To evaluate whether a structured perinatal psychiatry teaching series delivered during Obstetrics & Gynaecology (O&G) placements improves medical students’ awareness of perinatal mental health services, understanding of common and severe perinatal psychiatric conditions, knowledge of psychotropic safety in pregnancy and breastfeeding, and confidence in recognising and managing perinatal mental illness.

An online perinatal psychiatry teaching series was delivered to 5th-year medical students during their O&G placements. Sessions covered: (1) an introduction to perinatal psychiatry and services, (2) common perinatal psychiatric conditions, (3) severe perinatal mental illness, and (4) psychotropic medication in pregnancy and breastfeeding. Pre- and post-session questionnaires assessed self-reported understanding and confidence using Likert-scale responses. Qualitative feedback explored students’ perceptions of relevance and educational value.

Across the four teaching sessions, 99% of students (85/86) reported the sessions were useful. Following the introductory session, 100% of respondents (34/34) agreed that perinatal mental health teaching should be incorporated into O&G placements, and 85% of students (29/34) reported being at least ‘somewhat likely’ to consider perinatal mental health in their future clinical practice. Significant improvements in self-rated understanding were observed across all sessions. For the introductory session, the proportion of students reporting ‘moderate’ to ‘very good’ understanding increased from 32% (9/28) pre-session to 95% (35/37) post-session. For the session on common perinatal psychiatric conditions, ‘good’ or ‘very good’ understanding increased from 23% (5/22) pre-session to 94% (15/16) post-session. Understanding of severe perinatal mental illness improved from 14% (3/21) of students rating their understanding as ‘good’ or ‘very good’ pre-session to 87% (20/23) post-session. Prior to the psychotropics session, no students reported ‘good’ or ‘very good’ understanding (0/12); following the session, 92% (12/13) rated their understanding as ‘good’ or ‘very good’, with no students reporting ‘no’ or ‘basic’ understanding post-session. Qualitative feedback consistently highlighted the clinical relevance of the teaching and perceived value of the programme.

A structured perinatal psychiatry teaching programme delivered during O&G placements is feasible, highly acceptable to students, and associated with substantial improvements in self-reported understanding and confidence. Embedding perinatal mental health teaching into undergraduate O&G curricula may support earlier recognition of maternal mental illness and strengthen multidisciplinary maternity care.

Seizures can manifest with different symptoms including motor, autonomic, behavioural, cognitive, emotional, or sensory dysfunction. Non motor seizures can therefore be referred to a psychiatrist or missed. This study looks at a similar case where seizure disorder was mistaken for a cognitive disorder and sun downing in dementia.

An 81-year-old gentleman was referred to the memory clinic due to concerns about his memory and behavioural changes occurring mostly at night. At initial review he reported having episodes of disorientation, with associated behavioural changes like wandering, attending to chores e.g. cleaning, hoovering, with confusion and scored score 85/100 on ACE III. Further history revealed a previous episode of collapse, preceded by patient doing household chores at 3 am, lip smacking, urinary incontinence and retrograde amnesia of events. Diagnosis of cardiac syncope was made at the hospital, following ECG with dynamic changes but no rise in troponin. EEG showed no positive findings and He was then asked to inform Neurology if there are further episodes . Unfortunately, he had several episodes with similar behavioural symptoms but not motor manifestation which delayed treatment as family did not report them to neurology. He was then seen in psychiatry clinic for MCI review where a diagnosis of likely seizure disorder, with behavioural manifestation was made and was referred to the neurologist who prescribed lamotrigine with significant reduction in the frequency of these episodes.

The case highlights again, epilepsy as watershed between neurology and psychiatry. Seizure episodes may present with behavioural symptoms which can be referred to mental health specialists.

Mental health specialists should take detailed history, consider various differential diagnosis and complete a holistic review including medical history to avoid missing focal and complex partial seizures without motor manifestation.

Background:

Sexual safety is a core component of providing a safe and therapeutic inpatient mental health environment. Devon Partnership NHS Trust's (DPT) Sexual Safety Policy (C60) outlines responsibilities to protect patients from sexual harm, promote consent, and ensure appropriate sexual health assessment. National guidance from NICE, the CQC, and the Sexual Safety Collaborative highlights the importance of routine sexual history taking, trauma-informed care, and safeguarding, particularly for vulnerable inpatient populations.

Aim: This audit aimed to evaluate compliance with DPT's Sexual Safety Policy (C60) on Haytor Ward by assessing documentation of sexual health and sexual safety during inpatient admissions, and to explore resident doctors’ knowledge, attitudes, and practices regarding sexual history taking.

