appraisal Tool, and standardized quality checklists, as appropriate.

Sixty-two studies met the inclusion criteria, encompassing 5 longitudinal studies, 4 systematic reviews, 8 qualitative studies, and 45 cross-sectional studies. Across the different study designs, there was consistent evidence that greater time spent on social media and engagement with body image-focused content were associated with greater body dissatisfaction, internalization of the thin ideal, lower self-esteem, and disordered eating behaviours. Longitudinal research indicated that these associations were not due to direct exposure to social media but were driven by the internalization of beauty ideals and upward social comparison. Negative outcomes were strongly linked with photo-based platforms. Problematic social media engagement was linked to disordered eating behaviours in both genders. While adolescent boys showed a higher tendency for binge eating behaviour, girls were more at risk of engaging in restrictive eating and experiencing body dissatisfaction. Evidence from qualitative studies highlighted a mixed impact of exposure to appearance-related content driven by algorithms on recovery for patients with eating disorders.

The impact of social media on eating disorder symptoms and body image among children, adolescents and young adults is highly influenced by content type, engagement style, and individual vulnerability. Interventions should prioritise media literacy, address appearance-focused content, and strengthen protective factors such as body appreciation, resilience, and parental support.

This review aimed to examine the relationship between sleep disturbances and mental health outcomes in medical students, focusing on key mental health issues such as depression, anxiety, suicidal ideation and dropout intentions. It sought to determine the prevalence of sleep disturbances, assess the strength of the associations with mental health issues and evaluate the quality of the evidence across different study designs using a thematic approach. The study aimed to uncover gaps in the literature, particularly regarding longitudinal research, objective biological sleep assessments and interventional studies.

Following PRISMA guidelines, a comprehensive search was conducted in Scopus, PubMed and Web of Science, as well as hand-searching and citation tracking. Studies examining sleep disturbances were measured using validated tools such as Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS). Mental health outcomes such as depression, anxiety and burnout in medical students were included.

An initial appraisal was conducted extracting strengths and weaknesses of each study and then the Joanna Briggs Institute (JBI) Critical Appraisal Tool was used to assessmethodological quality of the included studies. Thematic analysis was applied to compare findings across studies.

Seven studies met the inclusion criteria, comprising a meta-analysis, a longitudinal study, a mixed methods study and four cross-sectional studies. Thematic analysis highlighted four key areas: (a) Prevalence and impact of poor sleep quality; (b) Sleep and mental health; (c) Risk factors for poor sleep and mental health; (d) Coping strategies and sleep’s role.

55% of participants in the Jahrami study reported poor sleep, confirming that there is a high rate among medical students. Poor sleep was linked to depression, anxiety, and suicidal ideation. However, most studies were cross-sectional and used self-reported data which limits causal conclusions. Only one study, Vollmer-Conna explored physiological mechanisms, highlighting the potential need for biological research on sleep and mental health. No study tested interventions aimed at improving sleep and mental health outcomes, leaving a significant gap in the literature for interventional studies.

This review confirms a strong link between poor sleep and worsened mental health in medical students, highlighting the need for interventions within this population. However, longitudinal studies, biological assessments and intervention experiments are needed to establish causality, increase reliability and implement potential interventions to improve the overall wellbeing and performance of medical students who are the future of the healthcare workforce. Medical schools should prioritise sleep hygiene, education, workload adjustments and mental health support to improve student wellbeing throughout the course and prepare them for a career as a doctor.

The training scheme prospectus is usually the initial reference for prospective Higher Trainees (HT) in ranking training programmes. An outdated prospectus fails to showcase the strength of individual training schemes, resulting in failure to attract prospective trainees. The North Central and East London (NEL) Prospectus for Child and Adolescent Psychiatry (CAP) on the Health Education England (HEE) website had not been updated since2021 and recruitment into the scheme had declined resulting in up to 40% vacancies for the February 2025 recruitment cycle.

The aim of this QIP is to revise and update the NEL CAP training scheme prospectus to improve recruitment and retention of HTs by enhancing trainee confidence.

A PDSA cycle using surveys and focus groups including trainees and trainers at each placement across 4 Trusts, was used to gather feedback to identify gaps in the Prospectus. The key areas identified for revision included providing detailed placement descriptions and job-specific teaching, research, psychotherapy, special interest and leadership opportunities.

An initial survey of the trainees in the last 3 years indicated that more than half of the trainees (53%) never referred to the outdated Prospectus to guide their scheme selection to inform placement ranking, or to explore training opportunities. Of the 47% who referred to the prospectus, only 31% felt that their scheme selection was guided by the prospectus. Only 33% of the trainees used the outdated prospectus to rank their placements and to explore job-specific special interest opportunities.

