To investigate disparities in the number and outcome of referrals to Sheffield Community Child and Adolescent Mental Health Services from different ethnic groups and areas of deprivation

The authors reviewed the the 2021 census data for Sheffield and grouped Sheffield into 3 areas of deprivation (low, medium, and high) based on Index of Multiple Deprivation (IMD 2019 Rank).

Reasons and outcome of referrals to Sheffield Community CAMHS for the months of March and April 2022 were analysed by ethnicity and deprivation,

Our study shows that, compared to their white counterpart, Black and Asian children and young people (CYP) were markedly under-represented in CAMHS referrals, whilst CYP of mixed ethnicities were over-represented. Of this group, Asian and mixed ethnicity CYP were less likely to have referrals accepted. Similarly, CYP from areas of high deprivation were also less likely to be accepted into the community CAMHS service. While anxiety was the most common reason for referral, CYP from areas of high deprivation were 3 times more likely to be referred for behavioural difficulties than CYP from areas of low deprivation.

Our study highlighted that black ethnicities are disproportionately underrepresented in CAMHS referrals. Furthermore, children and young people from an Asian background are not only underrepresented in the number of referrals but also in the proportion of referrals accepted. Similarly, it is reported that CYP from deprived backgrounds are more likely to experience barriers to accessibility to mental health services, and this was also evident from our evaluation.

Black and Asian CYP continue to be under-represented in CAMHS services as are CYP from deprived communities. However, these ethnic groups present the highest reported mental health difficulties at adulthood. More research is therefore needed in this area, to identify the specific barriers to accessing mental health care in Sheffield Community CAMHS, so as to allow the provision of culturally appropriate mental health services for the ethnic and high derivation groups.

To assess whether psychiatric comorbidities affect response to medications in adulthood ADHD.

This study included 236 subjects diagnosed with ADHD in adulthood between the ages of 18 and 65 years and receiving pharmacological treatment for the same across community treatment teams in Durham and Darlington.

Patients were identified by going through electronic case notes.

Review of SWMWEBS scores and clinic letters were carried out both prior to and following commencing medication for ADHD to assess response to treatment.

Comorbidities were recorded by reviewing clinic letters.

56% of the study subjects had no psychiatric comorbidity while 44% had at least one comorbid psychiatric diagnosis.

Both groups had a higher prevalence of males in the ratio of 1.9:1(with comorbidities) and 3:1 (without comorbidities).

Depression(56%) was noted to be the most common comorbidity followed by Autism(22%), Emotionally Unstable Personality Disorder(11%) and Bipolar Affective Disorder(10%).

94% patients without comorbidities responded favourably to treatment whereas only 56% of patients with comorbidities improved with treatment.

Having a comorbid psychiatric illness is likely to negatively impact both treatment response and recovery in adults with ADHD.

Both groups(with and without comorbidities) had a male predominance (2.5:1).

Higher number of patients amongst the nil comorbidities group responded favourably to treatment.

Most common psychiatric comorbidity was Depression.

Least favourable response to treatment was found among the groups of Emotionally Unstable Personality Disorder and Bipolar Affective Disorder.

No gender bias in response to treatment across both the groups.

Over recent years, there has been increasing national focus on High Intensity Users (HIU's) of Emergency Department's (ED's) and services designed to case manage and address the unmet needs of these individuals. The descriptive research literature focuses on measurable, demographic identifiers of this group, attendance trends and the presenting complaints driving attendance. There is more variable literature on the clinical profiles of these individuals, with findings describing a highly heterogeneous group. Our inner city service is well-established and staffed by a multidisciplinary team. We provide assessments and interventions to meet the needs of HIU's identified through a referral system which includes electronic flagging of cases. We aim to describe in detail the clinical and demographic features of a cohort of HIU's attending our department and demonstrate the utility of these data.

All individuals managed by the HIU service in 2022 were identified from our referral database. No individual was excluded. We undertook systematic notes reviews on each case, using medical, psychiatric and primary care records as well as interventional care plans produced by the service. Data were recorded against set domains covering socio-economic factors, demographics and clinical coding.

The analysis included 98 individuals. The majority were male (59%) with 85% in receipt of government benefits and 16% of no fixed abode. A variety of psychiatric diagnoses were present with 12% diagnosed with a psychotic illness, 40% with a mood disorder, 7% with a somatoform condition and 19% with a personality disorder. 83% were diagnosed with a medical long term condition (LTC), with 32% of these being diagnosed with >3 LTC's. 81% suffered from at least 1 LTC and 1 mental disorder in combination. 40% harmfully used or were dependent on alcohol and 21% misused recreational drugs. Known or likely cognitive impairment was seen in 28% of the group and 13% were diagnosed with learning disability.

Our findings demonstrate the complexity of the clinical profiles of HIU's of the ED and supports service models centred on individual case management. There is a high degree of mental and physical morbidity in this group, indicating that specialist assessment and management is required. The range of unmet need covers a breadth of health and social care requiring a multi-disciplinary approach. Homelessness, cognitive impairment and learning disability are particular areas which may benefit from expertise. Our project is limited to one localised system however we recommend ED's undertake similar analyses to better design HIU services.

