Situational judgement test (SJT) scores have been observed to predict actual workplace performance. They are commonly used to assess non-academic attributes as part of selection into many healthcare roles. However, no validated SJT yet exists for recruiting into mental health services.

To develop and validate an SJT that can evaluate procedural knowledge of professionalism in applicants to clinical roles in mental health services.

SJT item content was generated through interviews and focus groups with 56 professionals, patients and carers related to a large National Health Service mental health trust in England. These subject matter experts informed the content of the final items for the SJT. The SJT was completed by 73 registered nurses and 36 allied health professionals (AHPs). The primary outcome measure was supervisor ratings of professionalism and effectiveness on a relative percentile rating scale and was present for 69 of the participating nurses and AHPs. Personality assessment scores were reported as a secondary outcome.

SJT scores statistically significantly predicted ratings of professionalism (β = 0.31, P = 0.01) and effectiveness (β = 0.32, P = 0.01). The scores demonstrated statistically significant incremental predictive validity over the personality assessment scores for predicting supervisor ratings of professionalism (β = 0.26, P = 0.03).

These findings demonstrate that a carefully designed SJT can validly assess important personal attributes in clinicians working in mental health services. Such assessments are likely to represent evidence based, cost-effective tools that can support values-based recruitment to mental health service roles.

The association between perceived ethnic discrimination (PED) and mental health conditions is well studied. However, less is known about the association between PED and suicidal ideation, or the role of positive psychosocial factors in this association.

To examine the association between PED and suicidal ideation among ethnic minority groups in Amsterdam, The Netherlands, and investigate whether ethnicity and mastery (people's extent of feeling in control of their lives and environment) moderate this association.

Cross-sectional data from the multi-ethnic HELIUS study were analysed (n = 17 053) for participants of South-Asian Surinamese, African Surinamese, Ghanaian, Turkish and Moroccan origin. PED was measured using the Everyday Discrimination Scale, suicidal ideation using item 9 of the Patient Health Questionnaire-9 and mastery using the Pearlin–Schooler Mastery Scale.

Logistic regression analyses demonstrated a small positive association between PED and suicidal ideation (OR = 1.068, 95% CI 1.059–1.077), which did not differ among ethnic minority groups. Mastery did not moderate the association between PED and suicidal ideation among the ethnic minority groups.

Our findings support the hypothesis that PED is associated with suicidal ideation and this association does not significantly vary between ethnic minority groups. Although higher levels of mastery were associated with lower suicidal ideation, mastery did not moderate the relationship between PED and suicidal ideation. Besides targeting ethnic discrimination as a societal problem, future longitudinal research is needed to investigate whether interventions aimed at improving mastery could reduce suicidal ideation in ethnic minority groups.

The COVID-19 pandemic has presented a challenge for treating people with OCD and it could be postulated that those with OCD fearing contamination might be more affected in current circumstances. Although there have been some studies already published, results have been heterogeneous and conflicting; possibly because of different populations or geographical locations examined.

In this preliminary study we aim to identify the impact of the pandemic on the severity of OCD, as measured by Y-BOCS scores. To our knowledge, it is the first UK study of this kind and the only study that examines change in Y-BOCS scores over such a long time period.

Patients were identified from national OCD unit referral databases at Springfield Hospital. Referrals from March 2019–March 2020 were examined and patients included if they had a diagnosis of OCD, were accepted by the service following initial assessment and sufficient data were available. This preliminary study focused only on Y-BOCS to assess clinician-rated severity of OCD. Y-BOCS scores were compared from different time periods correlating to the progression of COVID-19. ‘Pre-pandemic’ score was taken from Jan–Dec 2019 or, if not available, from Jan–23 March 2020 (prior to UK lockdown). ‘Pandemic’ score was taken as the most recent rating from April 2020 onwards.

21 patients were included. All treated as outpatients (although 9 had undergone previous inpatient treatment during the time period above). 81% showed improvement in Y-BOCS score between pre-pandemic and pandemic time periods, with an overall mean decrease in Y-BOCS of 10.3.

