The community mental health team (CMHT) is actively involved in reviewing mental health patients who require commencing psychotropic medications. The responsibility to prescribe the psychotropic medications falls on the CMHT for the first 3 months. After this period, if the patient's mental health is stable, the prescribing role can be transferred to the GP by completion of an electronic shared care agreement (ESCA).

This project aimed to improve the management of emergency prescriptions (FP10s) requiring ESCA within the North Hub CMHT, BSMHFT focussing on reducing administrative time in receiving numerous urgent phone calls for repeat prescriptions, timely completion of ESCA and updating the electronic prescribing system.

Data collection was done by logging the numbers of the following on a weekly basis:

1. 1. FP10s issued.

2. 2. Calls related to FP10s.

3. 3. ESCA sent.

1. 1. Clinician prompt reminders to check ESCA status.

2. 2. Document FP10s instances on issue and inform patient about ESCA during outpatient appointments.

3. 3. A 4-week system for managing FP10s at reception desk.

4. 4. Increase consistent use of and access to EPMA.

This project resulted in a 14% reduction in the number of FP10s requiring ESCA and a 27% reduction in the number of calls for FP10s from January to August 2023. Data measuring sustainability in December 2023 showed a total reduction of 64% from the baseline of 28 FP10s per week at the beginning of the project (January 2023) to an average of 10 FP10s issued per week in December 2023.

In conclusion, patients benefit from having a clear understanding of where their medications will be issued from thus improving their experience with the mental health service. Having effective processes in the CMHT enables medical professionals to complete the ESCA in a timely manner. Altogether this reduces burden on all professionals and reduces costs of prescribing by transferring the prescribing responsibilities to GPs. This project has been effective in reducing the number of weekly emergency FP10s issued. The 4-week system of managing FP10s at reception has now been included in the Medication Management's new procedure and guidance and is being introduced across all CMHTs in BSMHFT.

There remains stigma surrounding electroconvulsive therapy (ECT) amongst junior doctors, as well as gaps in knowledge, recent studies have shown. The aim of this study is to reduce stigma and negative biases towards ECT among junior doctors in Hertfordshire.

This research strives to improve clinical knowledge regarding ECT amongst the same population of junior doctors.

After highlighting stigma and gaps in clinical knowledge amongst junior doctors, we aimed to implement an educational intervention to reduce these and assess the impact it made.

Over 80 doctors ranging from foundation year 1 doctors to consultants attended a weekly academic teaching for doctors working in Psychiatry. A 50-minute slot was set aside for a teaching session on ECT.

This included a pre- and post-teaching anonymous questionnaire, with open and closed questions, asking junior doctors about their previous exposure to ECT, and asking them to list three words they associated with ECT.

The teaching session included: what ECT is, indications, side effects, a short video explaining the procedure, an open discussion about stigma and ECT, a brief overview about the future of neuromodulation, and a consultant psychiatrist who is part of the ECT team talking through the before, during, after, and answering questions from the participants.

31 participants answered the pre-intervention questionnaire. Of the 31 respondents, 70% reported learning about ECT during medical school. However, 40% reported little teaching and only 13% had observed ECT. From thematic analysis of free text responses, 54% of respondents expressed detailed understanding of ECT, with 71% agreeing that ECT is a humane treatment. 80% expressed that ECT should be part of NICE guidelines. 50% of respondents conveyed that stigmatised portrayals of ECT in popular culture have influenced their negative opinion of ECT.

Of the 10 responses to the post-teaching questionnaire, 100% agreed that ECT is a humane treatment and that ECT should be part of NICE guidelines for treatment of severe/treatment-resistant depression. From thematic analysis, when asked to name 3 words they associated with ECT, 60% of participants described ECT as effective or successful and 40% described ECT as safe. 72% of the words used were positive descriptors.

ECT is not covered thoroughly during medical school. Before this teaching, about half of the trainees expressed a negative opinion of ECT due to popular culture. Post-teaching, positive opinions had increased, and more trainees (100%) agreed that ECT is a humane treatment and should be part of NICE guidelines.

Non-attended appointments can lead to adverse outcomes for a service and its users, including reduced service efficiency; increased waiting times; and impaired patient care. The audit objective was to explore whether DNA rates vary between the current modalities of face-to-face; virtual; and telephone. It was hoped that this would enable the service to better understand the reasons for patients not attending initial assessments and determine whether the modality may present a barrier.

A sample was obtained including all first assessment appointments between March 2022 and March 2023 (n = 386). Data included the modality for each initial appointment. Matched to this data, was whether the patient attended each appointment, creating a frequency of DNAs for each appointment modality across the year. Data analysis was conducted using Microsoft® Excel®. Beyond frequency and percentages, a chi-square test was used to assess for a statistical difference in appointment attendance between modalities.

For this one-year sample the overall attendance rate was 77%: with 299 appointments attended, and 87 ‘DNAs’. The DNA rates across the one-year sample were face-to-face (24%); virtual (22%); and telephone (23%).

The chi-square value produced when analysing the DNA rates between modalities was 0.92 (critical value 5.99). Hence, there was no statistically significant difference in DNA rates by modality.

