Aims: Doctors in training can be at high pressure to balance the service needs with their own training needs, thus leading to a risk of burnout. Hence, supporting their wellbeing is of paramount importance to optimize their training experience. This Quality Improvement (QI) project led to an improvement in well-being support for specialty trainee psychiatrists, training in Kent, United Kingdom.

Methods: This project employed a baseline survey among the specialty trainee psychiatrists training in Kent in Jan/Feb 2024 with support from the trusts’ medical education department and the wellbeing team. The survey questionnaire was modified from the NHS staff wellbeing survey. It utilized a Likert scale (1 to 5) to explore several aspects of awareness and access to available wellbeing resources. Additionally, open questions were included to collect views of the the resident doctors regarding wellbeing support.

Following the outcome of the baseline survey, the suggestions were implemented by the medical education department over a year and a follow-up survey was conducted to assess the impact of the changes. This project was registered with the QI department of the trust.

Results: Fifteen specialty trainee doctors participated in the baseline survey. The survey identified several gaps in the participants’ awareness about wellbeing resources such as; lack of information about the resources, lack of confidence in accessing wellbeing events/activities and inadequate wellbeing check-in during supervision. Moreover, several barriers were identified including having limited access to information about wellbeing resources, lack of time and fear of stigma/discrimination to access the resources if available.

Following the baseline survey, a document with all the available resources was developed and included in the induction pack for all the resident doctors. A protected wellbeing event was organized with wellbeing activities chosen by the specialty trainee resident doctors. The findings from the survey were also shared with the consultant supervisors in the CPD session. A QI fishbone session was further organized to explore what wellbeing meant to the resident doctors.

Sixteen specialty trainee doctors participated in the follow-up survey. The findings showed improvement in awareness about the resources available to them and confidence in accessing these resources. There was a significant improvement in their perception regarding wellbeing check at workplace (baseline 53.3%, follow up 81.3%). However, there were still concerns around stigma, fear of discrimination that need further exploration and intervention.

Conclusion: This project has demonstrated improvement in the specialty trainee resident doctors’ perception about their wellbeing support. However, there are several challenges in terms of sustaining these positive changes and fostering a positive culture of help seeking by mitigating stigma and fear of discrimination.

Aims: Lithium is a widely prescribed mood stabiliser with proven efficacy in managing bipolar disorder, but its narrow therapeutic index necessitates regular physical health monitoring. Inadequate monitoring can increase risks for patients. Within the Taff Ely Community Mental Health Team (TECMHT), we identified a lack of a structured system to track and manage the necessary monitoring tests. This quality improvement project aimed to determine whether the implementation of a structured record sheet could improve adherence to the National Institute for Health and Care Excellence (NICE) physical health monitoring standards for lithium treatment in TECMHT.

Methods: A retrospective review of clinical records for 30 patients was conducted to establish baseline monitoring practices. A pre-implementation meeting with the nursing team highlighted existing challenges, including inconsistent monitoring and lack of centralised tracking. The intervention consisted of three components: (i) a standardised monitoring proforma, (ii) a formal clinic protocol, and (iii) a training session for clinic nurses. Following the implementation, prospective data for 20 patients attending the clinic during the 6-week monitoring period were analysed. Run charts were used to compare monitoring practices before and after the intervention, while Pareto charts identified areas for improvement and helped track compliance over time.

Results: Before the intervention, monitoring of BMI was not routinely performed, and calcium monitoring was suboptimal. Serum lithium level monitoring, however, showed good compliance with guidelines. After implementing the intervention, lithium level monitoring achieved 100% compliance with NICE guidelines, BMI monitoring was completed for 82% of patients, and calcium monitoring improved from 8% to 33%. A decline in compliance for urea and electrolytes and thyroid function monitoring was noted, which was attributed to initial confusion over the new system. This issue was addressed in a subsequent training session aiming to improve clarity and compliance.

Conclusion: A physical health monitoring form was successfully developed and integrated into the lithium monitoring clinic, improving access to monitoring data and ensuring better adherence to NICE guidelines. The form streamlined monitoring without requiring additional resources or labour. Following approval from senior health board management, the form is being rolled out across the health board. To assess its broader impact, further data analysis is recommended, and additional educational resources for clinic staff may be beneficial. This intervention demonstrates the value of structured systems in enhancing patient care in outpatient settings.

Aims: Main aim of this quality improvement project was to ensure that each outpatient CAMHS clinic room is equipped with the necessary, functional equipment for safe and comprehensive baseline and ongoing monitoring of patients prescribed antidepressant, antipsychotic, and ADHD medications, in line with NICE guidelines, the Maudsley Prescribing Guidelines and hospital guidelines.

Methods: The sites included in this project are Raglan house (single point of access), The Clock house (Community Service South Oxfordshire), Slade and Maple house (neurodevelopmental conditions outpatient service in Oxford).

