Aims: Lithium is a well-established mood stabiliser used for conditions such as bipolar disorder, mania, and depression. Given its narrow therapeutic index, regular monitoring is essential to prevent toxicity, which can cause confusion, seizures, coma, or death. This audit evaluated long-term lithium monitoring compliance for adult community-based patients at the Behavioural Science Institute, Al Ain Hospital, United Arab Emirates. We assessed adherence to local hospital guidelines, which align with The National Institute for Health and Clinical Excellence (NICE) Guideline CG185, recommending six-monthly checks of serum lithium levels, thyroid function, renal function, calcium levels, and BMI, with some patient groups requiring more frequent testing notably older adults, those taking medications interacting with lithium, and patients at risk of kidney, thyroid, or electrolyte abnormalities.

Methods: This retrospective audit reviewed electronic case notes of 38 patients on long-term lithium therapy under community mental health services from January 2018 to January 2019. A questionnaire was developed to capture the necessary information anonymously. Data collection occurred between March and May 2024.

Results: Of the 38 patients, 20 (53%) were male, with an age range of 20–64 years and a mean age of 35.2 years. The most common diagnosis was bipolar disorder, which accounted for 44.7% of cases, followed by schizoaffective disorder at 18.4% and major depressive disorder at 10.5%. Regarding six-monthly monitoring, serum lithium levels were measured in 25 patients (65.8%), with documented reasons provided for only six of the 13 patients who did not undergo testing. BMI was monitored in 36 patients (94.7%), while thyroid function tests were conducted for 31 patients (81.5%). Renal function was assessed in 27 patients (71%), with urea and electrolytes checked in 32 patients (84.2%). Notably, serum calcium levels were measured in only three patients (7.8%), highlighting a significant gap in monitoring adherence.

Conclusion: The audit revealed considerable inconsistencies in lithium monitoring, particularly in the assessment of serum lithium and calcium levels. To address these gaps, we recommend enhancing staff training on lithium prescribing and monitoring protocols to ensure adherence to guidelines. Optimising electronic prescribing systems to generate automated reminders may improve compliance, while better documentation practices are needed to ensure that any deviations from standard monitoring are appropriately justified. A re-audit will be conducted one year after implementing these measures to evaluate their effectiveness.

No financial sponsorship has been received for this evaluative exercise.

Aims: Clozapine is a cornerstone in treating resistant schizophrenia, with evidence linking threshold plasma levels to positive clinical outcomes. The Maudsley Guidelines recommend levels of 250–420 µg/L for an adequate trial. Our trust requires trained staff to collect venous samples, with results taking several days. The updated clozapine pathway suggests checking levels at initiation and 12 months, prompting consideration of the Saladax MyCare Insite Analyzer. This point-of-care device uses a finger-prick sample and delivers results in 7 minutes. Despite promising studies, its effectiveness depends on local acceptance, warranting a pilot.

Aims were:

To evaluate the acceptability of the finger-prick test among patients and staff.

To enhance patient care with a quicker method, enabling timely referrals and decisions.

Methods: Clozapine testing was conducted at Lyme Brook Clozapine Clinic (23.10.2023–17.11.2023) using the Saladax MyCare Insite Analyzer on pin-prick samples, with prior patient consent and staff training. Separate anonymised questionnaires were provided for staff and patients.

Results: Patients (n=31) were aged 21–70 years (64.5% male, 35.5% female), majority follow ups (64.5%).

96.9% of tests were completed within 15 minutes (32.3% within 0–5 min, 58.1% within 5–10 min, 6.5% within 10–15 min, 3.2% within 15–20 min). Compared with venous blood tests, 87.1% had a positive experience, 90.3% were satisfied with the test and care received, and 90.4% valued the time-saving benefits. Overall, the test was acceptable to 90.3%, and 71.0% preferred the finger-prick test (22.6% unsure) over venous, with 90.3% willing to use it again (6.5% unsure), and 83.9% would recommend it (9.7% unsure). 97% reported no issues, with only one instance of test repetition.

Staff (n=32) were aged 31–64: 56.3% doctors, 6.3% nurse associates, 12.5% STRs, 25% trainee nurse associates; 68.8% female, 28.1% male.

96.9% completed testing within 15 minutes (0–5 min: 9.4%, 5–10 min: 62.5%, 10–15 min: 25%, 3.1% unspecified). 96.9% highly rated their experience (3.1% no response), while 100% valued time efficiency, ease of use, and care quality. 93.8% found it acceptable (6.3% neutral). 94% reported no issues, with one test repetition. All staff preferred the finger-prick test and wished to continue using it.

Conclusion: The pilot project showed strong acceptability of the finger-prick method among patients and staff, with high satisfaction, minimal issues, and improved time efficiency. Both groups preferred it over venous testing, supporting its potential to improve patient care.

Further evaluation of cost-effectiveness, clozapine pathway integration, and training for wider implementation across trust is recommended.

Aims: To explore factors in service design that can account for difference in length of stay (LoS) in acute inpatient care for general adult patients between a public mental health service in London, North London Foundation Trust (NLFT) with one in regional Australia, South West Healthcare (SWH).