Despite the absence of variation in DNA rates between modalities, the findings can be viewed as reassuring. The move to include multimedia alternatives to assessments does not appear to be impacting attendance when compared with assessments that continue to occur face-to-face. Balanced against this increased geographical inclusion afforded by remote appointments, is the competing equity issue of digital exclusion, highlighting the need for face-to-face appointment provision to remain accessible across the service.

This audit did not collect demographic data that may have provided insight into whether certain factors may have impacted attendance and could have acted as confounders, for example geographical location.

Introduction of a supportive reminder letter for patients, to bridge the wait between patient's referral and their initial assessment, was an outcome recommendation that was implemented by the service.

Mental illness is associated with poorer physical health and reduced life expectancy in comparison to the general population. This is influenced by many factors, one of which is medication related. Antipsychotics can have multi system effects on the body such as increasing the risk of metabolic syndrome and cardiovascular disease. Our objective was to understand current challenges when monitoring patients' physical health and thereby improve overall health outcomes.

Utilising a clinical audit template, the study group was 9 inpatients during cycle 1 and 10 inpatients during cycle 2, who were prescribed antipsychotics on an Old Age Psychiatry ward. Northumberland, Tyne and Wear (NTW) antipsychotic monitoring guidelines were used as criteria which stipulate that blood tests, ECGs, BMI, waist circumference, side effects and lifestyle effects should be recorded at defined intervals. A proforma highlighting these guidelines was created following audit cycle 1 and utilised by the MDT on the ward, the purpose of cycle 2 was to compare findings following the implementation of the proforma. The standard to meet was that 100% of patients should fulfil the guidelines. Data was collected by retrospectively reviewing paper and electronic notes.

Audit cycle 1 revealed 0 of the patients met the physical health criteria. 0 had the full set of required bloods in the correct timeframe, 0 had waist circumference checked and 2 and 1 patients had side effect and lifestyle effects documented respectively. By comparison, ECGs and BMIs were recorded well. Audit cycle 2 demonstrated significant improvement in all areas. 9 patients had bloods accurately measured. 3 and 6 had side effect and lifestyle reviews respectively. ECGs and BMIs continued to be monitored well. However, waist circumference remained poor with 1 patient recorded. Qualitative feedback when presenting these findings to the MDT highlighted an interest debate into the cost/benefit of measuring waist circumference with the main point being not wishing to cause undue anxiety to the patient.

The use of an accessible proforma clearly outlining the criteria to meet for each patient proved valuable in improving the monitoring of physical health parameters. This study highlighted a need for increased awareness of metabolic syndrome and the importance of empowering patients with knowledge regarding their healthcare to help tailor a patient-centred approach to physical health monitoring. Our presentation aims to encourage discussion among attendees around measuring waist circumference and raise awareness of metabolic syndrome.

Doctors completing on-call shifts at sites across a mental health trust identified a need to improve aspects of on-call work. This quality improvement project (QIP) aimed to improve response to trainee concerns arising from on-call work and support to junior doctors on-call.

A previous QIP cycle identified trainee concerns regarding on-call processes. In our first QIP cycle, surveys were sent to all consultants and SpRs working on non-residential on-call rotas, and Foundation, GP and Core Psychiatry trainees (on residential on-call rotas) in the Trust, regarding perceptions of on-call processes, senior support and on-call issues. A monthly, online forum was introduced in August 2023 to improve on-call feedback and communication. Trainees, consultants and SpRs from 2 localities were invited, along with representatives from the medical staffing team, medical education team and medical management. After 4 forums, participants who had attended an on-call forum were sent a further feedback survey collecting quantitative and qualitative data. Subsequently, forum frequency and scheduling were amended, advertisement improved, and the forum was expanded to include on-call doctors across the whole Trust.

First cycle data revealed consultant support for a regular meeting with trainees and senior colleagues to bring issues from on-calls for discussion (56% felt that an on-call forum would be helpful, 33% felt it might be helpful). Mean forum attendance was 14, with attendance from all grades. Feedback data from trainees (5 responses) was that most found the forum useful (80%); 80% felt listened to; all felt able to raise concerns, and all wanted the forums to continue. Qualitative feedback included: ‘we started a new QI project from the forum and many on-call guidelines became more defined.’ Consultant feedback (4 responses) was that most found the forums useful (75%); 100% gained a better understanding of trainee concerns; 100% thought forums should continue, although 50% thought the frequency should be reduced. Most consultants and trainees did not feel it would be useful to discuss clinical cases in the forums. Consultant qualitative feedback reported that the forum was helpful to understand trainee concerns, but there should be wider attendance.

Establishing an on-call forum was a valuable intervention for both consultants and trainees working on an on-call rota and has led to a further quality improvement project. Respondents felt that clinical supervision offered sufficient space to discuss clinical cases. Increasing trainee and consultant engagement with the forum is the next phase of this project.

The liaison psychiatry team at North Middlesex Hospital (NMH) noticed that many patients on clozapine were missing doses in hospital, risking the need for re-titration and deterioration in mental state. Although clozapine is a widely used medication in psychiatry, non-psychiatric clinicians may not be aware of the importance of compliance. In addition, clozapine is often not widely available in acute medical hospitals and ascertaining the correct dosage can be difficult as it is not prescribed by the GP. Furthermore, clozapine can cause a variety of side effects that our medical colleagues may not be familiar with.