A retrospective review of ten inpatients admitted to Haytor Ward in May 2025 was conducted using System One (s1). Patients were selected using a randomised bed-number approach. Documentation within physical health clerking, the assessment tab, and tabbed journal entries was reviewed using predefined search terms aligned with Trust policy requirements. In addition, a qualitative and quantitative survey of South Devon resident doctors was undertaken using Google Surveys to assess awareness of policy, clinical practice, and perceived barriers. The survey was open for 30 days and achieved a 50% response rate.

Documentation of sexual health and sexual safety was below expected Trust standards. Sexual history was inconsistently recorded, largely due to the absence of a sexual health section within the routinely used admission clerking proforma. The existing Sexual Health template on s1 was not easily accessible and did not capture several policy-required elements, including gender identity, sexual orientation, sexual safety understanding, historyof sexual harm, and MAPPA/safeguarding status. Patients who were acutely unwell on admission were less likely to engage in sexual history discussions. Only 50% of surveyed doctors were aware of the Sexual Safety Policy, and most reported not routinely undertaking sexual history taking, citing time pressures, patient distress, lack of training, and system-level barriers.

Sexual safety assessment on Haytor Ward is inconsistently documented, primarily due to IT system limitations and reduced staff awareness. Improving S1 templates, enhancing training, and embedding sexual safety into routine admission processes are essential to align practice with Trust policy and national guidance, and to ensure patient dignity, safety, and safeguarding.

Literature identifies South Asians as reporting significantly higher rates of mental health stigma compared to other ethnic groups. A significant component of this is ‘courtesy stigma’, where family members experience collective shame regarding an individual’s diagnosis. While low Mental Health Literacy (MHL) is cited as a primary driver of stigma, this study investigates the paradox: the persistence of stigma among ‘mentally literate’ South Asian households. The study aims to explore the lived experience of individuals navigating mental health while being raised by parents with high MHL, questioning whether MHL effectively translates into appropriate support.

This qualitative study utilizes semi-structured interviews via Zoom (Howe, Tickle & Brown, 2014). Participants were recruited through snowball sampling for their unique perspectives: All participants (2 males, 4 females) have parents with professional healthcare backgrounds or are in the field of psychology. Data was analysed using narrative thematic analysis to capture the various stigmas faced within familial dynamics.

Four core themes emerged: Denial, Courtesy Stigma and Labelling, Paradoxical Resistance to Treatment, and Stigmatised Protection and Exclusion. Denial was most prominent, where a psychiatrist father’s clinical expertise failed to overcome a “refusal to see” of his son’s diagnosis. Courtesy Stigma and Labelling, for example where the “mad person’s daughter” label, created such a traumatic environment of social shaming. Paradoxical Resistance to Treatment, where even high levels of MHL fail to ensure support. A pharmacist,well-versed in the efficacy of medication, discouraged treatment due to the specific stigma of psychiatric drugs. Noteworthy to mention an exceptional instance of supportive parents, including a psychiatrist father who encouraged medical treatment for her OCD from a young age, the participant still felt stigmatised. Stigmatised Protection and Exclusion, were evident when adults discouraged younger family members from interacting with the participants, ultimately leading to social exclusion.

This case series demonstrates that stigma within South Asian communities remains a structural force dictating family behaviour independent of clinical knowledge. MHL does not inherently mitigate cultural shame. Clinicians, for instance, should not assume that parents with medical knowledge will be more accepting of a child’s diagnosis. Recognising this will be key in tailoring effective, culturally sensitive care. Larger-scale studies are required to fully understand the broader population’s cultural barriers and the persistence of stigma in “literate” households. Several participants have channelled their experiences with stigma into advocacy, pursuing careers in psychology or engaging in public awareness efforts to bridge these gaps.

Journal Club Presentations (JCPs) are a mandatory component of the Royal College of Psychiatrists (RCPsych) portfolio requirements for Annual Review of Competence Progression (ARCP), with trainees required to complete at least one JCP per training year. At Mersey Care NHS Foundation Trust, JCPs are delivered within the weekly Local Academic Programme (LAP), but trainees frequently report reduced engagement, particularly during statistical discussions. Baseline LAP feedback identified difficulty understanding statistics, limited interactivity, and low perceived examination relevance as key contributors. As critical appraisal and research methods form a substantial component of the MRCPsych Paper B examination, this Quality Improvement Project aimed to enhance engagement by integratingbrief MRCPsych-style multiple-choice questions (MCQs), targeting a 25% improvement from baseline.