Data collection was conducted with the help of a checklist to be used for each clinic room in outpatient CAMHS. All four sites were included in the data interpretation process each having 54 items in the checklist. It includes quantitative and qualitative data which are crucial to ensure standards and to meet requirements by the guidelines mentioned above. These items consist of three groups, physical health monitoring, infection prevention as well as privacy, confidentiality and comfort. Some of the items were window blinds and engaged/vacant for privacy and confidentiality; sanitiser and soap for infection prevention; stethoscope and height measurement tool for physical health.

Results: On average, 44% of checklist items were present on the sites, which means 56% items were not available. Of the present items, 96% were working well, whereas 4% were dysfunctional such as a clock with no battery, an unstable scale, a faulty thermometer and limited amount of sanitiser. Moreover, concerns were raised about shortage of rooms for routine and urgent appointments across multiple sites despite online and telephone appointments being offered. In addition, some of the rooms did not have appropriate lighting. The issues that pose immediate risk to patients’ safety were prioritised and reported to the estates. The rest is planned to be reported at the time this abstract was written.

Conclusion: Functional clinical equipment is essential to ensure patient safety. Efficient and active use of channels to report missing or dysfunctional items as well as regular maintenance and calibration of clinical items are key to excellent caring and safe care. All staff members are responsible to make sure that appropriate equipment is available.

Aims: There is currently no standardised triage process utilised across perinatal mental health services. Oxleas Perinatal Service (located in South East London, offering service across three boroughs) introduced 15-minute video triage calls, where the staff on duty is allocated six calls a day to screen new referrals received by the service. This was introduced to attempt to standardise the triage process, increase service numbers, and improve patient experience. This study aimed to evaluate the effectiveness of this new triage system.

Methods: We retrospectively looked at all referrals received between 15/01/2024 to 15/04/2024. 3 standardised feedback questionnaires designed for staff, admin and patients were sent out through SmartSurvey to: 14 staff members on the duty rota, 3 admin staff involved in triaging referrals and 170 patients who attended the video triage calls across the three boroughs. 7 out of 14 staff members, all 3 of the admin staff and 12 patients responded to the SmartSurvey. 105 patients were subsequently contacted by telephone to try and obtain more responses. Following this, an additional 29 patients responded with a total of 41 patient responses obtained.

Results: Feedback analysis was grouped into 3 themes: emerging themes from patient, staff and admin responses. Majority of patients reported they preferred video appointments over telephone and felt that the next steps in their care were made clear to them. Patients who were subsequently offered appointments with clinicians expressed how useful the video triage process was. Recurring challenges reported by patients included: poor connectivity, pace of the session and personal preference between video and telephone.

Staff feedback highlighted an enhanced patient experience and information gathering. In addition to this, an increase in service access numbers was also cited. Common barriers reported included: workload pressures, assessments felt repetitive and logistical issues such as wi-fi connectivity.

Overarching themes from admin responses cited a friendly approach for patients and an increase in access numbers. One major challenge highlighted was the workload.

Conclusion: Most patients found video triage useful, thereby highlighting a potential for an adapted process to be used across other perinatal services. To address workload pressures, a change has since been introduced where daily triage calls have been reduced from 6 to 4 calls a day. Anecdotal feedback received says that this is much more manageable. We are in the process of measuring the impact of this change, and findings of this will be reported in the near future.

Aims: A questionnaire distributed to psychiatry trainees at the East London NHS Foundation Trust ascertained that, as of July 2024, trainees had not received formal training on navigating the Portfolio Online system. Additionally, there was no easily accessible document outlining key information for understanding the portfolio and the Annual Review of Competency Progression (ARCP) requirements.

This project aimed to enhance trainees’ understanding of the RCPsych Portfolio, improving their ability to navigate it efficiently. By addressing common challenges and providing clear guidance, the goal was to streamline the portfolio experience, enabling trainees to document their competencies and progress confidently.

Methods: An initial survey was conducted among trainees at the East London NHS Foundation Trust to assess their current training on portfolio navigation and ARCP requirements. Key findings included:

94.1% of participants had not received formal training on the RCPsych Portfolio.

64.7% were unclear about the contents of the Portfolio, despite available resources on the RCPsych website.

70.5% were unaware of all ARCP requirements.

100% of trainees felt that formal training on RCPsych Portfolio would be beneficial.

Based on these results, the following interventions were implemented:

Trainee Portfolio Handbook: A concise, user-friendly handbook was created, offering step-by-step instructions on key portfolio components and ARCP requirements for easy reference.

Formal Training Sessions: Structured, interactive sessions were organised to introduce trainees to the Portfolio and to clarify the ARCP expectations. These sessions are now incorporated into the local induction programme to ensure standardised training for all incoming trainees.

Results: Following the introduction of formal teaching and handbook distribution, feedback included:

100% of participants found the teaching sessions “extremely useful” and reported improved navigation of the portfolio.

100% respondents found the handbook very effective in improving their understanding of the portfolio.

86% found the handbook “extremely useful” in clarifying ARCP expectations.

The explanation of Placement-Specific Personal Development Plans was rated as particularly helpful.