Opioids, gabapentinoids, benzodiazepines and z-drugs cause dependence, increase deaths, and have been found to be ineffective for long-term conditions. Despite the risks, these are some of the most prescribed medications. In response, we worked with commissioners to develop an innovative service ‘Optimise’ for the treatment of prescription medication dependence. Optimise aimed to support patients to reduce and stop prescribed medications that can cause dependence when the medications were not clinically recommended.

Optimise started in February 2020 in the North of United Kingdom. The service was staffed by two addiction nurses, with support from the Addictions Consultant Psychiatrist and team leaders. GP's identified suitable patients, gained consent to refer and referred to Optimise. Patients received a harm information and service letter, after which they were offered telephone triage, assessment, and ongoing psycho-social support. The nurses worked closely with GP's and advised on prescribed medication reduction plans. Due to COVID-19, most patients had telephone appointments.

Humber Teaching NHS FT service evaluation approval. All referrals were reviewed retrospectively to assess demographics and outcomes. Friends and family (FFT) test offered to patients. Data were analysed via excel.

Twenty-one GPs referred 258 patients (Feb 20-Oct 22). Most were female (70%) and all white; mean age 56 (21-97) years. Patients were prescribed opioids (92%), gabapentinoids (32%), benzodiazepines (9%), and/or zopiclone (7%). The most common opioid prescribed was morphine, followed by oxycodone and fentanyl. A letter was sent to 254 patients referred, 217 patients attended telephone triage, with 148 agreed to work with Optimise. Of 145 (56% of referred patients) who attended the assessment, 86% gradually stopped (n=24; 17%) or reduced (n=100;69%) their prescribed medications.

Patient feedback:

Eighteen patients completed FFT and stated the service was good or very good.

‘The nurse was informative and has helped me reduce my medications when I thought I wouldn't be able to.’

‘Listened to my concerns and gave me time before changing my medication.’

Optimise is an innovative service that has helped patients of all ages to reduce and stop prescribed opioids, benzodiazepines, gabapentinoids and zopiclone, that can cause dependence, increase overdose risks, and were not clinically recommended. These patients had previously not been able to reduce or stop these medications. It is positive that with two nurses there has been such a great impact with excellent outcomes and good patient engagement. Commissioners should look at funding similar services to enhance the support for patients who are prescribed medications that can cause dependence.

Use of the ‘emerging personality disorder’ label in young people has been a controversial topic amongst CAMHS clinicians. Following discussions in a CAMHS focus group, we formally explored the views and experience of CAMHS clinicians across teams in Humber Teaching NHS Foundation Trust with the view to gain more understanding of the different stances of the clinicians, the reasons behind them and to inform future care pathways.

The service evaluation was approved by Humber NHS FT CAMHS Clinical Network and Clinical Audit Team and conducted across the Humber CAMHS service, made up of multi-disciplinary professionals including medical, psychological, therapy, nursing and social work clinicians. Data were collected prospectively, using an anonymous online survey design, with Likert scale and open-ended questions, with the option of additional comments. Consent was gained form all participants. Qualitative data collected from the open-ended survey questions were analysed using thematic analysis as described by Braun and Clarke (2006). Researchers were blind to the demographic variables of respondents, in order to promote anonymity. Authentic anonymous citations were used to illustrate the findings.

A total of 50 survey responses were received from CAMHS clinicians from 9 teams. Clinicians’ views of the helpfulness of the label of ‘emerging personality disorder’ within CAMHS (n = 49): 22.4% found it helpful (very or somewhat) to staff; 21.3% helpful to families; 65.4% found it unhelpful (somewhat or actively) to staff and 63.8% unhelpful to families. 47 responded to the optional open-ended questions eliciting experiences and views of the use of the label. Qualitative analysis revealed evidence of polarity of opinion, particularly in perceived consequences for the young people and families, and identified three major themes: a shared developmental and trauma-informed understanding; the perceived impacts associated with the label of ‘emerging personality disorder’ (9 subthemes); and clinicians’ proposed next steps. There was a shared understanding of the role of interpersonal trauma and invalidation, resulting impacts on the development of skills in emotion regulation and interpersonal relationships.

Our findings highlighted the polarity of the views, the lack of consensus in the use of this label amongst CAMHS clinicians and the importance of discussions around future pathways. There is a need to consider the view of experts by experience (young people and families who have been through this process) to consider the short and, more importantly, the long term impacts of living with a label of ‘emerging personality disorder’.

Ward 1 at The Newsam Centre, Seacroft Hospital is a 12 bedded PICU facility for the city of Leeds, United Kingdom (UK). Our average length of stay was between 3 and 4 weeks. This project aimed to evaluate our admissions in comparison to the National Association of Psychiatric Intensive Care Unite (NAPICU) guidelines on admission criteria and to describe the characteristics of our patient population. At the time of our evaluation, we operated without a specific admission criteria, and this was hypothesised to be a contributor to longer length of stay.