Methods: Information was gathered from the mental health organisations as below:

1. Data comparison of the 2 services over the period Nov 2023 to Dec 2024 relating to patient flow.

2. Comparison of service design in the two systems such as staffing levels, availability of supporting services and clinical practice.

3. Audit in each service comparing factors that can affect LoS.

Results: SWH had a shorter length of stay compared with NLFT (13 vs 43 days) in keeping with national and statewide comparison of LoS. Re-admission rates were also lower in SWH (9% vs 15%). There was a significant difference in the number of very long stayers (>60 days) with no such patients in the Australian service.

NLFT had a higher proportion of patients admitted formally (88% vs 65%) and a higher proportion of patients with a psychotic disorder (85% vs 75%).

The service comparison demonstrated higher levels of senior medical input available in the Australian service (1.2 vs 0.6 FTE per 10 patients) and medical staffing in general and more frequent reviews with a Consultant Psychiatrist (4 times weekly in SWH vs once a week in NLFT).

The audit showed more frequent use of high-dose antipsychotic prescribing at discharge (25% vs 18%) and higher amounts of antipsychotic doses in general in the Australian service (79% vs 59% of BNF Maximum Antipsychotic dose) at discharge.

Conclusion: The difference in LoS between the services is consistent with benchmarking data. The service evaluation identified several factors that might explain the difference.

There were more patients admitted with psychosis and a higher use of formal admissions in the UK service, both associated with longer LoS.

There were higher levels of medical staffing and in particular Consultant and Registrar levels in SWH. This is likely to explain the difference in frequency of senior reviews for patients in SWH which may result in frequent changes in management plans. The results suggest the use of higher doses of antipsychotic prescribing in SWH.

Staffing models and prescribing practice is likely to impact LoS. It would be important to consider differences in patient experience in the two systems in future evaluations of services.

Aims: Smoking contributes to poor mental health and increases inequalities in physical health and premature mortality. Smoking is a leading contributor to the 7–23-year lower life expectancy among people with severe mental illness (SMI) compared with the general population.

In Wales, an estimated 14.1% of people are smokers. Smoking is much more common (33% prevalence) among people with mental health conditions and is even higher among those with SMI (40.5% prevalence).

Welsh Government commissioned NHS Wales’ Joint Commissioning Committee and RCPsych Wales to develop a framework to help reduce smoking rates among people with mental health conditions in Wales.

The framework sought to address three priority areas for action:

Address misperceptions about smoking in mental health settings.

Improve implementation of quitting strategies in mental health settings.

Address the lack of data on smoking and quitting among people with SMI.

Methods: In partnership with the Public Mental Health Implementation Centre; a review of data, current interventions, policy and strategy across Wales was undertaken.

This was complemented by consideration of:

Overview of current evidence-based strategies in Wales.

Scaling evidence-based interventions for smokers with mental health conditions and SMI.

Addressing misperceptions among smokers and health professionals.

Upskilling mental health professionals to enable them to motivate and support quit attempts.

Results: In addressing the three priority areas for action, the framework focused upon:

Understanding local needs and assets.

Working Together.

Taking action for prevention of smoking, mental health promotion, and reducing inequalities.

Evaluation and measuring outcomes.

Additionally, a deficit in the following areas, led to several recommendations:

Provide training resources for upskilling people working in mental health to support smoking cessation.

Review and augment the implementation strategy for Help Me Quit and the Tobacco Control Delivery Plan to support people with mental health conditions.

Improve accessibility to nicotine replacement therapy (NRT) and other smoking cessation medication. People wanting to quit should have access to more than one quitting aid.

Address data gaps by collecting reporting information on rates of smoking, including among people with mental health conditions.

Conclusion: Several next steps are necessary to reduce smoking among people with mental health conditions in Wales:

Develop an implementation strategy for the Tobacco Control Delivery Plan to target people with mental health conditions including SMI.

National campaigns promoting positive mental health should include messages about the mental health harms of smoking.

Major gaps in data on smoking and quitting must be addressed.

Aims: This project aimed to evaluate our transition service for young people, from Child & Adolescent Service (CAMHS) to Adult Mental Health Services (AMHS), and to audit NICE transition guidelines compliance.

Methods: A retrospective case note survey of complex patients who had transitioned between January 2021 and September 2024 was undertaken. NICE Guideline standards on transition were compared with current practices.

Results: All individuals had been seen by a consultant psychiatrist prior to transitioning, usually with diagnoses confirmed, and medications stabilized.

37 participants were female and 7 male. 38 were transferred to community mental health team (CMHT), 3 to a learning disability team and 3 to early intervention in psychosis service.

13 participants had a diagnosis of bipolar affective disorder. 21 had a diagnosis of autism spectrum disorder (ASD) and 5 had attention deficit hyperactivity disorder (ADHD). A few awaited diagnoses confirmation. Emotionally unstable personality disorder was the second most common diagnosis, seen in 8 cases.

Individuals with severe anorexia nervosa and possible autism proved the most difficult to engage in treatment following transition. Most individuals continued to be managed in the community. Only 3 required brief admission to hospital for a maximum stay of 3 days.

Only one had contact with the criminal justice system.

Two continued to receive care from CAMHS post 18th birthday, as they didn`t meet the adult service eligibility criteria.