This prospective quality improvement project used a pre-post descriptive design within the weekly LAP. Baseline data were obtained from routinely collected LAP feedback surveys (August–September 2025; pooled n=427), assessing engagement, barriers to participation, and acceptability of MCQs. From 16 September 2025, MRCPsych-style MCQs were incorporated into every JCP. Presenters were asked to include 1–3 MCQs focused on statistical or methodological concepts relevant to the paper, taking no more than five minutes. Post-intervention evaluation was conducted at two predefined time points in December 2025 (pooled n=211). Outcomes included self-reported engagement on a 10-point Likert scale, understanding of journal articles, perceived knowledge retention, and interactivity. Data were analysed descriptively.

At baseline, 25–30% of respondents rated engagement as average, 40–50% reported difficulty understanding statistics, and 30–40% requested greater interactivity. Post-intervention, 65–70% reported a moderate to very significant increase in engagement (≥7/10), exceeding the 25% improvement target. Improved understanding of journal articles was reported by 63–65%, with up to 39.5% reporting better statistical understanding and overall comprehension. Knowledge retention improved for 69–70%, and interactivity for approximately 67%. Only 3–6% reported minimal or no improvement. Qualitative feedback was strongly positive, with requests to continue and expand MCQ use.

Sustained integration of MRCPsych-style MCQs into JCPs was associated withmeaningful improvements in engagement, understanding, retention, and interactivity. This lowcost, scalable intervention exceeded its primary objective and has now been embedded into routine teaching practice. Incorporating brief, exam-relevant interactive elements represents an effective strategy for enhancing postgraduate psychiatric education.

Feedback was collected from Core Trainees (CTs) working at Black Country Healthcare Foundation Trust to survey their satisfaction with the way that ECT was being delivered at the time. Primary aim was to assess/rectify CT issues that were causing difficulties in achieving their ECT competencies with secondary aims to improve delivery of ECT from a patient/trust perspective as well.

Initially a prequestionnaire was delivered to determine the extent of the need and whether CTs would be positive towards a separate rota.

Afterwards we implemented a new specific rota for ECT clinic, over a trial period of 3 months, where a dedicated CT would cover the entire ECT list rather than the rostered on-site on-call doctor (if that doctor was agreeable to this). This was tracked via a live Excel document that was regularly updated to show the ECT clinics that were and weren’t available and CTs were able to put themselves down for available clinics.

We then performed a post-trial survey with comparable questions to assess for benefit of the rota and then asked the cohort for their views on the ECT rota itself and whether it should be reimplemented (as well as advice on improving that process if it were to restart).

Pre-trial responses showed that 65% and 71% of CTs had not received ECT induction or had competencies signed off, respectively. Over half had difficulties achieving competencies and 94% thought a more structured programme would help with achieving these.

Post-trial feedback was overwhelmingly positive with significant improvements in all measured parameters. Particular highlights being how 100% of CTs surveyed had now performed ECT vs 65% previously; and 94% favoured re-introducing the ECT rota. The percentage of CTs that had their ECT competencies signed off more than doubled (from 36% to 67%) and the vast majority felt the ECT rota made things better and less stressful whilst it was running.

Our conclusion was that a separate ECT rota was required going forward, particularly considering the Royal College's current ECT training requirements for CTs. Itwas recommended – and agreed to – that a centralised rota managed through the postgraduate medical rota coordinators would be beneficial. These findings were discussed and presented at the Tutors and Trainees meeting, attended by College Tutors and the Head of School.

This project evaluated a new service for CAMHS patients with Eating Disorders within Avon and Wiltshire Mental Health Partnership Trust. The service (‘the Redcap clinic’) was commissioned in 2024, and began operating in January 2025, providing physical health review (physical observations, bloods, ECGs) for ED patients under 18. The clinic is run at the Bristol Royal Hospital for Children by paediatricians specialising in Eating Disorders, and interpreted results are shared with locality CAMHS teams. The key aim of the clinic is to safely and effectively assess the physical health needs of this patient cohort, facilitating collaborative clinical decision-making between paediatrics and psychiatry. This project aimed to explore clinicians’ views of the new service.

A nine-question electronic survey was disseminated amongst CAMHS and paediatric staff referring to, or running, the clinic. The survey ran over 90 days (September – November 2025), using convenience sampling. Mixed methods were used to interpret the results; the first five questions were analysed using descriptive quantitative methods. The latter four questions elicited free-text responses, on which the lead researcher conducted a thematic analysis based on Braun and Clarke’s method of thematic analysis.