Overall, this study indicates that severity of OCD decreased during the pandemic compared to pre-pandemic. It may be that patients found it easier to access remote appointments, or perhaps the pandemic environment of being encouraged to stay at home and limiting unnecessary contact may have allowed limited opportunity for exposure. It might be that the pandemic provided a reason for patients to be avoidant of potential contamination thereby leading to a perceived rather than real improvement in Y-BOCS scores.

Identification of specific contributing factors is beyond the scope of this preliminary study, however it will be important to conduct further research with a larger sample size that incorporates post-lockdown and post-pandemic scores to ascertain whether trends seen here are in fact maintained when normal social contact resumes.

Increased rates of visual impairment are observed in people with schizophrenia.

We assessed whether genetically predicted poor distance acuity is causally associated with schizophrenia, and whether genetically predicted schizophrenia is causally associated with poorer visual acuity.

We used bidirectional, two-sample Mendelian randomisation to assess the effect of poor distance acuity on schizophrenia risk, poorer visual acuity on schizophrenia risk and schizophrenia on visual acuity, in European and East Asian ancestry samples ranging from approximately 14 000 to 500 000 participants. Genetic instrumental variables were obtained from the largest available summary statistics: for schizophrenia, from the Psychiatric Genomics Consortium; for visual acuity, from the UK Biobank; and for poor distance acuity, from a meta-analysis of case–control samples. We used the inverse variance-weighted method and sensitivity analyses to test validity of results.

We found little evidence that poor distance acuity was causally associated with schizophrenia (odds ratio 1.00, 95% CI 0.91–1.10). Genetically predicted schizophrenia was associated with poorer visual acuity (mean difference in logMAR score: 0.024, 95% CI 0.014–0.033) in European ancestry samples, with a similar but less precise effect that in smaller East Asian ancestry samples (mean difference: 0.186, 95% CI –0.008 to 0.379).

Genetic evidence supports schizophrenia being a causal risk factor for poorer visual acuity, but not the converse. This highlights the importance of visual care for people with psychosis and refutes previous hypotheses that visual impairment is a potential target for prevention of schizophrenia.

The adverse effects of COVID-19 and the associated restrictions on eating disorder populations have been discussed in recent literature. However, little is known about the presentation of cases with avoidant/restrictive food intake disorder (ARFID) during this period.

To explore the extent of the literature on the presentation of ARFID, and ARFID-like cases, during the COVID-19 pandemic.

Cochrane Library, CINAHL (EBSCO), PsycINFO (EBSCO), EMBASE (Ovid) and Medline (Ovid) were searched for publications between March 2020 and May 2023. Google Scholar and reference lists were hand searched. At least two reviewers independently screened each paper. Narrative synthesis was used.

Seven papers were included: four case reports and three cohort studies (total ARFID sample of 46). Included papers were assessed as having high (n = 3) or moderate (n = 4) quality. Findings did not suggest an increase in ARFID cases during the COVID-19 pandemic, although it is unclear if this is because of a lack of impact or underrecognition of ARFID. A need for a multidisciplinary approach to differentiate between ARFID and organic causes of ARFID-like presentations (e.g. gastrointestinal effects of COVID-19) was highlighted.

Publications specifically pertaining to ARFID presentations during the COVID-19 pandemic have been few. Papers found have been of small sample sizes and lack subanalyses for ARFID within broader eating disorder samples. Continued surveillance is needed to evaluate any COVID-19-specific effects on the development, identification, treatment and outcomes of ARFID.

In the UK 17.8 million people have musculoskeletal pathophysiology, which becomes universal with age. Levels of discomfort and incapability correlate with symptoms of anxiety and depression. People with sufficient symptoms who seek care can benefit from collaborative diagnosis and treatment of mental and physical health organised by a case manager. This paper presents the protocol for a feasibility trial of collaborative care in an orthopaedic setting.