297 patients admitted over a period of 2 years were identified and their characteristics including age, sex, ethnicity, housing area, general practitioner (GP) practice, mental health diagnosis, and length of stay tallied. These were compared with NAPICU guidelines on admission criteria and 2 patient groups (NAPICU and Non-NAPICU) were identified, analysed, and compared using Microsoft Excel pivot table. We compared their length of stay corrected for outliers using the z-score calculation. We also looked at significant differences between the groups and looked in greater detail for the profile of the Non-NAPICU group to understand the reasons for their admission, and consider their impact on our length of stay.

We found that our mean length of stay was 25.9 (1 – 215) days. When the NAPICU admission criteria were applied onto the sample, 9 patients were excluded (Non-NAPICU group) resulting in a reduction of our mean length of stay to 20.5 (1 – 83) days. When the Non-NAPICU group were looked at separately, their mean length of stay was 66.22 (7 – 152) days. When the Non-NAPICU group was looked at in greater detail, 2 patients had 2 separate recurrent admissions; one of which had a primary diagnosis of Learning Disability while the other had no clear Psychotic nor Depressive Disorder, and was complicated by Personality Disorder and criminality. 2/9 patients were detained using the forensic section 37/41. In addition, 2/9 patients were from the elderly population and 1/9 was from the younger population. There were no major differences in gender, ethnicity or age distribution.

Our evaluation suggested the potential reduction of our mean length of stay from 25.9 days to 20.5 days when the NAPICU admissions criteria were applied. We recommended a careful implementation of an admissions criteria for Ward 1 at The Newsam Centre PICU.

The Joint Homelessness Team (JHT) is a specialist mental health service for rough sleepers in Westminster. Patients have many years of declining mental health, leading to a downward social decline, resulting in homelessness.There is a concern that mental health patients are discharged prematurely due to bed pressures. This means treatment may not be optimised, with social issues and risks remaining. Serious mental illness (SMI) is associated with reduced life expectancy and high morbidity. Thus, homelessness and SMI are a double-hit of risks for people. For JHT patients, there are many barriers to admission, including coordinating complex street or S135(1) assessments and police availability; some cases have taken months or years to plan. If patients remain sub-optimally treated at discharge, there's a high risk they abandon accommodation and return to rough-sleeping; leading to further lost years of illness and homelessness.

This was a retrospective analysis. Via SystmOne, we identified all JHT admissions in 2021 and their LOS. Data were collected, including demographics, mode of admission, discharge destination and whereabouts at three months (as a secondary endpoint). LOS figures were gathered for other Westminster patients from general adult wards for 2021.

There were 57 JHT admissions in 2021. 1 patient was excluded as still admitted. 22 patients were already care-coordinated by JHT and admitted for relapses; for the remainder it was a first admission.

For Westminster patients, there was a low variation throughout the year in number of monthly admissions and LOS; monthly average LOS range was 30-38 days. For JHT, there was higher variability for number of admissions and LOS with no seasonal pattern; monthly average LOS ranged from 4-95 days.

At three months, 22 (39%) patients were not housed in the community. Of these: 3 were discharged to the streets; 9 became street homeless; 3 were discharged to ‘Stepdown’ and went AWOL soon after; 5 patients were readmitted; 2 patients their location was unknown. 28 (50%) were housed in homeless hostels.

The data were presented at a borough-wide academic meeting.

While the dataset is small, the LOS for JHT was inconsistent, reflecting the variability of the cohort. This may need further exploration.

With 39% of admissions having unsatisfactory endpoints, this suggests that many patients were not well enough to work collaboratively out in the community. There was a consistent pattern of shorter admissions leading to poorer endpoints at three months.

The Supported Employment Programme of the General Directorate of Mental Health of the Autonomous City of Buenos Aires has been running for the last five years. Its purpose is to help adults with severe mental illness obtain and maintain competitive work in the community and provide the support necessary throughout the entire process and follow-up after successful inclusion. The aim of this paper is to evaluate the impact of the COVID-19 pandemic has had upon the Programme and to analyse the main causes of clients’ drop-off despite the fact the modifications were put in order to keep running the service during the lockdown.

Retrospective analysis of case records of the Supported Employment Programme from 1 January 2020 to 31 December of 2020.

Different variables were analysed to identify the main causes of dropout. Between them, variables related to the digital divide, fear of COVID-19, and increased economic vulnerability.

At the beginning of 2020, the programme had 51 users and received 11 referrals throughout the year, of whom 8 users were finally admitted. Therefore, 59 users entered this sample, 40.7% were women (n=24) and 59.3% were men (n=35). Mean age 40.4, ranging from 18 to 65 years of age (sd = 11.6). No significant differences were found in sex, age, or level of instruction between participants. The dropout rate after the lockdown was introduced reached 50.3% (n = 30), and there were no significant differences between those who left the programme and those who continued, with respect to sex, age, or level of instruction. Significant differences were found between these two groups in access to Technology (T= –6.158 p<0.000); Digital illiteracy (T–3.247 p<0.003); fear of getting COVID-19 (–7.616 p<0.000). However, having obtained a job through the programme was a protective factor against leaving, and only one user out of nine who got a job through the programme dropped out. This difference was at the significant level (T=2.671 p<0.05).