We compared our current practices with NICE standards. There was good compliance with most, other than Standard 1, regarding age at transition planning. Adult service policy was to identify a named worker only a month before the young persons` 18th birthday. Hence, most individuals transitioned aged 17 years and 11 months.

There was NICE compliance for having a coordinated transition plan, a named worker to coordinate transition care and support before, during and after transition., and a patient meeting practitioner from each anticipated adult service.

Conclusion: This review has helped us in confirming that our transition pathway is largely effective in transitioning complex and enduring cases to adult services and has identified gaps which require attention. We believe that having a dedicated consultant psychiatrist providing continuity of care, pre and post transfer has been pivotal in reaching these goals.

Additionally, good and early patient preparation, and focused, prioritised, multidisciplinary support for complex cases has been crucial.

Aims: The aim of this study was to explore the experiences and challenges faced by staff in pediatric wards when managing young patients with complex emotional and behavioural difficulties. It sought to understand the specific nature of these challenges, their impact on healthcare providers, and to identify potential strategies for improvement, particularly focusing on the staff’s interaction with Child and Adolescent Mental Health Services (CAMHS).

Methods: The study involved a qualitative survey of 16 healthcare professionals, including 12 nurses, 3 administrative or support staff, and 1 doctor, working in a Paediatric ward setting. Open-ended questions were used to gather detailed insights into the staff’s experiences. The responses were then segmented and analysed, focusing on the nature of the challenges faced, the impact on staff, suggestions for improvements, and the dynamics of their relationship with CAMHS.

Results: The survey revealed a multifaceted set of challenges. Staff reported a significant knowledge gap in managing patients with complex emotional issues, often leading to feelings of inadequacy and stress. These challenges were not just clinical but also emotional, affecting staff morale and mental health. The responses underscored the need for better support, specialized training, and enhanced resources. A recurring theme was the pivotal role of CAMHS, with staff expressing a need for more effective collaboration and communication. The data also hinted at nuanced challenges, such as dealing with manipulative behaviours, difficulty in patient–family interactions, and the emotional toll of such encounters. These findings highlight the complexity of emotional and behavioural management in pediatric care, extending beyond patient interaction to encompass broader aspects of the healthcare environment.

Conclusion: The study confirmed that Paediatric ward staff face considerable challenges in managing young patients with complex emotional difficulties. These challenges go beyond clinical management, significantly impacting the staff’s emotional well-being. The findings point to an urgent need for targeted training and support initiatives, along with stronger collaborative ties with CAMHS. Implementing such measures could lead to improved patient care and staff satisfaction. Additionally, regular debriefing sessions and feedback mechanisms are recommended to continually adapt and optimize care strategies in Paediatric wards, ensuring a resilient and empathetic healthcare environment.

Aims: This initiative aimed to establish a structured and collaborative pathway to address the mental health and psychosocial needs of Unaccompanied Asylum-Seeking Young People (UASYP) in Aberdeen. The project sought to provide trauma-informed, culturally sensitive interventions while fostering partnerships with local and national agencies to ensure comprehensive support. In 2023, the UK received 3,412 applications from Unaccompanied Asylum-Seeking Children (UASC), with Scotland accommodating a proportionate share through the National Transfer Scheme.

Methods: The pathway was developed within the Child and Adolescent Mental Health Services (CAMHS) at City Links Hospital, Aberdeen, inspired by Professor Renos Papadopoulos’ frameworks on refugee trauma and the “Enhancing Vulnerable Asylum Seekers’ Protection” handbook. Referrals were limited to UASYP with looked-after status, ensuring targeted support for the most vulnerable. Initial network meetings involved key stakeholders, including social workers, guardians, and lawyers, to assess the young person’s needs and determine appropriate interventions. Consent processes were designed to facilitate transparent communication between stakeholders and ensure ethical information-sharing. Collaborations with agencies like Aberlour, the Anchor Unit, and Freedom from Torture were integral. Data from 13 cases were analyzed to evaluate demographic trends, service engagement, and outcomes.

Results: The cohort had an average age of 17.2 years, representing countries including Afghanistan, Iran, Eritrea, and Sudan. Language barriers were notable, with Pashto, Tigrinya, and Kurdish Sorani as primary languages. Only 5% of referrals progressed to CAMHS, underscoring the selective nature of the pathway. Most referrals resulted in external partnerships, particularly with organizations like Freedom from Torture, or redirection to community resources. Guardians, managed through Aberlour in collaboration with the Anchor Unit, played a pivotal role as stable third parties, addressing the power dynamics inherent in social worker relationships.

Conclusion: This pathway highlights the value of integrating trauma-informed care with a networked, multidisciplinary approach to support UASYP. By leveraging existing frameworks and fostering agency partnerships, the initiative demonstrated the feasibility of providing culturally sensitive care tailored to the unique needs of asylum-seeking young people. Given the increasing number of UASC arrivals in the UK, further development of Tier 2 group interventions and ongoing evaluation of pathway outcomes are recommended to expand the model’s impact.