The aim of this project was to improve clozapine prescribing at NMH and improve communication with the liaison psychiatry team.

We reviewed the notes of 97 admissions in which patients were dispensed clozapine from the hospital pharmacy during the period April 2020 to December 2023 to determine what proportion had missed a dose of clozapine, and the clinical implications of this. We also reviewed the reasons for the missed doses to gather information on what could be done to improve patient safety.

From July 2022 we began implementing changes. This included the creation of a hospital guideline, putting in place an automatic email that would be sent to the liaison team when clozapine was prescribed, placing an alert on the online prescribing system to emphasise the importance of not omitting doses, and providing teaching to clinicians.

We compared omissions of clozapine doses and referrals to the liaison team before and after changes were implemented. The percentage of patients inappropriately missing at least one dose fell from 67.4% to 31.1%. The proportion of patients who were referred to the liaison team rose from 40.8% to 89.2%.

We identified several recurring causes of missed doses. These included doctors not being aware of clozapine prescriptions or dosages, poor awareness that clozapine is a critical medicine and long stays in accident and emergency. There were also incidents where clozapine was stopped by the medical team without obtaining advice from psychiatric colleagues.

We were able to reduce the proportion of patients missing doses by improving awareness of clozapine compliance within the hospital. We were also able to improve communication between medical and psychiatric teams.

The clozapine guideline and prescribing alerts will continue to be utilised within the hospital. We plan to continue to provide regular teaching to rotational junior doctors and to pursue a similar project for lithium prescribing.

Alcohol misuse presents a major health concern in Northern Ireland with a 50% rise in alcohol-specific deaths in the past 10 years1. Excessive alcohol use may lead to fat deposition within the liver and risks progressive liver disease secondary to fibrosis and/or inflammation. The aim is to extend upon an existent Hepatology referral pathway for patients with alcohol misuse and liver fibrosis on Fibroscan; to include onward referral to primary care for investigations of patients shown to have FLD in absence of fibrosis and facilitate early identification and intervention of associated metabolic syndromes. There was previously no referral mechanism for screening for metabolic syndromes such as diabetes, hypertension and hypercholesterolemia for these patients.

Case records were reviewed for all patients offered a Fibroscan through the Belfast Addictions service. Patients identified with evidence of steatosis on Fibroscan without fibrosis/cirrhosis i.e. liver stiffness score < 8Kpa and controlled attenuation score (CAP) > 248, would trigger an onward referral to primary care for further investigation and management. A letter was sent notifying the patients’ registered GP of the Fibroscan result and NICE recommendations for follow up liver function testing, HbA1c, lipid profile and Q-risk scoring for consideration of lipid lowering medication. A review of patients’ electronic care record (ECR) 2 months following the dispatch of letters was conducted to identify those patients who received further investigations.

286 Fibroscans were conducted in the Belfast Addictions Service in 2023. Alcohol misuse was the indication for 92% of these scans with 32% identified as having evidence of fatty liver disease without fibrosis. This prompted onward referral for primary care follow up and letters were sent out to GPs from November 2023. Review of ECR 2 months post-intervention revealed of the 7 letters sent out in November, 57% (4) had follow up bloods and 75% (3) of those were shown to be deranged. Data collection is ongoing and will be complete by date of congress.

32% of the patients who had a Fibroscan in the Belfast Addictions service in 2023 had evidence of fatty liver disease without cirrhosis. Initial data shows a positive change in clinical practice and patient care, and builds upon the existing hepatology referral pathway.

Assessment and management of the mental health needs of patients with dementia has been identified as a key role for a mental health liaison team (MHLT). The existing practice for referrals of patients with dementia made to Barnsley Hospital's MHLT was for them to be redirected to the memory team for assessment, who have limited scope for in-reach work into hospital, rather than being assessed by MHLT who are based on the hospital site.

This project aimed to clarify the pathway for dementia referrals presenting with psychiatric issues at Barnsley Hospital and determine which patients should be seen by either MHLT or the memory team. It also aimed for MHLT to increase the number of dementia referrals assessed compared with existing practice and increase the proportion of face-to-face reviews for these patients.

2 periods of data collection took place within MHLT, where the outcome of referrals made from Barnsley Hospital for patients with diagnosed or suspected dementia requiring assessment was recorded. The first period recorded existing practice and the second period recorded practice following the implementation of a new pathway for referrals.

The new referral pathway was created in collaboration between MHLT, memory team and Barnsley Hospital's dementia nursing staff. MHLT would review cases of suspected dementia not currently open to memory team whilst referrals made for patients open to memory team would be referred to memory team initially, with the option of MHLT input subsequently being requested.

First data collection period 3–28 April 2023:

4 referrals in total.

2 were assessed by MHLT, 1 seen face-to-face, 1 by telephone. 2 were redirected to memory team.

Second data collection period 17 July–17 September 2023 following implementation of the pathway:

10 referrals in total.

7 were assessed by MHLT, 7 seen face-to-face. 3 were redirected to memory team.