Even though, in an attempt to keep the Programme running during the strict lockdown that was imposed during the first year of the COVID-19 pandemic, moving the face-to-face interviews to remote ones through digital platforms did no guarantee the access to service. The digital divide was one of the main causes of dropout of users. It is important to point out the protective value that had to have obtained a job through the programme against leaving.

The use of antipsychotics in children and adolescents requires close supervision in a specialist clinic. The decision to commence antipsychotics should be made jointly with the young person, their parents, carers, and healthcare professionals. It is critical to provide age-appropriate information and discuss the possible benefits and side effects, including raised serum prolactin levels, potentially leading to serious consequences such as reduced bone density and abnormal pubertal development. This audit aimed to appraise the antipsychotic prescribing practice in children and adolescents in psychiatric outpatient clinicians in Al Ain Hospital, United Arab Emirates. The authors analysed the compliance against the standards set out in The National Institute for Health and Clinical Excellence (NICE) Clinical Guidance 155 concerning monitoring prolactin levels in children on antipsychotic medications at baseline, 12 weeks, and every six months thereafter.

This Hospital-wide audit involved a retrospective review of case notes. A questionnaire was developed to capture the required information anonymously. The audit sample comprised 135 children under the age of 16 who were on antipsychotics for more than six months and were followed up in the child psychiatry clinic between January 2018 and December 2019. We chose this pre-Coronavirus Disease 2019 (COVID-19) period when services were running as usual. Data collection took place between September and December 2022.

Out of 135, 28 (21%) patients were males, with 51 (38%) being Emirati citizens. The sample age ranged between 6 and 16 years, with a mean of 13.5 years. Risperidone was the most commonly used antipsychotic. The majority of patients (63%) had a diagnosis of psychosis in the context of Attention Deficit Hyperactivity Disorder (ADHD), Autistic Spectrum Disorder, and intellectual disability. None of the patients had a baseline prolactin measurement performed, while only 10 (7%) had prolactin levels checked at 12 weeks. No patient had prolactin levels checked at six-monthly intervals.

This audit has identified a clear need to develop local guidance on monitoring antipsychotic side effects in children and adolescents. We recommend enhanced staff training in monitoring for the relevant side effects and introducing a mechanism to electronically alert the prescribing clinician when the time of monitoring is due. We suggest educating the patients about symptoms of high prolactin levels and re-audit the practice after one year of implementing the above action plan.

No financial sponsorship has been received for this evaluative exercise.

Electroconvulsive Therapy (ECT) has been used since the 1930s for the treatment of depressive illness, mania and catatonia. This audit aimed to appraise the ECT pathway followed by the Behavioral Sciences Institute at Al Ain Hospital, United Arab Emirates. The authors analysed the pathway's compliance against the standards set out in the local Al Ain Hospital guidelines and The Royal College of Psychiatrists (RCPsych) standards, with a particular focus on capacity and consent issues.

This audit involved a retrospective review of case notes. After obtaining the relevant ethical approval for the audit, we collected the case notes of all patients who received ECT over a period of three years between May 2019 and June 2022. The audit sample comprised 30 patients, both from the inpatient and outpatient services in Al Ain Hospital. A questionnaire was developed to capture the required information anonymously. Data collection took place between September and November 2022.

Out of the total 30 patients, 21 (70 %) were males. The average age of the sample was 31 years, with a range of 19-71 years. Twelve patients (40%) were Emirati citizens, with Ethiopian nationals (17%) being the second largest ethnic group. A significant majority (90%) of the patients who received ECT were under the inpatient psychiatric services at Al Ain Hospital. The sample studied received, on average, eight sessions of ECT. Major depressive disorder (43% of the sample) was the most common diagnosis, followed by severe mania at 37% and Catatonia at 17%.

Of 30 patients, 16 (53%) had no documentation of their mental capacity to accept ECT on the consent papers. Out of 8 patients deemed lacking capacity, only 4 had proper documentation of the reasons for lacking capacity. Reviewing the consent papers demonstrated that 20 patients (67%) had no documentation of discussing the risk and benefits of the procedure.

This audit has identified areas for improvement in the implementation of Al Ain Hospital's current ECT pathway. The authors have suggested enhanced staff training on consent issues involving ECT, emphasizing better documentation of the decision-making process. Considering the possible medicolegal consequences, a particular area for documenting discussions of the risk and benefits of the procedure should be included in the ECT consent form. We aim to re-audit the practice after one year of implementing the above action plan.

No financial sponsorship has been received for this evaluative exercise.

Clinical research shows that compared to Caucasian patients, Asian patients appear to have a lower clozapine dose requirement for clinical efficacy. Hence, appropriate dose adjustment should be considered in Asian patients receiving maintenance clozapine therapy. Secondly, studies in the UK report that Asian patients with treatment-resistant schizophrenia were less likely to receive clozapine than Caucasian patients. The objectives of this study were to find out the ethnic difference in dose and levels of clozapine in ethnic minority patient (BME (Black and minority ethnic) populations and to explore if there is a need for any specific monitoring.

Demographic (age, gender, and ethnicity) and clinical variables (diagnosis, clozapine dose, plasma level of clozapine and nor-clozapine, smoking status, side effect profile, and physical comorbidities) were collected from the electronic patient records and analysed.