In total, 24 responses were received from members across the MDT in both CAMHS and Paediatrics. 100% of respondents felt that the clinic provided joined-up care, and 95% of respondents felt that the clinic allowed faster access to investigations. Views of respondents indicated that the clinic: 1) provided joined-up care between paediatrics and psychiatry; 2) allowed patients faster access to tests compared to appointments in primarycare; 3) was convenient for patients compared to having tests at the GP; 4) saved clinicians’ time; 5) had a robust and effective system for results feedback. Qualitative analysis of free-text responses generated five themes of the clinic’s impact on professionals – ‘saving time in community CAMHS’, ‘meeting patient needs’, ‘confidence in the system’, ‘facilitating safer decision-making’, and ‘connection with experts’. Regarding the impact of the clinic on patients and families, qualitative analysis of responses yielded four themes – ‘accessibility’, ‘containment’, ‘appropriate/adapted’ and ‘continuity’.

Overall, clinicians’ feedback on the Redcap clinic was positive; the clinic was felt to facilitate safe, effective, and joined-up care for a vulnerable group of young people with specific physical and psychological health needs. These results have supported local efforts for ongoing commissioning. Suggestions for further service development are discussed, as are future plans to explore feedback from young people and families using the service.

Mentalisation-Based Therapy-Introduction (MBT-I) is a brief, structured psychological intervention designed to enhance reflective functioning and emotional regulation, and to prepare individuals for longer-term psychotherapeutic work. Despite increasing use across NHS services, evidence relating specifically to MBT-I remains limited. This quality improvement project (QIP) aimed to evaluate the characteristics, engagement, and outcomes of participants enrolled in MBT-I groups within Leicestershire Partnership NHS Trust (LPT). Objectives included describing demographic and clinical characteristics, examining referral pathways and engagement, assessing post-intervention outcomes, and identifying service gaps and future needs for MBT group provision.

A retrospective audit was conducted across three MBT-I cohorts delivered in October 2023, July 2024, and February 2025. Referrals were accepted from primary care, secondary mental health services, Central Access Point, and self-referral pathways. Forty-eight individuals were considered for MBT-I. Groups were delivered weekly over 10–13weeks, co-facilitated by two MBT-trained clinicians. Data were collected at pre-intervention, during treatment, and post-completion using routinely recorded clinical information. Variables included demographics, mental health history, risk and safeguarding data, attendance, completion rates, and onward referrals.

Participants represented a clinically complex cohort (mean age 40.2 years; 77.1% female). Historical risk to self was present in 66.7% and 91.7% had previously engaged in psychological therapies. Most participants (85.4%) had no prior psychiatric admissions. Engagement was good, with a median attendance of 8.5 sessions with attendance ranging from 0 to 13 and low rates of non-attendance. Inpatient admissions during MBT-I were rare (2.1%). Following MBT-I, 20.8% completed and were referred for further psychological therapy, 12.5% completed and required no further intervention, and 4.2% were signposted to alternative services. A minority (22.9%) did not complete the programme, while 37.5% did not commence following assessment. Referrals predominantly originated from secondary mental health services, with minimal primary care referrals.

MBT-I appears to be a feasible, acceptable, and resource-efficient intervention for individuals with complex emotional and interpersonal difficulties. Findings demonstrate good engagement and low inpatient admission rates, supporting its safe delivery within high-risk populations. MBT-I may function both as a gateway to longer term psychological therapy and, for some individuals, as a sufficient standalone intervention. Non-commencement and drop-out highlight the importance of robust assessment and exploration of barriers to engagement. Future service development should prioritise routine outcome measurement, improved data quality, and clearer integration of MBT-I within stepped-care psychological therapy pathways. These findings align with NICE guidance and support further evaluation,expansion, and integration of MBT-I provision within NHS psychotherapy services nationally sustainably.

To verify whether clozapine and lithium plasma levels were monitored in accordance with trust guidelines in inpatient psychiatric settings.

A retrospective audit was conducted across eight inpatient wards.

Fifteen inpatients prescribed clozapine and/or lithium were included.

The audit period covered December 2024 to March 2025.

Data sources included clinical notes, WebICE, EPMA, and clozapine monitoring report form

Standards and Criteria

Clozapine: Plasma levels taken immediately before the morning dose (for twice-daily dosing) or 10–12 hours post-dose (for once-daily night dosing), after at least three days on a stable dose.

Lithium:Plasma levels taken 5–7 days after initiation, sampled 12–14 hours post-dose, with weekly monitoring until stable therapeutic levels are achieved.

Target compliance: 100%.

Clozapine (n=6): All patients had plasma levels checked after at least three days on a stable dose. Four patients (66.67%) had samples taken within the recommended post-dose time window. For two patients (33.33%), compliance could not be confirmed due to missing uploaded laboratory reports. Two patients were within the therapeutic range, while four were outside the target range. Dose adjustments were made for two patients; no changes were required for two due to good clinical response or increased cigarette use. Repeat plasma levels were obtained where clinically indicated.