Aims: This survey aimed to evaluate the impact of the Smoke-Free Perimeter Law on the staff working in the IPCU at New Craig’s Psychiatric Hospital. It focused on understanding how the law affected staff workload, their experiences with patient care, and the overall working environment in the IPCU.

Methods: A survey was conducted involving IPCU staff members, comprising various roles with diverse experiences ranging from 2 to over 30 years in psychiatric care. The survey included questions about changes in workload, patient behaviour, staff stress levels, and challenges faced due to the law. Open-ended questions allowed staff to provide detailed feedback and suggestions for improvement.

Results:

Workload and Staff Experiences:

All nine respondents reported a significant increase in workload, primarily due to the additional responsibilities related to managing smoking breaks for patients.

Staff observed notable changes in patient behaviour, including increased physical and verbal aggression, less tolerance, and more frequent aggressive outbursts.

Many patients who were restricted from off-ward smoking breaks exhibited increased irritability and agitation.

Challenges and Environmental Impact:

Managing patient distress and aggression became more challenging, especially when unable to facilitate timely off-ward smoking breaks.

Designated times for escorted smoking breaks led to inconvenience and heightened patient emotions, often resulting in aggression.

The inability to use the courtyard for smoking negatively impacted the ward environment, leading to increased stress and confrontations.

Staff Opinions and Feedback:

Some staff expressed support for a smoke-free hospital but acknowledged the challenges for detained patients.

Concerns were raised about the fairness of enforcing a smoking ban on involuntary patients.

The previous practice of using the courtyard for smoking was seen as beneficial for calming patients and maintaining a closer staff presence.

Training and support needs were mixed, with some staff requesting more support to manage patient aggression and distress.

Conclusion: The survey findings illustrate the significant impact of the Smoke-Free Perimeter Law on staff at the IPCU. The increased workload, heightened stress levels, and challenges in patient management highlight the practical difficulties in implementing this policy in a psychiatric setting. Staff feedback underscores the need for supportive measures and potential adjustments to the law’s implementation, ensuring it accommodates the unique needs of both patients and staff. Balancing the implementation of public health policy with the immediate needs of psychiatric patients and staff remains a complex, yet crucial, endeavour in ensuring effective and compassionate psychiatric care.

Aims: Comorbid attention deficit hyperactivity disorder (ADHD) and psychosis present significant challenges in Early Intervention in Psychosis (EIP) services. This study examined the prevalence, diagnostic patterns, and treatment challenges of this comorbidity within EIP teams in Halton and Warrington, UK.

Methods: A cross-sectional analysis of the current EIP caseload (N=180) was conducted, focusing on patients with suspected or diagnosed ADHD. Data on ADHD diagnosis, treatment status, antipsychotic medication use, and patient-reported outcomes were collected and analysed.

Results: Of the 180 EIP patients, 35 (19.4%) had suspected or diagnosed ADHD. Among these, 16 (45.7%) had a confirmed ADHD diagnosis, with only 8 (50%) receiving targeted ADHD treatment. No statistically significant differences were found in subjective quality of life or treatment satisfaction scores between patients receiving ADHD treatment and those not on treatment. The proportion of patients prescribed antipsychotic medication was similar between those on ADHD treatment (87.5%) and those not on ADHD treatment (88.9%).

Conclusion: This study reveals a high prevalence of comorbid ADHD in EIP services and significant gaps in diagnosis and treatment. The findings highlight the need for improved screening, integrated care pathways, and personalised treatment approaches for managing comorbid ADHD and psychosis. Future research should focus on developing evidence-based guidelines and exploring the impact of comprehensive intervention strategies on patient outcomes.

Aims: To analyse the in-hours emergency/crisis caseload trends of the King’s College Hospital (KCH) CAMHS Paediatric Liaison Service from November 2018 to December 2024, focusing on the impact of the COVID-19 pandemic and the subsequent recovery. The study aims to identify patterns in service demand and contextualise these trends with key pandemic milestones.

Methods: Monthly caseload data for in-hours referrals were collected and analysed over a six-year period from November 2018 to December 2024. The data were examined in relation to key events, such as lockdowns, school closures, and reopening phases, to explore potential influences on caseload trends. Median monthly caseloads were calculated, and patterns were compared across different stages of the COVID-19 pandemic and its aftermath.

Results: In the pre-COVID phase, monthly caseloads were stable, with a median in-hours emergency referrals of 30. During the COVID phase, caseloads dropped sharply during the first lockdown in March 2020, likely due to school closures and disruptions to referral pathways. Attendance began to recover during the partial reopening of schools in June 2020 but fluctuated with subsequent lockdowns. In the post-COVID recovery phase, caseloads steadily increased but appeared to return to pre-pandemic baselines by 2024. These findings demonstrate a clear relationship between school closures and reduced referrals during COVID lockdowns, as national lockdowns without school closures contributed to higher A&E attendance. This emphasises the critical role of schools in facilitating access to mental health services.

Conclusion: This study highlights the significant impact of the COVID-19 pandemic on CAMHS service demand and the resilience of paediatric liaison teams in adapting to fluctuating caseloads. The findings underscore the critical role of schools in identifying and referring young people for mental health support and emphasise the importance of collaborative planning between healthcare and education sectors to prepare for future crises.