The sample consisted of 66 (56.4%) Caucasians, 22 (18.8%) Asians, 21 (17.9%) African-Caribbean, and 8 (6.8%) mixed ethnicity patients. Their age range was 19-80, with an average of 46.9 ±11.9 years.

Among the ethnic groups, age, clozapine, nor-clozapine level and QTc were comparable, except for the dose of clozapine; Caucasian had the highest dose (414.8±140.0 mg), followed by African-Caribbean (373.8±163.7 mg), Asian (333.8±121.2 mg) and mixed (260.7±110.7 mg) (F3.68, p<0.05). The difference remained significant when all the BME groups were combined as well.

Side effects such as hypersalivation, drowsiness, blurred vision, polyuria, sore throat, headache, vomiting (none), dizziness, difficulty passing urine, urine incontinence, flu-like symptoms, nausea, were comparable among ethnic groups.

There was no difference in smoking among the groups. Considering comorbidities compared to BME, Caucasians had significantly lower rate of hypertension (27.1% vs 9.1%, p<0.01); diabetes (18.6% vs 4.5%, p<0.05), however dyslipidemia (5.1% vs 3.0%) was comparable.

In addition to the above, the dose of clozapine was positively correlated with clozapine and norclozapine levels (p<0.05). Clozapine and norclozapine levels correlated significantly (p<0.001). Age was negatively correlated with norclozapine assay (p<0.05) and positively with the number of cigarettes. It appears as the age increases, the number of cigarettes goes up, and norclozapine levels come down.

There are a few variations of clozapine prescribing in different ethnic groups. Although the Caucasians had higher doses, they had comparable blood levels. A higher proportion of BME patients on clozapine had hypertension and diabetes, emphasizing metabolic risk. Our study findings suggest clozapine monitoring should look into ethnicity related risk factors.

Like most health and social services, community ID teams are under increasing pressure to manage burgeoning caseloads. This evaluation was for the Red People Meeting video conferencing (VC) from its conception during the pandemic 2020 with particular reference to it's simple format to structure meetings for their effectiveness and promotion of team communication and well-being.

The Red people meetings is held every Mon – Fri between 11am and 12pm through an invite sent via e-mail or diary invite. A RED STATUS is identified by a support worker who poses:

• • Serious risk of harm to self or others

• • Serious concerns related to Physical / Health / Perceived challenging behaviours.

• • Individual requiring hospitalisation

Meeting Attendees (over TEAMS): Chaired by the Head of Service or Lead ID Nurses. With attendance of ID Consultant Psychiatrist, OT Team, Moving Home Manager, ID Nurse, Social Worker. Attendance depending on individual need include Clinical Psychology, AHPs, Social Work Team Manager, Social Worker, Police, GP, Housing, MHO, District Nurses, etc

Individuals identified as RED and are at risk of admission or an inappropriate alternative solution will likely require significantly longer discussions and a full plan to reduce the risk of harm.

Evaluation data were gathered via qualitative feedback from the multi-disciplinary team (MDT). Number of patients admitted among cases discussed from January 2020 until September 2022 (Total 248) was noted.

The MDT team were generally satisfied with the assistance they received and were able to be provided solution focused remedies with immediate feedback. In particular, they were satisfied with the accessibility in having a collaborated approach with addressing the challenges to request priority of interventions from NHS Highland ID staff and provision of timely advice and guidance to support providers. Out of the 248 People With Intellectual Disability (PWID) discussed from January 2020 to Sept 2022, only two required admission with the rest successfully being managed in the community.

With its easy accessibility and quick response via video conferencing, ‘Red people’ meeting can be used as a platform to discuss PWID and / or autism who have been classified with a RED status identifying the immediate support required, providing expert advice and guidance, enabling a quick prioritised response from professionals and provision of safe and timely discharge from hospital.

It is evident that further research needs to be undertaken into the contemporary and future practice of community ID teams in the management of crisis settings.

The aim of the study is to investigate if a trend in admissions to wards within Local Division in Mersey Care NHS Foundation Trust has been evident over the past five years and hypothesise rationale for this.

Mersey Care NHS Foundation Trust has collated information on admissions to wards within their Local Division from June 2017 to June 2022. These data were reviewed and analysed.

We considered contributory reasons for any trends in admissions, for example, establishment of the Crisis Resolution Home Treatment Team (CRHTT) in 2017 and the impact of the Coronavirus pandemic. We also reviewed the number of assaults over this period, to see if a trend was evident.

There has been a downward trend in the total number of admissions to wards within Local Division.

The average total number of monthly admissions pre establishment of the CRHTT was 186, which declines to 133 when the service was functioning. For general adult admissions, the average number of monthly admissions pre commencement of the CRHTT was 160, which reduced to 118 after implementation of the CRHTT, a 26.3% reduction. For old age admissions, the average number of monthly admissions was 25, which reduced to 19 after implementation of the CRHTT, a 24% reduction.

At the height of the Coronavirus pandemic, the average number of admissions dropped to 124, and 80% of results fell below the trendline. There was a less significant reduction in old age admissions due to the Coronavirus pandemic, perhaps reflecting less family support during lockdown periods, reduced access to carers and less input from the community mental health team in care homes; all of which could increase the need for older adults to be admitted to inpatient mental health beds.