To determine the feasibility and acceptability of providing collaborative care for patients with musculoskeletal conditions and co-existing symptoms of anxiety and depression identified on a screening tool in a physical and occupational therapy out-patient setting.

A two-arm parallel-group randomised controlled trial will recruit 40 adult out-patients with at least moderate anxiety and depression, who have been referred for physiotherapy and occupational therapy. Participants will be allocated on a 1:1 ratio to collaborative care or to usual care. Co-primary outcomes will be key feasibility indicators collected at baseline and at 6 months. A qualitative study will be conducted post-intervention to explore the acceptability and potential improvements to the collaborative care model.

This study will investigate the use of the collaborative care model for patients with musculoskeletal and co-existing moderate or severe levels of anxiety or depression.

The results will provide important evidence to determine a future trial.

Rates of self-harm among children and young people (CYP) have been on the rise, presenting major public health concerns in Australia and worldwide. However, there is a scarcity of evidence relating to self-harm among CYP from culturally and linguistically diverse (CALD) backgrounds.

To analyse the relationship between self-harm-related mental health presentations of CYP to emergency departments and CALD status in South Western Sydney (SWS), Australia.

We analysed electronic medical records of mental health-related emergency department presentations by CYP aged between 10 and up to 18 years in six public hospitals in the SWS region from January 2016 to March 2022. A multilevel logistic regression model was used on these data to assess the association between self-harm-related presentations and CALD status while adjusting for covariates and individual-level clustering.

Self-harm accounted for 2457 (31.5%) of the 7789 mental health-related emergency department presentations by CYP; CYP from a CALD background accounted for only 8% (n = 198) of the self-harm-related presentations. CYP from the lowest two most socioeconomic disadvantaged areas made 63% (n = 1544) of the total self-harm-related presentations. Findings of the regression models showed that CYP from a CALD background (compared with those from non-CALD backgrounds) had 19% lower odds of self-harm (adjusted odds ratio 0.81, 95% CI 0.66–0.99).

Findings of this study provide insights into the self-harm-related mental health presentations and other critical clinical features related to CYP from CALD backgrounds that could better inform health service planning and policy to manage self-harm presentations and mental health problems among CYP.

Benzodiazepine receptor agonists (BZRAs) are commonly used clinically and data on their hazardous use from large populations of psychiatric patients is limited.

To assess the current status of hazardous BZRA use and related factors in Chinese out-patient psychiatric settings.

The study included out-patients with at least one BZRA prescription from five psychiatric settings in east, central and west China in 2018. Demographic and prescription information were extracted from the electronic prescription database. We defined the co-occurrence of overdose and long-term use as hazardous use, and patients whose recorded diagnoses did not meet any indications approved by the Chinese Food and Drug Administration as over-indication users. Additionally, 200 hazardous users were randomly selected for follow-up interview to confirm the actual situation.

Among 720 054 out-patients, 164 450 (22.8%) had at least one BZRA prescription; 55.9% of patients were prescribed over-indication and 3% were defined as hazardous users. Multilevel multivariate regression analysis with hospital as a random effect showed that factors associated with hazardous use were older age (18–64 years: β = 0.018; 95% CI 0.013–0.023; >65 years: β = 0.015; 95% CI 0.010–0.021), male (β = 0.005, 95% CI 0.003–0.007), over-indication (β = 0.013, 95% CI 0.012–0.015), more out-patient visits (β = 0.006, 95% CI 0.006–0.006) and more visits to different doctors (β = 0.007, 95% CI 0.007–0.008); 98.5% of hazardous users (197/200) could not be contacted.

BZRAs are commonly used and there is a relatively large proportion of over-indication users among Chinese psychiatric out-patients. However, only a small proportion of hazardous users were detected. The study highlights how to use prescription data to support improvements in clinical practice.

To ensure close monitoring of physical health parameters when antipsychotics are prescribed and to liaise with primary care to ensure appropriate interventions are implemented.