Regular training sessions on RCPsych Portfolio are now being provided to all new psychiatry trainees at East London NHS Foundation Trust.

Conclusion: This Quality Improvement Project successfully enhanced the accessibility of resources and improved trainee comprehension of the RCPsych Portfolio and ARCP requirements. The positive feedback highlights the effectiveness of the handbook and training sessions. Additionally, the handbook has been submitted to the Royal College for review and potential inclusion in their official resources.

Aims: The rising caseloads in Swansea Bay University Health Board (SBUHB), with some sector consultants managing over 200 patients, exceed the Royal College of Psychiatrists’ recommended caseload of 100. Patients transitioning into Intellectual Disability Services are increasingly complex and therefore need more intensive support which has compounded the issue. This Quality Improvement (QI) project aimed to:

Assess outcomes for patients on Patient Initiated Follow Up (PIFU) within Cardiff West Psychiatry sector of Swansea Bay University Health Board.

Use Patient Reported Experience Measures (PREMs) to evaluate patient and carer satisfaction with the PIFU system.

Methods: The Model for Improvement and the Plan-Do-Study-Act (PDSA) cycle were utilised. Planning phase involved stakeholder analysis and process mapping to create a driver diagram identifying problems in the current system. A survey of carers for patients placed on PIFU in 2021–2023 assessed satisfaction with communication and service delivery.

Results: In 2021–2022, 9 patients were placed on PIFU; 5 were discharged, and 4 requested a review within 12 months. In 2023, 4 patients were placed on PIFU, with 1 returning for an urgent review. Carer satisfaction was high, with 50% reporting being “very satisfied” and 50% “satisfied”. Regarding communication, 75% of carers felt they understood the PIFU process “very well” and 25% felt they understood it “well”. One carer was unaware that their relative had been placed on PIFU despite generally positive feedback about communication.

Conclusion: PIFU has shown potential in reducing caseloads while maintaining high levels of carer satisfaction. The system allowed for appropriate emergency reviews when needed. Some carers expressed a preference for face-to-face follow-up rather than complete discharge. Two barriers were identified. The first, consultant reluctance to discharge due to concerns about vulnerable patients deteriorating without reliable monitoring. The second was administrative staff challenges with IT systems used to track and manage follow-up, in the main due to a lack of awareness of training. Future PDSA cycles will focus on increasing training for both administrative staff and clinicians on the benefits and implementation of PIFU, as well as enhancing carer and patient advocacy.

Aims: People with Intellectual Disabilities (PwID) have, on average, a life expectancy 20 years less than that of the general population. The Learning Disabilities Mortality Review found that in 23% of deaths among PwID, constipation was a long-term health problem. In the past year, Swansea Bay University Health Board’s (SBUHB) Mental Health and Learning Disability Delivery Unit reported four incidents of constipation among PwID living in the community, with one fatality.

Patients prescribed clozapine are more vulnerable to constipation due to side effects. This Quality Improvement (QI) project aimed to assess the current knowledge about constipation among PwID prescribed clozapine, along with their carers, and to use a brief educational tool to address knowledge gaps.

Methods: Stakeholder analysis, fishbone diagram, and process mapping were undertaken to create a driver diagram and identify change ideas. Education was chosen as the primary driver for this project, with a focus on assessing understanding, and providing patient and carer education. The project targeted all PwID prescribed clozapine within three geographical areas: Cardiff, Swansea, and Rhondda Cynon Taf. An initial knowledge survey was administered to both patients and carers, followed by a face-to-face educational session using an Easyread leaflet. Knowledge was reassessed one week later.

Results: Seven educational sessions were held, with patients and their primary carers participating. The knowledge survey revealed that all patients understood the basic concept of constipation, but fewer understood its health risks (30%) and the recommended frequency of bowel movements (14%). Knowledge improved and was retained one week after the education session, with 60% understanding the health risks and 71% knowing the recommended frequency of bowel movements. Carers demonstrated improved knowledge, particularly in using the Bristol Stool Chart. All carers recognized the increased risk of constipation among PwID and its potential fatal consequences.

Conclusion: This project demonstrated that targeted, brief educational interventions can effectively improve the knowledge of PwID and their carers regarding the risks of constipation associated with clozapine therapy. The results emphasise the importance of accessible information and suggest that continuing education is necessary for both PwID and carers. It also highlighted the importance of a stable and educated carer workforce, with appropriate training at induction. The future aim of the project team is to develop an online educational programme for carers about constipation, and how to seek timely and effective support.

Aims: Psychiatry intensive care units (PICU) are therapeutic environments that care for people with the most severe mental health conditions often characterized by heightened agitation, aggression, or self-harm behaviours. It is also one of the most restrictive units. Royal College of Psychiatrists standards for psychiatric intensive care units has given emphasis on the provision of therapeutic activities. We identified the scope to improve the choice, availability and accessibility of activities provided in PICU.