Lithium (n=9): Seven patients (77.8%) had lithium levels checked within 5–7 days of initiation. Two patients (22.2%) did not meet the recommended initiation timing. Two patients had samples taken outside the recommended 12–14-hour post-dose window. Eight patients had plasma levels outside the therapeutic range, prompting dose adjustments and repeat testing. One patient had a therapeutic lithium level and required no dose adjustment.

Summary: Only 66.67% of patients on clozapine or lithium were fully monitored in line with trust guidelines. Missing clozapine monitoring forms limited the ability to assess compliance. Inconsistent plasma sampling times were identified.

Recommendations and Action: Plan Improve staff awareness by displaying trust guidelines on wards and providing targeted teaching sessions. Educate patients on the importance of adherence to plasma monitoring schedules. Emphasise the importance of uploading clozapine monitoring forms and assign clear accountability. Work with IT services to address technical issues related to report uploads.

This audit demonstrated partial compliance with trust guidelines for clozapine and lithium plasma monitoring. Improved documentation practices and targeted staff education are recommended to enhance patient safety. A re-audit is planned to assess the impact of these interventions

Discharge summaries are essential documents that promote continuity of care and patient safety and communication between inpatient and outpatient providers. They are especially important in the psychiatric setting since they need to contain accurate records of the mental status of the patient, risk evaluation, and the education of both the patient and caregiver to avoid relapses and adverse events. This audit aims at evaluating the quality of psychiatric discharge summaries in our hospital and finding out the main areas that need improvement to be used in quality improvement initiatives

This clinical audit was conducted to determine the completeness and quality of 80 discharge summaries of patients admitted to the Psychiatry Department of Allied-2 Hospital, Faisalabad, using a structured checklist based on Royal College of Physicians (RCP) guidelines, between January and June 2025. The main components were patient identifiers, diagnosis, mental state at discharge, risk assessment, treatment summary, medications, follow-up plan, counseling documentation, and legibility. The data analysis was done descriptively using frequencies and percentages, with 100 percent compliance considered the gold standard.

The degree of compliance with RCP standards was overall 47.5, which was significant. There were high scores in the elements of administrative data such as admissions and discharge dates (100), final psychiatric diagnosis (100), a review of treatment (100), discharge medications (100), and patient identifiers (98.75). Nevertheless, compliance among critical psychiatric-specific elements was very low: presenting complaint (0%), examination of mental state at discharge (0%), documented risk assessment (1.25%), patient and care giver counseling (1.25%), and typed/legible discharge summaries (0%). There were critical deficiencies in five components that had a great impact on patient safety, continuity of care, and managing risks.

A review audit should be conducted to assess the effects of this intervention and to ensure that the RCP standards are followed so that psychiatric discharge paperwork and patient outcomes are improved. The absence of documentation of the mental state examination, risk assessment, and counseling places patients at a significant safety risk. To be able to deal with these issues, electronic discharge summaries and standardized templates with mandatory psychiatric assessments, structured counseling protocols, and targeted training of personnel should be introduced.

To audit DNACPR (Do Not Attempt Cardiopulmonary Resuscitation) documentation within inpatient units of the Mental Health Care Division at Mersey Care NHS Foundation Trust, assessing compliance with Resus Council and BMA standards.

This retrospective audit reviewed DNACPR forms identified via the in-house assessment database, with data extracted from electronic systems and case notes. The audit population included 30 patients, of which 8 were applicable during the audit period (January–June 2025). Compliance was assessed against seven defined criteria, including patient information, rationale for DNACPR decision, healthcare professional details, review information, notification, discussion documentation, and CPR alert on RIO.

Overall compliance was 72%, with an assurance level of Limited. High compliance (100%) was achieved for patient information, rationale for DNACPR, healthcare professional details, and CPR alerts on RIO. However, significant gaps were observed in review information (0% compliance), notification details (33% compliance), and documentation of discussions on RiO (60% compliance).

While DNACPR forms generally captured essential patient and professional details, critical areas of non-compliance were identified, particularly around review, notification, and documentation of discussions. These deficiencies pose risks to continuity and quality of care.

To explore how young people with a diagnosis of Anorexia Nervosa and their carers describe shifts in understanding, thinking and perspective during a clinician-moderated online forum group within a children’s eating disorder service.