Antipsychotics are the most frequently prescribed psychotropic medication for PwID. Treatment with antipsychotic agent is associated with cardio-metabolic risks such as obesity, diabetes, and dyslipidemia. A strong association is well documented between antipsychotic use and the risk of stroke in schizophrenia although the magnitude of this association has yet to be studied in PwID.

PwID have an increased risk of premature death. Cardio-metabolic monitoring and appropriate intervention to this vulnerable cohort will improve the preventable cardio-metabolic multi-morbidity. The NICE guideline (CG11) recommends antipsychotic medication should only be initially prescribed and monitored by the secondary care professionals for at least 12 months. They also should work together with primary care to ensure appropriate interventions are arranged where necessary.

A retrospective audit was performed for 40 service users, taking antipsychotic medication. Quota sampling was used to identify 10 cases each from the caseload of 4 consultant psychiatrists, within the Intellectual Disability community setting, between September 2019 and October 2019.

An audit tool was designed, in accordance with cardio-metabolic measures (smoking status, height, weight, Blood Pressure, HbA1c, Lipid profile), based on physical health CQUIN targets and the Lester adaptation tool. Collection of data was performed from electronic case records and electronic blood results service. The work was performed with the approval of local clinical audit team and analysed by using Microsoft Excel.

Baseline cardio-metabolic assessment was observed in over a half of the sample population (50–65%) whilst only less than 15% was noted at 3–6 months. Documentation Evaluation of physical health assessments for new admissions to the Oleaster during the first wave of COVID-19 on body weight and blood pressure was seen only in 15% and 2.5% of population respectively at 3–6 months. Collaboration with GP for annual health check was observed in 78–100% of population.

Intriguingly, our finding indicates a significant improvement in all required compliance when nursing team is involved.

Improving physical healthcare is essential to reduce the cardio metabolic outcome in PwID taking antipsychotic medication. Better involvement of community nurses as well as availability of Sphygmomanometers at every outpatient clinic will determine the successful implementation of cardio metabolic monitoring and effective collaboration with primary care clinicians.

Once the action plan is disseminated to the teams, the impact of change will be reassessed by a re-audit in one year's time.

Satisfaction with the medical interview has been rarely explored in primary care outside the UK, despite evidence suggesting that a trustful doctor–patient relationship is a key ingredient to facilitate treatment adherence and relief from illness-related distress.

The aims of this study are to analyse the construct validity of the Italian version of the Medical Interview Satisfaction Scale (MISS-21) and its correlations with two outcome measures, the Inventory of Depressive Symptomatology – Self-Report and World Health Organization Quality Of Life Brief Version, in patients with mild-to-moderate depression, recruited in primary care practices.

The factor structure underlying the MISS-21 was investigated with principal component analysis, and the internal consistency of the factors was evaluated with Cronbach's alpha. Network analysis was used to investigate the interrelationships among items. The importance of individual items in the network structure was determined with centrality analyses. Correlations of MISS-21 scores with changes in depression and quality of life were analysed with Spearman's correlation coefficient.

The MISS-21 proved to have a robust four-dimensional factor structure. Cronbach's alpha for the factors ranged from 0.77 to 0.93, suggesting good to excellent internal consistency. The four factors identified were positively correlated with improvement in depressive symptoms and three quality-of-life domains.

The MISS-21 has sound psychometric properties, and comprises four factors related to clinical outcomes, which makes it suitable for clinical and research applications. The central items in the network should be considered as possible targets for quality improvement interventions in primary care.

Online group therapy has gained popularity during the COVID-19 pandemic as an alternative to face-to-face group therapy. This service evaluation is aimed at assessing how this paradigm shift is received by the patients and how the quality of the provided services is assured and potentially improved.

1. We have retrospectively compared the attendance records from all psychotherapy groups in North Lanarkshire psychotherapy department between two distinct time periods: from November 2018 to January 2019 when only face-to-face groups were available (5 groups, 29 patients) and from November 2021 to January 2022 when only online groups were available (4 groups, 21 patients).