The number of assaults across wards within Local Division increased significantly from 602 in 2017 to 1527 in 2021. This suggests there is perhaps a higher threshold to admit patients, with more significant risk profiles.

A downward trend in admissions to Local Division within Mersey Care NHS Foundation Trust has been evident since 2017.

There are a several factors that could have contributed to this, including commencement of the CRHTT and restrictions due to the Coronavirus pandemic. The significant increase in the number of assaults, may also suggest there is now a higher threshold to admit patients, with more significant risk profiles.

Increasing demand and high rates of non-attendance (DNA) lengthen waiting lists for psychiatric services, a topic of significant public and political interest. NHS Lothian data between 2009/10 and 2018/19 averaged a DNA rate of 19% for new patient appointments. Our aim was to analyse the waiting list and DNA rate for patients referred for a routine Consultant-led General Adult Psychiatry outpatient clinic appointment (OPCA) within the North-West Edinburgh Community Mental Health Team. The goal was to identify lost clinical time and areas for service development.

We collected data of all patients on the waiting list for a routine OPCA, excluding ‘soon’ or ‘urgent’ appointments and those on the separate Neurodevelopmental Disorder waiting list.

We collected data of all OPCA attendances between 1st of January 2020 and 1st of January 2023.

In line with Royal College of Psychiatrists guidance, we allocated 30 minutes for a return patient and 60 minutes for a new patient to determine lost clinical time due to DNAs.

Data were collected from NHS Lothian Analytical Services and anonymised in line with NHS Information Governance Policy.

221 patients were on the waiting list for an appointment. 52% of patients were female (n = 115). The longest wait was 10 months.

Between the 1st of January 2020 and the 1st of January 2023, 1961 new patient appointments were booked. 263 were cancelled prior to the appointment. Of the appointments remaining, 30% were DNAs (n = 505), resulting in 505 lost clinical hours, an average of 168 hours/year.

9172 return patient appointments were booked. 1189 were cancelled in advance. 22% were DNAs (n = 1812), resulting in 906 hours of lost clinical hours, an average of 302 hours/year.

DNAs have a direct impact on service provision. Were our service to reduce our DNAs to the Lothian average for General Adult Psychiatry new patient OPCA, we would save on average 61 clinical hours/year.

We will disseminate this information to the NHS Lothian Digital Experience Mental Health Team to support the introduction of a text reminder service, before involving the NHS Lothian Quality Improvement team to explore the impact of this intervention on DNAs.

Furthermore, being placed on a waiting list can be an uncertain time for patients. We will create a waiting list pack for patients, including information of local supports and emergency contacts. We will pilot this in our sector before disseminating to other teams in Lothian.

This evaluation was done with the focus to improve the quality of pre-ARCP corporate report for core-trainees. The pre-ARCP corporate report is a document compiled by the medical education department guided by other departments to capture certain competencies. The area of interest was how the report could be up-to-date and accurate. This would ultimately lead to a fair and objective summation of facts for the Psychiatric and Educational Supervisor report which will be reviewed by the ARCP panel.

This evaluation included all full-time core trainees within the Northern training scheme of the Trust who have undergone ARCP in January and July 2022. Exclusion criteria included less-than full-time trainees and core trainees who did not take part in an ARCP panel in January and July 2022. The questionnaire was designed by the Project Team and approved by the Trust Audit Team prior to data collection. The data were collected from 11th July to 31st July 2022. Electronic questionnaires were sent out to 33 postgraduate doctors.

A total of 12 postgraduate doctors responded (36%). Out of the 12 doctors that responded, 11 (92%) had taken part in the ARCP panel in July 2022. 11/12 (92%) reported having received their pre-ARCP corporate report prior to the ARCP and in adequate time. Similarly, 11/12 (92%) of postgraduate doctors agreed with the record of both the RCPsych teaching attendance and audit involvement recorded on their pre-ARCP corporate report. In relation to capturing locality teaching attendance, 58% of postgraduate doctors reported the information as accurate. Inaccurate capturing of leaves, on-calls and/or rest days were pointed out by respondents as reasons for the discrepancy in attendance. Of those who contacted medical education, 10/10 (100%) reported that the issue was resolved before the portfolio submission date for ARCP. Of those who did not take action, 50% (1/2) reported the reason as being “I did not see the need to take action”.

We found that core trainees felt that capturing accurate RCPsych teaching attendance as well as accurate audit involvement before ARCP are areas that required improvement. There is room for improvement regarding recording locality teaching attendance and absences due to leaves, on-calls, and compensatory rest. It brings us back to reflect on the time spent by each affected postgraduate doctor to clarify their records when discrepancies are noted. Results were discussed with Medical Education department and suggestions for improvement implemented. A re-evaluation is scheduled to take place in July 2023.

Following the initial phase of the COVID-19 pandemic, and with the introduction of an off-site Crisis Hub, has there been a change in presentation to the Emergency Department (ED) with suicidality in the absence of self-harm?