The implementation of the pathway led to improved outcomes, with absolute increases of 20% in the proportion of referrals assessed by MHLT and of 45% in the proportion of patients assessed face-to-face. Undertaking the project also helped to identify that there was a training need for MHLT practitioners regarding dementia assessment and management. The next aim is for MHLT to assess 100% of dementia referrals following dementia training being delivered to the MHLT practitioners, and to continue regular MDT meetings to monitor the efficacy of the pathway and maintain collaboration between MHLT and the memory team.

To audit the recording of physical health parameters for the clients of Waverley Community Mental Health Recovery Service (CMHRS).

To ensure Trust and NICE guidelines are met for monitoring of:

1. 1) Psychiatric drug prescribing.

2. 2) Psychiatric disease monitoring.

3. 3) Past medical history and biophysical parameters relevant to prescribing decisions.

A random sample of 100 patients from Waverley CMHRS was analysed. The data was collected between November 2022 and January 2023. The process involved establishing the cohort, dividing the caseload for review, and applying an audit questionnaire. The questionnaire was applied to both SystmOne Electronic Patient Records and GP Shared Care Records to assess compliance with physical health monitoring in both secondary and primary care. All data collected were compiled onto an Excel Spreadsheet. The level of compliance for monitoring of each parameter was calculated and audited against Trust and NICE guidance.

For secondary care:

1. 1. Compliance with physical health monitoring requirements is consistently low.

2. 2. Higher levels of compliance (>50%) for height, weight, Audit C (Alcohol), Smoking status.

3. 3. Lowest compliance levels observed for: blood tests, ECG request, substance misuse status, sleep, medication side effects.

4. 4. Evidence of a comprehensive physical health review was found in 1% of patients.

For primary care:

1. 1. 95% of patients from our sample consented to giving access to their Shared Care Record.

2. 2. Compliance with physical health monitoring requirements in primary care was higher.

3. 3. Compliance was particularly high (> 87%) for: height, weight and BMI, BP, evidence of alcohol monitoring, evidence of smoking monitoring.

4. 4. Smoking monitoring is the parameter with the highest level of compliance (95%).

5. 5. Parameters are monitored more regularly.

The audit identified gaps in the documentation and assessment of physical health parameters within Waverley CMHRS. Compliance with monitoring requirements was significantly lower in secondary care, highlighting the need for intervention. Conversely, primary care demonstrated higher adherence to monitoring guidelines. The results show deficiencies in physical health monitoring that need to be addressed to ensure comprehensive psychiatric care.

The project was crucial in optimizing physical health monitoring within Waverley CMHRS. Recommendations include targeted training, improved communication between primary and secondary care, and the designation of physical health coordinators. An action plan was developed with assigned responsibilities and a timeline for implementation. A re-audit will follow to assess the impact of implemented changes.

Background: Mental health policy is crucial for enhancing mental health and well-being. Despite the significant contribution of mental disorders to the global burden of disease, 68% of the countries possess a comprehensive mental health policy. This review aimed to identify similarities and differences between low-income countries' (LICs) and lower middle-income countries' (LMICs) mental health policies, along with key gaps, limitations, and strengths, to inform Pakistan's mental health policy.

We conducted searches on Google, the WHO Mental Health Atlas, and the country's Ministry of Health website for mental health and general health policies. Recent mental health policies were included from LMICs that were available in English, whether published or unpublished. Scholarly articles, commentaries, books, and health policies that did not address mental health were excluded. Data extraction covered document title, policy status, country, policy formulation process, human resources, suicide prevention, finances, health service delivery, governance, leadership, involvement of ministries, and implementation plans. We synthesized the data through a comparative narrative review in both text and tables.

Fifty percent (8/16) of LICs and sixty-five percent (17/26) of LMICs have health and mental health policies in English. These policies cover topics like psychiatric disorders, psychotropic drugs, forensic mental health, substance abuse disorders, and communicable and non-communicable diseases. Approximately 65% of LMICs' policies outline the structure of their federal or national government, and 59% provide information on provincial and local government structures. Most LICs include their vision, mission, and objectives in their policies.

Mental health is often neglected in the healthcare policies of LICs and LMICs. To reduce the burden of mental illness and prevent self-harm, suicide, and substance misuse disorders, the implementation of evidence-based mental health policies in line with the Sustainable Development Goals (SDGs) is crucial.

At Chelsham House – an older adults, acute inpatient dementia mental health ward – morning handover meetings (‘huddles’) lacked structure and consistency, resulting in extended, inefficient patient handover discussions and unclear task allocation. These issues consumed valuable clinical time and impacted the continuity and effectiveness of care. Recognising these challenges, a need to revamp the huddle format emerged, prioritising clear communication, effective task distribution, and team cohesion to enhance patient safety and care efficiency.

This project aimed to improve the efficiency and effectiveness of morning huddles at Chelsham House by reducing their average duration by 10% and enhancing multidisciplinary team (MDT) staff satisfaction regarding patient handover dialogues, task distribution, and accountability within 2 weeks.

The intervention streamlined the huddle format by assigning a rotating MDT chairperson and task allocator, setting a strict 2-min per patient discussion target. New segments, such as a ward safety check and focused discussions on risks and discharge barriers within patient updates, were added. A task allocation board was implemented in the meeting room for assigning tasks. Staff surveys and data on meeting duration were collected pre- and post-implementation.