2. In order to prospectively assess patient's views regarding online group therapy, Client Satisfaction Questionnaires (CSQ-4, quantitative and qualitative) were distributed to January 2022 groups only.

1. The attendance rate was 5% lower in the face-to-face groups (76% vs 81%) while the non-attendance rate was lower by 1% in the online groups (9% vs 8%). The cancellation rate was also smaller by 5% in the online groups (14% to 9%).

2. In regard to the service satisfaction rates in the online groups, 57% of patients who responded, answered that “most of their needs have been met by the online services’’, 71% answered “services helped with their problems somewhat’’, 71% answered “they think they would come back to the program again and 66% answered” they are mostly satisfied with the services received.“The predominant positive aspects of the services according to free text comments were” “communication, understanding, sense of community’’ and the negative aspects that need improvement: “return to face-to-face (71% of answers), need personal interaction’’.*

* We have extended the deadline for the acceptance of the responses to 20th of February 2022 due to mailing systems being slowed down by the pandemic. (7 out of 21 questionnaires have been returned)

Overall the attendance rates between the online and face-to-face group therapy exhibit minor differences. Concerning the patient satisfaction rates they reveal that the majority of patients who receive group therapy online are above-average satisfied with the services, feel that the online therapy provides a sense community but would prefer to return to face-to-face therapy.

Further data and studies will be needed to reach more robust conclusions.

The aims of our study were to assess and to examine i. the psychological impact of the COVID-19 pandemic on medical residents working on the front and second line, ii. the association between coping strategies, resilience and optimism and different mental health outcomes like stress, anxiety, and depression among the medical residents’ workers during the COVID-19 pandemic, and iii. the coping strategies used on the same sample with consideration of different factors like seniority, frontliner, gender and coping style.

An electronic survey was sent to all medical residents in Qatar. Depression, anxiety and stress were assessed by the Depression, Anxiety and Stress Scale – 21 Items. Professional quality of life was measured by the Professional Quality of Life measure. The coping mechanisms were assessed with the Brief-COPE, resilience by the Brief Resilience Scale, and optimism by the Revised Life Orientation Test (LOT-R).

Of the 640 medical residents contacted, 127 (20%) responded. A considerable proportion of residents reported symptoms of depression (42.5%), anxiety (41.7%) and stress (30.7%). Multivariate analysis of variance showed significant effects of seniority in residency, with junior residents having poorer outcomes. In addition, there was a statistically significant interaction effect with moderate effect sizes between gender and working on the front line, as well as gender, working on the front line and seniority, on mental health outcomes. The most commonly used coping strategies were acceptance, religion, and active coping. The least reported coping strategies were substance use and denial. Avoidant coping style scores were higher among junior residents (p = .032) and non-COVID-19 frontliners (p = .039). Optimism LOT-R score was higher in senior than in junior residents (p < .001). Another important finding is that optimism and resilience were associated with better mental health outcomes. In addition, we find that avoidant coping style is highly associated with depression.

The COVID-19 pandemic may have a negative impact on junior residents’ mental health. Preventive measures to reduce stress levels and easy access to professional mental health services are crucial. This study also raises awareness among residency programs on the psychological and coping responses and strategies of medical residents.

Opioid dependence has high risks. Opioid substitution treatment (OST) improves outcomes. Addiction specialist prescribers prescribe OST and monitor safety, but nonattendance may lead to worse outcomes. Telemedicine can reduce travel and improve attendance at appointments. Before COVID-19, we started a telemedicine in addictions trial to see if this helped in addictions. We present the qualitative patient and staff experience results.

Health Research Authority approval for randomized controlled feasibility trial of Telemedicine versus Face-to-Face (control) consultations at community addictions semirural service (2500km2) using a modified Hub-and-Spoke (outreach) model. Adult opioid dependent patients prescribed OST and attending outreach were recruited. Participants received two appointments in randomized group. Telemedicine was delivered using Skype-for-business videoconferencing. Patients attended outreach, saw keyworker for drug testing first, and telemedicine conducted via keyworker's laptop. Addiction prescribers located remotely at Hub. Post-trial research interview conducted assessing patient and staff experience of Telemedicine versus Face-to-Face consultations. Data transcribed, inputted to RedCap Cloud and free-text analysed using qualitative thematic analysis.