Aim: of the quality improvement project is to improve the service user satisfaction of therapeutic activities provided in the PICU from 60% to at least 80% in a duration of 6 months.

Methods: The principles of Quality improvement were followed. Did a process mapping, change ideas was collected from the whole team including service users, a driver diagram was created, changes were introduced, and impact was measured through Plan Do Study Act (PDSA) cycles.

Data was collected from service users on a scale of 1 to 5 on a daily basis in community meetings. Balance and process measures data was extracted from the records. The data was plotted as a run chart.

Results: The primary outcome measure used was service user satisfaction. Balance measures used included risk incidents (absconsion, physical and non physical assaults, self harm and sexual offences). The process measures included occupied bed days and volume of admissions or transfers.

Service user satisfaction score improved from 3 at base line to 4.2 out of 5, soon after the launch of the project. Median of rate of risk incidents reduced from 12 to 4. There was no difference in the process measures over the project period.

Change ideas tested included improving the communication between service users and staff, improving the communication between multidisciplinary staff members, improving the interests and enthusiasm of team, maintaining the enthusiasm in the therapeutic activities for both staff and service users, improving the understanding among staff of the therapeutic activities of interest in the service users and ensuring to maintain the material resources.

Conclusion: The project fostered a multidisciplinary approach, involving collaboration among psychiatrists, nurses, social workers, occupational therapists, service users and other allied health professionals. There was an inertia to initiate therapeutic activities in the ward, the project has helped to break this and the stereotypies about who needs to take initiatives on providing therapeutic activities.

Aims: To assess and improve the consistency of family, carer and community team involvement in our MDT (multidisciplinary team) ward rounds on a PICU (Psychiatric Intensive Care Unit).

Methods: Baseline date involved retrospective analysis of EPR (electronic patient records) reviewing the documentation of 27 admissions over a six-month period (February to August 2024). We recorded details of demographics, diagnosis and length of stay. We reviewed MDT documentation for a maximum of eight weeks to ascertain invites, attendees and whether family/carers had been contacted within three days of their first MDT as this was an agreed expectation. A total of 101 MDTs were reviewed.

Following baseline data collection we made the following changes:

Circulation of expected standards regarding family involvement.

Change in format of our daily handover document to include details of important family/carer contacts and most recent recorded contact.

Use of a standardised MDT documentation proforma to improve accuracy of written records.

Results: Baseline data: The majority of our patients were male (74.1%), White British (74.1%), English speakers (88.9%), from the local area (81.5%) and had a diagnosis of a schizophrenic, schizotypal or delusional disorder (51.9%). The average age was 35 years and length of admission 35.5 days.

59.3% of admissions had documented contact with relevant family/carer within three days of their first MDT review.

On average relevant family/carers/professionals were invited to 61.4% of MDTs and attended 45.3% of the time.

On average MDT attendance reduced over time from 48.1% in week one to 33.3% in week eight.

Re-audit data: We are in the process of prospective re-audit between the period of January to March 2025. Thus far we have reviewed the records for 9 patients and analysed data entry of 18 individual MDTs.

100% of admissions had documented contact with relevant family/carer within three days of their first MDT review.

On average relevant family/carers/professionals were invited to 81.5% of MDTs and attended 59.3% of the time.

The MDT documentation proforma use was 61.5%.

We expect to have a larger data set as collection is ongoing.

Conclusion: Quality and accuracy of documentation is likely to have underestimated the frequency of contact with carers, particularly in the baseline data.

Timely, regular and meaningful liaison with family, carers and community professionals improves outcomes and quality of care for PICU patients. Simple interventions and reinforcement of expected practice can improve frequency and consistency of patient and carer involvement.

Aims: Serious mental illness is associated with higher rates of sexual assault and gynaecological cancers, alongside pre-menstrual disorders and the menopause which can be implicated in psychiatric presentation, relapse or treatment resistance. This project aimed to ensure better screening and referral for sexual and reproductive health issues in order to improve relevant health outcomes.

Methods: Two pre-existing health-recording forms were highlighted to nursing staff and encouraged using information posters placed in staff areas. Six individual referral pathways were developed for doctors’ use. Data was collected pre- and post-intervention including proportion of forms completed, abnormalities identified, appropriate follow-up initiated, and time spent carrying out these tasks. Reasons for non-completion were analysed. PDSA cycles were used to guide improvements and increase engagement.

Results: Prior to intervention, 53% of patients had the ‘women’s physical health’ (WPH) form completed, 0% the contraception form. Despite 59% of these finding abnormalities, 0% were referred for investigation or treatment (32 patients over a 2-month period August–September 2024). Post-intervention, completion of the forms remained static at 50% of WPH and 0% of contraception forms, though detected abnormalities rose to 88% and appropriate referrals to 40%. Of the remaining 60%, 7 patients identified as requiring a referral declined, most commonly refusing a smear test. 1 further patient was too unwell to engage. Overall patient group size was similar with 34 patients over a 2-month period November 2024–January 2025. Average time for form-reviewing and referring was 6.9 minutes per patient. Independently of the forms, 1 patient who remained admitted throughout both data periods was followed up for 3 separate issues, and 4 patients without completed forms were noted to have concerns, and subsequently referred appropriately.