Aims: This study examines the level of medical input for physical conditions provided to older age psychiatry patients compared with general adult ward patients. The assessment focuses on the frequency of medical reviews, the reasons for these reviews (e.g. falls, infections, heart failure), and National Early Warning Score (NEWS) escalations. The aim was to identify disparities in medical involvement and determine whether increased staffing is necessary in older age psychiatry wards.

Methods: The study included patients from an old age psychiatry ward (aged 65 and above) and a general adult ward (aged 18–64) over a one-month period. Data were collected from medical continuation sheets, patient records, and NEWS score documentation. Key variables included the number of medical reviews, reasons for these reviews, and the frequency of NEWS score escalations (≥5). A total of 46 patients were included in this study. Comparative statistical analysis was conducted to quantify medical input disparities between the two wards.

Results: The analysis revealed significant differences in medical input between the two wards. The mean age of patients in the old age psychiatry ward was 73.2 years, compared with 35.1 years in the general adult ward. Older patients required substantially more medical reviews, with a mean of 5.05 per patient per month, whereas younger adults had a mean of 0.91 review per patient (a significant difference, P<0.0001). The most common indications for medical reviews in older adults included falls, infections, heart failure, and respiratory distress. In contrast, younger adults primarily presented with milder complaints such as gastrointestinal issues and minor injuries. NEWS score escalations (≥5) occurred in 9% of older patients, compared with none in the younger cohort. Additionally, 21.7% of older patients required emergency department visits, significantly higher than the 4.3% observed in the general adult ward.

Conclusion: This study confirms a significantly higher requirement for medical input for older age psychiatry patients compared with general adult ward patients. It is recommended that additional medical staffing provision is considered in old age psychiatry wards. Additionally, regular training on NEWS escalation management and interdisciplinary collaboration between psychiatry and medical teams may improve patient outcomes.

Aims: Adolescents with eating disorders often require intensive inpatient care, and pharmacotherapy, including olanzapine, has been proposed as an adjunct to support weight restoration and reduce psychological symptoms such as food-related anxiety. However, evidence on olanzapine’s effectiveness in real-world adolescent settings remains limited. Ty Llidiard is the only inpatient general adolescent unit covering the whole of South Wales. The aim of this project is to evaluate whether Ty Llidiard provides effective medical care for its patients with eating disorders. The primary aim is evaluating weight restoration achieved as well as overall improvement in functioning. The secondary aim is evaluating whether the use of olanzapine is effective in achieving the primary aim.

Methods: A retrospective evaluation was conducted on all adolescents admitted to Ty Llidiard unit between May 2018 and December 2023 with a primary diagnosis of an eating disorder. Data collected included demographic information, length of stay, changes in %mBMI, and functional outcomes as measured by the Children’s Global Assessment Scale (CGAS). Comparisons were made between patients receiving olanzapine and those managed without pharmacotherapy. Data anonymization protocols ensured confidentiality. All patients admitted to the unit over the study period were included which eliminates selection bias.

Results: The cohort comprised 93 patients. The average length of stay was 105 days, during which patients achieved a mean weekly weight gain of 1% mBMI (approximately 0.5 kg per week) and an overall increase in %mBMI of 13.1%. Functional improvements were observed, with CGAS scores increasing from admission to discharge with an overall increase of 18.9 points. However, no significant differences in weight restoration or CGAS improvements were found between the olanzapine and non-pharmacotherapy groups. This result was no different when the analysis was limited to detained patients (marker of severity) or included those with any diagnosis of ED (not just as a primary diagnosis). There was more use of MHA in more unwell patients.

Conclusion: Ty Llidiard unit demonstrated effective treatment for weight restoration and functional improvement in adolescents with eating disorders. Evidence from RCTs and meta-analyses on olanzapine use in adolescents with eating disorders presents mixed findings. However, the findings from Ty Llidiard indicate that olanzapine does not provide additional benefits for these outcomes. These results challenge the routine use of pharmacotherapy in high-acuity inpatient settings and underscore the need for further research into the role of olanzapine in adolescent eating disorder treatment. This provides real-world generalisable information, especially for clinicians working in specialist inpatient services.

Aims: Manual and mechanical restraint are restrictive practices that are applied as a last resort in a high secure psychiatric setting in order to manage risk to self, others and to deliver safe care. These interventions can have inherent risks to the physical and mental health of patients and staff. Previous studies have shown a discrepancy in the way patients from different ethnic backgrounds can experience restrictive practice in mental health care settings. This service evaluation aims to understand whether a patient’s ethnicity has an influence on the use of manual and mechanical restraint at Broadmoor High Secure Hospital by considering restraint variables alongside demographic and risk factors.

Methods: This quantitative study involved the retrospective data collection of all manual and mechanical restraints in the hospital between April 2023 to April 2024. Manual restraints included 63 patients and 354 incidents. Mechanical restraints included 12 patients and 70 incidents.

Demographic variables included patient ethnicity, length of admission, index offence and psychiatric diagnosis. Restraint variables included frequency, duration, type, reason for restraint and target of the incident.

Results: Inferential analysis showed no statistical difference between the ethnic distribution of the manually restrained patient population and the ethnic distribution of the whole hospital patient population.