Digital interventions are increasingly used within eating disorder services to provide peer connection, psychoeducation and clinician support. Young people with a diagnosis of Anorexia Nervosa and their carers from Mid Mersey children’s eating disorder service were offered digital platform based clinician moderated forum groups as part of TRIANGLE research project, which generated discussions around their illness and their understanding and perceptions of recovery from Anorexia Nervosa. Previous qualitative studies have shown perspectives and sense making inAnorexia Nervosaare central to recovery processes and online support groups can reduce isolation and influence emotional regulation, however, little is known about how shifts in understanding, meaning and perspectives of an eating disorder are experienced within online group intervention in both patients and their carers. This study addresses that gap by analysing group transcripts to identify the processes through which participation may reshape cognitive and emotional narratives related to eating disorder experience and recovery.

Verbatim transcripts from three cohorts of seven consecutive online forum groups were analysed using reflexive thematic analysis, using NVivo software the discussions of 13 youngpeople with a diagnosis of Anorexia Nervosa or Atypical Anorexia Nervosa and 13 of their carers were analysed with attention to changes in participants’cognitive and emotional narratives over time.

Ethical considerations: This included informed consent for research use, anonymisation of transcripts and processes for escalation of safeguarding concerns within the groups. The ethical approval for the TRIANGLE study was taken from REC Liverpool, REC Ref – 25/NW/0029.

Preliminary patterns suggest that young people experience changes in understanding and insight into the impacts of eating disorders, greater capacity for emotional awareness and reframing of ED identity over the course of the online groups. Carers also experience shifts in understanding of young people’s eating disorder behaviours but also a greater ability to reflect and an increased perspective of the impact of their own emotional regulation. Clinician support provided prompts to reframe experiences and promote self-reflection, increased awareness about concepts such as expressed emotion and accommodation within the participants.

These findings suggest that digital group interventions within children’s eating disorder services can support recovery by facilitating shifts in cognitive, emotional and meaning based processes that may underpin change and motivation for recovery.

The effective implementation of evidence-based interventions is heavily dependent on matching interventions correctly to patients’ clinical needs, which, in turn, relies on the way the patients’ clinical needs are understood. Although previous research indicates a high degree of variability in assessment approaches, it remains unclear how clinicians determine clinical ‘caseness’ in routine practice. The aim of this study was to examine how clinicians make judgements about the nature of patients’ presentations when making care-related decisions in acute scenarios.

Semi-structured focus groups were undertaken with clinicians whose primary roles included assessments and decision-making in acute psychiatric scenarios. Participants were presented with a real-life vignette of a complex yet common presentation and asked to discuss their approaches to the assessment, conceptualisation and understanding a range of patient experiences illustrated in the vignette (with a particular focus on how the participant understands these experiences from perspective of phenomenology, psychopathology, causation and diagnosis). The interviews were recorded, transcribed and anonymised and the transcripts were subject to thematic analysis.

The results reported were based on an analysis of data from 4 focus groups involving a total of n=21 participants.

1. The thematic analysis of the way clinicians reached judgements about clinical ‘caseness’ identified four main themes:

2. Specific terminology to convey the relative clinical significance of patient experiences (e.g. ‘intrusive thoughts’ versus ‘voices’ or ‘hallucinations’).

3. Informal rules to reach a judgement about the clinical significance of signs and symptoms (e.g. rules based on the patient’s demeanour to determine whether or not to accept a patient’s self-report at face value).

4. Judgements about the typicality of the self-report.

5. Judgements based on causal assumptions about patients’ presentations (e.g. ‘drug-induced’ or ‘personality disorder voices’).

The findings of this study indicate that in routine mental health practice clinicians reach judgements about the clinical significance of patients’ presentation by using a range of assumptions that are outwith conventional guidance for assessing mental health morbidity. If these findings are supported by the results of other studies, then consideration should be given to (i) developing and implementing agreed approaches to determining clinical caseness in routine practice and (ii) ensuring that implementation research includes an evaluation of the impact of caseness-related judgements on the effectiveness of interventions in routine care.

Substance misuse and addiction-related problems are routinely encountered within psychiatric services, yet many core psychiatry trainees report limited confidence in assessing and managing alcohol- and opioid-related presentations. Traditional didactic teaching may not adequately prepare trainees for the complexity of real-world clinical encounters. Simulation-based education allows learners to practise challenging scenarios in a controlled setting, while case-based discussions (CBDs) encourage reflective learning using authentic clinical material. This educational initiative aimed to explore whether combining simulation with CBDs could improve trainee confidence in addiction psychiatry.

Two dedicated addiction psychiatry teaching days were delivered within a regional core psychiatry training programme. Each day consisted of immersive simulation scenarios, structured debriefs, and faculty-facilitated CBDs. Scenarios focused on core clinical skills including substance use history taking, assessment of risk, and management planning for alcohol withdrawal and opioid use. The first session was attended by 12 trainees and the second by 11 trainees (CT1–CT3). In response to feedback, a simulation scenario was revised for the second teaching day to prioritise collaborative discussion of short- and long-term management plans with the patient. Changes in self-reported confidence were measured using pre- and post-session questionnaires, alongside qualitative feedback.