Conclusion: Though patient referrals increased from 0 to 40% after the referrals guide was created, the proportion of concerns addressed remained low. Patient education is a key target for improvement, specifically cervical screening, and eye-catching patient education posters are to be displayed on the ward for this purpose. Form-completion rates did not improve, suggesting further engagement with nursing colleagues and specific time-allocation for completion would be of benefit. Perhaps most significantly, the increased identification of reproductive and sexual health concerns of patients without a completed form highlighted the team’s increased awareness of these issues. This suggests that clinician education can help in utilising inpatient admission as an opportunity to improve sexual and reproductive health for women with serious mental illness.

Aims: To determine whether an in-house phlebotomy clinic would reduce the length of time taken for blood tests to be completed and results reviewed within the CAMHS Eating Disorder Service in Coventry and Warwickshire Partnership NHS Trust, which would reduce patient safety incidents caused by these delays.

Methods: Collation of baseline data which includes the timeframe in days between:

Blood tests being requested and blood tests being taken.

Blood tests being taken and blood results being reviewed.

Blood tests being requested and blood results being reviewed.

This baseline data has been displayed in a statistical process chart to show the current length of time taken for each of the above. The baseline data also shows which patients had abnormal blood results that required A&E attendance for urgent repeat testing. It also reviews the near misses that occur due to the length of time taken to review blood results.

Testing change ideas using Plan-Do-Study-Act cycles for each change idea:

Created a central list of all patients who have had blood tests requested.

Introduced standardised days for checking if the blood test has been taken and reviewing the results accordingly.

Increased the number of standardised days for checking if the blood test has been taken.

Development of an in-house phlebotomy clinic.

Results: The statistical process charts show that since introducing the change ideas, the overall mean for the timeframe between blood tests being taken and blood results being reviewed has reduced from 17 days to 2 days. This shows the change in process has had a positive impact on this step. However, the same improvement has not been shown in the timeframe between blood tests being requested and blood tests being taken, nor blood tests being requested and blood results being reviewed. We hope to see an improvement in these two steps with the introduction of our in-house phlebotomy clinic.

Conclusion: Our findings show that the changes in process have had a positive impact regarding the reduction in time between blood tests being taken and the blood results being reviewed. We hope to see a continued improvement in this and all steps of the process with the introduction of our in-house phlebotomy clinic.

Aims: To improve multidisciplinary team awareness of doctor availability within the East-North-East Leeds Community Learning Disability Team.

To create and implement a resource listing accurate availability per half-day, contact details, and named cover in cases of absence.

To improve team communication, reduce uncertainty, and streamline contact and escalation processes.

To utilise baseline and post-intervention outcome measures to assess improvements in practice.

Methods: This project was formulated following reports of uncertainty around doctor availability, inefficient methods of contact attempts, and with no current effective rota system in place.

A Plan-Do-Study-Act (PDSA) approach was taken to assess and adopt continuous improvement throughout.

Baseline questionnaires were distributed to staff to assess current levels of awareness of doctor availability, escalation pathways, and perceived usefulness of a planned resource.

Key stakeholders (consultants, resident doctors, managers, senior administrators) were engaged to adapt and expand a current limited senior doctor rota, to include all doctors, named cover, enhanced contact methods, and a wider audience. This utilised Outlook calendars, was displayed in the team office, and was updated weekly.

Post-intervention questionnaires were circulated to assess the impact of the intervention.

Further procedures were implemented to sustain this change, including commitments from permanent staff to take responsibility in maintaining the resource, standard operating procedures formulated for administrative and medical teams, and safeguards created to identify future issues encountered.

Results: Response rates from staff were 32% and 36% pre- and post-intervention respectively.

Staff confidence in knowing which doctors were available and when rose from 22% to 91%.

Staff knowledge of how to immediately contact an available doctor rose from 44% to 91%.

Staff knowledge of how to further escalate concerns rose from 67% to 91%.

91% of staff reported using the resource, 91% found it useful, and 82% found it accurate.

Further adaptations were made as the project progressed and in response to feedback and issues encountered.

Conclusion: This project successfully resulted in improving awareness of doctor availability in all domains measured, and was well received.

By developing a clear, accessible rota and engaging staff in its use, staff confidence and team communication improved.

This project led to lasting changes in practice, ensuring ongoing effectiveness sustained beyond the project’s conclusion.

Key points of discussion include engagement of key stakeholders in planning, implementing, and sustaining improvement, ensuring feasibility and longevity. Furthermore, reflecting on the effective use of PDSA principles with simple, measurable changes, and implementing ongoing review processes.

Aims: Hampshire has an older population structure, compared with the national average, with increases predicted amongst the older population, aged 75 years and older. This group is more susceptible to social isolation, particularly those living in towns of the New Forest. We therefore are focusing on a project aimed at the older population, particularly men, in the town of Lyndhurst.