The implementation led to a 16% reduction in huddle duration (from 64 to 54 minutes) and a 21% decrease in time spent per patient discussion (from 4.09 to 3.23 minutes). Staff surveys showed a significant increase in satisfaction regarding safety discussions (21%), task clarity (23%), and discharge planning efficiency (26%). The effectiveness of mental and physical health discussions was maintained, with a high average Likert score of 4.64 post-implementation, on a scale where 1 is ‘Strongly Disagree' and 5 is ‘Strongly Agree'.

This QIP achieved a notable 16% reduction in huddle duration, enhancing clinical operations on the ward. The progress, combined with improved staff satisfaction and maintained quality of discussions, underscores the QIP's success in boosting clinical efficiency and offers valuable insights for future initiatives in similar settings.

People with Functional Neurological Disorder (FND) exhibit diverse symptoms, ranging from motor and sensory issues to non-epileptic attacks, potentially causing reduced functioning and quality of life. East Kent Neuropsychiatry Service developed written and video resources to educate patients about FND. We aim to improve patient education on FND through increasing resource options and identifying optimal implementation of the materials within the care pathway.

We implemented an existing symptom self-management psychoeducation booklet and novel video resources as part of a quality improvement project (QIP). The first QIP cycle trialled the resources across different treatment pathways using three groups, each of seven patients. Group 1 received the booklet first, then the video two weeks later. Group 2 received the video first, then the booklet after two weeks. Group 3 received both resources at the same time. After 4 weeks, patient feedback was collected by 4 medical students by telephone. Qualitative and quantitative data was obtained from 8 patients. Quantitative feedback was obtained using a 5-point Likert scale. In the second QIP cycle, 10 patients received both resources simultaneously, with improvements made to resource accessibility and readability.

The first QIP cycle highlighted that the videos were helpful in explaining FND, with 75% of patients rating the videos the same or higher than the booklet. Qualitative responses commented that videos were more personal and easier for family members to understand. Across both video and booklet resources, 67% of patients agreed or strongly agreed the resources were useful for explaining FND and their experience. One patient, in group 1, stated the resources improved their symptoms. 54% of patients agreed that they received the resources at the appropriate time; a common theme across all groups was the desire to access the resources earlier within the pathway. In the second QIP cycle (8 patients, 25% response rate), all agreed the resources improved FND understanding and self-management strategies.

Our study highlights that video resources are a valuable addition to FND psychoeducation, with benefits for patients, carers and family members. Both booklet and video resources were helpful in improving patient education on FND. Our findings emphasise the need for early integration of psychoeducation in the care pathway. Future developments could include collaborating with other specialties involved in the care of FND patients, such as neurology and emergency departments, to enable early integration of psychoeducation resources, empowering clinicians to effectively communicate about FND and enhancing patient psychoeducation.

Additional authors: Mr Alan Dunlop, Ms Wendy Collison and Professor Rafey Faruqui.

Fourth-year medical students from Manchester University undergo a four-week Psychiatry rotation in Stockport as part of their curriculum. Placed in both community and inpatient teams within General Adult and Older Adult Psychiatry services, this placement offers a unique opportunity for students to gain clinical and educational experience in Psychiatry, potentially shaping their perception of the field. This quality improvement project aimed to enhance the overall experience of medical students during their Psychiatry placement in Stockport.

A retrospective review of quantitative and qualitative feedback from the March to April 2023 cohort (n = 4) involved a 5-point Likert scale and comments covering 10 domains. The feedback focused on aspects such as induction, orientation, learning objectives, patient assessment, procedural skills, supervisor feedback, access to resources, timetables, and the overall experience. An average total score was calculated.

Subsequently, strategies were implemented for the April to May 2023 cohort based on the feedback. Weekly check-ins, updated timetables, team introductions, additional teaching sessions, and opportunities for case presentations were among the interventions.

Quantitative and qualitative feedback from the April to May 2023 cohort (n = 4) were collected and compared with the previous cohort's feedback.

The feedback scores demonstrated improvement, with the average total score increasing from 4.1/5 (82%) in March – April 2023 to 4.7/5 (94%) in April–May 2023. Students praised the helpful staff, opportunities to present cases, and the tailored and useful nature of the placement. Feedback on improvements included addressing vague timetables, unannounced cancellations of teaching sessions, and limited opportunities for case presentations.

This quality improvement project demonstrated that the targeted interventions helped enhance the educational experience of medical students during their psychiatry placement. The increased feedback scores underscore the positive impact of targeted interventions. The findings emphasize the importance of continuous quality improvement in medical education, ensuring a more positive and enriching experience for medical students in Psychiatry rotations.

The aim of our project is to support health literacy in patients and carers under the Nottinghamshire Intellectual and Developmental Disabilities (IDD) service. To achieve this aim, we will produce a 20 page newsletter, containing updated and accessible research on mental health disorders that are common in the IDD population. We will also utilise a Trust webpage to publish the newsletter and produce a video/ podcast for the webpage, showcasing individuals with intellectual disabilities discussing and interacting with the articles.