Of fifty-nine patient participants, 58 completed a research interview. Patient participants reported similar levels of satisfaction between the Telemedicine and Face to Face groups. The themes generated in relation to Face-to-Face were no difference, easy, kind staff and liking being part of research. For Telemedicine, themes were less travel, good experience, easier to access, good communication, saves time and saves money. For instance, one patient stated ‘Clear, easy to access less travel’ and another patient stated ‘I struggle with travel. I found it easier’. Of 19 staff participant research interviews completed, Staff reported Good or Very Good experience with telemedicine which was equivalent for Face-to-Face consultations. Eleven staff had experience of telemedicine consultations during the trial. They reported similar themes to patients with telemedicine leading to less travel, beneficial to patient care, improves attendance and was innovative technology. One staff member reported satisfaction with telemedicine due to ‘Time, travel and money reduction’. When questioned on the downsides to telemedicine, technological issues were mainly related to connection issues and sound issues.

In the first known RCT of Telemedicine versus Face-to-Face consultations for patients with opioid dependence attending prescriber review, we found that both patients and staff were satisfied with telemedicine as compared to face-to-face consultations. Overall themes were reduced travel, saving time and more convenience. This will be very important given the impact of COVID-19 on access to addictions services.

Financial Sponsorship

East Riding CCG

Academic Health Science Network

Watching videotaped personal compulsions together with a therapist might enhance the effect of cognitive–behavioural therapy in obsessive–compulsive disorder (OCD) but little is known about how patients experience this.

To performed a qualitative study that describes how watching these videos influences motivation for treatment and whether patients report any adverse events.

In this qualitative study, data were gathered in semi-structured interviews with 24 patients with OCD. The transcripts were coded by two researchers. They used a combination of open and thematic coding and discrepancies in coding were discussed.

The experience of watching videos with personal compulsions helped patients to realise that these compulsions are aberrant and irrational. Patients report increased motivation to resist their OCD and to adhere to therapy. No adverse events were reported.

Videos with personal compulsions create more awareness in patients with OCD that compulsions are irrational, leading to enhanced motivation for treatment.

None.

Risk assessment instruments have become a preferred means for predicting future aggression, claiming to predict long-term aggression risk.

To investigate the predictive value over 12 months and 4 years of two commonly applied instruments (Historical, Clinical and Risk Management - 20 (HCR-20) and Violence Risk Appraisal Guide (VRAG)).

Participants were adult male psychiatric patients detained in a high secure hospital. All had a diagnosis of personality disorder. The focus was on aggression in hospital.

The actuarial risk assessment (VRAG) was generally performing better than the structured risk assessment (HCR-20), although neither approach performed particularly well overall. Any value in their predictive potential appeared focused on the longer time period under study (4 years) and was specific to certain types of aggression.

The value of these instruments for assessing aggression in hospital among patients with personality disorder in a high secure psychiatric setting is considered.

Exploration of the association between financial concerns and depression in UK healthcare workers (HCWs) is paramount given the current ‘cost of living crisis’, ongoing strike action and recruitment/retention problems in the National Health Service.

To assess the impact of financial concerns on the risk of depression in HCWs, how these concerns have changed over time and what factors might predict financial concerns.

We used longitudinal survey data from a UK-wide cohort of HCWs to determine whether financial concerns at baseline (December 2020 to March 2021) were associated with depression (measured with the Public Health Questionnaire-2) at follow-up (June to October 2022). We used logistic regression to examine the association between financial concerns and depression, and ordinal logistic regression to establish predictors of developing financial concerns.