Our aims are threefold: to understand what current nature-based activities are on offer for older people in the New Forest, to appreciate the barriers for engagement to these and lastly through insights with this group to set up a heritage and nature group to try to tackle isolation and improve physical activity levels.

Methods: We have held several insight groups with local community groups to better understand their route to engage in nature-based activities and what barriers they faced. Additionally, we have met with social prescribers in the New Forest PCN to better understand isolation in the elderly population.

We have arranged two focus groups at the Heritage centre in Lyndhurst to better understand the current community offering and to also help us launch our pilot heritage and nature group running at the centre.

Results: Common themes were highlighted as barriers to engagement in nature activities including poor public transport, reduced mobility, caring responsibilities, lack of diversity of activities as well as the intangible barrier of ‘it’s not for me’. Digital barriers further negatively impact those who are unable to access information about groups in the local area and space can be difficult to find for groups to run such as for the Lyndhurst shed.

Conclusion: Our work so far has highlighted that older people are more susceptible to isolation and that it is more of a concern in towns rather than rural areas in the New Forest. We have identified that there is a gap in heritage and nature-based activities on offer in the New Forest, which would encompass several aspects of the 5 ways to wellbeing such as connecting with others, being active (brief history walk) and learning new things. By involving local older people in the set-up of the group through focus groups we have been better able to address any barriers they may have to engage in nature and heritage activities. This project adds to the existing evidence of the positive interaction between heritage and wellbeing.

Aims: Little is known about the proportion and patient profile of conditionally discharged patients supervised by general adult community mental health teams (CMHTs). In this study we aimed to evaluate the number of patients and their demographic, clinical and risk profile, and current practice in terms of supervision and structures.

Methods: We conducted a retrospective case note service evaluation of all conditionally discharged patients within a typical NHS Trust’s CMHTs.

Results: A third of all conditionally discharged patients within the Trust were supervised under the care of general adult community teams. The majority of patients were older, male, unemployed with schizophrenia and related disorder diagnoses. Main index offences were serious violence to others with use of weapons.

Conclusion: Conditionally discharged patients represent a low volume, high risk population. Supervision in the community is time and resource intensive. There is a need for NHS Trusts to ensure adequate support and structures, supervision, training, and joint working opportunity with forensic services to ensure safe quality care.

Aims: Mental health apps are increasingly available and accessible to the public. Global research indicated variable rates of use among people with main barriers identified are cost, privacy concerns, and difficulty of use. Little is known about prevalence and barriers of use of mental health apps in Saudi Arabia.

Methods: Descriptive questionnaire-based cross-sectional survey of a sample of Saudi adult population. We adopted a multiple logistic regression modelling of data to evaluate the impact of potential barriers and facilitators on use of mental health apps.

Results: The survey included (n=636) participants. The prevalence of use of mental health apps was (n=80, 12.6%), with only (n=32, 40%) finding them useful. Younger age, females, separated marital status, students, history of mental illness, taking psychiatric medications, attending psychiatric services, seeing a psychologist (offline and online), and chatting to psychiatric patients online were all associated with unadjusted increase in use of mental health apps. However, the adjusted impact on use of mental health apps was significant only for those using psychiatric medications (odds ratio (OR)=0.1289, p=0.0243), individuals who requested online psychology intervention (OR=7.9866, p<0.00001), individuals who believed in costliness of mental health apps (OR=2.9358, p=0.00034) or difficulty using them (OR=4.1875, p=0.0002). Stigma and privacy concerns were not statistically impactful on use of mental health apps.

Conclusion: Use of mental health apps is very low among Saudi patients. Those who use mental health apps remain sceptical of their therapeutic values and report concerns in terms of difficulty to use them and their cost-effectiveness. Design of effective, readable, safe, and cheap mental health apps should be attempted by health educators and mental health professionals to engage Saudi patients in using mental health apps.

Aims: Mother and Baby Units offer specialised treatment to women in the antenatal period from 32 weeks gestation to 12 months postpartum. All referrals are screened for admission suitability. Reasons to reject referrals include absence of serious mental illness and high risk of violence.

To analyse relationships between referrals received and accepted admissions regarding clinical and social variables, including deprivation levels, timing of referrals, diagnosis and ethnicity.

Methods: Retrospective data collection looking at all referrals to Yorkshire and Humber Mother & Baby Unit between 1 April 2023 and 31 March 2024. Total 129 referrals. Patient records were used for data collection.

Results: Deprivation decile: Most referrals were from the most deprived decile (35%). Least from the least deprived decile (3%). Of the most deprived decile referrals, 86% were accepted. All from least deprived decile were accepted.

Ethnicity: Most referrals were white British (71%), then Asian/Asian British (13%), then black/black British (6%). Least were ‘other ethnic group’ (4%). 6% had no ethnicity stated.

Of the referrals for white British ethnicity, 87% were accepted. For Asian/Asian British ethnicity, 94% were accepted. For black/black British ethnicity, 71% were accepted. For other ethnic group, 40% were accepted. With no ethnicity stated, 63% were accepted.