Research into the relevant articles included a search on Google Scholar and PubMed, and a list was written up. Final research articles to be included in the newsletter were selected after consultation with the consultant peer group within the Intellectual and Developmental Disability team within Nottinghamshire Healthcare NHS Foundation Trust. Easy read forms of all the articles were drafted by researchers, which will be sent to relevant authors to verify that this is an accurate representation of their research. An accessible 20-page newsletter will be produced, and an IDD focus group will review the content of the newsletter, discuss the articles and relevant videos/ podcasts will be made of these interactions. A webpage on the trust website will be created to publish the newsletter and allow users to interact with the articles electronically (using the standard electronic accessibility tools) and this will also contain the videos/podcasts produced. Feedback will be obtained electronically via a QR code and via traditional means e.g. an easy read reply slip.

The key outcomes of our project are producing 10 easy read articles within our newsletter. These articles need to be useful and accessible to the IDD population, which will be verified by small focus groups consisting of patients with IDD, carers and staff to review literature before publication as well as the feedback after publication. Another key outcome is the use of coproduction to involve people with IDD in production of the newsletter and webpage, in order to recognise the value of their lived experience, improve the quality of the project and drive success.

Successful publication and feedback will pave a way for exploring a second edition the following year for printing via Trust communications. If successful, this project could be used as a template for an effective way to share research findings that contribute to the understanding of assessment and treatment pathways for people with an Intellectual and Developmental Disability.

The project's aim is to record up-to-date BMI readings of 70% or more of our service users by September 2024. We have identified barriers limiting current data collection, such as challenges weighing wheelchair bound clients or limited availability of weighing scales, and will action our change idea methods to reach our target in this time period.

Significant health inequalities have been identified in the learning disability population, with men and women in our cohort dying 23 years and 27 years younger respectively compared with the general population. Furthermore, people with learning disabilities are at increased risk of being overweight or obese compared with other cohorts, which itself leads to a range of health and social complications. A recent audit of our psychiatry caseload revealed the need to improve weight monitoring and subsequent management for our service users, to help reduce health inequalities identified.

We have weekly project meetings with our MDT including psychiatrists, dietetics, occupational therapists, nurses and psychologists. We have arranged stakeholder involvement by inviting service users to these weekly meetings to contribute their own ideas to the project, and have organised focus groups for service users, carers and staff. We intend to generate change ideas by using quality improvement methodology to identify primary and secondary drivers. One of these already incorporated into the project is a machine in our waiting room monitoring our clients’ weight, height and blood pressure. Having identified obstacles in our service users obtaining their weight, we have successfully bid for funding for one of these machines.

We will use Plan Do Study Act (PDSA) cycles to evaluate the effectiveness of our change ideas. Convenient sampling of our psychiatry caseload showed only 26.7% of 71 service users have an updated weight and BMI, and identified that we don't have a robust process for monitoring patients' weights (total project caseload is 1264).

During the development of this project, we identified a variety of approaches to improve health outcomes for our service users including educating staff on incorporating weight monitoring into consultations and how to manage the results. This project comprises one part of East London Foundation Trust's overall Triple Aim: to improve population health; improve the quality and improve value for the system. Going forward, our intention is to incorporate weight management into our routine reviews and ensure staff are educated in the importance of regular weight monitoring, the health benefits and how to refer.

Incidents involving patient violence and aggression are a common occurrence on the neurosciences wards. Many staff do not know how to de-escalate or manage such incidents, leaving them vulnerable and unsupported. This project was designed to increase mean staff confidence by at least 2 points (on a scale of 1–10) regarding confidence and satisfaction in managing patient violence during a 6-week period.

Using Plan-Do-Study-Act (PDSA) quality improvement methodology, we carried out a preliminary survey on 2 neurosciences wards. Multidisciplinary staff were interviewed about their confidence (on a scale of 1–10) in managing violence. The survey and interview assessed which measures were already in place on the wards, such as Datix reporting and referral pathways. The first intervention focused on preventing patient violence with informative posters on referral pathways and verbal de-escalation techniques; these were distributed throughout the wards and staff were notified via email. Follow-up surveys were collected, enquiring whether staff had seen the posters and how their confidence levels have changed. The second intervention was implemented 2 weeks later and focused on post-incident support. We distributed leaflets on Critical Incident Staff Support and sent an email link to a verbal de-escalation playlist. Follow-up surveys were collected again to track changes in staff confidence and satisfaction. Weekly electronic clinical record searches were recorded to track the number of incidences of patient aggression during the same 6-week period.

Staff confidence (N = 24) in verbally de-escalating violence and aggression increased by 1.1 and 1.75 points for Wards A and B, respectively. Of the 6 staff members who were followed up, only 1 experienced a 2-point increase from baseline in confidence in verbal de-escalation; 1 staff member experienced a 1-point increase, 3 experienced no change, and 1 reported a 1-point decrease. Staff satisfaction in management of violence on their wards increased by 1.04 and 1.75 points for Wards A and B, respectively. Staff confidence in knowing which team to refer patient violence to increased by 1.167 and 1.07 points for Wards A and B. Incidences of patient violence reported on EPIC decreased by 8 episodes for Ward B and increased by 2 episodes for Ward A.