Descriptive analysis found varied distributions of restrictive practices across ethnic groups. Further inferential statistics revealed a significant difference between ethnic groups for manual restraints due to self-harm. Correlational analysis revealed a significant positive relationship between length of admission and frequency of manual restraints across a one-year period.

Conclusion: This service evaluation explored the use of restraint practices among patients of differing ethnicities within Broadmoor High Secure Hospital, enabling clinical and research recommendations to be made. This project highlighted varied distributions in relation to how different ethnic groups experience manual and mechanical restraint. Future projects should include a dataset spanning over a larger number of years to enable more robust conclusions to be drawn on whether there are ethnic disparities in restrictive practices. Future projects should also involve qualitative data from patients and staff to better understand the complexities surrounding the treatment of differing ethnicities within mental health care settings. The authors of this service evaluation have already planned to look at the use of short term seclusion and long term segregation among differing patient ethnic groups within Broadmoor High Secure Hospital, to further understand this critical issue.

Aims: Individuals with severe mental illness (SMI) are at significantly higher risk of physical health comorbidities compared with the general population. Factors such as long-term antipsychotic use, lifestyle choices, and reduced healthcare engagement contribute to this increased risk. Comprehensive annual physical health checks are recommended to identify and manage these risks. This study aimed to evaluate and improve the process of conducting annual physical health checks for patients with SMI in a Glasgow psychiatric rehabilitation unit, focusing on identifying risk factors, promoting a multidisciplinary team (MDT) approach, and ensuring timely follow-up of outstanding health concerns.

Methods: National guidelines from the National Institute for Health and Care Excellence (NICE), the National Institute for Health and Care Research (NIHR), and NHS Scotland were reviewed to establish key standards for physical health monitoring in psychiatric rehabilitation. A structured audit tool was developed covering systemic and lifestyle reviews, physical examinations, medication monitoring, external specialty input and general health screening. Annual health reports and clinical notes were retrospectively reviewed for 30 inpatients with a minimum one-year admission between November 2023 and October 2024. Based on audit findings, a new structured health check template and an improved MDT handover protocol were implemented before re-auditing their next review.

Results: Twenty-eight patients agreed to be reviewed, with 25 assessed using the old template and 15 so far with the new template. The proportion of patients receiving their health check within 12 months increased from 28% (7/25) to 73.3% (11/15). Physical examinations were documented in 96% (24/25) of previous reviews, with action-oriented comments in 40% (10/25). Following the introduction of the new template, documentation increased to 100%, with 53.3% (8/15) of cases including actionable comments. Systemic enquiry documentation improved from 92% (23/25) to 100%, with action-orientated comments rising from 36% (9/25) to 73.3% (11/15). Health screening documentation improved from 60% (15/25) to 100%, with 60% (9/15) requiring action. Diabetes risk was previously recorded in only 8% (2/25) of cases but increased to 100%, with 75% (10/15) prompting action. Previously, 60% (15/25) of outstanding health concerns were discussed within the MDT, whereas 86.6% (13/15) were formally addressed post-implementation.

Conclusion: This study highlights the effectiveness of a structured template in improving the quality and consistency of annual physical health checks in psychiatric rehabilitation. The new template enhanced documentation, facilitated multidisciplinary discussions, and improved identification of health risks. Strengthening MDT handover processes ensures timely follow-up, reinforcing the importance of structured, standardised approaches in psychiatric physical healthcare.

Aims: Antipsychotic medications are associated with metabolic syndrome and increased cardiovascular risk. Monitoring the physical health of patients receiving these medications is a key part of delivering safe and effective care.

Since 2020, audit cycles in the North-West Edinburgh Community Mental Health Team (NWCMHT) have found this monitoring to be consistently poor.

An experienced nurse was appointed lead of a new physical health clinic and it was incorporated into timetables of junior doctors to facilitate liaison with primary care. This weekly clinic was established in NWCMHT in 2023 focusing on those prescribed depot antipsychotic medication and clozapine.

We aim to assess the impact of this service development on patient care.

Methods: Scottish Intercollegiate Guidelines Network publication 131 was used as the gold standard, which cites 9 domains to monitor annually – past medical history (PMH), family history (FH), smoking history, BMI (or weight or waist circumference), blood pressure (BP), HbA1c, lipids, prolactin and ECG.

Data was collected for these domains for patients prescribed and administered depot antipsychotic medication or clozapine in the NWCMHT for the calendar year of 2024. Data was collected from the local computerised clinical notes system (TRAK) and anonymised in line with NHS Information Governance Policy.

Results: 163 patients were prescribed depot antipsychotic medication or clozapine by the NWCMHT in 2024. 58% (n=95) of these patients were offered an appointment at the physical health clinic, with 37% attending (n=60).

Across all domains, monitoring of those who attended clinic was better than those who did not – PMH (97% vs 48%), FH (95% vs 36%), Smoking (95% vs 44%), BMI (87% vs 28%), BP (97% vs 69%), HBA1c (82% vs 55%), lipids (74% vs 49%), prolactin (51% vs 35%) and ECG (85% vs 36%).

Of all 163 patients, the average completed monitoring across all nine domains was 60% in 2024. The average across all domains before the clinic was established was 30%.