Diagnosis: Most referrals were for diagnosis of Psychotic Disorder (46%), followed by Mood Disorder (33%), Multiple (10%), Other (7%), and least for Anxiety Disorders (4%).

Of referrals for Psychotic Disorder, 88% were accepted. Mood Disorder, 90% were accepted. Multiple, 53% were accepted. Other, 66% were accepted. Anxiety Disorders, 80% were accepted.

Time of Referral: For point of referral in perinatal timeline, most referrals were between 2–12 weeks postpartum (36%), then 12+ weeks postpartum (32%), 0–2 weeks postpartum (20%), and least from pregnancy (12%).

At 2–12 weeks postpartum, 85% were accepted. At 12+ weeks postpartum, 88% were accepted. At 0–2 weeks postpartum, 96% were accepted. During pregnancy, 47% were accepted.

Conclusion: The data highlighted discrepancies in number of referrals received from different deprivation decile areas and ethnicities, significantly higher from more deprived areas and higher number of referrals for white British ethnicity patients. The acceptance proportion was higher in less deprived areas, this could be due to significant difference in number of referrals. The acceptance proportion for different ethnicities were fairly in the same range. Targeted interventions to promote awareness could improve equitable access.

Aims: Assessing the referral patterns, patient characteristics, constraints, immediate and wider benefits of a GP/CMHT fortnightly consultation-liaison clinic as a component of an enhanced community mental health service design.

Methods: A Transformation initiative pilot GP/CMHT Consultation-Liaison huddles convened over 20 (21) months via video-link; January–December 2021 (23) to September 2022 (14). Initial session in December 2020 enabled both teams comprising two managers, GP, Psychiatrist, Primary care link worker and GP community outreach specialists and CMHT admin support established the format of the Hour long sessions. At various times Other GP Colleagues/Specialist Addiction Services/Sexual Health Consultants/team members/Memory Clinic Specialists joined as appropriate. The sessions provided opportunities for a few video-linked patient consultations and trainee observations. Ahead of the fortnightly sessions is an email list of patients from GP to Psychiatrists with specific queries. Number of patients range from 4 (2) to 12 (14) each session. However, some queries were addressed ahead of sessions or concluded at the meeting. Enquiries varied, ranging from referrals tracking, medication or management advice, diagnosis, risk mitigation strategies and learning on incidents.

Results: Total 354 patient encounters were listed or discussed with number of patients per sessions ranging from 2 to 15 mean of (9). Total 37 sessions with 223 patients (2021) and 131 (2022) discussed. Recurring patient encounters range from 2–14 times. Non-recurring patients overall 113 (32%). All patients were within working age group, with the youngest aged 17 plus and the oldest 67 years (four patients). Mean age 38.4 years. Patient characteristics, diagnoses, risks and immigration issues and impact to access to services frequently encountered. Presentations discussed varied with more complex cases frequently recurring.

Conclusion: Consultation liaison model has evolved over the years. With recent pandemic, demand for secondary care interventions has increased to the degree innovative approaches offer alternatives to mitigate risks, support primary care services, strengthen GP confidence and most importantly, improve transfer to primary care. Further research is required to strengthen approaches to CMHT/Primary care interfaces.

Aims: This study investigates the timing and patterns of patient admissions to a community psychiatry hospital, with the goal of optimizing resource allocation by identifying peak arrival times.

Methods: This study was conducted at Udston Hospital within NHS Lanarkshire. The hospital comprises two older adult wards, each with a capacity of 20 beds. Patients admitted to these wards were mainly aged over 65 and were admitted either informally or under the Mental Health Act. A duty doctor handles admissions during working hours, 9 am to 5 pm, while an off-site duty doctor covers evenings and weekends.

Data from 50 randomly selected patients admitted between January 2024 and January 2025 were collected using the electronic patient record platform MORSE. The primary outcome was patient arrival time, categorized into predefined time slots. The secondary outcome analysed admission sources (home, care home, or hospital) and whether patients were admitted informally or under detention (Emergency Detention, Short-Term Detention, or Community Treatment Order).

Categorical data analysis was employed to identify any significant trends in admissions.

Results: The study identified a notable peak in the afternoon. A majority of admissions, 37 patients (74%), occurred after 2 pm, with 23 patients (46%) being admitted between 2 pm and 4 pm. In contrast, only 7 patients (14%) were admitted between 9 am and 12:59 pm, highlighting an underutilization of morning hours for patient transfers. Half of these admissions were informal and originated from patients’ homes.

Conclusion: Late afternoon admissions delay lab results, requiring follow-up by the off-site duty doctor, which may postpone treatment or escalation to the out-of-hours GP. This disruption can affect sleep, a modifiable risk factor for delirium, raising fall risk and worsening outcomes.

Staff are also impacted, particularly during the evening shift and night shift, where reduced resources and increased workloads heighten admission errors, contributing to moral distress and lower job satisfaction.