Low-cost, simple intervention techniques are largely ineffective in improving staff confidence in handling violence. During verbal feedback, most staff agreed that training and simulation-based days would be useful. Ward managers should seek to include well-structured training to improve staff confidence.

The burgeoning focus on climate change has emerged as a prominent area of both interest and concern. As the importance of sustainable healthcare practices gains momentum, there is a heightened focus on tackling environmental issues and promoting planetary health. In a noteworthy achievement, the NHS became the world's first health service in October 2020 to commit to achieving carbon net zero.

Bradford District Care NHS Foundation Trust (BDCT) has been a strong advocate for sustainability and planetary health (S&PH) initiatives, driven by the committed leadership of the BDCT Sustainability department. While the non-clinical senior leadership displayed active involvement in these initiatives, there appeared to be, at least anecdotally, a somewhat limited participation from the clinical teams. This project aimed to investigate and analyse this perceived gap, utilising the findings to guide future initiatives.

Aims and Objectives:

The primary objectives of this research are to assess, evaluate, and empower medical staff at BDCT in sustainable healthcare practices. The specific aims include:

1. 1. Assessing the current awareness levels of S&PH among medical staff.

2. 2. Evaluating the extent of medical staff involvement in existing S&PH initiatives within the NHS and BDCT.

3. 3. Identifying barriers and challenges faced by medical staff in actively participating in sustainability and environmental initiatives.

4. 4. Contributing insights to broader S&PH initiatives within BDCT.

5. 5. Developing strategies to empower clinicians, service users, and communities to actively engage in environmental and sustainability initiatives.

We focused on three key themes: the staff, the patients, and the access to green spaces.

A research tool was developed to conduct this project. This entailed an online, semi structured proforma which was disseminated across the medical staff group in BDCT. The medical staff group included consultants, trainees, SAS/Trust Grade, and LAS doctors.

The proforma consisted of 18 questions and examined the following three themes:

• • Staff: Staff Knowledge and Awareness of S&PH

• • Patients: How do staff facilitate patients' awareness of S&PH?

• • WorkPlace: Access to green spaces.

Total 18 responses gathered via the semi structured proforma. 55% (n = 10) responses were from inpatient setting, 33.3% (n = 6) from community setting; 2 from other settings. 72.2% (n = 13) were in full time occupation while rest (n = 5) were less than full time.

Genders had almost equal representation.

Only a minority (27%) of staff were aware of the sustainability champion within BDCT, while only 22.2% were aware about the BDCT Green Plan initiative.

The common suggestions about methods to improve the awareness about the Green Plan and Sustainability were email, intranet page, sessions on the topic, posters, monthly update amongst various others. Email newsletter was overrepresented as a common theme (24%).

A majority of employees (78%) noted a significant change in the mileage which was a reduction (78% noted a reduction) as expected before and after Covid Pandemic.

Some of the suggestions received were innovative and interesting including cycle scheme, working from home, hybrid working amongst others. However, almost all responses were able to appraise the advantages of flexible working and the associated barriers.

The last segment explored the green spaces and their effect on mental health which was very encouraging.

This research project aligns with the RCPsych's vision of sustainability and nature, emphasising the critical role clinicians play in advancing sustainable healthcare practices. Some of the findings are really encouraging, however there is a still a significant gap in understanding the role of sustainability champion and the Green Plan.

By exploring awareness levels, involvement, and challenges faced by medical staff, this study seeks to provide actionable insights that not only enhance practices within BDCT but also contribute to the broader discourse on sustainability and planetary health in healthcare settings.

The findings are anticipated to catalyse strategies that empower clinicians and communities, fostering a culture of active engagement in environmental and sustainability initiatives.

Clozapine is a well-established and widely practiced treatment for treatment-resistant schizophrenia. Due to its significant side effect profile, it requires intense monitoring, including monthly blood tests and medical reviews. A patient's attitude towards clozapine can impact compliance with treatment and its monitoring process. This survey intended to identify the community mental health patients' perception of the clozapine treatment and its monitoring process and to help improve current practices of the service.

A structured survey with 17 questions was administered to patients registered at the community clozapine clinic via face-to-face or phone conversation at an Australian Community Mental Health Service by the principal researcher and clozapine coordinators.

17 out of 25 eligible patients (68%) participated; the mean age was 39.7 years. There were nine female and eight male participants. 94% of patients were on clozapine for more than one year. 70.5% agreed that clozapine helped to improve mental health, and they understand clozapine side effects and monitoring process. 76.5% agreed that the treating team provided psychoeducation. Seven participants reported clozapine improved side effects compared with previous medications. Three disagreed that clozapine improved side effects, and six remained neutral. Hypersalivation (35.2%), constipation (23.5%) and weight gain (17.6%) were identified as the worst side effects. Nine (52.9%) participants reported that they make healthy life choices. Factors affecting motivation for a healthy lifestyle are mental health symptoms (47%), finances (47%) and physical health well-being (52.9%). Only 35% identified motivation from others as necessary for a healthy lifestyle. Fatigue/poor motivation (47%) and mental health (35.2%) prevent them from making healthy choices. Side effects and finances equally (23.5%) impact healthy choices. Eleven participants (64.7%) felt clozapine monitoring was a positive experience, and 88.2% felt they had enough support during the clozapine monitoring process and were adequately informed about their treatment plan. Two participants disagreed that they were informed of their treatment plan. The majority (82.3%) said no change was needed in the monthly medical officer-led clozapine clinic or six-monthly psychiatrist-led clozapine clinics. Text messages (88.2%) and phone conversations (47%) were the most preferred method for treating team communication about treatment.