Prior to the first teaching day (n=12), most trainees reported low or neutral confidence in managing addiction-related presentations. Following the session, all trainees reported increased confidence, with the majority describing themselves as somewhat confident and a smaller proportion as extremely confident.

At the second teaching day (n=11), baseline confidence levels were higher, with over one third of trainees reporting some confidence before the session. Post-session responses again demonstrated an upward shift, with most trainees reporting being somewhat or extremely confident. Attendance at both teaching days by some trainees may have contributed to this higher baseline confidence.

Qualitative feedback across both sessions consistently identified simulation as the most impactful learning modality. Trainees valued the opportunity to practise clinical decision-making in real time, make mistakes in a safe environment, and receive immediate, structured feedback. The integration of CBDs was viewed as complementary, supporting consolidation of learning and reflective discussion based on authentic clinical cases.

This combined simulation and CBD teaching programme was associated with improved self-reported confidence. While limited by small participant numbers and reliance on subjective measures, the findings support the continued use of experiential learning approaches. Future iterations will aim to enhance realism through involvement of individuals with lived experience of addiction, with further sessions planned for April 2026.

Poor IT experience and support are well-recognised contributors to inefficiency, frustration, and burnout among resident doctors. Within West London NHS Trust, informal feedback suggested significant difficulties with access to clinical systems, hardware availability, and IT support responsiveness, impacting both workflow and patient care. This is especially noticeable during the rotation time–February and August. This Quality Improvement Project aimed to identify the IT difficulties resident doctors were facing and to improve resident doctors’ IT experience at West London NHS Trust by addressing key barriers.

Baseline data were collected using an anonymised online survey assessing access to IT hardware, login functionality, system reliability, and IT support satisfaction. Process mapping and stakeholder engagement with IT services, clinical leads, and junior doctor representatives identified priority areas for intervention. Change ideas were tested using Plan–Do–Study–Act (PDSA) cycles. Medical education manager attended the induction and ensured that all the new starters have access to the key systems–clinical system, pathology etc. Difficulties were flagged up to the ICT service.

In the pre-intervention questionnaire, 67% residents reported of experiencing some IT difficulties. The difficulties were with regards to accessing pathology system (ICE), hardware related, windows and NHS email log in. Key concerns around the IT experience were addressed this December, during the rotation of FY doctors. And they reported of improved experience. However, much larger number of doctors rotate in February and August. Similar induction day IT support will be made available in the first week of February. Data from this rotation will show the full impact.

IT system’s access was made part of the induction and early detection of difficulties helped to resolve some of the issues which would otherwise impact work in the first few weeks of the rotation. During the December rotation favourable outcome was noted.

Psycho education is a vital component of holistic and effective care within Child and Adolescent Mental Health Services (CAMHS). High-quality, accessible information enables young people and their families to better understand their mental health conditions and recommended treatments. This helps engagement, informed decision-making, improve clinical outcomes and patient safety. However, services face challenges in delivering consistent psychoeducation due to variability in available resources and clinician awareness. This Quality Improvement Project aimed to assess clinicians’ awareness, confidence, and use of psychoeducation resources within CAMHS in BCHFT and to develop a centralised system to support high-quality psychoeducation across the Trust.

This project was developed using the PDSA quality-improvement framework. An anonymous self-report survey was distributed to clinicians across the four boroughs, consisting of 14 items: 11 Likert-scale questions and 3 open-ended prompts. The survey examined clinicians’ awareness of psychoeducation resources, confidence in delivering psychoeducation, frequency of use, and familiarity with local materials such as websites, books, apps, leaflets, workshops, and skills groups. Clinicians were also invited to propose ways to improve psychoeducation provision to guide us in the development of a centralised resource for each borough.

A total of 32 clinician responses were analysed. Most respondents (96%) recognisedthe importance of psychoeducation for recovery and relapse prevention, and 90.5% reported routinely offering it in consultations. However, notable knowledge gaps emerged: 37% were unaware or strongly unaware of the Trust’s Service Directory, and 25.5% were neutral or unaware of existing CAMHS psychoeducation workshops. Although 85% felt confident delivering psychoeducation, only 62% were satisfied with current provision. Verbal explanation and website signposting were used most frequently, followed by leaflets. Clinicians recommended improving access to resources through printed materials, shared drives, and Microsoft SharePoint, as well as increasing availability in waiting areas. Additional suggestions included materials on parental mental health, coping strategies, condition summaries, staff training, and a parent portal.