A total of 3521 HCWs were included. Those concerned about their financial situation at baseline had higher odds of developing depressive symptoms at follow-up. Financial concerns increased in 43.8% of HCWs and decreased in 9%. Those in nursing, midwifery and other nursing roles had over twice the odds of developing financial concerns compared with those in medical roles.

Financial concerns are increasing in prevalence and predict the later development of depressive symptoms in UK HCWs. Those in nursing, midwifery and other allied nursing roles may have been disproportionately affected. Our results are concerning given the potential effects on sickness absence and staff retention. Policy makers should act to alleviate financial concerns to reduce the impact this may have on a discontent workforce plagued by understaffing.

Alcohol use is a leading risk factor for death and disability worldwide.

We conducted a systematic review on the cost-effectiveness evidence for interventions to prevent alcohol use across the lifespan.

Electronic databases (EMBASE, Medline, PsycINFO, CINAHL and EconLit) were searched for full economic evaluations and return-on-investment studies of alcohol prevention interventions published up to May 2021. The methods and results of included studies were evaluated with narrative synthesis, and study quality was assessed by the Drummond ten-point checklist.

A total of 69 studies met the inclusion criteria for a full economic evaluation or return-on-investment study. Most studies targeted adults or a combination of age groups, seven studies comprised children/adolescents and one involved older adults. Half of the studies found that alcohol prevention interventions are cost-saving (i.e. more effective and less costly than the comparator). This was especially true for universal prevention interventions designed to restrict exposure to alcohol through taxation or advertising bans; and selective/indicated prevention interventions, which involve screening with or without brief intervention for at-risk adults. School-based interventions combined with parent/carer interventions were cost-effective in preventing alcohol use among those aged under 18 years. No interventions were cost-effective for preventing alcohol use in older adults.

Alcohol prevention interventions show promising evidence of cost-effectiveness. Further economic analyses are needed to facilitate policy-making in low- and middle-income countries, and among child, adolescent and older adult populations.

The evidence base for racemic ketamine treatment for treatment-resistant major depressive disorder (TRD) continues to expand, but there are major challenges translating this evidence base into routine clinical care.

To prepare guidelines for ketamine treatment of TRD that are suitable for routine use by publicly funded specialist mental health services.

We consulted with senior leadership, clinical pharmacy, psychiatrists, nursing, service users and Māori mental health workers on issues relating to ketamine treatment. We prepared treatment guidelines taking the evidence base for ketamine treatment and the consultation into account.

Ketamine treatment guidance is reported. This offers two treatment pathways, including a test of ketamine responsiveness with intramuscular ketamine and the dominant use of oral ketamine for a 3-month course to maximise the opportunity for the short-term benefits of ketamine to accumulate.

We have responded to the challenges of translating the evidence base for ketamine treatment into a form suitable for routine care.

Acute behavioural disturbance (ABD) is a controversial descriptor for presentations of severe agitation, aggression and physiological compromise.

To characterise the use of ABD-related terms in the electronic record of a large UK provider of mental health services during 2006–2021.

The free text of all records relating to patient contacts with acute assessment mental health teams during 2006–2021 were searched for references to ABD. Identified text was coded for context of use and presence of clinical features of ABD described in the literature. Poisson regression was used to analyse differences in rates of use over time and between demographic groups.

Mentions of ABD increased by an average of 1.12 (95% confidence interval (CI), 1.08–1.17) per year, with the greatest increase from 2019 to 2021. Black people were more than twice as likely as White people to have reference to ABD included in their assessments (rate: 2.4/1000 (95% CI 1.8–3.1) in Black people compared with 1.0/1000 (95% CI 0.8–1.3) in White people). The clinical characteristics in notes describing a current presentation of ABD rarely corresponded to those included in UK medical guidelines on ABD.

The term ABD in mental health notes appears to often, but not exclusively, be a synonym for severe agitation and conveys little meaning beyond this. However, the term's connection to a literature emphasising the high risk of physical health collapse and need for urgent treatment means that its disproportionate use in Black people may contribute to existing racial inequalities in the use of coercive measures during crisis presentations.