The majority of patients identified that clozapine helped to improve mental health, and the monitoring process was a positive experience. Most participants were aware of clozapine and its monitoring process. Psychosocial support will be essential to improve quality of life and might improve the negative perception of clozapine's side effects.

Early Intervention Services (EIS) are in a unique position to assess patients presenting with their first episode of psychosis. The possibility that an organic disorder may be underlying their presentation must be ruled out, often necessitating neuroimaging and/or input from neurology and neuropsychiatry.

We aim to improve the management of neuropsychiatric presentations in EIS. We will determine the incidence of cases, from the London Boroughs of Sutton and Merton, which warrant referral to neurology, neuropsychiatry and neuroimaging. We will then review referral pathways and provide justification for community services, such as EIS, to autonomously request referrals and neuroimaging.

We retrospectively reviewed the complete caseloads of EIS for Sutton and Merton (n = 121). We considered the neurological comorbidities of patients to determine the incidence of cases which warranted a referral to neurology, neuropsychiatry and/or neuroimaging. We reviewed how requests were made and the subsequent results.

15% of the EIS caseload had a neurological comorbidity. Migraine was the most common condition (8.3%), followed by traumatic brain injury (3.3%), headache (2.5%), and seizure (1.7%). There was one case each of epilepsy, stroke, transient ischaemic attack, cavernoma and cerebral venous thrombosis. 83% of patients with a neurological comorbidity had received neuroimaging and all imaging results were either normal or confirmed known pre-existing neurological disease. The 17% of patients who did not receive neuroimaging had only migraine as a neurological comorbidity. One patient was reviewed by neurology and diagnosed with psychosis presumed to be secondary to paraneoplastic syndrome. All patients that fulfilled criteria for a neuropsychiatry referral had this completed electronically. However, there was no clear pathway to request a review by neurology, and Sutton EIS had difficulties autonomously requesting and accessing the results of neuroimaging, delaying provision of appropriate care.

There is a small but significant burden of neurological comorbidity among EIS patients. In our brief study, we found one patient whose symptoms of psychosis were likely attributable to an organic cause. Accessible pathways to refer patients for neuroimaging, and subsequently to neurology and/or neuropsychiatry if indicated, are crucial in the assessment and management of first episode psychosis where an organic cause is suspected. Access to these resources should be efficient and autonomous for EIS. We are in the process of implementing referral guidance alongside a direct electronic referral process to request neuroimaging and further input from neurology and/or neuropsychiatry, to optimise care for patients and our service.

To improve the visibility and accessibility of secure inpatients’ physical health needs by measuring staff satisfaction levels towards physical health information and monitoring.

Through purposive sampling we conducted a five-point Likert Scale on members of the multidisciplinary team (MDT) on one medium-secure forensic ward, within Oxleas NHS Foundation Trust, which provides 124 forensic inpatient beds to southeast London. We collated physical health data from across electronic patient records to create a single-point-of-access workspace on Microsoft OneNote, accessible to all members of the MDT contemporaneously, comprising past medical history, psychotropics requiring close monitoring (e.g. lithium, clozapine, valproate), vital signs, weight, bloodwork, electrocardiogram findings, hospital appointments/results and cancer screening.

We re-sampled members of the ward MDT after the workspace had been created and implemented.

Nine members of the multidisciplinary team were sampled before and after the OneNote workspace was implemented.

• • Pre-intervention, 56% disagreed that they were confident in quickly viewing recent investigation results. Post-intervention, 99% of users agreed/strongly agreed, with no negative responses.

• • Pre-intervention, 67% disagreed or strongly disagreed that they were confident in knowing what physical health appointments were scheduled. Post-intervention, 100% of respondents agreed/strongly agreed.

• • Pre-intervention, 78% disagreed or strongly disagreed that they were happy with the availability of past medical history information. Post-intervention, this increased to 99% agreed/strongly agreed.

• • Pre-intervention, 89% disagreed/strongly disagreed that they knew where to see patients on psychotropics requiring close monitoring. Post-intervention, this increased to 100% strongly agreed.

• • Pre-intervention, 66% disagreed/strongly disagreed being able to see single-point, up-to-date physical health information, at baseline. This increased to 99% agreed/strongly agreed post-intervention.

Physical health information is often overlooked in secure inpatient settings. Due to the limitations of the electronic patient record, it can be difficult to find relevant physical health information quickly. This can lead to dissatisfaction and a lack of confidence in the MDT, as shown in the baseline data.

After the Microsoft OneNote dashboard was introduced, there was a marked improvement in staff confidence, happiness, and awareness of physical health requirements for each patient.

Further data needs to be collected to assess for sustainability of these improvements. We intend to expand the scope of this system across the secure inpatient units in the Trust.