Systemically, late admissions disrupt patient flow and worsen inefficiencies. Research links evening and weekend admissions to poorer outcomes.

Addressing this issue requires streamlining workflows through measures such as designated admission timeframes for informal patients, prioritizing safer morning hours for non-urgent cases, and optimizing resource allocation through greater staffing levels during peak periods.

These strategies will enhance patient safety, alleviate the strain on staff, and improve overall operational efficiency.

Aims: This study assesses the frequency and adequacy of handovers for newly admitted patients in a community psychiatry hospital, focusing on formal communication to the duty doctor.

Methods: This study was conducted at Udston Hospital within NHS Lanarkshire, which comprises two older adult wards, each with a capacity of 20 beds. Patients, primarily aged 65 and above, were admitted either informally or under the Mental Health Act.

Data from 50 randomly selected patient admissions between January 2024 and January 2025 were collected using the electronic patient record platform MORSE. Handover was defined as any documented verbal or written communication to the duty doctor regarding a patient’s admission. Categorical data analysis was performed to identify trends in handover practices.

Results: The study revealed significant deficiencies in handover communication, with 54% of patients admitted without a formal handover. Home was the most common admission source (70%), with an even split in handover rates (51.4% handed over vs 48.6% not handed over). In contrast, hospital admissions had the lowest handover rate, 71.4% not handed over, suggesting direct transfers without a formal process in most cases. Care home admissions were also less likely to involve a handover with 62.5% not being handed over. Regarding detention status, 56.7% of informal patients were not handed over. In contrast, all patients under a Community Treatment Order (CTO) were handed over (100%), likely due to legal requirements for coordinated care. Patients under Short-Term Detention Certificates (STDC) and Emergency Detention Certificates (EDC) had a near-equal split in handover rates. These findings suggest that handover processes are more structured for detained patients but remain inconsistent for informal admissions and transfers from hospitals and care homes.

Conclusion: Inconsistent handover practices for new admissions highlight a critical gap in communication. Findings highlight the urgent need for standardized handover protocols, including mandatory documentation for all admissions, to enhance patient safety and care continuity. Implementing structured communication frameworks, such as SBAR (Situation, Background, Assessment, Recommendation), may enhance handover reliability and reduce patient safety risks.

Improving handover communication is critical to minimizing patient safety risks and ensuring seamless transitions of care, particularly in psychiatric settings where detailed histories and individual care requirements are crucial. The absence of a structured handover posed risks of fragmented care, delayed treatment initiation, and insufficient awareness of patient-specific needs.

Future research should investigate barriers to effective handovers and evaluate interventions that improve adherence and patient outcomes in psychiatric settings.

Aims: Evaluate the frequency of mental disorders patients present with in different sites in SCCMHT to inform quality improvement to better match patient needs. To assess the non-attendance rate in various sites for future projects to explore factors associated with patient non-attendance. To quantify outcomes following patient reviews to explore discharge/follow up frequency.

Methods: The service evaluation was done retrospectively for three-month period from September to November, 2024, by collecting data from WCCIS database. Patient WCCIS identifiers were only stored in the spreadsheet used. Descriptive statistics were used to identify the most common diagnoses, outcomes, and non-attendance rates through various methods of stratifying the data. The data was compared when split between consultant clinics vs speciality doctor, Risca Health Centre Base vs Mill Road Base, and between urgent and non-urgent clinics.

Results: Mill Road and Risca OPA clinic had 172 and 76 appointments attended respectively over three months. Mill Road OPA had higher rates of non-attendance (26.18%) compared with Risca OPA (21.65%). Patients in Risca clinic are booked in for less frequent follow ups (72% with 4–6 months of follow up). A substantial percentage of patients being seen urgently are subsequently discharged from the CMHT (29%). This includes urgent patients seen in the Home Treatment Team Clinic, which often uses urgent consultant reviews to support discharge of patients. DNA rates are similar between consultant and speciality doctor clinic (23.2% and 25.85% respectively). DNA rates are approximately 1/4 across total clinics (24.84%). Despite a separate ADHD service and a supervised Physician’s Associate Clinic for ADHD separately, ADHD reviews still account for a considerable amount of outpatient clinic time (32 among 248 consultations). Similarly, PTSD/CPTSD and Borderline Personality Disorder account for a large number of urgent reviews (13 among 34 patients consulted).

Conclusion: DNA rates would require further assessment. They have not been included in analyses of diagnoses; a further exploration of the data is indicated to identify factors/diagnoses associated with non-attendance. A high prevalence of patients requiring urgent review are patients with borderline personality disorder and PTSD/CPTSD indicating Trauma Informed Approaches especially in crisis are required. Demands for ADHD assessments/follow ups remain high despite the presence of a ADHD service and Physician’s Associate Clinic (review of stable shared care patients). Patients remain under the CMHT even if they have no additional CMHT needs outside of Shared Care ADHD reviews, highlighting ongoing resource demand on the CMHT.