Conclusion: There has been a significant improvement in monitoring in this patient group since the clinic was established in 2023. Patients who attend this clinic are monitored more effectively.

However, there are opportunities for further improvement. This would include identifying barriers that arise in achieving 100% across all domains in attendees and assessing factors that impede attendance at the clinic.

These results support plans to expand the clinic to ensure that the physical health of this patient group is appropriately monitored to achieve safe and effective care.

Aims: To reduce the waiting list, senior Psychologists and Psychotherapists started undertaking ADHD assessment as well as Psychiatrists in a CAMHS Outpatient Clinic. The aim of this Service Evaluation was to see if there was any difference regarding who performed the initial assessment and the management offered.

Methods: New assessment letters were reviewed from February–November 2024.

Data was collected including demographics, type of clinician, diagnosis and management.

Categorical data was assessed for statistical significance using Chi-square tests and numerical data using ANOVA.

The data was presented to the MDT to think about clinical significance.

Results: 103 patients were assessed with an average age of 11.7. Fifty-four were seen by a Psychiatrist, 39 were seen by a Psychotherapist and 10 were seen by a Psychologist. 25 of these patients required a follow-up with a Psychiatrist.

28 of the patients had a previous diagnosis of ADHD and therefore were required to be seen by a Psychiatrist. Of these patients, 26 retained their diagnosis at the point of initial assessment.

Of the children that had not been previously diagnosed with ADHD, 72% were given a new diagnosis of ADHD at initial assessment. After accounting for previously diagnosed patients, there was no statistical significance in number diagnosed by the different types of clinicians. There was no statistically significant difference between the management options offered and the type of clinician assessing.

Conclusion: Since this change, the service was able to nearly double the number of young people seen. This is a vital step as the number of referrals for the service has also increased over this time.

It was felt that there was a consistent approach across the service as there was found to be no statistically significant difference in either diagnosis given or management options offered by clinician types, after accounting for prior diagnosis. This allows some confidence that patients get the same, unbiased approach, regardless of clinician type.

Psychiatrists had a follow-up appointment with about half of the patients assessed by other clinicians. The follow-up takes less clinical time compared with the new assessment, however, this must be considered in the planning of a service.

Once a child has been diagnosed it is crucial that they are able to be offered the necessary services (Family Therapy, Psychology, Psychotherapy, Medication reviews) in a timely manner. Services must ensure a good balance between new assessments and looking after those post diagnosis.

Aims: It was intended to explore the change in nonattendance rate at outpatient clinics following the introduction of Short Message Service (SMS) reminders in the Black Country Healthcare NHS Foundation Trust, which serves four regions in the West Midlands.

Methods: The Trust introduced an SMS system in March 2024 to prompt the patients about their upcoming outpatient appointments. In a mirror-image design, we analysed the Did Not Attend (DNA) rates for 6 months pre and post-SMS introduction, from September 2023 to February 2024 and April 2024 to September 2024 respectively. All the patients offered an outpatient appointment were included in the data collection; with no exclusion. The study was approved by the Research and Innovation team of the Trust as a service evaluation.

Results: A total of 14094 appointments were taken into consideration before the introduction of SMS reminders, and a total of 14852 appointments were analysed post-SMS introduction. Before the introduction of SMS reminders, the average DNA rate across all four regions of the Trust was 22.8% (95% CI: 22.2–23.5) with a range of 19.9–24.8 in the six months. After the introduction of SMS reminders, the average DNA rate changed to 23.2% (95% CI: 22.5–23.8) with a range of 21.3–25.1 in the six months; and this change was statistically non-significant (NS). Two regions had an increase of DNA (21.1% to 21.9%, NS; and 20.7% to 24.7%, p<0.05) and others had a decrease (25.2% to 23.1%, p<0.05; and 24.7% to 23.6%, NS).

Conclusion: It appeared that within six months of the introduction of the SMS reminder system, there was no significant change in the DNA rates in the Trust; although there were regional variations of both increase and decrease in rates. There are multiple factors that can influence attendance at outpatient clinics such as accessibility, patient-related factors, and the effectiveness of a reminder system. It is also probable that the first six months may be early for the SMS system to establish its potential, and longer-term observational data might be needed. Similarly, the difference in DNA rates between regions cannot be explained without more in-depth data. There was a limitation in finding out whether all the patients were sent or received the reminders. There may be a scope to decrease the number of missed appointments through SMS, but further studies are required. In addition, the effectiveness of local processes of inviting patients and sending reminders needs to be checked.

Aims: One of the aims of this project was to look at changes in working patterns within our local Eating Disorder service over time, paying particular attention to changes in rates of accepted referrals, and rates of inpatient admissions during and after the COVID-19 pandemic. A secondary aim was to look at rates of co-morbidity in the local Eating Disorder Population and compare this to the general population of a similar age group. In order to do this, findings for the general population were extrapolated from the Youth Wellbeing Prevalence Study Northern Ireland (YWPS).