The survey highlighted a wide range of psychoeducation resources used across CAMHS but revealed inconsistent awareness, with more experienced clinicians accessing a broader selection. These findings highlighted the need for a centralised approach to share resources. In response, a resource booklet has been developed for each locality and will be circulated to all clinicians, with plans for regular review. This project aims to strengthen clinician confidence, improve service quality, and enhance the wellbeing and safety of children and families accessing CAMHS.

Unlawful medication administration under the Mental Health Act (MHA) poses significant patient safety and legal risks in Old Age Psychiatry. Cognitive impairment, fluctuating capacity and behaviour disturbances increase the likelihood of patients requiring rapid tranquillisation. In August 2025, four incidents occurred, where either the route or frequency were administered outside the parameters of medication authorisation forms (T3 particularly).

This Quality Improvement Project aimed to eliminate T3 medication errors by improving Registered Nurses' (RN) knowledge and confidence in compliance with MHA medication authorisation forms. We hypothesised that a combined intervention of a visual prompt and targeted teaching would improve compliance and reduce errors to zero.

We included all RNs on a 16-bed Old Age Psychiatry ward (n=10). Baseline data included incident reports and questionnaires identifying inconsistent knowledge and varied confidence of medication form processes among RNs.

Two interventions were implemented: (1) a visual whiteboard placed above the drug trolley identifying patients with active T3 medication forms to prompt checks at administration times; (2) a targeted teaching session using real ward-based incidents to reinforce legalrequirements for T3 authorisation. Monthly audits monitored medication authorisation errors, and questionnaires were repeated following the teaching session.

Following implementation, off-T3 medication incidents reduced from four in August 2025 to zero in September 2025, and remained at zero for four consecutive months. Staff reported that the visual prompt aided adherence to MHA T3 medication forms. Mean knowledge questionnaire scores increased from 58% at baseline to 71% after the teaching session. Mean self-reported confidence in interpreting T3 forms increased from 3.7 to 4.3 on a 5-point Likert scale.

Low-cost, scalable interventions integrating visual aids and focussed education eliminated unlawful T3 medication errors to zero and significantly improved staff knowledge and confidence, ensuring sustainable T3 compliance. This Quality Improvement approach supports safer practice and is transferrable to other inpatient psychiatric services.

Pregnancy/Childbirth is a period of immense physical, emotional and social changes to women’s life due to drastic hormonal, body image changes. The immunological and circadian rhythm disturbances postpartum is compounded by potential obstetric complications.

Postpartum psychosis can arise in about 1-2/1000 live births, developing rapidly within weeks of delivery. Presentation is heterogeneous ranging from affective, psychotic and a mixture of symptoms. A smaller proportion of women can have Catatonia presenting with abnormal movements/behaviours.

A 26year old woman was brought to A/E, confused and disorientated 5weeks after her first childbirth. Pregnancy was uneventful until 40weeks when developed hypertension. She was induced at 41weeks/3days after passing meconium-stained liquor. Labour lasted 3nights with postpartum haemorrhage of 1600mls. She had mastitis and UTI postpartum.

She was admitted to a mother and Baby Unit due to her deteriorating mental state. She was noted to present as mute periodically, with labile mood and abnormal movements. Other features of her presentation included thought disorder, gross confusion, delusions of paranoia and misidentification.

She experienced distressing visual, tactile and auditory hallucinations. In addition to catatonic features of echolalia, abnormal movements like walking backwards, crawling or climbing, negativism and staring with periods of immobility.

She had no previous psychiatric or medical history. She had no family history of mental illness and the rest of her psychiatric history was unremarkable with a good social support.

She had extensive investigations including Haematological, CSF tests, brain and body scans, EEG to rule out Autoimmune encephalitis or other organic aetiology. Results were unremarkable. She was commenced on Olanzapine with poor response despite optimisation resulting in a switch to Risperidone. She was commenced on Intra-muscular (IM) Lorazepam and responded to daily doses at 5mg though improvements were not sustained. There was a poor response to oral and sublingual Lorazepam that was tried due to concerns about frequent IM treatments.

She was subsequently treated with Electroconvulsive therapy (ECT), which led to a dramatic and rapid response. By the second session, most of the catatonic and psychotic symptoms resolved. She was subsequently discharged after 8sessions of ECT, and was able to rebuild the bond with her baby and reconnect with her family.

Postpartum Psychosis is a psychiatric emergency with significant impairment in functioning and impact on parenting, with associated risks to self and the infant. Diagnosis and treatment must be timely. ECT remains an evidence-based treatment for rapid relief of symptoms of postpartum psychosis with Catatonia.