Patients referred to the Liaison Psychiatry Service (LPS) from the ED at the Royal Cornwall Hospital with suicidal threat over a two-month period were identified in 2019 (pre-pandemic and the creation of the Crisis Hub), 2021 and 2022 (post pandemic and Crisis Hub implementation).

Demographic data for each attendance were recorded: age and gender, mode of arrival/route of referral and outcome of assessment.

The number of attendances has decreased since 2019 (87 in 2019, 71 in 2021 and 53 in 2022). This is on the backdrop of decreasing total departmental attendances and a fall in the proportion referred to LPS: 541 in 2019, 3.84% of the total ED attendances, 510 in 2021, 4.32% of the total ED attendances and 400, 3.7% of the total ED attendances in 2022.

The proportion arriving under Section 136 of the Mental Health Act (MHA), is also increasing: 0% in 2019, but 15.5% in 2021, and 13.8% in 2022. This corresponds to an increasing proportion taken from the ED by the police to another Place of Safety.

A small proportion of those attending were considered suitable to be assessed at the Crisis Hub and were subsequently taken there (5% in 2021 and 3% in 2022). The most common reason to reject referral to the Crisis Hub was recent alcohol consumption.

The proportion requiring admission varied: 3.4% in 2019, 5.6% in 2021 and 1.7% in 2022.

The number of patients arriving with the police under s136 has increased. The numbers were too small to see a trend in transfers to the crisis hub and psychiatric admissions.

Future work might evaluate the vanguard street triage service, or be a repeat of this evaluation once there is medical cover in the hub, or look at the fraction of patients seen in the hub who are referred on to ED, or be qualitative studies of staff and patients’ views of the hub.

The Psychiatric Resident On-Call (PROC) rota provides medical cover for all inpatients across Leeds and York Partnership NHS Foundation Trust outside normal working hours. With the introduction of a new regional inpatient CAMHS unit in August 2021, a service evaluation project was undertaken to establish if the current medical provision was sufficient to meet the increased demand of expanding services.

Workload monitoring was undertaken for 28 days during August and September 2022 for all evening, weekend, night and bank holiday shifts. Data collection documents in the form of Microsoft Excel spreadsheets were sent to one doctor to co-ordinate for all PROC doctors on each shift. For each 30-minute period, the number of doctors engaged in clinical activity was documented and the average number working at that time, as well as standard deviation, was calculated.

51 out of 56 on-call shifts were accounted for during the workload monitoring period by returning of a completed data collection document. Workforce demand for the remaining five shifts was estimated from reviewing handover document with listed times of call-out and expected duration for each job.

Data showed that workload was consistent throughout weekend shifts, but slowed around the time of handover. This is likely due to the end of shift being used to complete documentation, and the start of shift being used to assign roles and plan the shift ahead. In addition, lengthy non-urgent tasks may not have been appropriate to undertake if a PROC was due to shortly end their shift.

Patterns of night-shift working suggested a steady demand during the early hours of the shift, but a reduction during early hours of the morning, with trough levels being observed between 04:00 and 05:00 in the morning. No significant differences were observed between evening and night shifts across weekdays or weekends.

Assessing the above data led the authors to conclude two changes to workforce provision which may increase efficiency of workload. The first was to implement a cross-over role which could bridge periods of handover and ensure that a medic is still available to respond to tasks despite the change in workforce around these times. The second was to rebalance allocated provisions so that less medics were on shift during early hours of the morning, when demand was lowest, and re-allocated to evenings or weekends where demand appeared to be greater.

In response to the growing awareness of health inequalities in the UK, institutions are called to take responsibility in tackling obstacles to equality, diversity and inclusion to mental health services access. This study aims to evaluate the demographic profile of referrals from London borough of Camden residents (aged 18 to 25 years) to the Tavistock Adolescents and Young Adults Service (AYAS) for psychodynamic psychotherapy. We aim to evaluate whether the demographic characteristics of referrals were a good representation of the local population.

Age, gender, and ethnicity of Camden AYAS referrals received between 12th April and 14th December 2021 (n=38, age range 17 to 24 years) were collected retrospectively using the electronic patient record system and compared with the following age groups of the latest Camden Census data (2011): 16-17, 18-19 and 20-24 years.

The two sets of data were analysed using Chi-Square goodness of fit test.

Females were significantly overrepresented among AYAS referrals compared to Camden population (86.5% vs 52.8%, X2=16.83, p=.001).

No conclusion could be reached regarding transgender individuals due to lack of data about transgender population in 2011 Census data.

Ethnicity was recorded in n=33 referrals and evaluated at group and subgroup level, utilising standardised categorisation.

We found that the proportions of five main ethnic categories differed significantly between the AYAS and Census groups, (X2=13.07, p=.05). In the AYAS referrals Mixed ethnicity group was over 3 times higher than expected based on Census data, while the Asian group was markedly underrepresented.

Significant disproportions were also identified at ethnic subcategory level (X2=39.98, p=.01).

No one of Asian-Bangladeshi or Asian-Chinese ethnicity was referred to AYAS in the timeframe considered.

People of Black ethnicity were represented as expected overall with all referrals (n=3) identifying as Black-African.