Methods: Data on accepted referrals was extracted from a locally used electronic systemic LCID which came into use in 2018 in Northern Trust CAMHS. Additional information regarding admissions and co-morbidities were obtained using another electronic system widely used in Northern Ireland, NIECR. Data included referrals accepted between October 2017 and September 2024, and excluded referrals made to the CAMHS Eating Disorder Service which were rejected. Information regarding admissions to Beechcroft, a regional psychiatric inpatient unit for young people under the age of 18, was obtained from medical administration in the Belfast Trust. Data was generated regarding admissions accepted specifically from our Eating Disorder Service.

Results: The admission rate (including admissions to adult medical wards) was 13.84% (35–50% UK wide). Of the 64 young people who were admitted to the paediatric ward 11% were male and 89% were female. The average length of admission to A2 was 21.13 days and the average age at the time of admission was 13.64 years old. The rate of Autism/Autistic traits in those Eating Disorder patients admitted to the paediatric ward was nearly 4.4 times greater than the population from the YWPS. Rates of anxiety were increased by more than 4 times. Rates of low mood/depression were increased by more than 11-fold.

Conclusion: The hospital admission rate within our service is significantly lower than the UK-wide admission rate for Eating Disorders. There was a sharp increase in referrals to the CAMHS Eating Disorder Service during the COVID-19 pandemic. Following the end of the COVID-19 lockdowns and easing of restrictions there has been a return to almost pre-pandemic levels in terms of referrals. Paediatric admissions and psychiatric admissions increased significantly during the COVID-19 pandemic. Rates of psychiatric admissions for eating disorders are now much lower than pre-pandemic levels. Rates of paediatric admissions for eating disorders remain elevated.

Aims: Cherry Tree Close, a mental health rehabilitation and recovery unit based in Derby, England was assessed in October 2023 to compare current standards against the quality standards outlined in the Standards for Inpatient Mental Health Rehabilitation Services 4th Edition though did not fulfil the required criteria to achieve accreditation. Since then, the service has made further developments.

This is a service evaluation study to compare the current service delivery of Cherry Tree Close, against the quality standards set out in the Standards for Inpatient Mental Health Rehabilitation Services 4th Edition document to identify progress towards achieving accredited status.

Methods: The electronic patient records of service users admitted to the ward were reviewed between November and December 2024. Service users and members of the multidisciplinary team were interviewed. A visual inspection of the unit was carried out. Relevant standard operating procedures were reviewed.

To achieve accreditation, services are required to meet 100% of type 1, 80% of type 2 and 60% of type 3 standards.

Results: For type 1 standards, 95/109 standards (87.1%) were achieved in 2024 when compared with 93/109 (85.3%) in 2023.

For type 2 standards, 39/50 standards (78.0%) were achieved in 2024 when compared with 38/50 (76.0%) in 2023.

For type 3 standards, 8/14 standards (57.1%) were achieved in 2024 when compared with 5/14 (35.7%) in 2023.

The improvement relates to development of a local community enhanced rehabilitation service and expansion of the multidisciplinary professionals including recruitment of team psychologists, assistant psychologists, and resident doctor in training.

The remaining unmet standards relate to the infrastructure of the unit, care pathways, staff training, supervision, wellbeing, and service management.

Conclusion: Currently, Cherry Tree Close has not fulfilled the criteria to achieve accreditation status.

Further meetings have been arranged with the transformation team to work on further developing the service towards achieving accreditation.

Aims: The Early Intervention for Psychosis (EIP) service in Derby City and Derbyshire South County provides care for individuals aged 14–65 experiencing a first episode of psychosis. Derby City (Census 2021 population: 261,400) is ethnically diverse, with White residents forming 73.8%, Asian residents 18.1% (including mixed White/Asian, and Arab), and Black residents 6.1% (including White and Black Caribbean, mixed White/Black, and African). In contrast, Derbyshire South County (Census 2021 population: 349,000) has a predominantly White population (95.2%), with Asian residents at 2.8%, Black residents at 1.4%, and other ethnic groups at 0.5%.

Aim was to ascertain the ethnic profile of patients discharged from the EIP service in Derby City and Derbyshire South County, comparing these findings with respective census data.

Methods: All patients discharged from the EIP service between 1 April 2023 and 1 April 2024, who were under the service for more than 3 months and typically not more than 3 years, were included. Data on ethnicity was retrospectively collected from clinical records, recorded in an Excel spreadsheet, and analysed to identify disparities compared with census demographics.

Results: In Derby City, White patients were under-represented at 60.87% compared with 73.8% in the census. Asian patients were over-represented at 21.74% versus 18.1%, and Black patients accounted for 17.39% of discharges compared with 6.1%. Other ethnic groups were absent (0%) compared with 2.0% in the census.

In Derbyshire South County, White patients represented 61.36% of discharges, lower than 95.2% in the census. Asian patients were over-represented at 27.27% compared with 2.8%, and Black patients at 11.36% versus 1.4%. No representation was observed from other ethnic groups, despite a 0.5% census presence.

Conclusion: The study highlights disparities in the ethnic profile of discharged EIP patients. Asian and Black populations were consistently over-represented, while White populations were under-represented, especially in Derbyshire South County. The absence of other ethnic groups raises concerns about service access. Further investigation is needed to explore factors such as socio-economic influences, cultural perceptions of mental health, referral pathways, and potential systemic biases.