Following the initial survey, the updated prospectus was distributed to all the trainees in February 2026. Formal qualitative feedback from trainees showed that the updated job descriptions of posts ‘reads well’, ‘pitched at a good level of detail’, shows ‘what to expect’,‘eases anxieties’,helped them ‘understand their roles’,and provides job-specific opportunities. Consultant feedback suggested that the updated prospectus was necessary in reflecting the strength of the training scheme and the broad range of opportunities available to the trainees.

The revised prospectus will be shared with HEE and the second cycle of PDSA will be completed in the next recruitment cycle in August 2026.

The revised prospectus has improved trainee confidence in the Scheme and in guiding their training progression. Further cycles will evaluate its impact on trainee recruitment and retention to the scheme.

Dysregulation of cortisol and folate–two biomarkers central to stress physiology and one-carbon metabolism–has been consistently reported in schizophrenia. However, the extent to which clinical and lifestyle variables shape these biomarkers remains insufficiently understood. Factors such as smoking, thyroid dysfunction, and prior psychiatric history are biologically relevant confounders: nicotine alters folate turnover and methylation pathways; hypothyroidism disrupts one-carbon metabolism and HPA-axis regulation; and long-standing psychiatric illness is associated with chronic stress-system alterations. These mechanisms may generate atypical biochemical signatures that complicate interpretation of peripheral biomarkers in schizophrenia. This study therefore investigated whether these variables contribute to unexpected cortisol and folate variations beyond the anticipated case–control differences.

A case–control design was implemented involving 33 patients with schizophrenia (DSM–5 diagnosis confirmed by two consultant psychiatrists) and 33 age-and sex-matched healthy controls without personal or familial psychiatric history. To minimize circadian effects, fasting venous blood samples were collected between 07:00–08:00am. Serum cortisol and folate were measured using standardized AccuBind ELISA kits, with all assays performed in duplicate. Samples were processed under uniform laboratory conditions and stored at −20°C. Symptom severity and extrapyramidal side effects were assessed by a blinded psychiatrist using the PANSS and SAS scales. Demographic and clinical variables–including smoking status, thyroid disease, and psychiatric history–were systematically documented. Normality was assessed using the Shapiro–Wilk test; group comparisons employed t-tests or Mann–Whitney U tests; and associations were examined using Spearman correlations (p<0.05). Ethical approval was obtained from Golestan University of Medical Sciences.

Compared with healthy controls, patients with schizophrenia exhibited significantly lower serum cortisol (54.98 ± 26.90 vs. 96.10 ± 57.15 µg/dL; p<0.0001) and folate levels (2.21 ± 2.20 vs. 14.69 ± 11.68 ng/mL; p<0.0001). Beyond these expected findings, several distinct patterns emerged:

• Participants with a psychiatric history showed markedly reduced cortisol (12.16 ± 10.27 vs. 57.77 ± 26.45; p=0.017).

• Individuals with hypothyroidism demonstrated significantly lower folate (1.94 ± 1.89 vs. 5.30 ± 2.78; p=0.020).

• Smokers unexpectedly exhibited higher folate levels (4.70 ± 2.73 vs. 1.94 ± 1.86; p=0.036).

No significant correlations were found between biomarkers and PANSS or SAS scores.

In addition to global reductions in cortisol and folate in schizophrenia, this study identifies distinct biomarker signatures linked to smoking, thyroid dysfunction, and psychiatric history. These findings underscore the importance of accounting for metabolic and lifestyle factors when interpreting peripheral biomarkers in psychiatric research and clinical practice.

Mental health problems are the leading contributors to disease in children, with rising prevalence exerting significant pressures on Child and Adolescent Mental Health Services (CAMHS). Services are currently unable to meet demand, resulting in prolonged waiting lists.

CAMHS operates on a crisis-driven model, despite the recent WHO and Darzi reports recommending early intervention strategies, including the use of community-based lay practitioners to do initial assessments.

The aim in this study was to explore the translation of community-based interventions from low-resource settings into a UK context.

Participants were purposively selected from multi-agency teams and professionals working with children were invited to take part in a qualitative study using thematic analysis following informed consent. These professionals included CAMHS clinicians, managers, people with lived experience and educational professionals.

Six themes with four associated subthemes emerged: ‘CAMHS Structure and Accessibility’, ‘Pathologisation of Suffering’, ‘Workforce and Professional Challenges’, ‘Community-based Interventions’, ‘Structural and Policy Reform’, and ‘Future Governance of Layworkers’.

Findings emphasised the urgent need for structural and policy reform, with focus on innovative approaches to early intervention and adaptation of successful programmes from low-resource settings as models of task-sharing. This would fulfil two of the Darzi recommendations: a move from treatment to prevention, and a move from hospital to community.

Translation of community and lay practitioner models (CLPs) into the UK has potential to improve access, promote early intervention, and align with government recommendations. However, further research using focus groups and clinical trials is required to assess the feasibility of implementing CLP training and supervision in the UK.