Although overall White ethnicity was represented as expected, White-British were underrepresented (18.2% vs 39.2%) with majority of referrals identifying as other White ethnic subcategories (36.4% vs 15.5%).

Limitations of this study include sample size, outdated Census data and limitations of statistical tests used. Our findings indicate males are under-referred to the AYAS psychotherapy service together with some ethnic minorities (Asian overall, and in particular Asian-Chinese and Asian-Bangladeshi).

This may be due to unconscious bias in the referral process. Further exploration is needed to understand underlying causes so that effective strategies to promote equality in access to services can be implemented.

Safety plan and Goal setting are standard interventions offered by CAMHS Crisis Resolution and Home Treatment team. The Department of Health Best Practice Principles and NICE guidelines recommend collaborative production of risk management plans and recovery orientated input. We wanted to ensure compliance and understand patient's views on usefulness of these.Aims:- Did all patients complete safety plan and goal setting? Was this done collaboratively?Did these strategies help?Were documents easy to access?

There were two arms to the project.

1. 1. Review of 40 electronic case notes out of 715 patients seen from Jan to April 2021. We looked at completion of safety plan, goal setting, goals achieved, HONOSCA scores, risk ratings and mood scores.

2. 2. Between April and July 2022, willing patients were requested to complete anonymised electronic questionnaire through a QR code. The questionnaire asked if patients felt included when completing the safety plan and goal setting, whether these interventions helped recovery and if the documents were easy to access. A free text option for feedback was also given.

This proposal was approved by the Improvement and Knowledge Hub within the LPT NHS trust who confirmed that ethical approval was not required.

Results are reported in percentages.

Case notes review (n=40):

• • 99% had safety plans completed, done collaboratively.

• • 90% had goal setting completed, done collaboratively

• • Rationales documented within the notes for not completing.

• • 85% reported Improved mood scores

• • 90% reported improved risk ratings

• • 65% achieved 2 or more of 3 goals set.

• • 67.5% had HONOSCA at admission (average score 13.6) and discharge (average score10.5) – improvement documented.

Questionnaires: 18 questionnaires returned.

• • 100% completed safety plan and goal setting

• • 83% reported they felt included when doing safety plan and goal setting.

• • 83% said goal setting was helpful in recovery.

• • 94% said safety plan helped.

• • 82% reported easy access to documents.

Results suggest compliance with guidelines and strategies are useful. There is consistency in relevant information from the case note review and questionnaire feedback. Case note review included objective and subjective perspectives. Questionnaires gathered patient perspective; in confidence/anonymously.

Recommendations:

1. 1. Repeat survey ensuring case review and patient feedback for same period.

2. 2. Use children and young people friendly version, offer paper version, advertise widely - to improve questionnaire response rate.

3. 3. Complete HONOSCA on admission and discharge.

4. 4. Research to explore usefulness of interventions in CYP

The COVID-19 pandemic necessitated major changes in clinical care, including remote patient contact. Havering Older Adults Mental Health Team and Memory Service (HOAMHT&MS) patients often fell within the vulnerable category for poorer outcomes with the SARS-CoV-2 virus, so remote contact was preferable during the pandemic. Telephone assessments were offered to replace face-to-face reviews for some patients. Feedback from patients and carers was collected to compare these modes of patient contact. Remote assessment has positive impacts including; improving access to care in remote areas/when local services cannot meet demand and for disabled patients. Understanding the patient experience about remote assessments helps navigate decisions about future modes of consultation.

This evaluation was organised in HOAMHT&MS. A Rio* diary search was conducted for practitioners from 15/07/2020 to 15/10/2020. 75 questionnaires were sent from each clinic (OAMHT and Memory Service). We sent an equal number of questionnaires for telephone appointments and face-to-face reviews. Questionnaires were posted to patients with pre-paid envelopes to return responses.

*Rio is our Electronic Patient Record System

We had a total return of 23 questionnaires from the Memory Service and 24 from the OAMHT clinic. Most questions were a likert scale from Poor (1) to Excellent (5). The overall satisfaction score out of 5 (average of all the responses):

OAMHT:

Patient/telephone: 3.7 (n=13)

Patient/face-to-face: 4.1 (n=7)

Memory Service:

Carer/telephone: 4.4 (n=8)

Carer/face-to-face: 4.2 (n=9)

Some of the open ended feedback:

OAMHT:

• • Carer/telephone:

“The telephone was rushed and at the end of the meeting the person wanted to sign my husband off.”

• • Patient/face-to-face:

“Help was always there for me.”

“The clinic deserves a medal.”

Memory Service:

• • Carer/telephone:

“Very helpful - I am now contacting them for further advice. They understand my stress and give me full support.“

• • Patient/face-to-face:

“Very happy with the care and attention from the consultant, doctor and nurses at the memory service.”

OAMHT Responses:

• • Face-to-face feedback more positive

• • Patients experienced more distress - nature of illness (distress/crisis) compared to memory (usually gradual decline)

• • Telephone appointments seem less satisfactory - less likely to meet the emotional need of patient/carer

Memory Service:

• • Generally positive feedback from carers and patients in all areas - able to take a meaningful history over telephone